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From the inside out: Forming Professional Identity An Inclusive Transformation

Nancy Crigger, PhD, MA, FNP-BC Associate Professor Graceland University Lamoni, Iowa. From the inside out: Forming Professional Identity An Inclusive Transformation . Objectives.

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From the inside out: Forming Professional Identity An Inclusive Transformation

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  1. Nancy Crigger, PhD, MA, FNP-BC Associate Professor Graceland University Lamoni, Iowa From the inside out:Forming Professional Identity An Inclusive Transformation

  2. Objectives • Describe the current trend to move from an exclusively social paradigm to an inclusive paradigm of professional education. • Contrast the limitations of traditional ethics with that of virtue ethics to frame professional identity formation.

  3. Objectives • Discuss the usefulness of the Framework for Nurse Professionals for educating professionals and for life long professional growth. • Describe waysto implement a transformational approach in undergraduate and graduate nursing education.

  4. The Crisis: my doctor, my enemy • Professions misconduct and wrong doing have corrupted public trust. • Sullivan, 2005

  5. Response to theCrisis of Professionalism • Prompted a serious evaluation of professions and professional development • Carnegie Foundation funding five disciplines to address professionalism and professional education.

  6. Crisis of Professionalism in Nursing? Powell and Young • Powell and Young were charged with …a felony... Prosecutors say they failed to report that Sachdeva ordered nurses to make retroactive entries in patients’ files. • , Thomas Fortner, said the nurses are charged with failing to report a crime related to patient files, not the more serious allegations faced by the clinic, like reusing syringes on multiple patients. Young did not receive extra pay for not reporting the changes in patient files. • In sentencing …U.S District Judge Daniel Jordan said the “most horrifying” evidence was that unqualified technicians performed bone marrow biopsies. He also said syringes were re-used and multiple patients’ chemotherapy drugs were drawn from the same bag. • Authorities say the clinic billed Medicaid and Medicare for about $15.1 million during the scheme. • Mississippi Business Journal http://msbusiness.com/blog/2013/10/11

  7. Is this a problem for nursing? • Gallup Poll: • Please tell me how you would rank honesty and ethical standards in these fields. • Winners • Nurses……82% • Pharmacists…70% • Graduate faculty…70% • Medical doctors…69%

  8. Gallup Poll Losers Losers • State office holders…14% • Care salesmen….9% • Members of congress…8% • Lobbyists…4%

  9. Winds of change • Educators believe: • professional education deficiency. • dramatic changes in educating professionals. • educating for character development through virtue ethics

  10. How important is ethics to professionalism in nursing? • Who do you want taking care of you? • Smart nurse • or • Ethically excellent nurse

  11. How do we currently educate students ? Over packed Curricula

  12. What do we teach about professional identity formation ? One sided education

  13. Two paradigms of professional Education Sociological: empty uniform Psychological: Raging individualist Being a person of good character Practice is a manifestation of good character Transformational process How should I live? • Doing good work • Practice is following rules, standards • Transactional process • Am I doing what others expect?

  14. Social paradigm limitations Following rules is not situated. Compartmentalized into roles: Jekyll and Hyde No path to reconciliation Not inclusive of one’s professional development

  15. Psychological paradigm limitations Perception is not impeded by social norms or expectations Fairness and capricious

  16. Three Philosophical and Conceptual changes for Education

  17. ONE:Ethical as foundational • Almost all of our thinking, decision-making and doing as professionals requires ethical choices

  18. TWO: Changes in philosophical grounding: Broader view of Ethics

  19. Third: Change in conceptual foundation: Dual Paradigm • Current dominant view: sociological or consensus Enrichment and expand to include: psychological view: character/virtues

  20. Virtue ethics proper use of desirable traits • Qualities or dispositions of character • Are used contextually and applied to situations • If inappropriate can be too little or too much

  21. Virtue ethics addresses the “being” • Professional ideal: what you are striving to be? • Flourish through a transformational process that aspires toward professional ideals and that seeks the highest good for care recipients, community and themselves. • Applies virtues well: virtues are situated.

  22. Virtue adds contextualization • Each situation requires us to act in the appropriate way • Ones decisions are situated.

