How can interventions more directly address drivers of unprofessional behaviour between healthcare staff?

Unprofessional behaviours (UBs) between healthcare staff are widespread and have negative impacts on patient safety, staff well-being and organisational efficiency. However, knowledge of how to address UBs is lacking. Our recent realist review analysed 148 sources including 42 reports of interventions drawing on different behaviour change strategies and found that interventions insufficiently explain their rationale for using particular strategies. We also explored the drivers of UBs and how these may interact. In our analysis, we elucidated both common mechanisms underlying both how drivers increase UB and how strategies address UB, enabling the mapping of strategies against drivers they address. For example, social norm-setting strategies work by fostering a more professional social norm, which can help tackle the driver 'reduced social cohesion'. Our novel programme theory, presented here, provides an increased understanding of what strategies might be effective to adddress specific drivers of UB. This can inform logic model design for those seeking to develop interventions addressing UB in healthcare settings.

Insights into discrepancies in professional identities and role models in undergraduate medical education in the context of affective burden.

Introduction: International evidence strongly suggests that medical students are at high risk of mental health problems. This distress, which can be mediated by a variety of individual, interpersonal and contextual factors within the curriculum, can be mitigated by effective coping strategies and interventions. Central to this discourse is the recognition that the challenges of professional identity formation can contribute significantly to medical students' distress. The focus of our study is therefore to examine discrepancies in professional identities and role models in undergraduate medical education in relation to affective burden. Methods: Medical students at different stages of university education and high school graduates intending to study medicine were surveyed in a cross-sectional study. The study employed Osgood and Hofstätter's polarity profile to evaluate the self-image of participants, the image of an ideal and real physician, and their correlation with depression (PHQ-9) and anxiety (GAD-7). Results: Out of the 1535 students recruited, 1169 (76.2%) participated in the study. Students rated their self-image as somewhere between a more critical real image of physicians and a more positive ideal image. Medical students at all training levels consistently rated the ideal image as remaining constant. Significant correlations were found between the professional role models of medical students and affective symptoms, particularly for the discrepancy between the ideal image of a physician and their self-image. Furthermore, 17% and nearly 15% reported significant symptoms of depression and anxiety, respectively. Discussion: Our study adds to the growing body of knowledge on professional identity formation in medicine and socialisation in the medical environment. The study highlights the importance of discrepancies between self-image and ideal image in the experience of depressive and anxiety symptoms. Primary prevention-oriented approaches should incorporate these findings to promote reflective competence in relation to professional role models and strengthen the resilience of upcoming physicians in medical training.

Revised evaluation objectives of the Korean Dentist Clinical Skill Test: a survey study and focus group interviews

PURPOSE: This study aimed to propose a revision of the evaluation objectives of the Korean Dentist Clinical Skill Test by analyzing the opinions of those involved in the examination after a review of those objectives. METHODS: The clinical skill test objectives were reviewed based on the national-level dental practitioner competencies, dental school educational competencies, and the third dental practitioner job analysis. Current and former examinees were surveyed about their perceptions of the evaluation objectives. The validity of 22 evaluation objectives and overlapping perceptions based on area of specialty were surveyed on a 5-point Likert scale by professors who participated in the clinical skill test and dental school faculty members. Additionally, focus group interviews were conducted with experts on the examination. RESULTS: It was necessary to consider including competency assessments for "emergency rescue skills" and "planning and performing prosthetic treatment." There were no significant differences between current and former examinees in their perceptions of the clinical skill test's objectives. The professors who participated in the examination and dental school faculty members recognized that most of the objectives were valid. However, some responses stated that "oromaxillofacial cranial nerve examination," "temporomandibular disorder palpation test," and "space management for primary and mixed dentition" were unfeasible evaluation objectives and overlapped with dental specialty areas. CONCLUSION: When revising the Korean Dentist Clinical Skill Test's objectives, it is advisable to consider incorporating competency assessments related to "emergency rescue skills" and "planning and performing prosthetic treatment."

[Changing team structures in intensive care medicine]. / Teamstrukturen in der Intensivmedizin im Wandel.

