humanism in nursing essay

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A humanism for nursing?

Affiliation.

1 Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
PMID: 30656789
DOI: 10.1111/nin.12281

Humanism has appeared intermittently in the nursing literature as a concept that can be used in understanding nursing. I return to the concept in response to noticing the term appearing in the context of health humanities, where it is loosely associated both with humanities and being humane. I review the usage and critiques of humanism in both nursing and medical literature and then re-evaluate what the idea of humanism might hold for nursing, trying to avoid the traps of an over-determination of the human subject, or dichotomizing nursing as art or science, technology or caring. I draw on writings on humanism primarily from Emmanuel Levinas and Edward Said to emphasize strands in humanism of obligation towards others and of critical discernment within history and culture directed towards democratic practices. I discuss in passing the strong association in the UK particularly between humanism and scientism as a note of caution about the plurality of the term humanism. I conclude that humanism is a tradition that does offer productive ways of thinking about nursing with the proviso that it ought to be treated carefully as a problematic tradition and not as a new essence for nursing.

Keywords: humanism; liberal arts; nursing; philosophy.

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Honoring Our Heritage – Building Our Future

Humanistic nursing.

Contributor: Jacqueline Fawcett Updated March 31, 2020

Authors – Josephine Paterson, RN, DNSc and Loretta Zderad, RN, PhD

Year first published – 1976, major concepts.

Patient Call Nurse Response Dialogue

Nursology Theory

Practice Methodology

The process of practicing humanistic nursing theory involves “offers nurses a way to illuminate the values and meanings central to their lived experiences so that they may share them with other nurses and integrate them into their nursing practice … [which] helps nurses to realize their self-actualizing potential” (Kleiman, 2010, p. 338). Practice is a phenomenological process of reflection focusing on “synthesis and wholeness rather than reduction and logical analysis” (Kleiman, 2010, p. 339).

More specifically, humanistic nursing practice asserts that clinical practice is predicated on the existential experiences of the nurse that are deliberately and consciously constructed” and focuses on change, as well as being and becoming (Wolf & Bailey, 2013, p. 62),

Brief Description

Wolf and Bailey (2013) provided this definition of humanism and humanistic: “Humans are valued as unique individuals; human beings have a responsibility toward each other. Acknowledgement of the individual with respect toward personal experience person-centered perspective that emphasized growth and respect for persons, a feature that resonates between patient and caregivers” (p. 64).

Humanistic nursing theory encompasses a call from a person or persons (families, communities, humanity) for help with a health-related need, and a response to that call when recognized by a nurse or groups or communities of nurses. Through dialogue, nurse(s) and person(s) work toward resolving a health-related need (Kleiman, 2010). More specifically, nursing “is the ability to struggle with another through ‘peak experiences related to health and suffering in which the participants are and become in accordance with their human potential’” (Paterson and Zderad as cited in Kleiman, 2010, p. 339). Nursing is a nurturing activity for persons in need toward well-being (Kleiman, 2010).

Primary Sources

Kleiman, S. (2010). Josephine Paterson and Loretta Zderad’s humanistic nursing theory. In M. E. Parker & M. C. Smith (Eds.), Nursing theories and nursing practice (3rd ed., pp. 337-350). Philadelphia: F. A. Davis.

Paterson, J. G., & Zderad, L. T. (1976). Humanistic nursing. New York, NY: Wiley.

Wolf, Z. R., & Bailey, D. N.. (2013). Paterson and Zderad’s humanistic nursing theory: Concepts and applications. International Journal for Human Caring, 17(4), 60–69.

Josephine Paterson and Loretta Zderad

Dr. Josephine Paterson is originally from the east coast and Dr. Loretta Zderad is from the mid-west. They both were graduates of diploma schools and

Josephine Paterson (left), Loretta Zderad (right)

subsequently earned their bachelor’s degree in Nursing Education. Dr. Paterson did her graduate work at Johns Hopkins and Dr. Zderad did hers at Catholic University. In the mid-fifties they were both employed at The Catholic University and were assigned the task of working together to create a new program that would encompass the community health component and the psychiatric component of the graduate program. Subsequently they developed a collaboration and dialogue and friendship that have lasted for almost 40 years. Josephine Paterson and Loretta Zderad retired in 1985 and moved South where they are currently enjoying life. Although they are no longer active, they are pleased at the on going interest in their theory. (from http://libguides.twu.edu/c.php?g=270174&p=1803689 )

Understanding Humanism in Nursing

We can trace the ideas of Humanism to the ancient Greeks by noting the importance that they placed on understanding human inter-relationships especially within the context of social order. Socrates (470-399 BCE), Plato (384-345 BCE), and Aristotle (384-322 BCE) believed that we can glean an understanding of human nature by studying what humans do and the way they inter-act, especially inter-actions that are directed to doing good or evil towards others. The Greeks elaborated on the concepts of free choice and responsibility for one’s actions relative to those “free” choices. Free choice and responsibility are both central to a discussion of Humanism.

More recently Corliss Lamont, a noted scholar of humanism for over 50 years advanced the simple proposition that the chief end of human life is to work for the happiness of humans within the confines of the natural world. The “philosophy of enjoying, developing, and making available to everyone the abundant material, cultural, and spiritual goods of this natural world is profound in its implications, yet easy to understand and congenial to common sense”. The American Humanist Association describes humanism “as a progressive life stance, free of supernaturalism, which affirms our ability and responsibility to lead meaningful, ethical lives that add to the greater good of humanity”.

The phrase “free of supernaturalism” has at times been misinterpreted to mean that proponents of Humanism are anti-religious or anti-spiritual. For the reader who wishes to take up this controversial issue of religiosity or spirituality in Humanism, which is beyond the scope of this article, you are referred to two books of the Old Testament, which elucidate Humanist ideals. These are Ecclesiastes, focusing on a theme of enjoying life while one is able, even though all human happiness and achievement are transient, and The Song of Solomon, an allegorical roadmap for finding and giving happiness through human to human relationships in the world.

Although humanism is not unique to nursing, it is a philosophy that is strongly held as a value of the profession. The human-centered theory of life is easily recognized in the views of the earliest nursing professionals who described nursing as personalized, humanistic care, or a way of caring for the patient as a unique person.

Florence Nightingale claimed that the essence of nursing rested on the nurse’s capacity to provide humane, sensitive care to the sick, which she believed would allow healing. This approach is depicted through the well-known image of the lady with the lamp tending to soldiers in the middle of the night.

In 1948, Hildegard Peplau introduced her Theory of Interpersonal Relations, which focused on the human connection between nurse and patient. She explained, “It seems to me that interpersonal relation is the core of nursing. Basically, nursing practice always involves a relationship between at least two real people, a nurse and a patient”.

Commonly referred to as the “American Florence Nightingale,” and deeply concerned with humanistic values in nursing, Virginia Henderson characterized her view of modern nursing as embracing “self understanding and a universal sympathy for an understanding of diverse human beings”. Henderson noted that the practice of nursing inherently contained the human element, since one human being, whose intentional actions were directed in some manner toward involvement with other humans, performed nursing.

Josephine Paterson and Loretta Zderad were the first to combine the concepts of Humanism with the philosophical and methodological framework of Existentialism and Phenomenology as a way of examining experiences of the nurse-patient relationship. They portrayed the nurse as being in participating with the patient and brought attention to the inter-subjective experiences of the nurse. The central idea of humanistic nursing, according to Paterson and Zderad, is that of a lived dialogue, which offers a frame of orientation that places the center of the nurse’s universe at the nurse-patient, that is, human-to-human, intersubjective transaction.

Another significant nursing theorist who emphasizes humanism in nursing is Jean Watson, who developed the Human Caring Theory. Watson’s theory highlights the importance of a compassionate, holistic approach to patient care, focusing on the nurse-patient relationship and empathy, love, and caring in promoting healing. To learn more about Jean Watson’s Human Caring Theory and its impact and application in nursing, visit this resource. Watson’s theory can inspire nurses to embrace humanistic values and maintain a patient-centered focus even amidst the challenges of modern healthcare.

Nursing takes place within an economic, social, and technological context that may influence the way nurses practice and the ways they interact with patients. Certain aspects of the health care milieu are not congruent with a humanistic agenda in nursing. Some of these infelicities are:

Managed care as an intermediary between nurse and patient.
High technology in the form of computers, diagnostic equipment and pharmaceutical cures.
Robots as analogs to nurses which are given names! Penelope the scrub nurse!!!

After all is said and done the impact of economic, social or technological issues does not entail a change or modulation in the humanistic values held dear by nurses. However, nurses and patients are not closed off from the world. Despite today’s myopic vision for the way health care should be delivered there is no evidence that nurses’ views of themselves and society’s view of nurses have changed.

In today’s health care environment the imperative of the humanistic relationship (each person recognizing the other as a subjective human being like themselves) is sometimes overlooked in deference to technology, like the computer monitor that registers information about a patient’s vital signs but cannot reflect information that is vital and relevant to the patient as a person. The challenge is to integrate technology into the humanistic approach to patient care rather than technology dominating or replacing patient-centered care.

