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Experiences of Professionalism Attributes among Undergraduates Nursing Students and Nurses

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Abstract

Context: Professionalism is an essential ingredient in the nursing profession that begins during the foundational educational program when the student nurses learn the knowledge, skills, and attitudes and continue during their practices in the real world. Aim: This research aimed to assess the main attributes of professionalism among undergraduates nursing students and nurses. Methods: This study utilized a descriptive comparative correlational design. The current study was conducted in the faculty of nursing, as well as in Intensive Care Units, Neonatal Intensive Care Units, Cardiac Care Units, and Neurology Intensive Care Units at Tanta University Hospital. Subjects. The sample consisted of (897) nursing students and (149) nurses. The data collection's tool was the nursing professionalism attributes' questionnaire that was developed by the authors. It contains three dimensions, including; professional identity (12 statements), professional ethics (12 statements), and professional behaviors (16 statements). Results: This study suggested that the undergraduate nursing students perceived the high mean score in all professionalism attributes more than the practicing nurses did. Conclusion: This study concluded that the development of professionalism in nursing is an essential feature of the nursing profession and practice. The nurse students were high in areas of patients and colleagues' rights, obeying orders, commitment and collaboration, physical appearance, continuing education, and caring of the patient. While the nurses had very low scores in membership in the nursing association, autonomy, and research areas, this study recommended the encouragement of nurses and students' participation in scientific research activities, including; membership in professional organizations or associations, attending nursing conferences/workshops/symposium as a producer or consumer, and fellowship.
Evidence-Based Nursing Research Vol. 2 No. 1
January 2020
Article number 8 page 1 of 12
Experiences of Professionalism Attributes among Undergraduates
Nursing Students and Nurses
Lobna K. Mohamed1, Shereen R. Dorgham2, Walaa M. Eid3
1Nursing Services Administration Department, Faculty of Nursing, Tanta University, Egypt.
E-mail: lobnakhamis2020@gmail.com
2Nursing Services Administration Department, Faculty of Nursing, Tanta University, Egypt
E-mail: d_org_ham7@hotmail.com
3Nursing Services Administration Department, Faculty of Nursing, Tanta University, Egypt.
E-mail: drwalaaeid954@gmail.com
Received November 3, 2019, accepted December 5, 2019
ABSTRACT
Context: Professionalism is an essential ingredient in the nursing profession that begins during the foundational educational program
when the student nurses learn the knowledge, skills, and attitudes and continue during their practices in the real world.
Aim: This research aimed to assess the main attributes of professionalism among undergraduates nursing students and nurses.
Methods: This study utilized a descriptive comparative correlational design. The current study was conducted in the faculty of nursing,
as well as in Intensive Care Units, Neonatal Intensive Care Units, Cardiac Care Units, and Neurology Intensive Care Units at Tanta
University Hospital. Subjects. The sample consisted of (897) nursing students and (149) nurses. The data collection’s tool was the nursing
professionalism attributes' questionnaire that was developed by the authors. It contains three dimensions, including; professional identity
(12 statements), professional ethics (12 statements), and professional behaviors (16 statements).
Results: This study suggested that the undergraduate nursing students perceived the high mean score in all professionalism attributes
more than the practicing nurses did.
Conclusion: This study concluded that the development of professionalism in nursing is an essential feature of the nursing profession
and practice. The nurse students were high in areas of patients and colleagues’ rights, obeying orders, commitment and collaboration,
physical appearance, continuing education, and caring of the patient. While the nurses had very low scores in membership in the nursing
association, autonomy, and research areas, this study recommended the encouragement of nurses and students' participation in scientific
research activities, including; membership in professional organizations or associations, attending nursing
conferences/workshops/symposium as a producer or consumer, and fellowship.
Keywords: Professionalism, Attributes, nurses, Undergraduate nursing students
.
1
. Introduction
The presentation of professional experiences among
nursing students and practicing nurses in both personal life
and clinical field of work depends on many factors. Adams
and Miller (2001) have established a nursing professionals
wheel that describes the factors leading to overall nursing
professionalism, including adherence to code of ethics,
continuing education, orientation towards community
service, development, use and appraisal of theory or
research, autonomous and self-regulating activities,
involvement of professional organizations, publication,
communication, and educational preparation.
Moreover, recent studies argued that nursing
professionalism influenced by the availability of role
models in the academic and clinical training field during the
teaching process, communication skills, autonomy in
decision-making, intellectuality, and entrepreneurial.
Additionally, the content of the nursing program curriculum
plays significant roles in enabling the development of a
1
Correspondence author: Lobna Khamis Mohamed
professional identity (Ousey 2009; Altiok & Üstün 2014;
Wills, Wilson, Woodcock, Abraham & Gillum, 2018).
There is evidence indicated that the educational level
increased the commitment towards professionalism and the
development of professional attitudes, as well as the
acquisition of professional knowledge, skill, ethics, and
behaviors that, in turn, influences the future quality of
nursing. Professionalism in nursing has many positive
consequences that improved patient care, nurses' job
satisfaction, and retention (Karadag, Hisar, Çelik, &
Baykara, 2016).
A literature review on the theme of professionalism in
nursing suggested that it has a complex nature with multi-
dimensions concepts, including the profession's identity,
ethics, and values that restrict abuse actions in personal life
and work (Alidina 2013; Ghadirian, Salsali, & Cheraghi,
2014, Wuerz, 2017). The professional identity is the crucial
factor of nursing socialization that begins with formal
education and extends into working in the professional
clinical environment over time. It described as values and
beliefs held by nurses, which direct thinking, actions, and
interactions with their patients, colleagues, and
organizations (Arreciado Maranon, & Isla Pera, 2015).
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Lobna K. Mohamed, Shereen R. Dorgham, Walaa M. Eid: Experiences of Professionalism Attributes among Undergraduates Nursing……
Article number 8 page 2 of 12
In this context, ethics is a fundamental part of nurses'
work that refers to the moral and norms of the nursing
profession that protect patients' rights and guide nurses to
contribute to the development of a healthy society. In
nursing, professional ethics is built based on professional
and personal commitment, including rights, duties, and
responsibilities (Kangasniemi, Pakkanen, & Korhonen,
2015). While, professional values are standards for nursing
action that give justifications for judgment and choices, as
well as a framework for evaluating beliefs and attitudes that
influence nurses’ behaviors. The fact Generally,
professionalism is an elusive term that involves different
meanings to different people (Evan, 2008).
