personal statement health care professional

Personal Statements

Please read over the resources on this page, and then you are welcome to meet with a Pre-Health Professions Coach to discuss your ideas before starting your personal statement.

Recommendations for Personal Statements

The purpose.

The personal statement/essay should provide evidence to the admissions committees that you are knowledgeable about the profession (know what you are getting into) and are well-suited to the profession (have the necessary qualities, strengths and skills).

The Audience

The essays are likely to be read at different stages of the process.

• Initial review of the application
• Committee decision to invite for interview
• By interviewers in preparation for the interview
• Committee admission decision

You are not writing for one reader as you do for a course where you write what a particular professor is looking for.

The readers are very diverse. A committee may have up to 20-30 people on it who represent different generations and cultures and have a variety of ideas about who is suited to and prepared for the profession and a particular school.

Keys to Content

All essays are essentially about the same thing – you! – your strengths, your knowledge of the profession, how you have tested your desire to pursue this health profession and in what ways you are suited to and prepared for professional education and training. 

You need to know yourself and the profession well enough to choose the personal strengths, knowledge and insights you will write about.

Take inventory.

Take an inventory of your qualities and skills and how they relate to your experiences. Check out the “Tools to Help You Build Your Personal Statement” under Personal Statement Resources & Tools below. 

Get more mileage out of your essay with valuable content. 

Write about experiences that will demonstrate the qualities, strengths and skills that successful health care professionals must have.

Make the invisible visible.

Consider what the committees will see in your application. Is there something important about you that is not obvious from the numbers and information already listed in your application?

Make it matter.

Is there something included in your application that needs to be emphasized? For example, will you be listing one experience where you took on a leadership role, but the actual knowledge and abilities that you developed there are not obvious? Did you volunteer in one place rather than several but the experiences there were substantial and of great value in your pre-professional development? You may decide to give these more weight by writing about them

Read the prompt carefully.

The applicant is responsible for understanding the prompt and providing the kind of information that the admissions committees have asked for. 

Some prompts are as simple as “Why do you want to be a _________?”

Many are more complex.

In either case, the prompt requires thoughtful consideration, first to understand it and then to decide on the content of your response. 

Don’t get hung up on any one word or phrase in the prompt. Read the whole prompt, and decide what they are really asking for.

Can you explain the prompt in your own words? 

Decide which of your personal strengths as well as your knowledge and insight into the profession relate best to the prompt. (This is when the “Tools to Help You Build Your Personal Statement” can be of help.)

In responding to the prompt, your goal is to use your experiences to demonstrate those things about you that predict your success in professional school and in professional practice.

When Writing about You

“Why do you want to pursue a career in this health profession?”  is not asking you to write an essay on how very much you want to be in the profession. It is not asking what is so amazing about people who are in this profession. Admissions committees want to know who it is that wants to pursue this career and in what ways you are capable of and prepared for professional school and professional life. 

“I love science and want to help” is important but is not enough. Demonstrating how compassionate and caring you are is great, but there are many careers in which one can apply a love of science to help people. Write about the experiences that demonstrate specific knowledge of and exposure to the profession and the strengths and skills that will help you to succeed in this specific role.

When Writing about Mentors

If you write about what you observed/learned while shadowing a healthcare professional, you must then turn your attention to yourself and in what ways you have developed and demonstrated those qualities that you admire in your mentor.

Remember, this is about your qualities and skills, and knowledge. The experiences you choose to write about are the vehicles that convey that information.

Inspiration is important, but then what ….. ? 

Inspiration is essential to pursuing a health professions career. But… while the most interesting, breathtaking, awesome, unique, inspirational experience can be a place to start, after the aha moment, what did you do to test your motivation and to find out what professional education, training and practice are actually like? Show the committees that you are an informed applicant who has made a rational and mature decision to apply for acceptance into training for this profession.

By the way, it is not at all necessary to have one of those mythic and epic inspirational experiences. There are many health care professionals who realized their interest in their profession in a more gradual evolution of experiences.

No matter how you got here, the committees are more interested in what you’ve done recently than every step along the way.

This is not an English or Rhetoric or Creative Writing assignment.

Still it will make an important impression. So, if you want to make a very good impression that will help you earn an invitation to an admissions interview, it should be well-written, technically correct and, most importantly, respond appropriately to the prompt.

Don’t get hung up on having a theme. 

Doing so takes over and steals the room you need for details about valuable experiences. This is a very short essay, and the themes eat characters and spaces for lunch. Let the theme be subtle. Let the theme be the things about you that show you are suited to the profession and have what it takes to succeed and to care for patients. 

Use active verbs and active voice .

Health professionals are proactive. Write about what you’ve done and the value of those experiences. 

Everything you write should add value.  

If you write about a challenge or struggle or obstacle or mistake , get some mileage out of it by showing what you did to succeed, what you learned from it and who you are as a result.  

You have a small space and, hopefully, many strengths and experiences.  Each experience, paragraph, sentence, word takes up space.  Know why you are telling the committees a story and what messages you want to send. 