📎 References

1. Barnard A. (1997). A critical review of the belief that technology is a neutral object and nurses are its master. Journal of Advanced Nursing, 26, pp. 126-131. 2. Benner, P. and Wrubel, J. (1989). The primacy of caring. New York: Addison Wesley. 3. Doyle, R. (1999). By the numbers: Health care costs. Scientific American, 4, 280. 4. Bostock, D.(2000). Aristotle’s Ethics. New York : Oxford University Press. 5. Green-Hernandez C.(1992). Being there and caring: a philosophical analysis and theoretical model of professional nurse caring in rural environments In: Rural health nursing: stories of creativity, commitment, and connectedness. (Winstead-Fry P et al) National League for Nursing Publications Publisher: 1992 #21-2408 (pp 31-53) (40 ref). 6. Heidegger, M. (1927/1962). Being and time. Translator, Joan Staumbaugh. New York: Harper Rowe. 7. Hospital Accreditation Standards of the Joint Commission on the Accreditation of HealthCare Organizations (2002). Sec. RI.1, Sec. RI.1.1. Public Law 336. 8. Heller, B. R., Oros, M. T., & Durney-Crowley, J. (2000). The future of nursing education: 10 trends to watch. Nursing and Health Care Perspectives, 21(1),9-13. 9. Henderson, V. (1964). The nature of nursing. American Journal of Nursing, 64(8): 62-67. 10. Irwin, T.(1995). Plato’s Ethics. New York : Oxford University Press. 11. Katz-Rothman, B. (1987). The tentative pregnancy: Prenatal diagnosis and the future of motherhood. New York: Penguin. 12. Kleiman, S. (2002). The Lived-experiences of Nurse Practitioner’s Interacting with their Patients. (Doctoral dissertation, Adelphi University, 2002). University Microfilms International UMI Number 3051569. 13. Lamont, C. (1997). The philosophy of humanism, 8th Ed. Amherst, NY: Humanist Press 14. Leininger, M. (2001). A mini journey into transcultural nursing with its founder. Nebraska Nurse, 34, 2, p. 16-7. 15. Nightingale, Florence (1946). Notes on nursing: What it is and what it is not. Philadelphia: J. P. Lippincott. 16. Paterson, J. G., & Zderad, L. T. (1976) Humanistic nursing. New York: John Wiley & Sons. 17. Peplau, H. E. (1965). The heart of nursing: Interpersonal relations. Canadian Nurse, 61, pp. 273-275. 18. VlastosG. , Ed.(1971). The Philosophy of Socrates . San Angelo, Tx: Anchor. 19. Vlastos, G., Ed.(1971). Plato: A Collection of Critical Essays. Volume I: Metaphysics and Epistemology. Volume II: Ethics. San Angelo, Tx: Anchor. 20. Watson, J. (1988). Nursing: Human Science and Human Care. New York: National League for Nursing.

Crafted with Care:

Nursing Essays!

Precision, Passion, & Professionalism in Every Page.

DOI: 10.20467/1091-5710.9.1.9
Corpus ID: 150166801

Discourse on Humanism in Nursing

Published in International journal for… 1 February 2005
Philosophy, Medicine

19 Citations

Humanizing nursing care: an analysis of caring theories through the lens of humanism, student paper: humanism in nursing.

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Humanism in Nursing

While cleaning up my electronic files recently, I came across a 2005 article from the Academic Medicine journal titled “A medical experience that taught me about humanism in medicine.” The author, a physician, recounted a scene in which a 36-year-old woman, in her last hours of a not-to-be-resuscitated life, defeated by cancer, was still attached to a heart monitor. Many nurses have probably been in similar scenarios where the serenity of a dignified death is disrupted by mechanical alarms, drawing the family and the staff’s attention away from the dying person. In his essay, the physician recalled the nurse turning to him and saying, “Please turn off that monitor. All we need now are our eyes and our hearts.”

Describing the nurse, the writer observed: “When her patient struggled to breathe, the nurse increased the oxygen. When her patient cried out, the nurse increased the morphine drip. When the patient appeared to need a friend, the nurse held her hand tightly and caressed her forehead. The patient died a few hours later. Watching this nurse care for her dying patient was as powerful a display of one human being caring for another as I have ever seen.”

I was struck by these reflections because, as nurses, we typically don’t see ourselves (at least I didn’t when I was a staff nurse) as a source of inspiration to physicians. Perhaps it’s a by-product of my own implicit bias; assigning hierarchies with regard to who should inspire whom. Historically, nurses’ lament feeling under-recognized by their non-nursing colleagues, in spite of gaining the public’s highest rating in ethics among the professions for the past 20 years.

The author continued to say: “What made this nurse’s actions so special was her full engagement in the management of her patient’s death. She had a vision of how to make her patient comfortable and carried it out with great courage and compassion. She wore her heart on her sleeve and used it to guide her interventions. There were no treatment algorithms to follow nor laboratory tests to order. Her actions were visceral, instinctive… She would never receive any thanks from her patient, yet she would have something far more lasting—the inner satisfaction at having healed a soul. My mind filled with wonder as I contemplated the magnitude of this whole experience.”

My mind is filled with wonder, too. It made me realize that our physician colleagues not only see us, but they also take mental notes. In the healing osmosis of a caring environment, what we observe from one another transforms our narratives, maybe not in the here and now, but in the next patient encounter. I used to joke that if I got a dollar each time I taught a medical intern how to “do things” in my 19 years as a staff nurse at teaching hospitals, I could retire early. But then, when I think about it, I too have been blessed to witness humanism in medicine unfold while watching physicians and other healthcare workers.

I’ll drink to that

Around 6:30 am, the surgical team would descend on the ICU to round their patients. The standard recitation of medical-surgical history and overnight issues gave way to the plan for the day. I noticed that the chief surgical resident carried a bucket with single-serving apple juices. At the conclusion of the round, he would offer one to the patient while he opened one for himself; they clinked cups and drank to the health of the patient. I thought, what a marvelous idea! The patient was starting on a clear liquid diet, and the surgeon probably needed breakfast before going to the operating room. Together, they nourished a basic human need: connectedness.

In hospitals or wherever there are sick people, there is a certain dryness; beyond the sense of lack of hydration, a thirst for meaningful interaction. Water or fluids are a constant feature of nursing work—from bedbath to medications, from birthing to post-mortem care. I hope nurses will be inspired to raise a dixie cup with their patients each time they’re at the bedside — to be fully present and humane.

Reminders of humanism

In 1993, I attended a memorial service of a beloved patient who died of AIDS at the age of 35. I had a chance to care for this patient during his many admissions due to opportunistic infections. The patient’s family and friends spoke lovingly of the patient. As I exited the hospital chapel, I picked up a copy of the eulogy given by the patient’s physician and filed it somewhere. Now yellowed with time, I serendipitously rediscovered this touching tribute after 20 years. Here’s the part that moved me so: “I cannot say if David* lived indeed a short life, as it appears on the surface. But I can say that he lived a full life, dense with human relations, and that he did good, and he will be remembered, because he was sweet – not the saccharine sweetness so prevailing today, but a sweetness that nourishes. He didn’t have the fake jollity and call-me-joe mentality that seems to drown American life these days. He was genuinely there for anybody who needed him.”

Nurses and physicians devote tremendous amounts of energy saving lives. When a life is lost, they rarely get the chance to reset, to allow themselves a healing pause , before they carry on. Can you imagine if healthcare workers attended their patients’ memorial services? Would we see more humanism in healthcare? Dr. George E. Thibault, a thought leader in humanism in medicine, reminds us that to profess humanism is to renew our sense of purpose—the antidote to professional ennui and disillusionment afflicting many healthcare workers today. The proof of humanistic care is in caring. To paraphrase the British author Arthur Clarke, it’s best to remain optimistic if only to give us a shot at creating a self-fulfilling prophecy.

*Name is fictitious.

Thibault GE. Humanism in medicine: What does it mean and why is it more important than ever? Acad Med . 2019;94(8):1074-7. doi:10.1097/ACM.0000000000002796

The views and opinions expressed by My Nurse Influencer contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal . These are opinion pieces and are not peer reviewed.

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1 comment . leave new.

What a great read (especially before my overnight shift begins)! We often forget about the importance of the human touch in healthcare, but the heart is equally as important as the brain when it comes to caring for patients. Thanks for the great article!

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Humanism in Healthcare: A Pathway to Compassionate Care and Resilience

Within the health professions, humanity lies at the heart of care. Being human is a complex experience that includes physical, emotional, intellectual, social, and spiritual dimensions. As humans, we communicate complex thoughts and ideas and seek purpose and meaning in life. We have the capacity for rational thought, creativity, decency, and ethical decision-making. Being human is about our capacity to think, feel, and connect meaningfully with others. At its best, healthcare transcends diagnosis and treatment and embraces the holistic care of people in a manner that honors humanity – both the patients and the providers.

