Farah Demachkieh, Head of Quality, Research and Development at SANAD Hospice Lebanon, looks back at her career and her professional identity.
As a nurse who started her professional career in the emergency room as a bedside nurse and is currently working in palliative care in quality, training, research, managerial, and other aspects, understanding my professional identity has been a journey of self-reflection and several attempts of reconciliation of evolving professional responsibilities and personal values, beliefs, and perceptions.
Professional identity in nursing is defined as “a sense of oneself, and in relationship with others, that is influenced by characteristics, norms, values of the nursing discipline, resulting in an individual thinking, acting, and feeling like a nurse (Godfrey & Young, 2020).” Rasmussen and colleagues, describe factors that affect nursing identity into three categories, (1) the self (who I am or how do I perceive myself as a nurse), (2) the role (what I do in my professional practice) and (3) the context (where I do it or the society and environment in which I practice this role) (Rasmussen et al., 2018).
The concept of professional identity
I got first introduced to the concept of professional identity back in November 2022, by Marie Cooper and Heather Richardson, palliative care senior nursing advisors, during a session on professional identity in a Palliative Care Masterclass as part of the Fellowship in Palliative Care Course organized by the Institute of Palliative Medicine in Kerala and St Christopher’s Hospice in UK.
Intrigued by this enlightening session, my curiosity deepened, leading me to join an online workshop series, as part of the Global Palliative Nursing Network, about professional identity spearheaded by Marie Cooper at St Christopher’s CARE in 2023-2024. The workshop introduced definitions, theories, frameworks, and concepts related to professional identity. Most importantly, it created a safe space for nurses and provoked them to self-reflect and share their thoughts, opinions, and experiences relating to their professional identities and its evolution.
The workshop included 5 sessions that focused on reflecting on (1) the characteristics we are proud of, (2) inspiring others, (3) valuing and building our profession, (4) our voice and confidence and lastly (5) creating influence and bringing change. In sharing these reflections, my aim is to chronicle my journey and ignite a similar process of discovery and introspection within you. As this exploration has profoundly influenced my understanding and approach to my professional identity, I hope it inspires a cascade of insightful reflections on the essence and impact of professional identity in nursing within you.
It wasn’t until recently that I recognized professional identity as a unique and important concept which impacts our professional and personal lives, the lives of our patients and our relationships with others within the healthcare system. I never heard of professional identity in undergraduate education. And throughout my professional career; discussions, perceptions, thoughts, and reflections about professional identity have always been implicit, indirect, and mostly personal. It is like something for you to deal with or figure out.
Nursing aspirations
Back in 2002, embarking on my nursing journey, the reasons behind my aspiration to become a nurse weren’t crystal clear, yet something about this path felt inherently right—a sentiment that has only grown stronger over time.
Early in my professional career, and mainly during my undergraduate education, my perceptions about my identity as a nurse mostly stemmed from my environment and surroundings including perceptions of my family, friends, university peers, and society at large.
At the time when I joined the nursing school back in 2002, being a nurse in Lebanon was not perceived positively. Hearing phrases like “that is good (being a nurse), but you want to continue to become a doctor, no?”, “why did you choose to study nursing you could not get into med school?” made me skeptical. Nevertheless, as I entered clinical practice this perception shifted, to become deeply rooted in realizing nurses’ pivotal role in directly impacting the lives and well-being of patients and their families and the profound sense of purpose it brought me.
Advancing through various realms of the nursing profession, from bedside care to roles in quality control, research, and training, made me feel less of a ‘nurse’. There is a common perception and understanding that nurses’ core role revolves mainly around direct patient care. It is as if people forget that you are a nurse if you are not involved in direct patient care anymore and if they do remember, they think that you have moved to an easier, less stressful and demanding job. Until Marie Cooper once said to me on a beautiful afternoon in Kerala “you are not any less of a nurse if you are not doing bedside nursing” and this hit home. This affirmation was a turning point to me, challenging the conventional boundaries of nursing roles.
Challenges
“What do you do as a nurse?” has always been a tough question to answer; let alone adding to it a layer of public health education and then palliative care, two disciplines that are not easily described either. How do I define what do I do for myself and to others? Am I a nurse with a public health background? Am I a public health professional with a nursing background? Am I a researcher, trainer, or quality nurse? Or all the above?
The challenge I faced was reconciling diverse roles and perspectives, from saving lives in emergency care to ensuring a dignified death in palliative care and from patient-centered care to broader public health and community-based approaches.
My journey took an even more holistic turn upon embracing homeopathy[1] as part of my personal health philosophy. This prompted me to search for underlying commonalities across the disciplines that resonated with me the most—nursing, palliative care, public health, and homeopathy.