Your personal statement should be primarily about your experiences since high school. However, a pivotal moment or particularly valuable relevant experience from your pre-college years may be needed to set the stage for who you are today. If so, take care to write it concisely and save room for more current information.

Consider structure.

You may choose to write in a chronological order of events or in a modified chronological order in which you lead with an interesting recent experience and flashback to background information that is relevant. Either way, the first experience you write about should be interesting enough to get the reader’s attention.

There is not a lot of room for the Big Intro paragraph and the Big Concluding paragraph. Usually, a few lines of intro that lead into the first anecdote or background statement will work. You may use only the last few lines for your concluding statement. 

You may have room in a personal statement for only two or three experiences; however, each experience may reveal several different strengths that will be of interest to the admissions committees.

Be concise.

Avoid overuse of descriptive words and introductory words and phrases that are unnecessary to the message.

Get to the point. Each sentence moves the reader forward. No slow build. You don’t have that luxury. Neither does anyone else.

There is no space for reiteration.

There is usually some sacrifice of a smooth, flowing feel that you may have in longer essays.

Use your own vocabulary, not the thesaurus. When you interview, you should sound like the person who wrote the application essay.

You may see or hear the word “unique” in relation to essay prompts. While you want to stand out, you do not need to have an experience that no one else has had. A unique experience can be thought of as being unique or special to you in your own life rather than unique among all of the applicants.

Stand out by being well-prepared, mature, informed, experienced and able to communicate in writing that you possess the qualities that excellent health care students and professionals must-have.

Where to Find Help

Personal Statement Brainstorming – Health Professions Office

Pre-HP Coaches can help with

• Understanding prompts
• Content brainstorming
• Special circumstances – examples: academic difficulties, health issues, gaps in education, reapplication

Personal Statement Review and Feedback – University Writing Center

• Getting started writing
• Technical writing questions
• Help with structure, organization, style, tone

It is not the responsibility of UWC consultants to interpret prompts or select appropriate content. 

As the applicant, you should be able to explain to your writing consultant the prompt and the messages that you are attempting to get across.  Writing consultants can help with whether and how you are getting those messages into writing.

If you are still struggling with this, spend some time reading and thinking through the prompt. Discuss this in your Personal Statement Brainstorming appointment at the HPO.

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Drafting a Strong Personal Statement

(Adapted from Dr. James Woodruff's Personal Statement Workshop; University of Chicago, Pritzker School of Medicine)

Reflection and Gaining Perspective

A personal statement for application to a professional health school (or graduate program) is more than just a document for review by an admissions committee -- it is an opportunity for you to engage in meaningful introspection on your experiences with health care professions that have made you want to take the next step.

Drafting a personal statement provides you a valuable opportunity to use the writing process to reflect reflect and gain perspective on any of the activities that you have engaged in during your education, including research projects, clinical experience, patient interaction, and your coursework. This process of reflection and contextualization is an important one that is important as you continue your education and move into professional practice or whatever career you pursue -- enabling personal and professional growth by critical self-analyis and self-awareness.

By reflecting upon your experiences and putting them in the appropriate perspective, you will find yourself better able to answer the important questions that admissions committees will want to have answered:  Why do I want to pursue a career in a health field?  What is important to me in the work that I do?  How do I handle the interactions (e.g.: patient / doctor; stakeholder / service-provider) that I will encounter as a professional? How do I handle difficulties and adversity both professionally and personally?

Contextualizing Your Personal Statement

A personal statement for application to a program is not a document with a single purpose. While it is being read and evaluated by an admissions committee, it is also helping you give form to the ideas -- and questions, perhaps -- that you seek to address.

From the perspective of an admissions committee, it is a vital part of your application -- it provides an insight to your level of commitment, your career aspirations, and your ability to manifest your education and experience in a coherent and meaningful manner. While it is true that a personal statement might "weed out" undesireable candidates that are not a good fit for a particular program, it is better to view this as your opportunity to make a great first impression that helps set you apart from other candidates. With hundreds of applicants, programs need a way to put a face to the individuals they are selecting. A well-crafted and truly insightful personal statement not only give a program a chance to learn more about you as a candidate, but also provide an inroad to the meaningful dialgoues that will take place during your interview process.

For you, the applicant, the personal statement is a document to help you summarize and clarify your personal approach to a health career. In gathering your thoughts and reflecting upon your experiences, you may determine a specialty that you would like to pursue within the practice that you have chosen. In the event that you have already chosen one, the statement will give you a chance to refine your ideas about taking on a career in this field. In writing about what you have done and what you hope to do during your continuing education and career, you may gain more clarity on what you might need from a training program. Remember: a lot has changed in your life over the past few years -- solidifying your expectations and aspirations into a written statement is a chance for you to bring the next steps of your life into sharp focus.

