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The Traditional Model of Professional Practice
membership of Royal Colleges, reinforce entitlement. Professional and statutory regulatory bodies (PSRB) protect the public, policing entry onto and removal from professional registers, for example, the Nursing and Midwifery Council (NMC), the General Medical Council (GMC) and the Health and Care Professions Council (HCPC). The introduction of revalidation and fitness to practice procedures provides additional mechanisms for continuing registration.
Many of these features reflect an ‘old’ model of professional practice associated with what is known as a medical model of health (Box 3.2). This model is particularly problematic from a community and public health viewpoint as the focus is on the body, acute illness and the disease process such that social or economic causes of illness are omitted. Concepts within the medical model are informed by and reinforce values, attitudes and practice.
Becoming ‘a professional’ is a process of acculturation and socialisation where new recruits are exposed to the norms and values that pertain to a particular profession, including language and how to relate to clients. Professional education exposes students to role models or mentors with particular placement experiences that serve to define and reinforce attitudes, values and behaviours as much as the specialist knowledge.
This reflects the traditional apprenticeship approach. Training is separate from other professions, and patients do not play an active role in the curriculum, other than permitting students to practice their skills on them. At the end of this acculturation process, there has been a transformation from student to a fledgling practitioner.
Benner (1984), cited by Gatley (1992), describes this process in nursing as a continuum
‘from novice to expert’ whereby experiential learning is central to developing intuitive knowledge and skills. So, while professions share certain common characteristics (Box 3.1), not necessarily all, there remain differences in the way that professionals interact with clients, conceptualise their practice and relate to other professionals.
Training establishes professional identities and it is easiest to make distinctions between or within professions where practice is highly specialised, for example, neurosurgery.
Such distinctions may be codified by legislation and regulations, for example, except in an emergency, it is a criminal offence for anyone other than a UK-registered midwife
Reflection point
Do you consider yourself a professional? What defines you as a professional?
How is this different from acting in a professional way?
ACTIVITY 3.1
Box 3.2 Features of the medical model of health Focus on the disease process and cure
Scientific rational approach Professional as expert Task focused
Patient as a passive recipient of care
Illness model of health: Little emphasis on prevention or public health
or doctor to attend a woman in childbirth (Dimond, 2015). Such codification has led to the creation of hierarchies even within professional groups and characterising some groups as semi-professions, particularly along gender lines. Boundaries between professionals have emerged such that they jealously guard them in order to protect their roles. This can lead to resistance to change, defensive practice or tribalism (Dalley, 1989; Evetts, 2012). This reflects the traditional view of professions in terms of historical claims to knowledge and expertise and is ultimately an issue of power.
Differences between professions are frequently reinforced through traditions, training and discourse and to some extent stereotyping (Pietroni, 1991). Theoretical perspectives also underpin this, for example, in social care the concept of anti- oppressive practice (Ward, 2009) is key to explaining social work practice as well as a driver to empower service users. This reflects the social model of health (Box 3.3).
Doctors are associated with adopting a purely medical model of health while other professional groups across health and social care adopt the social model of health (Brechin et al., 2000) (Box 3.3) that takes in the wider determinants of health and health inequalities (Wilkinson and Pickett, 2010; Marmot, 2010). This is particularly important when taking a public health approach that is population based (Guest et al., 2013). These stereotypes or archetypes are too crude and do not take account of the huge variation across practice areas, different care settings and individual philosophies.
In the community, it would be difficult, not to say unethical, for any health or social care practitioner working with service users to ignore wider psychosocial and environmental factors impacting on care (see Chapter 1). For example, in occupational health nursing the work environment is a critical aspect of any care (Black, 2008) and must be balanced with the scientific explanations of occupational exposures to noise, dust or other hazards to health (Aw et al., 2006). However, these concepts and models are useful starting points for challenging assumptions about professions and the extent to which practice is task oriented.
Discussion point
Which professions are legally entitled to prescribe? What are the boundary issues?
You may find Radcliffe (2008) helpful to your discussion.
ACTIVITY 3.2
Box 3.3 Features of the social model of health Health is holistic and not just the absence of disease.
Wider determinants of health are seen as causes of ill-health and health inequalities.
Holistic approach is taken to assessment and sources of evidence.
Service user is expert in their own health.
Emphasis is on health and well-being.
Service user participates in health/community as a full citizen.
Emphasis is on prevention and public health.