Humanism in medicine is an approach to healthcare that emphasizes the importance of the human experience in medical practice. Humanism has been at the heart of medicine since Hippocrates and is centered on values like dignity, respect, compassion, and empathy. The fundamental principles of humanism include compassion, respect for self and others, holistic care, effective communication, and ethical practice. The characteristics of humanism include honesty, empathy, compassion, selflessness, personal connections, respect, self-awareness, and emotional expression. Humanism is about embodying these principles and characteristics when interacting with others, especially those who are suffering. Humanism in medicine encourages healthcare providers to see patients as whole individuals, considering their emotional, social, and spiritual needs alongside their physical health rather than focusing solely on the biological aspects of disease and treatment.

For healthcare providers to effectively deliver compassionate and empathetic care, it is equally important that they honor their own humanity. This can be one of the most challenging aspects of medicine. In a moment of crisis, there is no space for honoring the provider’s feelings and needs, and decades of training have prepared providers to shut off their own feelings and needs so that they can attend to the situation at hand. It’s in the moments after an emergency has been attended to or the patient has been treated that there needs to be space to acknowledge the provider’s own humanity. Through the practice of honoring their own humanity, providers can maintain the resilience needed to navigate the demands of their profession. Practicing humanism in medicine helps to prevent burnout and enhances the provider’s ability to connect with patients on a deeper level, offering truly patient-centered care.

The ability to be self-aware is deeply intertwined with emotional depth. Every human being experiences a vast spectrum of emotions—joy, love, fear and sorrow—that shape our relationships, decisions, and overall life experiences. When we as humans shut off to these emotions, we become robots instead of living, breathing humans. It is in honoring that we are human and have emotions that help us to show kindness, empathy, and compassion in times of suffering for others. Health professionals often support people in some of their darkest moments, and if they haven’t cultivated the ability to go deep within themselves, they will not be able to meet others in their depths.

Humanism can help mitigate burnout, especially in healthcare settings with high demands and emotional toll. Burnout, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, is common among healthcare providers. Humanism, emphasizing compassion, empathy, and connection, which can help mitigate and prevent burnout in several ways.

First, humanism restores meaning and purpose to healthcare workers by encouraging providers to reconnect with the deeper reasons they chose their profession—to care for the well-being of others. This renewed sense of purpose can counteract feelings of depersonalization and enhance job satisfaction as providers build more meaningful and rewarding relationships with their patients. By focusing on the human aspects of their interactions, healthcare professionals can find greater fulfillment in their roles, helping to combat the sense of isolation and emotional fatigue that often accompanies burnout.

A humanistic approach also helps to reduce depersonalization by encouraging providers to see patients as individuals with unique emotions, experiences and needs rather than just tasks or cases. This approach fosters more personal and empathetic interactions, diminishing the detachment contributing to burnout. Humanism encourages open communication and support among healthcare teams, promoting a culture where providers feel comfortable sharing their challenges and emotional struggles, reducing feelings of isolation and helping to create a community of care and support among team members.

Humanism strengthens emotional intelligence. Emotional intelligence is the ability to recognize, understand, and manage one’s own emotions while also empathizing with the emotions of others. Every human being has a deep desire to feel seen and heard. By becoming more aware of one’s own emotions, one can become more attuned to another’s emotions. Cultivating emotional intelligence impacts relationships with self, colleagues, and patients. This ability to tolerate and be with emotions is a powerful medicine.

Humanism requires practices like mindfulness and self-compassion, which help providers manage stress, anxiety, self-criticism, compassion fatigue, and burnout. Reflective practice allows providers to process complex emotional experiences, gain perspective, draw strength during challenging situations, and deal with failures and mistakes. These practices help providers resource themselves so that they can show up for the people they work with.

Humanism in healthcare is not just a philosophy; it is a practical and necessary approach to care that enhances emotional resilience, restores meaning, fosters supportive environments, and promotes holistic well-being. Systemic factors contributing to burnout, such as heavy workloads and administrative burdens, are rampant in medical systems. While humanism alone cannot address all of these challenges, it does advocate for systemic changes that prioritize patient and provider well-being. In environments where compassion and care are central, patients and providers benefit from more meaningful and nurturing interactions, reducing the emotional toll leading to burnout.

By placing humanity at the center of healthcare, we create a system that improves the quality of care and upholds the ethical and moral foundations of the healthcare profession. As F. Erhart aptly said, “Yet, it was the purest manifestation of empathy, compassionate care, and love toward a fellow human being. In other words, that day we practiced medicine.” By honoring both the humanity of their patients and their own, healthcare providers can sustain a compassionate, effective, and fulfilling practice.

Erhart F. (2023). 2023 Hope Babette Tang Humanism in Healthcare Essay Contest: First-Place Medical Student Essay: The Nail Salon. Academic medicine : journal of the Association of American Medical Colleges , 98 (12), 1394–1395. https://doi.org/10.1097/ACM.0000000000005423

Giaever, F., Lohmann-Lafrenz, S., & Løvseth, L. T. (2016). Why do hospital physicians attend work while ill? The spiraling effect of positive and negative factors. BMC health services research, 16(1), 548. https://doi.org/10.1186/s12913-016-1802-y

Hulail, M. (2018). Humanism in medical practice: What, why, and how? Hospice & Palliative Medicine International Journal, 2(6), 336-339. https://doi.org/10.15406/hpmij.2018.02.00119

Lee Roze des Ordons, A., de Groot, J. M., Rosenal, T., Viceer, N., & Nixon, L. (2018). How clinicians integrate humanism in their clinical workplace-‘Just trying to put myself in their human being shoes’. Perspectives on medical education, 7(5), 318–324. https://doi.org/10.1007/s40037-018-0455-4

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Historically, the basis of the knowledge called as education philosophy has been based on understanding the components of philosophy defined as metaphysics, epistemology and axiology by Greeks. Philosophy is a value system required in relieving of scientific nursing knowledge. The values and beliefs in the education program developed provide suitability, shape and consistency for a program. Organizations providing nursing education should define philosophy clearly during developing and implementing of an education program. While doing this, they should take into consideration organization's values, personal beliefs of lecturers as well as many social and political factors. Consequently, the philosophy that forms the basis of curriculum and necessary for revealing the scientific nursing information has been based on metaphysics to understand the culture, the real and the existent; on epistemology to question what and how we know; on axiology constituents for our values that distinguish the good from bad.

Walter Mason

Identity, difference, and the associated subject of cultural diversity pose challenges for nursing. As the demographics of the world change, demands are rising for nurses to provide sensitive, individualized care to people living in our ever-changing global community. Issues concerning gender, sexuality, disability, age, language, economic and occupational status, multiculturalism, and ethnicity are made more complex because many of these topics strike a personal chord for individual nurses. In order for nursing to provide appropriate care to the world's people and to meet future challenges, nursing must define itself in new ways. Kikuchi and Simmons have stated that the best way for nursing to approach this task is through the development of a ‘sound’ philosophy of nursing that will ‘accommodate diversity in nursing thought’. They contend that before we can establish a philosophy of nursing, nurses will have to agree upon the nature of reality, human beings, truth, and knowledge. This paper will suggest that neopragmatism, as described by Richard Rorty, is a way to assure diversity of thought in nursing. However, I will argue against the requirement for this philosophy to be ‘sound’ in the sense that Kikuchi and Simmons use this term. In place of their call for ‘truth and unity in nursing thought’. I will attempt to demonstrate how neopragmatic ideas relate to the construction of what Rorty called a unifying ‘plausible narrative of progress’. This change will allow nursing to abandon the dead end debate over epistemologies and instead focus on more important issues related to improving nursing practice.

Nurse Education in Practice

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Categories: Why Did You Choose Nursing Why I Want To Be A Nurse

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Dr. Hope Babette Tang Humanism in Healthcare Essay Contest

Eligibility, Selection Criteria, and Process
Past Winners
Essay Reviewers

The annual Dr. Hope Babette Tang Humanism in Healthcare Essay Contest asks medical and nursing students to engage in a reflective writing exercise that illustrates an experience where they or a healthcare team member (doctors, nurses, therapists, social workers, pharmacists, patients and families, etc.) worked to ensure that humanism was at the core of care. Submissions that touch upon students’ personal experiences of humanistic care or stories of family and friends are also accepted.

Congratulations to the winners of the 2024 Dr. Hope Babette Tang Humanism in Healthcare Essay Contest! Read the full announcement here.

First-, second-, and third-place essays for both nursing and medical students are chosen by a panel including healthcare professionals, writers/journalists, and educators.

Winners receive monetary awards of $1000, $500 and $250, respectively, and their essays are published in Academic Medicine and The Journal of Professional Nursing in the fall.

For details, visit Eligibility, Selection Criteria, and Process.

Contact our Staff:

Michelle Sloane, MPA mail_outline

Who was Dr. Hope Babette Tang?