The Nuts and Bolts of Your Personal Statement

For all our talk, to this point, of the nature of the personal statement, it's important to remember that it's not just abstraction and thought -- there are very specific expectations and guidelines for the writing that you will be doing. Here, we'll discuss a few of those.

For everything that a personal statement needs to be, there are some things that it shouldn't be. While you are using this statement to help set yourself apart from other candidates, it should not be a way to brag about your accomplishments or to leverage any connections that you might have made during your volunteer, clinical, or research experiences. It goes without saying that your pesonal statement should have a positive focus, and as such, any references to your experiences should be focused on what you learned and how it is informing your decision to pursue a health-related career, and not on any complaints or negative interactions that you may have had with patients or other care providers. Most importantly though, your personal statement is a crucial part of your presentation to an admissions committee -- so it is not something to be rushed, or completed without allowing the proper time for reflection, revision, and feedback from others.

As we've discussed, there are several key questions to be answered by your personal statement: who you are as an individual, why you have chosen the specialty that you want to pursue (if you have selected one at this point), what your career goals are, and what you need to succeed. Here are some questions that you might ask yourself, in reflecting on your answers to these questions:

Who are you? ⦁    What experiences made you want to pursue a health-related profession? ⦁    What about these experiences -- and the people that you encountered during them -- made a difference to you, and how? ⦁    How has this affected your future plans (i.e.: not just your choice of program, but your long-term career goals)?

Why this specialty / discipline? ⦁    Was there a specific event or events that triggered your decision to pursue a particular specialty? ⦁    Are there powerful role models for you in your chosen specialty? ⦁    Is there something specifically that attracts you to the area in which you want to specialize? Patient population? Research, teaching, or leadership opportunities? A way to make a meaningful contribution in an area of interest?

What are your career goals? ⦁    In what venue do you plan to apply your education? ⦁    Do you plan to pursue activities beyond professional practice (e.g.: mentorship, teaching, etc.)? ⦁    What are your personal motives for these choices?

What do you need to succeed? ⦁    What would maximize your learning? ⦁    What would maximize your professional and personal happiness?

These questions will give you a starting point for mapping out your personal statement. As you work through these, you may identify a way to structure these responses in ways that present natural transitions or in a complementary manner. Outlining your thoughts and planning what you will write can be every bit as important as the writing itself -- as this process allows you to identify those points that are most important to you and merit strong emphasis, as well as those thoughts that may need further development or that can be omitted.

You will need to be mindful of any restrictions that you may have for your personal statement, particularly with regard to word or page count. Using the questions above as a guideline, you would probably want to keep your statement focused largely (~80 percent) on the "Who" and "Why" of what you have to say, and streamline the "What" portion of your response to the remainder. It is important to remember that if your application and statement are well-received, you will probably have a chance to explore the specifics of those "What" questions during your interview -- so structure your statement accordingly.

As you write, remember the conventions for personal statements. They are biographic, by nature, and should thus be written in first-person style. It needs to be expository about you as a person, but focused and concrete when discussing the specifics of your experiences. Above all, you need to ensure that your tone does not come across as arrogant, brash, or in any way that suggests you might be difficult to work with.

As an example of how tone can make a large difference in how your message is received, compare the following sets of statements:

⦁    Performing this procedure was very easy for me. versus ⦁    Performing this procedure affirmed my understanding of the process.

⦁    My time as a hospice volunteer has made me sure that I want to be a doctor. versus ⦁    My experiences as a hospice volunteer have given me valuable perspective on the challenges of patient-caregiver interactions.

⦁    I know that medical school can be difficult, but I am prepared for the struggles that come with it versus ⦁    To me, the challenges of medical school represent an opportunity for growth as a person and as a professional.

Once you have a draft, and you have reviewed it for grammar and content, you should ensure that the tone and voice of your writing are what you would like them to be. Reading and re-reading your own writing with a critical eye can help you pick up on things that you might not have noticed when you were initially drafting and were more focused on structuring your ideas and giving them substance. Pay special attention to how each portion of your statement supports the larger presentation of yourself that you are trying to make.

Finally, you will want to make sure that someone else reads and provides response to what you have written. While friends and family members can help with this, it is strongly recommended that you get input from a professional -- whether it be a health professions advisor, academic mentor, or even your university's writing center. Perspective is important when writing, and letting others share their insight can help you refine or improve an area of your statement that you might not have realized was in need of improvement.

In Conclusion

Writing a personal statement for admission to a professional school or graduate program is just one part of a very large and challenging process. Compared to much of the writing you may have done as an undergraduate, it may seem small by comparison. While it alone will not get you into the program of your dreams, it will oftentimes be a deciding factor on whether or not you get an interview with an admissions committee. Keeping a focus on the entire process of drafting a personal statement -- reflection and thought, planning, writing, revision, and incorporating feedback -- can help a program understand why you're the right candidate.

Personal Statement

Writing a personal statement.

Most health-related professional schools require applicants to submit one personal essay, also called your personal statement. This essay is your chance to introduce yourself to admissions committees and discuss what will make you a unique and engaging part of your chosen health profession.

