Professionalism in nursing: a concept analysis

Mrs. S.D. MottianProf. Christa Van Der Walt

North-West University (Potchefstroom Campus)

INTRODUCTION

The concept professionalism is multifaceted, & in spite

of much research done, it is still poorly

conceptualised4.

Poor understanding of the concept within the nursing

profession:

Affects adequate development of valid instruments to

assess professionalism.

Affects nursing practice, health care service delivery

& the image of the profession.

Unfortunately, professionalism in nursing appears to

be deteriorating.

Nursing students entering the profession are at risk of

assimilating unprofessional behavior, from their

colleagues, which negatively affects quality service

delivery.

Nurse educators vital role in facilitating students

professional socialization helps in moulding them into

the profession during integration of fundamental

norms, values & standards governing the profession.

BACKGROUND

Professionalism is believed to occur during

the period students are in basic nursing

programmes continuing after graduation

during practice1

Many role models (educators, clinical

educators) other professionals & fellow

students shape development of the student’s

professional character/ attitude & behaviour 5

Preparation to practice a profession is complex, requiring students to learn skills and knowledge to take up norms & traditions of the chosen profession.

Students depend on support / guidance/ supervision & care of RN’s in clinical practice to develop into confident & capable practitioners3

Poor conceptualization of professionalism

limits content & construct validity of measuring

instruments.

A better understanding of professionalism

enables development of valid measuring

instruments, assisting educators to measure

growth & development of professionalism or

lack thereof during students’ years of training.

AIM AND OBJECTIVE

To define professionalism within the nursing profession.

To conduct a concept analysis of professionalism to construct a connotative (theoretical) definition in nursing.

METHOD & FINDINGSA concept analysis was conducted using the 8 steps recommended by Walker & Avant (2011) based on Wilson’s work (1963). The steps are:

1. Select concept- professionalism was selected

2. Determine purpose of the analysis- The concept professionalism is currently poorly conceptualized.

Assessing the level of professionalism to facilitate professionalism in nurses might lack conceptual clarity.

Concept analysis aimed to critically analyze the concept professionalism, determine its identifying attributes (connotation) & develop a theoretical definition.

Based on the attributes & definition, empirical indicators can be identified to formulate a denotative definition.

Development of empirical indicators did not fall in the scope of this study & should be addressed in further research.

3. Identify uses of the concept- Unit of analysis was the definition of professionalism as it appeared in general & professional literature.

A search strategy based on systematic reviews enabled locating many definitions of professionalism as possible in both scientific & non-scientific sources.

4. Determine the defining attributes - Analysis involved deductive & inductive reasoning to theoretically define professionalism & describe attributes of the concept.

This logic reasoning helped generate concluding statements from the empirical data

Determine the defining attributes Thematic analysis (qualitative in nature)-

resulted in identification of various uses of professionalism & extraction of attributes as it appeared in definitions

This enabled identification of all possible uses of the concept in ordinary & professional literature6,2

Repeated attributes identified were described as the defining attributes of professionalism.

Determine the defining attributes Most frequently identified attributes was obtained by

quantitative content analysis, involving systematic & objective reduction of the data into categories.

This was primarily deductive in nature, structured & helped refine the key attributes7

Repeated attributes identified in the ordinary & professional meaning of professionalism was further categorized into knowledge, attitudes & behaviors attempting to obtain key attributes.

The mind map following denotes these categories & key attributes:-

Categories of AttributesKnowledge Attitudes Behavior Knowledge Attitudes Behavior

* Competence * Positive * Conduct *Competence *Morals *Advocacy n= 34 Attitudes n=48 n=15 n=30 n=4 n= 4

* Continuous * Dedication * Personal *Special *Altruism * Quality Development n= 15 Quality Knowledge n=17 Service n= 2 n=5 n=13 n=33

* Specialised Knowledge, Expertise n= 16

Most Frequently identified attributes categorized above

Ordinary Meaning

Professional Meaning

Professionalism

Further clarification of the concept was done using 3 frameworks for professionalism present in nursing literature: The RNAO Best Practice Guidelines for

professionalismAmerican Nurses Association Code for

NursesSouth African Nurse’s Code of Service

Identification of attributes from the current study & above frameworks were compared, denoting shared & new attributes, thus an enhanced understanding of the meaning of professionalism

RNAO, Best Practice Guidelines 

The American Nurses Association Code for Nurses (ANA 1985)  

