Stephen Timmons

Improving Transition: a Qualitative Study Examining the Attitudes of Young People with Chronic Illness Transferring to Adult Care:

Transition is a process that attends to the medical, psychosocial and educational needs of young people as they transfer to adult-orientated care. With a growing population of adolescents surviving with chronic illness well into adulthood, it is remarkable that empirical research has paid little attention to transition. This qualitative study examined the attitudes of young people with chronic illness who were facing transition, considering what young people wanted from a transition service and the ways in which provision could be improved from a service-user’s perspective. A purposive sample of seven adolescents (aged 14–17) attending a hospital youth club were interviewed. To increase the likelihood of successful transition, strategies need to be informal, flexible, highly individualized and prepare adolescents steadily for adult services.

A qualitative study of stigma among women suffering postnatal illness

Background: Stigma is known to exist in mental health and is extensively researched. However, little is known about the effect of stigma on women who experience a severe postnatal illness. Aims: To consider whether or not women who are experiencing a severe postnatal illness and have been admitted to a mother and baby unit experience stigma. Method: A qualitative study consisting of six semi-structured interviews were undertaken to gain an understanding of the womens experience of stigma and the womens perceptions of themselves as mothers. Results: The findings suggested that stigma was felt both internally and externally. However the stigma did not always manifest itself in the way existing literature would suggest. Four main themes were identified as disclosure, access to services, feelings of being a bad mother, and label/diagnosis. Conclusion: An underlying stigma within the health care organization leads to groups of health professionals lacking understanding of this severe and debilitating illness. Clearer pathways of access into services are required. The women found the label and diagnosis useful and felt that a higher profile for mental illness would help to eliminate stigma. Declaration of interests: None.

Backstage in the theatre

Backstage in the theatre Observations undertaken in the operating theatre suggested that the social environment, and certain forms of staff behaviour could be explained using the space analysis developed by Erving Goffman (1969) in The Presentation of Self in Everyday Life. In the study reported in this paper the theatre department was found to be a strongly ‘backstage’ area. However, it was also found that there were limits to this analysis, and these are explained within this article. Some practical suggestions as to how this analysis might be helpful in the management of health care institutions and the education of health care professionals are made.

Operating theatre nurses: emotional labour and the hostess role.

Emotional labour has been established as a significant factor in nursing work, although no studies have been done looking at emotional labour specifically in an operating theatre nursing context. Theatre staff (17 nurses and three Operating Department Practitioners (technicians) were observed in practice over a period of nine months by one of the authors. Each of the staff was subsequently interviewed. The transcriptions of the observation fieldwork notes and the semistructured interviews were analysed for themes and content. The (predominantly female) nurses perceived that one of their responsibilities was ‘looking after the surgeons’. We have described this as the ‘hostess’ role. This role consisted of two major areas of activity: ‘keeping the surgeons happy’ and ‘not upsetting the surgeons’. Examples are given of how this was accomplished through talk and actions. The (predominantly male) operating department practitioners did not see this as part of their work. This ‘hostess’ role is a kind of emotional labour, but performed with coworkers rather than patients. Like other forms of emotional labour, it is strongly gendered. The emotional labour performed by the theatre nurses was necessary to maintain what has been called elsewhere the ‘sentimental order’.

Professionalization and its discontents

The sociology of professions has generally considered professionalization as a desirable outcome for occupational groups. This case study of professionalization in the UK National Health Service, based on an analysis of documents, presents a challenge to that view. For many groups, the state is now so comprehensively dominant in the process of professionalization that it can effectively dictate professional status on its own terms. Many of the advantages that accrued to professions that developed historically will not be available to groups that professionalize under this new regime. Though elite groups within the profession studied (Operating Department Practice) were strongly in favour of professionalization, throughout the process there were also dissenting voices. This case study will show how professionalization, despite being described as the ‘Holy Grail’ by those in favour of it, turned out to be, at best, a mixed blessing. While medicine may still be able to negotiate with the state for other groups, professionalization can in the future be equated with regulation.