The Basics of Writing a Personal Statement

• You should be clear and concise in your writing. Admissions committees are looking for a coherent essay with no spelling or grammatical errors.
• The length of your essay may vary depending on each school’s requirements. If you are submitting your applications through AMCAS, there is a 5,300 character limit, approximately 500 words.
• Use active voice instead of passive voice, for example, say “I learned” rather than “I was taught”.
• Write an essay that is personal and describes who you are as a person. Although you might want to discuss an engaging interaction or experience with another person, make sure your essay is primarily about you.
• Ask others to read over your essay and provide feedback.
• Expect to make several revisions of your essay.
• Avoid using slang words and colloquialisms.

We cannot stress this enough. A great way to proofread your own writing is to read it backwards: start reading at the very last word of your essay and read until you reach the beginning.

Although your essay should be structured and coherent, for example, correct grammar and spelling, it doesn’t have to be as formal as other academic writing. If writing isn’t your strongest skill, remember that you don’t have to be a great creative writer to write a great personal statement; and remember that your application doesn’t rest solely on your writing abilities. Your personal statement is just one piece of your application. Think of it as a supporting document that will help admissions committees see your true strength and potential.

If you would like help writing your personal essay, you can schedule an appointment with The Writing Center .

Additional Resources from The Writing Center:

Online Writing Resources

Tips for Writers of Application Essays, Personal Statements, Grants, and Cover Letters

Handout on Application Essays

Accessibility Tools

Highlight links, change contrast, increase text size, increase letter spacing, readability bar, dyslexia friendly font, increase cursor size.

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Writing Personal Statements

All health professional schools require applicants to submit a "Personal Statement" during the initial application phase. This statement is a critical element in the application process and can significantly help or harm a student's chance for success. This page is a tool to help you begin your personal statement. In addition to using this page, it is imperative that you consult with your pre-health advisor for further assistance. 

What is a personal statement?

A personal statement is…

• A revelation of your personality
• Includes your strengths, beliefs, and values
• Uses concrete, vivid details to demonstrate the qualities and characteristics you possess and will also aid you as a health care provider
• Your first (and perhaps only) opportunity to sell yourself

This statement is your initial opportunity to address the admissions committee. This statement can lead to an interview IF you express your commitments, motivations, and values. The personal statement should be a reflection of the unique individual that you are.

What should I include in my personal statement?

Review the following video and information below to learn how to write a personal statement for professional school: 

Discuss WHY you are interested in the chosen profession

• Schools want to assess your motivation for this career before they ask for an interview.
• Are there events, people and /or experiences that reinforced your interest? Share personal vignettes that support your stated interest and motivation.
• Avoid clichés and undocumented generalizations about wanting to help people. Remember that numerous other professions cite "helping people" in their mission statement.
• Before starting this statement, ask yourself “...what have I done to personally convince myself that I want to be a...?"
• Being a health care provider often means a lifetime of giving back to society--what sustained commitment have you made to humanitarian activities?

Consider discussing individuals or incidents that have shaped your life

• Avoid extensive references to childhood or high school experiences. Granted early exposure to medicine may have sparked an interest, but should not be the reason behind your pursuit of this goal. You must convey that you've made an adult decision to pursue this career.

ELABORATE upon extracurricular activities and/or volunteer/work experiences that you have listed elsewhere in the application

• Do not make the mistake of merely re-listing these activities.
• Use this opportunity to give new information about your involvement which is not listed elsewhere. Since many students are involved in a number of activities, focus on noteworthy ones.
• Describe the depth of your involvement in a fashion that implies you have certain characteristics necessary to be a good health care provider.
• Discuss your contribution, what you have learned from the experience, and the personal satisfaction you have gained. Discuss the personal impact of these activities.

Consider personal qualities that have been developed and/or enhanced through such involvement

• Do not write "I am a warm, compassionate person"-let the reader draw his/her own conclusions after reading your statement.
• Describe your experiences so that the reader concludes you are mature, independent, etc.--refrain from directly telling them so.
• Consider responses to the following questions: What did you learn? How has this reinforced your interest in the chosen profession?

Use this as an opportunity to answer any perceived questions

• Most applicants will not need to use this space to explain academic irregularities. However, if you have a significant number of "W's" or "I's" on your transcript, you may wish to consider addressing the reasons in the statement.
• Do not use the entire space to discuss your transcript and leave other questions about motivation and activities unanswered.
• If necessary briefly explain the nature of the situation and accept responsibility for your academic record.
• Consult with your pre-professional advisor if you need further guidance.

Many students wish to write about their personal philosophy

• Caution, this is a tricky thing to discuss in the statement because you may come across as being narrow-minded or intolerant to different opinions.
• While your personal philosophy is important, it is a difficult task to produce a relevant and sincere statement while discussing these items.
• Weigh the pros and cons before deciding to include this item. Perhaps your philosophy is better discussed at the interview.

