Boundary work in response to professionals’ contextual constraints: Micro-strategies in interprofessional collaboration

Boundary-work research has extensively explored how professionals engage in boundary work to protect or expand their professional boundaries in interprofessional collaboration (IPC). Yet professionals’ contextual constraints in everyday work, such as time pressure or legal restrictions, often result in competing interests of the professionals involved in IPC, prompting them to engage in boundary work to limit—instead of protect or expand—their boundaries. Our empirical analysis uses comprehensive qualitative data on IPC in Germany between self-employed general practitioners (GPs) and registered nurses employed in nursing homes in which GPs’ efficiency interests compete with nurses’ safeguarding interests, leading both professionals to engage in boundary-work efforts to limit their boundaries. Our findings provide a comprehensive understanding and framework of professionals’ boundary work, showing that individual GPs and nurses typically hold a portfolio of various defending and accommodating micro-strategies. Based on our first-order findings, we identify how different sources of power enable particular micro-strategies and explore how the choice of micro-strategies depends on different forms of trust in the collaborating partner. Lastly, we outline interactions of micro-strategies, illustrating how the outcomes of professionals’ bilateral boundary work depend on the sequence of these strategies.

Do we still need professional boundaries? The multiple influences of boundaries on interprofessional collaboration

Although a body of research suggests that interprofessional collaboration is hindered by the presence of professional boundaries, more recent work has demonstrated that removing these boundaries also has negative consequences for collaboration. To address these paradoxical findings, we examine two different team-level initiatives that aimed at softening and breaking down professional boundaries, drawing on data gathered from 78 in-depth interviews and two years of observations of four cross-occupational teams in the English National Health Service. Our inductive analysis of this data shows that professionals use boundaries and their manifestations —which become apparent through materialization, articulation, and embodiment— to identify and retrieve professional categories. The conspicuous presence of boundaries allows professionals to anticipate other team members’ expertise and roles, as well as different aspects of team tasks. We theorize our findings by showing how professional boundaries can be positively interlaced with interprofessional collaboration by making visible and grounding naturalized systems of classification.

Bewildered and alone: supporting people with cognitive impairment on COVID isolation wards

SUMMARY Managing isolation protocols for distressed, cognitively impaired COVID-19-positive patients presented a range of new challenges to our liaison psychiatry for the elderly service. In this article we present some of the scenarios we have experienced, our own reflections on the needs of this specific group and how this has challenged us in terms of tolerating risk, prescribing off-label, collaborating with distressed colleagues, professional boundaries and being creative in non-pharmacological interventions.

Attending Patient Funerals as a Follow-Up Practice of Pediatric Oncologists

This study assessed pediatric oncology professionals’ attitudes and attendance at patient funerals. Many professionals endorsed some level of agreement that funeral attendance respects professional boundaries. Nearly all pediatric oncology professionals (89.2%) reported attending a patient funeral at least once, a rate significantly higher than estimates in other specialties ( p <.001). Attitudes and rates of attendance were slightly higher in older physicians. While periodic funeral attendance may have been somewhat normative in this sample, further reflection and research is needed to ensure the risks and benefits of involvement in funerals and other family rituals and practices are better understood.

Death and Dying: Boundaries and Roles of Families and Healthcare Workers During Patient End of Life

While death and dying often occur within or adjacent to the healthcare setting, grief & support of patients at end-of-life (EOL) remain largely within the realm of the family. Given this division of roles, healthcare workers intentionally set professional boundaries that balance their need to be empathetic and compassionate for patient and their families during EOL, while also maintaining a sense of objectivity and detachment which allows them to cope with patient loss and manage the competing demands of their workday. Tensions occur when healthcare workers are required to cross boundaries at EOL, either voluntarily or involuntarily. Using unobtrusive digital ethnography of a publicly accessible online forum for healthcare providers, this research investigates the boundaries set by families and healthcare workers at EOL, and how EOL circumstances sometimes require healthcare workers to cross or violate these professional boundaries. We suggest that the needs of the family at EOL (not necessarily the patient) serve as the catalyst for both boundary crossing & boundary violations for healthcare workers. Our data reveal that (1) boundary setting and training ought to address the patient-physician-family relationship (not just patient-physician), since the family members are such an integral part of EOL; (2) these EOL dynamics apply beyond the physician and should include all healthcare workers (nurses, etc.). As a result, patient & family centered care may not be fully achieved at EOL due to the ambiguity in the expected roles played by both families and healthcare workers during patient death and dying.

