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Meaning contents of radiographers' professional identity as illustrated in a professional journal – A discourse analytical approach
Radiography (2007) 13, 258e264
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / r a d i
Meaning contents of radiographers’ professional identity as illustrated in a professional journal e A discourse analytical approach Antti Niemi*, Leena Paasivaara a University of Oulu, Department of Nursing Science and Health Administration, P.O. Box 5000, 90014 Oulu, Finland Received 28 November 2005; accepted 21 March 2006 Available online 15 May 2006
KEYWORDS Radiographer; Professional identity; Professional culture; Discourse analysis; Professional journal
Abstract Aim: The purpose of the present study is to describe and understand the meaning contents of radiographers’ professional identity. Background: The conceptualisation of professional identity in terms of radiographers’ perceptions of their role focuses on their preferred role-content and perception of the professional self. Professional identity defines values and beliefs that guide the radiographer’s thinking, actions and interaction. Method: The present study employs the method of discourse analysis to gain a profound understanding of the cultural meaning contents related to the formation of the professional identity of radiographers. Material for the study was gathered from articles published in the professional journal of the Society of Radiographers in Finland between the years 1987 and 2003. Findings: Technical discourse emphasised the importance of responding to the changes in radiology in the 1990s. Safety discourse emerged as the second content of meaning describing the formation of professional identity. The third content of meaning in professional identity was professional discourse, a central aspect being to promote the esteem of one’s profession and emphasise professional identity. Conclusions: The results suggest that the professional identity of a radiographer is dual in nature. On one hand, the professional identity of a radiographer is based on solid command of scientificemechanic technology in a technical working environment; while on the other hand, it consists of mastering the humane, humanistic nursing work. ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Introduction * Corresponding author. Tel.: C358 8 537 5609; fax: C358 8 537 5606. E-mail addresses: [email protected] (A. Niemi), leena. [email protected] (L. Paasivaara). a Tel.: C358 8 537 5603; fax: C358 8 537 5606.
The purpose of the present study is to describe and understand the meaning contents of radiographers’ professional identity. The meaning contents of professional identity in terms of radiographers’ perceptions of their role
1078-8174/$ - see front matter ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2006.03.009
Meaning contents of radiographers’ professional identity focuses on their preferred role-content and perception of the professional self.1,2 Professional identity is conceptualised as being directly connected with everyday radiographic practices and influenced by the radiographer’s educational background, place of work and, more specifically, the methods and language use of his or her working culture. Professional identity refers to the radiographer’s conception of what it means to be and act as a radiographer representing one’s philosophy of radiography. Professional identity also defines values and beliefs that guide the radiographer’s thinking, actions and interaction with the patient.1,2 The question of professional identity as a cultural phenomenon has been addressed in a number of nursing science studies.2e14 A central finding of the studies is that a strong professional identity helps nurses to develop their own mastery of the profession and assume the role of a professional in the field.14 There are, however, no previous studies on the professional identity of radiographers. ¨ hlen and Segesten14 suggest that a nurse’s professional O identity is a combination of the nurse’s personal qualities; communality of the nursing profession, and relationship with the working environment.11 The above-mentioned personal qualities include the nurse’s perceptions of the philosophy of work that are based on his or her personal views on identity, values and self-knowledge. The communality of the nursing profession has to do with shared values and principles, rules, codes and roles. The socialehistorical approach to the formation of professional identity takes notice of that the nursing profession is female-dominant and observes the development in the role of women in the society and the recognition of the nursing profession in the media.15 The socialehistorical context has paid special attention to the role of the organisation and its effects on the formation of professional identity.16,7,6 According to Halford and Leonard,7 also both the material (for example architecture, de ´cor, furniture and lighting) and symbolic spaces (for example the ways that material spaces are used and the meanings woven around hospital spaces: who has which space, how much space, who can go where and for how long) typical of an organisation affect the nurses’ conceptions of the profession, professional work and thus also professional identity. Radiographers are a small professional group of approximately 3.320 certified radiographers within the field of health care in Finland.17 Radiographers’ education has been available at polytechnic institutes. Polytechnic degrees are defined as tertiary (bachelor level) educational degrees. Polytechnic degrees have a more pronounced occupational base than academic degrees. The polytechnic system is governed by specific legislation. Students are accepted for the polytechnic curriculum after graduating from upper secondary school, and taken part in the matriculation exam (Finnish A levels). It is also possible that a person who has graduated from professional institutes can be accepted for the polytechnic curriculum. The polytechnic curriculum involves a total of 210 ETC credits and takes 3e4 years to complete. Minimum 30% from the studies are practical studies. Students train in different clinical placements in the field, including radiotherapy, diagnostic and nuclear medicine. After graduation radiographers work in diagnostic, radiotherapy, cardiological and nuclear medicine departments in the areas of primary health care and special health care.18
259 The purpose of the present study is to produce new information about the factors affecting the professional identity of radiographers. The research question is as follows: what are the meaning contents of radiographers’ professional identity? This investigation aims at studying the issue without attempting to immediately apply the findings into practice.19 Analyzing the professional identity of radiographic staff members helps to outline the present state of underlying values and knowledge in radiography. The findings of the study may be applied to analyze the values, actions and develop the knowledge and an exploratory approach to radiographers work.
The study Aim This study aims at producing new information about the factors affecting the professional identity of radiographers. The research question asks: ‘‘What are the meaning contents of radiographers’ professional identity?’’
