key: cord-0924620-c7am0bj1
authors: Calıskan, Nerıman Ozge; Yalın, Hayat; Eti Aslan, Fatma
title: Pandemic journey to prestige at nursing
date: 2022-03-30
journal: Clin Ethics
DOI: 10.1177/14777509221091091
sha: 1e01dd9708ad272d202fdb1190a95115de4dff6b
doc_id: 924620
cord_uid: c7am0bj1

Respect, which is human virtue by its very nature, is a universal feeling and action. Prestige; it is expressed as being respected, valuable, and reliable. These intertwined concepts draw attention basically for nursing, in which interpersonal interactions stand out compared to other professions. Moreover, while continuing the services in a kind of mobilization environment during the pandemic process that we have been faced with since 11 March 2020 and will obviously be affected for a long time in our country, the most common sense and respectful perspectives and approaches are needed. Respectful actions and respectful practices which are also included in the scope of professional ethics are more strategically important as we experience such a mass and historical human experience in which each of us is responsible for each other's health. The reputation of nursing continues to be formed and differentiated with how this profession is perceived by members of the profession and society, influenced by various processes from past to present. In this article, the change/development of the reputation of the nursing profession during the COVID-19 pandemic period was discussed.

Respect, which, as a concept, is a core value of being human, is an important issue for people. 1 As defined by the Turkish Language Society (TDK for short), respect is an "indicator of caring for others by behaving carefully, moderately and diligently around them, and of showing veneration", and "having reservations when it may cause disturbance to others". 2 Generally in literature, respect is defined as an act and noun. As an act, respect is the tendency of caring. As a noun, it relates to a sense of honor or prestige, and sense of having honor. Kant defends that having respect for an inherently core value is an unconditional moral obligation independent from one's tendencies or attitudes, 3 similarly, Ionna Kuçuradi defends that respect is for people, not for the opinions. Opinions are to be considered". Again, as defined by TDK, the word prestigious means "someone who inspires respect and admiration", while prestige means "the state of being respected, reliable and admirable" 2 Taking care of others rests at the heart of nursing, which is a discipline that combines science with art. In nursing, one and only occupation is the human. Nursing, as a profession, recognizes that human beings are holistic, hence equal. What is essential is the sustainability of services by showing unconditional respect to right to live regardless of nationality, race, belief, skin color, age, gender, political, or social status. 4 COVID-19 is a contagious disease caused by new coronavirus progressing from severe acute respiratory syndrome (SARS for short). For the first time, COVID-19 was reported as the cause of coronavirus pandemic in Wuhan province of China on 31 December 2019. Due to prevalence and fast-spreading characteristics of the pandemic, the World Health Organization (the WHO) announced it as a pandemic as of 11 March 2020. 5 Knowledge of nursing practices is still a power that is much needed in each and every step of pandemic and particularly in territories where vulnerable population perish in great numbers. Since workers and hundreds of volunteers initiated a fight against the pandemic, more people and health professionals began to respect rely on nursing science. 6 Prestige of nursing as a profession, which transformed forever in the pandemic process, was discussed in multiple contexts of respect for the profession by the health professionals, respect for individual/community, and respect for the profession by community. The pandemic process unearthed reflections of professional prestige on the one hand, and highlighted the fact that proceeding with the sense and acts of respect was not only a moral obligation but also an ethical principle on the other hand.

According to Virginia Henderson, a nurse is a "dynamic power that helps an individual recover health and gain independence as rapidly as possible". In the process of aiding the individual, the function of a nurse is to plan out, organize and evaluate any necessary practices and administrations, and to take responsibility for individuals/community's education. 4, 7 In achieving this function in a comprehensive way, a nurse collaborates with peers and in hand with other health disciplines.

