title: Living tensions: reconstructing notions of professionalism in occupational therapy.
abstract: OBJECTIVE
  Reform of health organisations has brought significant changes to healthcare systems with attendant consequences for the definition and practice of professionalism. Occupational therapists must continually strive to provide excellent patient care, delivering positive patient outcomes whilst responding effectively to increasing fiscal constraint and changing organisational paradigms. This paper explores the experiences of occupational therapists as they reconstruct professionalism as a consequence of health care reform in England.
  
  
  METHODS
  Fourteen occupational therapists were interviewed over 12 months across five National Health Service organisations in England. Each participant was interviewed three times and was asked to keep a monthly diary of critical incidents. A process of narrative analysis was developed to analyse these data.
  
  
  RESULTS
  Findings suggest that changes have occurred in the National Health Service which affects notions of professional values, expertise, status and accountability. However, far from seeing themselves as mere responders to stimuli, occupational therapists tell of mediating policies, of responding, experimenting and redefining choices whilst struggling to reconstruct professionalism.
  
  
  CONCLUSIONS
  It is suggested that professionalism can be conceived as a reflexive ethical concept in that it is through the process of reflecting on the discursive and behavioural options and values available that occupational therapists come to understand, and define their professional selves.
authors: Staffordshire and Stoke on Trent Partnership NHS Trust, Haywood Hospital, Stoke on Trent, UK; School of Health and Rehabilitation, Keele University, Keele, UK.
authors: Hazel
authors: H
authors: Mackey
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009788:Occupational Therapy; D011364:Professional Practice; D036301:Qualitative Research
keywords: culture; management and professional issues; organisational behaviour