A Different Kind of Holding Environment: A Case Study of Group Work with Pediatric Staff

ABSTRACT

This paper reports a nearly two-year intervention with staff at a major urban pediatric facility. The authors worked as trainers and consultants for two groups–the Emergency Department (ED) and Chronic Care units (CC). Following two days of training about grief and loss, highlighting skill building for work with traumatized and grieving children and parents, the consultants worked to develop teams which could provide a Winnicottian holding environment for staff. The efficacy of this staff training is analyzed and support needs of staff members are identified. Findings include varied willingness to make use of group support. Chronic care participants are more likely to express willingness to engage in on-going support for one another, while ED staff members seem to prefer structured, educational training and episodic support. The holding environment of the processing groups must be adapted to fit the needs of the medical sub-culture.     

The interpreter as institutional gatekeeper: The social-linguistic role of interpreters in Spanish-English medical discourse

Increases in immigration have led to an enormous growth in the number of cross-linguistic medical encounters taking place throughout the United States. In this article the role of hospital-based interpreters in cross-linguistic, internal medicine ‘medical interviews’ is examined. The interpreter's actions are analyzed against the historical and institutional context within which she is working, and also with an eye to the institutional goals that frame the patient-physician discourse. Interpreters are found not to be acting as ‘neutral’ machines of semantic conversion, but are rather shown to be active participants in the process of diagnosis. Since this process hinges on the evaluation of social and medical relevance of patient contributions to the discourse, the interpreter can be seen as an additional institutional gatekeeper for the recent immigrants for whom she is interpreting. Cross-linguistic medical interviews may also be viewed as a form of cross-cultural interaction; in this light, the larger political ramifications of the interpreters' actions are explored. ‘Interpreters are the most powerful people in a medical conversation.’ Head of Interpreting Services at a major private U.S. hospital, May 1999.     

Using the Delphi Method to Classify Medical Specialties

One medical specialty classification system applicable for research and career counseling is the person‐oriented versus technique‐oriented taxonomy. Given that the model was conceptualized in the 1960s, verification based on how medical specialties are practiced and viewed today is necessary. Five specialists in medical career development and advising verified the categorization of specialties. Based on their review, 100% consensus was reached regarding grouping of specialties. This outcome validates the taxonomy of medical specialties and supports its continued use for medical career specialty advising and choice.     

What are Social Work Students’ Perceptions of the Community Practice Method?

Summary. A unique aspect of the social work profession is the combination of intervention on the personal, community, and societal levels and their interaction. The purpose of this research is to determine students’ perceptions of community practice. Qualitative research was conducted among Israeli social work students before gaining any practical experience in community practice. Findings. The results demonstrated a change in students’ perceptions of the importance of community practice to the profession, and the factors that contributed to this change. Applications. Recommendations that may contribute to changing students’ perceptions of community practice are offered to educators.     

Re-inscribing Gender in New Modes of Medical Expertise: The Investigator-Coordinator Relationship in the Clinical Trials Industry

This article analyses the ways in which research coordinators forge professional identities in the highly gendered organizational context of the clinic. Drawing upon qualitative research on the organization of the clinical trials industry (that is, the private sector, for profit auxiliary companies that support pharmaceutical drug studies), this article explores the relationships between predominantly male physician-investigators and female research coordinators and the constitution of medical expertise in pharmaceutical drug development. One finding is that coordinators actively seek to establish relationships with investigators that mirror traditional doctor-nurse relationships, in which the feminized role is subordinated and devalued. Another finding is that the coordinators do, in fact, have profound research expertise that is frequently greater than that of the investigators. The coordinators develop expertise on pharmaceutical products and diseases through their observations of the patterns that occur in patient-participants' responses to investigational drugs. The article argues, however, that the nature of the relationships between coordinators and investigators renders invisible the coordinators' expertise. In this context, gender acts as a persistent social structure shaping both coordinators' and investigators' perceptions of who can be recognized as having authority and power in the workplace.     