The essay contest is named in memory of Hope Babette Tang, MD, an Assistant Professor of Pediatrics at Columbia-Presbyterian Medical Center and the Pediatric Medical Director of the hospital’s HIV clinic until her death in 1998 at age 36. Dr. Tang’s patients were often facing numerous obstacles on top of their devastating medical challenges, which made healing even more difficult. Her mantra in caring for her patients was “Whatever it takes.” Her approach meant she saw the person in front of her, not just their medical situation. Many of her acts of caring only came to be known after her death. She treated the whole patient, a hallmark of humanistic care.

2024 Medical Student Winners

First Place | “A Drop of a Person” Caterina Florissi Harvard Medical School

Second Place | “Apartment 5 on Dolphin Drive” Noor Ahmed Lake Erie College of Osteopathic Medicine at Seton Hill University

Third Place | “A Place for Grief” Danielle Collins Johns Hopkins University School of Medicine

2024 Nursing Student Winners

First Place | “Baby J’s Song” Hailey Sommerfeld University pf Utah College of Nursing

Second Place | “The Cat” Megan McDowell Brenau University

Third Place | “A Quiet Place” Erin Bowdish The Valley Foundation School of Nursing at San Jose State University

Read the full announcement of the 2024 winners.

2024 Dr. Hope Babette Tang Humanism in Healthcare Essay Contest Prompt

Students were asked to use the following quote to reflect on an experience in any healthcare setting where they or another healthcare team member worked to put the person at the center of care.

“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.” — William Osler

Hear past essay winners read and share about their essay through the Gold Connection Podcast

	who won first place for nursing students students in the 2022 contest, reads her winning essay, "As the Sun Sets." The reading is followed by a conversation with Jessica and Gold Foundation Editor in Chief Brianne Alcala, exploring the writing process. Jessica is pursuing her doctoral degree in Nurse Anesthesia at
	who won second place for medical students in the 2022 contest, reads her winning essay, “Every Patient After.” That reading is followed by a conversation with Molly and Gold Foundation Editor in Chief Brianne Alcala, exploring the writing process. Molly is a fourth-year student at the
	a medical student at won first place for medical students in the 2022 contest. In this podcast episode, he reads his winning essay, “The Light.” The reading is followed by a conversation with Mason and Gold Foundation Editor in Chief Brianne Alcala, exploring the writing process.

For more information about the Gold Foundation programs or their status, please contact Director of Program Initiatives Michelle Sloane at [email protected] .

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2021 Hope Babette Tang Humanism in Healthcare Essay Contest

Second place nursing student essay: nurses encounter diversity.

Swartzlander, Anna 1

1 A. Swartzlander is a graduate nursing student, University of Nebraska Medical Center, Omaha, Nebraska; email: [email protected] .

Editor’s Note: The patients’ names and other details have been changed to protect patient privacy.

I am reporting to the COVID-19 unit for my 12-hour nursing shift. Stretched to the limit, there are simply not enough nurses right now. I cannot complain. The COVID-19 unit is severely understaffed due to a variety of reasons. Some staff are ill. Some are weary. Some quite honestly are unwilling to throw themselves into the eye of a pandemic.

On this night of nursing, I suddenly discover I am responsible for 14 patients diagnosed with COVID-19, several of whom are very confused. Some are dying. One muddled gentleman is yelling, constantly, and has fallen several times this week. Our staff members are bone tired and doing their best.

After applying all protective gear—N95, surgical mask, eye protection, gown, booties—I see my first patient. But soon after “gowning,” I discover my patient’s blood sugar is dangerously low, and all that protective garb must come off, as quickly as humanly possible. I sanitize. Then I go in search of orange juice, a more challenging quest than anticipated. Amidst this pandemic, health care facilities have been forced to create emergency-built isolation COVID-19 wards, often with only enough space for closet-sized kitchens. So, I end up calling for orange juice to be placed in the breezeway—where I can retrieve it when the foyer is safely uninhabited—and grab a cup of apple juice and Lorna Doone cookies.

I can hear another patient yelling.

After robing all the required personal protective equipment—sweating under my masks and gowns, heart racing, mind ticking—I deliver apple juice and cookies for my first patient, a woman who helpfully shares that she dislikes apple juice and would have preferred Oreos. Nonetheless, she downs everything while I proceed with the rest of her cares. By the time I leave her, her blood sugar is stable.

Disrobe. Sanitize. Complete charting.

Next, gown up and head for the patient who has been yelling. He is urinating into the trash can, which is unlined. I clean him up, calm him down, put his oxygen back on. I try to answer his repetitive questions kindly and calmly. I turn on the TV. I give him his call light. I clean up the room. I disrobe and sanitize. His yelling ensues immediately upon my departure.

On to the next room. This patient is relatively easy: alert and oriented, able to take medications whole, feeling little pain. I perform his cares and administer his medications under layers of protection. He wants to talk. He is lonely. I chat with him for a few minutes, but sadly the clock is ticking, and I have 12 patients yet to go. I politely interrupt and tell him I have work to do. I feel like a jerk.

Disrobe. Sanitize. Chart. Patient still yelling in background.

Deep breaths, I am finally ready for my third patient (out of 14). But wait, my very first patient is calling, and she would like her blood sugar checked again. Robe. Check sugar. Stable. But this dear woman would still appreciate that Oreo I did not bring her last time. Disrobe. Walk down two hallways to get cookies, and return with cookies, making sure I adhere to all guidelines for personal protective equipment.

The Arnold P. Gold Foundation holds an annual essay contest to encourage medical and nursing students to reflect on their experiences and engage in narrative writing. The contest began in 1999 open to medical students and expanded in 2018 to include nursing students. Students are asked to respond to a specific prompt in a 1,000-word essay.

For the 2021 contest, students were asked to use the following quote as inspiration to reflect on humanism in health care during the past difficult year using their experiences or observations, as an individual or as a team (doctors, nurses, therapists, etc.)

“We’ll observe how the burdens braved by humankindAre also the moments that make us humans kind; Let each morning find us courageous, brought closer; Heeding the light before the fight is over.When this ends, we’ll smile sweetly, finally seeingIn testing times, we became the best of beings.”

—Excerpt from “The Miracle of Morning,” by Amanda Gorman

More than 270 essays were submitted. A distinguished panel of judges, including esteemed health care professionals and notable authors, reviewed the submissions. Three winning essays from medical students and three winning essays from nursing students were selected, along with 9 honorable mentions. The winning essays will be published in consecutive issues of Academic Medicine and the Journal of Professional Nursing in the fall/winter of 2021.

The contest is named for Hope Babette Tang-Goodwin, MD, who was an assistant professor of pediatrics. Her approach to medicine combined a boundless enthusiasm for her work, intellectual rigor, and deep compassion for her patients. She was an exemplar of humanism in medicine.

The Arnold P. Gold Foundation is a nonprofit organization that champions humanism in health care, defined as compassionate, collaborative, and scientifically excellent care. This Gold standard of care embraces all and targets barriers to such care. The Gold Foundation empowers experts, learners, and leaders to together create systems and cultures that support humanistic care for all.

Back to third patient.

My anxiety is rising. I am a seasoned bedside nurse who absolutely adores her patients. I am in my last year of graduate school aspiring to be a nurse practitioner. I am a single mom to 2 daughters. I am a strong woman. I do not cry at work. But I feel the tears coming. I cannot do this.

I approach my third patient with blurry eyes, read the electronic Medication Administration Record and prepare medications and treatments. This man is alert and oriented. He, too, takes his medications whole. I robe. Enter his room. He is pleasant. He is stable. I ask if he needs anything more, hoping silently that he does not. I have 11 patients left for bedtime medications and am already 3 hours into my shift. Unfortunately, he is out of ice water—and could I please bring a soda, any kind of soda is fine, but a Coke would be preferred.

I disrobe. I am on a simple mission for ice water and a soda, but I feel a breakdown coming on. Again, I am not sure that I can do this. For the first time in my decades-long nursing career I actually contemplate walking out on beloved patients.

But I do not walk out. Instead, I walk down 2 hallways to the makeshift closet/kitchen, open our tiny refrigerator and pray for a soda to appear. It is a miracle: There is one Coke left. It is Diet Coke, but it is cold, and it is a soda. I make a mental note to remember to call and get the soda restocked. I retrieve the ice water, collect the can of soda and return to the patient’s room. After putting on all my protective gear, I enter the room and offer his refreshments.

The dear man sighs, takes a sip, looks up at me and says, “You are a blessing.”

I pause, just for a moment, and somewhere—way underneath all my masks—I smile.

I disrobe. Sanitize. Chart. And take a deep breath.

I can do this.

On to patient 4.

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What is nursing professionalism? a concept analysis

1 Nursing College of Shanxi Medical University, Taiyuan, 030001 Shanxi People’s Republic of China

2 Linfen Hospital Affiliated to Shanxi Medical University (Linfen People’s Hospital), Linfen, 041000 Shanxi People’s Republic of China

3 The Third Peoples Hospital of Taiyuan, Taiyuan, 030001 Shanxi People’s Republic of China

Yangjie Chen

4 The First Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi People’s Republic of China

Qiaohong Wang

Associated data.

