Professionalism In Nursing: Theory And Skills

Do you remember being on your last placement and looking around at the staff who all seemed to know where to go, who to talk to, what to do and when to do it and feeling so incapable and so far from that level and almost wishing I could study for another year, another two! You may have felt like a fraud, that you had somehow gotten this far only because you had flown under the radar, which you hadn’t been ‘found out’ for being the inexperienced, unprepared nearlynurse or nearly-midwife that you felt you were.

Have you ever come across another student in their final year of their degree that is willing to be honest about how they feel? The first thing they will say is that they feel they don’t know enough, that they are scared that they are going to graduate, get their scrubs, put them on and walk into their first day on the floor and not actually know what to do next.

Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education

Development and implementation of a competency-based clinical evaluation tool for midwifery education.

The Importance of Professionalism and Non-Clinical Skills in Nursing

Being a nurse can never be defined as just a career or basically as a job. Nursing requires some non-clinical skills such as compassion, respect and a concern for the dignity of human person. Nursing as a profession calls for constant dedication to the needs of the patient and the society at large (Dent, & Tye, 2018). Professional nursing has been illustrated as adhering to the code: standards of conduct, performance, and ethics for nurses and midwives (El-Saharty, Ahmed, Ahsan, Barroy, El-Saharty, & Sparkes, (2015). This requires clinical skills such as beneficence, non-maleficence, justice fidelity and altruism. This has been seen as the foundation of good nursing practices and better standards of health to the community. This paper focuses on professionalism in nursing, various theories and models of being a professional nurse and a personal reflection on my progress as a nurse.

 Professional nursing has guiding values which enhance better provision nursing services. These values include having respect for human dignity, integrity, altruism, and justice. Human dignity entails respect for human rights. The dignity of the human person is the doctrine that encourages respect for human life. Life is sacred and human dignity can never be earned nor be taken from somebody. Human dignity, therefore, entails treating people basically the same regardless of who they are and their political social status. When a nurse has respect for the dignity of the human person, they are patient-centered. Other clinical skills include privacy and confidentiality. A nurse should not disclose a patient information to an authorized person.

Integrity is also an important skill in the nursing profession. Carpenter, (2018) argues that this gives a patient an assurance to explain themselves to the nurse for the better administering of services. In Collins, & Edelman, (2015) emphasizes on honesty, being accountable and also taking responsibility for every action they take.

Altruism and justice are also professional values in nursing posits Tanaka, Taketomi, Yonemitsu, & Kawamoto, (2016). Altruism entails being compassionate or having empathy and not being selfish towards assisting and helping others too. Justice as a value in nursing professionalism is described as being able to give equal treatment to everyone, fairly distributing the available resources and practice of using action towards achieving social and political stability amongst all.

There are both positive and negative implications of the clinical and non-clinical skills, it may impact positively and negatively in their work. One of the very positive effects is that developing these skills improves competence and enables nurses to gain resilience in their care delivery. Patterson, DeBaryshe, & Ramsey, (2017) argues that lack of these skills may make a nurse to be incompetent in their work and fail to deliver to the set standards of practice. 

Theories and Models of Professionalism in Nursing

There are several theories and models that can be used to examine professionalism in nursing. These theories observe areas of competency in nursing that nurses should work on to improve their expertise. Some of these models include the Dreyfus model of skill acquisition and Benner’s 5 stages of clinical competence. Patricia Benner, a doctor and a lecturer came up with 5 stages of clinical competence. These stages include novice, advanced beginner, competent, proficient and finally expert (Thomas, & Kellgren, 2017). In the first stage which is the novice stage, a nurse or a midwife has very little experience and exposure to the outside world. He or she is unable to effectively communicate and to convert the learned skills into practice. The nurse also lacks confidence and often gets stuck in small duties for longer hours.

In the second stage which is the advanced beginner level, a nurse has had several real life experiences. He or she is therefore able to skilfully conduct some roles. However, the nurse has not yet developed a level of competence and therefore requires someone to support and assist them as they go through their day to day duties. The nurse still gets stuck at some tasks but there is increased competence in how he or she handles her responsibilities.

The third level is the competency level. At this stage, the nurse has gained confidence in their actions. The nurse is also able to handle and conduct complex duties. He or she is able to multi task and can respond to emergencies. The nurse requires little support in performing their duties. Oshvandi, Sadeghi Moghadam, Khatiban, Cheraghi, Borzu, & Moradi, (2016) adds that the nurse is also able to plan and organize their work which makes them to achieve better results.

The fourth level of clinical competence is the proficiency level. At this level, a nurse is able to attend to all the needs of patients without having to divide the work into bits. The nurse is able to conceptualize the future, long term goals and the development process. The nurse is able to put all available factors in consideration before making a move. The nurse is able to modify their plans and actions to suite the present situations. At this point, a nurse is able to help other nurses who have not reached this level of competence. He or she is also able to step in in places where their colleagues are not able to work explains Carpio, Fuller-Wimbush, & World Bank. (2016).

Patricia Benner's 5 Stages of Clinical Competence

Finally, the last stage of clinical competence is the expert stage. At this stage a nurse is able to understand all situations and he or she is able to go direct into a problem without making mistakes as they have full understanding. The expert nurse does not waste time on unnecessary roles. The nurse is also able to make informed decisions easily and abstractly as they base on evidence. At this stage, Figueroa, Gardner, Irizarry, & Cohn, (2016) argues that the nurse takes up leadership roles and directs others nurses towards achieving higher levels of competence and proficiency.

