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Redefining the concept of professionalism in nursing: an integrative review

Azadeh Azemian
Azadeh Azemian
, 
Abbas Ebadi
Abbas Ebadi
 oraz 
Leila Afshar
Leila Afshar
   | 30 gru 2021
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Article Category: Review
Data publikacji: 30 gru 2021
Zakres stron: 327 - 340
Otrzymano: 10 lut 2021
Przyjęty: 26 mar 2021
DOI: https://doi.org/10.2478/fon-2021-0033
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© 2021 Azadeh Azemian et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

PRISMA diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
PRISMA diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Characteristics of the included articles.

Row Article Country Design Objective(s) Major finding(s)
1 Miller et al.4 USA Validation study To describe the development of an evaluative behavioral inventory based on Miller's Model for Professionalism in Nursing and to report the results of an investigation of registered nurses in eight western states. The majority of the participants displayed professional behaviors in continuing educational activities, autonomous quality assurance participation, community service, and theory-based nursing practice.
2 Weiset et al.31 USA Validation study To describe the NPVS, its development, reliability, and validity, and its derivation from the Code of Ethics of the American Nurses Association. Eight factors such as caregiving, activism, accountability, integrity, trust, freedom, safety, and knowledge were identified. The two major factors were caregiving and activism. The NPVS was found to be highly reliable and valid.
3 Tanaka et al.32 Japan Descriptive To compare NP among nurse leaders in the USA and Japan. The total mean score of professionalism was significantly higher in the USA. The mean scores of professionalism subscales were also significantly higher in the USA. While American participants scored significantly higher in the categories of education preparation, community service, theory development, and self-regulation and autonomy, Japanese nurse leaders scored significantly higher in publication and communication as well as research development.
4 Shahriari et al.33 Iran Descriptive-analytical To utilize a standard tool to explore perspectives on the application of ethical and professional values in the clinical environments of nursing care in Isfahan city. The most important criteria of professional ethics were protecting people's health and safety, respecting patients’ moral and legal rights, following practices guided by principles of fidelity and respecting individuals, and protecting patients’ right to privacy.
5 Hodges et al.13 Canada Discourse-analysis approach Determine the appropriate element for assessing professionalism. A multi-dimensional, multi-paradigmatic approach to evaluate professionalism at different levels, namely, individual, inter-personal, and societal-institutional.
6 Fantahun et al.25 Ethiopia The cross-sectional and qualitative design To investigate factors affecting professionalism in nursing. The main factors influencing professionalism were workload, lack of vision, government's lack of support of and focus on the profession, poor organization of the Ethiopian Nursing Association, lack of life insurance as well as the health professionals, and society's views of the profession.
7 Parandeh et al.8 Iran Systematic review To assess different factors affecting the development of professional values among nursing students and instructors. Educational, cultural, and individual factors played a role in developing nurses’ professional values. And four extracted themes include “education and achieving professional experiences,” “Students and instructors’ perspectives on professional values,” “the role of culture in considering and developing professional special values,” and “the effect of learners’ individual characteristics.”
8 Habibzadeh et al.34 Iran Qualitative To investigate facilitators of and barriers to nursing professionalization in Iran. Communication, motivation and attitude, organizational culture and structure, academic education, and supportive resources affect nursing professionalization.
9 Crowder et al.35 USA Historical perspective To explore historical evidence regarding nurses’ concerns about professionalism. Four important factors were found: education, commitment to the profession, community sanction, and professional organization.
10 Rassin et al.36 Israel Quantitative To measure professional and personal values among nurses and to identify the factors affecting these values. Three main professional nursing values including human dignity, equality among patients, and prevention of suffering were found.
11 Allari et al.9 Saudi Arabia Cross-sectional survey To evaluate the reliability and validity of the Arabic version of the NPVS-Revised. NPVS was empirically validated, indicating its suitability for national and regional application.
12 Ghadirian et al.37 Iran Concept analysis To identify the core attributes of NP. Cognitive, attitudinal, and psychomotor factors are the main attributes of NP.
13 Primm et al.38 USA Descriptive To describe eight aspects of NP. Nurses can use the wheel of professionalism to identify their behaviors and set goals for change or improve their professionalism in practice.
14 Hershberger et al.39 USA Survey To examine self-control as a component of resident professionalism through exploring residents’ and their program directors’ views. There was no correlation between residents’ self-reported professionalism and their program directors’ ratings, indicating the difficulty in understanding and measuring this competency.
15 Ali Dehghani et al.7 Iran Concept analysis To clarify and reduce the semantic ambiguities related to the concept of professionalism. NP comprises three main factors: principles of care, communication, and ethics. NP can positively affect nurses, the nursing profession, and the health care system.
