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The precarious character of routine practice in social and primary health care
Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
2015 (Engelska)Ingår i: Journal of Social Work, ISSN 1468-0173, E-ISSN 1741-296X, Vol. 15, nr 3, s. 317-336Artikel i tidskrift (Refereegranskat) 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. 

Ort, förlag, år, upplaga, sidor
2015. Vol. 15, nr 3, s. 317-336
Nyckelord [en]
Social work, dirty work, wicked work, evidence based practice, critical incident analysis, decision making, human services
Nationell ämneskategori
Socialt arbete
Identifikatorer
URN: urn:nbn:se:umu:diva-95035DOI: 10.1177/1468017314548121ISI: 000353474000005Scopus ID: 2-s2.0-84930385200OAI: oai:DiVA.org:umu-95035DiVA, id: diva2:756964
Projekt
Hur använder socialarbetare och läkare kunskap i praktiken? En jämförelse mellan två professioner
Forskningsfinansiär
Forte, Forskningsrådet för hälsa, arbetsliv och välfärd, Dnr 2009-0251Tillgänglig från: 2014-10-20 Skapad: 2014-10-20 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Ingår i avhandling
1. Professionsutövning och kunskapsstyrning: en jämförelse av socialarbetares och allmänläkares klientarbete
Öppna denna publikation i ny flik eller fönster >>Professionsutövning och kunskapsstyrning: en jämförelse av socialarbetares och allmänläkares klientarbete
2016 (Svenska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The aim of this thesis is to study whether the Swedish state’s efforts to govern the professional practice of social workers (SWs) by knowledge to achieve an evidence-based practice, address the difficulties that SWs encounter in their practice. The Swedish state’s ambition is to govern the practice of social work by ideas and methods originating from medicine. The thesis therefore compares, through four different studies, the professional practice of SWs with general practitioners (GPs) as the most comparable sub-profession in medicine. The research questions that the thesis seeks to answer are:

  • What situations are perceived as problematic and non-problematic by SWs and GPs?

  • How does the professionals’ relationship with clients affect the performative aspects of these occupations’ enactment of their practice?

  • How do SW and GPs experience the state’s efforts to govern their professional practice by knowledge?

  • What problems can arise when the Swedish state builds its knowledge governance of social work practice on a comparison with medicine, even though these professional fields exhibit a number of important differences?

The empirical material in the first and second studies consists of 52 narratives, written by SWs and GPs on problematic and non-problematic situations. The third study is based on vignette-based focus group interviews with 25 SWs and GPs. And the fourth study is based on a literature review, consisting of 54 articles about SWs’ and GPs’ practice.

A first finding is that professionals rarely describe lack of knowledge or difficulties with knowledge use as problematic. A second finding is that non-problematic situations are connected to professionals’ control of the intervention process. SWs gained control of the relationship with the client either by use of coercive means or by the client’s active co-operation. GPs gained control of the intervention process by the use of professional knowledge. A third finding is that an understanding of professional practice as a linear process consisting of diagnosis, inference and treatment reflects GPs’ practice but not all aspects of SWs’ practice. A fourth finding is that both professions hold ambivalent positions towards evidence-based risk reductions technologies. The responses towards organisational risk reductions technologies differ in that GPs are sceptical, whilst SWs take a more pragmatic view.

A main conclusion is that the Swedish state’s efforts to govern the performative aspects of SWs’ practice by knowledge, runs the risk of becoming a insufficient strategy since they tend to exhibit two main blind spots. The first is that these efforts tend to ignore that the relationship with the client has a crucial affect on and conditions SWs’ and in problematic situations also GPs’ knowledge use. The second is that the efforts also tend to ignore that control of the intervention process is not always maintained through control of knowledge use. For SWs control of the relationship with clients represents another mode of professional control of the intervention process. 

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2016. s. 128
Serie
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 84
Nyckelord
Social workers, GPs, performative aspects of professional practice, relationship with clients, welfare state, knowledge governance, EBP
Nationell ämneskategori
Socialt arbete
Identifikatorer
urn:nbn:se:umu:diva-127145 (URN)978-91-7601-598-8 (ISBN)
Disputation
2016-11-25, Hörsal B, Samhällsvetarhuset, Umeå, 13:00 (Svenska)
Opponent
Handledare
Projekt
Hur använder socialarbetare och allmänläkare kunskap i praktiken?, FAS/FORTE dnr 2009-0251
Forskningsfinansiär
Forte, Forskningsrådet för hälsa, arbetsliv och välfärd, dnr 2009-0251
Tillgänglig från: 2016-11-04 Skapad: 2016-11-01 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

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Rexvid, DevinEvertsson, LarsForssén, AnnikaNygren, Lennart

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