Method The present study employs the method of discourse analysis to gain a profound understanding of the cultural meaning contents related to the formation of professional identity in radiographers.5 Discourse analysis is a qualitative method that is generally described as an interpretative process of research. Owing to the differing research practices and traditions of different fields of science, discourse analysis is as a method yet unestablished and the use of concepts is highly irregular.20 Furthermore, there are no detailed instructions as to how to carry out a research process.21 Discourse analysis has to some extent been applied to research in nursing science. The method provides an interesting approach to phenomena discussing nursing work.22 Previous studies on nursing science have applied discourse analysis to investigate professional identity in a psychiatric community3 and within basic health care7 and to study the formation of the public image of nurses in the media.23,24,5 The roots of discourse analysis go back to structural linguistics21 and the method may be divided into a Foucauldian25e27 and social-constructivist21,28,29 theoreticale methodological research design. The basis of discourse analysis as applied in the present study lies in the socialconstructivist tradition where discourse not only describes social reality, but also constructs identities for being and acting in it.30 Cultural meanings are developed in interaction: talk, discussion, writing and other symbolic actions. Research brings out the meanings with the help of discourse.31
Data collection Media is thought to be able to change people’s consciousness by affecting their opinions and, in this way, shaping the way they perceive reality.32 Hence, articles in professional journals may be considered to have a significant effect on the professional identity of a radiographer.32 Material for the study was gathered from articles published in
260 the professional journal ‘‘Radiografia’’ (Radiography as in English) published by the Society of Radiographers in Finland between the years 1987 and 2003. The journal is the only radiography journal in Finland and is meant for radiographers working in the wide field of radiography and also for the students. The journal contains topical articles that deal with various fields of radiography, radiotherapy, nuclear medicine and health care in general. Articles can be sent by radiographers, students, radiologists and other health care personnel. Although the journal is not scientific by nature all articles are reviewed by editor-in-chief and editorial board. The journal is published four times a year and reaches about 3000 radiographers, radiation therapists and other health care personnel.18 Qualitative research such as discourse analysis emphasises the depth and richness of data rather than the quantification of data. As is characteristic of studies employing the method of discourse analysis, the present investigation aims at finding ‘‘a lot in little’’. Thirty articles discussing, among other things, the work of a radiographer, radiation, education and trade union activities, were chosen from the total of 459 articles. The main criterion in selecting data was that the article described radiographers’ work and profession versatility. Articles by authors other than radiographers were not included in the data. The present study sets out as a central feature of the cultural context, when interpretations aim at observing and recognising generally distributed cultural presumptions, habits and social atmosphere that sculpt professional identity as displayed in the professional journal. The aim is to re-organize the meaning of the articles in the data, which will help us to gain a more profound understanding of the meaning contents of radiographers’ professional identity in related texts.
Data analysis: interpretation of meaning contents and search for discourses This study aims at bringing forth cultural meaning contents pertaining to the professional identity of radiographers. The meaning contents enable us on one hand to describe what is said about a certain, individual subject and, on the other hand, to form a full picture of the different cultural meanings of the subject.33 According to Redwood,34 there are no extensive, general rules for interpreting meaning contents within discourse analysis. The researcher’s subjectivity is clearly present when interpreting meaning contents.35 Interpretation involves seeing things differently and making reality understandable from one’s own cultural basis.36 A central issue in interpreting meaning contents is to find discourses that will correspond to the research question and are formed by searching for similarities and entities in the data.20,21 A model proposed by Parker35 presenting seven central phases in searching for discourses was applied in the study. The phases are as follows: (1) processing the data into text, (2) finding subjects, (3) finding objects, (4) finding discourses in the text, (5) recognising interplay between the discourses, (6) making a general description of the nature of the text and (7) understanding the social and historical contexts. The data for the present study were already in a text format, and thus there was no need to type it out (Phase 1). The radiographers
A. Niemi, L. Paasivaara who had contributed to the professional journal were named as subjects for the discourse (Phase 2). The articles in the radiography professional journal that gave a certain picture of professional identity were named as objects for the discourse. In the present study professional identity consisted of the radiographer’s work philosophy, relationship with the patient, other persons involved and the working environment (Phase 3).11,30 The next step was to construct systems of meaning in the text by forming three interrelated and significant types of discourse: technical discourse, safety discourse and professional discourse (Phase 4). After that, interaction and interrelations between the different types of discourse were recognised by applying the categorisation of radiogra¨ hlen and Segesten (Phase phers’ professional identities by O 14 5). Discourses were first read in their respective contexts of use, and the next step was to make conclusions on the ways of creating meaning in professional identity within the professional culture of radiographers.36 The study made use of the above-mentioned discourse types in describing the texts in general (Phase 6). The texts were described as analytical in nature, since professional identity was approached in the data as a developing phenomenon. The descriptions that assist in forming an understanding of the tasks, position, ideology, etc. of a radiographer are products of the sociale historical actions between radiographers (Phase 7). In order to better understand the social and historical contexts, the present study made use of previous investigations on the professional identity of nursing staff (Table 1).
Findings The data enabled us to distinguish the following three different types of discourse describing radiographers’ professional identity: technical discourse, safety discourse and professional discourse. Technical discourse Technical discourse developed as the first meaning content describing the formation of professional identity. Seen from a socialehistorical point of view, technical discourse emphasised the importance of responding to the changes in radiology in the 1990s. Technology was seen both as a great challenge and a possibility to expand the contents of a radiographer’s work. Developing the contents of work was related to the intensity of using computers and processing data in a digital format, which significantly changed the nature of the work. An increasingly large part of the work had to do with applying information technology to everyday tasks, such as the introduction of PACS (picture archiving and communication system). Also the replacement of the previously used film-screen combinations with imaging plate technique set new requirements for the mastery of technology. From the beginning of the 1990s, the articles in the magazines increasingly dealt with the possibility to apply certain imaging techniques into radiography work. The most central issues featured in the articles were the technical properties, mastery, and correct usage of computer tomography and MRI (magnetic resonance imaging). Discussion on the expansion of radiographers’ traditional fields of know-how also belongs to technical discourse. The intensity of the work, rapid
Meaning contents of radiographers’ professional identity Table 1
261
Discourses shaping a radiographer’s professional identity
Discourse of professional identity/central dimensions
Technical discourse
Safety discourse
Professional discourse
Socialehistorical context 1987e2003.
