Approved by the Missouri Society for Respiratory Care for 1 CRCE
Authored by: Shawna Strickland, MEd, RRT-NPS, AE-C

Professionalism Definitions:

• Profess:
  • To affirm or avow
• Profession:
  • A vocation or occupation requiring special, usually advanced, education, knowledge and skill
• Professional:
  • One engaged in one of the learned professions or in an occupation requiring a high level of training and proficiency

Professionalism: How do I do this?

• Aspects of being a professional:
• Serve the needs of society
• Understand the characteristics of professionalism
• Behave in a professional manner
• Enhance and promote professional image

We are held to a higher standard

Societal Expectations
Society expects a certain level of experience, knowledge and standards from the health care profession. Specifically, society expects:

• Professional credentials
• Professional code of ethics
• Standards of practice
• Maintenance of knowledge and skills
• Peer review process
• Research and publication

Patient Expectations
Being a patient, for whatever reason, can be very stressful in even the best environment. For a moment, place yourself in the patient's place. What would you expect of the person who is caring for you?

• Personal integrity
• Confidentiality
• Appreciation for diversity
• Strong work ethic
• Sound judgment
• Failure of one individual to meet these expectations can result in condemnation of the entire profession.

Citizenship

• Society expects professionals to contribute to society above and beyond their professional roles.
  • Philanthropic endeavors
    • Community
    • Society at large
  • Civic responsibilities
    • Voter
    • Tax payer
    • Public policy shaper
• AARC Role Model Statement: http://www.aarc.org/resources/position_statements/rms.html

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Knowledge and Skills

Graduating from an accredited program in respiratory care is no longer "good enough" to maintain professionalism. Respiratory therapists are expected to possess our classroom knowledge as well as skills that can't be learned from a textbook.

• General education
• Psychomotor skills
  • This means being physically able to perform the daily work.
• Cognitive skills
  • Our ability to rationalize a situation or trouble-shoot on-the-spot is a necessary tool.
• Interpersonal skills
  • Flexibility, time management, team work, communication
• Teaching and administrative skills
  • Remember, our day consists of making sure our patients and their families can administer the home medications appropriately and efficiently.
  • Technology is advancing at an alarming rate and most of us utilize electronic charting within our facilities. What was formerly called "administrative skills" is becoming a necessity of every position within the facility.
• Research skills
  • Maintain a high standard of practice and ethics

Lifelong Learning

In most states, continuing education is a requirement for licensure (which is why you're here now!). Even though meeting these requirements can be tedious, time consuming and occasionally boring, there are some great reasons to engage in lifelong learning:

• Continued self improvement
• Continued professional development
• Continuing education into areas that are new and advanced
• Research.keep up with the therapeutics on the horizon

Appearance

• Visual and behavioral attributes exhibited by members of a profession help create the image of that profession held by others.
• The need to maintain a professional appearance may seem obvious, but it's effects are often underestimated.
• Professional attire shows that you care about the image you project and are committed to professional standards.

Professional Image?

Remember that our patients see this too!

• Limit use of personal cell phones and beepers
• Verbal and non-verbal communication "in sync"
• Cologne, perfume and other fragrances (lotions, oils, etc)

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What's wrong with this picture?

• No watch.a little hard to take a pulse without one (although we've all seen someone try!)
• No lab coat.this might be a little picky, but let's face it: we look more professional with a lab coat.
• Hair is down.again, this might be picky but can she see the patient when she bends her head?

Granted, new research has started to dismiss the idea that cell phones won't interrupt some equipment, but is her patient's well-being her first priority?

There is such a thing as being too relaxed at work.
(Disclaimer: This particular RT model is 8 ½ months pregnant in the photo.)

I'm pretty sure that her boss isn't paying her to sleep...

or him to play Solitaire on the hospital computer.

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Attitudes and Behaviors

• Positive attitude
  • When dealing with co-workers or patients
  • Even if we're in the worst of moods, the patients will not appreciate the remarks about how short staffed our department may be or whether or not you are friends with the nurse on staff for the day.
• Mature behavior
• Proper etiquette
  • Understanding what is appropriate in various situations
• Accept responsibility
  • Playing the "blame game" to avoid accepting responsibility won't help the situation or improve patient care
• Dependability
  • Are you the type of therapist that can be counted on when the chips are down and your co-workers need help?
• Completion of tasks
  • Timely
  • Thoroughly
  • Punctuality in meeting deadlines
• Communication technology skills
  • Acceptable practice with voice mail, e-mail, beeper and mobile phone etiquette
• Professional competence

Ever have one of "those" days?