A Pound of Flesh: Human Remains, Ethics and Museums in Tertiary Education

<p>The collection and display of human remains has long been accepted within many cultures and religions. However, in contemporary Western society the practice has become contentious, and acquisition by museums has all but ceased. Among academic and museum communities, debate and discussion on the problem have been centred almost entirely on indigenous repatriation claims and Body Worlds exhibitions, to the exclusion of other aspects of what is in fact a much broader issue. The purpose of this thesis is to examine the question of whether human remains can ever justifiably be collected and held by museums. The focus of the study is the situation of health science disciplinary museums within tertiary education, with specific and detailed reference to the W.D. Trotter Anatomy Museum and the Drennan Pathology Museum at the University of Otago, Dunedin, New Zealand. Three interconnected aspects of the topic are considered in order to answer the primary question. The first is an examination of the codes of ethics and professional practice that govern the treatment of human remains; the second reviews the justifications commonly given for the use of human remains; and the third aspect considers the role museums play in tertiary education. Documentary sources, exhibitions and interviews were analysed to address these issues and corroborate evidence. Examined together, these three areas of investigation bring a fresh focus on whether the acquisition and retention of human remains can be justified, at least within certain parameters. This study concludes that in the particular educational context of the health science teaching museum there is a strong justification for continued acquisition and display, albeit in a highly regulated and clearly defined ethical environment, of human remains. A key outcome of the research is that the most important consideration across all three areas of investigation, and for all groups working with human remains, was the concept of respect. Definitions and expressions of respect differed depending on context and professional boundaries, but within specific ethical parameters it is possible to determine that the collection and retention of human remains can be justified.</p>

A Pound of Flesh: Human Remains, Ethics and Museums in Tertiary Education

<p>The collection and display of human remains has long been accepted within many cultures and religions. However, in contemporary Western society the practice has become contentious, and acquisition by museums has all but ceased. Among academic and museum communities, debate and discussion on the problem have been centred almost entirely on indigenous repatriation claims and Body Worlds exhibitions, to the exclusion of other aspects of what is in fact a much broader issue. The purpose of this thesis is to examine the question of whether human remains can ever justifiably be collected and held by museums. The focus of the study is the situation of health science disciplinary museums within tertiary education, with specific and detailed reference to the W.D. Trotter Anatomy Museum and the Drennan Pathology Museum at the University of Otago, Dunedin, New Zealand. Three interconnected aspects of the topic are considered in order to answer the primary question. The first is an examination of the codes of ethics and professional practice that govern the treatment of human remains; the second reviews the justifications commonly given for the use of human remains; and the third aspect considers the role museums play in tertiary education. Documentary sources, exhibitions and interviews were analysed to address these issues and corroborate evidence. Examined together, these three areas of investigation bring a fresh focus on whether the acquisition and retention of human remains can be justified, at least within certain parameters. This study concludes that in the particular educational context of the health science teaching museum there is a strong justification for continued acquisition and display, albeit in a highly regulated and clearly defined ethical environment, of human remains. A key outcome of the research is that the most important consideration across all three areas of investigation, and for all groups working with human remains, was the concept of respect. Definitions and expressions of respect differed depending on context and professional boundaries, but within specific ethical parameters it is possible to determine that the collection and retention of human remains can be justified.</p>

The Essential Relationships Between School Social Workers and Teachers, Paraprofessionals, and Other School Personnel

This chapter offers practical strategies that school social workers can use to build relationships and establish trust with teachers, paraprofessionals, and other school personnel. The chapter illustrates the difference between interdisciplinary collaboration and parallel practice. With an understanding of systems and the person-in-environment fit, school social workers are in a unique position to serve as the vital link that pulls the various disciplines together on behalf of students and families. The chapter offers suggestions on ways school social workers can support teachers, students, and families by using a strengths-based perspective and a trauma-sensitive approach. Finally, the chapter explores ethical considerations and issues related to professional boundaries.