NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B ) BY SALMAH BT MD SHARIF 2010 Nursing Professionalism / Professionalisation in Malaysia 2.1 - Introduction “ The Lady with the Lamp,”which it is address to Florence Nightingale, is the most influential nurse in the history of modern nursing.The first training school for nurses at Thomas’s Hospital, London (1860) was founded by “The Lady with Lamp”. According to Florence Nightingale learning a unique body of knowledge was required to those wishing to practice professional nursing. Nurses provide a variety of services to their patients. In general, they help to prevent injury and disease, promote healthy living, and care for the sick. They provide direct care for their patients through administering medications, and assisting with convalescence and rehabilitation. Nurses help people improve and maintain health by creating and managing care plans for their patients. Nurses can either choose to specialize in an area or many are general nurses that perform 1
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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )
BY SALMAH BT MD SHARIF
2010
Nursing Professionalism / Professionalisation in Malaysia
2.1 - Introduction
“ The Lady with the Lamp,”which it is address to Florence
Nightingale, is the most influential nurse in the history of modern
nursing.The first training school for nurses at Thomas’s Hospital,
London (1860) was founded by “The Lady with Lamp”. According to
Florence Nightingale learning a unique body of knowledge was
required to those wishing to practice professional nursing.
Nurses provide a variety of services to their patients. In general,
they help to prevent injury and disease, promote healthy living, and
care for the sick. They provide direct care for their patients through
administering medications, and assisting with convalescence and
rehabilitation. Nurses help people improve and maintain health by
creating and managing care plans for their patients. Nurses can
either choose to specialize in an area or many are general nurses
that perform a variety of duties as needed for the physician. Areas
of specialty include surgical, neonatal, anesthetist, gynecological,
and many others. Nurses often advance to become department
heads and supervisors, managing over other nurses, setting
standards of patient care, and even composing the department's
budget..
2.21 - Nursing professionalism
Professionalism refers to the conducts, goals or qualities that
characterize or mark of a profession of a professional person.
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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )
BY SALMAH BT MD SHARIF
2010
Profession usually develops codes of ethic that describe the
expected behavior that reflect professionalism among its member.
Professionalism in nursing are set of rules, work ethics, ideologies,
work principles and dedication towards the service of a community,
that holistically gives a class and identity to this profession. In truest
sense, professionalism in nursing is more of an attitude of the
nurses towards the nursing profession.(Schwirian 1998)
2.22 - Nursing Professionlisation
Professionalisation is a process through which an occupation goes
through as it moves to the profession end of the occupation
profession continuum.(Schwirian 1998)
During the twentieth century, the nursing profession has under
gone immense change. Nursing has progressed from an
occupation to a fully licensed profession, with members that provide
a broad range of services independently, and in a variety of
professional relationship with other providers. This evolution has
changed how nurses are educated, clinically prepared, and how
they perceive their role.
According to Colyer,(2004) These changes can be characterized as
the professionalization of health care work, and also as moving
away from the tradiotional National Health Service (NHS) role
culture (where job titles denoted what people did and their place in
the hierarchy) towards greater role divertsity and a more
meritocratic system.
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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )
BY SALMAH BT MD SHARIF
2010
Becoming a professional involves unique training, formal education,
achieving credentials,activity in continuing education opportunities,
joining and actively involving in professional association.
2.3. Nursing issue in Higher Education
Nursing issue in Higher Education is identify relating in clinical
practice , which may effect nursing professionalism in Malaysia.
In this paper, I will try to highlight the need of higher education in
nursing profession. The changes in medical education have been
proposed earlier by Flexner report. The Report (also called
Carnegie Foundation Bulletin Number Four) called on American
medical schools to enact higher admission and graduation
standards, and to adhere strictly to the protocols of mainstream
science in their teaching and research. Flexner, Bixler’s & Bixler’s
and Kelly believed that practitioner needs to educate in Institution of
Higher Learning to become a peer profession. Perhaps no issue in
nursing has been more controversial than the education of its
practitioners. Nursing’s heritage, like that of medicine, was founded
in apprenticeship. Students were assigned to experienced
practitioners who taught the skills with which they were familiar.