Data used to support the findings of this study are available from the corresponding author upon request.

Nursing professionalism plays an important role in clinical nursing. However, a clear conceptual understanding of nursing professionalism is lacking.

Walker and Avant’s strategy was used to analyse the concept of nursing professionalism. We searched electronic databases, including PubMed, Scopus, and CINAHL, for studies published from 1965 to 2021. Quantitative or qualitative studies published in English that focused on nursing professionalism were included in the study.

The three attributes of nursing professionalism are multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism is defined as providing individuals care based on the principles of professionalism, caring, and altruism.

Conclusions

This study offers a theoretical definition and conceptual model of nursing professionalism that may be applied to develop standardized assessment tools or nursing professionalism training programs.

Introduction

The COVID-19 outbreak has exposed deficiencies in the underinvestment of the global health system, including the shortage in nursing resources and nursing staff, and a similar situation is noted in China ( https://www.icn.ch/news/investing-nursing-and-respecting-nurses-rights-key-themes-international-nurses-day-2022 ). An unbalanced number of nurses and patients, high work pressure, lack of social occupational identity and other reasons have led to job burnout, low job satisfaction, and even the resignation of many nurses. Research has also shown that the lack of nursing professionalism adversely affects patient care and patient outcomes [ 1 ]. Ohman [ 2 ] pointed out that lower levels of professionalism may cause negative outcomes, such as turnover and attrition and lower productivity.

In recent years, researchers have tried to solve the above problems through professionalism.

However, nursing professionalism plays a more important role in clinical nursing. Some studies have shown that professionalism can improve the professional knowledge and skills of nurses and ameliorate reductions in institutional productivity and quality [ 3 ]. Higher levels of professionalism can improve nurses’ autonomy and empowerment, increase their recognition and facilitate organizational citizenship behaviours, establish nursing care standards and even improve quality services [ 4 , 5 ].

Nursing professionalism has been discussed for several decades. Hall (1968) developed the Professionalism Inventory Scale [ 6 ]. Miller et al [ 7 ] (1993) first specified the 9 standards criteria of nursing professionalism (educational background; adherence to the code of ethics; participation in the professional organization; continuing education and competency; communication and publication; autonomy and self-regulation; community service; theory use, development, and evaluation; and research involvement.). Yeun et al. (2005) summarized five themes regarding nurses’ perceptions of nursing professionalism: self-concept of the profession, social awareness, professionalism of nursing, the roles of nursing services, and originality of nursing [ 8 ]. Yoder defined nursing professionalism based on six components: acting in the patients’ interests; showing humanism; practising social responsibility; demonstrating sensitivity to people’s cultures and beliefs; having high standards of competence and knowledge; and demonstrating high ethical standards [ 9 ]. Although some researchers have explored the concept of professionalism. How can professionalism be evaluated in nursing clinical practice? Few studies have shown a clear conceptualization of nurses’ professionalism [ 10 , 11 ]. To nurture nursing professionalism, the concept of professionalism must be clarified.

Given that the meaning of professionalism varies across time, contexts, or cultures, it is difficult to define, quantify or measure professionalism [ 12 , 13 ]. The operational definition of nursing professionalism in studies has shortcomings. Sullivan et al. [ 14 ] found professionalism to be a multidimensional concept, but some papers have addressed only one dimension, such as values [ 15 ] or behaviours [ 16 ]. Moreover, professionalism is considered a complex concept. The links and dynamic processes between these different inner characteristics have not been included in the concept. Thus, a comprehensive definition of nursing professionalism, including its characteristics and the relations between them, is necessary.

Recognizing and understanding the concept of nursing professionalism may be an essential step towards providing quality care for people. It may also provide more information for further developing nursing professionalism for nurses.

Method of concept analysis

Walker and Avant’s method used linguistic philosophy techniques to contribute to the philosophical understanding of a concept [ 17 ]. The W & A method is considered a mark of the positivist paradigm, which views the concept as a stable factor that can be reduced or extracted from its context of application [ 18 ]. This study used Walker and Avant’s method, which assumes that nursing professionalism is a relatively mature and stable concept (numerous studies on nursing professionalism have been published to date). This approach to conceptual analysis, although not perfect, is helpful in clarifying the concept of nursing professionalism.

Using the structured method of Walker and Avant enables conceptual clarity to be obtained based on an inductive identification of the concept’s attributes, antecedents and consequences. The concept analysis helps to clarify meanings and develop operational definitions, considering evidence from a wide range of information resources for further research or clinical practice [ 17 , 19 ]. These features make this method particularly useful for the analysis of the concept of ‘nursing professionalism’. The conceptual attributes as well as antecedents and consequences are based on the research team's analysis of the literature using Walker and Avant’s strategy and are not the product of a priori theoretical categories.

Walker and Avant’s [ 17 ] eight-step method includes the following: 1) selecting a concept; 2) determining the aims or purposes of analysis; 3) identifying all uses of the concept; 4) determining the defining attributes of the concept; 5) constructing a model case; 6) constructing borderline, contrary, invented, and illegitimate cases; 7) identifying antecedents and consequences; and 8) defining empirical references.

Selection criteria

The inclusion criteria were as follows: related to the concept of nursing professionalism; included nurse professionalism, nursing spirit, or nurse spirit; written in the English language; qualitative, quantitative, mixed methods or systematic reviews; published between 1965 and 2021 (when professionalism was first introduced by nursing in 1965); and published in books or dictionaries. We excluded articles published in nonpeer reviewed journals, editorials and letters to the editor.

Data sources

We searched several online databases, including PubMed, Scopus, and CINAHL, for articles published from 1965 to 2021. We searched the words that appear in the title, abstract, and keyword section of the studies.

(((((((((Nursing professionalism[Title]) OR (Nursing professionalism[Title/Abstract])) OR (Nurse professionalism[Title])) OR (Nurse professionalism[Title/Abstract])) OR (Nursing spirit[Title])) OR (Nursing spirit[Title/Abstract])) OR (Nurse spirit[Title])) OR (Nurse spirit[Title/Abstract])).

TI Nursing professionalism OR AB Nursing professionalism OR TI Nurse professionalism OR AB Nurse professionalism OR TI Nursing spirit OR AB Nursing spirit OR TI Nurse spirit OR AB Nurse spirit.

TITLE-ABS-KEY (Nursing professionalism) OR TITLE-ABS-KEY (Nurse professionalism) OR TITLE-ABS-KEY (Nursing spirit) OR TITLE-ABS-KEY (Nurse spirit).

Any quantitative or qualitative studies published in English focusing on nursing professionalism were included in the study. Two researchers independently screened titles and abstracts to determine the selection criteria for electronic retrieval and application. The study was included only when both researchers agreed that the study met the inclusion and exclusion criteria. If the two researchers’ judgements were different, a third person was consulted to resolve the issue. Researchers identified the different usages of the concept and systematically recorded the characteristics of the concept that appeared repeatedly [ 17 ].

We used definitions and examples in the systematic record (Table (Table2) 2 ) to define a cluster of antecedents, attributes and consequences (Figs. (Figs.1 1 and 2 ) frequently associated with the concept [ 20 ].

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Flowchart of the study selection process of the concept analysis

The connotations of nursing professionalism

Nursing professionalism	Author	Country
Have a systematic nursing knowledge system	Freidson,(2001) [ ] Hinshaw, A. S.(1987) [ ]	USA USA
Professional certification	Lamonte M. (2007) [ ] Stucky, C. H., & Wymer, J. A. (2020) [ ]	USA USA
Lifelong learning and participation	Hinshaw, A. S.et al,. (1987) [ ] Karadağ, A.,et al.(2007) [ ]	USA Turkey
Evidence-based practice	Cornett B. S. (2006) [ ]	USA
Innovate	Shen et al. (2021) [ ]	China
Striving for excellence	Boehm, L. M.,et al. (2020) [ ]	USA
Creating a caring-healing environment	Watson, J. (1988) [ ]	USA
Displaying kindness/ concern/empathy for others	Collins, H., (2014) [ ] Papastavrou E., et al. (2011); [ ] Jooste, K., (2010), [ ]	UK Greek South Africa
Using all ways of knowing support and involvement	Watson, J. (1988) [ ]	USA
Embracing the unknowns and miracles in life and practicing loving	Watson, J. (1988) [ ]	USA
Patient-first	Kubsch, S, et al. (2021) [ ]	USA
Dedication	Fernandez, R., et al. (2020) [ ] Zhang, M, et al.(2021) [ ] Goldie J. (2013) [ ]	Australia China UK
Public service	Riley, J. M etal (2010) [ ]	UK
Disaster and infectious disease rescue	McDonald L. (2014) [ ] Liu, Q., et al. (2020) [ ]	Canada China
Community service	Kim-Godwin, Y. S(2010) [ ]	USA

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Object name is 12912_2022_1161_Fig2_HTML.jpg

Antecedents, attributes, and consequences of nursing professionalism

We identified 6013 studies on nursing professionalism. After excluding duplicates, irrelevant studies, studies that were not original scientific studies or articles, and studies published in languages other than English, 138 studies were selected for analysis. Tables 1 and and2 2 show some typical literatures used in this study.