Intensive care units are highly complex environments where critically ill patients are treated. Therefore, it is mandatory for various professional groups to work closely together. In the past, mainly nursing and medical teams were involved, but today team structures are changing, and more professional groups are entering the environment. Demographic change with increasing comorbidities as well as increasingly complex treatments and technologies are challenges for the intensive care teams. Another enormous challenge is the increasing shortage of nursing staff, which affects the entire healthcare system. To meet these challenges, new concepts are necessary. In accordance with long-standing international standards, an academization of the nursing profession is proposed. The aim is to integrate academically educated nurses and to introduce new nursing roles. Concepts integrating nursing sciences should also be considered.

Identifying the impact of audit and feedback on the professional role of the nurse and psychological well-being: An integrative systematic review.

This systematic review aimed to critically synthesis evidence to identify the impact that audit and feedback processes have on the professional role of the nurse and psychological well-being. Little is known about the extent to which audit and feedback processes can positively or negatively impact the professional role of the nurse and psychological well-being. An integrative systematic review was conducted. Covidence systematic review software was used to manage the screening process. Data extraction and methodological quality appraisal were conducted in parallel, and a narrative synthesis was conducted. Nurse participation and responsiveness to audit and feedback processes depended on self-perceived motivation, content, and delivery; and nurses viewed it as an opportunity for professional development. However, audit was reported to negatively impact nurses' psychological well-being, with impacts on burnout, stress, and demotivation in the workplace. Targeting framing, delivery, and content of audit and feedback is critical to nurses' satisfaction and successful quality improvement.

An Overview of Nursing Regulation.

The rules and regulations that govern nursing practice are topics rarely covered in nursing education programs. This article aims to provide a basic understanding of state and federal rules that govern nursing practice; the role and duties of nurse regulatory boards; types of legal actions that nurses may face; and an overview of discipline, complaint, and reporting processes.

[Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study]. / Pflegerische Qualifikationsniveaus und Umsetzung von Aufgaben für eine Advanced Nursing Practice in Österreich.

Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study Abstract: Background: New fields of practice are emerging under the concept of "Advanced Nursing Practice" (ANP) that offer specialised care provided by nurses who hold master's degrees. In Austria, nurses are currently being trained as Advanced Practice Nurses (APN). Aim: The project aimed to investigate which advanced nursing practice tasks according to the Hamric model are undertaken by nurses at different levels of qualification in Austria. Methods: Certified nurses did participate in a cross-sectional survey through an online questionnaire based on the Role Delineation Model and tailored to the Austrian context. The tasks were assigned based on the Hamric model and were tested and evaluated descriptively according to the qualification level through factor analysis. Results: Completed data was available from 105 participants, among them 80% with undergraduate education, 20% with a master's degree. A tendency in the results showed that the level of qualification was related to the activities carried out. The higher the academic degree, the more activities were performed in the field of leadership. The central ANP-competencies, research and education, are rather weak among all respondents. Conclusion: The results show that activities corresponding to the competencies of an ANP are performed by a heterogeneous group of nurses. Conditions and a standardized understanding of ANP need to be established in order to offer a professional practice that matches the competency profile.

Characteristics and Outcomes of Postgraduate Midwifery Fellowships: A Mixed Methods Study.

INTRODUCTION: Postgraduate fellowships are growing in midwifery and yet are poorly understood by the profession. These fellowships are optional for midwives interested in developing advanced skills, transitioning to specialty practice, or entering or re-entering professional practice. The purpose of this study was to explore the characteristics and outcomes of US postgraduate midwifery fellowships as described by midwifery fellowship program directors. METHODS: Postgraduate midwifery fellowship programs in the United States were identified through an environmental scan and snowball sampling. Directors of these fellowship programs were invited to complete a survey and an open-ended interview to determine their program's characteristics and outcomes. Quantitative data were summarized, and thematic analysis was used to explore the qualitative data. RESULTS: An environmental scan and snowball sampling identified 17 postgraduate midwifery fellowship programs. Thirteen fellowship program directors completed a survey (76.5%), and 11 completed an interview (64.7%). The findings identified program characteristics, including location, structure, funding, and educational offerings, of midwifery fellowship programs. The thematic analysis revealed the emergence of 3 themes highlighting the creation of support for midwives in transition, including new graduates and practicing midwives returning to practice after a hiatus or shifting to specialty practice: (1) stepping stones, (2) empowered and equipped, and (3) innovative future. Community birth practice was defined as specialty practice by these directors. DISCUSSION: The results of this study inform the profession of the availability of fellowships and the development of future high-quality midwifery fellowships. Postgraduate midwifery fellowships should not be required for entry to practice but have a place in the work-study opportunities available to US midwives.

