CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
The concept of professionalism has been a cornerstone of medical practice since the days of Hippocrates and it has been regarded as “the basis of medicine’s contract with society.” (Askitopoulou and Vgontza, 2018; Askitopoulou and Vgontza 2018; Alexis et al., 2020). In 1990s, the principles of professionalism were reinvigorated by medical field leaders who established a more precise set of ethical values and competence standards expected in the delivery of clinical care.e (Lesser, 2010; Egener et al., 2017; Dupree et al., 2011).
Over time, these core competencies have been incorporated into medical education and training at both undergraduate and graduate levels. The focus has been on promoting acceptable professional behaviors and adhering to ethical principles in providing safe and effective clinical care, as well as in conducting oneself in the public sphere (Chestnut, 2017; Hafferty, 2018; Berger et al., 2020).
Professionalism in healthcare refers to a set of standards that healthcare professionals are expected to adhere to (College of Health Care Professions, 2022). The American Board of Medical Specialties expands on this definition, stating that “medical professionalism is a (normative) belief system about how best to organize and deliver health care, which calls on group members to jointly declare (“profess”) what the public and individual patients can expect regarding shared competency standards and ethical values and to implement trustworthy means to ensure that all medical professionals live up to these promises” (Wynia et al., 2014).
Professionalism competence is defined as “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served” (Epstein and Hundert, 2022). The definitions of professionalism have varied and evolved over time and across different contexts. More recent definitions have emphasized the importance of observable and measurable behaviors (Modi et al., 2014). The fundamental elements of professionalism include several qualities such as “altruism, dependability, responsibility, quest for excellence, appreciation of duty, agency, honesty, rectitude and integrity, collegiality, respect for others, continuous learning and improvement, and humility” (Chestnut, 2017)
Healthcare professionalism is crucial for safeguarding patients and maintaining their privacy and confidentiality (College of Health Care Professions, 2022). Healthcare providers strive to enhance patient safety and the quality of care by adhering to professional standards. They are equipped to promptly identify and address any changes in a patient's condition, leading to more effective treatments. For example, nurses utilize their professional skills to detect potential issues before they escalate into bigger problems.
Moreso, professionalism in healthcare is crucial in building and maintaining trust between patients and healthcare professionals, which is essential for successful treatment outcomes. By exhibiting courtesy, attentiveness, and respect, healthcare professionals instill confidence in patients, which leads to improved health and well-being, faster recovery times, and better disease management. The significance of professionalism in healthcare spans from communication with colleagues to interactions with patients, highlighting its critical role in the delivery of quality care (Ali, 2023).
In recent years, there has been a growing concern about the decline of medical professionalism, with authorities pointing to a decrease in professional attributes among healthcare workers (West and Shanafelt, 2007). Relman (2008) gave a keynote address at Harvard Medical School, in which he stated that medical professionalism in the United States was facing a crisis. He emphasized that the ethical foundations of medicine were at risk, including the commitment of physicians to prioritize patients' needs over personal gain, to treat patients with honesty, competence, and compassion, and to avoid conflicts of interest that could undermine public trust in medicine's altruism. Relman attributed the decline of professional values to the changing scientific, economic, legal, and social landscape of medicine. He identified the commercialization of the US healthcare system as a significant reason for this decline. Similarly, numerous studies have documented instances of unprofessional conduct among healthcare providers, including poor communication skills, lack of empathy towards patients, and unethical behavior (Westbrook et al., 2020; Dabekaussen et al., 2023; Saghaei, 2020). The issue of unethical behavior among healthcare workers in Nigerian health facilities has become a growing concern (News Agency of Nigeria, 2022). Specifically, nurses have been found to engage in various unethical behaviors, including tardiness, theft, misappropriation of funds, and other forms of misconduct (Bichi, 2017), resulting in adverse effects on both the healthcare system and patient welfare..
To address this issue, it is important to examine the attitudes of healthcare providers towards professionalism in the service delivery, as unprofessional behavior can have significant detrimental effects.