  23. Cardinal Virtues for Nursing • Compassion • Humility • Integrity • Courage

  24. A Good Fit: The Framework for Nurse Professionals

  25. Stairstep Model of Professional Transformation

  26. Your Career: Groups of Four • Describe characteristics of your ideal nurse . • Have these ideals changed over time? • Identify “mild stones”, critical events that shaped you. What significant processes have occurred over your career life?

  27. Your Career: Groups of Four • What significant processes have occurred over your career life? • Have you made mistakes and taken steps down? How did you overcome? • What future changes do you see for yourself?

  28. KohlbergMoral Development: good fit? • 3 Stages: • Pre-conventional: motivated by fear • Conventional: motivated to follow the rules • Post-conventional : situated and does things from critical thinking

  29. Changing from the inside out: strategies

  30. Implementation of and Stair Step Model • Nothing piecemeal: this is a paradigm shift in two ways: • Educating for transformation: Being and Doing paradigms • Educating to view ethical traditions • Educating for moral resiliency and a life-long process

  31. Step I: Educate the Faculty and Administrators • US: little knowledge of virtue ethics • Resistance to educating in a secular environment • Awareness of the Framework for Nurse Professionals and shift in conceptualization

  32. Step 2: Thread or block into Curriculum • Lens through which the professional is viewing the world and the lens through which the faculty member views the student. • Frequent and multiple integration • Applicable, out of the classroom and into the clinical wastelands.

  33. Step 3: Content Broader view of self development; more inclusive Work with development of situated use of virtues, moral resiliency, and reconciliation. Teach virtues, and how to show a virtue to others How to manage mistakes

  34. Step 4: Methods • Use of exemplars • Reflection • Weaknesses as opportunity • Portfolios • Shift from evaluative role to education • Faculty become more transparent

  35. Nancy Crigger and Nelda Godfrey Foreword by Patricia Benner The Making of Nurse Professionals

  36. References • . • Coulehan, J., & Williams, P.C.(2003 a). Conflicting professional values in medical education, Cambridge Quarterly of Healthcare Ethics, 12, 7-18.. • Coulehan, J., Williams, P.C., McCreary, V. & Belling, C. (2003b). The best lack all conviction: biomedical ethics, professionalism, and social responsibility. Cambridge Quarterly of Healthcare Ethics, 12, 21-38. • Crigger, N.J., & Godfrey, N. (2011). The making of nurse professionals: a transformational ethics approach. Sudbury, MA: Jones and Bartlett. • Crigger, N. & Godfrey, N. (2011). Of courage and ‘leaving safe harbors’. Advances in Nursing Science. 34 (4), E13-E22. • Crigger, N., Godfrey, N, (2010). The importance of being humble Advances in Nursing Science, 23(4): 310-319. • Dierckx de Casterle, B., Izumi, S., Godfrey, N.& Denhaerynck, K.(2008), Nurses response to ethical dilemmas in nursin practice: meta-analysis, Journal of Advanced Nursing, 63(6); 540-549.

  37. References • Erde, , E.L.(2008). Professionalism’s facets: ambiguity, ambivalence, and nostalgia, Journal • of Medicine and Philosophy, 33; 6-26. Godfrey, N. & Crigger, N. (2012). Ethics and professional conduct: Striving for a professional ideal. Journal of Professional Regulation, 3 (1) 10, 32-7. • Godfrey, N.S. & Crigger, N. (2011). Ethics and professional conduct. An online offering for the Learning Extension, National Council of State Boards of Nursing .Chicago: NCSBN • Handelsman, M.M., Knapp, S. & Gottlieb(2009). Positive ethics: themes and variations, Chap. 11, in Oxford Handbook of Positive Psychology, ED C.R. Snyder & S.J. Lopez, Oxford: Oxford University Press. • McCammon, S.D. & Brody, H.(2012). How virtue ethics informs medical professionalism, HEC, 24; 257-272. • Sullivan, W.M.(2005). Work and integrity. (2nd ed.). San Francisco: Jossey-Bass. • www.gallup .com/poll/1654-honesty-ethics-professions.aspx

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