The other theory that can be used to critically analyze professionalism in nursing is the Dreyfus model of skill acquisition. The model was advanced by Stuart and Herbert Dreyfus. The model bases its argument of four qualities which include recollection, recognition, decision and awareness (Lyon, 2015). Each of these qualities can be absorbed differently in each of the five stages of clinical competence proposed by Patricia Benner which include novice, advanced beginner, competence, proficient and finally mastery level. At each of these stages the four qualities improve progressively.

Reflection is an important learning tool for nurses and midwifes as it helps them to share their experiences and help others to learn through such experiences. This is made possible by the fact that all nurses encounter almost similar problems as they develop competency and professionalism in their work. It therefore necessary to reflect on the NMBA registered standards of nursing practice which include thinking critically and analyzing nursing practice, developing a plan for nursing practice and engaging in therapeutic and professional relationships among other standards. There are various models of reflection that a nurse can use to reflect on their experiences. Gary Rolfe’s model is one good reflective model. According to Rolfe, (2014), the model is based on three questions that seeks to understand the experience, how it impacts and what one can do about it.

What?

In my own experience as a graduate nurse, the first week I was put in the emergency department. I encountered several challenges due to my poor communication skills as I didn’t know when or how to seek clarification. I also felt that I didn’t have time to do research as I knew very little in the practical field. This always made me afraid of talking much not was also having chills in to clear the doubt.  My body especially handling critically ill patients. Most of my responsibilities included relieving pain so I really had to be careful to perform this. With time, I was moved to the renal unit. This was quite challenging also not because sometimes I was left alone as nurses moved to other departments due to the work load. I had a difficult time consulting with the standards of professional practice, patients’ rights and ethical requirements in my field.

The Dreyfus Model of Skill Acquisition

So what?

I knew I had to develop competence and good communication skills which required me to keep doing the same things over and over again. I also sought help from the other experienced nurses and also share with my colleagues on my experiences in order to seek help. I developed a plan where I would work more and very actively in group tasks rather than working alone as this would help to boost my self-confidence. Working alone always made me fear even when I knew I was doing the right thing. I also started communicating more with the patient and collaborating to make sure I delivered the best care.

Now what?

By so doing I was able to develop and build on my self-confidence. However at every single time, I have always wanted to do better, to outdo my past and to gain more expertise in my job. These initial experiences helped me to be able to set goals, improve on my communication skills and learn to help others. Helping others has always helped me to become more competent as am able to perform a task faster and more effectively every time I do it again.

Conclusion

In conclusion, professionalism is important in nursing in order to improve the quality of care and also assure patients of safety. It is therefore necessary for nurses to strive towards professionalism by putting into practice professional standards of care, inculcating the moral and ethical requirements such as fidelity, justice, beneficence and non-maleficence and by having strong personal values such as integrity and compassion. A nurse should also be guided by the theories of professional practice to be able to reflect on their experiences and to help other nurses.

References

Carpenter, M. (2018). The new managerialism and professionalism in nursing. In Health and the Division of Labour (pp. 165-195). Routledge.

Carpio, C., Fuller-Wimbush, D., & World Bank. (2016). The nurse workforce in the Eastern Caribbean: Meeting the challenges of noncommunicable diseases.

Dent, B., & Tye, J. (2018). The heart of a nurse leader: Values-based leadership for healthcare organizations. United States: Paradox Twenty One, Inc. 

El-Saharty, S., Ahmed, S. M., Ahsan, K. Z., Barroy, H., El-Saharty, S., & Sparkes, S. P. (2015). The Path to Universal Health Coverage in Bangladesh: Bridging the Gap of Human Resources for Health. Washington, DC: The World Bank. Hajra, N. H. (2016). common problems in the nursing profession. mims today

Figueroa, S., Gardner, J., Irizarry, J., & Cohn, T. (2016). Married state preceptorship model: Crossing the state line in new graduate nurse transition to practice. The Journal of Continuing Education in Nursing, 47(11), 511-517.

In Collins, C. F., & Edelman, M. W. (2015). Black girls and adolescents: Facing the challenges.

Lyon, L. J. (2015). Development of teaching expertise viewed through the Dreyfus model of skill acquisition. Journal of the Scholarship of Teaching and Learning, 88-105.

Oshvandi, K., Sadeghi Moghadam, A., Khatiban, M., Cheraghi, F., Borzu, R., & Moradi, Y. (2016). On the application of novice to expert theory in nursing; a systematic review. Journal of Chemical and Pharmaceutical Sciences.

Patterson, G. R., DeBaryshe, B. D., & Ramsey, E. (2017). A developmental perspective on antisocial behavior. In Developmental and Life-course Criminological Theories (pp. 29-35). Routledge.

Rolfe, G. (2014). Rethinking reflective education: what would Dewey have done?. Nurse Education Today, 34(8), 1179-1183.

Tanaka, M., Taketomi, K., Yonemitsu, Y., & Kawamoto, R. (2016). Professional behaviours and factors contributing to nursing professionalism among nurse managers. Journal of nursing management, 24(1), 12-20.

Thomas, C. M., & Kellgren, M. (2017). Benner’s Novice to Expert Model: An Application for Simulation Facilitators. Nursing science quarterly, 30(3), 227-234.