- rapid development of technology - changes in the content of work - widening of fields of know-how/requirement for expert knowledge - considering the patients’ status - patient as object
- professional use of radiation as a basis for work - question of radiation leave
- development of education and esteem of the profession - evidence-based work
Relationship with the patient/others involved/working environment
Radiographer’s philosophy of work Nature of text
- trade union activities
- radiographer as protector
- radiographer as expert
- mechanistic
- mechanistic/humane
- descriptive, instructive, guiding
- strongly normative, exhorting, directive
- relationship towards nursing work - role of radiographer within the health care system - multiprofessionalism - on the leading edge of technological development - humane/emancipatory - descriptive - promoting work, status and esteem
development of methods, and changes in work content all contributed to the shifting of tasks previously belonging to radiologists on to radiographers. Expansion is a challenge that requires the radiographers to master more and more specified tasks and have certain special expertise. The basis for a radiographer’s professional identity was the mastery of technology based on professional skills and expertise, which has a significant effect on patient care in the form of tests performed and care received. The texts provide a very mechanistic, natural-scientific picture of the work philosophy. Actions and technology were perceived not only as tools for performing tasks, but also as central factors of work. Technical discourse also discussed the patient’s position and the relationship between the patient, radiographers and the working environment. The use of technology was seen as part of a radiographer’s work, not for the sake of technology as such, but in order to help cure the patient. The main focus of technical discourse was to draw the radiographer’s attention to the technical equipment and their use. The patient was first and foremost the object of actions, examined with the help of technology. He or she was thus considered more from a biophysical rather than humanistic perspective. The nature of texts in the technical discourse was mostly manifested as descriptive, instructive information packets. The information packets were typically market oriented, as illustrated by the following example of a text attempting to affect the stock of equipment at the wards: ‘‘Multislice CT enables the taking of quick and precise pictures of the patient from head to toe.’’ (2000) ‘‘To get best result all digital imaging technique should be designed with caution.’’ (1990)
The texts also considered to some extent the costs of the new technical equipment. New technology was seen as initially expensive, but it was believed to pay back in the future with its efficiency and speed, enabling a constant stream of patients.
Safety discourse Safety discourse emerged as the second content of meaning describing the formation of professional identity. Professional use of radiation, considered mostly from the point of view of safety, was seen as the basis of a radiographer’s profession. The use of radiation was approached in the texts by describing the work of a radiographer in different radiological examinations and the radiographer’s means of affecting radiation doses. The texts paid attention to optimising the use of radiation in different radiological examinations. Special points of interest included considering radiation doses in different examinations and their optimisation, using radiation shields, selecting proper imaging technique and considering the radiographers’ own radiation safety. Radiographers were found to have the role of protectors in relation to patients, other radiographers and the working environment. The role of a protector is dual in nature: the basis for his or her work is to keep the exposure to radiation at a minimum for both the patients and staff. ‘‘Taking a new set of images because of the bad quality of previous ones increases the exposure to radiation for both the patient and staff and also causes extra costs.’’ (1993) Within safety discourse, the radiographers’ philosophy of work appeared at the same time both mechanistic and humane. Mechanistic work philosophy was displayed in the
262 texts as a scientific approach to the radiographers’ work, as evidenced by the following statement: ‘‘Give radiation shields a visual estimation and take images if necessary. There must be an adequate number of radiation shields for patients of all sizes.’’ (1987) Meanwhile, humane philosophy of work emphasises the importance of protecting the patients and staff members while using radiation: ‘‘Ensuring patient safety is the primary issue in magnetic examinations. Good patient safety is reached by constant vigilance.’’ (1999) Seen from the point of view of the socialehistorical context, the texts paid attention to administrative safety factors: radiation laws and regulations set the framework for appropriate operation. Changes in the radiation law and regulations in the 1990s have reverberated to radiographers’ work. Radiographers were entitled to get 2-week radiation leave according to Finnish radiation law and regulations. Radiation leave was meant to reduce radiographers’ radiation doses per year. A major issue shaking the sense of community and working conditions within the profession was the transformation of the previous fixed benefit of radiation leave into a system of differing practices. By the time of the new millennium, radiation leave was no longer a shared benefit meant for all radiographers, but something to be negotiated on separately within each hospital district and unit. Radiation leave as such either disappeared or was replaced with compensation in money. Radiographers reacted strongly to the discontinuation of an acquired right, i.e. radiation leave. Explanations for the discontinuation included, among other things, development in imaging techniques and results from follow-up studies in radiographers’ radiation exposure. The annual amount of radiation that radiographers are exposed to has diminished as a result of development, and there appeared to be no need for a special radiation leave. The trade union took special notice of the discontinuation of the radiation leave, as it was perceived as a threat against radiographers’ safety and an insult to the trade union. The texts indicate that the discontinuation of the radiation leave strengthened the sense of community and solidarity among radiographers. However, there was also dissatisfaction with the trade union regarding the matter, which was evidenced by protests, questions and discussion on whether the trade union had any actual significance. The nature of the text in safety discourse is strongly normative, exhorting and counselling. Texts were used as a means to emphasise the importance of safety in the work of a radiographer. Occupational safety was seen as a basis for professional skill. An interesting feature found in texts dealing with safety was that the focus was only on actions related to imaging, while other patient and staff safety factors, such as things related to the working environment and well-being, were hardly addressed at all. Professional discourse The third content of meaning in professional identity was professional discourse, a central aspect being to promote the esteem of one’s profession and emphasise professional