The South African Nurse’s Code of Service

Some Attributes identified in present study

 Accountability Accountability   Accountability  Human dignity Dignity RespectAdvocacy Advocacy   AdvocacyInnovation & visionary, Spirit of Inquiry

Continuous development   Continuous development

Collegiality & collaboration

Collaboration   Collaboration

  Confidentiality Maintain confidentiality

Integrity

  Competence/ qualifications   Competence/ qualification/ special knowledge

Ethics & values     Morals/values/ ethics Autonomy     Autonomy    Service to

humanity, Promise Conscience, Duty, Honour, Respect for human life 

Trust, Altruism, CourageProfessional conduct & service, Committed, Compassionate,Positive attitude, Authority, Resilience

Theoretical (connotative) definition of Professionalism

Professionalism is characterized by an integration of affective, behavioral & cognitive attributes which must be demonstrated by persons from a specific profession. A professional person displays: Respect for all Takes responsibility for actions Exhibits authentic truthfulness in action

(verbal/non-verbal) Able to assume accountability Practice reflection & strive for self-determination Has essential qualities of autonomy & self-

efficacy Is resilient in spite of daily work challenges

Theoretical (connotative) definition of Professionalism

Acquires specialised skills, education & continuous development.

Exercises high standards of professional judgment which form the foundation to perform competently & at a mastery level; thus ensuring delivery of high standard & quality of health care

Ability to express empathy, altruism, compassion & respect for diverse cultures- affective domain of professionalism

An affiliation to a professional association or country’ Professional Regulator differentiates a professional from a non-professional

Ethical & professional values always displayed.

5. Identify a model case – to further clarify the meaning of the concept a model case constructed showed presence of key attributes of professionalism using a nursing example annotating the connotations of professionalism - provided insight, clarity & meaning to the concept.

6. Identify a borderline & contrary caseBorderline case presented showed what contained most of the defining attributes of professionalism but not all of them – thus helping to clarify thinking about the defining attributes of the true concept professionalism.

Contrary case - displayed what was definitely not professionalism

7. Identify antecedents & consequences Antecedents – events taking place prior to

occurrence of the concept 5

A 2nd reduction resulted in main categories of values, knowledge & behaviors further reduced providing a clearer perspective in their association to professionalism.

Values – affective attributes } antecedentsKnowledge – cognitive attributes } ofBehaviors – behavioral attributes} professionalism

If the above are absent – professionalism cannot be claimed

Consequences – events occurring due to presence of the concept. Consequences of professionalism recognised from all definitions & cases were as follows:ExpertnessProfessional conductExercising high standards of trained

judgementLearned valuesMastery of knowledge, skill & competency

Consequences help further refine the defining attributes

8. Empirical Referents - Identification & description of empirical referents of professionalism would permit construction of a denotative (operational) definition of professionalism in nursing.

On viewing the theoretical definition of professionalism more extensive work is required to gain better understanding to identify empirical referents of professionalism & to construct an operational definition- a recommendation for further research.

CONCLUSION The meaning of professionalism as a concept featured

more regularly in the medical profession but also appeared in professions of lawyers, social workers, teachers, engineers & psychologists.

This indicates applicability of the concept to different professions.

Various professions highlight different attributes unique to that particular profession.

Affective attributes like altruism & compassion appear predominantly in the nursing & medical professions & not highlighted in engineering & law professions.

The nursing profession like some health professions highlight certain attributes distinguishing them from most other professions.

Nursing profession – entails working with people every day, including nurses, doctors, patients, administrative staff and community members.

These individuals have a different perspective of the nurse & what is required of the profession.

However the defining attributes demonstrated by the nurse will create a sense of commonality that will guide other people’s understanding & expectations of professionalism in nursing.

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2. Lewis-Beck, M.S., Bryman, A. & Liao, T.F. 2004. The Sage Encyclopedia of Social Science Research Methods. Volume 1. California: SAGE Publications.

3. Mabuda, B.T., Potgieter, E. & Alberts, U.U. 2008. Student nurses’ experiences during clinical practice in the Limpopo Province. Curationis, 31(1):19-27.

4. Registered Nurses Association of Ontario. 2007. Nursing best practice guidelines program. Healthy work environments best practice guidelines. Professionalism in nursing. Toronto: RNAO

5. Van Mook, W.N.K.A., Van Luijk, S.J., De Grave, W., O’Sullivan, H., Wass, V., V., Schuwirth, L.W., Van der Vleuten, C.P.M. 2009. Teaching & learning professional behavior in practice. European Journal of Internal Medicine, 20:105-111.  

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