J Dent Educ. 70(8): 825-834 2006
© 2006 American Dental Education Association
Milieu in Dental School and Practice |
Perceptions of Professionalism Vary Most with Educational Rank and Age
Charlotte Nath, B.S.N., Ed.D.;
Rebecca Schmidt, D.O., F.A.C.P.;
Erdogan Gunel, Ph.D.
Key words: health occupations schools, professional ethics, professional role, education/professional, medical education/graduate and undergraduate, nursing education, dental education, pharmacy education, allied health education
Submitted for publication 12/13/05;
accepted 05/09/06
 |
Abstract
|
|---|
The purpose of this study was to assess whether the perception of what constitutes professionalism varies with age, discipline, gender, or educational level among students and faculty at the major academic health sciences center in West Virginia. This exploratory descriptive survey study asked participants to classify behaviors described in a survey as professional, unprofessional, or unrelated to professionalism. Results were analyzed using contingency tables. For 2 x 2 contingency tables, test of independence of homogeneity was carried out by using Fisher’s exact test. For tables of higher dimensions, chi square test was used. The survey yielded a 45 percent return rate and demonstrated that the perception of professionalism varied most with the level of education and age and, to a lesser extent, with gender and health care discipline. Undergraduates, females, the youngest age group (
26), nursing students, and faculty other than dental or medical were more likely to label behavior depicted in the survey statements as unprofessional. The findings of this study underscore the complexities of the genesis of professionalism. Further study in regard to the teaching of professionalism is warranted.
Today’s health care arena poses complex ethical and moral dilemmas for both faculty and students of the health professions. The socialization process within various training programs contributes to the molding of and internalization of both personal and professional values specific to a particular discipline. Are those values standard across disciplines? Is professionalism a characteristic that a student brings to the field, or does he or she learn it in the socialization process inherent to the particular discipline? Is professionalism inherent to cultural and socioeconomic background? Is it the responsibility of health care educators to teach aspects of professionalism as part of the basic curriculum? Can professionalism be defined, taught, and measured?
Professionalism embraces a continuum of behaviors that have been defined as basic or generic at one end of the spectrum and highly altruistic at the other end.1 As such, professionalism may be as basic as doing the right thing well (when the task is defined, the solutions are available and affordable, and equitable compensation for services is received). Higher professionalism may be defined as a service that transcends self-interest and manifests when the task is poorly defined, solutions are not available or affordable, and rendering service is not in one’s own best financial, social, emotional, or physical interest. In medicine, Barondess2 framed professionalism as a social contract in which the public social value has been eroded by complexity in health provision, especially with regard to fiscal issues. Brand3 counters by arguing that medical professionalism must be framed within the context of a social construct, rather than a contract, in order to determine ways professionalism has impacted provision of health care and develop corrective steps. With the advent of "professionalism" requirements for residency program accreditation4 and medical school competency definitions, the teaching of professionalism has become a subject of intense focus among medical educators. Although most medical schools in the United States now address this topic in some manner, the strategies used to teach professionalism are not universal and may not always be adequate. Indeed, a survey by the Association of American Medical Colleges revealed that the teaching of professionalism in undergraduate medical education varies widely.5
While a concrete definition of professionalism may be lacking or, at best, inconsistent across disciplines, a review of codes of conduct documents for nurses, dentists, physicians, and pharmacists suggests that the values ascribed to professionalism appear to be similar, reflecting societal expectations related to health care providers’ responsibilities. Educational objectives for health care professionals have traditionally focused on knowledge and other content-based abilities to the exclusion of more subjective context-driven issues, such as professionalism. It can be argued that professionalism is inherent to cultural and socioeconomic background and that students enter health care professional schools with personal standards and ethics derived from past exposure to family, teachers, friends, or other social contacts. If it is not synonymous with upbringing, however, professionalism must be learned and/or acquired.