A. Niemi, L. Paasivaara identity. Professional discourse consisted of an attempt to support radiographers’ professional identity by taking up research results based on master’s theses, development projects, and research carried out by individual radiographers and units. Promoting actions based on presentation can thus be considered as a basis for the texts, even though the concept was not used as such in the texts. Supporting professionalism was considered a significant factor for professional identity. The texts were descriptive in nature and promoted the work, esteem and position of radiographers. The socialehistorical context became evident especially in articles related to the education and training of radiographers. It appears that radiographers’ professional identity has strengthened along with the changes in education organisation in the 1990s. Articles from the turn of the 1990s emphasised patient care and patient care methods. A factor that has significantly affected the professional identity of radiographers is the relationship to other nursing work. The work of a radiographer was, especially from the point of view of education, considered equal to nursing education in general. Recent changes in education were reflected in the texts in that the work was increasingly discussed from the point of view of radiographers themselves. A reform in the Finnish polytechnic school system and the commencement of university-level education in radiography at the end of the 1990s gave the articles a more scientific edge. In relation to the patient, other radiographers and the working environment, nursing was seen as a significant dimension in the work of a radiographer. However, radiographers’ role as professionals combining technical knowhow and nursing became increasingly emphasised by the end of the millennium. The philosophy of work manifested itself as humane actions promoting the patients’ wellbeing. In relation to other nursing work, the philosophy of work was mostly emancipatory: the profession and work of a radiographer was a field requiring special skills and thus not replaceable by other nursing staff. The radiologiste radiographer relationship was seen equal based on respectful collaboration. The studied texts emphasise radiographers’ professional skills and expert knowledge: ‘‘We can only earn the respect of other occupations by displaying our own professional skills and our willingness to develop as professionals in this field.’’ (2002) ‘‘Expertise obliges us as radiographers to continuous developing and maintaining of professional skills and knowledge.’’ (1993) Professional discourse was brought out first and foremost in editorials and articles dealing with trade union activities. This was partly due to the increased publication rate of the professional journal. From 1987 to 1996 the magazine was published annually, then biannually during the period 1997e1999, and quarterly from 2000 to 2003. A theme issue on the history of radiography up until the present day emphasised the strengthening quality of professional identity. The importance of professional identity was emphasised when the trade union attempted to affect radiographers’ working conditions through an article. The texts indicate a strengthening of the trade union through
Meaning contents of radiographers’ professional identity various comments on changes within health care (such as discontinuing the radiation leave).
Rigour and ethical considerations According to Juhila,37 the reliability of discourse analysis is described in terms of how convincing the interpretation is. To indicate the reliability of the interpretations, the data of the present study include factors that explain how, e.g. concepts describing radiographers’ profession can shape professional identity. It was possible to detect the effects of education (e.g. changes in secondary education, polytechnic reform, university-level education) and internationalisation (e.g. the application of the English concept of ‘radiography’) in articles concerning radiographers’ work. A very clear change in texts describing the work is, for instance, that the term ‘radiography’ replaced the previously used ‘radiological nursing’. Owing to the lack of clear rules within discourse analysis, defining the extent of the data was a challenge. However, data analysed with this method tend to be less extensive than with many other qualitative research methods.30 The phases of analysis are adaptable, while the essential points are the recognition and understanding of meaning contents, relations between different discourses, and social, historical and cultural contexts. The results are formed through a multi-phased process, which makes their presentation quite challenging. This article includes excerpts from the data that enable the readers to make their own interpretations.35 The present study includes data from only one subject group, although discourse analysis would also enable the making of comparisons between data from two subject groups.38,39 It is, however, more common to have one group rather than two. We did not opt for a comparative arrangement, as a comparison between two different groups, e.g. nurses and radiographers, would not have served the purposes of the present study. Admittedly, a comparative approach could bring some interesting tension to the study. Data used in this study consisted of articles on radiographers and their work in a Finnish professional journal, which necessarily affects and restricts the generalizability of the results. When carrying out a discourse analysis, the general guidelines for research and result interpretation must be considered also from an ethical point of view.40 The data of the present study does not allow for distinguishing individual radiographers and their opinions. The material was treated in an anonymous and confidential way. The results always reflect the researcher’s interpretations of reality, in which case the ethical issues are related to his or her participation in constructing the social reality. To allow for an optimally open-minded description of the social reality (professional identity) and to avoid prejudices or presuppositions, efforts were made to keep the researchers’ position in relation to the data as objective as possible.
Discussion The purpose of the present study was to describe and understand the meaning contents of the professional identity of radiographers. The present study does not give
263 grounds for considering the professional identity of a radiographer as being equal to the conventional image of the professional identity of a nurse.41,4,5 The results indicate that radiographers’ professional identity consists of three central types of discourse: technical discourse, safety discourse and professional discourse. The types of discourse thus formed were studied from the points of view of first, socialehistorical context, second, the radiographers’ relationship with patients, staff and the working environment and third, work philosophy.14 The role of a radiographer has changed over the past 20 years, as radiological examinations have gone through significant development; making new demands on radiographers’ professional skills.42 The professional identity of radiographers builds on their expert knowledge, which is clearly displayed in the articles.13 Interestingly, the results suggest that the professional identity of a radiographer is dual in nature.43,44 On one hand, the professional identity of a radiographer is based on solid command of scientificemechanic technology in a technical working environment; while on the other hand, it consists of mastering the humane, humanistic nursing work. This is well evidenced in the education of radiographers, where the basis has been on the values and premises of nursing: working for the patient’s best. In this respect the results ¨ hlen of this study are similar to those by Fagermoen2 and O and Segesten,14 whose studies emphasised human worth and altruism as starting points for nursing work. Further investigations could study the structure and formation of radiographers’ professional identity in the form of, e.g. interviews and questionnaires.45,46 Cross-cultural studies and a comparative research design studying the differences between, e.g. Finnish and British radiographers or between different occupational groups (radiographerse nurses) could provide new, varied information on the professional identities of health care workers and the similarities ¨ hlen and Segesten14 and Halford and differences within.14 O 7 and Leonard also take up the role of gender in defining professional identity. The present study did not study the differences between male and female radiographers. This approach could, however, offer a new, interesting point of view for studying professional identity. The application of discourse analysis provides radiography science with a new method for searching information on phenomena within the field of radiography. Discourse analysis can yield rich, diversified information on phenomena within radiographic work. Radiography science can profit from the method in the form of information necessary for developing radiographic work and research methodology.