Keeping Sane in a Changing Climate: Assessing Psychologists' Preparedness, Exposure to Climate-Health Impacts, Willingness to Act on Climate Change, and Barriers to Effective Action.

Evidence of the impact of climate change on mental health is growing rapidly, and healthcare professionals are being called to be active participants in protecting the population's health. Yet, little is known about psychologists' understanding of climate-health impacts and their role in mitigation actions. We surveyed Australian psychologists (N = 59) to examine preparedness in identifying and managing the impact of climate change on mental health, exposure to climate-health impacts, willingness to act, and barriers to acting on climate change. Data was analysed through descriptive and associative methods. We found that participants are not prepared to identify and manage mental health presentations related to climate change, and they are not engaged in climate change mitigation. We identified that a lack of knowledge of climate-health impacts and tackling and mitigation strategies, in addition to ethical concerns, were the main barriers to engagement with communication and advocacy. With the impacts of climate change on mental health expected to soar, there is a clear and urgent need to prepare the psychological workforce to address this public health issue by establishing professional education programs and reframing climate change as a health crisis.

Evaluation of a virtual interprofessional oral-systemic health simulation experience in nursing, dentistry, medicine, and pharmacy education.

PURPOSE: The annual teaching oral-systemic health (TOSH) virtual clinical simulation and case study activity exposes interprofessional teams of nurse practitioner, nurse midwifery, dental, medical, and pharmacy students to a virtual clinical simulation experience that uses oral-systemic health as a clinical exemplar for promoting interprofessional core competencies. The present study examines changes in participating students' self-reported interprofessional competencies following participation in virtual TOSH from 2020 to 2022. These findings are also compared to those from in-person TOSH (2019) to examine the equivalence of student outcomes of both the in-person and virtual programs. METHODS: A pre- and post-test evaluation design was used to examine the effectiveness of exposure to the TOSH program on self-reported attainment of interprofessional competencies for participating students using the interprofessional collaborative competency attainment scale. RESULTS: Analysis of pre- and post-surveys demonstrated statistically significant improvement in students' self-rated interprofessional experience competencies following the virtual TOSH program, which aligns with results from the in-person cohorts. Similar findings between the in-person and virtual cohorts indicated no statistically significant difference between the two formats. CONCLUSION: These findings demonstrate the success of TOSH in promoting attainment of interprofessional competencies among future health professionals. We encourage administrators and faculty who lead health professional programs to take advantage of using virtual simulations as an integral component of interprofessional oral health clinical experiences where students from different health professions learn from and about each other in assessing and treating patients across the lifespan.

Measuring performance in allied health professional role substitution models of care: a clinician survey.

BACKGROUND: Professional role substitution models of care have emerged as a key strategy to address increasing healthcare demand. Gaining insights from those actively engaged in the process of these models' implementation and evaluation is pivotal to ensuring sustainability and further successful implementation. The purpose of this study was to describe allied-health clinicians' perceptions, practice, and experiences of healthcare performance evaluation in professional role substitution models of care. METHODS: Data were collected via an online platform between 22 June - 22 July 2022 using a combination of convenience and network-based sampling of allied-health clinicians involved or interested in the implementation and evaluation of professional role substitution models of care. Clinicians answered 25 questions which consisted of demographic and targeted questions regarding performance evaluation across six domains of healthcare quality (effectiveness, safety, appropriateness, access & equity, continuity of care, and cost, efficiency, productivity & sustainability). RESULTS: A total of 102 clinicians accessed the survey, with 72 providing complete survey data. Eleven allied-health professions were represented, working across twelve specialities in thirteen hospital and health services. Whilst most allied-health clinicians (93-100%) supported measuring performance in each of the six healthcare quality domains, only 26-58% were measuring these domains in practice. Allied-health leadership support (62.5%), clinician drive (62.5%), consumer engagement (50%) and medical support (46%) were enablers whilst a lack of resources (human, time, financial (47%)), healthcare performance frameworks and/or policies (40%) were identified as barriers. Given the opportunity, clinicians would invest the most financial resources in digital solutions as a core strategy to improve performance evaluation. CONCLUSIONS: Allied-health professionals expressed strong support for principles of performance evaluation, however in practice, performance evaluation is still in its infancy in professional role substitution models of care. Organisations can implement strategies that maximise the enablers whilst addressing barriers identified to improve performance evaluation in these models of care.