Non-traditional background

• If yes, use it to your advantage.
• If returning to school after a significant gap in time, describe why your career change is a well thought out decision.
• Focus on the positives of your current career while describing how medicine will fill the gaps of what is missing.

What format should I use?

This statement must be well written with an introduction, body and conclusion. Do not expect your first draft to be the final product. Once the statement is complete, it is beneficial to have it reviewed by several individuals with different perspectives. An individual who has good editing skills for both spelling and grammar usage is of particular importance.

Take advantage of the consultants in the " Writing Center " in 300 Bessey Hall and various residence halls who are available to work with writers at all levels of proficiency and at various stages of the composing process.

• Call (517) 432-3610 to schedule an appointment.
• The campus grammar hotline (517) 432-1370  can also be consulted for current information of proper grammar usage.

When writing the statement take advantage of the maximum number of characters allowed. You are given a certain amount of space for a reason, and using one-half page does not convey a strong interest in the application. If you are submitting an application through a service (i.e. AMCAS), do not express an interest in a specific health professional school. Your application may not be very successful if MSU-CHM reads about your strong interest in U of M.

Personal Inventory Questions

Download the Personal Statement Questionnaire for more assistance with identifying and developing elements you want to include in your finalized personal statement

Schools Not Participating in Application Service

Personal statements sent directly to schools not participating with an application service should include a brief discussion of your interest in the school and its program.

Maximum characters by application service:

Pre-health advisors.

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Schedule an Appointment Contact for Alumni and MSU Graduates Please call (517) 355-4470 to schedule a Pre-Health Appointment Follow us on Instagram @msu_prehealth and visit the Pre-Health Student Blog !

Contact for Prospective Students Gabby Wahla, M.A. Undergraduate Recruitment Coordinator Email:  [email protected]    Phone: 517-355-4470

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Healthcare Management Personal Statement Samples & Tips

Table of Contents

A one- to two-page personal statement describes what you intend to do in your profession, why, and how. We have provided effective healthcare management personal statement samples to help you write your own.

Be sure to follow the guidelines given in the guide to help you craft an insightful and engaging personal statement for the application process.

What Is a Healthcare Personal Statement?

A Healthcare Management Personal Statement is an individualized, written summary that outlines the qualifications, experiences, and goals of a professional in the healthcare field.

This statement provides insight into how the writer approaches their work, communicates with patients and colleagues, and manages health systems efficiently and ethically. It should include facts about the writer’s accomplishments and demonstrate an understanding of the critical issues within healthcare management.

Additionally, it should convey a passion for serving others and show how they utilize technological advances to create better patient solutions.

A successful personal statement will reflect the author’s unique personality while employing creative language and thought-provoking examples to stand out from similar applicants.

How to Write a Compelling Healthcare Management Personal Statement

The personal statement can tell medical schools why you want to study there and how your background and experiences will benefit their faculty.

Remember that you want your statement to sound like you rather than like a list of clichés. Since the personal statement is generic and will be used for other school and course applications, don’t mention schools or departments.

Include the following in your statement of purpose:

• Explain your interest in the position and your qualifications to the reader. Mention why you want to become a healthcare manager and what aspects of healthcare particularly intrigue you.
• Include any relevant experience, talents, or accomplishments you’ve picked up in your time at school, on the job, or elsewhere. Use it to explain how you make a good candidate for a future in healthcare.
• Think back on your time in the workforce and the lessons you learned about yourself or the field.
• Discuss any recent events you have heard about in the medical or healthcare fields, and elaborate on why you found them so fascinating.
• Provide details about any further higher education outreach events you may have attended and why you found them engaging.
• Remember to mention your hobbies and how they’ve helped you grow professionally.

Include in your statement any extenuating circumstances that have influenced your academic performance or your choice of specialization. Things like caring for a sick family member, experiencing a medical emergency, etc.

Great Healthcare Management Personal Statement Samples

These INK samples show the different perspectives of a personal statement. Use these samples to inspire your writing to prepare a hugely successful personal statement!

I’ve driven good change in healthcare administration for over two decades thanks to my extensive knowledge and insight.

I provide compassionate, efficient, and cost-effective patient care solutions by combining empathy, innovation, and thoughtfulness.

I can manage persons, resources, and processes to implement successful plans with tangible outcomes by identifying and assessing possibilities and foreseeing potential hazards.

I’ve utilized my skill set to create and maintain effective relationships with patients, families, and medical staff. Additionally, by leveraging technology and data analytics, I can ensure that sound decisions are made in accordance with established protocols and standards.

I can manage competing priorities within tight deadlines and deliver high-quality results due to my experience managing complex projects. With each accomplishment, I endeavor to push myself further to see what else I can achieve.

I look forward to applying my talents and understanding towards new challenges within healthcare management.

I’ve worked in healthcare management for over 20 years and am driven to make a difference.

I can quickly learn, analyze complex systems, and create unique ideas that work, thanks to my experience.