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a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / r a d i
Meaning contents of radiographers’ professional identity as illustrated in a professional journal e A discourse analytical approach Antti Niemi*, Leena Paasivaara a University of Oulu, Department of Nursing Science and Health Administration, P.O. Box 5000, 90014 Oulu, Finland Received 28 November 2005; accepted 21 March 2006 Available online 15 May 2006
KEYWORDS Radiographer; Professional identity; Professional culture; Discourse analysis; Professional journal
Abstract Aim: The purpose of the present study is to describe and understand the meaning contents of radiographers’ professional identity. Background: The conceptualisation of professional identity in terms of radiographers’ perceptions of their role focuses on their preferred role-content and perception of the professional self. Professional identity defines values and beliefs that guide the radiographer’s thinking, actions and interaction. Method: The present study employs the method of discourse analysis to gain a profound understanding of the cultural meaning contents related to the formation of the professional identity of radiographers. Material for the study was gathered from articles published in the professional journal of the Society of Radiographers in Finland between the years 1987 and 2003. Findings: Technical discourse emphasised the importance of responding to the changes in radiology in the 1990s. Safety discourse emerged as the second content of meaning describing the formation of professional identity. The third content of meaning in professional identity was professional discourse, a central aspect being to promote the esteem of one’s profession and emphasise professional identity. Conclusions: The results suggest that the professional identity of a radiographer is dual in nature. On one hand, the professional identity of a radiographer is based on solid command of scientificemechanic technology in a technical working environment; while on the other hand, it consists of mastering the humane, humanistic nursing work. ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Introduction * Corresponding author. Tel.: C358 8 537 5609; fax: C358 8 537 5606. E-mail addresses: [email protected] (A. Niemi), leena. [email protected] (L. Paasivaara). a Tel.: C358 8 537 5603; fax: C358 8 537 5606.
The purpose of the present study is to describe and understand the meaning contents of radiographers’ professional identity. The meaning contents of professional identity in terms of radiographers’ perceptions of their role
1078-8174/$ - see front matter ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2006.03.009
Meaning contents of radiographers’ professional identity focuses on their preferred role-content and perception of the professional self.1,2 Professional identity is conceptualised as being directly connected with everyday radiographic practices and influenced by the radiographer’s educational background, place of work and, more specifically, the methods and language use of his or her working culture. Professional identity refers to the radiographer’s conception of what it means to be and act as a radiographer representing one’s philosophy of radiography. Professional identity also defines values and beliefs that guide the radiographer’s thinking, actions and interaction with the patient.1,2 The question of professional identity as a cultural phenomenon has been addressed in a number of nursing science studies.2e14 A central finding of the studies is that a strong professional identity helps nurses to develop their own mastery of the profession and assume the role of a professional in the field.14 There are, however, no previous studies on the professional identity of radiographers. ¨ hlen and Segesten14 suggest that a nurse’s professional O identity is a combination of the nurse’s personal qualities; communality of the nursing profession, and relationship with the working environment.11 The above-mentioned personal qualities include the nurse’s perceptions of the philosophy of work that are based on his or her personal views on identity, values and self-knowledge. The communality of the nursing profession has to do with shared values and principles, rules, codes and roles. The socialehistorical approach to the formation of professional identity takes notice of that the nursing profession is female-dominant and observes the development in the role of women in the society and the recognition of the nursing profession in the media.15 The socialehistorical context has paid special attention to the role of the organisation and its effects on the formation of professional identity.16,7,6 According to Halford and Leonard,7 also both the material (for example architecture, de ´cor, furniture and lighting) and symbolic spaces (for example the ways that material spaces are used and the meanings woven around hospital spaces: who has which space, how much space, who can go where and for how long) typical of an organisation affect the nurses’ conceptions of the profession, professional work and thus also professional identity. Radiographers are a small professional group of approximately 3.320 certified radiographers within the field of health care in Finland.17 Radiographers’ education has been available at polytechnic institutes. Polytechnic degrees are defined as tertiary (bachelor level) educational degrees. Polytechnic degrees have a more pronounced occupational base than academic degrees. The polytechnic system is governed by specific legislation. Students are accepted for the polytechnic curriculum after graduating from upper secondary school, and taken part in the matriculation exam (Finnish A levels). It is also possible that a person who has graduated from professional institutes can be accepted for the polytechnic curriculum. The polytechnic curriculum involves a total of 210 ETC credits and takes 3e4 years to complete. Minimum 30% from the studies are practical studies. Students train in different clinical placements in the field, including radiotherapy, diagnostic and nuclear medicine. After graduation radiographers work in diagnostic, radiotherapy, cardiological and nuclear medicine departments in the areas of primary health care and special health care.18
259 The purpose of the present study is to produce new information about the factors affecting the professional identity of radiographers. The research question is as follows: what are the meaning contents of radiographers’ professional identity? This investigation aims at studying the issue without attempting to immediately apply the findings into practice.19 Analyzing the professional identity of radiographic staff members helps to outline the present state of underlying values and knowledge in radiography. The findings of the study may be applied to analyze the values, actions and develop the knowledge and an exploratory approach to radiographers work.
The study Aim This study aims at producing new information about the factors affecting the professional identity of radiographers. The research question asks: ‘‘What are the meaning contents of radiographers’ professional identity?’’
