This document presents a concept analysis of professionalism in nursing. The analysis used Walker and Avant's 8 step method to analyze the concept. Key attributes of professionalism were identified through a literature review and included competence, dedication, ethics, and conduct. A theoretical definition of professionalism in nursing was developed as "characterized by integration of affective, behavioral and cognitive attributes including respect, accountability, truthfulness, autonomy, resilience, specialization and upholding of standards." The analysis provides clarity around professionalism as a concept to help with its assessment and development among nurses.

1. Professionalism in nursing:
a concept analysis
Mrs. S.D. Mottian
Prof. Christa Van Der Walt
North-West University (Potchefstroom Campus)

2. INTRODUCTION
 The concept professionalism is multifaceted, & in
spite of much research done, it is still poorly
conceptualised4.
 Poor understanding of the concept within the nursing
profession:
 Affects adequate development of valid instruments
to assess professionalism.
 Affects nursing practice, health care service
delivery & the image of the profession.

3.  Unfortunately, professionalism in nursing appears to
be deteriorating.
 Nursing students entering the profession are at risk of
assimilating unprofessional behavior, from their
colleagues, which negatively affects quality service
delivery.
 Nurse educators vital role in facilitating students
professional socialization helps in moulding them into
the profession during integration of fundamental
norms, values & standards governing the profession.

4. BACKGROUND
 Professionalism is believed to occur during
the period students are in basic nursing
programmes continuing after graduation
during practice1
 Many role models (educators, clinical
educators) other professionals & fellow
students shape development of the student’s
professional character/ attitude & behaviour 5

5.  Preparation to practice a profession is
complex, requiring students to learn skills
and knowledge to take up norms & traditions
of the chosen profession.
 Students depend on support / guidance/
supervision & care of RN’s in clinical practice
to develop into confident & capable
practitioners3

6.  Poor conceptualization of professionalism
limits content & construct validity of measuring
instruments.
 A better understanding of professionalism
enables development of valid measuring
instruments, assisting educators to measure
growth & development of professionalism or
lack thereof during students’ years of training.

7. AIM AND OBJECTIVE
 To define professionalism within the
nursing profession.
 To conduct a concept analysis of
professionalism to construct a
connotative (theoretical) definition in
nursing.

8. METHOD & FINDINGS
A concept analysis was conducted using the 8
steps recommended by Walker & Avant (2011)
based on Wilson’s work (1963). The steps are:
1. Select concept- professionalism was selected
2. Determine purpose of the analysis- The
concept professionalism is currently poorly
conceptualized.
 Assessing the level of professionalism to
facilitate professionalism in nurses might lack
conceptual clarity.

9.  Concept analysis aimed to critically analyze the
concept professionalism, determine its
identifying attributes (connotation) & develop a
theoretical definition.
 Based on the attributes & definition, empirical
indicators can be identified to formulate a
denotative definition.
 Development of empirical indicators did not fall
in the scope of this study & should be
addressed in further research.

10. 3. Identify uses of the concept- Unit of analysis was
the definition of professionalism as it appeared in general
& professional literature.
 A search strategy based on systematic reviews
enabled locating many definitions of professionalism
as possible in both scientific & non-scientific sources.
4. Determine the defining attributes - Analysis
involved deductive & inductive reasoning to theoretically
define professionalism & describe attributes of the
concept.
 This logic reasoning helped generate concluding
statements from the empirical data

11. Determine the defining attributes
 Thematic analysis (qualitative in nature)-
resulted in identification of various uses of
professionalism & extraction of attributes as it
appeared in definitions
 This enabled identification of all possible uses
of the concept in ordinary & professional
literature6,2
 Repeated attributes identified were described
as the defining attributes of professionalism.

12. Determine the defining attributes
 Most frequently identified attributes was obtained
by quantitative content analysis, involving
systematic & objective reduction of the data into
categories.
 This was primarily deductive in nature, structured
& helped refine the key attributes7
 Repeated attributes identified in the ordinary &
professional meaning of professionalism was
further categorized into knowledge, attitudes &
behaviors attempting to obtain key attributes.
The mind map following denotes these categories
& key attributes:-

13. Categories of Attributes
Knowledge Attitudes Behavior Knowledge Attitudes Behavior
* Competence * Positive * Conduct *Competence *Morals *Advocacy
n= 34 Attitudes n=48 n=15 n=30 n=4
n= 4
* Continuous * Dedication * Personal *Special *Altruism * Quality
Development n= 15 Quality Knowledge n=17 Service
n= 2 n=5 n=13 n=33
* Specialised
Knowledge,
Expertise
n= 16
Most Frequently identified attributes categorized above
Ordinary
Meaning
Professional
Meaning
Professionalism

14.  Further clarification of the concept was done
using 3 frameworks for professionalism
present in nursing literature:
 The RNAO Best Practice Guidelines for
professionalism
American Nurses Association Code for
Nurses
South African Nurse’s Code of Service
 Identification of attributes from the current
study & above frameworks were compared,
denoting shared & new attributes, thus an
enhanced understanding of the meaning of
professionalism