Primary health care: Nurses' meanings in a Colombian municipality

Introduction: Primary health care is a strategy that involves the different health professionals and other agents in the system who can influence the social determinants that affect human wellbeing. Objective: To know the meanings about primary health care of nursing professionals practicing in this field in a municipality of Colombia. Materials and Methods: Qualitative, exploratory, descriptive study. The research was conducted in a State Social Company (ESE for its acronym in Spanish) that provides primary health care services. Data was collected through semi-structured interviews. The sample consisted of 13 professionals. IRaMuTeQ software was used to help data interpretation. Results: 'Nurse' was the most frequent word. The content analyzed was categorized into four classes: 'Meanings about primary health care', 'nursing activities in primary health care', 'barriers encountered in primary health care', 'primary health care organization and work team'. Conclusions: Primary health care meaning is understood as the entry point of users into the health system and the one responsible for coordinating their passage through other points of the healthcare network according to users' health needs. In addition, primary health care is understood as the level of care at which essential health actions focused on the early detection of health risks and complications are carried out, so that health interventions can be planned, implemented, and evaluated on that basis.

Professional identity and representations of advanced practice nurses specialising in psychiatry and mental health: A national study.

Advanced practice nurses constitute a new professional group within the French health care system. Advanced practice nurses specialise in one of five disciplines including Psychiatry/Mental-Health. This specific discipline is strongly marked by stigmatising representations by healthcare users and other health professionals (including other advanced practice nurses), whose consequences have a deleterious effect. The aim was to highlight all advanced practice nurses representation of Psychiatry/Mental-Health advanced practice nurses. An observational descriptive survey, based on an anonymous online questionnaire was conducted in April 2022 among qualified and student advanced practice nurses from the five specialist disciplines. Overall, 356 advanced practice nurses completed the survey questionnaire. No significant difference in stigmatising representations of Psychiatry/Mental-Health advanced practice nurses versus other advanced practice nurses was observed. Only 3.3% of other advanced practice nurses thought that Psychiatry/Mental-Health advanced practice nurses are often 'strange'. Psychiatry/Mental-Health advanced practice nurses and other advanced practice nurses appeared to have similar representations of the professional roles of advanced practice nurses in general and of advanced practice nurses APN specifically. Unlike other professionals in the psychiatric field (e.g. medical interns, nurses), very little stigmatisation of Psychiatry/Mental-Health advanced practice nurses by their colleagues (i.e. other advanced practice nurses) was observed. This could be partly due to the fact that advanced practice nurses professional identity appeared to be built collectively around the concept of advanced practice. Advanced practice nurses constitute a professional group that is fully involved in contemporary transformations in care and organisational innovation. The very low level of stigmatisation of Psychiatry/Mental-Health advanced practice nurses by other advanced practice nurses in our study suggests that these new healthcare actors could play a crucial role in the improvement of professional health practices, particularly in terms of improved coordination between psychiatric-care and physical-care.

What moral weight should patient-led demand have in clinical decisions about assisted reproductive technologies?