Method The present study employs the method of discourse analysis to gain a profound understanding of the cultural meaning contents related to the formation of professional identity in radiographers.5 Discourse analysis is a qualitative method that is generally described as an interpretative process of research. Owing to the differing research practices and traditions of different fields of science, discourse analysis is as a method yet unestablished and the use of concepts is highly irregular.20 Furthermore, there are no detailed instructions as to how to carry out a research process.21 Discourse analysis has to some extent been applied to research in nursing science. The method provides an interesting approach to phenomena discussing nursing work.22 Previous studies on nursing science have applied discourse analysis to investigate professional identity in a psychiatric community3 and within basic health care7 and to study the formation of the public image of nurses in the media.23,24,5 The roots of discourse analysis go back to structural linguistics21 and the method may be divided into a Foucauldian25e27 and social-constructivist21,28,29 theoreticale methodological research design. The basis of discourse analysis as applied in the present study lies in the socialconstructivist tradition where discourse not only describes social reality, but also constructs identities for being and acting in it.30 Cultural meanings are developed in interaction: talk, discussion, writing and other symbolic actions. Research brings out the meanings with the help of discourse.31
Data collection Media is thought to be able to change people’s consciousness by affecting their opinions and, in this way, shaping the way they perceive reality.32 Hence, articles in professional journals may be considered to have a significant effect on the professional identity of a radiographer.32 Material for the study was gathered from articles published in
260 the professional journal ‘‘Radiografia’’ (Radiography as in English) published by the Society of Radiographers in Finland between the years 1987 and 2003. The journal is the only radiography journal in Finland and is meant for radiographers working in the wide field of radiography and also for the students. The journal contains topical articles that deal with various fields of radiography, radiotherapy, nuclear medicine and health care in general. Articles can be sent by radiographers, students, radiologists and other health care personnel. Although the journal is not scientific by nature all articles are reviewed by editor-in-chief and editorial board. The journal is published four times a year and reaches about 3000 radiographers, radiation therapists and other health care personnel.18 Qualitative research such as discourse analysis emphasises the depth and richness of data rather than the quantification of data. As is characteristic of studies employing the method of discourse analysis, the present investigation aims at finding ‘‘a lot in little’’. Thirty articles discussing, among other things, the work of a radiographer, radiation, education and trade union activities, were chosen from the total of 459 articles. The main criterion in selecting data was that the article described radiographers’ work and profession versatility. Articles by authors other than radiographers were not included in the data. The present study sets out as a central feature of the cultural context, when interpretations aim at observing and recognising generally distributed cultural presumptions, habits and social atmosphere that sculpt professional identity as displayed in the professional journal. The aim is to re-organize the meaning of the articles in the data, which will help us to gain a more profound understanding of the meaning contents of radiographers’ professional identity in related texts.
Data analysis: interpretation of meaning contents and search for discourses This study aims at bringing forth cultural meaning contents pertaining to the professional identity of radiographers. The meaning contents enable us on one hand to describe what is said about a certain, individual subject and, on the other hand, to form a full picture of the different cultural meanings of the subject.33 According to Redwood,34 there are no extensive, general rules for interpreting meaning contents within discourse analysis. The researcher’s subjectivity is clearly present when interpreting meaning contents.35 Interpretation involves seeing things differently and making reality understandable from one’s own cultural basis.36 A central issue in interpreting meaning contents is to find discourses that will correspond to the research question and are formed by searching for similarities and entities in the data.20,21 A model proposed by Parker35 presenting seven central phases in searching for discourses was applied in the study. The phases are as follows: (1) processing the data into text, (2) finding subjects, (3) finding objects, (4) finding discourses in the text, (5) recognising interplay between the discourses, (6) making a general description of the nature of the text and (7) understanding the social and historical contexts. The data for the present study were already in a text format, and thus there was no need to type it out (Phase 1). The radiographers
A. Niemi, L. Paasivaara who had contributed to the professional journal were named as subjects for the discourse (Phase 2). The articles in the radiography professional journal that gave a certain picture of professional identity were named as objects for the discourse. In the present study professional identity consisted of the radiographer’s work philosophy, relationship with the patient, other persons involved and the working environment (Phase 3).11,30 The next step was to construct systems of meaning in the text by forming three interrelated and significant types of discourse: technical discourse, safety discourse and professional discourse (Phase 4). After that, interaction and interrelations between the different types of discourse were recognised by applying the categorisation of radiogra¨ hlen and Segesten (Phase phers’ professional identities by O 14 5). Discourses were first read in their respective contexts of use, and the next step was to make conclusions on the ways of creating meaning in professional identity within the professional culture of radiographers.36 The study made use of the above-mentioned discourse types in describing the texts in general (Phase 6). The texts were described as analytical in nature, since professional identity was approached in the data as a developing phenomenon. The descriptions that assist in forming an understanding of the tasks, position, ideology, etc. of a radiographer are products of the sociale historical actions between radiographers (Phase 7). In order to better understand the social and historical contexts, the present study made use of previous investigations on the professional identity of nursing staff (Table 1).
Findings The data enabled us to distinguish the following three different types of discourse describing radiographers’ professional identity: technical discourse, safety discourse and professional discourse. Technical discourse Technical discourse developed as the first meaning content describing the formation of professional identity. Seen from a socialehistorical point of view, technical discourse emphasised the importance of responding to the changes in radiology in the 1990s. Technology was seen both as a great challenge and a possibility to expand the contents of a radiographer’s work. Developing the contents of work was related to the intensity of using computers and processing data in a digital format, which significantly changed the nature of the work. An increasingly large part of the work had to do with applying information technology to everyday tasks, such as the introduction of PACS (picture archiving and communication system). Also the replacement of the previously used film-screen combinations with imaging plate technique set new requirements for the mastery of technology. From the beginning of the 1990s, the articles in the magazines increasingly dealt with the possibility to apply certain imaging techniques into radiography work. The most central issues featured in the articles were the technical properties, mastery, and correct usage of computer tomography and MRI (magnetic resonance imaging). Discussion on the expansion of radiographers’ traditional fields of know-how also belongs to technical discourse. The intensity of the work, rapid
Meaning contents of radiographers’ professional identity Table 1
261
Discourses shaping a radiographer’s professional identity
Discourse of professional identity/central dimensions
Technical discourse
Safety discourse
Professional discourse
Socialehistorical context 1987e2003.