15. RNAO, Best
Practice
Guidelines
The American Nurses Association
Code for Nurses (ANA 1985)
The South African
Nurse’s Code of
Service
Some Attributes
identified in present
study
Accountability Accountability Accountability
Human dignity Dignity Respect
Advocacy Advocacy Advocacy
Innovation &
visionary, Spirit
of Inquiry
Continuous development Continuous
development
Collegiality &
collaboration
Collaboration Collaboration
Confidentiality Maintain
confidentiality
Integrity
Competence/ qualifications Competence/
qualification/ special
knowledge
Ethics & values Morals/values/ ethics
Autonomy Autonomy
Service to
humanity, Promise
Conscience, Duty,
Honour, Respect for
human life
Trust, Altruism, Courage
Professional conduct &
service, Committed,
Compassionate,
Positive attitude,
Authority, Resilience

16. Theoretical (connotative) definition of
Professionalism
Professionalism is characterized by an integration of
affective, behavioral & cognitive attributes which
must be demonstrated by persons from a specific
profession. A professional person displays:
 Respect for all
 Takes responsibility for actions
 Exhibits authentic truthfulness in action
(verbal/non-verbal)
 Able to assume accountability
 Practice reflection & strive for self-determination
 Has essential qualities of autonomy & self-
efficacy
 Is resilient in spite of daily work challenges

17. Theoretical (connotative) definition of
Professionalism
 Acquires specialised skills, education &
continuous development.
 Exercises high standards of professional judgment
which form the foundation to perform competently
& at a mastery level; thus ensuring delivery of high
standard & quality of health care
 Ability to express empathy, altruism, compassion
& respect for diverse cultures- affective domain of
professionalism
 An affiliation to a professional association or
country’ Professional Regulator differentiates a
professional from a non-professional
 Ethical & professional values always displayed.

18. 5. Identify a model case – to further clarify the meaning
of the concept a model case constructed showed presence
of key attributes of professionalism using a nursing
example annotating the connotations of professionalism -
provided insight, clarity & meaning to the concept.

19. 6. Identify a borderline & contrary case
Borderline case presented
showed what contained most
of the defining attributes of
professionalism but not all of
them – thus helping to clarify
thinking about the defining
attributes of the true concept
professionalism.
Contrary case - displayed
what was definitely not
professionalism

20. 7. Identify antecedents & consequences
 Antecedents – events taking place prior to
occurrence of the concept 5
 A 2nd reduction resulted in main categories of
values, knowledge & behaviors further reduced
providing a clearer perspective in their
association to professionalism.
Values – affective attributes } antecedents
Knowledge – cognitive attributes } of
Behaviors – behavioral attributes} professionalism
If the above are absent – professionalism cannot
be claimed

21.  Consequences – events occurring due to
presence of the concept. Consequences of
professionalism recognised from all
definitions & cases were as follows:
Expertness
Professional conduct
Exercising high standards of trained
judgement
Learned values
Mastery of knowledge, skill & competency
Consequences help further refine the defining
attributes

22. 8. Empirical Referents - Identification &
description of empirical referents of
professionalism would permit construction of a
denotative (operational) definition of
professionalism in nursing.
On viewing the theoretical definition of
professionalism more extensive work is required
to gain better understanding to identify empirical
referents of professionalism & to construct an
operational definition- a recommendation for
further research.

23. CONCLUSION
 The meaning of professionalism as a concept featured
more regularly in the medical profession but also
appeared in professions of lawyers, social workers,
teachers, engineers & psychologists.
 This indicates applicability of the concept to different
professions.
 Various professions highlight different attributes
unique to that particular profession.
 Affective attributes like altruism & compassion appear
predominantly in the nursing & medical professions &
not highlighted in engineering & law professions.

24.  The nursing profession like some health professions
highlight certain attributes distinguishing them from
most other professions.
 Nursing profession – entails working with people every
day, including nurses, doctors, patients, administrative
staff and community members.
 These individuals have a different perspective of the
nurse & what is required of the profession.
 However the defining attributes demonstrated by the
nurse will create a sense of commonality that will guide
other people’s understanding & expectations of
professionalism in nursing.

25. REFERENCES
1. Karaoz, S. 2005. Turkish nursing students’ perception of caring. Nurse Education
Today, 25:31-40.
2. Lewis-Beck, M.S., Bryman, A. & Liao, T.F. 2004. The Sage Encyclopedia of Social
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3. Mabuda, B.T., Potgieter, E. & Alberts, U.U. 2008. Student nurses’ experiences
during clinical practice in the Limpopo Province. Curationis, 31(1):19-27.
4. Registered Nurses Association of Ontario. 2007. Nursing best practice guidelines
program. Healthy work environments best practice guidelines. Professionalism in
nursing. Toronto: RNAO
5. Van Mook, W.N.K.A., Van Luijk, S.J., De Grave, W., O’Sullivan, H., Wass, V., V.,
Schuwirth, L.W., Van der Vleuten, C.P.M. 2009. Teaching & learning professional
behavior in practice. European Journal of Internal Medicine, 20:105-111.
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Boston: Prentice Hall
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