Background
Across the Western world, demographic changes have led to healthcare policy trends in the direction of role flexibility, challenging established role boundaries and professional ...hierarchies. Population ageing is known to be associated with a rise in prevalence of chronic illnesses which, coupled with a reducing workforce, now places much greater demands on healthcare provision. Role flexibility within the health professions has been identified as one of the key innovative practice developments which may mitigate the effects of these demographic changes and help to ensure a sustainable health provision into the future. However, it is clear that policy drives to encourage and enable greater role flexibility among the health professions may also lead to professional resistance and inter‐professional role boundary disputes. In the foot and ankle arena, this has been evident in areas such as podiatric surgery, podiatrist prescribing and extended practice in diabetes care, but it is far from unique to podiatry.
Methods
A systematic review of the literature identifying examples of disputed role boundaries in health professions was undertaken, utilising the STARLITE framework and adopting a focus on the specific characteristics and outcomes of boundary disputes. Synthesis of the data was undertaken via template analysis, employing a thematic organisation and structure.
Results
The review highlights the range of role boundary disputes across the health professions, and a commonality of events preceding each dispute. It was notable that relatively few disputes were resolved through recourse to legal or regulatory mandates.
Conclusions
Whilst there are a number of different strategies underpinning boundary disputes, some common characteristics can be identified and related to existing theory. Importantly, horizontal substitution invokes more overt role boundary disputes than other forms, with less resolution, and with clear implications for professions working within the foot and ankle arena.
Boundary dissolution has broadly been defined as the breakdown of boundaries and loss of psychological distinctiveness in the parent–child subsystem. Qualitative reviews have highlighted the ...developmental and clinical value of examining boundary dissolution as a multidimensional construct. Though prior work suggests patterns share minimal variance, research has yet to quantitatively synthesize the weighted effect of distinct patterns. The primary aim of this meta-analysis was to aggregate empirical research on associations between boundary dissolution patterns and children’s internalizing and externalizing symptoms. Four patterns of boundary dissolution were identified across developmental, clinical, and family systems literatures: (a) enmeshment—entanglement and blurring of the intergenerational parent–child boundary through psychologically controlling and intrusive behaviors, (b) disorganization—chaotic parent–child boundary (e.g., inexplicable, contradictory behaviors, and responses) reflecting no coherent pattern of relating, (c) caregiving—child functions as a caregiver providing parents with instrumental and emotional support and guidance, and (d) coerciveness—child operates as a disciplinarian or authoritarian to intimidate and control parents. The meta-analysis reviewed 478 studies. Although each boundary dissolution pattern was associated with internalizing and externalizing symptoms, weighted effects across patterns significantly varied in magnitude. Regarding externalizing symptoms, the weighted effect of enmeshment was stronger relative to the weighted effect of caregiving. Turning to internalizing symptoms, the weighted effect of enmeshment was stronger than the weighted effect of caregiving and coerciveness. Additionally, the weighted effect of disorganization was stronger than the weighted effect of caregiving. The robustness of weighted effects depended on child, contextual, and methodological characteristics as well as time lag. (PsycInfo Database Record (c) 2024 APA, all rights reserved) (Source: journal abstract)
Throughout social work’s history, practitioners have faced challenging boundary issues. Boundary issues occur when social workers encounter actual or potential conflicts between their professional ...duties and their social, sexual, religious, collegial, or business relationships. Today's social workers face a wide range of boundary challenges that are unprecedented because of practitioners’ and clients’ widespread use of digital and other forms of internet-enabled technologies. This article presents a typology of boundary-related challenges arising out of social workers’ and clients' use of technology; reviews and applies emerging ethical and practice standards; and discusses risk-management protocols designed to protect clients and social workers. The author offers practical recommendations to protect clients and practitioners, including compliance with state-of-the-art ethics standards related to technology use and development of a comprehensive social media policy.
A third wave of technological advancements, which is often referred to as “digitalization,” is affecting organizations across the board. This paper aims to present a comprehensive synthesis of the ...extant scholarly work on digitalization in the accounting literature. It does so through a systematic literature review that focuses on articles on digitalization published by the highest-ranked accounting journals in the period 2007–2017. By conducting a thorough review, we extend Rom and Rohde's (2007) literature review on integrated information systems (IIS) in management accounting. Furthermore, we utilize a modified version of the framework proposed by Rom and Rohde (2007) to classify and interpret the literature. This allows us to understand the differences between IIS and digitalization in accounting, and to illuminate avenues for future research. The paper concludes with an overview of three main differences in how IIS and digitalization have influenced accounting, and three concurrent avenues for future research on digitalization in accounting: the elusive boundaries of accounting, power relations, and knowledge production for decision making.
•Digitalization is the impetus for increasingly elusive boundaries of accounting.•Digitalization is changing power relations.•Digitalization raises new issues of knowledge production in decision making.