- rapid development of technology - changes in the content of work - widening of fields of know-how/requirement for expert knowledge - considering the patients’ status - patient as object
- professional use of radiation as a basis for work - question of radiation leave
- development of education and esteem of the profession - evidence-based work
Relationship with the patient/others involved/working environment
Radiographer’s philosophy of work Nature of text
- trade union activities
- radiographer as protector
- radiographer as expert
- mechanistic
- mechanistic/humane
- descriptive, instructive, guiding
- strongly normative, exhorting, directive
- relationship towards nursing work - role of radiographer within the health care system - multiprofessionalism - on the leading edge of technological development - humane/emancipatory - descriptive - promoting work, status and esteem
development of methods, and changes in work content all contributed to the shifting of tasks previously belonging to radiologists on to radiographers. Expansion is a challenge that requires the radiographers to master more and more specified tasks and have certain special expertise. The basis for a radiographer’s professional identity was the mastery of technology based on professional skills and expertise, which has a significant effect on patient care in the form of tests performed and care received. The texts provide a very mechanistic, natural-scientific picture of the work philosophy. Actions and technology were perceived not only as tools for performing tasks, but also as central factors of work. Technical discourse also discussed the patient’s position and the relationship between the patient, radiographers and the working environment. The use of technology was seen as part of a radiographer’s work, not for the sake of technology as such, but in order to help cure the patient. The main focus of technical discourse was to draw the radiographer’s attention to the technical equipment and their use. The patient was first and foremost the object of actions, examined with the help of technology. He or she was thus considered more from a biophysical rather than humanistic perspective. The nature of texts in the technical discourse was mostly manifested as descriptive, instructive information packets. The information packets were typically market oriented, as illustrated by the following example of a text attempting to affect the stock of equipment at the wards: ‘‘Multislice CT enables the taking of quick and precise pictures of the patient from head to toe.’’ (2000) ‘‘To get best result all digital imaging technique should be designed with caution.’’ (1990)
The texts also considered to some extent the costs of the new technical equipment. New technology was seen as initially expensive, but it was believed to pay back in the future with its efficiency and speed, enabling a constant stream of patients.
Safety discourse Safety discourse emerged as the second content of meaning describing the formation of professional identity. Professional use of radiation, considered mostly from the point of view of safety, was seen as the basis of a radiographer’s profession. The use of radiation was approached in the texts by describing the work of a radiographer in different radiological examinations and the radiographer’s means of affecting radiation doses. The texts paid attention to optimising the use of radiation in different radiological examinations. Special points of interest included considering radiation doses in different examinations and their optimisation, using radiation shields, selecting proper imaging technique and considering the radiographers’ own radiation safety. Radiographers were found to have the role of protectors in relation to patients, other radiographers and the working environment. The role of a protector is dual in nature: the basis for his or her work is to keep the exposure to radiation at a minimum for both the patients and staff. ‘‘Taking a new set of images because of the bad quality of previous ones increases the exposure to radiation for both the patient and staff and also causes extra costs.’’ (1993) Within safety discourse, the radiographers’ philosophy of work appeared at the same time both mechanistic and humane. Mechanistic work philosophy was displayed in the
262 texts as a scientific approach to the radiographers’ work, as evidenced by the following statement: ‘‘Give radiation shields a visual estimation and take images if necessary. There must be an adequate number of radiation shields for patients of all sizes.’’ (1987) Meanwhile, humane philosophy of work emphasises the importance of protecting the patients and staff members while using radiation: ‘‘Ensuring patient safety is the primary issue in magnetic examinations. Good patient safety is reached by constant vigilance.’’ (1999) Seen from the point of view of the socialehistorical context, the texts paid attention to administrative safety factors: radiation laws and regulations set the framework for appropriate operation. Changes in the radiation law and regulations in the 1990s have reverberated to radiographers’ work. Radiographers were entitled to get 2-week radiation leave according to Finnish radiation law and regulations. Radiation leave was meant to reduce radiographers’ radiation doses per year. A major issue shaking the sense of community and working conditions within the profession was the transformation of the previous fixed benefit of radiation leave into a system of differing practices. By the time of the new millennium, radiation leave was no longer a shared benefit meant for all radiographers, but something to be negotiated on separately within each hospital district and unit. Radiation leave as such either disappeared or was replaced with compensation in money. Radiographers reacted strongly to the discontinuation of an acquired right, i.e. radiation leave. Explanations for the discontinuation included, among other things, development in imaging techniques and results from follow-up studies in radiographers’ radiation exposure. The annual amount of radiation that radiographers are exposed to has diminished as a result of development, and there appeared to be no need for a special radiation leave. The trade union took special notice of the discontinuation of the radiation leave, as it was perceived as a threat against radiographers’ safety and an insult to the trade union. The texts indicate that the discontinuation of the radiation leave strengthened the sense of community and solidarity among radiographers. However, there was also dissatisfaction with the trade union regarding the matter, which was evidenced by protests, questions and discussion on whether the trade union had any actual significance. The nature of the text in safety discourse is strongly normative, exhorting and counselling. Texts were used as a means to emphasise the importance of safety in the work of a radiographer. Occupational safety was seen as a basis for professional skill. An interesting feature found in texts dealing with safety was that the focus was only on actions related to imaging, while other patient and staff safety factors, such as things related to the working environment and well-being, were hardly addressed at all. Professional discourse The third content of meaning in professional identity was professional discourse, a central aspect being to promote the esteem of one’s profession and emphasise professional