Despite frequent use in many organizations and ease to
recognize, but it is difficult to define. There is a lack of
consensus about the meaning of professionalism (Rowland
2016). Ghadirian Salsali & Cheraghi (2014) defined
professionalism as a set of attitudes and behaviors, which
seems like the expression of what is required or expected of
members toward a specific profession. In other words,
Ibrahim and Qalawa (2016) stated professionalism as a
personal characteristic that displayed in an approach to an
occupation represented in intelligence, integrity, maturity,
and thoughtfulness. It involves behaving ethically and
fulfilling responsibilities in all situations with appropriate
behavior and communication. Furthermore, there is a need
for specific applied skills and knowledge that enable people
to execute their roles successfully. Professionalism includes
attitudes that reflect levels of identification with a particular
profession and commitment (Wynd, 2003; Danesh et al.,
2013).
Professionalism in nursing is a crucial component to
maintain a healthy working environment and is easily
enabled by practice (Registered Nurses Association of
Ontario (RNAO) 2007). It is a comprehensive concept that
provides nurses with opportunities to grow personally and
professionally (Alidina, 2013). It requires nurses to
illustrate specific behaviors, as well as demonstrate
knowledge, attitudes, and skills (Adams & Miller 2001).
The term of nursing professionalism possesses
characteristics of expertise, autonomy, long academic
preparation, commitment, collaboration, and responsibility
that contribute to marking a profession or a professional
person (Van e De Bragancaa & Nirmalab 2017).
In nursing, the professionalism process begins during
the foundational educational program when the student
nurses learn the knowledge, skills, and attitudes and
continue during practices in the real world. During this
process, the student nurses acquire professional standards
and develop their own professional identity (Black, 2016).
Experiences of professional socialization help the nurse
students to develop the skills of communication,
organizational and affective commitment, responsibility,
intrinsic motivation, autonomy in decision-making, and
problem-solving, and professional identity (Ousey, 2009).
This process is required to plan the nursing curriculum
and educational activities in both theoretical and clinical
training for students to become professionals with the
required qualifications (Altiok & Üstün 2014). Hence, nurse
students and practicing nurses should maintain and update
their competencies regularly regarding professionalism that
affect patients' satisfaction and achieving positive health
outcomes (Ghadirian, Salsali & Cheraghi, 2014; Fenwick,
2016; Rowland, 2016). It cannot be overlooked is that
nursing has a particular profession identity rooted in
professional ethics and ethical values (Altiok & Üstün
2014; Poorchangizi et al., 2019).
2. Significance of the study
The academic nursing leaders have a lack of evidence
regarding how the undergraduate nursing students and
practicing nurses perceive professionalism and how to
maintain it throughout the profession. Understanding the
perspectives of undergraduates nursing students and nurses
about professionalism is an essential issue for providing
appropriate educational activities to enhance and maintain
the professional socialization. Additionally, professionalism
in nursing has many positive aspects that can be used to
attract young students as a viable career choice.
Consequently, it becomes imperative for the academicians
to re-assess the present status of professionalism in nursing.
Therefore, this research investigated the baccalaureate-
nursing students' and nurses' experiences regarding
professionalism.
3. Aim of the study
This research aimed to assess the main attributes of
professionalism as perceived by undergraduate nursing
students and nurses.
3.1. Research Questions
The current study aimed to answer the following
research questions:
- What are the levels of professionalism as perceived by
nursing students?
- What are the levels of professionalism as perceived by
nurses?
- Are the demographic characteristics of nurses or nursing
students affecting their levels of professionalism?
- Is there a difference between nursing students’
professionalism and nurses’ professionalism
perspectives?
4. Subjects and Methods
4.1. Research design
The present study was utilized as a descriptive
comparative correlational design, which used to describe
the three attributes of professionalism. This design involves
systematic investigation for the nature of relationships or
associations between and among variables. It examines
whether and to what degree the statistical relationship, as
well as to detect its direction, magnitude, and strengths
(Polit & Beck 2018).
4.2. Research Setting
This study was conducted in the faculty of nursing, as
well as in Intensive Care Units (ICU), Neonatal Intensive
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Evidence-Based Nursing Research Vol. 2 No. 1 January 2020
Article number 8 page 3 of 12
Care Units (NICU), Cardiac Care Units (CCU), and
Neurology Intensive Care Units at Tanta University
Hospital.
4.3. Subjects
This study utilized a convenience sample, which
consisted of (897) undergraduate nursing students from
third, fourth, and interns, as well as (149) nurses from the
previously mentioned settings according to their attendance
and availability during the time of data collection. The
overall response rate was 72.7% out of 205 nurses and
82.3% out of 1090 nursing students (males & females) in
the academic year of 2018/2019, who agree to participate in
data collection.
4.4. Tools of the study
4.4.1. Nursing Professionalism Attributes’
Questionnaire
Data collected using a structured interview
questionnaire. It was developed by the researchers based on
an extensive related literature review (Danesh et al., 2013;
Black, 2016; Dikmen et al., 2016; Doost et al., 2016; Ana
Vaz e De Bragancaa, & Nirmalab, 2017, Poorchangizi et
al., 2019). The nursing professionalism attributes’
questionnaire consists of two parts.
The first part involves the nurses' demographic data,
age, gender, marital status, educational level, years of
experiences, working department, working hours per week,
shift preference and type of contract while the nurse
students' demographic information are age, gender, marital
status, and academic year.
The second part involves 40 statements for measuring
the professional attributes that dividing into three
dimensions involving:
Professional identity: This dimension showed the
significance of nursing profession for a nurse, which
reflects nursing image (4 statements), caring of patient (3
statements), professional appearance (1 statement), nursing
research (1 statement), decision-making autonomy (1
statement), membership in nursing association (1 statement)
and continuing education (1 statement).
Professional ethics: This dimension encompassed the
personal and corporate standards of behaviors, which
reveals a code of ethics (4 statements), patients' rights (6
statements), and colleagues’ rights (2 statements).