Current traditions and the lack of formal training in professionalism suggest an unspoken expectation that professional development evolves in parallel with acquisition of basic science and clinical knowledge. The value of integrity, accountability, responsibility, tolerance, compassion, maturity, appearance, and work ethic as attributes of "the professional" may vary widely with age, gender, type of health care professional student, level of education, and social background. In turn, the perception and significance of professionalism are likely to reflect one’s maturity level, one’s progression through the profession, or the distinction between actually "practicing a profession" and learning the "practice of a profession."
Faculty selected to the Teaching Scholars Program (TSP) of West Virginia University (WVU) acknowledged a perceived lack of professionalism in today’s students manifested by inappropriate classroom behavior, plagiarism, lack of accountability, and confusion regarding professional role in the face of personal hardship. The TSP is a unique multidisciplinary faculty development initiative of the Health Sciences Center, focused on improving teaching and learning across all health care disciplines. The perceived professionalism deficits among students prompted exploration of questions regarding the genesis of professionalism among students and faculty of the health care professions at WVU. To examine current perceptions of professionalism, the TSP class of 2000–01 surveyed all levels of practitioners across various health care disciplines at WVU, the major academic center in West Virginia for health care training. The TSP classes of 2000–02 who participated in the development and execution of this study were Rebecca Schmidt, D.O., Charlotte Nath, R.N., Ed.D., Ann Cleveland, R.N., Ed.D., Cathryn Frere, M.S., Anne Hackett, M.D., Mark Newbrough, M.D., and Kathleen Rosen, M.D. Advisors were Rashida Khakoo, M.D., and Donald Fidler, M.D. These scholars represented the schools of nursing, dentistry, and medicine.
The purpose of this study was to assess whether the perception of what constitutes professionalism varies within the schools of the health sciences center, specifically, among students (S) and faculty (F) of various education levels, health care schools, age, and gender.
|
Methods
|
|---|
This study was an observational descriptive survey study that compared the perceptions of professionalism among various professional groups at the start of the 2002 school year. The Institutional Review Board of WVU approved the study.
Faculty and students entering undergraduate (UG) and graduate (G) schools of the Health Sciences Center as well as postgraduate (PG) students entering fellowships or residency programs were asked to complete the survey. UG students are those without a bachelor’s degree, G students are those with a bachelor’s degree, and PGs are those with a master’s or professional degree. The entering student enrollment in the fall of 2002 was 728 (62 dental, 99 medical, 303 allied health, 184 nursing, and 80 pharmacy). The faculty census in fall 2002 totaled 634 (38 nursing, 30 pharmacy, 67 dentistry, 499 medicine and allied health). Of those faculty, 250 were female and 384 were male. Of the 610 responders, 239 were faculty, 69 were postgraduates, 162 were graduate students, 126 were undergraduates, and 14 were submitted without identifiers and could not be used. Of the 1,362 distributed surveys, 596 were usable, yielding a 44 percent response rate.
The survey consisted of twenty-nine anecdotal statements exemplifying behaviors that depict the following specific components of professionalism: honesty and integrity, accountability, responsibility, respectful and nonjudgmental behavior, compassion and empathy, maturity, self-directed learning, appraisal skills, and skillful communication, confidentiality, and privacy in all patient affairs. Surveys were color-coded by F, PG, G, and UG groups. The statements may be viewed in Appendix 1.
The seven members of the 2000–01 TSP class collectively created the anecdotal statements to reflect a behavior deemed reflective of one or more components of professionalism. The statements were developed over a ten-month period after an extensive discussion of the components exemplified by each statement and were vigorously edited so that final wording met with unanimous agreement.
Survey participants were asked to choose one of three standards of behavior (professional, unprofessional, or unrelated) by which to assess the twenty-nine anecdotes. Responders classified their age into one of three groups: 26, 27–50, or 
51; their discipline as medicine, dentistry, nursing, pharmacy, or allied health; their gender as male or female; and their educational status as UG, G, PG, or F. The surveys were administered during orientation for incoming students and in the fall for faculty.