A. Niemi, L. Paasivaara identity. Professional discourse consisted of an attempt to support radiographers’ professional identity by taking up research results based on master’s theses, development projects, and research carried out by individual radiographers and units. Promoting actions based on presentation can thus be considered as a basis for the texts, even though the concept was not used as such in the texts. Supporting professionalism was considered a significant factor for professional identity. The texts were descriptive in nature and promoted the work, esteem and position of radiographers. The socialehistorical context became evident especially in articles related to the education and training of radiographers. It appears that radiographers’ professional identity has strengthened along with the changes in education organisation in the 1990s. Articles from the turn of the 1990s emphasised patient care and patient care methods. A factor that has significantly affected the professional identity of radiographers is the relationship to other nursing work. The work of a radiographer was, especially from the point of view of education, considered equal to nursing education in general. Recent changes in education were reflected in the texts in that the work was increasingly discussed from the point of view of radiographers themselves. A reform in the Finnish polytechnic school system and the commencement of university-level education in radiography at the end of the 1990s gave the articles a more scientific edge. In relation to the patient, other radiographers and the working environment, nursing was seen as a significant dimension in the work of a radiographer. However, radiographers’ role as professionals combining technical knowhow and nursing became increasingly emphasised by the end of the millennium. The philosophy of work manifested itself as humane actions promoting the patients’ wellbeing. In relation to other nursing work, the philosophy of work was mostly emancipatory: the profession and work of a radiographer was a field requiring special skills and thus not replaceable by other nursing staff. The radiologiste radiographer relationship was seen equal based on respectful collaboration. The studied texts emphasise radiographers’ professional skills and expert knowledge: ‘‘We can only earn the respect of other occupations by displaying our own professional skills and our willingness to develop as professionals in this field.’’ (2002) ‘‘Expertise obliges us as radiographers to continuous developing and maintaining of professional skills and knowledge.’’ (1993) Professional discourse was brought out first and foremost in editorials and articles dealing with trade union activities. This was partly due to the increased publication rate of the professional journal. From 1987 to 1996 the magazine was published annually, then biannually during the period 1997e1999, and quarterly from 2000 to 2003. A theme issue on the history of radiography up until the present day emphasised the strengthening quality of professional identity. The importance of professional identity was emphasised when the trade union attempted to affect radiographers’ working conditions through an article. The texts indicate a strengthening of the trade union through
Meaning contents of radiographers’ professional identity various comments on changes within health care (such as discontinuing the radiation leave).
Rigour and ethical considerations According to Juhila,37 the reliability of discourse analysis is described in terms of how convincing the interpretation is. To indicate the reliability of the interpretations, the data of the present study include factors that explain how, e.g. concepts describing radiographers’ profession can shape professional identity. It was possible to detect the effects of education (e.g. changes in secondary education, polytechnic reform, university-level education) and internationalisation (e.g. the application of the English concept of ‘radiography’) in articles concerning radiographers’ work. A very clear change in texts describing the work is, for instance, that the term ‘radiography’ replaced the previously used ‘radiological nursing’. Owing to the lack of clear rules within discourse analysis, defining the extent of the data was a challenge. However, data analysed with this method tend to be less extensive than with many other qualitative research methods.30 The phases of analysis are adaptable, while the essential points are the recognition and understanding of meaning contents, relations between different discourses, and social, historical and cultural contexts. The results are formed through a multi-phased process, which makes their presentation quite challenging. This article includes excerpts from the data that enable the readers to make their own interpretations.35 The present study includes data from only one subject group, although discourse analysis would also enable the making of comparisons between data from two subject groups.38,39 It is, however, more common to have one group rather than two. We did not opt for a comparative arrangement, as a comparison between two different groups, e.g. nurses and radiographers, would not have served the purposes of the present study. Admittedly, a comparative approach could bring some interesting tension to the study. Data used in this study consisted of articles on radiographers and their work in a Finnish professional journal, which necessarily affects and restricts the generalizability of the results. When carrying out a discourse analysis, the general guidelines for research and result interpretation must be considered also from an ethical point of view.40 The data of the present study does not allow for distinguishing individual radiographers and their opinions. The material was treated in an anonymous and confidential way. The results always reflect the researcher’s interpretations of reality, in which case the ethical issues are related to his or her participation in constructing the social reality. To allow for an optimally open-minded description of the social reality (professional identity) and to avoid prejudices or presuppositions, efforts were made to keep the researchers’ position in relation to the data as objective as possible.
Discussion The purpose of the present study was to describe and understand the meaning contents of the professional identity of radiographers. The present study does not give
263 grounds for considering the professional identity of a radiographer as being equal to the conventional image of the professional identity of a nurse.41,4,5 The results indicate that radiographers’ professional identity consists of three central types of discourse: technical discourse, safety discourse and professional discourse. The types of discourse thus formed were studied from the points of view of first, socialehistorical context, second, the radiographers’ relationship with patients, staff and the working environment and third, work philosophy.14 The role of a radiographer has changed over the past 20 years, as radiological examinations have gone through significant development; making new demands on radiographers’ professional skills.42 The professional identity of radiographers builds on their expert knowledge, which is clearly displayed in the articles.13 Interestingly, the results suggest that the professional identity of a radiographer is dual in nature.43,44 On one hand, the professional identity of a radiographer is based on solid command of scientificemechanic technology in a technical working environment; while on the other hand, it consists of mastering the humane, humanistic nursing work. This is well evidenced in the education of radiographers, where the basis has been on the values and premises of nursing: working for the patient’s best. In this respect the results ¨ hlen of this study are similar to those by Fagermoen2 and O and Segesten,14 whose studies emphasised human worth and altruism as starting points for nursing work. Further investigations could study the structure and formation of radiographers’ professional identity in the form of, e.g. interviews and questionnaires.45,46 Cross-cultural studies and a comparative research design studying the differences between, e.g. Finnish and British radiographers or between different occupational groups (radiographerse nurses) could provide new, varied information on the professional identities of health care workers and the similarities ¨ hlen and Segesten14 and Halford and differences within.14 O 7 and Leonard also take up the role of gender in defining professional identity. The present study did not study the differences between male and female radiographers. This approach could, however, offer a new, interesting point of view for studying professional identity. The application of discourse analysis provides radiography science with a new method for searching information on phenomena within the field of radiography. Discourse analysis can yield rich, diversified information on phenomena within radiographic work. Radiography science can profit from the method in the form of information necessary for developing radiographic work and research methodology.
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