Professional values: This dimension stand out for the
beliefs and principles that guide nurses’ decisions and
actions in their career, which incorporates carrying
responsibility (5 statements), accepting criticism (1
statements), obeying orders (2 statements), communication
skills (3 statements), and showing commitment &
collaboration (5 statements).
Scoring system:
The responses for answering the second section of the
questionnaire were measured on a 5-point Likert rating
scale as 5= strongly agree; 4= agree; 3=unsure; 2=disagree;
and 1= strongly disagree with describing how well the
nurses' students and nurses' opinions about the
professionalism attributes. There are three statements with
an inverse Likert scale; one statement presented in each
subscale. The subtotal score for each dimension was
calculated separately according to the statements’ number.
The subtotal score of either professional identity or
professional ethics ranged between 12 and 60, while the
subtotal score for the dimension of professional values
ranged from 16 and 80.
The total scale score ranged from 40-200. The levels of
total professionalism attributes determine according to the
following:
- The high level has a score that ranged from160 to 200
that represented between 80% and 100%.
- The moderate level has a score that ranged from 120 to
158 that represented between 60 and 79%.
- Low level has a score of < 120 (less than 60%).
4.5. Procedures
Data were collected through a self-administered
questionnaire, which translated into the Arabic language to
be clear for all participants' level of education and back-
translated to ensure accuracy. The questionnaire took
approximately 10 to 15 minutes for each participant. The
actual time for data collection between January 2019 and
March 2019 during the academic year 2018/2019.
Ethical considerations: The authors obtained approval
from the authoritative personnel at the Faculty of Nursing
(Dean of the college), Tanta University, and Tanta
University hospital (Hospital director) before initiating the
data collection. Oral consent was obtained from nursing
students and practicing nurses after explaining the aim of
the study. The participation in the study was voluntary
without penalty from unwilling participants. They were told
that their answers would be kept confidential.
A panel of five experts was invited to review the
questionnaire from the nursing administration specialty to
assess the face and content validity, as well as to check the
fidelity. Based on this revision, necessary modifications
were done, and a pilot study was conducted on 10% (who
are excluded from the study sample). As well as, the tool
was examined for reliability by two times (test-retest
reliability) with separate two weeks to be sure from the
applicability of the questionnaire and stability of the
respondents' answers. The value of Cronbach's coefficient
alpha test was equal to 0.78, and the test-retest reliability
value for nominal data was more significant than 0.8.
4.6. Data analysis
All data were collected, tabulated, and subjected to
statistical analysis that was performed by SPSS in general
(version 20), while Microsoft Office Excel is used for data
recording of the two groups. The Mean and Standard
Deviation (SD) describe quantitative variables. Independent
samples t-test is used for comparing the means.
Analysis of Variance one-way ANOVA F test was
applied for comparing the means of more than two groups.
Z-test was used to compare population means to the
sample. The Pearson correlation coefficient is applied to
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Lobna K. Mohamed, Shereen R. Dorgham, Walaa M. Eid: Experiences of Professionalism Attributes among Undergraduates Nursing……
Article number 8 page 4 of 12
study the correlation between two variables. Proportions
and percentages describe qualitative categorical variables.
The significance level was considered at P ≤ 0.05.
5. Results
Table 1 describes the demographic characteristics of
nurses at Tanta University Hospital. It was observed that
49% of nurses were in the age group 25 to >30 years old
with a mean score of 25.28±2.67, 89.3% of them were
females, and 87.9% of them were married. Slightly more
than two thirds (67.8%) of nurses had a Baccalaureate
degree, 70.5% had less than five years of experience, and
39.6% of them worked in general intensive care units.
Moreover, more than half of the participants (58.4%)
worked in the morning shift, and 68.5% of them had a full-
time job.
Table 2 represents the demographic characteristics of
nursing students. It was apparent that 44.0% of participants
were in the age group 23-year-old and more with a mean
age of 22.02±0.99, and 69% were females. The majority of
respondents (79.3%) were singles, and (38.9%) of them
were in the third academic year.
Table 3 displays the nurses’ perception of
professionalism dimensions’ subscales. About professional
identity subscale, the nurses stated that they do not
disseminate false information (79.9%), wear official
uniform and keep physical appearance (70.5), focus all
efforts on the patients during caring (71.2%), create
positive image about their profession (59.1%), seek for
additional continuing education (53.7%) and document
patients' information accurately and completely (52.4%).
While the nurses report that they do not look for
membership in the nursing association (87.2%), have not
decision-making autonomy (73.1%), and do not participate
in nursing research (71.2%).
Concerning professional ethics subscale, the nurses
report that they request advice to meet the patient needs
(81.2%), keep the patient-related information securely and
confidentially (79.2%), treat patients with empathy and
rapport (77.2%), safeguard patients' right to privacy
(71.1%), treat all patients equally (68.4%), and provide the
service in a respectful manner (64.4%). On the other hand,
they do not cheat to achieve a higher bonus (92.6%) and do
not report for any illegal (81.9%) or unethical behaviors
(66.5%).
Regarding professional values subscale, the nurses
reported that they commit to help and care of patients
(86.6%), have enough knowledge and skills to do the
assigned work (77.2%), follow written rules and regulation
in the institution (71.8%), accept orders and decisions from
the supervisors (67.8%), communicate effectively (67.1%),
organize work on time (57.8%) and did not complete work
independently (61.8%). On the same scene, they do not
show creativity for catching opportunities (80.6%) and do
not accept either participating in ethical opposition (61.1%),
or negative criticism (51%).
Table 4 shows the nurse students’ perception of
professionalism dimensions’ subscales. As regard
professional identity subscale, the students documented that
they wear official uniform & keep physical appearance
(94.9%), seek for additional continuing education (90.8%),
document patients’ information accurately and completely
(90.5%), as well as focus all efforts on the patients caring
(90.2%), create a positive image about their profession
(87.2%) and do not disseminate false information (79.9%).
They have a decision-making autonomy (79.4%), proud to
study in nursing (70.2%), be pleased to belong to this
profession (66.2%), and participate in nursing research
(64%) while only (44%) of them reported that they look for
membership in nursing associations.