16 College of Nurses of Ontario11 Canada Guidelines for nursing standards To provide guidelines for professional standards. Guidelines on the knowledge, skills, judgment, and attitudes necessary for safe practices were suggested.
17 Finnbakk et al. Sweden Cross-sectional survey To examine the reliability and construct validity of the new Professional Nurse Self-Assessment Scale (ProffNurse SAS) in Norway. The instrument has acceptable reliability and construct validity, and can be used for assessing practicing nurses’ clinical competence.
18 Lesser et al.40 USA Review To provide a practical approach for physicians and the organizations in which they work. Professional behaviors could be affected by the organizational and environmental context of contemporary medical practice. These external factors should be controlled to foster professionalism in practice, providing opportunities to improve health care services via reforms in education and the whole system.
19 Wilkinson et al.12 New Zealand Literature review To match assessment tools to definable elements of professionalism and to identify gaps where professionalism elements are not well-addressed by existing assessment tools. Professionalism consists of the following elements: adherence to ethical practice principles, effective interactions with patients and with people who are important to them, effective interactions with people working within the health system, reliability, and commitment to autonomous maintenance/improvement of competence in oneself, others, and systems. Several assessment tools were identified: observed clinical encounters collated views of coworkers, records of incidents of unprofessionalism, critical incident reports, simulations, paper-based tests, patients’ opinions, global views of the supervisor, and self-administered rating scales.
20 Fisher41 USA Descriptive To compare the development of professionalism in pre-licensure nursing students in associate degree, diploma, and BA programs. The amount of time spent in nursing programs does not affect professionalism. Educators should use strategies to foster these values. The quantity and quality of pre-licensure education should be re-evaluated. Personal and professional values should be integrated into the ethical standards of the nursing profession while students advance along the continuum of professionalism.
21 Li et al.42 China Systematic search To systematically evaluate the psychometric properties of NP instruments and the methodological quality of the studies they were used in. Content validity, cross-cultural validity, and criterion-related validity were either unreported or received negative ratings in most studies. Based on the best-evidence synthesis, three instruments such as Hisser's instrument for nursing students, nurse practitioners’ roles and competencies scale, and perceived faculty competency inventory were recommended.
22 Wynd2 USA Descriptive comparative/correlational To explore registered nurses’ attitudes toward professionalism and to examine differences and relationships among degrees of professionalism, levels of education and experience, membership in professional organizations, and specialty certification in nursing. The findings indicated that professionalism was significantly associated with years of experience as a registered nurse, higher educational degrees in nursing, membership in organizations, service as an officer in the organization, and specialty certification.
23 Ayla43 Turkey Descriptive To explore the professional values of nursing students and the factors affecting them. The scores of student nurses’ professional values were at a good level. Personal and environmental factors could affect the professional values of student nurses. Professional values of nursing are the most important components of the protection of high-quality standards in the nursing profession. Nurses should be provided with these values in their education.
24 Karadağ et al.44 Turkey Descriptive To explore nursing students’ attitudes toward professionalism. The mean total scores of professional attitudes were satisfactory. The highest mean scores were for autonomy, competence, and continuous education while the lowest ones were for cooperation, contribution to scientific knowledge, and participation in professional organizations.
25 Hisar et al.45 Turkey Descriptive To investigate the professional behavior of nurse executives. The lowest scores were reported for participation in professional organizations, educational preparation, and autonomy. Moreover, most participants did not have a copy of the ethics codes. Furthermore, the professional behavior and conduct of middle nurse managers and nurse executives were low.
26 Kim-Godwin et al.46 South Korea Descriptive To assess the levels of professionalism and examine factors associated with professionalism among Korean American nurses. Several factors were associated with professionalism among Korean American registered nurses, namely, membership in professional organizations, current nursing employment positions, current employment status, work settings, total years of nursing experience, total years of nursing experience in the USA, location of obtaining their final degree, and duration of nursing education in the USA.
27 Çelik et al.47 Turkey Validation study To confirm the identified factor structure of the IPASN. The factors of the IPASN including an increase in scientific information load, autonomy, cooperation, competence, and continuous education, participation in professional organizations and professional development, working in committees, community service, and ethical codes and theory were confirmed by CFA. IPASN was confirmed theoretically and statically.
28 Altiok et al.48 Turkey Qualitative To explore students’ experiences of professionalism in clinical practices as well as their perceptions about the concept of NP. Seven major themes related to professionalism were as follows:

Behaving according to ethical principles.

