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Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press
Radiography xxx (2016) 1e6
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Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press R. Stalsberg*, E.R. Thingnes Department of Health Science, The Norwegian University of Science and Technology, Trondheim, Norway
a r t i c l e i n f o
a b s t r a c t
Article history: Received 31 May 2016 Received in revised form 19 July 2016 Accepted 21 July 2016 Available online xxx
Purpose: To explore how Norwegian radiographers are portrayed in written press. Method: Textual discourse analysis, following a multiple step strategy, combining both a quantitative and a qualitative approach. 189 newspaper articles were included. The articles were registered and subject fields were inductively categorized. Each subject field was analysed regarding the field's role as an agent of influence on public perception of radiographers. Results: On average, less than one article a year concerning radiography profession is published in Norwegian newspapers. A majority are published in newspapers with small circulation figures, often reporting on resources in the local health services where radiographers are involved. Mostly radiographers are placed in the articles' background playing supporting roles, frequently mentioned in the cutline as an operator of a new medical technology. There is a heavy emphasis on the technology, leaving the specialized expertise and radiography knowledge out. This focus persist in the instances where radiographers play a main role in the texts. When patient stories are told, positive value-laden words are used to describe the radiographer and both the technical and the patient-care aspects of being a radiographer are noticeable. Conclusion: Norwegian radiographers typically appear, in glimpses, as anonymous allied health technicians in local reports on new diagnostic equipment or resource utilization. The professional qualities and decisive skills required to handle sophisticated diagnostic equipment and continuity of patient care are underestimated. A more-nuanced media coverage might give radiographers a strengthened identity as important health-care service contributors. © 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Keywords: Occupational distinctiveness Discourse analysis Media Public dissemination
Introduction Traditionally, studies of health professions have been centred on medical doctors, nurses, and physical therapists. The extensive knowledge base developed within these professions has contributed to respect and confidence, and thus to support in professional conflicts of interest. In addition to efficient patient care, radiographers are responsible for handling expensive and complex diagnostic equipment and hold specialized knowledge that is unavailable to the general population. To benefit from the public's confidence and support for radiographers, it is important to legitimize this unbalanced relationship by systematically unveiling the radiographers' profession and identity.
* Corresponding author. E-mail addresses: [email protected] (R. Stalsberg), [email protected] (E.R. Thingnes).
Identity can be defined as “the sets of meanings people hold for themselves that define ‘what it means’ to be who they are as persons, as role occupants, and as group members.”1 The scientific knowledge base of radiographers exists between advanced imaging technology and patient care. Their professional identity is developed in between this duality,2 where conflicting epistemological disparities, after all, interact. The Norwegian Society of Radiographers politically emphasizes a strong professional identity among radiographers.3,4 In spite of this, only a few studies have aimed to describe aspects of identity formation in radiographers, and, possibly because of the aforementioned duality, previous findings are rather ambiguous. Radiographers are found to have an increased technical emphasis5,6 in addition to a safety and a professional discourse.2 There has been an evolving research identity among some radiographers,7,8 while perceived subordination has resulted in poor professional identity along with poor autonomy and a poor sense of responsibility in others.9 In regard to patient care, positive attitudes for interacting with elderly patients are
http://dx.doi.org/10.1016/j.radi.2016.07.003 1078-8174/© 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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R. Stalsberg, E.R. Thingnes / Radiography xxx (2016) 1e6
found,10 but radiographers also differ in their approach to taking the time to adequately inform patients.11 Besides the dispersed and limited number of studies, the picture of vocational identity has been drawn largely from radiographers' descriptions or observations in the diagnostic department. Identity can indeed be explored by studying the tangible and specific professional duties of radiographers, as well as their clothing and equipment. However, as identity is both relational and contextual, the construction of identity also takes place in the interaction with others, as pointed out also by Decker.6 Taking a constructivist perspective, the way radiography is construed by the population in general is highly significant in studying identity formation. Perceptions of a particular phenomenon are formed partially by the way the phenomenon is discussed by others, and one might assume that newspapers could provide proper presentations of whatever phenomenon is being discussed. According to critical discourse analysis12 and discourse psychology,13 however, language has the ability to preserve, strengthen, or weaken relations in terms of their power; thus, it is never neutral. Language users will always have particular interests or perspectives reflected in their choice of words and expressions. Consequently, newspapers' presentations of the radiography profession play an important part in people's ideas about radiographers. An increased awareness of the impact of various discourses on the development of their professional role, according to Boyes,14 could also be helpful in their continuing professional development (CPD). The idea is that discourse and identity are thus interrelated. Referring to the journal of the Norwegian Society of Radiographers (NRF),15 Norwegian radiographers are currently concerned with role extension, radiation protection, and working conditions in general. There are reasons to expect that other issues are prioritized in newspaper articles presented for the general public. Analyses of subject fields in newspapers may enable radiographers to more adequately identify mistaken presentations and discuss strategies to adjust the picture. The aim of this study is, therefore, to explore how Norwegian radiographers are portrayed in the printed press.
Based on analyses from a sample of 189 articles in 69 different Norwegian newspapers, a profile of the Norwegian radiographer's representation in the written media was drawn. The first section of results presents subject fields; the second deals with the qualitative aspects of appearance, providing examples from the analysed texts.
Method and materials
Subject fields
Computerized searches were conducted in the Retriever database (Atekst), which is Scandinavia's largest digital, high-quality news archive providing access to information not generally available on the Internet. Original articles from all of the major Norwegian printed newspapers and several union publications and magazines (not the journal of NRF) are retrievable.16 The aim was to identify all relevant articles published in Norway during the last five years. The only search term was the truncated term Radiographer*. There was no upper limit for any manageable number of identified documents before the documents could be reviewed, thus no further limitations were imposed on the search. As shown in Fig. 1, the search identified 369 documents, and after screening documents according to the inclusion and exclusion criteria, a sample of 189 articles remained for initial categorization.