According to the professional ethics subscale, the
students had high scores in all items. They treat all patients
equally (97.2%), keep patients’ information securely and
confidentially (95.1%), respect the individuals’ experiences
(94.3%), safeguard patients’ right to privacy (93.8%),
request advice to meet patient needs (93%), act as an
advocate (92.9%), respectfully provide the service (91%),
and treat patients with empathy and rapport (90.3%). They
also use a code of ethics as a guide for practice (87.2%),
report about unethical (85.2%) or illegal (81.9%) behaviors,
and do not cheat for achieving higher bonuses (74.4%.
Concerning professional values dimension, the
majority of students reported high scores in all items except
45.1% of them do not accept to participate in patients' care
if in ethical opposition to their own professional values.
Table 5 illustrates the comparison between nurses' and
nursing students' perceptions of professionalism
dimensions. The undergraduate nursing students
experienced the highest mean score in their perception
regarding professional ethics (83.14), followed by
professional behaviors (79.06), while they had the lowest
perception of their professional identity (78.07). Moreover,
the highest mean score perceived by practicing nurses was
in professional identity (62.68), followed by professional
ethics (57.07) and, finally, professional behaviors (54.34).
In this context, the total mean score of professionalism
items among nurses' students (80.11) was higher than in
practicing nurses (54.62). Therefore, the student nurses’
perception was higher in all professionalism dimensions
compared to the nurses with highly statistically significant
differences among all professionalism dimensions in both
studied groups
Figure 1 presents the total professionalism scales as
perceived by nurses and nursing students. The perception of
nurses' students for total professionalism scales represented
mostly in high (59%) and moderate (37.9%) levels. While
the perception of practicing nurses for total professionalism
scales represented in low (78.5%) and moderate (21.5%)
levels.
Table 6 clarifies the correlation between nurses'
perception of professional attributes and their demographic
data. There were no significant differences among the
nurses' total perception of professional attributes and their
demographic characteristics. Otherwise, statistically
significant differences were found among nurses'
professional identity regarding their age (r=2.38,
p<0.01851), years of experiences (r=1.99, p<0.04831),
83
Evidence-Based Nursing Research Vol. 2 No. 1 January 2020
Article number 8 page 5 of 12
educational level (f=2.2, p<0.03883) and working
department (f=3.88, p<0.0105). On the other side, there
were significant differences among nurses’ professional
behaviors concerning the working department (f=3.21,
p<0.02479).
Table 7 states the correlation between nursing students’
perception of professionalism dimensions and their
demographic data. It was apparent that there were
statistically significant correlations between the total score
of professionalism attributes and students' demographic
characteristics (at p<0.001, p<0.05), except regarding their
gender. Additionally, the dimensions of professionalism
were significantly correlated with all students’ demographic
data.
Table (1): Frequency and percentage distribution of
studied nurses’ demographic characteristics (no. 149).
Items
No.
%
20 to >25 years
65
43.6
25 to > 30 years
73
49.0
30 or more
11
7.4
Mean±SD
25.28±2.67
Male
16
10.7
Female
133
89.3
Single
18
12.1
Married
131
87.9
Postgraduate studies
17
11.4
Baccalaureate degree
101
67.8
Diploma degree
31
20.8
Less than five years
105
70.5
Five years or more
44
29.5
Mean±SD
3.59±2.08
≥18 hrs./wk.
45
30.2
19-36 hrs./wk.
104
69.8
NICU (Neonatal)
19
12.8
ICU (Neurology)
33
22.1
CCU (Cardiology)
38
25.5
ICU (General)
59
39.6
Night
34
22.8
Afternoon
28
18.8
Morning
87
58.4
Part-time
47
31.5
Full time
102
68.5
Table (2): Frequency and percentage distribution of
studied students' demographic characteristics (no. 897).
Nursing students’ demographic characteristics
Items
No.
%
Age
20-<21
57
6.4
21-<22
251
28.0
22-<23
218
24.3
23 or more
371
44.0
Mean±SD
22.02±0.99
Gender
Male
278
31.0
Female
619
69.0
Marital status
Divorced
2
0.2
Widow
2
0.2
Single
711
79.3
Married
182
20.3
Academic Year
Third-year
349
38.9
Fourth-year
248
27.6
Interns
300
33.4
6. Discussion
Nowadays, society is overwhelmed with technological
changes that led the nursing profession to provide the
clients with more significant ethical and philosophical
challenges, therefore, creating a new approach of
identifying professionalism is an essential demand (Wynd
2003; Ghadirian, Salsali & Cheraghi 2014). The nurses
and nursing students have a responsibility and an obligation
to demonstrate professionalism in their daily routine
practice. The positive aspects of professionalism need to be
recognized for facilitating retention of experienced nurses
and favor of young students' entry into this viable career
(Van e De Bragancaa & Nirmalab 2017). Thus, it becomes
imperative to assess the status of professionalism attributes
among undergraduates nursing students and nurses. This
research aimed to assess the main attributes of
professionalism as perceived by undergraduate nursing
students and nurses.
The prominent finding of this study is that the
undergraduate nursing students perceived the high mean
scores in all attributes of professionalism more than the
practicing nurses did with a statistically significant
difference between both groups. The possible reason for
this finding is that the professionalism curve may be
changed considerably during the socialization process of
nursing students starting from entry-level into education
until they are involved in real situations practice. This
finding may also refer to the nursing student is taught under
strict discipline, continuous supervision from their teachers,
presence of role models, and availability of supportive
educational environment.
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Article number 8 page 6 of 12
Table (3): Frequency and percentage distribution of nurses’ perception of professionalism dimensions (no. 149).
Professionalism Subscales (nurses)
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
No.
%
No.
%
No.
%
No.
%
No.
%
Professional identity:
Be pleased to belong to this profession.
32
21.5
38
25.5
34
22.8
43
28.9
2
1.3
Proud to work or study in this profession.
17
11.4
41
27.5
43
28.9
32
21.5
16
10.7
Create a positive image about this profession with my personality
and behaviors.
0
0.0
9
6.0
52
34.9
59
39.6
29
19.5
Think that nursing profession is more essential for society than
any other job.