1.2 Statement of the Problem
Healthcare practitioners are becoming less professional, which is a worrying trend because unprofessional behaviour has a negative influence on patient outcomes and the standing of healthcare organizations (Ellaway et al., 2018; Hickson et al., 2022; Rosenstein, 2011; Rosenstein, 2015). Despite the significance of professionalism in the provision of healthcare, there is a dearth of study on the attitudes of healthcare workers in Nigeria, notably at the University of Uyo Teaching Hospital (UUTH).
The University of Uyo Teaching Hospital is a tertiary healthcare institution situated in Uyo, Akwa Ibom State, serving the South-South region of Nigeria, West Africa. The University of Uyo Teaching Hospital (UUTH) was formerly known as the Akwa Ibom State Specialist Hospital and was established in 1994. The hospital boasts of 500 beds and comprises 25 departments, including 21 clinical and 4 non-clinical departments, as well as various support units. Its primary focus is on delivering quality tertiary healthcare services, clinical training, and research (University of Uyo Teaching Hospital, 2023).
The University of Uyo Teaching Hospital (UUTH) employs a large number of healthcare workers, including doctors, nurses, pharmacists, lab scientists, and other allied health professionals. Unprofessional conduct by healthcare workers at UUTH has, regrettably, been the subject of multiple reports. These incidents underline the necessity for research on the attitudes of healthcare providers towards professionalism in service delivery in UUTH.
Hence, this study aims to fill this gap in the literature and provide insights into the attitudes of healthcare providers towards professionalism in service delivery in UUTH.
1.3 Aim of the Study
The study aims to assess the attitudes of healthcare providers towards professionalism in service delivery using the University of Uyo Teaching Hospital as a case study.
1.4 Objectives of the Study
The study had the following specific objectives:
1. To identify the factors that influence the attitudes of health care providers towards professionalism in service delivery.
2. To assess the level of professionalism exhibited by health care providers in UUTH.
3. To develop recommendations for enhancing professionalism among healthcare providers in UUTH based on the findings of the study.
1.5 Research Questions
1. What are the factors that influence the attitudes of health care providers towards professionalism in service delivery?
2. What is the level of professionalism exhibited by health care providers in UUTH?
3. What recommendations can help enhance professionalism among healthcare providers in UUTH based on the findings of the study?
1.6 Research Hypothesis
H0: There is no significant difference in the level of professionalism among healthcare providers in UUTH based on their demographic characteristics, such as age, gender, educational level, and years of experience.
Ha: There is a significant difference in the level of professionalism among healthcare providers in UUTH based on their demographic characteristics.
1.7 Justification of the Study
This study is justified by the lack of research on attitudes towards professionalism among healthcare providers in UUTH, which limits the development of strategies for addressing unprofessional behavior among healthcare providers. Since healthcare providers play a critical role in ensuring the health and well-being of the population, unprofessional behavior among healthcare providers can negatively impact patient outcomes, satisfaction, and trust in the healthcare system.
Therefore, this study will provide valuable insights into the attitudes of healthcare providers towards professionalism in service delivery in UUTH, The findings of the study will enable health workers to identify areas where they need to improve their professional conduct and enhance their communication and interpersonal skills. The study will also promote a culture of accountability and ethical behavior among health workers, which will ensure that they adhere to professional standards and promote patient-centered care.
The study will provide insights into the factors that influence healthcare providers' attitudes towards professionalism in UUTH. This information will be valuable in the development of strategies to improve the work environment, address workload issues, and promote ethical behavior among healthcare providers in the hospital. The study will also contribute to the body of knowledge on attitudes towards professionalism among healthcare providers in Nigeria, which will be useful to policymakers and other stakeholders in the healthcare sector.
1.8 Scope of the Study
The scope of this study on attitudes of health care providers towards professionalism in service delivery covers the healthcare providers employed by the University of Uyo Teaching Hospital, including doctors and nurses. The study will investigate their attitudes towards professionalism in healthcare service delivery as well as the factors that influence their attitudes.
