Breastfeeding support for mothers and their babies historically was the informal work of family and community members. In the United States today, breastfeeding support is embedded in the biomedical system, and is provided by a new allied health professional: the International Board Certified Lactation Consultant (IBCLC). This dissertation explores this professionalization of breastfeeding support and the origins of this new profession. It studies how IBCLCs working in the U.S. cultural context perceive and practice the profession and examines the relationship between the profession of lactation consulting and the medicalization of breastfeeding. Oral history interviews with 17 founders of the profession, which was established in 1985, and a content analysis of the professional journal (the Journal of Human Lactation) from 1985 to 2010, allowed me to build the story of how and why breastfeeding support became professionalized and how experiential breastfeeding knowledge entered the domain of expert knowledge. While constrained by the biomedical system in which they created the profession, the founders exhibited a both agency and creativity in their production and reproduction of professional values and practices. Interviews with 30 currently certified IBCLCs and observations of the clinical practice of 3 IBCLCs provided insight into the daily practice of IBCLCs working in different settings--hospitals, WIC clinics, pediatric offices, and private practice. The data collected from these ethnographic methods demonstrated how the medical knowledge base of IBCLCs translates into clinical practice with patients, and allowed me to understand the relationship between the profession of lactation consulting and the medicalization of breastfeeding. While IBCLCs' draw on medicalized knowledge and evidence about breastfeeding and human lactation, their interactions with clients are best described as empathetic and humanistic, and are derived from nursing and mother-to-mother breastfeeding support models rather than from a technocratic, biomedical approach to care. While the appropriation of certain biomedical values and standards helped to legitimize the professionalization efforts of the founders, in practice, lactation consultants apply their medical knowledge and clinical experience in a way that reflects the compassionate, empowering care approach of mother-to-mother breastfeeding support and that thus resists the overt medicalization of breastfeeding.

This study was conducted to determine if specialty areas are emerging in the magnetic resonance imaging (MRI) profession due to advancements made in the medical sciences, imaging technology, and clinical applications used in MRI that would require new developments in education/training programs and national registry examinations. In this exploratory study, statistical analysis incorporated the use of factor analysis and chi square. Factor analysis was used to group tasks performed by MRI technologists into factors to better identify emerging specialty areas within the MRI profession. Chi square was used to analyze the association between the tasks performed in (a) the employment setting, and (b) hospital size. Factor analysis identified four meaningful factors. The four named factors were: (a) Routine Imaging non-Central Nervous System Imaging; (b) Advanced Imaging; (c) Routine Imaging with Central Nervous System Imaging; and (d) Musculoskeletal and Spine Imaging. From the four named factors, three emerging specialty areas were identified: (a) central nervous system imaging; (b) vascular/cardiovascular imaging; and (c) musculoskeletal imaging. Chi square analysis identified 47 of the 78 tasks as being significant when finding an association between the employment setting and the frequency of tasks performed. Cramer's V was used to measure the strength of their association. The more complicated the procedure the more likely this procedure is performed in either a university or private hospital. Further, chi square analysis identified 42 of the 78 tasks as being significant when finding the association between the hospital size and the frequency of tasks performed. Gamma was used to measure the strength of their association. This means the larger the hospital, the more frequent the tasks were performed.

Background. A constantly changing reform agenda has frequently changed NHS management arrangements. Impacts are documented for medicine and nursing but much less so for the third largest profession, physiotherapy. Aims. To evaluate the impact of NHS reforms on physiotherapy analysing whether the resulting management structures impacted on staff and patient care; comparing English and Welsh arrangements with previous periods. Method. Observational mixed methods including a narrative literature review; questionnaire census; semi-structured interviews; physiotherapy narrative history; and a normative evaluation of physiotherapy management structures. Results. NHS reforms had impacted on the structure of physiotherapy management and organisation. Of the eight management structures described in Øvretveit’s (1992) schema: Three were not observed; two were observed but needed modification; three were observed and empirically applicable with small modifications; social enterprises had evolved with management structures similar to those in the NHS. The main changes to physiotherapy managers’ roles between1989-2014 were substantial reorganisations affecting the employing organisation and role of the managers with a reduction in Community Trusts and the introduction of competing providers into English NHS physiotherapy. Clinical autonomy had been extended with advanced practice roles in some areas. The role of the professional body and TU (the CSP) was generally well-regarded by managers. The differences between England and Wales related more to management structures than national policy differences. Conclusions. Most physiotherapists were managed within cross-AHP structures. Devolved structures were increasingly emerging but physiotherapy managers preferred professionally-led structures. Physiotherapy managers ranked the AHP Directorate the highest and the Fragmented structure the lowest. The AHP professions will need to consider merging to conserve their power as professions and to maximise their combined contribution to patient care and organise to meet fiscal challenges in both countries.

Due to an increase in the need for allied health professionals, there is a growing interest to assess the allied health workforce and its employment needs. This is especially true in medically underserved rural areas where there is a critical shortage of allied health professionals. A survey was sent to allied health administrators across a variety of allied health disciplines working in Tennessee hospitals in order to gauge opinions on retention and recruitment strategies. Overall successful strategies for recruitment and retention of allied health professionals were reported as well as differences between urban and rural areas, differences of perceptions of strategy effectiveness among allied health disciplines, and key strategies for rural allied health recruitment. Little is known about organizational policies impacting recruitment and retention practices of allied health professionals in Tennessee hospitals. Understanding of this problem is vital to the prevention of a critical shortage of allied health professionals. Therefore, this study sought to compare rural and urban hospital in Tennessee with respect to recruitment and retention needs.

Retiring baby boomers and the lack of interest and awareness among college students to enroll in an accredited Clinical Laboratory Science (CLS) program have created a shortage of CLS professionals in the 21st century. The U.S. Bureau of Labor Statistics predicts 18,000 CLS vacancies by 2018. However, only about 5,000 students graduate from accredited CLS programs each year. The purpose of this study was to explore students' perceptions of allied health professions and factors that influenced students and CLS professionals to select CLS as a profession. Bandura's social cognitive career theory served as the theoretical framework for this phenomenological study. Convenient purposeful sampling was used to select the 7 CLS professionals, 5 high school students, and 5 college students in the Chicago area. Participants took part in either a 30- to 60-minute group session or a 45- to 90-minute semi structured interview. Qualitative analysis included open axial coding to identify emerging patterns and themes from the transcripts. Findings revealed that the perceptions of both high school and college students' knew little about the CLS profession, and factors influencing CLS as a career choice included interests in science, health care, and family. CLS professionals indicated their interests in science and a high demand for CLS services in the workforce led them to pursue careers in the field. Implications for social change include improving professional-development programs for student awareness of allied health professions and mitigating the shortage of clinical laboratory scientists.

This project is a plan for using a special web-based learning project to teach medical terminology through distance education between University of Loma Linda and Humanatec Rehabilitation College.