Throughout my career, I’ve worked on numerous projects that have helped streamline processes and reduce costs significantly. I also have excellent interpersonal skills, which helps me cooperate with stakeholders to design health equity and accessibility strategies.

This holistic approach to healthcare management drives me to push beyond limits and drive good change through resilient, forward-thinking strategies.

I’ve always loved healthcare management because I want to help people. I’m a highly experienced professional with a background that includes managing complex systems in hospitals and clinics throughout my career. With an innate sense of empathy and enthusiasm for practical problem-solving, I believe I can bring both knowledge and innovation to any healthcare organization.

I used inventive methods in a critical care unit to cut wait times and enhance efficiency without compromising patient outcomes. This experience inspired me to pursue additional health service administration certifications, allowing me to gain further insight into how this dynamic sector operates.

Familiarizing myself with cutting-edge trends such as data analytics has enabled me to develop farsighted approaches to improving service delivery. My ability to build trust, understanding, and support among varied coworkers has also improved. My dedication to bettering our healthcare system is evidenced by my record of initiating quality control initiatives that prioritize ethical integrity above all else.

As someone always looking for ways to make a difference, I plan to use my skills and interest in healthcare management. In addition to bringing fresh perspectives to projects, I am confident that I can leverage my insights and enthusiasm to generate tangible results.

Final Words

Healthcare management personal statement samples allow you to get a sense of how personal statements look and function in myriad fields. Start with the offered samples and compose your statement to ensure that your topic is conveyed as desired .

Abir Ghenaiet

Abir is a data analyst and researcher. Among her interests are artificial intelligence, machine learning, and natural language processing. As a humanitarian and educator, she actively supports women in tech and promotes diversity.

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Home » Academics » Academic Centers » Health Professions Advising » Writing a Personal Statement

Writing a Personal Statement

When applying to professional or graduate schools for health care programs, students will need to write a personal statement to identify their interest and background for this field and depending on the application, address their desire to be enrolled in a particular program.

Some schools or centralized application systems will specifically delineate what they want covered while others will give more vague instructions on what to include in a personal statement. Regardless, there are certain techniques to be used when drafting an effective personal statement.

A personal statement is typically a 1-2 page, single-spaced narrative in first person explaining why an applicant wants to go into a particular profession and what life experiences shaped their development. It is not the same as a resume or cover letter. Health professions applications have different prompts, and applicants should be sure to review the prompt when drafting their essay.

• Tells your story.
• Explains your fit and readiness for the profession. Doesn’t stop at your initial introduction to the field; explains what has led to your sustained interest in this profession.
• Describes your values and goals.
• Start writing early!
• Have your drafts reviewed. Use your best judgment on what feedback to incorporate, especially with conflicting feedback.
• Be aware of your tone. Avoid hypercorrection so that your language is genuine and natural but not too casual that it comes across as unprofessional.
• Use precise and clear language so stories and examples are clear to the reader.
• Make the essay personal to you. Write about you, your experiences, and your insights rather than other people.
• Use examples to “show” your audience what you did rather than “tell” them.
• Answer all parts of the prompt as directed. Be mindful of character, word, and document-size limits.
• Highlight key experiences rather than repeating everything covered in your application or on your resume in the essay.

Starting the Writing Process

To begin your first draft, you can use the application prompt or the questions below to generate your initial topics. If you have writer’s block, it may help to try freewriting. Be patient with yourself. A strong personal statement takes time to come together. Most applicants write several drafts before submitting their application. This is why starting early is beneficial.

• Why do you think you would be happy taking care of people?
• What motivates you to pursue this field?
• What have you observed or learned from your clinical experiences that excites you?
• How would this field fit your goals/values?
• Describe a meaningful life experience that influenced your interest in the field or your professional goals.
• What challenges have you overcome along your vocational journey? How have you grown as a person?

The health professions advisor is available to help in this process. Please schedule an appointment to make sure you are on the right track. The following resources may also be useful as you begin writing.

• AAMC Advisor Corner: Crafting Your Personal Statement
• AAMC’s 7 Tips to Writing Your Personal Comments Essay
• ADEA Article: Engage in Storytelling: A Fresh Approach for Your Personal Statement
• ADEA Personal Statement Suggestions

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Master of Health Administration (MHA)

• Admission Requirements
• Career Outlook

How to Write an MHA Personal Statement

If you’re applying to a Master’s in Health Administration program, you must be passionate about helping medical facilities run smoothly and supporting life-saving care. You’ve also done a lot to prepare for this point in your career, having earned an undergraduate degree and likely held at least one position in this rapidly growing field. Now, you’re ready to advance your career with the right master’s degree. One thing stands in your way: crafting the perfect personal statement to include with your application.

Also called a statement of purpose, the MHA personal statement is your chance to make your application more than just a collection of data and facts. An effective statement of purpose will give the admissions office an idea of who you are, complete with a glimpse into your personal and professional goals and accomplishments. It should communicate why you’re a good fit for the university’s MHA program.