The data were analyzed using contingency tables. For 2 x 2 contingency tables, test of independence or of homogeneity was carried out by using Fisher’s exact test. For tables of higher dimensions, chi square test was used.
|
Results
|
|---|
The survey was administered to 1,362 F, first-year PG, UG, and G students across all professions at the health sciences center. Demographic information requested on the survey included gender, age, geographic history, and educational/professional status. Of the 610 surveys returned, fourteen were without demographic information and others were incomplete; hence, the number of subjects responding varies from a low of 591 to a high of 596 for different items.
Educational Level and Perceptions of Professionalism
Significant differences in views when compared by educational level were found for eighteen of twenty-nine statements. Tables 1
and 2 display all twenty-nine statements and note whether there was agreement or lack of agreement across educational levels.
View this table:
[in this window]
[in a new window]
|
Table 1. Educational level and statements indicating agreement: percent indicating statement represented unprofessional behavior
|
|
View this table:
[in this window]
[in a new window]
|
Table 2. Educational level and statements indicating lack of agreement: percent indicating statement represented unprofessional behavior
|
|
Table 1
lists those behaviors and their respective statements that generated universal agreement across all levels of education. Behaviors labeled as unprofessional included those reflecting honesty as represented in statements 3, 8, 4, 13, 21, and 28; responsibility for repayment of student loan as represented in statement 18; and maintaining confidentiality as represented in statements 5 and 26. Budgeting time each week to keep abreast of current literature in one’s field (statement 27) was considered professional as was honoring a commitment in the face of a better opportunity (statement 22).
Table 2 represents the statements for which the views differed among the educational levels. Overall, Gs and UGs shared similar views, as did Fs and PGs, though for statements 9, 14, 17, and 29, UGs differed in their views from all others. Overall, UGs and Gs were more critical in their ranking and were more likely than Fs or PGs to rank a given behavior as unprofessional.
Statements 1 and 11 reflect maturity in dealing with the social/moral issues of sex (11) and marijuana use (1). UGs and Gs were more likely to rank marijuana use on personal time as unprofessional compared to Fs and PGs. To the contrary, UGs and Gs were less inclined to classify sex with the single patient (11) as unprofessional compared to Fs and PGs.
Age and Perceptions of Professionalism
When age was the variable of interest, there were significant differences in views on eighteen of the twenty-nine statements. Results are summarized in Table 3.
View this table:
[in this window]
[in a new window]
|
Table 3. Statements generating lack of agreement by age: percent indicating statement represented unprofessional behavior
|
|
Younger individuals ( 26) were significantly more likely to rank behaviors as unprofessional than the other age groups. Specifically, they were more likely to rank statements 6 (whispering in class), 7 (arriving late for class), 10 (lying about fatal diagnosis), 14 (dentist alters attire), 17 (taking uninterrupted lunch time), 19 (failing appointment), 20 (looking up personal labs), 23 (personal home shopping), 24 (hygiene issue with faculty member), and 29 (attire in adolescent psychiatric unit) as unprofessional. Those in the oldest groups ( 51) were more likely to rank four of the statements that reflected honesty and responsibility as unprofessional: statement 9 (forging signature for child excuse), statement 13 (nurse calling in sick to attend concert), statement 25 (avoiding speeding), and statement 28 (physician calling in sick). Statement 28 reflected the biggest contrast between the age groups with the 51 age group viewing this behavior as unprofessional and the youngest age group as unrelated to professionalism.
Within the age groups, those in the middle age group (27–50 years) differed from the other two groups in their view of professional attributes by being less likely overall to rank behavior as unprofessional. Notably, statements 3 (using report from Internet as one’s own), 8 (copying exam answers), and 16 (nurse practitioner, NP, fails to correct error in timely manner) were rated exactly the same in the younger and older groups, while members of the middle group were significantly different in their willingness to label this behavior as unprofessional. The only behavior that the middle age group was most willing to rank as unprofessional was reflected in statement 11 (sex with patient).
