Introduction
Clinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR.
Methods
Using a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources.
Results
The results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates.
Conclusion
The conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.
Abstract: The past two decades of higher education research in Europe describe new-managerial and neo-liberal turns in governance policies that have brought shifts in the way institutions of higher education are defined and run, justify their existence and practices, and recruit and educate students. The expansion of higher education is often lifted as a key feature and motivation of these changes and it is also used in arguments for the need to change further. The European Union Lisbon Agreement is often referenced when changes are discussed and motivated by change agents. It describes needs of effectiveness and new kinds of programmes and courses to deal with increased volume and widening participation. New demands are described as having been placed on teachers, students and leadership, including an expanded role for student choices of and in higher education. Based on ethnographic research key aspects of extended choice are examined in the present article. Keywords: cultural capital, choice rationalities, skilled/semi-skilled choices, generification
Based on interviews with and questionnaires completed by upper secondary school pupils (n = 27) from academic and vocational programmes, respectively, the present paper focuses on some of the social and individual conditions that precede the individual decision-making process in education transitions. The paper shows that an organic view of decision-making is in better accordance with observations than is a hierarchical view, and thus supports previous research claiming that pragmatic rationality (based on habitus and reflexivity) plays a more important role in students’ decision-making processes than does instrumental rationally.
Healthcare is often conducted by interprofessional teams. Research has shown that diverse groups with their own terminology and culture greatly influence collaboration and patient safety. Previous studies have focused on interhospital teams, and very little attention has been paid to team collaboration between intrahospital and prehospital care. Addressing this gap, the current study simulated a common and time-critical event for ambulance nurses (AN) that also required contact with a stroke specialist in a hospital. Today such consultations are usually conducted over the phone, this simulation added a video stream from the ambulance to the neurologist on call. The aim of this study was to explore interprofessional collaboration between AN’s and neurologists when introducing video-support in the prehospital stroke chain of care. The study took place in Western Sweden. The simulated sessions were video recorded, and the participants were interviewed after the simulation. The results indicate that video has a significant impact on collaboration and can help to facilitate better understanding among different professional groups. The participants found the video to be a valuable complement to verbal information. The result also showed challenges in the form of a loss of patient focused care. Both ANs and neurologists saw the video as benefiting patient safety.
This article investigates professional identities in Swedish Higher Education Institutions (HEIs). The aim is to explore how professional negotiation takes place by incorporating the perspectives of teachers, managers, and strategic human resource management (HRM) representatives through a case study of three HEIs with different conditions for collegial influence and forms of management. The study examines how spaces of professional autonomy are defined and formed and how authenticity and legitimacy are established (Davies & Petersen, 2005; Deem & Lucas, 2007). The project was designed with the intention to relate analytical distinctions of different actors’ perceptions and objectives within the institutional conditions that form the meaning and objectives of education (Vaughan, 2002). The methods used are interviews with HEI management, strategic HRM representatives, and research and teaching staff. Contemporary researchers and teachers in academia have to handle increased evaluation pressure and, in many cases, strategic planning and organization of HEIs subjected to market-based principles (Widmalm et al., 2016). One question that has been raised in the research field is whether current trends in organizing academic work also contribute to changed academic identities (Clegg, 2008). By contextualizing the objectives of HEIs from the perspectives of teachers, management, and HRM departments, the results show that professional negotiations undergo conversion pressures under New Public Management (NPM)-implemented governance. However, professional identities are, at the same time, strongly rooted in academic core values, and the article offers a discussion via the aid of Pierre Bourdieu (1998) of the possibilities of forming autonomous professional identities and independent knowledge claims in NPM-inspired HEIs.
This article concerns how spaces of professional autonomy are defined and formed in Swedish higher education institutions (HEIs). Swedish HEIs have become increasingly characterised by rivalling principles of management and professional autonomy. The relational aspects of how a professional habitus is formed and negotiated in relation to management ideals and practices are investigated. The research methods used in this study were interviews with HEI management, strategic human resource management (HRM) representatives and research and teaching staff at three HEIs under different conditions of collegial influence and forms of management. The results show that professional negotiations are undergoing conversion pressures under New Public Management (NPM)-implemented governance, but because professional identities are strongly rooted in academic core values, they are relatively resistant to NPM imposition and encroachment. In light of this, the article offers a discussion on the dilemma of conforming to managerial demands and priorities without losing a professional self.