6
4.0
61
40.9
42
28.2
21
14.1
19
12.8
Focus all efforts on the patients while caring them.
1
0.7
7
4.7
35
23.5
71
47.7
35
23.5
Help to disseminate the false information regarding the
profession and professional practices.
60
40.3
59
39.6
30
20.1
0
0.0
0
0.0
Document patients’ information accurately and completely.
12
8.1
26
17.4
33
22.1
57
38.3
21
14.1
Wear official uniform and keep physical appearance.
7
4.7
17
11.4
20
13.4
69
46.3
36
24.2
Participate in nursing research.
42
28.2
64
43.0
15
10.1
20
13.4
8
5.4
Have decision-making autonomy especially in critical situation.
47
31.5
62
41.6
19
12.8
13
8.7
8
5.4
Seek for additional continuing education to update my knowledge
and skills.
12
8.1
29
19.5
28
18.8
65
43.6
15
10.1
Look for membership in nursing association.
99
66.4
31
20.8
8
5.4
11
7.38
0
0.0
Professional ethics:
Report about unethical behaviors or practices.
35
23.5
64
43.0
28
18.8
16
10.7
6
4.0
Report for any illegal behaviors or practices.
49
32.9
73
49.0
19
12.8
7
4.7
1
0.7
Use code of ethics as a guide for practice.
26
17.4
3
2.0
50
33.6
27
18.1
43
28.9
Cheat for achieving higher bonus.
73
49.0
65
43.6
10
6.7
1
0.7
0
0.0
Treat all patients equally regardless of their religion, education,
or economic status.
5
3.4
17
11.4
25
16.8
78
52.3
24
16.1
Safeguard patients’ right to privacy.
0
0.0
7
4.7
36
24.2
68
45.6
38
25.5
Keep the patient related information securely and confidentially.
0
0.0
5
3.4
26
17.4
86
57.7
32
21.5
Act as an advocate for patients, family, community and
profession.
8
5.4
42
28.2
30
20.1
50
33.6
19
12.8
Provide the service in a respectful manner regardless of patients’
personal attributes.
7
4.7
27
18.1
19
12.8
65
43.6
31
20.8
Treat patients with empathy and rapport.
2
1.3
5
3.4
27
18.1
56
37.6
59
39.6
Respect the individuals who have experiences more than I have.
6
4.0
48
32.2
28
18.8
45
30.2
22
14.8
Request consultation or advice when unable to meet the patient
needs.
1
0.7
8
5.4
19
12.8
84
56.4
37
24.8
Professional values:
Know my responsibilities and accept the consequences for own
practice.
15
10.1
34
22.8
29
19.5
56
37.6
15
10.1
Complete my assigned work independently without any
supervision or monitoring.
29
19.5
63
42.3
22
14.8
29
19.5
6
4.0
Initiate action to produce high quality work.
16
10.7
34
22.8
30
20.1
46
30.9
23
15.4
Work organized, well prepared and timely.
34
22.8
13
8.7
16
10.7
36
24.2
50
33.6
Accept to participate in patients’ care if in ethical opposition to
own professional values
34
22.8
57
38.3
20
13.4
30
20.1
8
5.4
Accept the negative criticism.
23
15.4
53
35.6
36
24.2
33
22.1
4
2.7
Accept orders and decisions from the supervisors/instructors in
authority.
8
5.4
23
15.4
17
11.4
66
44.3
35
23.5
Follow written rules and regulation in the institution.
6
4.0
10
6.7
26
17.4
75
50.3
32
21.5
Establish relationships with all health team members without any
discrimination.
23
15.4
29
19.5
22
14.8
60
40.3
15
10.1
Talk with diplomacy when expressing ideas and expressions.
15
10.1
39
26.2
35
23.5
45
30.2
15
10.1
Communicate effectively both verbally and nonverbally with
patients and other healthcare
5
3.4
16
10.7
28
18.8
68
45.6
32
21.5
Able to assess patients’ problems independently.
14
9.4
32
21.5
30
20.1
50
33.6
23
15.4
Have enough knowledge and skills to do the assigned work.
4
2.7
11
7.4
19
12.8
66
44.3
49
32.9
Show creativity by catching opportunities that enhances nursing
profession.
56
37.6
64
43.0
20
13.4
6
4.0
3
2.0
Commit to help and care of patients.
0
0.0
0
0.0
20
13.4
93
62.4
36
24.2
Promote collaboration with other healthcare providers
10
6.7
30
20.1
39
26.2
54
36.2
16
10.7
85
Evidence-Based Nursing Research Vol. 2 No. 1 January 2020
Article number 8 page 7 of 12
Table (4): Frequency and percentage distribution of nursing students’ perception of professionalism dimensions (no.
897)
Professionalism Subscales (nurse students)
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
No.
%
No.
%
No.
%
No.
%
No.
%
Professional identity
Be pleased to belong to this profession.
52
5.8
68
7.6
183
20.4
395
44.0
199
22.2
Proud to work or study in this profession.
40
4.5
73
8.1
154
17.2
426
47.5
204
22.7
Create a positive image about this profession with my
personality and behaviors.
10
1.1
20
2.2
85
9.5
419
46.7
363
40.5
Think that nursing profession is more essential for society than
any other job.
14
1.6
34
3.8
105
11.7
346
38.6
398
44.4
Focus all efforts on the patients while caring them.
11
1.2
23
2.6
54
6.0
407
45.4
402
44.8
Help to disseminate the false information regarding the
profession and professional practices.
500
55.7
217
24.2
58
6.5
75
8.4
47
5.2
Document patients’ information accurately and completely.
6
0.7
8
0.9
72
8.0
379
42.3
432
48.2
Wear official uniform and keep physical appearance.
11
1.2
7
0.8
28
3.1
323
36.0
528
58.9
Participate in nursing research.
12
1.3
100
11.1
211
23.5
367
40.9
207
23.1
Have decision-making autonomy especially in critical situation.
7
0.8
46
5.1
131
14.6
431
48.0
282
31.4
Seek for additional continuing education to update my
knowledge and skills.
5
0.6
4
0.4
73
8.1
411
45.8
404
45.0
Look for membership in nursing association.