|
Differences Based on Gender
|
|---|
Males and females were more alike than different in their perceptions of actions that depict professional behavior. Males and females agreed that statement 11 (sex with patient) depicted unprofessional behavior with only about 20 percent viewing this as unrelated to professionalism. Males and females were evenly split in labeling the use of marijuana on personal time as either unprofessional or unrelated to professionalism. Gender differences were identified for twelve of the twenty-nine statements (Table 4), and the differences reflected an overall increased likelihood for females to rank a given behavior as unprofessional. The only exception was for statement 9 (a lawyer’s child wants to skip school to be home with a visiting cousin and the lawyer forges a doctor’s excuse to the school) where males were more likely to view this behavior as unprofessional.
View this table:
[in this window]
[in a new window]
|
Table 4. Statements generating lack of agreement by gender: percent indicating statement represented unprofessional behavior
|
|
Figure 1 depicts the gender proportion and distribution among class ranks. There are significantly fewer females in F and PG ranks and significantly more females in the UG rank. Among faculty, there are fewer females in all disciplines except nursing.
Differences Based on Discipline
Faculty.
Significant differences in views of behavior depicted as unprofessional among faculty by discipline were found for only seven statements (approximately 25 percent). Among the differences, a few stand out. Medical faculty participants were least likely to label classroom behavior (statements 6 and 7) as unprofessional, while nursing and "other" faculty participants were most likely to do so. Medical faculty were also least likely to view the use of work computer for home shopping (statement 23) as unprofessional. They agreed with their dental colleagues in viewing the personal hygiene issue (statement 24) as unrelated to professionalism and with their nursing colleagues in viewing sex with a single patient as unprofessional behavior. Dental faculty were most likely to label marijuana use on personal time as unprofessional (statement 1) and least likely to label single physician having sex with a patient (statement 11) as unprofessional. In these respects, dental faculty shared the same views as their students (see below). Nursing faculty were most likely to label the behavior depicted in statement 15 (principal kept parent waiting and did not apologize) as unprofessional. Faculty differed on their views regarding three statements for which students across disciplines expressed agreement: statements 7 (habitually late for class), 15 (lack of apology for lateness), and 24 (personal hygiene issue). (See Table 5.)
View this table:
[in this window]
[in a new window]
|
Table 5. Faculty by discipline and statements indicating lack of agreement: percent indicating statement represented unprofessional behavior
|
|
Students.
Overall, there was more agreement than disagreement between disciplines, with differences being manifested on only a third (34 percent) of the statements (see Table 6). Within those significantly different views, nursing students were more likely overall to rank behavior as unprofessional. They were in agreement with medical students in ranking statement 29 (refusal to adjust attire in adolescent unit) as unprofessional. Nursing students stood out in their difference in their views on statements 17 (M.D. takes personal time during lunch), 18 (default on student loan), 20 (checking personal labs), and 23 (personal shopping on work computer) in that they were more likely to rank these behaviors as unprofessional. Nursing students were least likely to label marijuana use on personal time (statement 1) as unprofessional, while dental students were most likely to do so. This difference may have been enhanced by the fact that the statement involved a dental professional. Dental students were least likely to rank those behaviors depicted in statements 11 (sex with patient), 18 (default on student loan), and 29 (refusal to adjust attire) as unprofessional. Due to their small numbers, pharmacy, exercise physiology, physical therapy, and occupational therapy respondents were grouped into the "Other" category. This group differed significantly from the others by being least likely to rank behavior depicted in statements 3 (purchasing report from Internet), 6 (whispering in class), 20 (checking personal labs), and 23 (personal shopping on work computer) as unprofessional.