If you feel intimidated by writing your personal statement, you’re not alone. Many people find writing about themselves to be a difficult task. However, to gain admission to a top MHA program , you’ll need a compelling statement of purpose – and this guide will teach you how to achieve just that.

Step 1: Brainstorm

Your first step in crafting an effective MHA personal statement or statement of purpose is to brainstorm. Many people find brainstorming methods like freewriting, clustering, or listing useful. However, there’s only one hard-and-fast rule for this step in the process: Write down your thoughts. Brainstorming is most effective when you make notes or a visual representation of how you might answer the personal statement prompt. The questions below are a few examples that may be helpful to ask yourself during this step:

• Why did I decide to pursue a career in health administration?
• What do I want to accomplish in my career?
• What are my goals in earning my MHA?
• Why am I applying to this MHA program?
• Why do I want to attend this university?
• How do my accomplishments make me a good fit for this MHA program?

Step 2: Outline

Writing out an outline for your essay will save time later. Return to what you wrote during the brainstorming phase. Which parts of your notes are the most compelling? Which ones make you feel genuinely passionate about the MHA program you’re applying to? These are the pieces of information you should be sure to include in your statement of purpose.

If the application provides a prompt, use it when building your outline. For example, the MHA personal statement prompt at Methodist University is: “Complete a typed personal statement including your background, interest in attending Methodist University, interest in the program, and your career goals.”

Here is an example outline for an essay responding to this prompt:

• Explain why you chose to pursue a career in health administration.
• Describe your educational background.
• Identify details about MU that made you interested in attending this school.
• Point to specifics about this program that make it the right fit for you.
• Explain what you want to accomplish in the next few years.
• Describe how this MHA program will help you achieve your goals.
• Summarize your main points.

Step 3: Draft

After taking the time to brainstorm and outline your statement of purpose, the process of writing your first draft should go smoothly. Return to your outline, and use your brainstorming notes to fill out each section. Think of this as the part of the process where you tell a story. Add relevant details to make your personal statement more compelling to the reader, and include examples from your lived experiences to demonstrate the message you’re trying to communicate.

Step 4: Revise

Revision is just as important as the drafting stage. Read through your statement of purpose and revise it to make the essay more clear and compelling to the reader. Here are a few examples of questions to ask yourself during the revision process:

• Is anything I wrote unclear?
• Can I be more specific about any of these details?
• Does my personal statement directly respond to the prompt?
• If I worked for the admissions office, what questions would I have?

Step 5: Proofread

Finally, proofread your personal statement for grammar, punctuation, or spelling mistakes. It’s essential for your final statement to be professional and free of errors, as mistakes could cloud your overall message. Once you’re happy with your statement of purpose, you’re ready to apply for your MHA program.

MHA Personal Statement Example

MHA personal statement examples are useful tools in planning your essay. Read the example below, and use it as a guide or inspiration for your statement.

“I’ve aspired to work in the health care field since I was a teenager. For much of my adolescence, my mother, who lives with rheumatoid arthritis, was also a caregiver to my maternal grandmother, who was battling Alzheimer’s. Due to the medical needs of the entire family, we all spent a great deal of time in medical facilities. I soon learned just how lucky my family was to have access to top-notch care and treatment. The more I learned about the medical system, though, the more I realized that not all families are so fortunate. Since then, my desire has been to help improve the level of care offered to all families and individuals.

I have always valued the hard work of nurses and doctors who take hands-on responsibility for care. However, the more I interacted with the health care industry, the more I developed a growing appreciation for those who often work behind the scenes – the health service managers, clinic supervisors, and consultants who keep day-to-day health care operations running smoothly. When I entered college, I felt that my place in the field was among their ranks, working to expand access to quality care throughout my community. That’s why I completed the Bachelor of Science in Community Health, and it’s why I’m now applying for admission to Methodist University’s Master in Health Administration program.

Through my research of MHA programs, Methodist University quickly became an obvious choice. As a health administration professional currently working in the field, entering an online program that will allow me to study at my own pace without sacrificing the quality of my education is a top priority. That’s why the excellent reputation of Methodist’s online program and outstanding faculty stood out to me. I’m excited to apply to a program with a low student-to-faculty ratio and built-in support services to support me along the way.

Specifically, the MHA program at MU is unmatched. Its focus on preparing students with the strategies, tools, and techniques to lead teams, make important decisions, understand organizational effectiveness, and change processes to improve performance tells me that this program will truly prepare me to advance as a leader in my field. After reviewing the course list, I’m most interested in expanding my learning with two courses: HCA 5680: Global Health and HCA 5600: Health Care Policy Issues. Both will prepare me to support efforts to increase access to quality health care in all communities.

After several years working as an administrator in medical facilities, I’ve learned a great deal about how my work can support health services for patients. Completing MU’s MHA program will help me pursue my future career goals, including management positions. My hope is to graduate from MU with a solid understanding of health care administration and the skills I need to advance. Additionally, I look forward to completing the required capstone experience to solidify and showcase my skills for future employers.