206
23.0
104
11.6
183
20.4
189
20.0
215
24.0
Professional ethics
Report about unethical behaviors or practices.
19
2.1
23
2.6
91
10.1
389
43.4
375
41.8
Report for any illegal behaviors or practices.
19
2.1
23
2.6
121
13.5
388
43.3
346
38.6
Use code of ethics as a guide for practice.
4
0.4
12
1.3
99
11.0
451
50.3
331
36.9
Cheat for achieving higher bonus (i.e. grades, money etc.).
461
51.4
206
23.0
75
8.4
90
10.0
65
7.2
Treat all patients equally regardless of their religion, education,
or economic status.
5
0.6
1
0.1
19
2.1
174
19.4
698
77.8
Safeguard patients’ right to privacy.
3
0.3
5
0.6
48
5.4
302
33.7
539
60.1
Keep the patient related information securely and
confidentially.
6
0.7
2
0.2
36
4.0
290
32.3
563
62.8
Act as an advocate for patients, family, community and
profession.
3
0.3
3
0.3
58
6.5
383
42.7
450
50.2
Provide the service in a respectful manner regardless of
patients’ personal attributes.
8
0.9
13
1.4
60
6.7
401
44.7
415
46.3
Treat patients with empathy and rapport.
4
0.4
14
1.6
69
7.7
371
41.4
439
48.9
Respect the individuals who have experiences more than I have.
11
1.2
11
1.2
29
3.2
339
37.8
507
56.5
Request consultation or advice when unable to meet the patient
needs.
20
2.2
14
1.6
29
3.2
307
34.2
527
58.8
Professional values
Know my responsibilities and accept the consequences for own
practice.
3
0.3
17
1.9
45
5.0
451
50.3
381
42.5
Complete my assigned work independently without any
supervision or monitoring.
19
2.1
116
12.9
98
10.9
349
38.9
315
35.1
Initiate action to produce high quality work.
6
0.7
13
1.4
84
9.4
439
48.9
355
39.6
Work organized, well prepared and timely.
6
0.7
14
1.6
79
8.8
396
44.1
402
44.8
Accept to participate in patients’ care if in ethical opposition to
own professional values
177
19.7
228
25.4
171
19.1
188
21.0
133
14.8
Accept the negative criticism.
67
7.5
53
5.9
142
15.8
413
46.0
222
24.7
Accept orders and decisions from the supervisors / instructors
in authority.
8
0.9
13
1.4
75
8.4
447
49.8
354
39.5
Follow written rules and regulation in the institution.
16
1.8
14
1.6
52
5.8
389
43.4
426
47.5
Establish relationships with all health team members without
any discrimination.
17
1.9
12
1.3
93
10.4
379
42.3
396
44.1
Talk with diplomacy when expressing ideas and expressions.
4
0.4
29
3.2
118
13.2
455
50.7
291
32.4
Communicate effectively both verbally and nonverbally with
patients and other healthcare
26
2.9
25
2.8
89
9.9
442
49.3
315
35.1
Able to assess patients’ problems independently.
3
0.3
27
3.0
160
17.8
391
43.6
316
35.2
Have enough knowledge and skills to do the assigned work.
12
1.3
25
2.8
142
15.8
428
47.7
290
32.3
Show creativity by catching opportunities that enhances nursing
profession.
7
0.8
10
1.1
108
12.0
396
44.1
376
41.9
Commit to help and care of patients.
4
0.4
3
0.3
62
6.9
367
40.9
461
51.4
Promote collaboration with other healthcare providers
8
0.9
9
1.0
48
5.4
393
43.8
439
48.9
86
Lobna K. Mohamed, Shereen R. Dorgham, Walaa M. Eid: Experiences of Professionalism Attributes among Undergraduates Nursing……
Article number 8 page 8 of 12
Table (5): Comparison of nurses and nursing students’ perception of professionalism dimensions.
Professionalism dimensions
Nurses
Students’ Nurses
Z
P-Value
Mean
SD
Mean
SD
Professional Identity
62.68
13.05
78.07
14.06
12.50
0.000000
P <0.001
Professional Ethics
57.07
6.88
83.14
11.19
27.56
0.000000
P <0.001
Professional Behaviors
54.34
6.08
79.06
11.55
25.55
0.000000
P <0.001
Total Professionalism
56.62
4.13
80.11
10.07
28.07
0.000000
P <0.001
Table (6): Correlation between nurses’ perception of professionalism attributes and their demographic data.
Demographic data
Professional
Identity
Professional
Ethics
Professional
Behaviors
Total
Professionalism
Age
20 to 24 years
r
P-value
2.38
0.01851
0.045
0.58766
0.009
0.90988
0.002
0.98141
25 to 29 years
30 or more
Years of
experiences
Less than five years
r
P-value
1.99
0.04831
0.05
0.53483
0.12
0.14987
0.05
0.58416
Five years or more
Gender
Male
t
P value
0.78
0.43601
1.02
0.3117
0.43
0.6682
0.26
0.79763
Female
Marital status
Single
t
P-value
0.050
0.54516
0.45
0.65676
0.46
0.64527
1.89
0.06017
Married
Working hours
18 hrs./wk.
t
P-value
1.71
0.08965
1.13
0.26186
0.59
0.55456
1.04
0.299135
36 hrs./wk.
Type of
contract
Part-time
t
P-value
0.04
0.64728
1.05
0.29653
0.02
0.98037
1.60
0.111206
Full time
Educational
level
Postgraduate
f
P-value
2.2
0.03883
1.55
0.21503
1.81
0.16661
0.19
0.82956
BSN
Diploma degree
Shift
preferences
Night
f
P-value
0.74
0.47745
0.21
0.8139
2.22
0.11268
1.15
0.31914
Afternoon
Morning
Working
departments
Neonatal
f
P-value
3.88
0.0105
0.43
0.73178
3.21
0.02479
1.68
0.17425
Neurology ICU
Cardiology ICU
Medical ICU
87
Evidence-Based Nursing Research Vol. 2 No. 1 January 2020
Article number 8 page 9 of 12
Table (7): Correlation between nursing students’ perception of professionalism dimensions and their demographic
data.
