Measuring Professionalism in Medicine and Nursing: Results of a European Survey

Background
Leveraging professionalism has been put forward as a strategy to drive improvement of patient care. We investigate professionalism as a factor influencing the uptake of quality improvement activities by physicians and nurses working in European hospitals.
Objective
To (i) investigate the reliability and validity of data yielded by using the self-developed professionalism measurement tool for physicians and nurses, (ii) describe their levels of professionalism displayed, and (iii) quantify the extent to which professional attitudes would predict professional behaviors.
Methods and Materials
We designed and deployed survey instruments amongst 5920 physicians and nurses working in European hospitals. This was conducted under the cross-sectional multilevel study “Deepening Our Understanding of Quality Improvement in Europe” (DUQuE). We used psychometric and generalized linear mixed modelling techniques to address the aforementioned objectives.
Results
In all, 2067 (response rate 69.8%) physicians and 2805 nurses (94.8%) representing 74 hospitals in 7 European countries participated. The professionalism instrument revealed five subscales of professional attitude and one scale for professional behaviour with moderate to high internal consistency and reliability. Physicians and nurses display equally high professional attitude sum scores (11.8 and 11.9 respectively out of 16) but seem to have different perceptions towards separate professionalism aspects. Lastly, professionals displaying higher levels of professional attitudes were more involved in quality improvement actions (physicians: b = 0.019, P<0.0001; nurses: b = 0.016, P<0.0001) and more inclined to report colleagues’ underperformance (physicians – odds ratio (OR) 1.12, 95% CI 1.01–1.24; nurses – OR 1.11, 95% CI 1.01–1.23) or medical errors (physicians – OR 1.14, 95% CI 1.01–1.23; nurses – OR 1.43, 95% CI 1.22–1.67). Involvement in QI actions was found to increase the odds of reporting incompetence or medical errors.
Conclusion
A tool that reliably and validly measures European physicians’ and nurses’ commitment to professionalism is now available. Collectively leveraging professionalism as a quality improvement strategy may be beneficial to patient care quality.

## 背景
依托职业素养作为提升患者照护质量的策略已被学界提出。本研究聚焦欧洲医院内的医师与护士群体，探究职业素养作为影响其参与质量改进活动的影响因素。

## 研究目标
(i) 验证本研究自研的医师与护士职业素养测评工具所获数据的信度与效度；(ii) 描述两类从业者所展现的职业素养水平；(iii) 量化职业态度对职业行为的预测程度。

## 研究方法与材料
本研究依托横断面多水平研究「深化欧洲质量改进认知」（Deepening Our Understanding of Quality Improvement in Europe，缩写DUQuE），面向欧洲医院的5920名医师与护士设计并发放了调查问卷。研究采用心理测量学方法与广义线性混合模型（generalized linear mixed modelling）技术以达成前述研究目标。

## 研究结果
最终共有来自欧洲7个国家74家医院的2067名医师（有效回收率69.8%）与2805名护士（有效回收率94.8%）参与本研究。本研究所开发的职业素养测评工具包含5个职业态度子量表与1个职业行为总量表，内部一致性与信度处于中等到较高水平。分析显示，医师与护士的职业态度总分均处于较高水平（满分16分，分别为11.8分与11.9分），但二者对职业素养各细分维度的认知存在差异。进一步分析表明，职业态度水平更高的从业者更积极参与质量改进（Quality Improvement, QI）活动（医师：b=0.019, P<0.0001；护士：b=0.016, P<0.0001），且更倾向于举报同事的履职不力行为（医师：优势比（odds ratio, OR）=1.12，95%置信区间（confidence interval, CI）1.01–1.24；护士：OR=1.11，95%CI 1.01–1.23）与医疗差错（医师：OR=1.14，95%CI 1.01–1.23；护士：OR=1.43，95%CI 1.22–1.67）。此外，参与质量改进活动可提升从业者举报履职不力或医疗差错的概率。

## 研究结论
本研究现已开发出可信效度良好地测评欧洲医师与护士职业素养承诺度的工具。总体而言，将职业素养作为质量改进策略加以整合应用，或可助力提升患者照护质量。