Compared to other professions, nursing, by nature, requires reciprocity, communication, harmonized interaction with many different individuals. Throughout COVID-19 pandemic, nurses serve as precious sources in identifying clinical symptoms, prognostic factors, needs, and requirements of patients, evidence-based caring practices, and problems faced in the administration of nursing services. 5 When performing their service in controlling and preventing the spread of contagious diseases, nurses are and have been the key members of health care teams, who most often contact and spend time with patients infected with COVID-19. 8 Nursing is a profession that makes ultimate contributions to human health and welfare, and it definitely is an extraordinary responsibility assumed for the good of humanity. 4, 9 In defining nursing as a discipline, moral and ethics are referred to; respectful performance with due diligence guided by professional ethics and principles are expected. In nurses' pledge, respect to ethical principles and obligations is unederlined. 9 Nurses need to have a strong will, moral courage, and resilience to be in the front line of the fight against the pandemic. 8, 10 As a nurse, academician, and theorist, Ernestine Wiedenbach interconnect respect and esoteric values by referring to two concepts with which she summed up the essence of nursing philosophy. These are "respect for the gift of life", and "respect for every individuals' honor, value, self-determination and individualism". In addition to this, the American Nurses Association (ANA) calls on nurses to be consciously integrative with respect. 3 The fact that nursing is a must for societies clearly manifests itself in days of coronavirus pandemic when health/ illness demographics deteriorate if and when nurses cannot function their role, population explodes due to lack of family planning services, infections occur due to nonperformance of medical and surgical asepsis principles, patients'/patient relatives' complaints and dissatisfaction tend to mount in case of underemployment of nurses. 11, 12 Respect is not a trait that distinguishes one individual from another, or not something that can be attained by making efforts. It is a common sense that every human being inherently possesses. Nevertheless, individuals can be evaluated differently because of certain traits and benefits they may have. 1 If a society recognizes nursing as an indispensable profession, this encourages people to be respectful toward the profession and feel respect for it. 1, 11 Interestingly, COVID-19 pandemic has been a wake-up call for nurses to notice the importance of their profession, and for society to become aware of profoundness of nursing and appreciate its value. 5 Formerly seen as an extension of physicians' practices only, 13 and reduced to stereotypes of sisters who merely read blood pressure and take blood, 7,11 the nurses are the real-life heroes of pandemic nowadays. 14, 15 Respect for nursing and effects of pandemic on the professional prestige