How do nurse prescribers integrate prescribing in practice: case studies in primary and secondary care

AIMS AND OBJECTIVES To report a study investigating how nurse prescribers integrate prescribing in clinical practice. Factors that influence integration are explored and how nurses approach integration is defined. BACKGROUND There are expectations that nurse prescribers will prescribe for patients. Nurse prescribers share jurisdiction of prescribing with doctors in the workplace and new divisions of labour must be agreed to enable the nurse to begin prescribing. Little is known about how nurses integrate prescribing in practice but these agreements are potentially important to the organisation of professional work and the delivery of healthcare. DESIGN Case study. METHODS Twenty six nurse prescribers were interviewed in case studies of primary and secondary care prescribing. Case data were collected by semi-structured interview and combined with field notes and socio-demographic data in case summaries. Data were organised in vivo (QSR International Pty Ltd, Doncaster, Victoria, Australia) and subject to manual analysis at single and cross-case level. RESULTS Twenty-one of the 26 cases were prescribing. Trust between doctor and nurse and nurse and employer was shown to be necessary for effective integration. There were differences in how prescribing agreements were reached in primary and secondary care. Restrictions were imposed in secondary care. In primary care, nurses made decisions themselves about the medicines they prescribe but frequently asked doctors to check their decisions. Nurses described three approaches to prescribing: as opportunity presents, for specific conditions and for individuals. CONCLUSIONS Nurse prescribers described three approaches to prescribing and in two approaches the nurse self-restricted prescribing activity. Secondary care prescribers had more employer restrictions than their primary care counterparts. Trust between doctor nurse and nurse employer was shown to be necessary for integration; without trust, the nurse will not prescribe. RELEVANCE TO PRACTICE Trust in prescribing relationships is necessary for effective integration of nurse prescribing in practice.

Implementing lean methods in the Emergency Department: The role of professions and professional status

PURPOSE The purpose of this paper is to examine the implementation of lean methods in an Emergency Department (ED) and the role of the professions in this process. DESIGN/METHODOLOGY/APPROACH Qualitative, semi-structured interviews with ED staff in a UK NHS hospital. FINDINGS Lean was met with more engagement and enthusiasm by the professionals than is usually reported in the literature. The main reasons for this were a combination of a national policy, the unique clinical environment and the status of the professional project for doctors in emergency medicine. RESEARCH LIMITATIONS/IMPLICATIONS Single site, one-off study. PRACTICAL IMPLICATIONS The status and development of professionals involved may play a big part in the acceptability of initiatives like lean methods in health care. The longer-term sustainability of the organisational changes introduced remains open to question. ORIGINALITY/VALUE This paper analyses the success of lean methods in health care with reference to the professional status and stage of development of the professions involved, using the sociology of professions. This approach has not been used elsewhere.

How do lay people come to trust the Automatic External Defibrillator

Defibrillators are now widely installed in a variety of public places for the immediate treatment of people who have collapsed with a suspected cardiac arrest. These initiatives are predicated on the defibrillator being used by ‘lay’ volunteers. This presents a problem of trust, as the volunteer rescuers need to trust an unfamiliar technology to diagnose and treat an immediately life-threatening condition they are unlikely to have encountered before. Based on qualitative interviews with volunteers and defibrillator trainers, we show how trust in the defibrillator is constructed and maintained as a social process. This trust is a complex phenomenon, placed in technology, people and institutions, all of which work together to enable the volunteer, when an emergency occurs, to ‘push the button.’

Animals and anomalies: an analysis of the UK veterinary profession and the relative lack of state reform

The sociology of professions literature would predict that the contemporary state would not allow groups to continue unregulated or unreformed. However, this is indeed the case with the UK veterinary profession, with legislation dating back to 1966. Using an interdisciplinary analysis of published literature and reports, this paper assesses whether wider social, political and ethical dynamics can better explain this intriguing anomaly. We conclude with critical implications for the sociology of the professions. Furthermore, we argue that continuing to ignore the veterinary profession, and animals more generally, in sociological research will result in an impoverished and partial understanding of contemporary healthcare and occupations.

Critical realist review: exploring the real, beyond the empirical

This article defines the ‘critical realist review’, a literature-based methodological approach to critical analysis of health care studies (or any discipline charged with social interventions) that is robust, insightful and essential for the complexities of twenty-first century evidence-based health and social care. We argue that this approach, underpinned by a critical realist philosophy and methodology, will facilitate students and researchers to employ relevant theoretical insights from a range of disciplines that have necessary contributions to make to our understanding of health and social care practice and provision. We explore the limitations of randomised controlled trials (RCTs) and the systematic review for informing evidence-based health and social care. The article also offers some suggestions on method, although, as we argue, the approach deliberately eschews a ‘cookbook’ approach. A glossary of terms is provided in the Appendix.