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Critical Care Nurses' professional identity constructions in an Australian Intensive Care Unit: Contextual and Contingent
Abstract and Figures
Professional identity is a social identity that is informed by the experience of being a member of a professional group and undertaking work activities within a specific professional jurisdiction. Despite a dominant ideology of professionalism within university based nursing degrees, in practice, professional identity among nurses is often marked by ambiguity and a lack of clarity. Some writers have described a disconnection between the ideology of professionalism that informs nursing’s professional identity, and the experience of nursing practice. This thesis uses a social constructionist approach and ethnographic methods to explore professional identity among Critical Care Nurses (CCNs). The research aimed to build an in-depth understanding of the ways that CCNs, as specialty nurses, construct their professional identity in the context of their practice. The research was conducted in a single Intensive Care Unit (ICU) in Tasmania, Australia over a six-month period. The data was collected from participant observation of 13 CCNs as they went about their work and semi-structured interviews with 8 CCNs. The fieldnotes and interview transcripts were analysed using a process of thematic analysis.
The analysis found that CCNs actively construct their professional identity through subjective meaning making and multidimensional processes of similarity and difference (boundary work) within and across dynamic professional boundaries. CCNs were found to attach meanings to particular actions, symbols, rituals and utilisation of artefacts to construct their professional identity. These were then used to negotiate boundaries of difference between themselves and other nurses as well as other health professions. The analysis also revealed that CCNs’ experiences of professional identity are complex and contingent due to the influence of structural and organisational forces that shape and constrain their meaning-making during everyday work interactions.
These findings provide new theoretical and empirical knowledge about the ambiguity of professional identity and its contextual construction at inter- and intra-professional levels. They also show that for CCNs, professional identity is actively constructed through interactions and practice. This contributes to a more insightful understanding of the subjectivity of CCNs’ professional identities within the context of ICUs, and thus, not only offers the basis for comparative studies of professional identity between nursing specialities, but also between nursing and other health care professions/occupations. The thesis findings also suggest that there is incongruence between nursing’s ideology of professionalism and the structure of employing organisations that do not always acknowledge or support postgraduate nursing qualifications or the development of advanced nursing practice roles. A strong sense of professional identity appears to increase worker satisfaction and contributes to the capacity of professional groups to achieve improved working conditions. As such, barriers to the development of professional identity among CCNs have implications for the lived experiences and may help explain high levels of worker turnover in this nursing speciality.
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... With this in mind, we conceptualise professional identity as socially constructed whereby it is constituted by context-bound meaning-making processes that occur through social interactions with others and the surrounding environment (Berger & Luckmann, 1966). From this, professional identity is actively constructed and reconstructed, prior to, and throughout education and practice (Belle, 2017;Fitzgerald, 2020). ...
... Subordinate groups engage in strategies of inclusion to resist exclusion, and dual closure (usurpation and exclusion) to counteract demarcation, thereby aiming to extend their occupational control. In this way, health professions exist in relative competition for control over work areas as new professions emerge, expand, and encroach on jurisdictional boundaries in response to technological, organisational, and socio-cultural changes (Belle, 2017;Fitzgerald, 2020). ...
... In the case of speciality nurses, research suggests that professional identity is distinguished by values, beliefs and work activities associated with their practice area rather than the nursing profession generally (Belle, 2017;Kunhunny & Salmon, 2017). These findings suggest that professional identity is an ongoing project, rather than identifiable by a singular feature or one defined timepoint. ...
Historical sociological perspectives posit professional identity to emerge from socialisation and attainment of 'traits' considered unique to and distinguishing of a profession. Such essentialist understandings, however, cannot account for group heterogeneity, nurses' lived experiences, nor the fluidity of professional and personal identity. This article conceptualises professional identity as being both individual and collective, influenced by context, involving subjective meaning-making, and membership to a specific professional group. Drawing on ethnographic data gathered through participant observation and semi-structured interviews with Critical Care Nurses in an Intensive Care Unit in regional Australia, we identify four themes that reveal different aspects of professional identity: conceptualising professional identity; professional identity as a title and legislative requirement; professional identity as qualifications and training; and professional identity as a social performance. The findings demonstrate that Critical Care Nurses hold multifaceted perceptions of professional identity. While they collectively distinguish their nursing training, knowledge, and practice from other nurses, they struggle to articulate what professional identity is, while creating boundaries between different forms of nursing education and qualifications to construct their professional identity. These uncertain and diverse meanings of professional identity contribute to nurse identity ambiguity, while also reflecting the necessity of flexible individual and collective nursing identities.