The introductory coding procedure resulted in 19 different subject fields. The seven largest categories (>10 articles per subject field) are shown in Table 1. The “other” category, containing twelve small subject fields (<5 articles per field) included union work, history, Health Safety and Environment (HSE), working conditions, role development, training and education, overconsumption of diagnostic services, privacy, popular science, stories from radiographers outside Norway, and recruitment. Due to each field's small number of articles, these were not included in the further analyses. The total distribution of newspaper articles across subject fields was fairly even, although excluding the “other” category, there was a larger proportion of articles concerning issues on organization, capacity, waitlists and the like (Table 1, first column). The category of manpower: supply and demand had similar features; therefore, the two categories could be considered together (for a total number of 67 articles). Consequently, more than two-fifths of the newspaper articles written about radiographers in Norway during the chosen period reported on issues concerning challenges and difficulties due to resources in the health services domain in which radiographers are involved. Excluding the “other” category, the three smallest subject fields were patient stories, emergency preparedness, and mobile x-ray, with 15, 16, and 16 included articles, respectively. The remaining categories included either articles about mammography and/or breast cancer or new technology/equipment (24 articles each). Together, the
Data excerption and analysis All documents included were imported into Nvivo1117 to organize, analyse, and gain insight into the material. The analysis followed a multiple-step strategy, combining both a quantitative and a qualitative approach to what is referred to as document analysis18 or textual discourse analysis.19 Considering the documents as a container filled with content,20 the first step was to manually and inductively label each article
with keywords based on its main topic and thereafter categorize articles with similar topic. The frequency of each subject field indicated the extent of media coverage during the last five years. Thereafter, the sources (newspapers) were divided into four categories based on their average circulation figures. The coded articles were then counted by newspaper circulations to clarify any imbalance. A further analysis was aimed at how radiographers are portrayed in the media, thereby illuminating the articles' roles as active agents,20 simultaneously shifting towards the fields of critical discourse analysis.12 The initial step was to mark the text where the word radiographer occurred, and then to decide whether the radiographer's position was in the foreground, having a leading role, or in the background, relegated to a supporting role with less importance. Counting instances of both positions illustrated how radiographers were described by these terms within each category and said something about how the professional image of radiographers emerged to the reader through the Norwegian media. Eventually, the denomination of the words describing the radiographers in both the foreground and the background was thoroughly analysed. Positive or not-positive wordings and valueladen adjectives used in describing radiographers' work imply whether readers get a favourable or less-than-favourable impression of the profession and radiographers' professional knowledge. Both radiographers' positions and denominations were analysed by subject field to reveal accumulations in any category. The entire analysis process was completed jointly by two researchers to ensure consensus in coding the data, thereby increasing the study's validity. Results
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
R. Stalsberg, E.R. Thingnes / Radiography xxx (2016) 1e6
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Figure 1. Search strategy and selection process.
Table 1 Numbers of articles covering subject fields separated across newspapers' circulation figures. Subject field
Newspaper articles
4 Nation
6 local 30000e75000
19 local 10000e29999
40 local 1411e9999
Organization, capacity, waitlist, bottleneck Manpower: supply and demand New technology/equipment Mammography, breast cancer Mobile x-ray Emergency preparedness Patient stories Total number of articles analysed Other Articles included Newspaper articles per paper per 5 years
35 32 24 24 16 16 15 162 27a 189 2,7b
3 1 0 2 1 3 6 16 n.a. 16 4
2 2 4 1 5 5 2 21 n.a. 21 3,5
14 12 10 13 6 4 5 64 n.a. 64 3,4
16 17 10 8 4 4 2 61 n.a. 61 1,5
The total number of articles, both included and analysed, seen in bold. a Includes categories with a total of <5 articles. b 189 articles/69 newspapers.
last two subject fields represented nearly one-fourth of the articles in the present sample. Regarding the type of newspaper from which the articles were sampled, 146 of 162 articles were published in local newspapers with smaller circulation figures. During the five-year period, the national newspapers published 16 articles concerning radiographers. Nevertheless, the average number of articles per newspaper per period was fairly even regardless of type: 4, 3.5, 3.4 and 1.5, respectively. The subjects, however, varied depending on the type of newspaper. Mostly, patient stories were presented in the national papers, whereas issues on resources in general were noticeably present in local newspapers. Radiographers' appearances Radiographers themselves were at the centre of attention (“foreground”) in 29 of the 162 analysed texts. In the remaining four-fifths of the material, radiographers were placed in the background and relegated to a supporting, less-conspicuous role. The positioning seemed to be related to the subject field, except when manpower: supply and demand, mammography/breast cancer, or mobile x-ray were discussed. These issues seem to have paved the
way for discussing the radiography profession, as some of these articles clearly put radiographers in the foreground. The radiographers' position and denomination in the text across subject fields are shown in Table 2.
Radiographers in supporting roles In general, the articles in which radiographers were barely mentioned often involved new equipment, medical technology such as mobile radiography, or services such as new medical district centres. Radiographers were most frequently mentioned in the cutline, often depicted next to a brand new MRI or CT machine. The medical equipment mostly filled the images, and the radiographer was often standing aside as the operator, with virtually no significance in regard to diagnostic acumen: Radiographer NN prepares a patient for examination in a CT scanner at NN hospital. Such computer tomography, which takes numerous thin-section images of the body, has been shown to detect cancer early. Radiographer NN next to a new MRI-machine.