This is when the “holistic approach” showed up as a central and foundational principle among all these disciplines; where the person is viewed as a whole, and health transcends beyond the physical well-being to encompass emotional, mental, social, and spiritual dimensions. This holistic approach, unfortunately often overlooked, is where nursing excels, leveraging our unique position and the trust we build with patients and families to provide care that encompasses all aspects of well-being.
Professional and personal identities
Identifying these commonalities allowed me to reconcile the various facets of my professional and personal identities, moving beyond a binary perception of my role; “am I a quality nurse?” versus “am I a research nurse?” to a more fluid role with a diverse set of skills; “I am a nurse with different set of skills and expertise in quality, research, training, public health, etc.”
This reflection was an eye opener to delving into a soulful and inspiring realm and a unique specialization; public health palliative care, where palliative care, public health and compassionate care come together to empower communities and embrace compassion for a more compassionate world.
We also reflected together on different aspects related to what nursing means to each one of us, touching on the ultimate purpose of nursing, how it can be achieved, barriers and facilitators and how we view ourselves as nurses.
A particularly enlightening moment occurred when I got introduced to the concept of “practical wisdom”; phronesisin ancient Greek. It is, as Marie described it, the culmination of honed skills over the years, from assessment skills, creativity, ethical considerations, decision making, intuition, and critical analysis skills to guide decisions on what best to do in a given moment.
We do this as best described by Schon’s model in 1983 on how practitioners think in action which he calls “reflection in action”. Schon (1983) describes it and here I quote as “this entire process of reflection-in-action which is central to the “art” by which practitioners sometimes deal well with situations of uncertainty, instability, uniqueness, and value conflict.”
This concept is pivotal to practice palliative care nursing particularly in addressing and managing highly sensitive and critical situations such as handling difficult chaotic families, truth telling, conflicts in goals of care, spiritual distress, death anxiety, saying goodbye to a patient, and other situations. In other words, practical wisdom is depicted in asking the right questions, saying the right words, using the right tone, and taking the right steps at the right time. The concepts “practical wisdom” and “reflection in action” came to put names to what I always intuitively knew to be the case.
Reflections
These reflections brought to my attention the significance of vital strategies to bolster nurses’ professional identity, notably introducing the concept of professional identity in undergraduate education; a glaring omission in current curricula where the seeds of our nursing identity begin to sprout. Furthermore, the indispensable role of nursing mentors became apparent in illuminating the path to understanding and evolving our professional identities.
Venturing into the realm of professional identity has been nothing short of transformative on both personal and professional levels, finding answers to longstanding fundamental questions.
The insights gained have illuminated the profound depth of nursing, beyond the surface-level tasks to the core of who we are as caregivers and healers, allowing us to navigate the complex landscape of healthcare and our evolving professional and personal values with wisdom, compassion, and resilience, paving the way to personal growth and self-actualization.
By Farah Demachkieh- Head of Quality, Research and Development at SANAD Hospice Lebanon and a nursing champion of the St Christopher’s CARE Global Palliative Nursing Network.
References:
Godfrey N, Young E. Professional identity. (2020). In: Giddens JF, ed. Concepts for Nursing Practice. 3rd ed. New York, NY: Elsevier.
Rasmussen, P., Henderson, A., Andrew, N., & Conroy, T. (2018). Factors influencing registered nurses’ perceptions of their professional identity: an integrative literature review. The Journal of continuing education in nursing, 49(5), 225-232.
Schon, D. (1983). How Professionals Think in Action. Basic Books, Inc.
[1] The word ‘homeopathy’ is made up of the Greek words ‘omoios’, meaning ‘similar’, and ‘pathos’, meaning disease. The main law on which Homeopathy is based is the Law of Similars which means diseases are treated by remedies that can produce similar symptoms of those of the patient. Retrieved from https://www.vithoulkas.com/homeopathy/about-homeopathy/
This article is republished from the St Christopher’s website with permission from St Christopher’s and the author.
Than you Farah Demachkieh, Head of Quality, Research and Development at SANAD Hospice Lebanon for such inspiring and trailing journey and long practice and professionalism. I have to thank Maria Cooper to who tapped the talent and propagated the right wisdom you . It is good that today we are all sharing and will make a difference in our lives and the coming generation will utilize and do better as the continue too championing Palliative care nursing, in our communities and other institutions for health. Capacity building will go on far and more research evolves our disadvantaged patient will be surved even better and quality of life will be felt. Thank you Farah ones more and keep up the good work.