In this aspect, an Iranian study conducted by
Poorchangizi, Borhani, Abbaszadeh,, Mirzaee and
Farokhzadian (2019), who found that nursing students had
high awareness and perception regarding the importance of
professional values. On the contrary, Karadag, Hisar,
Çelik, and Baykara (2016) suggested that the total mean
score of nursing students’ professionalism attitudes
subscales was relatively low.
The present study findings illuminated that the
undergraduate nursing students experienced the highest
mean score in a professional ethics dimension, especially in
the areas of patients' rights, followed by colleaguesrights
then code of ethics. Concerning professional behaviors’
dimension, the students distinguished in the areas of
obeying orders, followed by commitment and collaboration,
after that communication skills, carrying responsibility, and
finally accepting criticism. The students were featured in
the areas of physical appearance, continuing education,
caring of the patient, decision-making autonomy, nursing
image, and research regarding the professional identity
dimension. Nevertheless, the students have the lowest score
in the area of looking for membership in the nursing
associations.
These findings reflected the conscious and deliberate
efforts of teachers for creating positive climates that
encourage the development of ethical student behaviors. In
this scene, Karadag, Hisar, Çelik, and Baykara (2016)
conducted a study on 1474 undergraduate students of the
final academic year that were randomly selected from 25
nursing schools in Turkey. The findings of previous
research indicated that the professional attitudes of nursing
students were high in subscales of autonomy, community
service, and competence, continuous education, while the
students were relatively low in contribution to scientific
knowledge, and cooperation.
Additionally, Ayla, Ozyazicioglu, Atak, and Surenler
(2018) found a good level of professional values among a
first and fourth academic year of nursing students, and they
determined gender, class level, willingness to make an
academic career, willingness to attend scientific meeting
and satisfaction with the profession as factors affecting
development of professional values. Kim and Kim (2016)
confirmed that nursing professionalism begins to be
developed during clinical training and continuously grows
during career practice that becomes stronger between 3 to 5
years after graduation.
On the other hand, the nurses experienced the highest
mean score in the professional identity dimension,
especially in the areas of caring of the patient, physical
appearance, and continuing education. Besides, they obtain
a very low score in obtaining membership in the nursing
association, decision-making autonomy, and nursing
research areas. The nurses recorded a satisfying score in
patients' and colleagues' rights of professional ethics'
dimension. Also, they had low scores regarding the code of
ethics and acceptable scores in the areas of compliance with
orders, commitment, and collaboration. However, they
obtain a marginal score in the area of accepting criticism,
obeying orders, and communication skills.
These findings can be explained that nursing is a high
demand job, has a lack of social support. Therefore, nurses
continuously experienced fatigue, exhaustion, and health
problems when struggling for adaptation to stressful
working conditions. Results were quite similar to a Turkish
study offered by Dikmen, Karatas, Arslan, and Ak (2016),
who studied the level of professionalism among 89 nurses
working in a public hospital, which revealed low nurses’
professionalism level where the highest levels of
professionalism attributes were in areas of competence and
continuing education, while the lowest areas were in
autonomy, publication, and research. These findings are
incompatible with Yüksekol and Atalay's (2017) study, who
reported that nurses gained high scores in conducting
scientific research, qualifications, and continuous
education, while the lowest scores assigned for connection
with colleagues and patients.
In this context, Tanaka, Taketomi, Yonemitsu, and
Kawamoto (2015) compared the professional behaviors
among nurse leaders in the United States of America and
Japan, which found out that the nurses' professionalism
subscales were high in the USA in educational preparation,
theory development, self-regulation and autonomy,
community service, whereas publication and
communication, and research development was high in
Japan.
Demographic data
Professional
Identity
Professional
Ethics
Professional
Behaviors
Total
Professionalism
Age
20 years
F
P-value
3.16
0.02412
5.23
0.00139
15.28
0.00000
11.43
0.00000
21 years
22 years
23 years or more
Gender
Male
t
P value
3.10
0.00200
3.69
0.00024
2.25
0.02447
0.62
0.53423
Female
Marital
status
Divorced
t
P-value
3.57
0.00037
1.83
0.03389
1.89
0.05921
2.55
0.01088
Widow
Single
Married
Academic
year
Third
F
P-value
8.61
0.00020
32.92
0.00000
92.27
0.00000
69.54
0.00000
88
Lobna K. Mohamed, Shereen R. Dorgham, Walaa M. Eid: Experiences of Professionalism Attributes among Undergraduates Nursing……
Article number 8 page 10 of 12
On another scene, Fisher (2014) conducted a study of
professional value development among 69 associate degree
(AD), 97 diploma, and 39 Bachelor of Science (BSN)
nursing students, who revealed no statistical significance
between beginning and senior-levels of ADN and BSN
students regarding the overall scores of professional values,
but significance was seen among levels of diploma
participants. The author indicated that personal values and
morals should be formulated in the nursing profession code
of ethics during students' advancement along the continuum
of professionalism.
The study findings reflected that the nurse students'
perception of total professionalism attributes represented
mostly in both high (59%) and moderate (37.9%) levels.
While the nurses' perception of total professionalism
attributes represented in both low (78.5%) and moderate
(21.5%) levels. These findings were in the same line with
Karadag, Hisar, and Elbas, (2007) findings, who showed
that nurses working inwards with associate degrees were
lower in professionalism attributes. The previous study
considered the educational level at the baccalaureate degree
as one of the prerequisites of a profession in any discipline,
especially in nursing.
Besides, there were statistically significant differences
between both groups regarding professionalism subscale.
This finding can be explained due to coherent and
interference among nursing profession ethics, behaviors,
and identity. The students' perceptions of professionalism
were promoted by their current educational process that
enhances professional ethics, behaviors, and identity. In this
perspective, the study of Kavas, Demirören, Koşan,
Karahan, and Yalim (2015) pointed out that the structured
educational activities concerning professionalism are
considerably limited due to informal, hidden curricula.
The result of the current study pointed out that no
significant correlation among the nurses' total perception of
professionalism attributes and their demographic
characteristics. However, a significant correlation was
found among nurses' professional identity regarding their
age, years of experiences, educational level, and working
department. These mean that nurses with increasing age,
the greatest amount of experiences, highly qualified
education, and place of the working department had the
highest mean scores of professionalism attributes and knew
the essence of nursing profession identity.