Once those skills were acquired, the student moved into the world
of employment. Earliest programs of education were located in
hospitals rather than colleges or universities.
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BY SALMAH BT MD SHARIF
2010
2.4 Aim
To highlight the need of higher education in nursing profession.
2.5 Discussion
2.5.1 A Day In Nursing Life. Nurses work in many different
settings, including hospitals, clinics, nursing homes, schools,
corporations and even patient homes. Home health and public
health nurses travel more than other nurses, to patients' homes,
schools, and other sites. Nurses generally work eight hour shifts,
but some hospitals have nurses work ten and twelve hour shifts for
three or four days a week. Nurses in hospitals, and nursing and
residential homes tend to work weekends, nights, and even
holidays, and are often on-call. Nurses are on their feet a lot at
work and therefore must be in relatively good physical shape. They
must also have good communication skills in order to deal
effectively with patients by practicing good listening and giving clear
directions to both patients and aides. A positive disposition and
mental strength is essential to this position as it can be stressful
and emotionally challenging to deal with human suffering and
emergency situations on a day-to-day basis. A nurse should have a
caring and sensitive nature in order to best care for patients.
2.5.2 Education and training.
Over time, the settings in which nurses are educated have
changed. Today, most nursing programs preparing Registered
Nurses are located in institutions of higher education or
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BY SALMAH BT MD SHARIF
2010
collegiate settings. But, not all nurses today are educated in
colleges and universities. There are four main educational
programs available for nursing. To become a licensed practical
nurse you must complete a state-approved practical nursing
program, which are usually offered through community and
technical colleges, and last for two years. There are three programs
available for registered nurses, including the Associate Degree in
Nursing( A.D.N), the Bachelor of Science in Nursing( B.S.N.) and
the diploma program. The associate degree in nursing (A.D.N.)
program is a two to three year program offered at junior and
community colleges and combined with hospital training. The
Bachelor of Science degree in nursing (B.S.N.) program is offered
at colleges and universities, and normally takes four to five years to
complete. And lastly, diploma programs are offered at hospitals,
and typically last from two to three years. Students are required to
graduate from an approved nursing program and pass a national
licensing examination to practice nursing. Periodic licensing
renewal is required, and usually involves continuing education and
additional training. It is important that nurses pursue higher
education in order to be eligible for promotions to supervisory and
higher paying roles. Also, a bachelor's degree is required to pursue
a career as an advanced practice nurse such as a nurse
practitioner or certified nurse anesthetist.
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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )
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2010
2.6 The Transformation Factors To Commit Higher Education
In Nursing Profession.
2.6.1 The Need To Become Professional Profession.
Over time, the settings in which nurses are educated have
changed. Today, most nursing programs are located in institutions
of higher education or collegiate settings (at either colleges or
universities). Controversy over the length of nursing education
programs (associate degree versus baccalaureate degree) and the
“technical” aspects of patient care continues. Additionally, not all
nurses today are educated in colleges and universities. In
Malaysia, hospital based programs still provide an avenue to
nursing education for prospective nursing students but now we are
moving towards higher education such as minimum diploma and
now degree and even do master’s and doctoral in local and private
university. Even do there is growing numbers of master’s and
doctoral programs in nursing but its small compared with others
health profession. The legitimate question is ’How can nursing
take its place as a peer among the professions when the most
nurses currently in practice hold less than a baccalaureate
degree?’. The professional status and power comes and increase
with postgraduate education. Education of nurses needs to change
to accommodate the increased expectations of nurses as
practitioners, educators, researchers, managers and administrators
as well as policy shapers. Flexner, Bixler’s & Bixler’s and Kelly
believed that practitioner needs to educate in Institution of Higher
Learning to become a peer profession.