Abstract Decentralisation and deregulation in Swedish secondary education has put more responsibility on local school organization to manoeuvre in a competitive educational context. Political claims foregoing this form of quasimarket development in education stress enhanced opportunities for choices and stimulation of pluralistic interests among students inside a more autonomous school organization. In this paper the issue of educational opportunities is underlined by discussing initial results from an ongoing fieldwork at a Swedish secondary school. Shaped as a case study, the purpose is to investigate how students at both academic and vocational study programmes view their future opportunities in a wider socioeconomic context. More specifically the purpose is to examine how sociocultural conditions become decisive for evaluating possibilities and restraints of schooling. The methodological approach uses multiple qualitative methods, and is inspired by theoretical perspectives that underline the interconnection between individual, organization and society. Emphasis is in particular put on how individual choices are shaped, mediated and channelled by institutional conditions. A theoretical elaboration will be tested by using Pierre Bourdieu’s concept of Habitus, as socially embodied structures, that can be viewed upon as a mediating link between individual action and external power relations of the society. Preliminary results indicate that educational objectives set by the school in question are interpreted rather differently by the vocational and academic students. Individual perception of opportunities coincides with norms and values in the local cultural environment, and results in individual strategies that overlap with local collective beliefs. Both academic and vocational students pursue instrumental goals of material security and social establishment. However, the difference tends to lie in collectively tied practices of pursuing and defining those aims. At the academic oriented programmes school objectives are commonly agreed upon, and are incorporated in the cultural environment. Conversely, mistrust and disagreement towards the goals of the vocational programme seems to prevail among the students. Organisational strategies are shifting in accordance to these different goals, respectively. From supportive and dialog-oriented conduct at the academic track, to conflict filled and disciplining relations at the vocational programme. These early results indicate that students need to take an active part in the specific cultural setting with explicit notions of consistency in order to allocate organizational resources to their favour. Moreover, this case study demonstrate the increasing strong tendency that education is becoming a kind of quasi-market, which presupposes well-informed and ambitious students who seeks to utilise the gains in schooling. Hence, this illuminates the importance of further examination of how sociocultural structures condition students’ practical understanding of the possibilities and limitations of education.
This thesis investigates how students’ practical considerations for future choices in education and occupations correspond to policy objectives of socially productive educational choices. This is conveyed through the primary aim of analyzing the correspondence between on the one hand educational policy intentions and on the other hand students’ educational choices and the social and cultural conditions that structure them. These concerns are addressed with specific aims in four different articles. However, the following research questions have been of central guidance for framing the main issue: (1) How are economic, political and social processes brought together on a policy level for motivating and regulating individuals’ educational choices (Article I)? (2) How do students’ educational choices correspond with policy intentions and the assumptions of rational choice that the latter are founded on (Article I-II)? (3) How are students’ educational choices shaped by wants and identities (Article II-IV)? (4) What is the relationship between students’ want formation and relevant social and cultural conditions (Article II-IV)? The empirical material consisted of interviews and semi-structured questionnaires with young people in secondary education and higher education, and interviews with school staff in secondary education. Empirical inquiries were also conveyed via a semiotic content analysis on recent policy: specifically the Swedish Long-Term Surveys from 2008 and 2011. In comprehensive terms, the rationality of choices from both how choice is practiced and what is desired has been of primary interest. These concerns are addressed by the following emphases in the different investigations. In Article I the form of government that aims to shape actors’ wants and decisions in relation to productive educational choices in the Long-Term Surveys is investigated. The forms of rationality in general, and the suggested implementation of rational choices in particular, are here analyzed through a critical semiotic analysis. The result of the study lifts forward critical distinctions of ontological and epistemological assumptions in how to delineate social and economic claims for the righteousness, reasonableness and necessity of choices. Article II focuses on how students’ wants and choices are formed in a vocational (vehicle maintenance program) and a theoretical (social science program) upper secondary education. By examining students’ want-lists complemented by interviews with students and school staff the study argues that it is important to view wants in an organic totality based on individual and collective experiences. The results show a pragmatic rationality in students’ decision-making, which challenges instrumental rationality in educational choices. This is importantly about how structural support guides students’ decisions over the future under conditions of the radical uncertainty that marks decisions in open social systems. In article III the analysis of vocational and theoretical upper secondary students’ want formations are further developed in relation to their educational environment. Through analysis of interviews with students, teachers, principals and student counselors the article pays particular attention to institutional school effects and school habitus. The results showed that different forms of school habitus in the investigated programs could be empirically attributed to how students form their wants. Article IV investigates identity work via a semi-structured questionnaire and group interviews with students from a Swedish Human Resource program in higher education. What in particular was investigated was how symbolic signification of education and occupations occurred within education. The actual meaning students attributed to education rested importantly on collective sense-making. Indicated in the results is that the meaning of being a student incorporates an awareness of social status and an ability to form relatively autonomous personal projects related to social forces. The result of the thesis points to a lack of correspondence between, on the one hand, political notions of how rational and utility maximizing choices should be made based on effective matching of education and working life and, on the other hand, how young people form their paths into the future in practice through education choices. Students often make their educational choices due to a lack of better alternatives and are often uncertain about where their choices will take them in life. These results show that there is a need for concrete support in schools in order to turn students’ insecurity about the future into useful strategies for educational and occupational paths.
