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Salcedo-Álvarez RA. The nursing professional that Mexico needs. Rev Enferm Inst Mex Seguro Soc. 2017 Jan-Mar;25(1):75-9.

The nursing professional that Mexico needs

Rey Arturo Salcedo-Álvarez¹

¹Universidad Nacional Autónoma de México, Escuela Nacional de Enfermería y Obstetricia, División de Estudios Profesionales, Ciudad de México, México

Correspondence: Rey Arturo Salcedo-Álvarez

Emails: rasalced@hotmail.com

Received: June 2^nd 2016

Judged: October 29^th 2016

Accepted: November 29^th 2016

Abstract

Throughout professional development, one can simply be professional, professional enough, an outstanding professional or, in the best-case scenario, an excellent professional. The difference between each degree has to do with the commitment that individuals show toward themselves and, therefore, toward their professional association. This degree of commitment is closely related to the eagerness for knowledge that becomes perceptible from the continuous academic and professional development. Thus, if the question is What does nursing mean to me?, the possible answers along these lines would be “It’s just my job,” “It’s part of my lifestyle,” or “It is my philosophy of life.” Surely, the selected answer will be on par with the type of professional that each of us has become. Obviously, practising humanism implies knowing oneself: it is the self-concept reflected in another person. As Duchscher has stated, humanism implies respect for the man’s own inner freedom to think, feel and believe.

Keywords: Professional competence; Nursing ethics; Humanism; Empathy; Knowledge; Love

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Like the Phoenix

In Greek culture, the phoenix bird was a mythological being that was consumed by fire every 500 years and then rose from its ashes. It had the virtue to heal with its tears, was surprisingly strong, controlled fire and had great physical resistance.

In the pretense of making an analogy, the strength of nursing and its professionals is doubtless, since fire symbolizes the light of a lamp that overcomes darkness in the sublime dichotomy between life and death, that is to say, the care of the person who is the object of nursing attention, life and death, health and illness. The challenge of every nursing professional is to fight the battle of the everyday, the routine, recognize their potential, learn from their limitations and resurface with renewed conviction to conquer what is rightfully theirs.

Teaching

While the formal teaching of nursing is relatively recent, the practice of caring may be as old as humanity itself. Literature on the history of nursing agrees that "traditionally, it has been identified as a practice carried out by women, centered on the care of the patient and with a humanistic connotation."¹ In our country, too, formal nursing education was born from the initiative of Eduardo Liceaga (1839-1920), who influenced General Porfirio Diaz (1830-1915) and, by presidential agreement, in 1898 established the first Escuela Práctica y Gratuita de Enfermeros en el Hospital de Maternidad e Infancia, which in 1907 became the Escuela de Enfermería del Hospital General de México.^2,3 At that time it was established that the program of study would last for three years and candidates would take the following subjects: anatomy, physiology and healing during the first year; in the second year, hygiene and general healing; and in the third year, small pharmacy, healing and care of children, parturients, and the demented. Learning in this career was practice based. The students took classes once a week, the basic text being the Manual Práctico de la Enfermera, published by Bournevill, and the rest of the time was dedicated to practical activities in the unit.⁴

Of course, with the passing of the years, the curricula evolved and incorporated substantial changes according to emerging needs and technologies. In the 1980s, it was focused on training of the nursing professional as an element of the health team, on school work based on an instructional methodology, the ecological perspective and the diagnostic and formative evaluations as part of a final stage of the process. Likewise, during that decade, attempts were made to achieve teaching-service integration in development of clinical and community practices. For the '90s and early 2000, curricular reforms incorporated methodologies such as the use of information and communication technologies (ICT), online teaching materials, three-dimensional anatomical images, clinical teaching using robotic simulators, evidence-based nursing, philosophy and humanism, transculturality, holistic care and gender perspective, patient safety and quality of care, among others.

The exiting student

Notwithstanding the incorporation of these didactic and technological advances in nursing education, the results of the Examen General para el Egreso de la Licenciatura en Enfermería (EGEL-ENFER), applied by the Centro Nacional de Evaluación para la Educación Superior (CENEVAL), showed that in 2011 there were 6636 candidates from 110 institutions of higher education in the country. The EGEL is a national test, specialized for professional career, whose objective is to identify the degree to which the undergraduate exiting students have the knowledge and skills essential for the beginning professional practice in the country. The areas evaluated were health education and promotion, the assistance area, techniques and integral patient care, management, administration, and research. Some 703 (10.6%) exiting students outperformed, 3536 (53.3%) had a satisfactory performance and 2397 (36.1%) had an unsatisfactory performance.⁵ While it is true that these data do not necessarily reflect the national reality, of course, it is worrying that more than one third of the candidates have obtained an unsatisfactory performance, that is to say, they do not have the necessary competences to begin in the professional practice of nursing.