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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Table 2 Number of articles concerning radiographers' position and instances of denomination in the texts. Subject field
Organization, capacity, waitlist, bottleneck Manpower: supply and demand New technology/equipment Mammography, breast cancer Mobile x-ray Emergency preparedness Patient stories Total
Number of articles
35 32 24 24 16 16 15 162
Clearly, both the cutline texts above and the image accentuated what the technical equipment is able to accomplish. In other texts where radiographers were relegated to a minor role, they were mentioned in a long litany of medical personnel required for specific situations, such as the trauma team: Stroke team: From left: NN. Nurse (…), NN, nurse (…), NN project manager (…) and NN, radiographer. In such a listing of professionals, no disclosure of expertise and knowledge was provided. Common to the articles in which radiographers played supporting roles was the omission of the radiographer's perspective. When, for example, articles were dealing with capacity shortages and waitlists or bottlenecks, the emphasis was placed on the high demand for X-ray services or violations of the waitlist warranty, without considering the aspect of the need for additional radiographers. We are working on different solutions, both in terms of outsourcing services and purchasing capacity where necessary, in order to exploit our machines as much as possible. The same was also true when a lack of medical equipment or a radiologist shortage was discussed. The radiographers might be mentioned but not as a profession that could make any decisive impact on the problem. Radiographers in main roles Regarding the 29 articles that placed radiographers at the centre of attention, the emphasis on technical equipment persisted. Obviously, a larger body of text was devoted to radiographers in these articles, and the radiographer's work was brought to the surface. Nevertheless, although the profession was the object of discussion in these texts, the radiographers referred to tended to focus on the importance of the equipment in their occupational practice. In addition, when they spoke about the profession as such, the emphasis was placed on the equipment's advantages and its peculiarities: It is fun and exciting, although it still will take some time before we have learned all new (…). New machines are better for the patient (…). Now I get razor-sharp X-ray images at the screen after just ten to fifteen seconds …. made digitally, this will make the job much easier, making the diagnostics better. In both examples, the new machinery was described as being better for patients, while radiographers' communications with
Radiographers' position in text
Denomination of radiographers in text
Background
Foreground
Positive
Not positive
34 21 23 19 10 14 12 133
1 11 1 5 6 2 3 29
0 12 1 7 7 4 2 33
0 1 0 0 0 0 2 3
patients, their understanding of people and patient care, in addition to their competence in handling the diagnostic equipment, were considered secondary to technology. Articles that placed the radiographer in the foreground were mainly concerning manpower, mobile x-ray, and mammography or breast cancer. As shown next, these subject fields also tended to present radiographers in a positive manner. Value-laden descriptions of the profession In total, only three instances presented text formulations that were unfavourable toward the radiography profession, all with the radiographer in the background and focussing on other themes. By comparison, the work of radiographers was described positively in 33 instances. All the positive denominations were found in articles where radiographers were in the foreground, and primarily in articles that were dealing with manpower, mobile x-ray, or mammography/breast cancer issues. When radiographers were valued, the journalist described the radiography work with phrases such as the following:
… she handles the equipment (…) with well-trained hands or … a radiographer is literally just a click away, supplemented with spared from the strain and resource saving The positive wording was used to describe the radiographer's handicraft, the patients' advantages, or the economic benefits. In articles where the journalists presented patient stories, the praise offered the radiographer was made evident by using positively charged adjectives:
… with a warm smile and a couple of kind words, the radiographer enters the room … No subject areas except patient stories seemed to present both the technical and the patient-care aspects of being a radiographer. When doing so, the profession was described with positive valueladen words. Discussion The aim of the present study was to explore how Norwegian radiographers are portrayed in Norwegian print press by means of textual discourse analysis. A review of 189 articles from 69 different-sized newspapers painted a somewhat vague picture of a profession that, seemingly, above all, operates expensive medical equipment to support other professions in their diagnostic work. Although the emphasis on technology supports the previous findings,5,6 considering the scientific base of radiography as well as the
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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general knowledge of radiography work, the newspapers seem to be providing a partial truth. First, it is appropriate to comment on the material on which the results are based. The sample size indicates that, on average, the 42 percent of Norwegians who read newspapers21 have the opportunity to read a newspaper article that touches upon the radiography profession less than once a year. Without comparable figures, there are reasons to assume that this represents significantly lower exposure than that given to other health professions. Moreover, many of the newspapers have small circulation figures and thus are read by only a small part of the population. It can be argued that the low number of articles represents an insufficient basis on which to build any knowledge. On the other hand, weak public exposure is an expression of something significant in itself. Whether it is a result of deliberate choices or not, the omission of certain matters in media reduces the readers' experiences of the subject area's significance to their lives. Thus, few stories of radiographers in the newspapers may reflect unimportance. In general, radiographers also meet their clients in few settings and for a short time. Broader media coverage within current subject areas could have compensated for the limited opportunity to directly acquire adequate knowledge about the profession and thus enable a more in-depth understanding of the radiographer's contribution to health care. Furthermore, the subject areas receiving priority in the media do not necessarily reflect what the profession involved considers most important. Although reports on local resource issues should not be ignored, as they are important both politically and professionally in local communities, a tighter correspondence of subject fields in focus would increase a shared understanding of common interests. A considerable number of the newspaper articles concerning Norwegian radiographers during the current period reported on resource issues. Although many radiographers feel the pressure of long waitlists, for example, the perspectives in the articles were most often from the angle of patients and not radiographers. Role development and skill mix, as frequently discussed in union magazines,22e24 represent a radiographer perspective clearly relevant to these discussions, although barely dealt with in newspaper articles. Regardless of the profession's controversies and the discourse it represents, (potential) patients would profit from any cleared bottlenecks a task shift could cause. Patients would gain more knowledge about what causes bottlenecks and how the various aspects of role development and skill mix between different health-care personnel, such as radiographers, could affect them. A one-sided focus, leaving relevant perspectives aside, prevents the audience from joining radiographers' work intentionally and consequently ignores the importance of radiographers' work in cases where they themselves come to be in need of diagnostic examination. The characteristic feature of discourses is their ability to let something be true by the way the phenomena are discussed. As Prior20 put it, newspaper articles are capable of doing things as well as saying things. By continuously placing radiographers in the background when reporting on important and newly acquired diagnostic devices, the social position of radiographers persists in being overshadowed. When newspapers repeatedly emphasize the importance of diagnostic equipment and ignore the radiographers who are handling it, radiographers are reduced to exclusively having the very easy work of pushing buttons. The art of handling complex diagnostic equipment and providing appropriate patient care, whether in critical emergency situations or working with alienated or anxious patients, or frightened children or non-native speakers, is overlooked. The diagnostic significance of producing high-quality medical images as a member of a fast-paced, complex health-care team while, at the same time, treating patients with compassion is highly ignored, yet crucial.11 By describing