On the other side, the nurses' professional behaviors
affected by the place of the working department only.
Similarly, Iranian research developed by Doost, Moghadas,
Momeni, and Rafiei (2016) on registered nurses in two
teaching hospitals found out that nurses had a moderate
level of professionalism, which positively and significantly
correlated with their age and years of experience at p<0.05.
In this regard, Wynd (2003) argued that nursing is a
less attractive profession due to poor working conditions,
low salaries, adherent stigma, and lack of power. The view
restricted the development of professionalism processes in a
nursing career. Therefore, Karadag et al., (2016), Ayla et
al., (2018) stated that nursing educators and managers need
to provide nurses with unique opportunities for professional
advancement through encouraging them to participate in
educational nursing programs for fostering their
professionalism, job satisfaction, and retention.
Furthermore, statistically significant correlations were
apparent between the total scores of professionalism
attributes and students' age, marital status, and academic
years. Also, the dimensions of professionalism were
significantly correlated with all students' demographic data.
These findings may be due to each student enters into the
nursing program with a great view about the profession and
set of values that magnified during the teaching and
learning processes. In this aspect, Donmez and Ozsoy
(2016) conducted a cross-sectional study involving 1432
nursing students selecting by stratified sampling from
different academic years studying in a nursing faculty in
Western Turkey. This study found out that female student
aged between 18 and 20 and had intentionally chosen the
profession had higher and stronger professional values
more than male students.
The truth cannot be overlooked that acquiring nursing
professionalism is central to professional development. The
professional behaviors bounce both nursing education and
profession that shape the present and future education
strategies and acquiring the privileges of professional status
(Donmez & Ozsoy 2016, Van e De Bragancaa & Nirmalab
2017)
7. Conclusion
In conclusion, the current study findings illuminated
that the development of professionalism in nursing is an
essential feature of the nursing profession and practice. The
study findings illuminated that the perception of nurses'
students for total professionalism dimensions represented
mostly in high and moderate levels, while the perception of
practicing nurses embodied in low and moderate levels. The
total mean score of professionalism subscales among nurse
students was higher than in practicing nurses. Statistically
significant correlations were found between the overall
scores of professionalism attributes dimensions and
subscales with demographic characteristics of students
except for their gender.
In the nursing professionalism dimensions subscales,
the nurse students' scores of patients and colleagues' rights,
obeying orders, commitment, and collaboration, physical
appearance, continuing education, caring of patient,
autonomy, positive image, and research were found to be
higher. While the nurses' professionalism dimensions
subscales were proportionally higher in caring of the
patient, physical appearance, and continuing education,
while they were very low score in membership in the
nursing association, autonomy, and research areas.
8. Recommendations
Because of these findings, the present study
recommended the following:
- Involvement of the professionalism issues in different
courses of nursing education curriculum accompanied by
training.
89
Evidence-Based Nursing Research Vol. 2 No. 1 January 2020
Article number 8 page 11 of 12
- Encouragement of nurses and students' participation in
scientific research activities, including; membership in
professional organizations or associations, attending
nursing conferences/workshops/symposiums as a
producer or consumer, and fellowship.
- Establishment of a collaboration between nurse leaders'
academicians and hospital administrators to create
policies and expand opportunities for the professionalism
of nurses as well as getting prestige and value as a career.
- Clinical tutors and school educators act as behavioral
models among their nursing students and for nurses in the
clinical setting.
- Presenting periodic workshops and seminars about
professionalism for both undergraduate nursing students
and nurses.
- Planning to carry out projects as an educational strategy
aiming to build professionalism process among
undergraduate nursing students.
- Conducting longitudinally future studies throughout
teaching the nursing curriculum in order to assess the
development of professionalism and determine the
factors affecting these developments.
- Further researches are recommended on professionalism,
particularly among nurses in Egypt.
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What purpose is served by renovation or redesign of professionalism, and how successful a process is it likely to be? This article addresses these questions by examining the effectiveness as a professional development mechanism of the imposition of changes to policy and/or practice that require modification or renovation of professionalism. The ‘new’ professionalisms purported to have been fashioned over the last two or three decades across the spectrum of UK education sectors and contexts have been the subject of extensive analysis, and this article avoids going over old ground and revisiting issues that have already been much debated. Nevertheless, the example of UK government education policy during this period is used as a basis for considering the pitfalls associated with mechanisms for modifying professionalism through a reform and standards agenda. The article’s analysis incorporates redefinition and examination of the concept and substance of professionalism and offers new perspectives in the form of three distinct conceptions: demanded, prescribed and enacted professionalism. Exploring the existentialist status of ‘new’ or ‘modified’ professionalisms and the relationship between professionality, professional culture and professionalism, it examines how professionalism may be interpreted and utilized for the development of education professionals.
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The Relationship between nurse image and nursing professionalism, according to nursing students' gender
  • I Kim
  • J Kim
Kim, I., & Kim, J. (2016). The Relationship between nurse image and nursing professionalism, according to nursing students' gender. Advanced Science and Technology, 132, 30-36.
Socialization of student nurses-the role of the mentor. Learning in Health and Social Care
  • K Ousey
Ousey, K. (2009). Socialization of student nurses-the role of the mentor. Learning in Health and Social Care, 8(3), 175-184.
Essentials of Nursing Research: Appraising Evidence for Nursing Practice
  • D F Polit
  • C T Beck
Polit, D. F., & Beck, C. T. (2018). Essentials of Nursing Research: Appraising Evidence for Nursing Practice, 9 th ed. Philadelphia: Wolter Kluwer, 137-160.
What is Professionalism? The validation of a comprehensive model of professionalism
  • A W Rowland
Rowland, A. W. (2016). What is Professionalism? The validation of a comprehensive model of professionalism.
Professionalism among Nurses: A concept analysis
  • A Vaz E De Bragancaa
  • R Nirmalab
Vaz e De Bragancaa, A. & Nirmalab, R. (2017). Professionalism among Nurses: A concept analysis. International Journal of Business and Management Invention, 6(7), 60-66.