Competencies

Although two-thirds has good results in the national evaluation, it would be highly desirable to add to the curricula the competences that today are favored in European countries. According to the Organization for Economic Cooperation and Development (OECD) project Definition and Selection of Competence (DeSeCo), competence is the ability to respond to individual or social demands or to perform an activity or task. Each competence rests on a combination of interrelated practical and cognitive skills, knowledge, motivation, values, attitudes, emotions and other social and behavioral elements that can be mobilized together to act effectively. According to this organization, the four main competencies that a professional must develop are: 1) to know how to use tools interactively, 2) to interact in heterogeneous groups, 3) to act autonomously, and 4) to cooperate (Table I).^6,7

Challenges in health

The main challenges of the Mexican health system are related to the fulfillment of international commitments, specifically those acquired at the Millennium Summit, which include reducing maternal mortality; reducing mortality of children under 5; and combating illnesses of international relevance, such as AIDS, malaria, and tuberculosis. On the other hand, there are problems related to the lag in health to resolve, such as diabetes, heart disease, prevalence of overweight and obese conditions, cervical-uterine and breast cancer, adolescent pregnancy, addictions, violence, accidents,  suicide, and patient safety. Attention must also be given to emerging problems such as influenza⁸ and other vector-borne diseases such as Zika virus and Chikunguan fever. Although only the main pathologies were mentioned in the diversity of these challenges, nursing professionals' commitment should come from their field of competence to develop specific actions for diagnosis, prevention, treatment ,and control. This implies the professional and social commitment to be competent for the care of people with neoplasias, chronic degenerative diseases, mental illnesses, those emerging and reemerging, as well as those transmissible by vector.

What nursing professionals need

Knowledge

The nursing professional must demonstrate solid theoretical, conceptual and methodological knowledge adhered to science. This will certainly grant them autonomy of being and self-determination in acts of personal and professional life. The recognition of colleagues or other health professionals gives one respect, trust, and credibility to professional action. But it will achieve greater authority if it also dominates the skills of using tools interactively, if one knows how to interact in heterogeneous groups, act autonomously, and cooperate in a disciplined way.

Ethics

The complexity in the teaching of ethics lies in the fact that the norms and values taught to students in the classroom do not necessarily agree with what the historical-social reality that their country is experiencing. Ethics and care have a profound philosophical basis and their usefulness is essentially practical. That is why it is not enough to know in matters of ethics, but they must always be practiced. In nursing practice, ethical behavior must be inherent in each person. It should be established that, "An ethical action ... in the organization of work of health institutions ... the need to exercise power on the part of these professionals, in relation to their desires, aspirations, as well as in relation to others, patients, health professionals and administrators of institutions, among others."⁹

Empathy

Empathy is perhaps the most difficult to achieve. The usual concepts that accompany humanized care are communication, trust, solidarity, respect, technical aptitude, patient safety, among other issues. However, to put oneself in the place of the other in a true way upsets all those concepts that accompany the humanized care and that were only learned in classrooms and services, but for some reason we can not apprehend.

The nursing team strives to improve on the handling of ventilators, catheters, monitors and lack of preparation to care. Are we going about it the wrong way? It is good to lean on technology, but not forgetting the center of the task: the person.¹⁰

Love

People usually have a homogeneous notion of the meaning of loving someone else, but ... what does it mean to love yourself? Certainly not to the narcissistic and egotistical degree, but within a "rationality" that is visualized in a combination of self-acceptance, self-control, and self-awareness, issues that should lead us to respect ourselves and make us feel that we are worthy of respect, being, living, and being part of something and someone else. And that is why we take care of ourselves and thus, having a healthy self-image, we can take care of others. "Integrate care and love, to match the science of nursing ... spirituality and care."¹¹

Where is my role as a nursing professional?

It is not a matter of discussing whether the whole is the sum of its parts or whether the parts, added together, conform the whole. In the human sphere, sums and subtractions do not represent any solution, the human being is indisputably more complex. Unlike other professions, nursing has great differences in levels of training and functions. Each professional leaves school with a wealth of knowledge that contributes to the adoption of attitudes that provide personal and professional identity. However, the human being, eminently social, cultural, historical and complex, adopts a series of beliefs and practices that paradoxically sometimes seem to disagree with knowledge. Let's think of one example: those who work in nursing designate ourselves as professionals in the science of care. However, many of us adopt self-destructive lifestyles, risks, and behaviors that are harmful to health. It is incomprehensible, since we represent a collective of care and frequently we do not even take care of ourselves; if this were not true, nurses would be the healthiest people, which is not necessarily the case.

In professional development you can be simply professional, professional enough, outstandingly professional, or at best, excellent professional. The difference between one and the other makes it the degree of commitment that each individual person has and demonstrates towards the consolidation of his person and, consequently, of the trade. Degree of commitment is closely related to the avidity of knowledge that becomes perceptible from continuous professional, academic and graduate improvement. If things were this way, the question is what is nursing for me? And the possible answers in this order of ideas would be: it's just my job, it's part of my way of life, or it's my philosophy of life. Surely the answer selected will go hand in hand with the type of professional that each of us has become (Figure 1). Obviously, "to practice humanism is to know oneself: it is self-concept reflected in another person. Humanism implies respect for man's inner freedom to think, feel, and believe."¹²

So it is necessary to "take care of yourself to care better"

We must be rigorously scientific, academic, ethical, empathic and have enough love to care for ourselves and, as an extension of humanism, lovingly care for healthy and sick people; only in this way will we be able to face the challenges of the care that is demanded of people in this new millennium.

References

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