... Nurses frequently face ethical dilemmas in their daily practice that challenge their moral convictions [1][2][3]. These situations may involve conflicting beliefs and values that can impact the quality of nursing care provided [4][5][6][7]. Possessing moral courage is essential to address these challenges, as it reinforces ethical conduct and enables nurses to carry out courageous actions in patient care [8,9]. ...
... Moral sensitivity, conscience, and experience are prerequisites for moral courage which results in personal and professional growth and empowerment [14]. In a study on moral courage in nurses, it was defined as taking appropriate action, defending rights and implementing ethical principles to provide care to patients, even in the face of personal risks and threats [6]. ...
Background
Having moral courage is a crucial characteristic for nurses to handle ethical quandaries, stay true to their professional obligations towards patients, and uphold ethical principles. This concept can be influenced by various factors including personal, professional, organizational, and leadership considerations. The purpose of this study was to explore the predictors of moral courage among nurses working in hospitals.
Methods
In 2018, an observational cross-sectional study was carried out on 267 nurses employed in six hospitals located in the northern region of Iran. The participants were selected through a simple random sampling technique. To collect data, a demographic information form was used along with two questionnaires. The first questionnaire was a standard survey on moral courage, while the second questionnaire was designed to assess the ethical climate. Linear regression was used to assess the predictors of moral courage.
Results
Nurses had an average moral courage score of 87.07 ± 15.52 and an average moral climate score of 96.12 ± 17.17. The study showed that 16% of the variation in moral courage scores among nurses was explained by ethical climate and monthly overtime hours.
Conclusion
This study underscores the significance of establishing an ethical work environment and minimizing overtime hours in order to enhance moral courage among nurses. These findings carry weight for both nursing practice and organizational policies focused on fostering ethical conduct within healthcare settings.
... In their daily activities, nurses encounter problems and issues that might be inconsistent with their moral values (Dehghani et al., 2020;Numminen et al., 2018;Ranjbar et al., 2018). In other words, nurses might face with controversial beliefs and values in doing the right thing and these might affect providing quality nursing care (Belle, 2017;Mahdaviseresht et al., 2015;Mousazadeh et al., 2019). It is essential therefore, to have moral courage as a strategy to reinforce ethics and doing courageous deeds in nursing care (Bickhoff et al., 2017;Hawkins et al., 2014). ...
Background: Moral courage, as a strategy to reinforce ethics and doing courageous deeds, is essential in providing nursing cares. Proper management of ethical challenges, professional commitment to patients, and ethical performance require moral courage. In addition, this concept is affected by personal and professional traits and organizational cultural. Ethical climate is a part of organization character, represents ethics in the organization. Ethical climate helps individuals to assess the problems and also acts as a guide for making decision about acceptable and unacceptable behaviors. The present study is an attempt to examine some of the predicting variables of moral courage in nurses.
Methods: The study was carried out as predictive study in 2019. The subjects were 267 nurses working in hospitals who were selected through simple random sampling. Data gathering tool included a demographics form, Sekerka’s job satisfaction standardized questionnaire, and Elson’s ethical climate standardized questionnaire.
Results: The mean scores of moral courage and ethical climate in nurses were 87.07±15.52 and 96.12±17.17 respectively. The findings showed that 16% of moral courage score in nurses was attributed to ethical climate and overtime work hours per month.
Conclusions: Although, ethical climate and overtime work hours were the main factors in moral courage, not a notable percentage of the variance of moral courage was attributed to them. Therefore, there is a need to determine other factors in moral courage.
Healthcare development mainly depends on nurses’ activities, since nurses often take much time in contacting patients during clinical activities. Their awareness of the hospital’s moral climate disturbs nurses’ attitudes and associated ethical concerns. Hospital ethical climates have become a crucial working area element for nurses to prepare and apply ethical judgments. The ethical climate is one feature of an institution that denotes the collective insights of morally correct activities and techniques of handling ethically varied conduct. Better consciousness of the difficulty of ethical problems in the health facility situation has powered attention to nursing ethics. Yet, there is insufficient data on the connection between nurses’ awareness of the ethical climate worldwide. Hospital ethical climate has been studied in several industrial countries for decades but has only been investigated in some developing countries in the past two decades. In general, the chapter explained the perception of nurses and correlation between hospital ethical climate and job satisfaction, and dimensions of job design.
Objectives
This study is conducted with the aim of the relationship between moral courage and the perception of ethical climate in hospital nurses.ResultsThe study was carried out as descriptive-correlation study in 2019. The subjects were 267 nurses working in hospitals who were selected through simple random sampling. Questionnaire was used to collect data. The mean scores of moral courage and ethical climate in nurses were 87.07±15.52 and 96.12±17.17 respectively. The findings showed that 16% of moral courage score in nurses was attributed to ethical climate and overtime work hours per month. Although, ethical climate and overtime work hours were the main factors in moral courage, not a notable percentage of the variance of moral courage was attributed to them. Therefore, there is a need to determine other factors in moral courage.
