Tuesday, 18 September 2018

Professional identity and conflict: has the higher education of nurses changed professional relations between nurses and doctors?

Dear Editor,
In reference to the article in JAN by Fealy et al. (2018) titled: from September 2018: Discursive constructions of professional identity in policy and regulatory discourse, we would like to include a significant element – question – to this discourse. Can we talk about the conflict of professional identities?
In the period from October to December 2017, we conducted focus group interviews (FGI), which were attended by nurses and physicians in two university centres in Poland educating medical personnel - Gdansk and Bydgoszcz. The research concerned the professional identity of nurses and professional relations between nurses and doctors. The results of the research allow to draw two main conclusions:

  • Doctors see weakening of teamwork, which was a principle in health care. They talk about the tension between the doctor and the nurse, which makes the situation worse. The opinion prevails that the increase of formal requirements - higher education - in the profession of nurses destabilized the working conditions in hospitals.
  • Nurses place emphasis on their dependence on the doctors, but modern nursing is, above all, the extension of professional tasks. In their opinion, the doctors rather defend the previous state of professional subordination and treat this state as obvious. Nurses see the doctors' attitudes as seeking to transform nurses work into a doctor's secretary's: writing cards, writing sick leave, etc. Nurses building their professional identity put the main emphasis on being perceived and appreciated as highly specialized professional staff (Luca & others, 2015).

Statements of physicians and nurses participating in research show a clearly outlined conflict between these groups of medical professions (Hartog, Benbenishty, 2015). It seems that nowadays their professional identity changed, hence they can not clearly defined the field of cooperation, and sometimes even differently define their participation in therapeutic and caring activities (Hughes, 1988, Radcliffe, 2000). Particularly difficult situations arise when the nurse has doubts as to the procedure proposed by the doctor. Doctors treat this situation as unacceptable and even as a proof of personal dislike towards a doctor. It also seems characteristic that both professional groups blame each other for the resulting situation.

The research results indicate the need to develop new relationships between doctors and nurses, including changes in university study that would improve the skills of cooperation and partnership and mutual respect for their work (Donelan & others 2013). Regular training in this area is also necessary in the course of specialization and professional work (Cummings & others, 2018).

We also want to support the thesis contained in the article, that academic study of identity construction is important to disciplinary development by raising nurses and physicians consciousness, alerting them to the ways that their own discourse can shape their identities, influence public and political opinion and, in the process, shape public policy on their professions.

Your Sincerely,

Prof. Janusz Erenc, Department of Sociology, University of Gdańsk, erenc@poczta.fm

Dr. Piotr Pankiewicz, Department of Psychiatry, Medical University of Gdańsk, piotr.pankiewicz@gumed.edu.pl

Dr. Małgorzata Filanowicz, Nicolaus Copernicus University, gosiafilanowicz@cm.umk.pl

Carciati, L., Guberti, M., Borgognoni, P., Prandi, C., Spaggiari, I., & Iemmi, M. (2015), The role of professional and team commitment in nurse–physician collaboration: A dual identity model perspective Journal of Interprofessional Care 29: 464–468.

Cummings, G.G., MacGregor, T., Wong, LH., Lo, E., Muise, M., & Stafford, E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review International Journal of Nursing Studies 85:19-60.

Donelan, K., DesRocjes, C.M., Dittus, R.S., & Buerhaus, P. (2013) Perspectives of Physicians and Nurse Practitioners on Primary Care Practice New England Journal of Medicine 368:1898-1906.

Fealy, G., Hegarty, J-M., McNamara, M., Casey M., O'Leary, D., Kennedy, C., O'Reilly, P., O'Connell, R., Brady, A-M., & Nicholson, E. (2018) Discursive constructions of professional identity in policy and regulatory discourse Journal of Advanced Nursing 74: 2157-2166.

Hartog, C. S., & Benbenishty, J. (2015). Understanding nurse–physician conflicts in the ICU Intensive Care Medicine 41:331-333

Hughes, D. (1988). When nurse knows best: some aspects of nurse/doctor interaction in a casualty department Sociology of Health and Illness 10: 1–9.

Radcliffe, M. (2000) Doctors and nurses: new game, same result BMJ,320: 1085.

Sunday, 9 September 2018

Scared of needles?

Roger Watson, Editor-in-Chief

Are you frightened of needles, by which I mean injections given for medical purposes? I guess we all are as, no matter how often you have one at the dentist or at a surgery, it hurts Yes, it does and we all anticipate that initial stab as the outer layer of the skin, where the pain receptors are located, is punctured. But most of us 'put on a brave face' and pretend not to be frightened. Some brave souls may, genuinely, not be frightened - but I am and I don't mind admitting it. However, while most people learn to accept the momentary discomfort, some people never do and genuinely have what is described as 'fear of needles.'

This fear of needles was the subject of a study from the USA by McLenon et al. (2018) and published in JAN titled: 'The Fear of Needles: A Systematic Review and Meta‐Analysis'. The review found 35 relevant articles and established that the fear of needles ranged from 20-50% in young people and up to 30% in adults. In some people this has serious personal and workplace protection significance as: 'Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long‐term care facilities, and 8% of healthcare workers at hospitals.' According to the authors: 'Needle fear was common when undergoing venipuncture, blood donation, and in those with chronic conditions requiring injection.'

The authors concluded: 'fear of needles occurs frequently in populations throughout the world, with higher prevalence at younger ages and in women. Fear of needles is common in patients requiring preventive care and those undergoing treatment. Greater attention should be given to alleviate this fear with an ultimate goal of improving health. We recommend implementation studies of nonneedle approaches to standard needle injection, with direct application to public health and clinical settings. We also recommend randomized trials to assess specific cognitive and behavioural strategies to alleviate fear.'

You can listen to this as a podcast

Mclenon, J. and Rogers, M. A. (2018), The Fear of Needles: A Systematic Review and Meta‐Analysis. J Adv Nurs. doi:10.1111/jan.13818