5
radiographers without discussing these qualities, their withdrawn and secluded role has a risk of being the fortified truth for people who do not have knowledge about the profession beyond what they get from their newspapers. Consequently, the power relations and perceived subordination in the diagnostic health services, as indicated by Lewis et al.7 seem unwavering. Nevertheless, the fact that the positive denominations in the descriptions found in our material are mostly related to the underexposed part of the radiographer's work is interesting. Again, the radiography profession might benefit from broader and more-nuanced media coverage. According to Fairclough,12 discourses contribute to the creation of social identities; thus, newspaper presentations concerning the radiography profession are involved in radiographers' comprehension of what it means to be a radiographer. Claiming then, on the basis of our findings, that the identity of radiographers is solely to have a secluded support function would probably be to jump to conclusions. It is reasonable to assume that the greater part of the professional identity of radiographers is created in the diagnostic department, where they interact with patients and other healthcare professionals, rather than through discourses taking place in union magazines. Nevertheless, an important marker of professional identity is the impact the profession has on society. A general perception of radiographers as less important, as reflected by limited media attention shown in the present study, would therefore still be of great importance to the identity of the radiography profession. At any rate, the processual aspect of identification and the continuous negotiation with society regarding identity imply that identity is changeable,1 thus allowing radiographers to become more visible in the future. The present study refers to newspaper discourses affecting radiographers in Norway. Partly because they have fewer opportunities for promotion than enabled by, for example, the British four-tier model,25 it could be argued that Norwegian radiographers differ too much for comparison. Nevertheless, it is likely that the described conditions are valid at least in other Nordic countries. Moreover, the phenomenon of subservience and invisibility demonstrated is also previously described in international literature on radiographers,26; therefore, it seems to be a general concern of the entire radiography profession. Although different framework conditions are involved, the discourse analytic approach in the present study might also launch an awareness of the publicminded discourse about radiographers in other countries and thereby contribute to their desired continuous professional development (CPD). Perspectives The political influence of public discourse is evident. The medical arguments for state-of-the-art diagnostic equipment are clearly important for state grants. The desired diagnostic possibilities of excellent equipment, however, are still dependent on the radiographer's skills and expertise. The demand for advanced imaging equipment in diagnostics is therefore indubitably related to the need for skilled radiographers. The more aware the population becomes of this interdependence, the more confidence and support there will be in political controversies where radiographers are involved. How to highlight the radiographer's real work to the public is, therefore, an important question. One way could be to take advantage of the benefits to be gained from extensive use of social media.27 Conclusion The radiography profession is not a prioritized subject field in Norwegian newspapers. They typically appear, in glimpses, as
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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anonymous allied health technicians in local reports on new diagnostic equipment or resource utilization. The professional qualities and decisive skills required to handle sophisticated diagnostic equipment and continuity of patient care are underestimated. A more-accurate picture might enable an understanding of the common interests of radiographers and the general population and thereby adjust the power relations in the diagnostic department, thus giving radiography professionals a strengthened identity as important health-care service contributors. Further studies on radiographers' identity would benefit from including ongoing discourses in union journals and public correspondence. Conflicts of interest None. Acknowledgements We are most thankful to the Norwegian Society of Radiographers for their financial contribution. References 1. Burke PJ. Identities and social structure: the 2003 Cooley-Mead award address. Soc Psychol Quart 2004;67(1):5e15. 2. Niemi A, Paasivaara L. Meaning contents of radiographers' professional identity as illustrated in a professional journal e a discourse analytical approach. Radiography 2007;13:258e64. 3. Politisk plattform 2013 e 2015 [Internet] Oslo, Norway. Norsk Radiografforbund [cited 21.04.2016] Available from: http://spotidoc.com/download/ 2810936. 4. NRFs Politiske plattform 2016 e 2018 [Internet] Oslo, Norway. Norsk Radiografforbund [cited 21.04.2016] Available from: http://www.radiograf.no/ meningerogpolitikk/Documents/politisk%20plattform%202016-18.pdf. 5. Decker S, Iphofen R. Developing the profession of radiography: making use of oral history. Radiography 2005;11:262e71. 6. Decker S. On being a radiographer: identity construction and the radiographer. In: Narrative, memory & knowledge: representations, aesthetics, contexts. University of Huddersfield, Huddersfield; 2006. p. 159e64. 7. Lewis S, Heard R, Robinson J, White K, Poulos A. The ethical commitment of Australian radiographers: does medical dominance create an influence? Radiography 2008;14:90e7.
8. Snaith B, Harris MA, Harris R. Radiographers as doctors: a profile of UK doctoral achievement. Radiography 2016. http://dx.doi.org/10.1016/j.radi.2016.04.006. 9. Vikestad KG, Hafskjold L, Kjelle E, Sebuodegaard S, Hofvind S. A national survey on radiographers and research: roles and attitudes. ECR; 2016 [Oral presentation]. 10. Kada S. Radiographers' attitudes towards persons with dementia. Eur J Radiogr 2009;1(4):163e8. 11. Egestad H. Radiografens kommunikasjon med pasienter som gjennomgår en CT-undersøkelse. Hold Pusten 2011;5:21e7. 12. Fairclough N. Discourse and social change. Cambridge: Polity Press,; 1992. 13. Potter J, Wetherell M. Discourse and social psychology: beyond attitudes and behavior. London: Sage Publications; 2010. 14. Boyes C. Discourse analysis and personal/professional development. Radiography 2004;10:109e17. 15. Hold Pusten [internet]. Oslo, Norway. The Norwegian Society of Radiographers [23.05.2011, cited 21.04.2016]. Available from: http://www.holdpusten.no/ extra/snarveier/hold-pustene-the-scientific-journal-of-the-norwegiansociety-of-radiographers-. 16. ATEKST [internet]. Oslo, Norway: Retriever AS 21.04.2016 [updated 21.04.2016; cited 21.04.2016] Available from: https://web.retriever-info.com/ services/archive.html and http://www.retriever-info.com/no/category/newsarchive/. 17. NVivo (version 11) [computer program]. Available from: http://www. qsrinternational.com/what-is-nvivo. 18. Rapley T. Doing conversation, discourse and document analysis. London: SAGE Publications Ltd; 2007. 19. Sherzer JA. Discourse-centered approach to language and culture. Am Antropol 1987;89:295e309. 20. Prior L. Documents in health research. In: Bourgeault I, Dingwall R, de Vries R, editors. The sage handbook of qualitative methods in health research. London: SAGE; 2010. p. 417e32. 21. SSB. Statistics Norway [Internet] Oslo. Norsk mediebarometer. 2015 [14.04.2016, cited 21.04.2016]. Available from:, https://www.ssb.no/kultur-ogfritid/statistikker/medie/aar/2016-04-14. 22. Støre JG. [internet] Oslo, Norway. På glid med jobbglidning. [30.01.2013, cited 21.04.2016]. Available from: http://www.holdpusten.no/nyheter/pa-glid-omjobbglidning/87d90480-f0ac-4142-91d5-d79d815dd75a. 23. Aasen SN, Gjerberg LA. Ad meliora e mot noe bedre? Hold Pusten 2011;8: 26e32. 24. Stranden E, Rotstigen E, Norum IA, Thevatas U. Quo Vadis, radiograf? Hold Pusten 2009;8:8e13. 25. DH, Learning and Personal Development Division. [Internet]. Radiography Skills Mix: A report on the four-tier service delivery model. [03.06.2003, cited 21.04.2016]. Available from: http://webarchive.nationalarchives.gov.uk/ 20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_ digitalassets/@dh/@en/documents/digitalasset/dh_4061260.pdf. 26. Yielder J. Creating our future: conformity or change? J Med Rad Sci 2014;61: 63e5. 27. Lawson C, Cowling C. Social media: the next frontier for professional development in radiography. Radiography 2015;21:e74e80.
