PROFESSIONAL NURSING

PRACTICE
• • Profession has been defined as an
occupation that requires extensive education
or a calling that requires special knowledge,
skills, and preparation.
• • It can also be defined as an occupation
that meets specified criteria beyond that of
occupation.
• • By definition, profession is autonomous
in decision making, and accountable for his or
her own actions.
• • Personal identification and commitment
to the profession are strong, and individuals
are unlikely to change profession
 NURSING AS A PROFESSION
• • Nursing is not simply a collection of specific skills and the
nurse is not simply a person trained to perform specific task.
• • Nursing is a profession
• • No one factor absolutely differentiates a job from a
profession but the difference is important in terms of how
nurses practice.
• • When we say a person acts professionally, we imply that
• • The person is meticulous in actions,
• • Knowledgeable in the subject and
• • Responsible to self and others.
 PRIMARY CHARACTERISTICS OF A
PROFESSION
• • Requires an extended, specialized training/ education of
it members, as well as a basic liberal foundation
• • Has a theoretical body of knowledge leading to defined
skills, abilities, and norms
• • Strong service orientation
• • Members have autonomy and accountability in decision
making and practice
• • Has a code of ethics.
• • Professional organization that sets standards
• • Shared values
• • Ongoing research
 EXTENDED EDUCATION
• • Nursing / midwifery as a profession
requires that its members possess a significant
amount of education

• • Nursing/ midwifery education is

important to practice and it must respond to
changes in health care created by scientific
and technological advances
 BODY OF KNOWLEDGE
• The term body of knowledge refers to the
collection of information that defines a
discipline’s overall areas of concern and
reflects its philosophy
 SERVICE ORIENTATION
• Nursing/ midwifery has always been a service
profession, although in the past the service
was usually viewed as a charitable one.
Nursing has a tradition of service to others.
This service however, must be guided by
certain rules, policies, or codes of ethics. Now,
nursing is a vital and indispensable component
of the health care delivery system.
 SELF- ENFORCE CODE OF ETHICS
• • Code of ethics is used to discern which actions are
correct in a given situation. Nursing has a code of ethics that
helps to regulate their relationships with clients and each
other.
• • The code of ethics can be formal that is, written such as
the ANA v(1985) code for nurses, or informal, that is
unwritten.
• • Ethics and ethical conduct are critical components of
professionalism. Nursing has a code of ethics that defines the
principles by which nurses function.
• • The ethics of nursing provides professional standards for
activities which protects the nurse and the patient.
 SHARED VALUES
• • All professions have professional values,
that is, beliefs or concepts that influence
practice and are generally accepted as being
important to the discipline. Individuals who
enter a profession undergo a socialization
process during which they are introduced to
the values of the profession and gradually
integrate these values into their personal
philosophy of nursing
 ON GOING RESEARCH
• • Increasing research in nursing/
midwifery is contributing to nursing /
midwifery practice. Today, nursing / midwifery
are actively generating, publishing, and
applying research to improve client care and
enhance nursing’s scientific knowledge base.
 AUTONOMY AND ACCOUNTABILITY IN
PRACTICE
• • Autonomy and accountability are related concepts and are an essential
element to professional nursing / midwifery. Autonomy is independence or
freedom to choose one’s action. Accountability means taking responsibility
for one’s action. Expecting autonomy without accountability is irresponsible.
• • Autonomy means the person is reasonably independent and self-
governing in decision making and practice. Professional autonomy means
giving nurses the authority to determine their roles, functions, and
responsibilities in the practice setting
• • Professional accountability means that giving nurses are directly
responsible to their patients for the quality of care they provide.
• • Nurses exercise autonomy and freedom to make decisions and clinical
judgments within their scope of practice. Nurses have autonomy in
delivering nursing care to clients, and they are also held accountable for that
care.
FLEXNER CRITERIA OF / CHARACTERISTICS OF
A PROFESSION
• • Is basically intellectual (as opposed to physical),
with high responsibility
• • Is based on a body of knowledge that can be
learned.
• • Is practical (applied) rather than theoretical
• • Can be taught through the process of
professional education
• • Has a strong internal organization of members
• • Have practitioners who are motivated by altruism
(the desire to help others).
 PROFESSIONALISM AND
PROFESSIONALIZATION
• • Professionalism refers to professional
character, spirit, or methods. It is a set of
attributes of a way of life that implies
responsibility and commitment
• • Professionalization is a the process of
becoming professional, that is, of acquiring
characteristics considered to be professional
or the process through which an occupation
achieves professional status.
 SOCIALIZATION TO NURSING
• • Socialization is the process through
which a person acquires the knowledge, skills,
and values necessary to become a functioning
member of society.
• • Hinshaw (1986) defines socialization as
“the process of learning new roles and the
adaptation to them and as such, continual
processes by which individuals become
members of a social group”.
 PROCESS OF SOCIALISATION
• • Defines clients in terms of health and promoting and
maintaining Health
• • Views the relationship between the nurse and client
as a therapeutic and analytic process.
• • Learns technical mastery of procedures and tools
from the aspect of principles guiding their use.
• • Uses critical inquiry and creativity processes to
manipulate knowledge in relation to the client’s concerns.
• • Accepts responsibility and accountability for client
care decisions
• • The socialization process therefore involves changes in knowledge,
skills, attitudes and values. Changes that are often associated with
strong emotional reactions and conflict as well as critical values of
professional nursing.