Within the context of evidence-informed decision making, health care professionals are critical consumers of research evidence. Clinician scientists, including nurse researchers, play a central role in producing this research evidence to inform and improve health practice, education, and policy. Health research is commonly conducted within one of three different paradigms: quantitative, qualitative or mixed methods. Each research approach is underpinned with unique philosophic assumptions, methods, and rhetoric. The evidence produced within each paradigm is necessary to provide health care decision-makers with information about the complex, and intrinsically diverse, human experiences of health and illness. Qualitative health research has been defined as a discipline, which has its roots in qualitative research and yet is unique in its focus, methods, and rules. The focus of qualitative health research is to describe, explore, and explain the health-illness continuum and issues specific to health services or policy contexts. Research designs unique to conducting qualitative health research include qualitative description, interpretive description, focused ethnography, and case study. Each qualitative health research design helps to logically and pragmatically determine the appropriate methods to use to: 1) define a purposeful sample; 2) identify appropriate strategies for data collection; 3) rigorously apply analytic techniques to the gathered data; and 4) present valid findings. In health, qualitative studies are often an integral component of program evaluations to identify and describe contextual factors related to individuals, teams, organizations or social structures that inhibit or facilitate the successful adoption, implementation and delivery of an intervention or program. Findings from qualitative studies can also inform the development of theoretically and contextually relevant assessment tools that can be used in practice.
This section presents the third volume of Max Weber's fundamental work Economy and Society which has been translated into Russian for the first time. The third volume includes two works devoted to the sociology of law. The first, 'The Economy and Laws', discusses differences between sociological and juridical approaches to studies of social processes. It describes peculiarities of normative power arenas (orders) at different levels and demonstrates how they influence the economy. The second, 'Economy and Law' ('Sociology of Law'), reviews the evolution of law orders (primarily, the three "greatest systems of law" including Roman Law, Anglo-American Law, and European Continental Law) in the context of changes in the organization of economy and structures of dominancy. Law is considered an influential factor of the rationalization of social life which in turn is affected by a rationalized economy and social management. The Journal of Economic Sociology here publishes an excerpt from the chapter 'Law, Convention and Custom' in this third volume, which shows the role of the habitual in the formation of law; explains the importance of intuition and empathy for the emergence of new orders; and discusses the changeable borders between law, convention and custom. The translation is edited by Leonid Ionin and the chapter is published with the permission of HSE Publishing House. © 2018 National Research University Higher School of Economics. All rights reserved.
This article explores the concepts of bullying and harassment, defines the terms and their implications, and explores similarities and differences between the two. It also examines pertinent legislation and identifies strategies to raise awareness and optimise a bullying and harassment-free perioperative environment. Bullying and harassment in the workplace was the focus of this presentation at NATN Congress 2002. Challenging behaviours involving patients and careers is another topic in itself.
Wellhouse NHS Trust moved its inpatient services to the new Barnet General Hospital in 1997 and merged with Chase Farm Hospital NHS Trust in 1999. To assist with the trust's management of resulting changes in care provision, a short project was conducted to examine the nursing services provided by ward managers (20) and senior nurses (27), that is nurses who undertake specialist/ advanced nursing practice. The project also aimed to present the views of the stakeholders (66) with regard to nursing in the trust and nurse-led services. The project involved two stages of data collection--focus groups and postal questionnaires. The project provided a great deal of information about the nursing service within the trust: a profile of the senior nurses, roles and responsibilities, skills and competencies, training and development, and support needs for their roles. The findings considered a number of issues: (i) employment--diversity of grading for posts; (ii) work roles--conflicts in role composition; (iii) stakeholders--perspectives of stakeholders on nursing. It is anticipated that the findings are not unique to the one trust and that they will contribute to the development of new clinical career pathways for senior nurses within the trust.
Nurses5 ability or inability to work as autonomous professionals is central to any analysis of power and nursing. Nursing’s status as work, as an occupation, as a profession or a semi-profession affects nurses5 relationship to the state, their role in the health care team and their work with patients and clients. Whether and how well those who provide nursing care are paid, managed, educated, promoted and involved in decision making has often been identified as being dependent on the professional status, or lack of it, of nursing. This is not surprising. Occupations regarded as professions earn more and enjoy more control and higher social status than do many non-professional jobs. Professions are seen as having a special place within society