Developing Professional Practice in Health and Social Care

Adam Barnard, Adam Barnard

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317615439
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Addressing the changing world of professionalism, this text combines theory, research and practice, using real case studies, to investigate the process of becoming professional. Mapping the journey from allied or associate practitioner positions through qualifying and into advanced practitioner status, it is a valuable companion for health and social care, social work and allied health students from the beginning of their studies.

Developing Professional Practice in Health and Social Care is an accessible text, including case studies, reflective exercises and activities, chapter aims and summaries and further reading boxes throughout. It covers:

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• the context for professional practice, including historical perspectives, policy and discussion of relevant competencies and frameworks

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• the concept of professionalism, exploring what it means to be a professional

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• values and ethics underpinning professional practice

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• professional identity development, including formation and changes in identity

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• professional practice in complex environments, paying particular attention to working in organisations

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• becoming a critical and globally aware practitioner

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• the role of evidence and knowledge in professional practice

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• working with supervision.

Maintaining a strong focus on the ethical dimensions of professional practice, this text emphasises how health and social care practitioners can contribute to social justice and challenge social exclusion.

Chapter 1

The current context and climate of professionals

Definitions and history

Adam Barnard

Chapter outline

This chapter will introduce:

• the current context

• definitions of key terms

• understanding professions

• being and becoming

• practice

• reflection

• social justice.

This chapter will set the scene for professionals. Mapping and defining what being a professional encompasses and what it excludes will provide the contours, parameters, shape, form, function and purpose to professions. The different views of professions historically and from different disciplines will define professionals.

Becoming a professional is a timely and necessary discussion for all those involved in health, social care and social professions, particularly in uncertain times and in an age of austerity with savage public sector cuts to services. The competency and capability frameworks for becoming a professional will also be discussed. The contested nature of professionalism and the contextual tensions between rational instrumental approaches and an ethos of professionality will be considered, along with the possibilities, demands and increase in interprofessional working.

Context

The contextual discussion of professional practice is always set in a complex context of profound structural changes taking place in the ecological, political, economic, technological and social context of government and public services. Practice, and the ethics and values that underpin it, depends heavily on the ideologies of governments, social and economic situations and public opinion (Seden et al. 2011). Media criticism of perceived failures, the impact of globalisation reconfiguring communities, and the rise of managerialism under neo-liberalism’s austerity are the contemporary challenges for those engaged with or entering into professions of any sort. Professions in the public, independent and voluntary sectors face particular challenges as the landscape of public sector work is increasingly being reordered by neo-liberalism (Harvey 2005).

The force field of changes to professions increases complexity, uncertainty, undecidability and fluidity across professional practice such as decision making, managing, and planning. Public sector professionals have to manage escalating demand in a period of austerity (Prowle et al. 2014). It is within this landscape that professional experience is currently undergoing a range of contemporary challenges.

Definitions of professions, professionalism and professionalisation

At their simplest, professions are the collective agency and experience of a group of people performing or undertaking a specialised area of activity. Professionals are individual actors who are bearers of the purposeful action of the profession, and who are engaged in everyday practice actions.

The definition of professions needs to recognise the context of professional practice so there are a range of factors that have a determining influence on how we understand professions and ‘professions’ as a collective activity. For example, in the 1990s there was an increased drive to develop professional activities and practice across a range of social activity such as policing and soldiering. The development of Third Way politics, New Labour’s modernisation agenda and new public management provided further impetus for professions (Clarke and Newman 1997) and the age of austerity under the Coalition and later Conservative administrations has produced a range of forces to reconfigure professionalism in a contemporary age. The post-war settlement of the state playing a major role in promoting a more equal society and promoting social justice via state provision and public expenditure is now under threat.

Professions themselves, as an identified group activity, have responded to current changes with increased forms of performance management, reordering of organisational imperatives and increasingly complex demands on the workforce and individuals committed to delivering professional services. For example, actuarial approaches to systems management, increased accountability, globalisation, consumerism, individuation, rights, scrutiny, reviews of performance and managerial demands have provided a contemporary context for professionals with committed values to professionalism. These ‘old’ and ‘new’ ways of working in social professions (Seden et al. 2011) are the invitation for those joining professions at the current time. An investigation into the history of professions and reflective practice provides the contours for this book.

Professions

Oakley (1986) suggests that a profession is a ‘superior type of occupation’ which requires greater formal entry requirements and training. A profession may be characterised as an occupational group which regulates and controls itself and requires advanced education to acquire a specific and exclusively owned body of knowledge and expertise.

Professionalisation is closely linked to professional identity, which is discussed in subsequent chapters. It has also led to the blurring of boundaries between professions. For example, many of health and social care’s functions have been appropriated by reconfigured disciplinary areas such as health, psychiatry and psychology (Atwal and Jones 2009).

As society undergoes profound economic, social, political, economic and environmental change, professionals have experienced deep change and the rise of the expert (Brint 1994). Professional identities are framed around efficiency and commerce (Anderson-Gough et al. 1999; Goodrick and Reay 2010) and have replaced the traditional logic and ethos of ethics and public service (Brint 1994). Professions are now multidisciplinary and transnational (Muzio et al. 2013).

Economic rationalism has had a significant impact on many professions in Western society. Much of the neo-liberal agenda has been concerned with targeting professions’ capacity to capture domains of service and their funding has fuelled deprofessionalisation (Braverman 1974) or a market rationality (Brown 2006) based on an autonomous and calculating subject, which situates competitive individualism as the central requisite attribute for a citizenry of constantly reinventing entrepreneurs and a new morality of self-development (Lynch 2006).