Being well-informed in the field.

Providing integrated care.

Gaining and developing professional skills.

Behaving autonomously.

Ensuring cooperation.

Having altruism.
29 Lombarts et al.49 The Netherlands Qualitative To evaluate the reliability and validity the researcher-made scale for measuring professionalism among physicians and nurses, and the relationship between professional attitudes and professional behaviors. Both physicians and nurses reported equally high professional attitudes but physicians scored highest in professional competence and lowest on the inter-professional collaboration. Nurses scored highest on improving quality of care and authority as the lowest subscale.
30 Svensson50 Sweden Descriptive To explore the relationship between professionalism, trust, and competence, and to outline some conditions for professionalism as a means to provide trust and confidence in professional work organizations. The concept of professionalism in this article was highly dependent on knowledge, competence, and skill, and coupling with occupations and occupational practice.Professionalism was considered as a contextual competence rather than a general capability. Practical knowledge, experience and familiarity, and the utilization of practical knowledge were considered more important than theoretical knowledge and formal education.
31 Lehna et al.51 USA Qualitative To investigate the effect of current nursing attire on the image of the nursing profession. Professionalism is a total package consisting of attire, mannerisms, and a certain attitude. The sub-themes were role identification and competency.
32 Tanaka et al.52 Japan Descriptive To examine nurse managers’ perceptions of professional behaviors and the contributing factors. The highest and lowest scores for professional behaviors were obtained in “competence and continuing education” and “publication and communication,” respectively. Higher NP was significantly related to the increased length of nursing experience, higher levels of educational preparation, and the current position as a nurse administrator.
33 Rhodes53 Literature review To review the related literature on professionalism, comment on professionalism in health services professions, present a model of reaction to professionalization and draw conclusions about the results of this trend. to propose a model for professionalism in the health service professions based on ten characteristics of “professionalism” that include a full-time occupation, a strong motivation or calling for the career, a specialized body of knowledge and skills acquired during a prolonged period of education and training, decision-making on behalf of the client in terms of principles, theories or propositions, service orientation, service based on the objective needs of the client and mutual trust, autonomy of judgment for performance, formation of professional associations and other professional credentials, a specific set of knowledge, not allowing professionals to seek out clients,
34 Bragancaa54 GOA Qualitative To explore the factors influencing professionalism among nurses. and internal factors such as communication challenges, individual characters, and responsibility as well as external factors like educational and cultural development, organizational preconditions, and support systems affecting professional ethics in nursing practice. Findings imply that knowledge of professional ethics and the contributing factors may help nurses and other healthcare professionals to provide better patient services.
35 Hintistan et al.55 Turkey Descriptive To identify professionalism characteristics among nurses working in the internal medicine clinics of a university hospital. Nurses believed the most important characteristics were “taking individual responsibility in nursing practices” and “paying attention to using a simple and clear language by establishing a good communication with patients and team members.” The characteristics included “becoming a member of a nursing association,” and “feeling the necessity” to use the titles of a specialist nurse.
36 Balang et al.56 Turkey Literature review Describing the professionalism among Malaysian nurses. Promoting and maintaining professional behavior from the individual level to the organization level. Through mandatory regulations for nurses to participate in CPD programs for the renewal of certificates, mentor and mentee programs, and the allocation of postgraduates for nurses in the health care system.
37 Konukbay et al.57 Turkey Descriptive Compressive assessment of nurses’ professional behavior. The lowest scores were reported in autonomy, publishing, and professional organization educational preparation while the highest scores were obtained in continued education, use of theory, education, research, nursing codes, and social services.
38 Mahmoud Salem et al.58 Saudi Arabia Analytic cross-sectional Investing the nature of the relationship between conflict and nurses’ perceptions of their professionalism. Findings show that most nurses had a low-level perception of their professionalism. Factors that were effective in the low-level perception of nurses of professionalism include the personal interest in the nursing profession and view of family, society, and consumers to the profession.