• • It is within the nursing educational programme that professional

values are developed, clarified and internalized.
• • She points out that from the perspective of professional nursing,
the adult socialization or resocialization process focuses on the provision
of values and behaviors basic to the delivery of quality client care.

• • Standards for this process are derived from the norms of the
profession and they guide the specific role of professional nurses.
 PROFESSIONAL SOCIALIZATION

• • Professional socialization an important aspect of adult

socialization is the process of learning the roles and values
of a professional.
• • Watson (1981) defines professional socialization as “
the process whereby the values and norms of the profession
are internalized into one’s own behavior and concept of self;
• • It is the process whereby the knowledge, skills,
attitudes and characteristic of a profession are acquired”.
• • Professional socialization is associated with the
specialized knowledge, skills, attitudes, values and norms
needed to perform the professional role.
 Socialization to professional nursing
• is the process of learning the skills, roles and values of the
profession, with the outcome being the development of a
professional identity. It represents a complex process by
which a student or practicing nurse acquires the
knowledge, skills, and a sense of occupational identity. It
involves gaining an identity in nursing
• • Internalizing the values and norms of the profession
• • Becoming equipped with a process for continued
learning
• • Gaining a process for accommodation to changing
ideas and knowledge
 Watson outlines 4 values critical for the
profession of nursing
• 1. A strong commitment to the service that nursing
provides for the public, the need to value their
contribution to the health and well-being of people
and nurses also need to value the caring aspect of
nursing.
• 2. Belief in the dignity and worth of each person:
The nurse always acts in the best interest of the patient
because nursing is a person-oriented profession, a
basic value of the worth of each person regardless of
nationality, race, creed, colour, age sex, politics, social
class, and health status is basic to nursing.
• 3. A commitment to education: Continuous
education is needed for graduates to maintain and
expand their level of competencies to meet
professional criteria.
• 4. Autonomy or the right of self- determination
as a profession: “Nurses must have freedom to
use their knowledge and skills for human
betterment and the authority and ability to see
that nursing service is delivered safely and
effectively”.
 MODELS OF SOCIALIZATION
• BENNER’S STAGES OF NURSING EXPERTISE

• • Benner’s model(2001) describes five levels of proficiency in

nursing which have implications for teaching and learning are:
• • Stage I, Novice- No experience (e.g., nursing student).
Performance is limited, inflexible, and governed by context-free
rules and regulations rather than experience.
• • Stage II, Advanced Beginner-Demonstrate marginally
acceptable performance. Recognizes the meaningful “aspects” of
a real situation. Has experienced enough to make judgment about
them.
• •
• •Stage III, Competent- Has 2 or 3 years of experience. Demonstrate s
organizational and planning activities. Differentiates important factors from
less important aspects of care. Coordinates multiple complex care
demands.
• • Stage IV, Proficient- Has 3 to 5 years of experience. Perceives
situations as whole rather than in terms of parts, as in stage II. Has holistic
understanding of the client, which improves decision making and focus on
long- term goals
• • Stage v, Expert- Here, performance is highly proficient; no longer
requires rules, guidelines to connect understanding of the situation to
appropriate action. Demonstrates highly skilled intuitive and analytic ability
in new situations. Is inclined to make a certain action because “it felt right”.
• • Benner’s model portrays that experience is essential for the
development of professional expertise.
 COHEN’S MODEL OF SOCIALIZATION
• • Stage 1. Unilateral dependence. The learner relies on
external controls and searches for the one right answer.
• • Stage 2. Negative/independence-Learners begin to
question the instructor and ideas presented to them.
• • Stage3. Dependence/mutuality- Students begin to think
more abstractly, are able to evaluate the ideas of others rather
than to merely accept them and begin to demonstrate empathy
and commitment to others.
• • Stage 4. Interdependence-In the final stage, students are
able to exercise independent judgment and weigh alternatives.
Cohen described this stage as the one in which the student has
become a professional.
SOCIALIZATION THROUGH EDUCATION AND
WORK SETTING
• • The individuals conception of what it means to be a nurse
and to act as a nurse occurs initially through education and is then
extended into the work setting
• • Learning any new role may be a challenging and anxiety-
producing task. As adults, individuals have developed
competencies in various previously learned roles. The choice to
learn a new role returns the adult to novice status, one of limited
or no knowledge of new role expectations.
• • Education is only the initial process in socialization. When a
new graduates enters the work setting, the socialization process
begins again, this time enabling the nurse to modify the
professional nursing role learned in an educational setting to fit
the work place.
• READING ASSIGNMENT
• WHAT ARE THE FACTORS THAT INFLUENCE
CONTEMPORARY NURSING PRACTICE?