So how can we understand this shift in professions?

Sociology of the professions

Reports on ‘the death of professions as a relevant discipline’ (Gorman and Sandefur 2011) and the dominance of conflict-based paradigms (Friedson 1970, 1986, 1994, 2001; Johnson 1972; Larson 1977) have been extremely successful in addressing the limitations of earlier trait-based perspectives and the focus on dominance and monopoly, but have obscured the role that professionals have in constructing, organising and ordering social life (Burrage and Torstendahl 1990; Halliday 1987; Halliday and Karpik 1997; Johnson 1993).

Professions are grounded in Scott’s (2008) seminal characterisation of professions as ‘Lords of the Dance’ who choreograph the broad transformations reconfiguring contemporary political economic systems. As Scott (2008: 219) observes, ‘the professions in modern society have assumed leading roles in the creation and tending of institutions. They are the preeminent institutional agents of our time’.

Professions are agentive in that they have the capacity for change, and to drive change they still need to be understood against a backdrop of dominant tendencies and a context of broad change (Abel 1988; Brint 1994; Broadbent et al. 1997; Brock et al. 1999; Cooper and Robson 2006; Hanlon 1999; Krause 1996; Leicht and Fennell 2001; Reed 1996).

Scott’s (2008) pillar framework views professions as regulative, normative and cultural-cognitive:

• the regulative pillar stresses rule-setting, monitoring and sanctioning activities, both formal and informal;

• the normative pillar introduces a prescriptive, evaluative and obligatory dimension into social life, stressing ‘appropriate’ behaviour – given the demands of the situation and the actor’s role within it – versus ‘instrumental’ behaviour, in which attention is focused on the actor’s preference and pursuit of self-interest; and

• the cultural-cognitive pillar emphasizes the centrality of symbolic systems: the use of common schemas, frames and other shared symbolic representations that guide behaviour (Scott 2008: 222).

Although professionals might be ‘Lords of the Dance’ this is not a clear-cut or uncontested terrain. Professions, professionals, professionalisation and deprofessionalisation all have a rich and long history, but we have an emerging definition.

Definitions

Profession/professional: 1) used as a folk concept to signify (a) prestige, respect; (b) full-time work for pay; (c) to perform some task with great skill or proficiency; 2) used as a sociological concept of study: (a) elite classes of occupations with a focus on the characteristics or attributes of such occupations as a taxonomy (the attribute model of professions); (b) a process model, to study the processes through which certain occupations come to acquire power, develop monopolies, and/or lay claim to the status of professional (Leicht and Fennel 2001: 8).

Professional projects: based on the work of Friedson (1986) and Abbot (1988), professional projects are attempts to: 1) enhance the autonomy and freedom of action for occupational incumbents under a set of well-defined professional norms; and 2) defend a specific task domain from encroachment by competing occupational groups or stakeholders (Leicht and Fennel 2001: 8).

Professionalisation: the result of a successful professional project: an occupation is professionalised to the extent that it successfully defines a set of work tasks as its exclusive domain, and successfully defends that domain against competing claims (Leicht and Fennel 2001: 8).

Deprofessionalisation: the process by which professional prerogatives become eroded (Braverman 1974).

Autonomy: the ability of a work group or individual to control their own work behaviour and work conditions.

What does being a professional encompass?

Historically professions have four formative moments. Lester (2007) suggests these are the ancient professions of priesthood, university teaching, law and physicianship; medieval trade occupations of surgery, dentistry and architecture; industrial-era occupations such as engineer; and various groups that have emerged in the twentieth century such as police, social workers, teachers, accountants and personnel managers.

The uneven process of emergent, dominant and residual professions has provided professionalism with different intensity and reach at different times. For example, social work is undergoing an assertive push for professionalism with its protected title, establishment of a learned society such as the (now defunct) College of Social Work, and regulatory bodies such as the Health and Care Professional Council.

There are a range of common-sense, taken-for-granted understandings of what a professional is and an attribute approach that ‘begins from the basis assumption that it is possible to draw up a list of fixed criteria for recognizing a profession on which there will be general consensus’ (Dingwall 2008: 11). For example, Biestek (1957) attempted this list-type approach for social work:

Processional activity was basically intellectual, carrying with it great personal responsibility, it was learned, being based on great knowledge and not merely routine; it was practical, rather than academic or theoretic, its technique could be taught, this being the basis of professional education; it was strongly organized internally; and it was motivated by altruism, the professional v...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• Notes on contributors
• Preface
• Acknowledgements
• Introduction
• 1 The current context and climate of professionals: Definitions and history
• 2 Philosophy for professionals: The practice of philosophy
• 3 Values and ethics for professionals
• 4 Professional identity
• 5 Working in organisational systems: Current challenges and dilemmas
• 6 Critical practice: ‘Touching something lightly many times’: Some thoughts on language and reparation in relation to mental health and social justice
• 7 Globalised practice
• 8 Reflections on conditionality: Issues of social policy for the emerging professional
• 9 Professional supervision
• 10 Reflective writing for professional practice
• 11 Contemplating ‘career’ across disciplines: Reflexive explorations of ‘career’
• 12 Personal development planning as reflection
• 13 Journeys of faith: Personal stories and faith development in church schools
• 14 A personal learning journey
• 15 ‘Tain from the mirror: Towards an education for reflection in the helping professions
• Conclusion
• Index