Nurses showing respect to their fellow workers and to the patients relate to respect they have for the profession. 1, 16 Performing one's profession without showing respect makes it difficult to argue and defend that the individual lives a valuable professional life. Every individual should get to know his or her profession and have respect for it. 1 Studies show that COVID-19 has introduced love, honor, respect, appreciation, and gratitude for the nursing profession, and has offered opportunities for development that entails active collaboration while taking care of patients. 5 The pandemic has actually led to opportunities for learning together, finding better ways to do things together in practice, and make contributions to establish policies with evidence-based research and empowering strategies. It has been underlined once again that both society and fellow workers should profoundly comprehend ethically justified expectations from nurses in case of emergency. 10 The part that provides "I will do all in my power to maintain and elevate the standard of my profession, and will endeavor to aid the physician and fellow workers in the practice of my calling" in the nurses' pledge stresses the respect one must have for the profession. Ethical codes released by the International Council of Nurses (ICN) in 2012 are discussed under the captions of "Nurses and Practices of Nursing", "the Nurse and the Profession", "the Nurse and the Fellow Workers" which clearly supports the afore-cited emphasize. It is specified that respect improves good vibes and trust 3 Also, the Turkish Nurses Association (THD) released ethic obligations in 2009 and discussed "Nurses' responsibilities toward the profession, professional society, and healthcare professionals" under a dedicated caption. 9 In addition, nurses play a part in preparing suitable environment for learning for the practicing nurses. 9 Nursing education affects professional prestige, values, and professionalism. Opinions of the young minds, their perception, and evaluation of the profession are also significant for professional prestige. 3, 16 When those young minds initially began to perform the profession, they rely on what they have learned when studying. Professional self-esteem is openly related to professionals' performing their profession enthusiastically and feeling rewarded in return. 16 Status of a profession affects the society's opinion of and consequently respect for that profession. 7, 17 Professionals are primarily responsible as to whether status of the profession puts a correct perception of the intended impression. Presence of an established professional authority, autonomy, professionalism, organization, specialization, improved funds of professional, and scientific knowledge are directly related to the professionals. 17 Nurses are pioneering in responding to the unique needs and requirements of the society during the COVID- 19 pandemic. An explicit strategy should be adopted at any and all clinic circles and by any other clinical institutions for an improved image of nurses among themselves and among members of the society. 5 The ICN is established to improve and enhance knowledge for competent, well-equipped, and highly esteemed nursing around the globe. Nurses, in turn, assume responsibility for stronger professional organizations and improved and continued respect for the profession. 9 Predicting of nurses' respect for society/individual, we come across Doğan Cüceloğlu's books and interviews on respect for human beings and human behavior. According to Cüceloğlu, respect is to accept the existence of the person with its boundaries, to establish a relationship by valuing the essence of the person. An another important point about respect is the desire to maintain the established relationship. 18, 19 Based on these explanations, it can be drawn that unconditional acceptance and will to carry on with the individual's care is what defines respect for the patient. We were sometimes heartbroken sometimes honored to have witnessed numerous examples of the definition(s) referred to the above during the COVID-19 pandemic. Knowledge and experience in nursing, which is significant in taking control over pandemic, is crucial for care and survival of severely affected patients. For many reasons, the pandemic has unexpectedly challenged nurses' ethic values-moral and complicated human rights issues included. Under these conditions, nurses were obliged to compensate their professional duties and competences with urgent ethic choices and on-the-job decisions. 10 Respect for the individual means and entails accepting that individual as is, comprehending him or her in his/her autonomy. 1 The fact that the nurses' pledge provides "I will not permit considerations of religion, nationality, race or social standing to intervene between my duty and my patient", and "I will maintain the utmost respect for human life.", and "autonomy and respect for human" is emphasized in the ethic codes released by THD, that "Nurses and the society" makes up one of the ethic codes released by the ICN, and that "Nurse's responsibility toward the individual, family and society that is being served" is described in the ethical obligations of the THD highlight the profession's respect for society/individual. 9 Society's respect for nurses and prestige of the profession has always been an issue by numerous pioneering figures, Florence Nightingale in particular, and many other members of the profession. Good efforts continue to improve it. Tasks and obligations of nursing, education, social aspects, importance as a profession are yet to be fully comprehended by societies. The profession of nursing is reduced to taking blood pressure, injecting, taking blood, assisting physicians, etc. 7,11 It is not even known that nurses hold a bachelor's degree. 11 The fact that nursing has not been able to constitute a whole in terms of education since the past, and that members of the profession tend to have different professional opinions because of different educational backgrounds might have caused it to be perceived as a profession with underrated social status. 11, 17 This, in turn, has adversely affected the society's respect for the profession. 12 People feel more respect for professions that require higher education, enhance decision-making process, are independent of co-workers, and involve more authorization and obligations. 20 However, the profession of nursing constantly evolves in line with the changing world order and specializes in independent practices.

Opinions and attitudes or other health disciplines that work in collaboration with nurses are also important for respect for nursing. Because physicians are another professional group with which nurses collaborate the most, and also because they have a powerful image in health circles, they should take nurses not as their assistants but as fellow workers, emphasizing the importance of nurses, which is needed for an improved image of nurses. 7 Feeling respected is important because it makes nurses feel valued by the individual and/or society that is being served. 21 Sociologist Lawrence-Lightfoot defends that respect is a reciprocal and symmetrical process, and that respect leads the way for respect. 3 As per the recent legislation in law; a bachelor's degree qualifies for being a nurse, attending nurses increase in number, qualified scientific studies on nursing are more prevalent and selfdetermination is recognized, which are all in all accepted as improvements. But still, members of the profession should take up responsibilities to make sure the qualities are perceived by and made accessible to society. 20 Having been fighting for self-esteem in society and survival in academic circles since the past, nurses rely on their personal experience in fulfilling their tasks and obligations. Such experience enables them to have learned the importance of adapting. Having learned from experience, achievements, and mistakes, nurses have adapted to future needs and requirements and improved themselves. Florence Nightingale, who ignited a great change in the Crimean War, can be mentioned as the very first example for this. Challenges she faced with transformed the perception of nursing in society and in itself. 22 Significantly with the increasing influence of Florence Nightingale, nursing as a profession attained more respect and moved to a scientific background. Before the pandemic, violence and incidents against nurses and health professionals, medical misconducts were widely covered on news and newspapers. Society had a poor perception of nursing. 13 In response to fatal threat of coronavirus, people felt themselves weak and alone, and they remembered the indispensable need for nurses. The pandemic revealed that the status of nursing as a profession improved for the society. Influence of nursing has never been this popular in the eyes of the public until recently. 23 Public appreciation of nursing care as globally applauded. 6 Nurses and health professionals were announced as heroes in our country and in the world during the pandemic. Despite this, it should not be disregarded that they are still targets of violence every now and then. Although the foregoing disclosures create a paradoxical picture in terms of social perception, it is an undeniable fact that professional self-esteem holds onto a solid ground for its philosophy that has adapted humanist and holistic principles and for role model leading figures in the profession.