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
Contents lists available at ScienceDirect
Radiography journal homepage: www.elsevier.com/locate/radi
Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press R. Stalsberg*, E.R. Thingnes Department of Health Science, The Norwegian University of Science and Technology, Trondheim, Norway
a r t i c l e i n f o
a b s t r a c t
Article history: Received 31 May 2016 Received in revised form 19 July 2016 Accepted 21 July 2016 Available online xxx
Purpose: To explore how Norwegian radiographers are portrayed in written press. Method: Textual discourse analysis, following a multiple step strategy, combining both a quantitative and a qualitative approach. 189 newspaper articles were included. The articles were registered and subject fields were inductively categorized. Each subject field was analysed regarding the field's role as an agent of influence on public perception of radiographers. Results: On average, less than one article a year concerning radiography profession is published in Norwegian newspapers. A majority are published in newspapers with small circulation figures, often reporting on resources in the local health services where radiographers are involved. Mostly radiographers are placed in the articles' background playing supporting roles, frequently mentioned in the cutline as an operator of a new medical technology. There is a heavy emphasis on the technology, leaving the specialized expertise and radiography knowledge out. This focus persist in the instances where radiographers play a main role in the texts. When patient stories are told, positive value-laden words are used to describe the radiographer and both the technical and the patient-care aspects of being a radiographer are noticeable. Conclusion: Norwegian radiographers typically appear, in glimpses, as anonymous allied health technicians in local reports on new diagnostic equipment or resource utilization. The professional qualities and decisive skills required to handle sophisticated diagnostic equipment and continuity of patient care are underestimated. A more-nuanced media coverage might give radiographers a strengthened identity as important health-care service contributors. © 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Keywords: Occupational distinctiveness Discourse analysis Media Public dissemination
Introduction Traditionally, studies of health professions have been centred on medical doctors, nurses, and physical therapists. The extensive knowledge base developed within these professions has contributed to respect and confidence, and thus to support in professional conflicts of interest. In addition to efficient patient care, radiographers are responsible for handling expensive and complex diagnostic equipment and hold specialized knowledge that is unavailable to the general population. To benefit from the public's confidence and support for radiographers, it is important to legitimize this unbalanced relationship by systematically unveiling the radiographers' profession and identity.
* Corresponding author. E-mail addresses: [email protected] (R. Stalsberg), [email protected] (E.R. Thingnes).
Identity can be defined as “the sets of meanings people hold for themselves that define ‘what it means’ to be who they are as persons, as role occupants, and as group members.”1 The scientific knowledge base of radiographers exists between advanced imaging technology and patient care. Their professional identity is developed in between this duality,2 where conflicting epistemological disparities, after all, interact. The Norwegian Society of Radiographers politically emphasizes a strong professional identity among radiographers.3,4 In spite of this, only a few studies have aimed to describe aspects of identity formation in radiographers, and, possibly because of the aforementioned duality, previous findings are rather ambiguous. Radiographers are found to have an increased technical emphasis5,6 in addition to a safety and a professional discourse.2 There has been an evolving research identity among some radiographers,7,8 while perceived subordination has resulted in poor professional identity along with poor autonomy and a poor sense of responsibility in others.9 In regard to patient care, positive attitudes for interacting with elderly patients are
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Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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found,10 but radiographers also differ in their approach to taking the time to adequately inform patients.11 Besides the dispersed and limited number of studies, the picture of vocational identity has been drawn largely from radiographers' descriptions or observations in the diagnostic department. Identity can indeed be explored by studying the tangible and specific professional duties of radiographers, as well as their clothing and equipment. However, as identity is both relational and contextual, the construction of identity also takes place in the interaction with others, as pointed out also by Decker.6 Taking a constructivist perspective, the way radiography is construed by the population in general is highly significant in studying identity formation. Perceptions of a particular phenomenon are formed partially by the way the phenomenon is discussed by others, and one might assume that newspapers could provide proper presentations of whatever phenomenon is being discussed. According to critical discourse analysis12 and discourse psychology,13 however, language has the ability to preserve, strengthen, or weaken relations in terms of their power; thus, it is never neutral. Language users will always have particular interests or perspectives reflected in their choice of words and expressions. Consequently, newspapers' presentations of the radiography profession play an important part in people's ideas about radiographers. An increased awareness of the impact of various discourses on the development of their professional role, according to Boyes,14 could also be helpful in their continuing professional development (CPD). The idea is that discourse and identity are thus interrelated. Referring to the journal of the Norwegian Society of Radiographers (NRF),15 Norwegian radiographers are currently concerned with role extension, radiation protection, and working conditions in general. There are reasons to expect that other issues are prioritized in newspaper articles presented for the general public. Analyses of subject fields in newspapers may enable radiographers to more adequately identify mistaken presentations and discuss strategies to adjust the picture. The aim of this study is, therefore, to explore how Norwegian radiographers are portrayed in the printed press.
Based on analyses from a sample of 189 articles in 69 different Norwegian newspapers, a profile of the Norwegian radiographer's representation in the written media was drawn. The first section of results presents subject fields; the second deals with the qualitative aspects of appearance, providing examples from the analysed texts.
Method and materials
Subject fields
Computerized searches were conducted in the Retriever database (Atekst), which is Scandinavia's largest digital, high-quality news archive providing access to information not generally available on the Internet. Original articles from all of the major Norwegian printed newspapers and several union publications and magazines (not the journal of NRF) are retrievable.16 The aim was to identify all relevant articles published in Norway during the last five years. The only search term was the truncated term Radiographer*. There was no upper limit for any manageable number of identified documents before the documents could be reviewed, thus no further limitations were imposed on the search. As shown in Fig. 1, the search identified 369 documents, and after screening documents according to the inclusion and exclusion criteria, a sample of 189 articles remained for initial categorization.