View this table:
[in this window]
[in a new window]
|
Table 6. Students by discipline and statements indicating lack of agreement: percent indicating statement represented unprofessional behavior
|
|
Differences by Statement
Statements 2, 4, 13, 18, 21, 22, 26, 27, and 28 represent issues about which almost everyone agreed. Marked differences in opinion were seen for statements 6, 11, 14, 17, 20, 23, and 24 although these differences largely reflect varying degrees of agreement rather than oppositional views. Table 7 shows the statements and variables that were shown to have significant differences. Talking during class (statement 6) was more likely to be viewed as unprofessional by undergraduates, nursing, and other (not dental or medical) faculty; those twenty-six years of age and younger; dental and nursing students; and females. A single physician dating and having sex with a patient from his or her practice (statement 11) was more likely to be viewed as unprofessional by PGs and Fs and by those between the ages of twenty-seven and fifty. This behavior was less likely to be viewed as unprofessional by dental students and faculty. Males and females agreed that this behavior was unprofessional.
In another statement, altering attire to make a patient comfortable (statement 14) was most likely to be viewed as unprofessional by UGs when compared to other educational levels, those twenty-six years of age and younger, and females. It should be noted that this behavior was largely viewed as professional, but significant differences were found in the above mentioned groups. No differences were found across disciplines in students or faculty. Taking uninterrupted time at lunch each day (statement 17) was most likely to be viewed as unprofessional by UGs, those twenty-six years of age and younger, females, and nursing students. Faculty across disciplines agreed that this behavior was unrelated to professionalism. The issue of "looking up personal lab values" (statement 20) was most likely to be viewed as unprofessional by UGs, those twenty-six years of age and younger, females, and nursing students. Faculty across disciplines agreed that this behavior was largely unrelated to professionalism.
Statement 23 depicted a surgical resident using the hospital computer to do "home shopping." This behavior was most likely to be classified as unprofessional by UGs, those twenty-six years of age and younger, females, and nursing students. Medical faculty were least likely to classify this behavior as unprofessional. Statement 24 depicts a medical resident’s expression of concern about a supervising faculty member who has bad body odor. This behavior was most likely to be classified as unprofessional by UGs, females, those twenty-six years of age and younger, and nursing faculty. Students across disciplines agreed that this behavior was unrelated to professionalism.
|
Discussion
|
|---|
Results from this study demonstrate that the perception of professionalism varies most with level of education and age and, to a lesser extent, with health care discipline and gender. Differences in perception were found between educational levels but not between age groups in regard to the use of marijuana (statement 1), physician-patient responsibility (statement 2), poor self care (statement 12), and principal tardiness (statement 15). Differences in perception were found between disciplines in faculty but not in students in regard to arriving late to class (statement 7), altering attire to make patient comfortable (statement 14), using computer at work for home shopping (statement 23), and dealing with hygiene issues in a supervisor (statement 24). While males and females showed significant differences in their views of several of the statements, the gender variable was the only one that was significant for statements 5 and 26 (patient confidentiality and contacting student’s family without permission).
Limitations of this study include the lack of longitudinal follow-up of participants as their own controls, particularly the follow-up of students as they progressed from undergraduate to higher ranks. For some statements, the response by discipline may have been influenced by the discipline represented. For example, statement 1 described a dental hygienist using marijuana on personal time. Dental faculty and students were significantly more likely to rank this behavior as unprofessional than did respondents in the other disciplines. However, other disciplines did not differ significantly in their ranking when so named in an example.
The results of this study may reflect a maturation process or an acceptance of the predominant values and mores of the professional group to which one belongs. Graduates or UGs were more inclined than Fs or PGs to classify behaviors as unprofessional in areas of significant differences with few exceptions. The youngest group was most likely of the three age groups to rank a statement depicting a particular behavior as unprofessional, reinforcing the trend seen when examining views of students (UGs, Gs, and PGs) and Fs. Males were less inclined than females to recognize and classify behaviors as unprofessional in areas of significant difference with one exception: when a patient was lied to about a fatal diagnosis. The participants in the middle age range of twenty-seven to fifty were less likely to classify behaviors as unprofessional in areas of significant difference with one exception: physician having sex with single patient. Nursing students were more likely to classify behavior as unprofessional in areas of significant difference with one exception: marijuana use on personal time.