Evidence suggests that one reason doctors provide certain interventions in assisted reproductive technologies (ART) is because of patient demand. This is particularly the case when it comes to unproven interventions such as 'add-ons' to in vitro fertilisation (IVF) cycles, or providing IVF cycles that are highly unlikely to succeed. Doctors tend to accede to demands for such interventions because patients are willing to do and pay 'whatever it takes' to have a baby. However, there is uncertainty as to what moral weight should be placed on patient-led demands in ART, including whether it is acceptable for such demands to be invoked as a justification for intervention. We address this issue in this paper. We start by elucidating what we mean by 'patient-led demand' and synthesise some of the evidence for this phenomenon. We then argue that a doctor's professional role morality (PRM) yields special responsibilities, particularly in commercialised healthcare settings such as ART, because of the nature of professions as social institutions that are distinct from markets. We argue on this basis that, while there may be reasons (consistent with PRM) for doctors to accede to patient demand, this is not always the case. There is often a gap in justification between acceding to patient-led demands and providing contested interventions, particularly in commercial settings. As a result, acceding to demand in such settings needs a strong justification to be consistent with PRM.

Multidisciplinary perspectives on roles of hospital pharmacists in tertiary settings: a qualitative study.

In today's complex healthcare landscape, exacerbated by resource constraints at various levels, optimization of health professionals' roles is becoming increasingly paramount. Interprofessional collaboration, underpinned by role recognition and teamwork, leads to improved patient and organizational outcomes. Hospital pharmacists play a pivotal role in multidisciplinary teams, and it is imperative to understand multidisciplinary viewpoints on hospital pharmacists' roles to guide role prioritization and organizational efficiency. However, no study extensively investigated multidisciplinary views on values of diverse pharmacist roles in tertiary settings. This study aims to address this gap by examining non-pharmacist health professionals' views on hospital pharmacists' roles, recognizing their specialized niches as a crucial step towards optimizing their roles and services in Australia and internationally. Multiple focus group discussions and interviews were held via a virtual conferencing platform. Study participants were recruited using the study investigators' professional networks who were non-pharmacist health professionals with experience working with pharmacists in hospital settings. Data were collected from transcripts of the focus group recordings, which were later summarized using descriptive statistics and thematic analysis. Overarching themes were categorized and mapped against work system models to conceptualize organizational implications of multidisciplinary feedback, linking them to patient and organizational outcomes. Twenty-seven health professionals participated across focus groups and interviews, with the majority of professions being doctors and nurses. Three major themes were identified as follows: (i) overarching perceptions regarding hospital pharmacists; (ii) professional niches of hospital pharmacists; and (iii) future opportunities to optimize hospital pharmacy services. Valued professional niches included patient and health professional educators, transition-of-care facilitators, and quality use of medicines analysts. The study highlights critical insights into hospital pharmacists' roles in Australia, identifying their niche expertise as vital to healthcare efficiency and success. Based on multidisciplinary feedback, the study advocates for strategic role optimization and targeted research for enhanced clinical, economic, and organizational outcomes.

Roles and competencies of nurses and physicians in shared decision-making in cardiac surgery: A scoping review.

AIM: Identification and synthesis of research data related to the roles and competencies of physicians and nurses that are prerequisites for careful shared decision-making with patients potentially undergoing cardiac surgery. DESIGN: A scoping review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews and the PRISMA Extension for Scoping Reviews. METHODS: PubMed, EMBASE and CINAHL were searched from inception dates up to March 2022, to identify primary studies published in a peer-reviewed journal. Study selection, assessment of the methodological quality and data extracting of the included studies were done by at least two independent researchers. To describe the findings of the studies, an emergent synthesis approach was used to visualize a descriptive representation of professional roles and competencies in shared decision-making, in an overview. RESULTS: The systematic search revealed 10,055 potential papers, 8873 articles were screened on title and abstract and 76 full texts were retrieved. Eight articles were included for final evaluation. For nurses and physicians, 26 different skills were identified in the literature to practice shared decision-making in cardiac surgery. The skills that emerged were divided into five professional roles: moderator; health educator; data collector; psychological supporter and translator. CONCLUSIONS: This review specifies the professional roles and required competencies related to shared decision-making in cardiac surgery. Further research is needed to compare our findings with other clinical areas and from there to arrive at a professional division of roles between the different clinical disciplines involved. IMPACT: The visualization of generic shared decision-making competencies and roles should establish the professional division of positions between various clinical physician and nurse disciplines in order to create a treatment plan based on evidence, values, preferences and the patient's personal situation. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Negotiating new roles in general practice: a qualitative study of clinical pharmacists.