The attributes of the nursing professionalism

Nursing professionalism	Author	Country
Knowledge	Fogarty, T. J., et al. (2001) [ ]	USA
Attitude	Wynd C. A. (2003) [ ] Hall, R. H.. (1968) [ ] Takada, N., et al. (2021) [ ]	USA USA Japan
Behaviours	Schwirian P.M. (1998)? [ ] Miller, B. K.. (1988) [ ]	USA USA
Socialization process	Hinshaw, A.S. (1976) [ ]	USA
process of interaction	Swick H. M. (2006) [ ] Dehghani, A(2016) [ ]	USA Iranian
Cultural attribute of nursing professionalism	Chandratilake, M., et al.(2012) [ ] Jin P. (2015) [ ]	UK China

Uses of the concept

Dictionary definitions of the concept.

The Merriam-Webster Dictionary defines professionalism as ‘the conduct, aims, or qualities that characterize or mark a profession or a professional person’ [ 48 ], whereas the Cambridge Dictionary [ 49 ] defines professionalism as ‘the combination of all the qualities that are connected with trained and skilled people’. These definitions are generic and difficult to use to clarify the factors involved in nursing professionalism.

Definitions of the concept reported in the literature

Hwang et al. [ 50 ] defined professionalism as commitment to a profession and professional identity level. Health-care workers demonstrate professionalism through attitudes, knowledge, and behaviours, which reflect approaches to the regulations, principles, and standards underlying successful clinical practices [ 33 ]. Nursing professionalism reflects the value orientation, concepts of nursing, work attitude and standards of clinical nurses [ 51 ].

Subconcepts

The Nightingale Spirit, named in honour of the founder of professional nursing, refers to the spirit of altruism, caring, and honesty [ 52 ]. In the past, the Nightingale Spirit advocated that nurses are willing to dedicate themselves, but the term currently encompasses more innovation [ 53 ]. E-professionalism is defined as evidence provided by digital means, attitudes and behaviours reflects the traditional models of professionalism [ 54 ]. Nurses use the internet to communicate about work or daily life, blurring the boundaries between individuals and professions; thus, e-professionalism applies to nurses [ 55 ].

The defining attributes of nursing professionalism

The defining attributes of the concept aim to understand its meaning and differentiate it from other related concepts [ 17 ]. The key defining attributes are as follows.

Nursing professionalism is multidimensional

Nursing professionalism is a three-dimensional concept based on the knowledge, attitudes, and behaviours that underlie successful clinical practice [ 33 ].

Professionalism can be conceptualized as a ‘systematic body of knowledge’ with complex configurations of work expertise [ 21 ].

Professionalism refers to the attitude that represents levels of recognition and commitment to a particular profession [ 22 ]. Hall [ 6 ] noted that nurses’ attitudes have a high correspondence with the behaviours of the respondent. Measuring professionalism at the cognitive level can be thought of as measuring potential professionalism at the behavioural level. Researchers noted that given the reduced restrictions of environmental constraints, measuring professionalism at the cognitive level may be more precise than measuring it at the behavioural level [ 23 ].

Nursing professionalism is often described as a set of professional behaviours [ 11 ]. Some researchers judge whether nurses exhibit professionalism through their behaviours. Miller [ 24 ] (1988) developed the Wheel of Professionalism in Nursing Model. The model is considered a framework for understanding professional behaviours among nurses. Kramer [ 56 ] (1975) quantified professionalism by assessing the number of professional books purchased, subscriptions to journals, and the number of articles published.

In addition, the perspective of professional identity formation complements the behaviour-based and attitude-based perspectives on professionalism [ 57 ].

The formation and development of professionalism are dynamic processes

Nursing professionalism is an inevitable, complex, varied, and dynamic process [ 58 ].The professionalism concept is considered ever-changing, replacing static or definitive views [ 59 ].

Socialization process

Nursing professionalism is instilled through a process of socialization in formal nursing education [ 25 ]. Nurses’ socialization process begins with formal, entry-level education to acquire knowledge and skills.

Yeun et al. [ 8 ] (2005) discussed the developmental process of nursing professionalism in which the individual’s thoughts and beliefs are formed by socialization factors through perception. These thoughts and beliefs may in turn influence the individual’s professional image or self-concept, thereby influencing nurses’ actions and performance.

Process of interaction

The dynamic of professionalism is also reflected in the process of interaction. Dehghani et al. [ 26 ]noted that nursing professionalism means the appropriate interaction of the individual and the workplace and the maintenance of interpersonal communication.

Culture oriented

One study showed that altruism is an essential element of medical professionalism in Asia or North America but not Europe [ 27 ]. In China, medical professionalism was influenced by its longstanding Confucian traditions [ 28 ]. Therefore, any definitions of professionalism should match its rooted culture and be validated with respect to the culture and context in which it is applied [ 60 ].

The connotation of nursing professionalism

Professional, having a systematic nursing knowledge system.

The nursing process is considered a method for solving problems or dilemmas in a logical and scientific manner [ 11 ]. Freidson [ 29 ] (2001) noted that professionals perform their specialized work only with the required training and experience. Professionals have specific, tacit, almost esoteric knowledge to do their work [ 61 ]. Miller et al. [ 7 ] considered that a formal university education with a scientific background is critical for professionalism in nursing.

Professional certification

Nurses actively seek specialty certification given their personal commitment to the nursing profession [ 30 ]. Specialty certification promotes nursing professionalism. When attaining the highest levels of clinical knowledge, nursing professionalism also indicates personal responsibility and dedication to best practices [ 31 ].

Lifelong learning and participation in continuing education

Due to professional and ethical obligations, nurses should sustain continuous professional growth and development to maintain individual competence. Professional growth in nursing requires lifelong learning. Lifelong learning includes continuing education and self‐study, seeking advanced degrees, etc. [ 62 ].

Continuing education is one of the indicators of professionalism. Professionals keep up with the latest developments in the field and partake in continuing education. Additionally, continuing education is as important as other criteria for increasing professionalism in nursing [ 7 , 32 ]. Ongoing education brings fresh knowledge to health care, consequently leading to more efficient and quality service for people.

Evidence-based practice

Evidence-based practice (EBP) is a hallmark of professionalism [ 33 ]. Dollaghan [ 63 ] (2004) reported that we identify and use the highest quality scientific evidence as an integral part of our efforts to provide the best patient care; EBP is a knowledge base that responds to specific clinical issues in a clear, intelligent, and serious manner while considering clinical practice in the context of the highest-quality scientific evidence available.

Innovation in nursing helps to improve patient care quality and improve nurses’ job performance [ 64 ]. Shen et al. [ 34 ] noted that innovative education plays an important role in the professional quality of undergraduate nursing students.

Striving for excellence

Striving for excellence is a requirement and attribute of nursing professionalism. There is a growing need in nursing practice to possess knowledge and skills in quality improvement science, translational research, and implementation science [ 35 ]. Clinical nurses have the same responsibilities as nursing scientists.

Caring is considered the core attribute of nursing professionalism

The practice of caring is central to nursing [ 65 ]. Caring is defined as the moral ideal of nursing [ 36 ]. Therefore, caring is an important core attribute of nursing professionalism.

Creating a caring-healing environment

Nurses devoted to creating a caring-healing environment embody professionalism. Caring means nurses should create a healing environment at all levels by providing a supportive, protective environment as well as a corrective mental, physical, societal, and spiritual environment for patients. People’s basic needs include a clean environment, comfort measures, safety concerns, and feeling safe or protected [ 65 ].

Displaying kindness/concern/empathy for others

A nurse is defined as someone caring for the ill within the hospital setting [ 66 ]. Caring means showing or having compassion, concern and empathy for others [ 37 ]. Caring behaviours are an interactive and mental process between patients and nurses [ 38 ]. Displaying kindness and concern for others is shown by love, compassion, support and involvement [ 39 ].

Using all methods of knowing support and involvement

‘Human problems reside in ambiguity, paradox, and impermanence’. Therefore, suffering, healing, miraculous cures, and synchronicity are all part of knowing support and involvement.

Researchers suggest that nursing comprises Caritas Nursing, Energy Nursing, Transpersonal Nursing, Holistic Nursing, or Contemplative Nursing…… It goes beyond ordinary nursing. Nursing should have higher standards with excellence for caring, healing, and peace in the world. Therefore, caring means using all methods of knowing support and involvement [ 65 ].

Embracing the unknowns and miracles in life and practising loving

Nursing is a special profession. Nurses confront special circumstances daily and witness people’s struggles with life and death. Everyone has his or her own specific story about his or her experiences and predicaments. Each person seeks his or her own meanings to find inner peace and balance in the midst of fear, doubts, despair, and unknowns. Therefore, the care of nurses is not to blindly sacrifice their own needs but to be a real nurse, embracing the unknowns and miracles in life and caring for patients [ 65 ].