The introductory coding procedure resulted in 19 different subject fields. The seven largest categories (>10 articles per subject field) are shown in Table 1. The “other” category, containing twelve small subject fields (<5 articles per field) included union work, history, Health Safety and Environment (HSE), working conditions, role development, training and education, overconsumption of diagnostic services, privacy, popular science, stories from radiographers outside Norway, and recruitment. Due to each field's small number of articles, these were not included in the further analyses. The total distribution of newspaper articles across subject fields was fairly even, although excluding the “other” category, there was a larger proportion of articles concerning issues on organization, capacity, waitlists and the like (Table 1, first column). The category of manpower: supply and demand had similar features; therefore, the two categories could be considered together (for a total number of 67 articles). Consequently, more than two-fifths of the newspaper articles written about radiographers in Norway during the chosen period reported on issues concerning challenges and difficulties due to resources in the health services domain in which radiographers are involved. Excluding the “other” category, the three smallest subject fields were patient stories, emergency preparedness, and mobile x-ray, with 15, 16, and 16 included articles, respectively. The remaining categories included either articles about mammography and/or breast cancer or new technology/equipment (24 articles each). Together, the
Data excerption and analysis All documents included were imported into Nvivo1117 to organize, analyse, and gain insight into the material. The analysis followed a multiple-step strategy, combining both a quantitative and a qualitative approach to what is referred to as document analysis18 or textual discourse analysis.19 Considering the documents as a container filled with content,20 the first step was to manually and inductively label each article
with keywords based on its main topic and thereafter categorize articles with similar topic. The frequency of each subject field indicated the extent of media coverage during the last five years. Thereafter, the sources (newspapers) were divided into four categories based on their average circulation figures. The coded articles were then counted by newspaper circulations to clarify any imbalance. A further analysis was aimed at how radiographers are portrayed in the media, thereby illuminating the articles' roles as active agents,20 simultaneously shifting towards the fields of critical discourse analysis.12 The initial step was to mark the text where the word radiographer occurred, and then to decide whether the radiographer's position was in the foreground, having a leading role, or in the background, relegated to a supporting role with less importance. Counting instances of both positions illustrated how radiographers were described by these terms within each category and said something about how the professional image of radiographers emerged to the reader through the Norwegian media. Eventually, the denomination of the words describing the radiographers in both the foreground and the background was thoroughly analysed. Positive or not-positive wordings and valueladen adjectives used in describing radiographers' work imply whether readers get a favourable or less-than-favourable impression of the profession and radiographers' professional knowledge. Both radiographers' positions and denominations were analysed by subject field to reveal accumulations in any category. The entire analysis process was completed jointly by two researchers to ensure consensus in coding the data, thereby increasing the study's validity. Results
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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Figure 1. Search strategy and selection process.
Table 1 Numbers of articles covering subject fields separated across newspapers' circulation figures. Subject field
Newspaper articles
4 Nation
6 local 30000e75000
19 local 10000e29999
40 local 1411e9999
Organization, capacity, waitlist, bottleneck Manpower: supply and demand New technology/equipment Mammography, breast cancer Mobile x-ray Emergency preparedness Patient stories Total number of articles analysed Other Articles included Newspaper articles per paper per 5 years
35 32 24 24 16 16 15 162 27a 189 2,7b
3 1 0 2 1 3 6 16 n.a. 16 4
2 2 4 1 5 5 2 21 n.a. 21 3,5
14 12 10 13 6 4 5 64 n.a. 64 3,4
16 17 10 8 4 4 2 61 n.a. 61 1,5
The total number of articles, both included and analysed, seen in bold. a Includes categories with a total of <5 articles. b 189 articles/69 newspapers.
last two subject fields represented nearly one-fourth of the articles in the present sample. Regarding the type of newspaper from which the articles were sampled, 146 of 162 articles were published in local newspapers with smaller circulation figures. During the five-year period, the national newspapers published 16 articles concerning radiographers. Nevertheless, the average number of articles per newspaper per period was fairly even regardless of type: 4, 3.5, 3.4 and 1.5, respectively. The subjects, however, varied depending on the type of newspaper. Mostly, patient stories were presented in the national papers, whereas issues on resources in general were noticeably present in local newspapers. Radiographers' appearances Radiographers themselves were at the centre of attention (“foreground”) in 29 of the 162 analysed texts. In the remaining four-fifths of the material, radiographers were placed in the background and relegated to a supporting, less-conspicuous role. The positioning seemed to be related to the subject field, except when manpower: supply and demand, mammography/breast cancer, or mobile x-ray were discussed. These issues seem to have paved the
way for discussing the radiography profession, as some of these articles clearly put radiographers in the foreground. The radiographers' position and denomination in the text across subject fields are shown in Table 2.
Radiographers in supporting roles In general, the articles in which radiographers were barely mentioned often involved new equipment, medical technology such as mobile radiography, or services such as new medical district centres. Radiographers were most frequently mentioned in the cutline, often depicted next to a brand new MRI or CT machine. The medical equipment mostly filled the images, and the radiographer was often standing aside as the operator, with virtually no significance in regard to diagnostic acumen: Radiographer NN prepares a patient for examination in a CT scanner at NN hospital. Such computer tomography, which takes numerous thin-section images of the body, has been shown to detect cancer early. Radiographer NN next to a new MRI-machine.
