Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

Survivor mission: Do those who survive have a drive to thrive at work?

Are helping professionals who have experienced the same types of struggles as their clients more engaged at work? In the current investigation, we examine this question in samples of police detectives (with and without a history of violent victimization) and mental health workers (with and without a history of mental illness). Our results indicate that police detectives who have experienced violent victimization and mental health professionals who have experienced the same mental illness as their clients do indeed exhibit greater work engagement than their colleagues who lack these parallel life experiences. The link between a professional’s firsthand experience of his/her client’s hardships and work engagement appears to be partially explained by higher levels of grit among police detectives and by a greater sense of life-narrative continuity among mental health professionals.     

Negative hallucinations,dreams and hallucinations: The framing structure and its representation in the analytic setting

This paper explores the meaning of a patient's hallucinatory experiences in the course of a five times a week analysis. I will locate my understanding within the context of André Green's ideas on the role of the framing structure and the negative hallucination in the structuring of the mind. The understanding of the transference and countertransference was crucial in the creation of meaning and enabling the transformations that took place in the analytic process. Through a detailed analysis of a clinical example the author examines Bion's distinction between hysterical hallucinations and psychotic hallucinations and formulates her own hypothesis about the distinctions between the two. The paper suggests that whilst psychotic hallucinations express a conflict between life and death, in the hysterical hallucination it is between love and hate. The paper also contains some reflections on the dramatic nature of the analytic encounter.     

Changes in the Frequency of Coworker Incivility: Roles of Work Hours,Workplace Sex Ratio,Supervisor Leadership Style,and Incivility

Previous research has identified individual characteristics that affect experiences of coworker incivility. However, much less is known about environmental characteristics that affect these experiences. Drawing on the social learning theory and the frustration–aggression hypothesis, this study examined the effects of supervisor incivility and work hours on coworker incivility. Data collected from 692 full-time employees showed that changes in the frequency of supervisor incivility positively predicted changes in the frequency of coworker incivility over the next 6-month period. This relationship tended to be stronger for employees who had a supervisor lower rather than higher in the levels of autocratic leadership style. Furthermore, changes in work hours positively predicted changes in coworker incivility. The workplace sex ratio was not an important factor that differentiated experiences of coworker incivility for either men or women. The results of this study highlight the importance of attending to the environmental characteristics of the workplace to understand the occurrence of coworker incivility.     

Within-individual relations of emotional,social, and work self-efficacy beliefs to organizational citizenship behaviors

Organizational citizenship behaviors (OCBs) represent a specific class of prosocial behaviors observable in the organizational environment. This study examined the longitudinal relations among regulatory emotional, social and work self-efficacy beliefs, and their relations to Organizational Citizenship Behaviors directed at specific individuals (OCBIs) at work, using a Latent State-Trait Model with Autoregressive effects (LST-A). The LST-A decomposes variance into trait, autoregressive, and occasion-related components, and allowed for testing of all hypotheses at the within-worker level. The model was tested using longitudinal data from N = 562 italian workers. Results supported the hypotheses that both social and work self-efficacy fully mediated the longitudinal relations between regulatory emotional self-efficacy in managing negative emotions at work and OCBIs. Theoretical and practical contributions of the findings are discussed.     

Travailler dans un réseau de santé : effets sur la santé psychique au travail

The new needs as regards care taking charge of patients have contributed to the creation of health networks. As they are growing fast, they are an integral part of the French sanitation system. The impact, on the health professionals, of networking is, today, the object of contrasted research and results, but has little been studied as far as Social Psychology, Work and Organizations are concerned. This article follows a research project which had the objective, on the one hand, to describe the effects of the participation to a health network mental health at work and, on the other hand, to examine the variables and process accounting for the variability of these effects. This research privileges an approach to the health network as a place of socialization and personalization (Malrieu, 1979). The research on the ground is carried out in collaboration with the health network town-hospital Prevention and Taking charge of Pediatric Obesity Network (RéPPOP) Midi-Pyrénées. We have carried out semi-guided interviews with 20 private professionals (8 doctors, 8 dieticians, 3 psychologists, 1 physiotherapist) members of the RePPOP Midi-Pyrénées network. The main results show that the perception of positive and/or negative effects of networking on mental health varies according to the age of membership of the network and the processes of transfer of experience (from professional practice within the network to professional practice off-network and vice versa). Proposals are deduced in terms of continuing education within the network.     

Secret médical en santé au travail

The occupational physicians are obliged, like any doctor, to respect the ethical obligations imposed on their profession, including in the exercise of the missions specific to occupational medicine and contained in the Labor Code. The occupational physician is not isolated and works in a multidisciplinary team of a health service at work. He must communicate with other health professionals, but also with employers, representative bodies of staff. Medical confidentiality holds a special place in the triangular relationship between the occupational physician, the employee and the employer. The medical practice in the field of occupational health requires that many provisions of the Labor Code be followed, including the respect of the secret of manufacture and the position of advising employers and employees. The occupational physician must communicate with the employer in order to best achieve his mission, but in practice, it may be difficult for the occupational doctor to make his recommendations heard to improve the working conditions of employees without power, when he cannot argue his opinions on medical information.     

Job demands,job resources and innovative work behaviour: a European Union study

This study aims to investigate the relationship between several job design variables and innovative work behaviour (IWB). Guided by the Job Demands Resources model, the aim was to evaluate the relationship between work demands (time constraints), resources (autonomy and social support), and other work factors (task monotony, complexity, and dealing with unforeseen circumstances) with idea generation and idea implementation behaviours in a sample of 12,924 participants from the 27 European Union member states in 2010. We also wished to investigate if individual IWB, at the country level, is associated with country innovative performance (an aggregate of process/product and marketing/organizational innovation). We employed a multilevel generalized structural equation model to test our hypotheses. In our final model autonomy, manager encouragement and dealing with unforeseen problems showed the highest positive relationship with idea generation and idea implementation. Conversely, monotonous tasks and working at high speed were negatively related to IWB. Furthermore, we have found strong indications that country-level IWB positively relates to the odds of a country scoring higher on the aforementioned innovation indicators. Between-country unexplained variance in IWB was reduced from 17.1% in our initial model, to 1.9% in our final iteration. Limitations, implications and suggestions for future research are discussed.     

Managing the interactions between multiple identities in inter-organizational collaborations: an identity work perspective

Inter-organizational collaboration (IOC) research considers the achievement of a collaborative identity as a key enabler of a successful collaboration. As a result, little has been said about the interactions between collaborative and non-collaborative identities. We build on narrative identity work and positioning theory, to explore how collaboration partners engage in identity work positioning to manage the interactions of the multiple identities emerging through the process of collaboration as they try to accomplish collaborative work. We illustrate this process through a qualitative longitudinal study of an educational partnership in Greece. Our analysis shows how IOC partners manage the interactions between collaborative and non-collaborative identities by positioning themselves, and others, in narratives of collaboration as part of their daily identity work when responding to emerging collaborative needs. Our research extends our current understanding of identity work processes in IOCs by demonstrating the paradoxical nature of the collaboration, which requires relying on both collaborative and non-collaborative identities for the successful achievement of aims. We therefore suggest that identity tensions should not be resolved but rather managed, since they enable partners to respond creatively to contextual organizational changes and make sense of the collaboration as it happens.