Paraprofessionals and caring: tensions between individual views and normative expectations of providing care

Author(s):

Chris KubiakFredrik Sandberg

Conference:

ECER 2009

Network:

2. Vocational Education and Training (VETNET)

Format:

Paper

Session Information

02 SES 03 B, NW 02 Paper Session

Paper Session

Time:

2009-09-28

14:00-15:30

Room:

HG, HS 24

Chair:

DAVID GUILE

Contribution

A focus on the development of paraprofessionals in health and social care (for example, health care assistants or care workers) has emerged as one of the main planks in government policy both in England (see Cameron and Boddy 2006; DH 2006a, b; SRC 2008) and Sweden (KS 2006; SD, 2004). In both countries, Government strategy not only emphasises the need to remain abreast of a rapidly changing field but the reconfiguration of roles and responsibilities. This is not simply a matter of creating a workforce of flexible, skilled and qualified staff (DH 2001; SD 2007; SD 2008) but the melting of traditional professional and practice boundaries (Dawson et. al., 2007; DH 2001; SD 2007; SD 2008) and the ‘professionalisation’ of a staff group. This programme of development is often delivered through competency-based vocational programmes and the teaching of technical tasks. In addition to these more clearly defined aspects of practice, the more elusive concept of ‘care’ remains at the core of worker practice. Concerns that services are less compassionate than ever before have been raised in England (Darzi 2008; Goodrich and Cornwell 2008). In Sweden, a similar discussion can be found especially in connection to the care of elderly (SD 2008). In this paper, developing caring practice is conceptualised using Billett’s (2001) concept of co-participation. Learning is understood as arising out of activity in a range of different settings. The nature of the setting, whether workplace or educational institution, and one’s role within it will influence what and how individuals come to learn (Billett, 2001a). Hierarchies, group affiliations, personal relations, cliques and cultural practices all shape one’s practice (Billett, 2002). However, Holloway (2006) is particularly critical of such an analysis arguing that the capacity to care is not simply a matter of social structure but also personal capacity. Following the work of Billett (2001) and Hodkinson et. al. (2004), it is argued that the participant’s sense of self, interests, drives and motivations will determine how they engage in and learn through work or educational activities shaping how caring practice is understood and constructed. This paper investigates the way in which paraprofessionals in Sweden and England learn to provide care and to be caring. Specifically: 1. How is caring practice shaped and developed through participation in the practices of the workplace, formal education and other contexts? 2. How do practitioner characteristics and personal circumstances influence the production of caring practice?

Method

The English study draws from a series biographical and critical incident interviews with 14 paraprofessionals (four interviews each) across three settings in health and social care. 6 of these 14 workers were also observed in practice over half a day to two days with debrief interviews and ongoing discussion throughout the observation. The Swedish study encompasses 23 semi-structured interviews and two group interviews with health care assistants in an education program for becoming assistant nurses. Further, observations have been carried out throughout the education program. Both studies used the constant comparative method to analyse the data.

Expected Outcomes

This is a work in progress but early results suggest a transactional relationship between setting (educational or workplace) and practitioner. Settings exert considerable agency towards the reproduction and co-configuration of caring practice. Settings shape what activities are possible by modelling and affirming practice. At the same time, the practical implications of caring practice are contested by explicitly and assertively confronting or subverting activities that are seen as incompatible with group norms. At the same time, the participant’s caring orientation appears to arise out of vocational drives and as such, presents as a deeply personal matter. Developing caring practice is partly the pursuit of a distinctive approach, an expression of who one is and a personal connection with their service users.

References

Billett, S. (2001a). 'Learning throughout working life: Activities and interdependencies', Studies in Continuing Education, 23 (1), pp. 19-35. Billet, S. (2002). 'Workplaces, communities and pedagogy: an activity theory view'. In Lea, M. R. and Nicoll, K. (Eds.), Distributed Learning : Social and Cultural Approaches to Practice, Routledge in association with the Open University, London. Cameron, C. and Boddy, J. (2006). ‘Knowledge and Education for Care Workers: What do they Need to Know?’ In Boddy, J., Cameron, C. and Moss, P. (Eds.), Care work : present and future. Routledge, London, pp. 197. Darzi, A (2008). High Quality Care For All: NHS Next Stage Review Final Report. Department of Health, London. Dawson, S., Slote-Morris, Z., Erickson, W., Lister, G., Altringer, B., Garside, P. and Craig, M. (2007). Engaging with Care: a vision for the health and care workforce of England. The Nuffield Trust, London. Department of Health (2001). A Health Service for all Talents: Developing the NHS workforce, available from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003182?IdcService=GET_FILE&dID=15951&Rendition=Web, [accessed 6th of November, 2008]. Department of Health (2006a). The Regulation of the Non-medical Healthcare Professions: A review by the Department of Health, Department of Health, Leeds. Department of Health (2006b). Learning for Change in Healthcare, available from http://www.wideningparticipation.nhs.uk/pages/report-01.html, [accessed 10th of November, 2008]. Goodrich, J. and Cornwell, J. (2008). Seeing the person in the patient: The Point of Care Review Paper. London: The Kings Fund. Hodkinson, P., Hodkinson, H., Evans, K., Kersh, N., Fuller, A., Unwin, L. and Senka, P. (2004). 'The significance of individual biography in workplace learning', Studies in the Education of Adults, 36 (1), pp. 6. Holloway, W. (2006). The Capacity to Care: Gender and Ethical Subjectivity. Hove: Routeledge. Kompetensstegen. [The competence ladder]. (2006). Faktablad 5: Kompetensstegens försöksverksamhet. [Information sheet 5: the pilot scheme of the competence ladder] Stockholm: Kompetensstegen Socialdepartementet. [Ministry of Health and Social Affairs] (2004). Kommittédirektiv Dir. 2004:162 – Stöd till kvalitetsutveckling inom den kommunala vården och omsorgen om äldre genom kompetensutveckling för personalen. [Committee directive Dir. 2004: 162 - Support for quality development within the municipal care sector and the care for elderly through competence development of the personnel] Stockholm: Socialdepartementet Socialdepartementet (2007). [Ministry of Health and Social Affairs]. SOU 2007:88. Att lära nära. Stöd till kommuner för verksamhetsnära kompetensutveckling inom omsorg och vård av äldre. [To learn close. Support for municipalities activity-close competence development work in the care for elderly] Stockholm: Socialdepartementet. Socialdepartementet. (2008). [Ministry of Health and Social Affairs]. SOU 2008:51. Värdigt liv i äldreomsorgen. [A dignified life in the elderly care sector] Stockholm: Socialdepartementet

Author Information

Chris Kubiak

The Open University

Faculty of Health and Social care

Milton Keynes

Fredrik Sandberg

Linköping University

The department of behavioural sciences and learning

Linköping

186

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