Performance Evaluations as Gender Barriers in Professional Organizations: A Study of Auditing Firms

Gendering processes often take the form of organizational subtexts, that is, seemingly gender‐neutral practices that have gender implications. The purpose of this article is to study performance evaluations, which, based on management by objectives systems, may appear neutral, but tend to be based on male norms of what is regarded as good performance. We analysed the careers and performance evaluations of 391 newly licenced Swedish auditors, using an open‐ended question survey. In this industry 50 per cent of new employees and 92 per cent of partners are men. Even in the early stages of their careers, there are notable differences between women and men. The women achieved less and show lower career ambitions and expectations as well as greater intentions to leave the auditing industry. Performance evaluations are also perceived differently, men focusing on what is evaluated (reflecting the perceptions of those at higher hierarchical levels) and women focusing on who does the evaluating and how.     

Information sharing and reporting systems in the UK and Ireland: Professional barriers to reporting child maltreatment concerns

Across the UK recent policy developments have focused on improved information sharing and inter‐agency cooperation. Professional non‐reporting of child maltreatment concerns has been consistently highlighted as a problem in a range of countries and the research literature indicates that this can happen for a variety of reasons. Characteristics such as the type of abuse and the threshold of evidence available are key factors, as are concerns that reporting will damage the professional‐client relationship. Professional discipline can also impact on willingness to report, as can personal beliefs about abuse, attitudes towards child protection services and experiences of court processes. Research examining the role of organisational factors in information sharing and reporting emphasises the importance of training and there are some positive indications that training can increase professional awareness of reporting processes and requirements and help to increase knowledge of child abuse and its symptoms. Nonetheless, this is a complex issue and the need for training to go beyond simple awareness raising is recognised. In order to tackle non‐reporting in a meaningful way, childcare professionals need access to on‐going multidisciplinary training which is specifically tailored to address the range of different factors which impact on reporting attitudes and behaviours. Copyright © 2009 John Wiley & Sons, Ltd.     

A future for the humanities?

The future of the humanities is an extremely complex question as it bears upon the status of a particular form of knowledge in society, the flexibility of a set of academic disciplines and institutions, the openness of political leaders to changing conceptions of education, and a host of other difficult issues. In order to illuminate these problems, it is necessary to focus upon the peculiar character of humanistic knowledge, why such insight is indispensable to individual and collective self-understanding, how the humanities as they are conventionally practised contribute to their own malaise and why the humanities must be accorded pride of place among the studies of human action. There is, in fact, a considerable demand for humanistic knowledge and the fruit of humanistic scholarship in our technological culture, especially in the area of adult education. The discussion ends with several examples of various ways in which that demand is being met.     

城乡医疗保障制度一体化研究

公平和正义是社会保障制度价值的核心理念,也是衡量一个国家或地区社会保障制度能否充分和真正发挥作用的重要衡量因素。在新医改背景下,"人人公平享有健康保障"成为医疗保障制度建设进程中的一个重要目标,而推动城乡医疗保障制度一体化,进而实现三项医保制度整合衔接是实现这一目标的途径。下一步要重点完善社会医疗保障制度的运行环境;努力保障流动参保人员的就医权益,完善基本医疗保险关系转移接续;整合经办资源,强化管理体制统一化;确定合理的筹资补偿机制,强化财政补贴机制。     

Engendering Response: Professional Gesture and the Assessment of Eyesight in Optometry Consultations

Many of the procedures undertaken within healthcare require specialized forms of participation that may be unfamiliar, even disturbing, to patients or clients. The practitioner has to encourage and enable participation in the investigation in an appropriate fashion while preserving the structure and integrity of the procedure. In this article, we consider optometry and the deployment of a vision test, known as subject refraction, that provides data to help determine the characteristics of any corrective lens that may be required by clients. The procedure's ability to establish robust and reliable data relies upon the optometrist's ability to encourage the client to respond to a series of stimuli without consideration or reflection. That is, the client is required to produce an unwitting response—conduct that might be considered nonsymbolic rather than symbolic. In this article, we also consider the optometrist's talk and bodily comportment during subjective refraction and how it serves to shape and determine the quality of the client's response and participation, and in turn to produce reliable test results.