Self-casting and alter-casting: Healthcare professionals’ boundary work in response to peer workers

Within mental health services, the recovery model has been a guiding philosophy over the past decades. This model stresses ‘person-centred care’ and focuses on assisting service users to live a meaningful and hopeful life even if their illness has not been cured. As part of the recovery orientation, ‘peer workers’ (PWs), i.e. people with lived experiences of mental illness, are increasingly employed within mental health services. In this article, the authors explore how these changes open up frontiers and set in motion boundary work and identity discussions among healthcare professionals. Empirically, the article draws on qualitative data – interviews with healthcare professionals and observations of meetings – collected in mental healthcare services in Denmark. Theoretically, the article combines literature on professional boundary work with theories on ‘self-casting’, ‘alter-casting’ and ‘othering’. Analysing two sets of demarcations – those between healthcare professionals and PWs, and those between professionals and patients – the study shows how the recovery model leads to defensive boundary work as well as an opening up of boundaries.

Venus: victim or violator?

This article explores sexual boundary violations and their clinical implications in forensic settings. In particular, the authors consider whether female professional and male patient relationship transgressions have similar clinical meanings as the inverse, or whether there is an inherent or perceived difference between genders. Furthermore, attention is brought to the problematic aspects of reductive, dichotomous interpretations of victim–violator relationships. Composite cases of such clinical "accidents" are presented. These are set within secure environments in the United Kingdom. The scope of these cases encompasses incidents between clinician and patient, as well as inter-professional boundary violations. By discussing these vignettes, the authors demonstrate the risk of a subtle, gradual, and insidious erosion of boundaries, alongside more overt incidents of a sexual nature and abuse of power. Contemporary societal factors that may influence conscious and unconscious biases will also be considered in the post #MeToo world. Where clinical examples are given, they are composites of cases reported in the public domain known to the authors. They are clinically accurate but do not involve actual identifiable people and cases.

EXPRESS: Professional Boundaries in-Action: Using Reflective Spaces for Boundary Work to Incorporate a New Health Care Role

Prior research on professional boundary work emphasises the importance of subtle interactions among affected individuals when a new role is inserted into an established professional setting, which inevitably changes the prevalent division of labour. Thus, managers may set reflective spaces for professionals to collaboratively arrange their boundaries and make room for the new professional. This ethnomethodologically oriented study examines boundary arrangements in work development meetings in a university hospital, while professionals made room for a new role, a hospitalist. Examining professionals’ naturally occurring interactions in reflective spaces, the findings depict seven categorisations for the hospitalist. Elaborating on the dynamics of these categorisations, we propose that technically based categorisations sustain stability and context-bound categorisations allow change in work practices, whereas their combination enables transformation within the institutional context. Accordingly, the study adds to the literature on the transformative potential of reflective spaces by illuminating the intertwining of engaged professionals’ boundary talk-in-interaction with the consequences of configurational boundary work in relation to a new professional role.

Relationship-Based Practice in Therapeutic Residential Care: A Double-Edged Sword

This article draws on the lived experiences and perspectives of young people and practitioners in therapeutic residential care to examine what constitutes relationship-based practice. Eight young people and twenty-six practitioners across three residential care services in Australia participated in this qualitative study. Framework analysis identifies that personalised engagement, a delicate balance between care and control, and perseverance through turbulent times are conducive to relationship-based practice in therapeutic residential care. Relationship-based practice is also found to be employed in a unique historical and relational context that demands mindful navigation through three specific professional boundary issues including self-disclosure, over-identification and physical contact. Against this context, relationship-based practice in therapeutic residential care is considered a ‘double-edged sword’, offering practitioners copious opportunities to build connections with young people in informal environments whilst needing to mitigate multiple ethical ambiguities. Implications for practice include the need to safeguard the ‘do no harm’ priority whilst resisting defensive or detached practice. Contextualising relationship-based practice within an ethical practice framework to embed ethics work in day-to-day practice becomes paramount.

Perspectives from the stakeholder: Students’ views regarding learning analytics and data collection

This article reports on a study exploring student perspectives on the collection and use of student data for learning analytics. With data collected via a mixed methods approach from 2,051 students across six Australian universities, it provides critical insights from students as a key stakeholder group. Findings indicate that while students are generally comfortable with the use of data to support their learning, they do have concerns particularly in relation to the use of demographic data, location data and data collected from wireless networks, social media and mobile applications. Two key themes emerged related to the need for transparency to support informed consent and personal-professional boundary being critical. This supports findings from other research, which reflects the need for a nuanced approach when providing information to students about the data we collect, including what we are collecting, why and how this is being used. Implications for practice or policy: When implementing the use of dashboards, institutions should ideally include opportunities for students to opt in and out, rather than being set so that students have agency over their data and learning. When undertaking work in relation to learning analytics, staff need to ensure the focus of their work relates to student learning rather than academic research. When institutions and academic staff collect and use student data (regardless of the purpose for doing so), all aspects of these processes need to be transparent to students.

Situating Boundary Work: Chronic Disease Prevention in Danish Hospitals

Noncommunicable diseases, such as type 2 diabetes, are the leading cause of death globally. This paper focuses on the boundary work among health professions involved in lifestyle-related preventive measures at Danish hospitals. Drawing on documents, qualitative in-depth interviews and extended conversations conducted with health professionals about goals, dilemmas, and practices related to lifestyle disease prevention, as well as site visits at Danish hospitals, it is identified which professional groups have claimed responsibility for the tasks, how they are defined, and through what kinds of interactions and infighting. The analysis grounds Abbott’s framework of jurisdictions and his meso-level vocabulary in a situated account of professional boundary work and follow the way nurses in particular create, and sometimes stabilize or standardize techniques for prevention of lifestyle-related diseases. It is demonstrated by different forms of boundary work how nurses work to extend, defend or refashion established work boundaries when handling these new tasks.