BACKGROUND: To address general practice workforce shortages, policy in England has supported the recruitment of 'non-medical' roles through reimbursement funding. As one of the first to receive funding, the clinical pharmacist role offers insight into the process of new role negotiation at general practice level. AIM: To identify factors influencing clinical pharmacist role negotiation at practice level, comparing the process under two different funding and employment models. DESIGN AND SETTING: Qualitative interview study with staff involved in the following schemes: 1) the national NHS England (NHSE) Clinical Pharmacists in General Practice scheme; and 2) a local clinical commissioning group-funded scheme, providing clinical pharmacist support to general practices in one area of Greater Manchester in the UK. METHOD: Semi-structured interviews with purposive and snowball sampling of pharmacists, GPs, and practice staff took place. The interviews were analysed using template analysis. RESULTS: In total, 41 interviews were conducted. The following four factors were found to influence role negotiation: role ambiguity; competing demands and priorities; potential for (in)appropriate utilisation of clinical skills; and level of general practice control over the role. Key differences between the two funding and employment models were the level of influence GPs had in shaping the role and how adaptable pharmacists could be to practice needs. The potential for inappropriate utilisation was reported under both schemes, but most apparent under the role reimbursement, direct employment model of the NHSE scheme. CONCLUSION: This study has highlighted lessons applicable for the introduction of non-medical roles more widely in general practice. It has provided insight into the factors that can influence role negotiation at practice level and how different funding and/or employment models can impact on this process.

Work for the Prison Service: selected health consequences - investigating the role of personal resources, job demands, work stress, and burnout.

OBJECTIVES: The specific job demands of the Prison Service (PS) may affect the health of officers. The job demands-resources model (JD-R) model was used to design a survey of the consequences of working subject to particular job demands. The aim was to gain an insight into the relationship between job demands, personal resources, occupational stress and burnout and selected health consequence indicators (such as behaviors associated with the consumption of alcohol, stress symptoms). MATERIAL AND METHODS: A total of 1732 PS officers in Poland were surveyed. The following tools were used as part of the survey: the Copenhagen Psychosocial Questionnaire (COPSOQ II), the Multidimensional Inventory for Assessing Coping Responses (COPE), the Alcohol Use Disorders Identification Test (AUDIT) and a form with a respondent's particulars. Path analysis using partial least squares structural equation modelling (PLS-SEM) was performed. RESULTS: The assumed hypotheses were partially confirmed by the results. Out of 4 job demands categories only work pace turned out not to be a significant predictor of burnout and stress. For alcohol related behaviors, stress level was the only significant predictor, both as a direct and indirect effect taking into account job demands. It transpired that support from superiors rather than support from colleagues or self-efficacy was a significant moderator in the emotional demands - stress relationship. Limitations of the study and perspectives for its continuation are also presented herein. CONCLUSIONS: Based on the obtained results it may be concluded that job demands and support from superiors do have an impact on stress in the PS group. This is also consistent with available reports in literature. At the same time stress is a significant predictor of alcohol related behaviors. Coping through the use of psychoactive substances was not a significant factor in statistical analyses and it has still not been subject to sufficient scientific analysis. Int J Occup Med Environ Health. 2023;36(6):744-60.

Medically Assisted Death and the Ends of Medicine.

This paper aims to refute a common line of argument that it is immoral for physicians to engage in medical assistance in death (MAiD), i.e., the practices of euthanasia and physician-assisted suicide. The argument in question is based on the notion that participating in MAiD is contrary to the professional-role obligations of physicians, due to MAiD's putative inconsistency with the ends of medicine. The paper describes several major flaws from which that argument suffers.

Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic.

Objective: This study aimed to (1) collect and analyze statements about how to celebrate chiropractic in the present and roles that chiropractors may fulfill in the future, (2) identify if there was congruence among the themes between present and future statements, and (3) offer a model about the chiropractic profession that captures its complex relationships that encompass its interactions within microsystem, mesosystem, exosystem, and macrosystem levels. Methods: For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings. Results: Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts. Conclusion: A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.