Abstract The present article is based on a critical semiotic investigation of the Swedish Long-Term Survey on economic development. It aims to examine how recent Swedish policy trends bring specific economic, political and social processes together to form a system of meaning for both motivation and regulation over individuals’ educational choices. What is specifically investigated is how the survey directs attention to shaping actors’ wants and decisions in relation to economically productive educational choices through information about education and employment and how education reorganization can redirect economic liabilities from the public to the individual. The particular consequences for educational choices are discussed from the concepts of righteousness, reasonableness and necessity as semantic distinctions that are used to illustrate causal claims on a policy level. The article indicates that these policies rest on apparently categorical ontological and epistemological assumptions on how to direct choices. This appears to be a complexity reduction with the attempt to imply the pre-eminence of economic meaning and motivation for people’s decisions in education and social participation. Keywords: Critical semiotics, educational choice, educational policy, communicative rationality.
Abstract The present article examines student identity work in a vocationally oriented higher education programme. Two questions are addressed specifically: what are the relations between personal projects and specific group and institutional conditions and what is the role of surrounding social circumstances when choices and decisions about higher education are rationalised? When answering these questions the article identifies distinctive reflexive and strategic processes as a means of creating an educational identity. These are shown to be characterised by a form of resistance based on a self-awareness of social position and a capability of forming relatively autonomous personal projects. The possible success and sustainability of the students’ education identity processes seem to rest on collective and institutional support within the education programme. Keywords: Institutional habitus, personal projects, semi-skilled choice, identity
What is indicative of current developments in higher education institutions (HEI) is how the terms of knowledge that make up neoliberal rationalities and entrepreneurial practices are gaining influence at the expense of academic traditions. The logic behind these HEIs’ practices can be seen as the ambition to offer ’products’ in an educational ‘market’. Higher vocational education are especially exposed to these changes, in terms of how the selection and organisation of knowledge is closely related to local conditions of assigned relevance and the practical orientation of learning. In Basil Bernstein’s terms, ‘a horizontal knowledge orientation’ is prevailing. This on-going research project investigates current trends in Swedish HEIs. After the 2011 implementation of institutional autonomy reform in Sweden, HEIs have increasingly transformed into new public management-inspired organisations, where adjustments for employability and economic benefits have gained significance at the expense of academic and pedagogic values. The Swedish higher education sector as a whole, however, is characterised by diversity. The current project aims to examine which governing mechanisms and forms of autonomy are apparent in three cases of higher vocational education. The project design aims to uncover analytical distinctions of different actors' perceptions and objectives within the institutional conditions that form the meaning and objectives of education through interviews with academic professionals and decision makers in HEI. The initial results expose the intrinsic relationships among forms of collegiality, professional autonomy and management ideals in how frictions between academic integrity and adaptability to entrepreneurial practices are handled.