The central tenet of professionalism is to put the needs and best interest of others over self-interests. Altruism is an engagement in caring acts towards others without expecting something in return [ 67 ].

Patients first

To be altruistic means to put others’ needs before your own. Altruism is the selfless concern for others and doing things with the other person’s well-being in mind [ 40 ].

During pandemics, nurses were considered to have a high sense of duty and dedication to patient care [ 41 ]. Front-line nurses perceive high work engagement, especially in self-dedication [ 42 ]. Grøthe et al. [ 43 ] showed that cancer patients in a palliative unit appreciate nurses who have the most dedication and expertise characteristics.

Public service

Due to a strong sense of civic and social responsibility, nurses participate in public service. Nurses volunteer as participants in summer camps, schools, or health-care teams. Nurses are also committed to responding to large-scale crises, such as the terrorist attacks on the World Trade Center in New York, as well as national and international relief efforts, such as tsunamis and Hurricane Katrina [ 44 ].

Disaster and infectious disease rescue

Individuals involved in providing disaster relief face many challenges, experience fatigue and personal suffering, and encounter numerous personal stories of life and death [ 45 ]. Nurses have played a significant role in the fight against infectious diseases such as severe acute respiratory syndrome (SARS) and the coronavirus disease 2019 (COVID-19) pandemic [ 68 ]. Nurses are closest with patients. Nurses provide intensive care, regularly assessing and monitoring airways, tubes, medications, and physical therapy. Nurses are also devoted to reducing complications. Nurses assist with daily living activities when patients are unable to care for themselves [ 46 ].

Community service

In addition, emphasizing professionalism means respecting values and commitment to community service delivery [ 69 ].

According to Walker and Avant [ 17 ], cases help further clarify concepts.

Model cases (a real case example)

Model cases help demonstrate all the defining attributes of a concept and helps to better articulate its meaning [ 17 ].

MS A is a 63-year-old nursing director. She worked in clinical nursing and management for 42 years. As she progressed from a new nurse to a nursing expert, she gradually poured her enthusiasm (Multidimensional: Attitudes) into nursing work (Dynamic). She believes that the core of nursing professionalism in China is dedication and responsibility (Culture oriented). In 2020, COVID-19 broke out in Wuhan, China. She led a team to Wuhan to provide support (Multidimensional: Behaviours), reflecting the spirit of altruism (Altruism). She actively promoted exchanges and cooperation among disciplines and the development of academic conferences. She guided students to pay attention to practical innovation and develop evidence-based innovations (Professional). Although she is retired, she still imparts knowledge and experience to students everywhere (Multidimensional: Behaviours). She stated that the development of nursing professionalism is very difficult and requires nursing education and role models. (Multidimensional: Knowledge). The role of a nurse is like that of a mother, bringing care to the people (Caring).

Borderline cases (a real case example)

Borderline cases provide the examples that contain the most defining attributes of the concept [ 17 ].

B is a novice nurse. When working in the infection ward, she was so worried about being infected. She was reluctant to care for patients and wanted to escape from the ward environment. Fortunately, her nurse manager fully understood her situation and helped her adapt to work and reduce her anxiety. B observed that her nurse manager had been helping patients solve problems and giving them comfort and hope. This prompted her to think about what nursing truly means. In 2020, she volunteered to help COVID-19 patients (Altruism).

Related cases (a real case example)

Related cases are related to the concept but do not contain all its defining attributes [ 17 ].

C is a novice nurse. After graduating from nursing school, he became a nurse in the emergency department. He saw many patients who died or recovered, which made him realize the importance of caring (Caring). He said that emergency nurses need strong professionalism (Multidimensional: Attitudes). He participated in social service activities (Multidimensional: Behaviours), for example, promoting knowledge of cardiopulmonary resuscitation (Altruism) in the community. After working for five years, he returned to school for a master’s degree to help the head nurse conduct nursing research or evidence-based practice (Professional). In his Asian cultural milieu, his is embarrassed about his identity as a male nurse (Culture oriented), but he believes he can do well.

Contrary cases (a fictional case example)

A contrary case does not include any defined attributes of the concept [ 17 ].

D is a nurse in paediatrics. She disliked nursing when she was a nursing student and even did enjoy communicating with patients (poor dynamics). She was exhausted after work and felt her life was out of balance. One of the values of the hospital where she worked was dedication, which confused her (Poor culture orientation). She considers it unrealistic to require professionalism (Poor nursing professionalism knowledge) and thinks that taking care of new-borns is particularly troublesome (Poor nursing professionalism attitudes), so she is always careless in her work (Multidimensional: poor attitude). D’s child felt ill last week, so she secretly reduced a patient’s medicine (Poor nursing professionalism behaviours) and took the remaining medicine home for her child (lack of altruism). She stopped doing so after her colleagues sensed something strange. One day, a baby kept crying; D reported it to the doctor and did not make further observations (Poor professional). When the shift nurse took over, she observed abnormal limb activity on one side of the child. The child’s family asked the nurse to bear legal responsibility. D said it was no big deal; she no longer wanted to be a nurse (Poor dynamic, professionalism not established).

Antecedents

Antecedents are events that occur before the intended concept [ 17 ].

Macro antecedents

Jin [ 28 ] suggested that the conceptualization of professionalism is influenced by culture. Employees defined organizational culture underlies an organization’s values and beliefs [ 70 ]. Nursing professionalism may be supported by a variety of cultures, so a firm understanding of and personal congruence with each particular culture is essential [ 71 ].

Religious beliefs

Religiosity is another contributing factor in the cultivation of altruism [ 72 ]. Taylor noted that nurses’ job motivation and views of the patient and nursing services are affected by their religious beliefs [ 73 ].

Micro antecedents

Snizek [ 74 ] (1972) reported that devotion to work is a professional value originating from a sense of calling to the field. Liaw et al. [ 75 ] (2016) found that nursing students who had caring and compassionate qualities as the most common personal characteristics strongly believed that they were called to nursing.

Individuals who pursue excellence in the workplace may be described as motivated and devoted to their work. Attree [ 76 ] (2005) noted that nurses’ perceived lack of autonomy over their practice could impact quality of care.

Personal characteristics

Nursing professionalism is influenced by various factors, such as educational background, personal interests, professional satisfaction, and professional values [ 77 , 78 , 79 ]. In each country, nurses with higher educational levels may have a higher level of professionalism [ 22 ]. Professionalism is thus a trait related to personal character and upbringing [ 80 ]. Researchers [ 81 ] have demonstrated that professionalism is positively associated with female gender, striving for professional goals, and acceptability. One study found that people’s values tend to shift to emphasize altruism over personal gain as they age [ 79 ]. Nursing professionalism is closely associated with personality traits (extraversion, conscientiousness, and agreeableness) [ 82 ].

Consequences of nursing professionalism

Consequences are events or incidents that are the result of the occurrence of a concept [ 17 ].

Consequences for patients

Professionalism is one of the decisive factors that critically influences patient satisfaction [ 50 ]. Professionalism can also improve practising nurse career development and the quality of service [ 81 ].

Consequences for nurses

Studies have shown that professionalism and a sense of belonging with colleagues and managers affect the satisfaction [ 83 ] and retention rate of nursing students in academic institutions [ 84 ]. Izumi et al. [ 85 ] (2006) found that good nurses felt pride and happiness in caring for patients closely related to their professionalism.

Empirical references

As the last step to concept analysis, empirical references can further clarify the concept and facilitate its measurement [ 17 ].

Hall’s professionalism inventory scale

Hall’s Professionalism Inventory Scale [ 6 ] identified five attitudinal attributes of professionalism: (a) use of professional organizations as major referents, (b) belief in public service, (c) self-regulation, (d) a sense of calling to the field, and (e) autonomy. Nursing researchers used Hall’s Professionalism Inventory Scale to measure professionalism in nursing [ 22 , 47 ]. Snizek [ 74 ] (1972) modified the professionalism scale to more closely match the clinical context of nursing and better reflect the professionalism of nursing staff.

Kramer’s index of professionalism

Kramer (1974) [ 86 ] constructed an index of professionalism that includes indicators of behaviours, such as the number of professional books published, subscriptions to professional journals, hours spent on professional reading, continuing education, participation in professional organizations, number of professional publications, speeches given, committee activity, and participation in research.

The behavioural inventory for professionalism in nursing (BIPN)

The Behavioural Inventory for Professionalism in Nursing [ 7 ] (BIPN) identifies professional behaviours and values among nurses. The nine categories in the BIPN are (1) educational background; (2) adherence to the code of ethics; (3) participation in the professional organization; (4) continuing education and competency; (5) communication and publication; (6) autonomy and self-regulation; (7) community service; (8) theory use, development, and evaluation; and (9) research involvement.

Definition of the concept

Based on the present analysis, we define nursing professionalism as follows: ‘Nursing professionalism is a multidimensional concept manifested by the knowledge, attitudes, and behaviours that underlie successful clinical practice. Nursing professionalism is dynamicized through a process of socialization in formal nursing education. This feature is also reflected in the process of interaction. Therefore, nursing professionalism should match its rooted culture.

