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The precarious character of routine practice in social and primary health care
Umeå University, Faculty of Social Sciences, Department of Social Work.
Umeå University, Faculty of Social Sciences, Department of Social Work.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
2015 (English)In: Journal of Social Work, ISSN 1468-0173, E-ISSN 1741-296X, Vol. 15, no 3, 317-336 p.Article in journal (Refereed) Published
Abstract [en]

Summary: This article presents a description and analysis of the written narratives of problematic situations given by social workers and general practitioners (GPs) within the framework of the sociology of professions and organisations. The narratives were collected from 28 social workers and 24 GPs, working in several Swedish counties.

Findings: Our findings show that the professionals rarely described lack of knowledge or difficulties choosing the right intervention or treatment as problematic. Rather, the problematic situations contained encounters with clients perceived as disruptive to professional routine practice. We conclude that there were three different types of problematic situations where the professional routine practice was disrupted: (1) Situations related to ‘client-making work’, where the professionals perceived it difficult to, e.g., gather enough information about the client to make a diagnosis, set a timetable or decide on adequate interventions; (2) Situations related to ‘wicked work’, where the professionals experienced clients unable to articulate their problems or understand and follow the interventions suggested by the professionals; (3) Situations related to ‘dirty work’ were only present in GPs’ narratives and typically occurred when GPs perceived that they were dealing with clients who endangered their profes- sional status. 

Applications: Contrary to previous studies, this study indicates that problematic situ- ations are not necessarily connected with traits and characteristic of the client or a lack of professional competence. Instead, they might be connected to situations where professional routine practice is disrupted. Furthermore, it is questionable to what extent problematic situations connected to such disruption can be managed by evi- dence-based methods, manualisation and standardisation. 

Place, publisher, year, edition, pages
2015. Vol. 15, no 3, 317-336 p.
Keyword [en]
Social work, dirty work, wicked work, evidence based practice, critical incident analysis, decision making, human services
National Category
Social Work
URN: urn:nbn:se:umu:diva-95035DOI: 10.1177/1468017314548121ISI: 000353474000005OAI: diva2:756964
Hur använder socialarbetare och läkare kunskap i praktiken? En jämförelse mellan två professioner
Forte, Swedish Research Council for Health, Working Life and Welfare, Dnr 2009-0251
Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2015-05-29Bibliographically approved

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Rexvid, DevinEvertsson, LarsForssén, AnnikaNygren, Lennart
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