Behavior is guided by personally held principles, beliefs, and values,6 and "professional values are standards for action that are accepted by the practitioner and professional group and provide a framework for evaluating beliefs and attitudes that influence behavior" (p. 366).7 Several studies in the nursing literature have reported a positive link between professionalism and level of education, 8–11 despite the absence of "professionalism" in the curriculum. The Nursing Professional Values Scale12 (derived from the Code of Ethics of the American Nurses Association) was used to measure professional values in graduating nursing students. Professional values were significantly related to gender and ethnic/cultural background, regardless of educational program.6 This would suggest that students bring their professional values with them to the educational process. Professionalism in nursing (as indicated by the use of professional organizations as symbols for defined professional conduct, belief in public service, autonomy, self-regulation, and a sense of calling) has also been related significantly to years of experience as an R.N., higher educational degrees in nursing, membership in professional organizations, service as an officer in the organization, and specialty certification.13 This assessment would suggest that students learn professionalism within the profession. The present study suggests there is some truth in both views.
|
Summary and Conclusion
|
|---|
Undergraduates, females, the youngest age group ( 26), nursing students, and nondental or nonmedical faculty were more likely to label behavior depicted in the statement as unprofessional when there was a significant difference between groups. This may reflect a maturation process or an acceptance of the predominant values and mores of the professional group to which one belongs. This study underscores the complexities of the genesis of professionalism in regard to its perception as well as its teaching and suggests that further study in this arena is warranted.
|
APPENDIX 1
|
|---|
Survey Statements on Professionalism
- A dental hygienist smokes marijuana almost every weekend at home when not working.
- A surgeon asks a partner to manage a patient whose heart stopped and was restarted moments earlier in order to go to a daughter’s piano recital.
- A junior undergraduate student is taking a course that does not seem particularly interesting and purchases a literary report off the Internet to turn in for a grade.
- A banker wants to go fishing with a good friend who just came into town and thus calls in "sick."
- While riding in a hospital elevator, two hospital pharmacists talk about their patients and the patients’ illnesses.
- A nursing student finds a nursing class boring and whispers throughout the class to a good friend.
- A medical student has a habit of arriving nine to ten minutes late to classes.
- An undergraduate student really wants to get into health professional school and asks to copy a classmate’s exam answers.
- A lawyer’s child wants to skip school to be home with a visiting cousin, and the lawyer forges a doctor’s excuse to the school.
- A nursing student lies to a patient about the patient’s condition so as not to reveal that the patient was diagnosed with a fatal disease.
- A single family physician dates and has sex with a patient from the physician’s practice.
- A pharmacy student severely overeats, refuses to exercise, and does not comply with taking blood pressure medications.
- A nurse wants to go to a concert with a good friend who just came into town and thus calls in "sick."
- A dentist alters a style of dressing in order to make patients feel comfortable.
- A school principal keeps a parent waiting for 20 minutes and does not apologize.
- A nurse practitioner realizes after going home that a routine pap smear was not ordered on a patient and decides to wait until the patient returns next year to tell the patient to get a pap smear.
- A family physician takes 30 minutes off after lunch everyday, requesting not to be interrupted while reading the newspaper and listening to music on the radio.
- A college student does not pay back a student loan.
- A dental student makes an appointment with a supervisor and does not show for the appointment and does not call to cancel.
- A pediatric resident uses a computer to go online to go into medical records and look up personal lab values after having gone to a family physician for a checkup.
- A medical student wants to go hiking with a good friend who just came into town and thus calls in "sick."
- A psychiatric resident matches to do a fellowship in a university program, then has an offer from a better program, but turns down the better offer to honor the agreement with the initial program.
- A surgical resident uses a computer at the hospital to go to the Internet to do 20 minutes of "home shopping."
- A medical resident expresses concern to a faculty member that the supervising faculty member has bad body odor.
- A health sciences student learning at a rural health center is careful not to speed in the town where the center is located.
- Concerned about the performance of a student, a health sciences faculty member contacts the student’s parent (who is a colleague in another department) without first seeking the student’s permission.
- A practicing health professional allots three hours per week to spend in the library reading journals to keep current.
