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Facilitators and Barriers to the Professionalization of Nursing in Iran

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Facilitators and Barriers to the Professionalization of Nursing in Iran ORIGINAL ARTICLE Facilitators and Barriers to the Professionalization of Nursing in Iran Hosein Habibzadeh, PhD Candidate; Fazlollah Ahmadi, PhD; Zohreh Vanaki, PhD Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Corresponding author: Fazlollah Ahmadi, PhD; Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box: 14115-331, Tehran, Iran. Tel: +98 21 82883590; Fax: +98-21 82883558; Email: [email protected] Received: 24 October 2012 Revised: 29 November 2012 Accepted: 3 December 2012 ABSTRACT Background In recent years, healthcare organizations have supported the professionalization of nursing in order to improve the quality of care delivered to patients. The purpose of this study was to explore facilitators and barriers to professionalization of nursing in Iran. Methods A qualitative study was conducted using the conventional content analysis. Semi-structured interviews were held with 18 nurses working in various nursing positions and in different healthcare settings. Themes related to the professionalization of nursing was developed. Results During the data analysis, five themes were developed: “communication”, “motivation and attitude”, “organizational culture and structure”, “academic education”, and “supportive resources”. Each theme as a factor impacted the professionalization of nursing in a positive or negative manner. Conclusion Recognizing factors influencing professionalization of nursing contributes to improvement of quality of nursing care delivered to patients. Healthcare system authorities can facilitate the development of the nursing profession and facilitate the professionalization of nursing through increasing the number of postgraduate nurses and also improving the nurses’ work conditions. KEYWORDS: Content analysis; Nursing; Professionalization; Qualitative research Please cite this article as: Habibzadeh H, Ahmadi F, Vanaki Z. Facilitators and Barriers to the Professionalization of Nursing in Iran. IJCBNM. 2013;1(1): 16-25. INTRODUCTION Although professionalization is a familiar concept used in nursing, there is an ongoing controversy on whether nursing is a profession.1 Nowadays, becoming professional is a challenge in nursing.2 16 ijcbnm .sums.ac.ir Professionalization of nursing American Association of Clinical Nursing skills must begin from clinical settings and (AACN) and other nursing education centres continue to other situations.13 as well as healthcare organizations emphasize With regard to the background of the importance of the professionalization of professionalization of nursing in Iran, nursing.3,4 Such organizations encourage Iranian nursing has been strongly initiating changes in the structure influenced by the British nursing tradition of the healthcare system to facilitate characterized by the apprenticeship style professionalization, which can lead to the of nurse education. About a quarter of a improvement of the quality of care.5,6 century ago, nurses began to be educated There are many factors influencing the in higher education institutions and development of the nursing profession. the bachelor’s degree in nursing was Therefore, recognising and determining determined as the minimum requirement to such factors can be the first step to move enter nursing practice. Despite the changes, towards the professionalization of nursing.7,8 nursing is still striving to be accepted and For instance, a descriptive study in the recognized as a profession by the public. U.S. by Bruhn (2001) on the culture of This change was heralded as an opportunity professionalization in healthcare professions to enhance the professional status of nurses showed that the indices of professionalization in Iran. At present, university-based consisted of ‘moral consideration to the programs for nursing consist of Bachelor public’, ‘sympathy and empathy’, ‘quality of Science (BSc), Master of Science (MSc), of healthcare’, ‘professional consideration’, and Doctor of Philosophy (PhD) degrees.14 ‘communication’, ‘accountability’, Development of modern nursing education ‘collaborative work’, ‘humanity’, ‘knowledge in Iran has faced a lot of difficulties since improvement’, and ‘being a model’.9 its beginning early in the twentieth century. Additionally, Jamison et al. (1999) in the In other words, the main direction of nurse U.S. using the constant comparative method education has been positive in the early years revealed that healthcare organizations should of this century, but it has faced undeniable design a new model of professional due to challenges,15 and professionalization of its connection to the professionalization of nursing has been one of these challenges. nursing, which could predict a high quality For instance, Tabari-Khomeiran et al. nursing care.10 Rischel et al. (2008) in (2007) and Adib Hajbaghery (2003) in their Denmark declared the necessity of designing studies in Iran revealed that nurses were a new pattern for professionalization of the core elements of the professionalization nursing based on different cultures and of nursing, and healthcare organizations contexts.11 Also, Christine and Wynd (2003) would positively influence it. In addition, in a descriptive study in the U.S. on a random improving the nurses’ professional identity, sample of clinical nurses introduced factors self-confidence would empower the nurses’ contributing to the professionalization of professional capabilities. It was advised nursing. They believed that nursing was that involving the nurses in the process moving toward professionalization, but of decision-making would empower them different social and professional changes and replace the routine-oriented style of should be considered in order to facilitate delivering nursing care with evidence- it. In this respect, a lack of coordination of based nursing practice.8,15 Moreover, it nursing with such changes has hindered the was believed that a new structure must be professionalization of nursing.12 According designed to help with the professionalization to Julie et al. (2006), the professionalization of nursing.16,17 of nursing using specific communicative According to the literature, a few behaviours associated with different nursing qualitative studies in Iran have been IJCBNM January 2013; Vol 1, No 1 17 Habibzadeh H, Ahmadi F, Vanaki Z conducted on the professionalization of subthemes were identified, data saturation nursing,14 professional competence,18 and was achieved. The participants were professional empowerment,19 but no study interviewed in a private room at their was available on facilitators and obstacles workplaces. The interview guide consisted to the professionalization of Iranian of open-ended questions to allow the nursing. Therefore, this study aimed to respondents to explain their own opinions, explore facilitators and obstacles to nursing perceptions, and experiences freely without professionalization from Iranian nurses’ any limitation. Each participant was asked perspectives. to describe his/her own experiences on the professionalization of nursing. The main questions asked during the interviews were: SUBJecTS AND METHODS o What are your experiences on nursing professionalization? Study Design o According to your work experiences, A qualitative study using a conventional which factors may influence the professional- content analysis approach was used. Content ization of nursing? analysis is a descriptive qualitative approach The duration of each interview session whereby the researcher identifies themes ranged from 20 minutes to 2 hours with an or patterns in data in order to reflect the average of 75 minutes. The first researcher participants’ experiences.20 It is an approach for contacted each potential participant to sorting through large amounts of data, making explain the aim of the study and its research inferences from data about their context, questions. If the participant agreed to take providing new insights, and conceptualizing part in the research, an interview session realities presented in the text.20,21 was scheduled. Probing questions were used during the interviews in order to clarify the Participants and Settings participants’ comments and increase the The study participants consisted of depth of interviews. 18 people (6 nurses, 3 head nurses, 2 supervisors, 2 matrons, 3 nurse educators, Data Analysis and 2 members of the Iranian Nursing The data collection and analysis were Organization (INO) chosen through conducted consecutively. Initially all of the purposive sampling method.21 Their age interviews were transcribed verbatim and range was between 27 and 52 years. Of read several times in order to get the sense the participants, 9 nurses had a bachelor’s of whole. A total of 486 primary codes degree, and 7 and 2 master and PhD were identified from the transcriptions. The degrees, respectively. Seven nurses were codes were considered to be provisional and female. As an inclusion criterion, having revised several times in order to find the the experience of working as a clinical latent meanings behind the participants’ nurse for more than 5 years in a clinical statements and sentences. In this respect, setting was considered for the selection of the level of abstraction of the codes was the participants in order to gather in-depth improved through conducting comparisons and high quality data. between codes during the different stages of data gathering and analysis. Similar codes Data Collection relating to the same content were grouped Data were
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