The purpose of this article is to discuss professionalism in the context of health and human services, the meaning of provision of quality care and service within a safe, ethical and legal context, in an individual and interprofessional framework. Finally to identify the mechanisms by which health and human service professionals' behaviours are monitored and how they may contribute to quality improvement mechanisms.
Professionalism can be described in many different ways, however, in a nutshell Professionalism is "the competence or skill expected of a professional" (Oxford Dictionary). It can also be said that a person's "standing, practice or methods of a professional as distinguished from an armature" (Macquarie Dictionary). Furthermore a true profession is characterised by five characteristics in common, those being specialised knowledge, exclusivity, high ethical standards, autonomy and accountability. (Loh, 2000).
When acquiring a qualification in the area of health care and obtaining a position of employment, a health care worker is accepted as a member of the profession. The rights and responsibilities associated with being a health care professional should be accepted and applied by the worker in practice. Other areas of human endeavour claim they are classified as a professional when they obtain the same respect, privileges and powerful positions (Freegard, 2007).
"Professionalism", in the context for nurses creates the expectation that all nursing personnel conduct themselves in manner of professionalism that pertains them to a set of codes and practices and personal and professional values. Maintaining the trust of the general public and confidentiality are key components that must be included in the aforementioned values. (Australian Nursing & Midwifery Council, 2005). The Nursing Profession has the responsibility of providing a duty of competent care and safety for individuals, groups and communities by adhering to these codes of practice specifically. These codes of practice are targeted specifically toward nursing but other health care professionals such as social workers and physiotherapists can also utilise these practices. The standards set out here are specific to the nursing profession and focused mainly on issues and areas of practice.
The founder of modern nursing, Ms Florence Nightingale, who was born on 12 May 1820 and died in 1910, was an advocate of health, self-healing and healthy environments.
Florence Nightingale dedicated her life to the nursing profession and improving health care. Florence Nightingale emphasised that the infectious diseases were
burdened by issues related to hygiene. This has now shifted to the
lifestyle choices of the chronically ill patients of today. (Donnelly,
2010). The standards created by Florence Nightingale have helped to transform
the professionalism of the nursing ranks into the professional people
we know today. The medical profession has several characteristics that set it apart from some other professions. According to William Osler 'The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head' (Osler, 1932).
Nurses are expected to act ethically and professionally within their career. Nurses are bound by the Professional Code of Ethics for Nurses and the Professional Code of Conduct for Nurses by the Australian Nursing and Midwifery Council (ANMC). To be professional, nurses must adhere to the Code of Ethics & Practice therefore considering their behaviours, beliefs, morals and values at all time and in respect of all situations, in particular when at work and dealing with patients. Values that are essential to the practice of medicine are honesty, integrity, modesty, be nonjudgemental, respectful and accountable to patients, colleagues and society (Loh, 2000).
Continuous quality improvement in nursing is important and always evolving. In today's day health care professionals are not just expected to provide high quality care, they are expected to be able to also demonstrate how and when targets are met or exceeded and the quality of the work shown accordingly. (Willis, Evans, Stoelwinder & Cameron, 2007).
The Australian Institute of Health and Welfare has initiated the Health Care Safety and Quality Unit in order to "support the development of the evidence base for safety and quality in health care" (AIHW, 2010). Developing and maintaining a nation system of information to enhance the safety and quality of health care is the main role of the unit. (AIHW, 2010). The development of national indicators of healthcare safety and quality
is a major component of the work this unit conducts. This includes the
improving of the capacity to measure safety and quality using national
data sets and standards developed to improve data quality and
consistency. This unit works in collaboration with the Australian
Commission on Safety and Quality in Health Care
Evidence based health care relates to all the health professions, in simple terms evidence-based practice is a combination of individual clinical judgement and expertise, used to create a practice that will lead to the most positive outcomes for patients. "Evidence based clinical practice takes into account the context within which care takes place; the preferences of the client; and the clinical judgement of the health professional, as well as the best available evidence" (Joanna Briggs, 2008). Evidence based practice is obtained from research, practice trends, technological development and social issues. Patient care is improved through choices and preferences in care and lifestyle planning. (Bellchambers, H; Penning C, 2003).
The Australian Commission on Safety and Quality in Healthcare has developed the Australian Charter of Healthcare Rights, which was developed as a charter "of healthcare rights for all people receiving or seeking healthcare in all settings in Australia" (Australian Commission on Safety and Quality in Healthcare (ACSQH), 2010). This charter informs the community of what they can expect from the Australian healthcare system mainly:
Access - right to the healthcare system to address all healthcare needs,
Safety - "receive safe and high quality health services, provided with professional care, skill and competence" (ACSQH, 2010),
Respect - right to be shown, dignity, consideration and respect no matter what culture, nationality, values, personal characteristics or beliefs a person holds,
Communication - to receive open, timely and informed communication in respect of treatment, services and costs in a way that is understood by all community members.