Respect means an individual exists within his or her own boundaries, and comprehends his or her individualism, genuineness. 1, 3 Nursing is a profession that is directly related to the individual and the society. 4 A nurse is, with due regard, obliged to fulfill his or her responsibilities toward the profession, co-workers, and society on the one hand and assumes a significant role in establishing the professional respectability. 9 Even though it is expressed that respect, which is a core principle of social life and is a universal feeling, should be senses for/shown to any human simply for the sake of being human 1,3 there are certain deep-seated prejudices, which may set a barrier to respect being shown to nurses. 7 It is thought that nurses will be respected more as society/individuals and other health disciplines recognize nursing-which is indispensable for the health teams and is and will be needed forever 7,12 -as a profession that protects and improves public health and betters the quality of life for all, 20 and attributes more meaning to nurses' tasks and obligations. 24 Along with COVID-19 pandemic, the prestige of nursing as a profession has been affected positively. Nursing is a profession that deserves respect and prestige at each stage of health services and at all times beyond extraordinary times such as warfare, natural disasters, pandemics when they are heroized and brought into view. It is strongly recommended to conduct scientific studies with a view to improving social status of nurses, to encourage professionals toward professional academic initiatives, and to support legal arrangements and rights conditioning beyond and independent from extraordinary incidents that trigger perceived professional prestige in society.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Nerıman Ozge Calıskan https://orcid.org/0000-0002-5351-3665

Vanished value: respect

Respect: an integrative review

Hemşireliğin dört temel kavramı: insan, çevre, sağlık and hastalık, hemşirelik. Ahi Evran Üniversitesi Sag lık

Exploring nurses' perception of taking care of patients with coronavirus disease (COVID-19): a qualitative study

Nursing: forever changed by a pandemic

A review on nursing profession stereotypes

Nursing perspectives on the impacts of COVID-19

Hemşirelik mesleğinin ilk etik kodları: geçmişten günümüz hemşirelik andı

Challenging times: ethics, nursing and the COVID-19 pandemic

Hemşirelik imajı ve1950 ′ li yıllarda bir seri ilan

Image perception of the society for nursing profession: systematic review

Respect for nursing professional: silence must be heard

Nurses and doctors heroes? A risky myth of the COVID19 era

The perception of nurses towards their roles during the COVID-19 pandemic

The effect of cognitive distortions on nurses' professional self-esteem and nursing perception

Developments and difficulties in the professionalization process of nursing occupation in Turkey: a sociological evaluation. İ ş, Güç Endüstri İ lişkileri ve İ nsan

Doğan Cüceloğlu: yaşamı, eserleri ve psikoloji anlayışı

Hemşirelik mesleğine yaklaşım ile toplumsal statü arasındaki ilişkinin incelenmesi. Sag lıkta Performans ve

Nurses' experiences of communicating respect to patients: influences and challenges

Nursing services recommendations in crisis and pandemic

Who speaks for nursing? COVID-19 highlighting gaps in leadership

Nursing's professional respect as experienced by hospital and community nurses