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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Table 2 Number of articles concerning radiographers' position and instances of denomination in the texts. Subject field
Organization, capacity, waitlist, bottleneck Manpower: supply and demand New technology/equipment Mammography, breast cancer Mobile x-ray Emergency preparedness Patient stories Total
Number of articles
35 32 24 24 16 16 15 162
Clearly, both the cutline texts above and the image accentuated what the technical equipment is able to accomplish. In other texts where radiographers were relegated to a minor role, they were mentioned in a long litany of medical personnel required for specific situations, such as the trauma team: Stroke team: From left: NN. Nurse (…), NN, nurse (…), NN project manager (…) and NN, radiographer. In such a listing of professionals, no disclosure of expertise and knowledge was provided. Common to the articles in which radiographers played supporting roles was the omission of the radiographer's perspective. When, for example, articles were dealing with capacity shortages and waitlists or bottlenecks, the emphasis was placed on the high demand for X-ray services or violations of the waitlist warranty, without considering the aspect of the need for additional radiographers. We are working on different solutions, both in terms of outsourcing services and purchasing capacity where necessary, in order to exploit our machines as much as possible. The same was also true when a lack of medical equipment or a radiologist shortage was discussed. The radiographers might be mentioned but not as a profession that could make any decisive impact on the problem. Radiographers in main roles Regarding the 29 articles that placed radiographers at the centre of attention, the emphasis on technical equipment persisted. Obviously, a larger body of text was devoted to radiographers in these articles, and the radiographer's work was brought to the surface. Nevertheless, although the profession was the object of discussion in these texts, the radiographers referred to tended to focus on the importance of the equipment in their occupational practice. In addition, when they spoke about the profession as such, the emphasis was placed on the equipment's advantages and its peculiarities: It is fun and exciting, although it still will take some time before we have learned all new (…). New machines are better for the patient (…). Now I get razor-sharp X-ray images at the screen after just ten to fifteen seconds …. made digitally, this will make the job much easier, making the diagnostics better. In both examples, the new machinery was described as being better for patients, while radiographers' communications with
Radiographers' position in text
Denomination of radiographers in text
Background
Foreground
Positive
Not positive
34 21 23 19 10 14 12 133
1 11 1 5 6 2 3 29
0 12 1 7 7 4 2 33
0 1 0 0 0 0 2 3
patients, their understanding of people and patient care, in addition to their competence in handling the diagnostic equipment, were considered secondary to technology. Articles that placed the radiographer in the foreground were mainly concerning manpower, mobile x-ray, and mammography or breast cancer. As shown next, these subject fields also tended to present radiographers in a positive manner. Value-laden descriptions of the profession In total, only three instances presented text formulations that were unfavourable toward the radiography profession, all with the radiographer in the background and focussing on other themes. By comparison, the work of radiographers was described positively in 33 instances. All the positive denominations were found in articles where radiographers were in the foreground, and primarily in articles that were dealing with manpower, mobile x-ray, or mammography/breast cancer issues. When radiographers were valued, the journalist described the radiography work with phrases such as the following:
… she handles the equipment (…) with well-trained hands or … a radiographer is literally just a click away, supplemented with spared from the strain and resource saving The positive wording was used to describe the radiographer's handicraft, the patients' advantages, or the economic benefits. In articles where the journalists presented patient stories, the praise offered the radiographer was made evident by using positively charged adjectives:
… with a warm smile and a couple of kind words, the radiographer enters the room … No subject areas except patient stories seemed to present both the technical and the patient-care aspects of being a radiographer. When doing so, the profession was described with positive valueladen words. Discussion The aim of the present study was to explore how Norwegian radiographers are portrayed in Norwegian print press by means of textual discourse analysis. A review of 189 articles from 69 different-sized newspapers painted a somewhat vague picture of a profession that, seemingly, above all, operates expensive medical equipment to support other professions in their diagnostic work. Although the emphasis on technology supports the previous findings,5,6 considering the scientific base of radiography as well as the
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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general knowledge of radiography work, the newspapers seem to be providing a partial truth. First, it is appropriate to comment on the material on which the results are based. The sample size indicates that, on average, the 42 percent of Norwegians who read newspapers21 have the opportunity to read a newspaper article that touches upon the radiography profession less than once a year. Without comparable figures, there are reasons to assume that this represents significantly lower exposure than that given to other health professions. Moreover, many of the newspapers have small circulation figures and thus are read by only a small part of the population. It can be argued that the low number of articles represents an insufficient basis on which to build any knowledge. On the other hand, weak public exposure is an expression of something significant in itself. Whether it is a result of deliberate choices or not, the omission of certain matters in media reduces the readers' experiences of the subject area's significance to their lives. Thus, few stories of radiographers in the newspapers may reflect unimportance. In general, radiographers also meet their clients in few settings and for a short time. Broader media coverage within current subject areas could have compensated for the limited opportunity to directly acquire adequate knowledge about the profession and thus enable a more in-depth understanding of the radiographer's contribution to health care. Furthermore, the subject areas receiving priority in the media do not necessarily reflect what the profession involved considers most important. Although reports on local resource issues should not be ignored, as they are important both politically and professionally in local communities, a tighter correspondence of subject fields in focus would increase a shared understanding of common interests. A considerable number of the newspaper articles concerning Norwegian radiographers during the current period reported on resource issues. Although many radiographers feel the pressure of long waitlists, for example, the perspectives in the articles were most often from the angle of patients and not radiographers. Role development and skill mix, as frequently discussed in union magazines,22e24 represent a radiographer perspective clearly relevant to these discussions, although barely dealt with in newspaper articles. Regardless of the profession's controversies and the discourse it represents, (potential) patients would profit from any cleared bottlenecks a task shift could cause. Patients would gain more knowledge about what causes bottlenecks and how the various aspects of role development and skill mix between different health-care personnel, such as radiographers, could affect them. A one-sided focus, leaving relevant perspectives aside, prevents the audience from joining radiographers' work intentionally and consequently ignores the importance of radiographers' work in cases where they themselves come to be in need of diagnostic examination. The characteristic feature of discourses is their ability to let something be true by the way the phenomena are discussed. As Prior20 put it, newspaper articles are capable of doing things as well as saying things. By continuously placing radiographers in the background when reporting on important and newly acquired diagnostic devices, the social position of radiographers persists in being overshadowed. When newspapers repeatedly emphasize the importance of diagnostic equipment and ignore the radiographers who are handling it, radiographers are reduced to exclusively having the very easy work of pushing buttons. The art of handling complex diagnostic equipment and providing appropriate patient care, whether in critical emergency situations or working with alienated or anxious patients, or frightened children or non-native speakers, is overlooked. The diagnostic significance of producing high-quality medical images as a member of a fast-paced, complex health-care team while, at the same time, treating patients with compassion is highly ignored, yet crucial.11 By describing