Participation - the right to be included in decision making process in respect of, care planning,
Privacy - personal privacy and confidentiality is maintained, all personal health and other information is secure,
Comments - patient can comment or complain about the care being provided and address any concerns, which will be dealt with promptly and properly. (ACSQH, 2010).
As it is a nurse's obligation to ensure that they provide safe and ethical care to their patients by ensuring quality delivery of care and patient satisfaction, there are many different mechanisms in place to ensure quality care is provided. One of those mechanisms is quality indicators and there seems to be an increased demand placed on quality indicators in order to assess quality healthcare. Quality indicators provide measures for contributing facilities to exhibit their performance. Quality indicators can be used to recognize any differences from best practice, allow similarities between providers, and ascertain trends in quality of care over particular time frames. (Willis et al, 2010). Further to this there are many different audits available to the nursing profession to ensure that healthcare is being provided in respect of best practice, for example Harrow GP, Dr Mark Levy has developed an audit tool which provides a benchmarking system for practice, nurses, GP's etc to do a comparison of the management of patients who present with uncontrolled asthma (Anonymous, Practice Nurse, 2008). It is important for nurses to continue professional development both the individual and the service development. Identification of training needs is imperative and therefore staff appraisals are a central tool. However, a study done by Emma-Jane Berridge, Daniel Kelly and Dinah Gould states that "appraisal was perceived as frequently rushed and often appeared undervalued by managers. The purpose of appraisal was often misunderstood; and where no clear link existed between appraisal and access to development opportunities, staff viewed appraisal with antipathy" (Berridge, Kelly & Gould, 2007). The National Competency standards for the registered nurse are standards by which performance of the nurse is assessed in order to obtain and retain their licence to practice within Australia as a registered nurse and used for the said staff appraisals. (Australian Nursing & Midwifery Council, 2008). When dealing with all of these quality assessment tools nurses need to ensure that on a daily basis they are working within their scope of practice. Should a nurse go beyond his/her scope of practice disciplinary action can be taken by the Board and deregistration due to an offence may result.
Every health professional is required to abide by whatever local, state and federal laws apply. Furthermore, health professionals are obligated to follow the organisation in which they work for in an ethically and legally acceptable manner. The connection between law and ethics is not always obvious as there can be inconsistency between them both. There are decisions and actions that are both ethical and legal, such as the patient obtaining the knowledge of a medical procedure beforehand, given the patient has the time to consider the implications as to make an informed decision. Of course there are also actions and/or situations that are both illegal and unethical, such as laying blame on someone else for your errors (Freegard, 2007). The legal frameworks that inform nurses include provision within codes of conduct, registration statutes, and other registered authorities. There have been some challenges faced by national registration of nurses in Australia in 2010. Previously registered nurses were regulated by a body within the state or territory in which they practiced. That same regulatory body obtained costs in respect of both registered nursing as well as for a midwife. To eliminate this burden and to regulate the Nursing profession throughout Australia a single regulatory body has been developed which overseas registrations nationally, together with one Code of Practice and Ethics for all of the nursing profession. Therefore as at 1 July 2010 the responsible accreditation authority in Australia is the Australian Nursing and Midwifery Council, who are responsible for accrediting education providers and programs for the nursing profession to study, national registration and codes and guidelines for nurses (Thomas, 2010).
A team whether it be interprofessional, multidisciplinary, specialised expertise team or a management team is a group of skilled people who have a common interest and bring their skills and knowledge together to solve problems, efficiently and effectively. Nurses are an integral part of an interprofessional team and working in that team they must continue to behave in a professional capacity, work within their scope of practice, respect their colleagues. However a concern within healthcare sector is how team members communicate and work together as this can impact on the patient, the outcome of any procedure and job satisfaction. Further interdisciplinary teams are prone to miscommunication, personality clashes, professional disputes but regardless of the type of conflict or issue the outcome will have negative consequences for the patient, health professionals involved and organisations in saying this no health professional works alone as there is inevitably always a relationship between the health professional and the patient (Freegard, 2007).
In summary, professionalism is a vital part of nursing within Australia. Those who obtain a qualification and become registered nurses take on a responsibility to the care of patients within society. Codes of practice and ethics are to be used as guidelines when working with patients. Nurses have powerful positions in society and it is important to gain patients trust. Quality improvement in nursing is important and always evolving with expectations of work being continuously assessed and monitored. The improvement of safety and utilising facilities to measure and improve quality of safety are vital in the health care services. Patient satisfaction and ethical provision of care is essential for nursing, therefore a nurse must be of high character in order to have a high standing as a professional and provide the necessary and essential care that they are trained to do.