The connotations of nursing professionalism include professional, caring, and altruism. These connotations are detailed as follows:

Possesses a systematic nursing knowledge system; professional certification
Exhibits lifelong learning and participation
Participates in evidence-based practice
Demonstrates innovation
Strives for excellence
Creates a caring-healing environment
Displays kindness/concern/empathy for others
Uses various methods of knowing support and involvement
Embraces the unknowns and miracles in life and practices loving
Patient-first

A conceptual model of nursing professionalism is shown in Fig. 2 .

Defining the connotation of nursing professionalism

Nursing professionalism has been defined as professional, caring, and altruistic.

Professional values are characteristic of nursing professionalism. Nursing work requires rich knowledge and scientific evidence-based work to improve the quality of nursing services for patients. Nurses need lifelong learning, qualification certification, and participation in academic and practical activities.

Caring is regarded as the core of professionalism. This study suggests creating a caring-healing environment, displaying kindness/concern/empathy for others, employing all methods of knowing support and involvement, embracing the unknowns and miracles in life and practising loving to care for people to obtain high professionalism. This study notes that nursing professionalism emphasizes care for the individual patient and that the nurse does everything possible to create a caring and healing environment for patients. In different health systems worldwide, nurses have incorporated caring about nursing professionalism into everything they do. This characteristic is consistent with Nightingale's view that “Nurses need to be sensitive. A nurse must use her brain, heart and hands to create healing environments to care for the patient’s body, mind and spirit” [ 87 , 88 ].

Nursing has an altruistic nature, and people interested in helping patients are attracted to this profession [ 89 ]. However, some studies have shown that altruistic care is equated with self-sacrifice, self-denial, and unidirectional and unconditional care [ 90 ]. Care for a nurse’s own needs is equally important, but nurses should be able to put aside their own needs when required to focus on the needs of others [ 91 ]. Nurses should view self-care and altruism as dialectical. Self-realization and providing care for others are not conflicting concepts [ 92 ].

Defining the attributes of nursing professionalism

In this study, we defined nursing professionalism as multidimensional, dynamic, and culture oriented.

Nursing professionalism is a multidimensional concept that includes knowledge, attitudes, and behaviour. Previous studies have defined professionalism as the degree of commitment by individuals to the values and behavioural characteristics of a specific career identity [ 6 , 7 ]. However, current research on nursing professionalism is mostly single dimensional. The Behavioural Inventory for Professionalism in Nursing (BIPN) is based on Miller’s model and is used to measure professional behaviours among nurses [ 7 ]. Hall’s Professionalism Inventory Scale [ 6 ] identified five attitudinal attributes of professionalism. This study highlights that it is also necessary to focus on the knowledge dimension of professionalism. Nursing students and nurses should first understand the nursing professionalism that is necessary to become a nurse, which may be the first step in developing professionalism. Nursing students and nurses need to know the values that are necessary to practice the nursing and not have vague impressions. Some studies have shown that nursing students or nurses learn values and norms in informal trainings [ 93 ]. Therefore, this study suggests that the development of assessment tools for the knowledge dimension of professionalism is also necessary. Multidimensional evaluation tools are not available for nursing professionalism. Thus, clarifying the multidimensional nature of nursing professionalism will contribute to the development of multidimensional evaluation tools.

Moreover, understanding the dynamics of professionalism is helpful for cultivating nursing professionalism in stages and steps. Inquiries into medical professionalism should be integrated into the culture of social media interaction [ 94 ]. Nursing educators and managers should dynamically cultivate nursing professionalism in their interactions.

Differences in the connotation of nursing professionalism are noted in different cultures. This study suggests that the cultivation and evaluation of nursing professionalism need to consider the cultural attributes of different regions and countries.

Future research directions

Exploring the antecedents of nursing professionalism can help schools or hospitals cultivate nursing professionalism and develop courses and specific measures.

The macro antecedents of nursing professionalism include culture and religion, and the micro antecedents include calling, autonomy, and personal characteristics. Some researchers have explored methods to cultivate nursing professionalism; for example, role modelling, feedback, group discussions, case-based discussions, reflection, holding ethical rounds, and reports potentially represent more effective methods [ 95 ]. Some researchers have tried to enhance professionalism through social media [ 96 ]. One of the findings this study is that nursing professionalism is complex and its cultivation difficult. Studies have shown that didactic lectures are ineffective for teaching professionalism [ 97 ]. The development of true nursing professionalism requires national advocacy and the immersion of a good professional environment that incorporates professionalism into daily nursing practice. Role modelling is considered an effective method for developing professionalism in nursing [ 98 ]. Therefore, this study suggest that studies should be actively conducted to deeply discuss the causes and processes affecting professionalism and to cultivate and intervene at macro and micro levels as well as the key time periods and populations that form professionalism to truly shape the formation of professionalism. Moreover, an environment for building professionalism [ 99 ] is very important. Williams [ 100 ] (2015) considered that the development of professionalism should begin as early as the first semester of an undergraduate nursing course. One of the themes of nursing students’ professional identity development is ‘doing-learning-knowing-speaking’. Students should develop professionalism in all these areas of nursing practice.

The relationship between nursing professionalism and health outcomes or nurses’ human resources needs to be further studied.

Our research suggests that the ultimate goal of nursing professionalism is to serve patients with professional knowledge and special professional quality. The public has become increasingly aware of certain possibilities, limitations, and consequences of professionalism. COVID-19 significantly increased the discussion of professionalism and patient outcomes.

Improving professionalism has a positive impact on job satisfaction, professional quality of life, and the willingness to continue in the profession [ 101 , 102 , 103 ]. Therefore, it is important to improve support for nurses, create a good environment for professionalism, and establish a training system for professionalism, thus paving the way to enhance training in professionalism and create opportunities for nurses.

Implications for nursing management

In April 2020, the World Health Organization (2020) issued the First State of the World’s Nursing 2020 [ 104 ]. The report highlighted that nursing professionals are the largest occupational group in the health sector, numbering 27.9 million worldwide. Nurses spend more time with patients than any other health care professionals [ 105 ].

Worldwide, nursing professionalism is considered important and associated with expectations. This study clarifies the concept of nursing professionalism and contributes to a framework for developing a theoretical model as well as instruments to measure the concept. A conceptual model of nursing professionalism may increase nurse managers’ insight into nurses’ behaviours and values, creating a good working environment.

Nurse managers should integrate nursing professionalism into their philosophy, mission, and objectives and provide necessary resources, tools, and projects to develop professionalism among nurses. Nurses should cultivate professionalism to provide good nursing services to patients. Further research should explore the relationship between nursing professionalism and patient health outcomes and formulate effective training programs for professionalism.

Limitations

This conceptual analysis has some limitations. First, research on nursing professionalism published in English may be conducted in different countries and cultures. However, it is also necessary to obtain a more comprehensive and mature concept of the study of different national languages. Second, the lack of research on the combination of all elements of professionalism may lead to overestimation of the impact of these subelements on professionalism. Third, the concept analysis focused on the research process and the researchers’ perspectives, possibly reflecting a lack of other professional understandings of nursing professionalism in medical groups. In addition, the concept analysis included a risk of selection bias, extraction bias, and analysis bias because the study selection process, data extraction, and analysis were all conducted by two researchers. Despite these risk, the studies were all described accurately and systematically.

Nursing professionalism is one of the important foundations of clinical nursing. It is multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism has been defined as providing people care based on principles of professionalism, caring, and altruism. The definition, attributes, antecedents, consequences, and reference analysis of the experience of nursing professionalism determined in this study provide a theoretical basis for future research. This information can be used to evaluate nursing professionalism, develop assessment tools, or generate theory-based training courses and interventions.

Acknowledgements

The authors would like to thank Hui Yang for the great efforts made in designing the research. We would like to thank linbo Li for providing valuable suggestions for this study.

Author’s contributions

Hl C and HY made substantial contributions to conception and design. HL C, YJ S, YM W, YF D Collectioned and analysis the data. Hl C was a major contributor in writing the manuscript. XY H, YJ C, QH W revised it critically for important intellectual content. All authors read and approved the final manuscript.

Postgraduate Education Innovation Program of Shanxi Province in China (No. 2020BY067).

Availability of data and materials

Declarations.

Our study was approved by the ethical committee of The First Hospital of Shanxi Medical University,Shanxi, China,(approval no. 2020K061).

Not applicable.

There is no conflict of interest in this study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Huili Cao, Email: moc.qq@2855838711 .

Yejun Song, Email: moc.qq@9109580601 .

Yanming Wu, Email: moc.621@6927myw .

Yifei Du, Email: moc.qq@3283291401 .

Xingyue He, Email: moc.361@320eHeuygnix .

Yangjie Chen, Email: moc.qq@8011856511 .

Qiaohong Wang, Email: [email protected] .

Hui Yang, Email: moc.361@0202iuhyq .

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