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Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.

This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.

The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.

This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.

Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.

This research study provides insight into students’ perceptions of teaching through virtual and face-to-face clinicals in an introductory education course in a pre-education program at a minority-serving institution.

This study took place at an urban–suburban-centered community college in the Midwestern United States and was reviewed by the higher education institutional review board (IRB). Data were collected from pre-education majors enrolled in a four-hour Introduction to Education with field experiences.

The findings indicated that both virtual and face-to-face clinicals were beneficial to the development of pre-service teachers, particularly in an early introduction to education course.

The finding that virtual clinicals are significant to teacher growth is significant to teacher recruitment and preparation.

The flexibility of a virtual clinical provides greater opportunities for low-income and marginalized populations with limited means and access.

This finding can lead to strategies to diversify teacher candidates.

This study sought to answer the following question: how do pre-education students reflect to understand the roles and responsibilities of teaching through virtual options vs face-to-face clinicals? The interest of this research is to expand pathways into the teaching profession to nontraditional, ethnically and culturally marginalized groups and historically underrepresented groups.

Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

New Public Management-informed pay-for-performance policies are common in public sectors internationally but can be controversial with delivery agents. More attention is needed on contingent forms of bottom-up implementation of challenging policies, in emerging market economies, for professionals who face tensions between policies and their codes of practice. Street-level bureaucrats (SLBs) mediate policy implementation through discretionary practices; health professionals have enhanced space for discretion based on autonomy derived from professional status. The authors explore policy implementation, adaptation and resistance by physicians, focusing on payments for health workers in Turkey.

The researchers conducted semi-structured qualitative interviews with 12 physicians in Turkish hospitals and thematic analysis of interview transcripts, using a blended (deductive and inductive) approach.

The policy fostered discretionary behaviours such as cherry-picking (high volume, low risk procedures) and pro-social rule-breaking (e.g. “upcoding”), highlighting clinical autonomy to navigate within policy restrictions. Respondents described damage to relationships with patients and colleagues, and dissonance between professional practice and perverse policy incentives, sometimes leading to disengagement from clinical work. Policymakers were perceived to be detached from the realities experienced by SLBs. Tensions between the policy and professional values risked alienating physicians.

This study utilises participant self-reported perceptions of discretionary behaviours. Further work may adopt alternative methods to explore the relationship between self-reporting and observed practice.

The authors contribute to research on differentiated, contingent roles of groups with high scope for discretion in bottom-up implementation, pointing to the potential for policy-professional role conflicts between top-down P4P policies, and the values and codes of practice of professional SLBs.

This chapter investigates the ongoing process of academization within the field of educational therapy in Germany, particularly in the context of the introduction of university degrees in integrative educational therapy and the psychology of learning. The introduction of these degrees brought about transformative changes in the professional landscape. Educational therapists holding such degrees often demonstrate a more advanced understanding of their roles, which is underpinned by thorough university education and the legitimizing influence of their academic titles. Prior to the establishment of these degree programs, the field of educational therapy was notably unregulated, devoid of a protected professional title or a specific qualification. This lack of regulation resulted in a proliferation of varied providers, giving rise to what’s known as the “after-school market” phenomenon. This chapter explores the genesis and institutionalization of degree programs in educational therapy as a path toward professionalizing the field. It reveals the crucial role that professional associations along with scientific experts have played in launching these degree programs. Additionally, it discusses the impact of competition among different approaches to educational therapy within this rapidly evolving landscape.

In this chapter, the author critically examines the deeply entrenched practices and theories within counselor education, revealing their roots in historically dominant, Eurocentric, and often racially oppressive assumptions. This study brings to light the pervasive impact of these traditional approaches, illuminating their role in perpetuating racial oppression and disparities in mental health care. The author presents a compelling argument for adopting Critical Race Theory (CRT) as an effective pedagogical and clinical practice framework in the counseling profession, a step toward its much-needed liberation. CRT's tenets are examined as a robust alternative, promoting socially just outcomes in counseling and psychotherapy. The article highlights CRT's capacity to address the well-established relationship between racism, white supremacy, and minority mental health. It proposes a groundbreaking model for praxis, predicated on CRT, which holds potential not only to challenge and disrupt oppressive structures but also to pave the way for the liberation of both the oppressed and the oppressor. This seminal work prompts a re-envisioning of counselor education, asserting a call for a transformative shift toward a liberation-based, social justice pedagogy.

Burdened by undernutrition, micronutrient deficiencies and overweight and obesity as a consequence of both internal conflict and the global nutrition transition, Iraq is in need of adequate public health nutrition education to mitigate nutrition-related outcomes and risks. To address nutrition-related health outcomes, trained nutrition professionals are warranted. This paper examines current nutrition-affiliated programs offered across post-secondary institutions in Iraq.

An electronic review of universities and colleges’ websites, department webpages and academic programs’ homepages and resources of all the private and public universities in Iraq was conducted to find programs related to nutrition, nutrition sciences and dietetics.

All identified programs belonged to the governmental sector, were administered and financed by the Iraqi Government and were under the purview of the Iraqi Ministry of Higher Education. The review highlighted a predominant focus on food sciences in agricultural departments rather than public health or clinical nutrition. Advanced education in topics such as human metabolism, medical nutrition therapy and public health nutrition are required to adequately address over- and undernutrition in Iraq.

The current state of public health and nutrition-related postsecondary education in Iraq warrants an increased emphasis on clinical and public health nutrition education. Despite a commendable focus on food science studies, the country’s ongoing challenges with obesity, nutrition-related noncommunicable diseases and conflict-associated food insecurity signal an urgent need for balancing this focus with grounding in postsecondary training in public health nutrition.

Effective use of data is critically important for the provision of health services. A large proportion of employees in health organisations work in non-clinical roles and play a major part in organisational information flows. However, their practice, data-related capabilities and learning needs have been rarely studied. The purpose of this paper is to investigate issues of capabilities and learning needs related to employees' interactions with data in non-clinical work roles.

The study used a mixed-method approach. Qualitative methods were used to explore issues, and survey was administered to gather additional data.

Data use and related capabilities at the workplace are highly contextual. A range of general, core and data-specific capabilities, underpinned by transferable skills and personal traits, enable successful interactions with data. Continuous learning is needed in most areas related to data use.

The study was conducted in a large public-health organisation in Australia, which is not representative of unique organisations elsewhere. The study has implications for the provision of health services, workplace learning and education.

Findings have implications for organisational decisions related to data-use and workplace learning, and for formal education and lifelong learning.

The study contributes to closing a research gap in understanding interactions with data, capabilities and learning needs of employees in non-clinical work roles. Capabilities continuum presented in this paper can be used to inform education, training and service provision. The workplace-based results contribute to theoretical considerations of capabilities required for work in technology-rich environments.

This study aims to examine nurses’ motivation for leadership and explore important challenges nurses face in leadership positions.

Semi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data.

Nurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership.

Studies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers.

The role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002).

By identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness.