Significance of Nursing

Theory:
Discipline and Profession
ABIGAIL F. MONGE, RN, MAN
Presenter
“The systematic accumulation of knowledge is
essential to progress in any profession . . .
however theory and practice must be
constantly interactive.
Theory without practice is empty and practice
without theory is blind.”
(Cross, 1981, p. 110).
 Overview
• At the beginning of the twentieth
century, nursing was not recognized as an
academic discipline or a profession. The
accomplishments of the past century led to
the recognition of nursing in both areas.
The terms discipline and profession are
interrelated, and some may even use them
interchangeably; however they are not
the same.
 Overview
• Discipline is specific to academia and a
branch of education, a department of
learning or field of knowledge.
• Profession refers to specialized field of
practice, which is founded upon the
theoretical structure of the science or
knowledge of that discipline and the
accompanying practice abilities.
 Overview
• Nursing Theoretical Works represents the
most comprehensive ideas and systematic
knowledge about nursing.
• Therefore, nursing theoretical works are
vital to the future of both the discipline
and the profession of nursing.
Significance of Nursing Theory as
a Discipline
•The significance of theory for the
discipline of nursing is that the
discipline is dependent upon
theory for its continued
existence, that is, we can be a
vocation, or we can be a discipline
with a professional style of
theory-based practice.
The Discipline is Dependent Upon
Theory
• The theoretical works have taken
nursing to higher levels of education and
practice as nurses have moved from the
functional focus, or what nurses do, to
a knowledge focus, or what nurses know
and how they use what they know for
thinking and decision making while
concentrating on the patient.
Theoretical Works Have Taken
Nursing to a Higher Level
• The emphasis has shifted from a focus
on knowledge about how nurse
function, which concentrated on the
nursing process, to focus on what
nurses know and how they use
knowledge to guide their thinking
and decision making while
concentrating on the patient.
 Significance of Nursing Theory as
a Profession
• Clearly, nursing is recognized as a profession
today having used the criteria for a
profession to guide development.
• Nursing development was the subject of
numerous studies by sociologists.
• The application of nursing knowledge in
practice is a criterion that is currently at
the forefront, with emphasis on
accountability for nursing practice,
theory-based evidence for nursing
practice, and the growing recognition
of middle-range theory for
professional nursing practice.
(Alligood, 2014)
 What is a Profession?
• A profession is an occupation with ethical
components, i.e, devoted to the promotion
of human and social welfare.
• The services and knowledge by a profession
are based on specialized skills.
• Professions are those occupations
possessing a particular combination of
characteristics.
•Nursing profession is an occupation
based on the specialized intellectual
study and training, the purpose of
which is to supply skilled services
with ethical components.
 Criteria of Profession
• Bixler and Bixler Criteria for Profession
• Abraham Flexner’s criteria for a profession
• Kelley’s criteria
 Bixler and Bixler Criteria for
Profession
• Genevieve and Roy Bixler who were against
the status of Nursing as a profession 1945,
appraised nursing according to their original
seven criteria as follows:
1. A profession utilizes in its practice a well
defined and well organized body of
knowledge, which is on the intellectual level of
the higher training.
2. A profession constantly enlarges the body
of knowledge its uses and improves and
improves its techniques of education and
service by the use of the scientific method.
3. A profession entrusts the education of its
practitioners to institutions of higher
education.
4. A profession applies its body of knowledge
in practical service, which is vital to human
beings and social welfare.
5. A profession functions autonomously in the
formulation of professional policy and in control
of professional activities there by.
6. A profession attracts individuals of intellectual
and personal qualities who exalt service above
personal gain and who can recognize their chosen
profession as lifelong.
7. A profession strives to compensate its
practitioners by providing freedom of action,
opportunity for continuous professional growth
and economic security.
Abraham Flexner’s Criteria for a
Profession
• Flexner believed that professional work:
1. Is basically intellectual ( as opposed to
physical) and is accompanied by a high degree
of individual responsibility.
2. Is based on a body of knowledge that can be
learned and is refreshed and refined through
research.
3. Is practical in addition to being theoretical.
4. Can be taught through a highly
specialized professional education.
5. Has a strong internal organization of
members and a well developed
group consciousness.
6. Has practitioners who are motivated
by altruism( the desire to help
others) and who are responsive to
human interests.
 Kelley’s Criteria
• Kelley(1981) reiterated and expanded Flexner’s
criteria in her 1981 listing of characteristics of a
profession.
1. The services provided are vital to humanity and
the welfare of the society.
2. There is a special body of knowledge that is
continually enlarged through research.
3. The services involve intellectual activities;
individual responsibility (accountability) is a strong
feature.
4. Practitioners are educated in institutions
of higher learning.
5. Practitioners are relatively independent
and control their own policies and
activities (autonomy).
6. Practitioners are motivated by service
(altruism) and consider their work as an
important component of their lives.
7. There is a code of ethics to guide the
decisions and conduct of practitioners.
8. There is an organization (association)
that encourages and support high
standards of practice
 To sum up Criteria Of Profession
……
•  Specialized education
•  Body of knowledge
•  Service Orientation
•  Ongoing Research
•  Code of Ethics
•  Autonomy
•  Professional organizations
 Characteristics of Profession
1. Great responsibility
Professionals deal in matters of vital importance
to their clients and are therefore entrusted with
grave responsibilities and obligations. Given these
inherent obligations, professional work typically
involves circumstances where carelessness,
inadequate skill, or breach of ethics would be
significantly damaging to the client and/or his
fortunes.
2. Accountability
Professionals hold themselves ultimately
accountable for the quality of their work
with the client. The profession may or may
not have mechanisms in place to reinforce
and ensure adherence to this principle
among its members. If not, the individual
professionals will (e.g. guarantees and/or
contractual provisions).
3. Based on specialized, theoretical
knowledge
Professionals render specialized services
based on theory, knowledge, and skills that
are most often peculiar to their profession
and generally beyond the understanding
and/or capability of those outside of the
profession. Sometimes, this specialization
will extend to access to the tools and
technologies used in the profession (e.g.
medical equipment).
4. Institutional preparation
Professions typically require a significant
period of hands-on, practical experience in
the protected company of senior members
before aspirants are recognized as
professionals. After this provisional period,
ongoing education toward professional
development is compulsory. A profession
may or may not require formal credentials
and/or other standards for admission.
5. Autonomy
Professionals have control over and,
correspondingly, ultimate
responsibility for their own work.
Professionals tend to define the terms,
processes, and conditions of work to
be performed for clients (either
directly or as preconditions for their
ongoing agency employment).
6. Clients rather than customers
Members of a profession exercise
discrimination in choosing clients rather
than simply accepting any interested
party as a customer (as merchants do).
7. Direct working relationships
Professionals habitually work directly
with their clients rather than through
intermediaries or proxies.
8. Ethical constraints
Due to the other characteristics on this list, there
is a clear requirement for ethical constraints in the
professions. Professionals are bound to a code of
conduct or ethics specific to the distinct
profession (and sometimes the individual).
Professionals also aspire toward a general body of
core values, which are centered upon an
uncompromising and unconflicted regard for the
client's benefit and best interests.
9. Merit-based
In a profession, members achieve employment
and success based on merit and corresponding
voluntary relationships rather than on corrupted
ideals such as social principle, mandated support,
or extortion (e.g. union members are not
professionals). Therefore, a professional is one
who must attract clients and profits due to the
merits of his work. In the absence of this
characteristic, issues of responsibility,
accountability, and ethical constraints become
irrelevant, negating any otherwise-professional
characteristics.
10. Capitalist morality
The responsibilities inherent to the practice of a
profession are impossible to rationally maintain
without a moral foundation that flows from a
recognition of the singular right of the individual
to his own life, along with all of its inherent and
potential sovereign value; a concept that only
capitalism recognizes, upholds and protects.
•As individual nurses grow in their
professional status, the use of
substantive knowledge for
theory-based evidence for nursing
is a quality that is characteristic of
their practice (Butts & Rich,
2011).
• This commitment to theory-based
evidence for practice is beneficial to
patients in that it guides systematic,
knowledgeable care.
• It serves the profession as nurses are
recognized for the contributions they
make to the health care of society.
• As noted previously in relation to the
discipline of nursing, the development of
knowledge is an important activity for
nurse scholars to pursue.
• It is important that nurses have
continued recognition and respect for
their scholarly discipline and for their
contribution to the health of society.
•Finally and most important, the
continued recognition of nursing
theory as a tool for the reasoning,
critical thinking, and decision
making required for quality
nursing practice is important
because of the following:
“Nursing practice settings are complex, and
the amount of data (information) confronting
nurses is virtually endless. Nurses must analyze
a vast amount of information about each
patient and decide what
to do.
A theoretical approach helps practicing nurses
not to be overwhelmed by the mass of
information and to progress through the nursing
process in an orderly manner.
Theory enables them to organize and
understand what happens in practice, to
analyze patient situations critically for clinical
decision making; to plan care and propose
appropriate nursing interventions; and to
predict patient outcomes from the care and
evaluate its effectiveness. “(Alligood, 2004, p.
247)