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Professionalism in paramedic practice

Netta Lloyd-Jones

Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK

Contents

1. Introduction
2. Professionalism in paramedic practice
3. Defining professionalism
4. Professionalism as ethical practice
5. Professional identity, socialisation, and culture
6. How do students learn professionalism?
7. Assessment and standards of professionalism
8. Regulatory areas, fitness to practise processes, and outcomes
9. Conclusion
10. Activities
11. Glossary
12. References

Learning outcomes

On completion of this chapter the reader will be able to:

• Discuss the importance of professionalism in relation to paramedic practice.
• Identify three key themes of professionalism.
• Describe three concepts which influence professionalism.
• Describe how you may learn professionalism.
• Describe the potential outcomes of behaving unprofessionally.

Case study

A paramedic student is on a hospital placement and has been allocated to work in the operating theatre suite. This is her second of four days in this placement and she is anxious about learning airway management. She enters an operating department anaesthetic room where an anaesthetist and an operating department practitioner (ODP) are with a conscious patient, preparing him for imminent anaesthetic for surgery. The paramedic student does not introduce herself to anyone and asks loudly: 'Can I practise intubation on this patient?'

Introduction

Today's paramedic must not only demonstrate extensive clinical knowledge and skills for paramedic practice, but must also demonstrate professionalism throughout their daily lives, both on and off duty. This chapter identifies and discusses key aspects of professionalism required by paramedic practice.

Professionalism in paramedic practice

For the paramedic to demonstrate professionalism, they must know what is required of them by their professional statutory regulatory body. In the UK this is the Health and Care Professions Council (HCPC). The HCPC provides a professional code of conduct that applies to all registered paramedics. Part of this code relates directly to professional knowledge, skills, behaviour, and attitude, as well as professional clinical performance by being the 'knowledgeable doer' (the term adopted by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1986) as a rationale for the Project 2000 curricula) and practising safely within the scope of training and practice. The HCPC (2008) Standard 13 states:

You must behave with honesty and integrity and make sure that your behaviour does not damage the public's confidence in you or your profession.

Behaving professionally is a standard expected not only by the HCPC and new regulatory bodies of other countries such as Australia, where recent legislation allows paramedics to be a regulated profession (Townsend 2017), but also by patients, co-workers, other healthcare professionals, and the general public. Healthcare professionalism is currently under a great deal of scrutiny, with increasing numbers of fitness to practise cases being heard by all healthcare professional statutory regulatory bodies, where issues of inappropriate or unprofessional behaviour are cited. In the UK, paramedic fitness to practise cases heard by the HCPC comprise 33% of the total of 16 professions governed (HCPC 2017). This appears to be a higher rate than for other, more established professions, which may be due to the highly challenging practice environments in which paramedic practice is provided. It is therefore important that all paramedics consider professionalism as a lifelong competence that will require continual demonstration (and development) throughout their careers. To support this, the role that professional associations (such as the British College of Paramedics) provide in supporting and promoting professionalism and ethics is developing (van der Gaag et al. 2017).

In 2011, research was commissioned by the HCPC which explored healthcare professionals' understanding of professionalism. It concluded that the key to professional behaviour is 'the interaction of person and context, and the importance of situational judgement' (HCPC 2014, p. 3). This is particularly relevant to paramedics, where responses to crisis, trauma, and emergency situations involving family and significant others, and the heightened emotion at such times, can result in misperceptions and miscommunication (van der Gaag et al. 2017).

Defining professionalism

So what is professionalism? Defining professionalism is not easy, as it is diverse, multifaceted, and open to individual interpretation. In recent years, there has been an increasing focus in the literature on what constitutes professionalism in healthcare, and the concept is evolving according to societal changes. Sociologists may define 'a profession' in terms of being a vocation with a specific body of knowledge, a defined range of skills, which is inherently trustworthy and ethical, and which provides a service to society (e.g. as usefully summarised in Hugman 1991, pp. 2-9; Johnston and Acker 2016). Other healthcare literature focuses upon values of care and compassion held by the profession itself, and roles undertaken by its registered practitioners, for example developing honest relationships with patients (e.g. Burges Watson et al. 2012), patient advocacy (e.g. Batt et al. 2017), and clinical excellence.

There is an increasing body of knowledge that provides more helpful detail. For example, Bossers et al. (1999) devised useful schemata of professionalism, dividing the concept into three main themes:

• Professional parameters (e.g. legal and ethical aspects)
• Professional behaviours (e.g. discipline-related knowledge and skills)
• Professional responsibilities (e.g. responsibility to patients, oneself, employers, and the public)

Professionalism is now more regarded as a meta-skill, comprising situational awareness and contextual judgement, which allows individuals to draw on the communication, technical, and practical skills appropriate for a given professional scenario (HCPC 2014), rather than it comprising a set of discrete skills. Such professional judgement will be dependent upon the knowledge developed through logic; sensed intuitively; gained through experience, particularly prior experience of similar events; and influenced by education, socialisation, and the human resources of employing organisations (Johns 1992; Gallagher et al. 2016; Brown et al. 2005). In addition to this, the current focus is upon consistently demonstrating of a set of identifiable, positive professional attributes, values, and behaviours. It is this challenge of embedding a discrete body of knowledge into the philosophy and values of a profession which the paramedic profession is still exploring (Donaghy 2013; Johnston and Acker 2016; Givati et al. 2017).

Professionalism as ethical practice

Whatever aspect of healthcare we are in, regardless of the specific engagements within the paramedic role, the nature and practice of healthcare demand that paramedics are concerned with morals and ethics (see Chapter 8, Legal and Ethical Aspects of Paramedic Practice). As this chapter details, what paramedics view ethics to be is important within a professional context. Meta-ethics (what is meant by 'right' and 'wrong'), normative ethics (placing the concepts of 'right' and 'wrong' into professional practice situations), and applying ethics in specialised areas, such as healthcare or public health ethics, are all part of demonstrating professionalism. In a scoping review to outline scales for measuring professional behaviour amongst paramedics, Bowen et al. (2017) identified the key characteristics of professionalism. These include practising within a professional code of ethics. Key principles which underpin professionalism as ethical practice include integrity, honesty, trustworthiness, probity, objectivity, and fairness. These key professional characteristics are also applied as legal principles when determining cases of professional misconduct. Professionalism can thus be regarded as ethical competence in all aspects of professional activity.

Professional identity, socialisation, and culture

Professional identity, professional socialisation, and professional culture will all influence understanding of what professionalism is within particular professions.

Identity

Identification encompasses basic cognitive and social processes through which we make sense of and organise our human world (Monrouxe 2010). Our thoughts, experiences, and reflections create a complex catalogue of who we are as individuals and members of groups (Ashmore et al. 2004)....