5
radiographers without discussing these qualities, their withdrawn and secluded role has a risk of being the fortified truth for people who do not have knowledge about the profession beyond what they get from their newspapers. Consequently, the power relations and perceived subordination in the diagnostic health services, as indicated by Lewis et al.7 seem unwavering. Nevertheless, the fact that the positive denominations in the descriptions found in our material are mostly related to the underexposed part of the radiographer's work is interesting. Again, the radiography profession might benefit from broader and more-nuanced media coverage. According to Fairclough,12 discourses contribute to the creation of social identities; thus, newspaper presentations concerning the radiography profession are involved in radiographers' comprehension of what it means to be a radiographer. Claiming then, on the basis of our findings, that the identity of radiographers is solely to have a secluded support function would probably be to jump to conclusions. It is reasonable to assume that the greater part of the professional identity of radiographers is created in the diagnostic department, where they interact with patients and other healthcare professionals, rather than through discourses taking place in union magazines. Nevertheless, an important marker of professional identity is the impact the profession has on society. A general perception of radiographers as less important, as reflected by limited media attention shown in the present study, would therefore still be of great importance to the identity of the radiography profession. At any rate, the processual aspect of identification and the continuous negotiation with society regarding identity imply that identity is changeable,1 thus allowing radiographers to become more visible in the future. The present study refers to newspaper discourses affecting radiographers in Norway. Partly because they have fewer opportunities for promotion than enabled by, for example, the British four-tier model,25 it could be argued that Norwegian radiographers differ too much for comparison. Nevertheless, it is likely that the described conditions are valid at least in other Nordic countries. Moreover, the phenomenon of subservience and invisibility demonstrated is also previously described in international literature on radiographers,26; therefore, it seems to be a general concern of the entire radiography profession. Although different framework conditions are involved, the discourse analytic approach in the present study might also launch an awareness of the publicminded discourse about radiographers in other countries and thereby contribute to their desired continuous professional development (CPD). Perspectives The political influence of public discourse is evident. The medical arguments for state-of-the-art diagnostic equipment are clearly important for state grants. The desired diagnostic possibilities of excellent equipment, however, are still dependent on the radiographer's skills and expertise. The demand for advanced imaging equipment in diagnostics is therefore indubitably related to the need for skilled radiographers. The more aware the population becomes of this interdependence, the more confidence and support there will be in political controversies where radiographers are involved. How to highlight the radiographer's real work to the public is, therefore, an important question. One way could be to take advantage of the benefits to be gained from extensive use of social media.27 Conclusion The radiography profession is not a prioritized subject field in Norwegian newspapers. They typically appear, in glimpses, as
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003
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anonymous allied health technicians in local reports on new diagnostic equipment or resource utilization. The professional qualities and decisive skills required to handle sophisticated diagnostic equipment and continuity of patient care are underestimated. A more-accurate picture might enable an understanding of the common interests of radiographers and the general population and thereby adjust the power relations in the diagnostic department, thus giving radiography professionals a strengthened identity as important health-care service contributors. Further studies on radiographers' identity would benefit from including ongoing discourses in union journals and public correspondence. Conflicts of interest None. Acknowledgements We are most thankful to the Norwegian Society of Radiographers for their financial contribution. References 1. Burke PJ. Identities and social structure: the 2003 Cooley-Mead award address. Soc Psychol Quart 2004;67(1):5e15. 2. Niemi A, Paasivaara L. Meaning contents of radiographers' professional identity as illustrated in a professional journal e a discourse analytical approach. Radiography 2007;13:258e64. 3. Politisk plattform 2013 e 2015 [Internet] Oslo, Norway. Norsk Radiografforbund [cited 21.04.2016] Available from: http://spotidoc.com/download/ 2810936. 4. NRFs Politiske plattform 2016 e 2018 [Internet] Oslo, Norway. Norsk Radiografforbund [cited 21.04.2016] Available from: http://www.radiograf.no/ meningerogpolitikk/Documents/politisk%20plattform%202016-18.pdf. 5. Decker S, Iphofen R. Developing the profession of radiography: making use of oral history. Radiography 2005;11:262e71. 6. Decker S. On being a radiographer: identity construction and the radiographer. In: Narrative, memory & knowledge: representations, aesthetics, contexts. University of Huddersfield, Huddersfield; 2006. p. 159e64. 7. Lewis S, Heard R, Robinson J, White K, Poulos A. The ethical commitment of Australian radiographers: does medical dominance create an influence? Radiography 2008;14:90e7.
8. Snaith B, Harris MA, Harris R. Radiographers as doctors: a profile of UK doctoral achievement. Radiography 2016. http://dx.doi.org/10.1016/j.radi.2016.04.006. 9. Vikestad KG, Hafskjold L, Kjelle E, Sebuodegaard S, Hofvind S. A national survey on radiographers and research: roles and attitudes. ECR; 2016 [Oral presentation]. 10. Kada S. Radiographers' attitudes towards persons with dementia. Eur J Radiogr 2009;1(4):163e8. 11. Egestad H. Radiografens kommunikasjon med pasienter som gjennomgår en CT-undersøkelse. Hold Pusten 2011;5:21e7. 12. Fairclough N. Discourse and social change. Cambridge: Polity Press,; 1992. 13. Potter J, Wetherell M. Discourse and social psychology: beyond attitudes and behavior. London: Sage Publications; 2010. 14. Boyes C. Discourse analysis and personal/professional development. Radiography 2004;10:109e17. 15. Hold Pusten [internet]. Oslo, Norway. The Norwegian Society of Radiographers [23.05.2011, cited 21.04.2016]. Available from: http://www.holdpusten.no/ extra/snarveier/hold-pustene-the-scientific-journal-of-the-norwegiansociety-of-radiographers-. 16. ATEKST [internet]. Oslo, Norway: Retriever AS 21.04.2016 [updated 21.04.2016; cited 21.04.2016] Available from: https://web.retriever-info.com/ services/archive.html and http://www.retriever-info.com/no/category/newsarchive/. 17. NVivo (version 11) [computer program]. Available from: http://www. qsrinternational.com/what-is-nvivo. 18. Rapley T. Doing conversation, discourse and document analysis. London: SAGE Publications Ltd; 2007. 19. Sherzer JA. Discourse-centered approach to language and culture. Am Antropol 1987;89:295e309. 20. Prior L. Documents in health research. In: Bourgeault I, Dingwall R, de Vries R, editors. The sage handbook of qualitative methods in health research. London: SAGE; 2010. p. 417e32. 21. SSB. Statistics Norway [Internet] Oslo. Norsk mediebarometer. 2015 [14.04.2016, cited 21.04.2016]. Available from:, https://www.ssb.no/kultur-ogfritid/statistikker/medie/aar/2016-04-14. 22. Støre JG. [internet] Oslo, Norway. På glid med jobbglidning. [30.01.2013, cited 21.04.2016]. Available from: http://www.holdpusten.no/nyheter/pa-glid-omjobbglidning/87d90480-f0ac-4142-91d5-d79d815dd75a. 23. Aasen SN, Gjerberg LA. Ad meliora e mot noe bedre? Hold Pusten 2011;8: 26e32. 24. Stranden E, Rotstigen E, Norum IA, Thevatas U. Quo Vadis, radiograf? Hold Pusten 2009;8:8e13. 25. DH, Learning and Personal Development Division. [Internet]. Radiography Skills Mix: A report on the four-tier service delivery model. [03.06.2003, cited 21.04.2016]. Available from: http://webarchive.nationalarchives.gov.uk/ 20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_ digitalassets/@dh/@en/documents/digitalasset/dh_4061260.pdf. 26. Yielder J. Creating our future: conformity or change? J Med Rad Sci 2014;61: 63e5. 27. Lawson C, Cowling C. Social media: the next frontier for professional development in radiography. Radiography 2015;21:e74e80.
Please cite this article in press as: Stalsberg R, Thingnes ER, Who are they? Identities in the Norwegian radiographer profession as presented in the Norwegian printed press, Radiography (2016), http://dx.doi.org/10.1016/j.radi.2016.07.003