Abstract Crossing professional boundaries in the context of Czech social work remains an understudied phenomenon. Additionally, the recent situation caused by the COVID-19 pandemic dramatically ...affected work conditions and transformed social work practice. The aim of this article is to answer the following research question: How do subjectively experienced risk factors affect the social worker in situations when professional boundaries are crossed and in the context of a pandemic situation (COVID-19)? The text is based on the theory of professional boundaries in the client–worker relationship and also includes the perspective of professional boundary crossing in social work. The key conceptual framework is ecosystem theory qualitative research carried out in two phases via in-depth semi-structured interviews in the selected locality. Each phase included informers who were active as social workers in low-threshold centres for children and youth. The text is a reflection of the influence of external factors on professional boundaries and of the internal dispositions of social workers, on the basis of which the text offers practical recommendations for social work practice in three categories: social workers at the individual level, leadership and organisations, educational institutions.
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.
This text is a summary of an online interview with gastrojournalist. The conceptual basis of the text is P. Bourdieu's concept of taste. On the one hand, taste was considered as a way of building ...symbolic boundaries between social groups, on the other hand, as a skill acquired by physical and mental training. Taste was correlated with food choice as interrelated components of behavior. Аgents of gastronomic discourse were identified as mediators for the audience in the process of demonstrating their social status, group, or ethnicity through food consumption. The interview showed the high importance of drawing a line between journalists and bloggers as agents of gastronomic discourse, as well as the non-triviality of this task due to the blurring of boundaries between these professional statuses. Knowledge, professional qualities, and skills necessary for functioning as an agent of discourse were taken as the main criteria for distinguishing between journalists and bloggers. What was said in the interview made it possible to conclude that the distinction between bloggers and journalists as professional statuses is accompanied by their coexistence as social roles — the revealed duality may be the main reason for the difficulty of formalizing the demarcation criteria. The criteria by which the agent of gastronomic discourse forms an idea of the audience were also discussed. The image of readers and the intentions of discourse agents are formulated, with the help of which the audience of various Internet platforms is influenced. The means of influencing the audience, which are available to agents of discourse, are mentioned. As a result, it was found that professionalism in a certain sense also serves to organize ideas about the audience and to determine the style of building interaction with it.
Burnout represents a significant problem for many modern-day workers, but perhaps none more acutely than those in healthcare. Imbued with the chronic stressors that often accompany high-risk, ...interpersonal work, the healthcare industry is rife with stories of burnout, and the addition of a pandemic has intensified the challenges of an already demanding work environment. With an aim toward understanding the root causes of pandemic-exacerbated burnout, we document the experiences of 93 healthcare workers during the COVID-19 pandemic and, in doing so, explore an important link between burnout and work-nonwork boundaries. We find the contextual shock of the pandemic resulted in an increased incidence of boundary violations-undesired disruptions between work and other important life domains such as personal and family life. These boundary violations-which we classify as physical, temporal, or knowledge-based-frequently corresponded to greater reports of burnout manifested by exhaustion, detachment, and inefficacy. We detail specific patterns within the broader context of boundary violations whereby intrusion events are associated with increased job-related demands and distancing events are associated with reduced job-related resources. In addition to documenting the connection between burnout and boundary violations, we also reveal how workers utilized specific boundary work tactics in response to specific types of boundary violations to redefine boundaries and forestall burnout. Our grounded theorizing points to theoretical and practical implications for the impact of boundary work tactics on burnout and other stress-related phenomena.
Delivery of interdisciplinary integrated care is central to contemporary health policy. Hospitals worldwide are therefore attempting to move away from a functional organisation of care, built around ...discipline-based specialisation, towards an approach of delivering care through multidisciplinary teams. However, the mere existence of such teams may not guarantee integrated and collaborative work across medical disciplines, which can be hindered by boundaries between and within professions. This paper analyses the boundaries that affect collaboration and care integration in newly created multidisciplinary teams. Empirical data are drawn from an ethnographic research conducted in the sub-intensive stroke unit of an Italian public hospital. Data collection involved 180 h of observations and conversations with 42 healthcare providers. Findings show that disciplinary boundaries hinder both intra-professional and inter-professional collaboration. Doctors from different disciplines adopt different, and sometimes conflicting, clinical approaches, doctors and nurses construct discipline-specific professional identities, and conflicts emerge between doctors and nurses from different disciplines over the regulation of the medical–nursing boundary. Achieving collaboration and integration between professionals from different disciplines may be particularly challenging when the group with less institutional power (nurses, in this case) has developed a high level of expertise on the needs of the patients targeted by the team. Effective interdisciplinary work thus requires not only bridging boundaries within the medical professional group, but also addressing the dynamics of resistance in merging doctors and nurses with different disciplinary backgrounds. In the paper, we summarise these results in a framework that contributes knowledge to the field of professional boundaries in healthcare while offering practical insights to forge new interdisciplinary relationships, which are more embedded in the daily experience of care providers.
•Analyses disciplinary boundaries in a newly created hospital team.•Disciplinary boundaries affect both intra- and inter-professional relationships.•Disciplinary boundaries are experienced by doctors as well as nurses.•Merging doctors and nurses from different disciplines can exacerbate power imbalances.•Discipline-dependent learning paths shape clinicians' practices and identities.
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