39 Solomon et al.20 South West Ethiopia Cross-sectional and Qualitative Determining the level of professionalism and its predicators among nurses. The results revealed a low level of professionalism among nurses that lead to negative outcomes including increased turnover and attrition and decreased productivity. The most substantial finding of this study is that organizational culture is a significant predictor of the nursing profession.
40 Alidina59 Canada Literature review To explore and analyze NP and the contributing factors; to recommend strategies for fostering NP. Nurses should display the attributes of professionalism in their daily practice because it positively affects patient satisfaction and health outcomes. NP provides nurses with opportunities to grow personally and professionally.
41 Hershberger et al.39 USA Descriptive To investigate the extent to which self-control is a component of resident professionalism among residents and their program directors. Self-control is an important facet of human behavior and interpersonal interaction, including the behaviors constituting medical professionalism. There was no correlation between resident and program director professionalism.
42 Hwang et al.60 Korea Descriptive To compare the factors affecting job satisfaction among Korean and Chinese nurses. Professionalism was the key factor contributing to job satisfaction in Korean and Chinese nurses. Professionalism was positively associated with job satisfaction in both groups.
43 Ojlovich et al.61 USA longitudinal Identify the relationship between organization culture, personal sense of accomplishment, and NP. Organizational culture is an important predictor of NP. There is a strong link between organizational culture and professional nursing practice. Also, positive links among culture, the moral, and retention of employees and decrees patient mortality were found.
44 Karadag et al.62 Korea Descriptive To evaluate professionalism among nurses in Korea. The lowest scores were reported in autonomy and educational preparation while the highest scores were obtained in ethical codes for nurses and community service. Mean scores on the BIPN were higher for nurse instructors and in the group proceeding with graduate studies, and they were lower in nurses working in the ward and those with associate degrees.
45 Dikmen et al.63 Turkey Descriptive To evaluate the professional behavior of nurses in a hospital. The highest scores were for the sub-scales of competence and continuing education while the lowest ones were for autonomy and publication and research sub-scales. There was a statistically significant difference between the total BIPN scores and the education levels of the nurses and working of the nurses.
46 Lasala64 USA Review To explore the factors contributing to professionalism. Creating a positive first impression is important in seeking a new position or working with patients, colleagues, and the public. Nurses should pay special attention to their appearance and behavior.
47 Schönrock-Adema et al.65 The Netherlands Descriptive To examine the effect of peer assessment on professional behavior. The findings indicated that peer assessment could enhance professional behavior. Moreover, female students’ professional behavior was significantly higher than male students.
48 Tabatabai et al.66 Iran Qualitative Concept analysis of professionalization from the perspectives of nurses working in cardiac care units. The results of concept analysis showed that professionalization consists of seven major themes: community service, nursing knowledge and skills, support organizations, professional independence, good interpersonal relationships, ethical commitment, and attention to professional vulnerability.
49 Jafaragaee et al.67 Iran Qualitative To explore the barriers to professionalism from the perspective of clinical nurses and facilitate the commitment to the nursing profession. Three main themes were extracted, namely, the nature of the nursing profession (professional adherence and excellence professional adherence and excellence), factors facilitating professional commitment (value and professional motivation), and barriers to professional commitment (feelings of inferiority, experience, hardship, and frustration).
50 Nikbakht Nasrabadi et al.68 Iran Qualitative To explore first-year nurses’ experience of professionalism. The major themes were sufficient knowledge of nursing, experience, independence in practice, and provision of comprehensive patient care.
51 Ravanipour et al.69 Iran Qualitative To explore criteria for professionalization in nursing from the viewpoints of nursing teachers. Four main and eight sub-themes, such as the promotion of empowerment (individual empowerment—professional empowerment), professional ethics and commitment (ethics and individual values —professional ethics and commitment), resources and structure (educational resources and structure—resources and organizational structure), social status reform, were identified in this study.
52 Afshar70 Iran Qualitative To identify barriers to professional empowerment from the perspectives of nurses working in a surgery department. “Learned disability” was found as the major theme. It consists of three main sub-themes: “basic deficiencies,” “lack of professional support,” and “basic professional disadvantage.”
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Język:
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Dziedziny czasopisma:
Medicine, Assistive Professions, Nursing
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