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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )
BY SALMAH BT MD SHARIF
2010
2.6.2 The Growth Of Science And Technology. With the growth
of science and technology and the increase in complexity of
modern society, new fields of study have opened up to the
community via universities. Although nursing could not be seen as
a new science, technological advances and the explosion of
nursing and care models throughout the world has led to an
extraordinary increase in nursing knowledge and complexity. This
has resulted in the transfer of nurse preparation to higher education
with the view to ensuring nurses are prepared adequately to
guarantee safe practice. Preparation to degree levels is seen by the
nursing profession as a minimum standard. The requirement of
nurses to keep abreast with advancing technology and treatments
will increase the demand on the provision of higher education for
the profession.
2.6.3 Expectation of Community. A community should expect
that basic rights will be afforded it by its government. One of these
basic rights is access to quality health care. This can only be
provided in a system that is not only adequately funded but is
provided by health professionals well grounded in knowledge and
skills required to provide that health care.
2.6.3 The Attributes Required By Nurses. These skills and
attributes can no longer be provided in an apprenticeship type
system, hence the transfer of nurse education to the higher
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education sector. The attributes required by nurses to operate
effectively in their professional lives are:
a. Knowledge of clinical treatments for specific illnesses.
b..Awareness of and competence in emerging health
technology.
c. Skilled in counseling both patients and other nurses and
members of the health care team.
d. Ability to supervise other members of the health care team
in the care of patients.
e. An understanding of multiculturalism and the ability to
relate to people of many differing cultural backgrounds.
f. Ability to effectively manage both human and material
resources.
g. The capacity to observe, act and interact appropriately
with a whole person, not just the illness or condition they
exhibit.
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2.7 Implication of Higher Education to Nursing Profession
2.7.1 The Need of Health Industry. The health care industry is
one that is experiencing considerable growth, and as the population
continues to age, the need for provision of health care will expand.
It's been widely reported that there is a nursing shortage in the
United States, and it is expected to grow worse as the population
increases and ages and new medical procedures are developed.
Hospitals, nursing homes, adult-care facilities and home-care
services will suffer increasingly, industry experts say, as the current
trend seems likely to continue. Nursing faculties within Australian
universities have not kept pace with the health industry’s demand
for registered nurses and this has resulted in a shortfall of adequate
nursing numbers at both general and specialist level. This will
continue to have significant impact on workforce needs. A recent
workforce survey undertaken in Victoria, Australia shows a shortfall
of 516 effective full time positions in 412 facilities, this figure if
translated across the state results in one thousand unfilled nursing
positions. The major areas noted in the study as experiencing
particular difficulty in recruitment of nurses are operating theatres,
critical care, accident and emergency, renal dialysis, rehabilitation,
midwifery and general medical and surgical units. Although some
of the nursing workforce shortages in Victoria can be attributed to
specific cuts to the health budget, Victorian nurses are also
extremely concerned at the significant cost of undertaking post
graduate studies in specialist nursing domains.
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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )
BY SALMAH BT MD SHARIF
2010
2.7.2 In Malaysia, we face two problems that is shortage of nurses
that we need to import foreign nurses and shortage of graduate
nurses. We have about 75,000 nurses nationwide, less than five
per cent of whom are graduates. The percentage of graduates we
need is actually about 10 per cent. Currently there is about one
nurse to care for 500 people but the industry is hoping to narrow
the gap to one nurse to 200.
2.7.3 Nursing as a Lifetime Commitment. Bixler and Bixler
(1945) emphasized in their list of criteria for professions that a
profession should attract people of certain intellectual and personal
qualities, who exalt service above personal gain and who consider
their chosen occupation to be their life work. Shortage of people
chooses these professions are increase. The higher education is
the one that can ensure the better pay, promotion, hierarchy in
upper position and other great career benefits. With these benefits,
the recruitment can be easier. The need of higher education brings
the changes in nursing curriculum. Today in Malaysia, hospital
based programs still provide an avenue to nursing education for
prospective nursing students but now we are moving towards
higher education such as minimum diploma and now degree and
even doing master’s and doctoral in local and private university.