The premise of scarcity is central in economics, sociology and politics: we find it, for example, in Hobbes problem of order, Durkheim’s problem of solidarity, or in Menger’s economic problem. However, there could not be any scarcity without there being no wantingness (Robbins 1932/1945). Therefore, it is essential to study the underlying mechanisms of human wants. The purpose of this paper is thus to develop an explanatory approach of wants. We do this in relation to the concept of preferences of rational choice theory (Becker 1996). By using a favorite case of this theory, namely choices in meritocratic education (Coleman, and Goldthorpe), we manage to show that the assumption of stable preferences is unrealistic. The want-lists of different student’s (n=27) demonstrate this. These lists contain, from the perspective of rational choice, high level of inconsistency (Elster 1990): that is, they violate the principle of transitivity (leads to irrationality) and manifests indifference which is derived from the principle of completeness (leads to indeterminacy). We argue that this inconsistency arise because of radical uncertainty (Beckert 2002), denominated as epistemological opaqueness. From this we propose an alternative approach to want formation anchored in the concept of the habitus (Bourdieu 1986) and reflexivity (Archer 2003). The habitus establish the set of wants (merely the bundle of wants), whereas reflexivity condition the want-list (the interconnectedness of wants). This approach does both ease the problem of epistemic opaqueness and maintains that wants form an organic totality. Consequently, choice as well as scarcity on an individual level depends on the habitus and the reflexive capability of an individual, which ultimately hinges on an agent’s ability to deal with micropolitical affairs. Keywords: preference, wants, rational choice theory, habitus, reflexivity
In this article, we approach the significance of moral stands in professional practices among practitioners in Support and Service for Persons with Certain Functional Impairments from the perspective of Bourdieu's concept of symbolic order and ethos. Our study illustrates how negotiations about agency takes place within a network of relationships, where the normative and professional judgment of staff in practice becomes crucial in relation to how self-determination for users is conditioned in everyday life. This involves questions about how rights, obligations and norms are conveyed, negotiated and implemented. These everyday practices involve individual planning, follow-up, and relationships with support staff in various professional categories. The results illustrate how staff motivation in regard of their work to support and help others rests on emotional and ethical attributes linked to the professions. These ethic dispositions become indicative of the meaning that the concept of self-determination has for the staff. Ethos, is in this context regarded as a focal professional attribute of being able to place the ideal of users as active subjects within a social service context.
This research project addresses the conference theme of citizenship and inclusion. Variables of class, gender and ethnicity are here vital in evaluating the meaning of inclusion – both in a wider societal context, and how it affects individuals’ perspective on opportunities. This project description is part of a doctoral thesis, and addresses the issues: (1) which student groups are entering an average-sized Swedish University College, and (2) how students allocate their education as a resource in relation to their social grouping. The selected University College for a case study is characterised by advocating closeness between study programmes and working-life, and the social background of the students is fairly heterogeneous. Many of the students are women, and the issue of gender in relation to qualitative and quantitative goals of higher education is essential. The working hypothesis states that patterns of social stratification persist in Swedish higher education, and this leads to the question of how an increased number of students in higher education relates to goals of equality and diversity. Methods used are both qualitative and quantitative.
The increasing function of universities as institutions for mass education might affect democracy and the universities' contribution to society. Students as choice-agents need to be involved in these processes. This paper scrutinises how students’ practical considerations for choices in education and future occupations correspond to policy objectives of socially productive educational choices. These objectives currently follow neoliberal rationalities regarding how to divide the responsibilities between the state and its citizens. In this context, choice-agents have to learn to identify themselves as economic subjects able to cope with economic transformation. The aim of our research is to examine the correspondence between educational policy objectives and students’ educational choices in practice. The research questions posed are to what extent students’ choices and motives reflect a (neoliberal) instrumentality? Is there a resistance against such rationalities in students’ actual choice-strategies? This issue is empirically investigated via a semi-structured questionnaire (n=322) with students from 7 vocational Swedish Human Resource programs in higher education. The case of higher education programme was seen as relevant, since weak professional university programs tend to stimulate rationalities amongst students that ritualise the role of education in terms of its formal credentials. Vocational programs are also a significant growth sector in higher education, with large proportions of non-traditional students. What is unclear, however, is whether these forms of education reinforce a desired policy ambition with regard to instrumental choices in education. These are policy rationalities that are questioned in the paper from a choice agency approach. The results of the study point to patterns where students tend to resist instrumentality and integrate their decisions in education as reflexive and relative autonomous personal projects in relation to the recognized social powers of the labor market.
Swedish higher education policy is currently moving toward consumption ideals that focus on promoting the efficiency and economic viability of student choices. This paper scrutinizes students’ practical considerations when making decisions regarding their education and future occupations and the choice rationalities and motives that these reflect. This issue is empirically investigated via a semi-structured questionnaire (n = 322) distributed to students from seven vocational Swedish human resource management (HRM) university programs. Vocational university programs like HRM are a significant growth sector in higher education. What is unclear, however, is whether these forms of education reinforce a desired policy ambition toward consumerist subjectivity among choice agents. The results of the study do not exclusively or even primarily express consumerist subjectivity. By vitalizing Pierre Bourdieu’s term “reasonable”, an organic form of reasoning becomes apparent that does not separate intrinsic dimensions of learning, knowledge, or personal and social concerns from merit and economic compensation. Moreover, the results indicate that security and interpersonal distinctions relating to professional alignment are situated in the forefront of the expressed motives for these educational choices.