- A physician wants to go to a sports event with a good friend who just came into town and thus calls in "sick."
- A 60-year-old psychiatrist wears formal suits to work on an adolescent unit even though knowing it makes the adolescent patients uncomfortable.
|
Footnotes
|
|---|
Dr. Nath is Professor, West Virginia University School of Medicine, Department of Family Medicine, Robert C. Byrd Health Sciences Center; Dr. Schmidt is Professor and Section Chief, Department of Medicine, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center; and Dr. Gunel is Professor, Department of Statistics, West Virginia University. Direct correspondence to Dr. Charlotte Nath, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, P.O. Box 9152, Morgantown, WV 26506-9152; 304-598-6900, ext. 9-7-5890 phone; 304-599-6921 fax; nathc{at}rcbhsc.wvu.edu.
|
REFERENCES
|
|---|
- Bryan CS, Theodore E. Woodward Award, HIV/AIDS, ethics, and medical professionalism: where went the debate? Trans Am Clin Climatol Assoc 2003;114:353–67.[Medline]
- Barondess JA. Medicine and professionalism. Arch Intern Med 2003;163(2):145–9.[Free Full Text]
- Brand CA. Professionalism: a barrier to provision of quality health care? Arch Intern Med 2003;163(14):1742–3.[Free Full Text]
- Accreditation Council for Graduate Medical Education (ACGME) institutional requirements. Approved by ACGME, 2/11/03; effective 7/1/03. At: www.acgme.org/acWebsite/irc/irc_IRCpr703.asp. Accessed: July 12, 2006.
- Swick HM, Szenas P, Danoff D, Whitcomb ME. Teaching professionalism in undergraduate medical education. JAMA 1999;282(9):830–2.[Abstract/Free Full Text]
- Martin P, Yarbrough S, Alfred D. Professionalism values held by baccalaureate and associate degree nursing students. J Nurs Scholarsh 2003;35(3):291–6.[Medline]
- Weis D, Schank MJ. Toward building an international consensus in professional values. Nurse Educ Today 1997;17(5):366–9.[Medline]
- Schriner JG, Harris I. Professionalism among nurse educators. J Nurs Educ 1984;23(6):252–8.[Medline]
- Eddy DM, Elfrink V, Weiss D, Schank MJ. Importance of professional nursing values: a national study of baccalaureate programs. J Nurs Educ 1994;33(6):257–62.[Medline]
- Duckett L, Rowan M, Ryden M, Krichbaum K, Miller M, Wainwright H, Savik K. Progress in the moral reasoning of baccalaureate nursing students between program entry and exit. Nurs Res 1997;46(4):222–9.[Medline]
- Elfrink V, Lutz EM. American association of colleges of nursing values: national study of faculty perceptions, practices, and plans. J Prof Nurs 1991;7(4):239–45.[Medline]
- Weis D, Schank MJ. An instrument to measure professional nursing values. J Nurs Scholarsh 2000;32(2):201–4.[Medline]
- Wynd CA. Current factors contributing to professionalism in nursing. J Prof Nurs 2003;19(5):251–61.[Medline]
This article has been cited by other articles:
|
|
|
|
 
N. Capa, O. Malkondu, E. Kazazoglu, and S. Calikkocaoglu
Evaluating factors that affect the shade-matching ability of dentists, dental staff members and laypeople
J Am Dent Assoc,
January 1, 2010;
141(1):
71 - 76.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Hutchins and S. Cobb
When Will We Be Ready for Academic Integrity?
J Dent Educ.,
March 1, 2008;
72(3):
359 - 363.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. L. Davis, D. C.L. Stewart, M. Guelmann, A. G. Wee, J. L. Beach, K. M. Crews, and R. S. Callan
Serving the Public Good: Challenges of Dental Education in the Twenty-First Century
J Dent Educ.,
August 1, 2007;
71(8):
1009 - 1019.
[Abstract]
[Full Text]
[PDF]
|
|
|
Top
Abstract
Methods