The nursing profession in Malaysia has also seen remarkable
progress over the years. In 1992, the nursing curriculum in our
colleges was upgraded from certificate to diploma levels. In the
same year the University of Malaya introduced the tertiary-level,
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BY SALMAH BT MD SHARIF
2010
nursing degree programme. Today, we have 6 local universities
and 4 privately-owned colleges conducting the degree programme
for nurses. They are planning to expand its contribution to produce
more graduate nurses by offering a nursing degree through Long
Distance Learning and e - Learning. With all the programme will
allow Ministry of Health to retain its workforce while at the same
time upgrading their knowledge and skills . In 1994, the conversion
programme for the upgrading of assistant nurses to staff nurses
was introduced.Malaysia .
2.7.4 In terms of career development, nurses in Malaysia have
now been upgraded from being a support group to a professional
group with the creation of the degree scheme for nurses from U41
to U54 grades. This shows that the government acknowledges the
significant contribution of nurses (the higher education and
professional level) to the health of the nation. The good support
from government in Malaysia for nursing profession have
encourage and attract people of certain intellectual and personal
qualities, who exalt service above personal gain and who consider
their chosen occupation to be their life work
2.7.5 Responsibility of Nursing Autonomy Body And
Authority. One of the responsibilities of nursing autonomy or
authority body is to promote and maintain the honors, interest and
the advancement of nursing as a profession. The bodies need to
double up their contribution to encourage nurse to grab the
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BY SALMAH BT MD SHARIF
2010
opportunities with continuing studies up to graduate level. Others
policy they should remains and highlighted are:
a. To serve as the vehicle of integrated voice of the whole
profession to express its opinion and to acquaint the
government and other bodies with the policy and aspirations
of the nursing profession.
b..To promote nursing education, a high standard of nursing
practice and nursing research.
2.8 Recommendation
For this paper, I have three recommendation to be register, they
are:
2.8.1 Education Of Nurses Needs To Change To
Accommodate The Increased Expectations Of Nurses.
Education of nurses needs to change to accommodate the
increased expectations of nurses as practitioners, educators,
researchers, managers and administrators as well as policy
shapers. The requirement of nurses to keep abreast with
advancing technology and treatments will increase the
demand on the provision of higher education for the
profession. Skills and attributes can no longer be provided
in an apprenticeship type system, hence the transfer of
nurse education to the higher education sector.
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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )
BY SALMAH BT MD SHARIF
2010
2.8.2 Government Policy Should Be Remaining. The
good support from government for nursing profession have
encourage and attract people of certain intellectual and
personal qualities, who exalt service above personal gain
and who consider their chosen occupation to be their life
work.
2.8.3 Responsibility of Nursing Autonomy Body And
Authority. The bodies need to maintain their contribution to
promote and encourage nurses to grab the opportunities
with continuing studies up to graduate level. Remain the
requirements to qualify for the higher level such as
applicants should have a diploma in nursing or equivalent
with a minimum of two years working experience, is currently
practising as a registered nurse.
2.9 Conclusion
Nurses practice in the interest of public safety and provide a service
to society equally with other essential services such as the police
and army. The transfer of nurse education to the higher education
sector has provided a much needed stimulus to nursing research.
The continued availability of nurse researcher preparation through
the university process is essential for the continual addition of
nursing knowledge and evidence to nursing practice. As the
conclusions, I can say that the professional status and power
comes and increase with postgraduate education.
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NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )
BY SALMAH BT MD SHARIF
2010
References:
1.Creasia, L. C., & Parker, B. (2001) The bridge to professional
nursing practice, conceptual foundations (3rd ed.). St Louis,