• Professional attitude does not have to mean cold and unfeeling.
  • Warm and friendly interaction is acceptable and even encouraged.
  • Caring behaviors are appropriate and expected of professionals
• Physical and emotional limits should be maintained in the patient/professional relationship.

Ethics

• "A system of moral principles or standards governing conduct."
• (Taber's Cyclopedic Medical Dictionary, 17 th Ed, 1993)

I know we've all heard the term "ethics" and we all believe that we know what this is, but how many of us can put a definition to this term?  Can you differentiate between ethics and morality?  How about ethics and the law? One of the most popular phrases in ethics is The Golden Rule: do unto others as you would have them do unto you. Many people associate this with Christianity, but almost all religions have a variation of the golden rule. If you're up on your philosophers, you might remember Immanuel Kant and his categorical imperative.  Basically, he says that the goal of morality is to cultivate people of a good will.

Before we go too far into ethical principles, let's define a few terms:

• Ethics: custom of ideal behavior that people should follow (what is the right thing to do?)
• Morality: concerned with relationships between people and how they can best live in peace and harmony
• Law: society's minimum behavior standard (also construed as "minimum ethic")
• Just because something's legal doesn't mean it's ethical.does Nazi Germany ring a bell?

We're not born with an inherent knowledge of morality; we develop it during our growing years (and, really, all of our lives). Lawrence Kohlberg constructed three levels of morality development. Read the three levels below. What level of development have you achieved?

1. Pre-conventional reasoning (we do what we do because the authority figure says to do it)
2. Conventional reasoning (we do the "right thing" because it's good for society)
3. Post-conventional (principled) reasoning (reasoning alone determines the behavior, not emotion)

Ethical Principles

Now let's look at ethical principles.  There are eight major ones, but you'll hear people talk about the "four basic principles."  I've listed all eight ethical values, but the big four are in blue.

• Beneficence (doing good)
• Non-maleficence (doing no harm)
• Justice (being fair)
• Autonomy (letting the person make his or her own decisions)
• Fidelity (being truthful)
• Life (the right to live or not to live)
• Confidentiality (keeping secrets)
• Role duty (the duty that the health care provider has towards the patient)

There are many ethical theories out there.  One of the principles that I want to look at a bit more closely is virtue ethics.  In this principle, the person is the focus, not the act.  What we're doing here is examining the character traits of the person; if the person is ethical, then it stands to reason (in the virtue theory) that the acts of the person will also be ethical.

One principle that might be familiar (though many have not put a name to it) is casuistry.  This is another name for narrative ethics.  Think about Christianity: how does Jesus teach morality? By providing his listeners with a story about someone who has done the wrong (or right) thing and providing a moral to the story.  Christianity is not the only religion to use this tactic; as a matter of fact, it's not even specific to religion.  Have you ever heard of Aesop's fables?

Another principle that I want to bring to your attention is the Feminist Theory.  In contrast to the male dominated world (where justice is the highest ethical value), the feminist philosophy focuses more on doing good (beneficence), being true (fidelity) and caring.

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How does this apply to health care?

• Hippocratic oath
  "I swear by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath.
  
  To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.
  
  I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
  
  To please no one will I prescribe a deadly drug nor give advice which may cause his death.
  
  Nor will I give a woman a pessary to procure abortion.
  
  But I will preserve the purity of my life and my arts.
  
  I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
  
  In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
  
  All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
  
  If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."
  
  Reference: http://en.wikipedia.org/wiki/Hippocratic_Oath

• Nightingale's Oath
  • Adaptation of the Hippocratic Oath for nurses:
    "I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care" ( http://www.countryjoe.com/nightingale/pledge.htm ).
    

• AARC Statement of Ethics: http://www.aarc.org/resources/position_statements/ethics.html
  I encourage you to check out the statement of ethics on the AARC website.

While "RCP" stands for Respiratory Care Practitioner, it also stands for:

• R espect
• C ompassion
• P rofessionalism

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