Health care in our society relies on talented health administration professionals who can ensure access to care for each and every patient. I want to dedicate myself to becoming one of those professionals, and I believe my next step is to complete Methodist University’s Master in Health Administration program.”

Final Tips for Writing an MHA Personal Statement

You may find these tips helpful in writing your MHA personal statement:

• Ask a friend or family member to review your statement and provide feedback.
• Read your personal statement out loud to look for errors.
• Ask a colleague or close friend to list your top strengths and qualities from their perspective. Then, make sure your essay demonstrates these qualities.
• Avoid repetition. If you find yourself using the same words or phrases repeatedly, search for synonyms and other ways to express your thoughts.

Taking the time to learn how to craft your MHA personal statement or statement of purpose shows that you’re serious about preparing for advancement in health administration. Graduating from a top online program can make all the difference when it’s time to apply for leadership positions. Learn more about Methodist University’s online MHA program , which offers working professionals the opportunity to study at their pace with flexible online coursework taught by field experts. Request more information about this program or apply today .”Interested in other health care degrees? Explore all the online health care programs we offer at Methodist University.

• Ellis, M. (2022, June 2). How to Write a Powerful Personal Statement . Grammarly. Retrieved on October 21, 2022, from “ https://www.grammarly.com/blog/personal-statement/?gclid=Cj0KCQjw48OaBhDWARIsAMd966BK6sa3AFL2z6fBzcz2bOBtut8HUbTQD5_NRj1UJq6bAReWC057wBwaAtdlEALw_wcB&gclsrc=aw.ds .”
• McCombes, S. (2019, Feb. 12). How to Write Your Personal Statement | Strategies & Examples . Scribbr. Retrieved on October 21, 2022, from “ https://www.scribbr.com/graduate-school/personal-statement/ .”

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Health and social care personal statement example.

Due to previous experiences of working with a range of people in the care sector I believe that throughout my time on various work placements with people who have disabilities and difficulties in communicating, along with the experiences gained throughout my studies, my wish to pursue a career in the care profession has grown.

To further my interest in working with and around people I completed a course in childcare. Throughout this course I was able to gain valuable experience of working with special needs children. While this was very challenging I also found it an extremely rewarding and enjoyable experience.

To further my knowledge and passion for working with people I took a health and social care advanced course and took a weeks experience in a day centre that involves working with people who suffer from difficulties in communicating and having disabilities.

This again helped to broaden my understanding of working with people and also how to deal with children and adults with disabilities. Within my spare time I have researched the job role and requirements for health promotion to find out what is involved.

To build upon these interests further, I am taking up a one week work experience within the health field. I will be spending the first week in a care home focusing on helping elderly people that suffer from dementia and my second week assisting a health promoter to experience a more professional job role in health care. I am looking forward to this valuable experience as it will further consolidate my desire to study health and social care.

I currently work as a sales assistant which has given me a valuable experience of working with people and how to assist their needs in any way possible. During this time I am developing effective communication skills and good working relationships.

In addition to this it is also helping me to show how committed I am to my responsibilities as well as demonstrating good organisation skills. Having to juggle work and school as well as social activities this also shows that I am developing my time keeping skills to make myself more committed and more punctual.

During my first year of sixth form I helped to raise money for the McMillan Cancer trust charity. I also found this very rewarding as I was helping others that were in need, just like during my work placements. I often play sports after sixth form with my friends; this has helped me to develop extra skills in working well in a team.

In addition I have completed voluntary work with a year six class to increase my knowledge of working with young people, another activity that I very much enjoyed and found extremely rewarding. To further my interest in working with people I have recently volunteered to do a level 3 v-volunteering in my spare time, the certificate itself is an accreditation form Newcastle University.

During my spare time I mainly like to dance and sing. I find this is a good way to express myself in addition to help me keep fit. I also attend the gym often to also help keep me fit I also like to attend various different events and take advantage of any activities that I am offered whether it is through school or outside of school.

This helps to increase my confidence and also helps me to meet new people. I feel that university is definitely the right path for me. I am always working extremely hard to achieve the best I can, a feat which I intend to carry on throughout my university years.

I feel I have the necessary skills needed to enjoy university to the full and also be successful in future years. In addition I would also like to go to university to help develop my skills even further so I can gain a good job in the health and social care sector which is always my main interest.

Profile info

This personal statement was written by fayej44 for application in 2011.

fayej44's university choices Newcastle College University of Sunderland

Green : offer made Red : no offer made

fayej44's Comments

This is what i have sent to the universities i am applying to. could people please give me feedback on what you think of how my personal statement sounds please. one of the universities i have apllied for has already recived it and i'm hoping that with this p.s it is good enough.

This personal statement is unrated

Related Personal Statements

Its very good but you should.

Sun, 01/09/2013 - 19:34

Its very good but you should write what universities you had applied for just for the help of other people.

You have written in such simple writing that makes it even more incredible. Well Done. :)

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Although most applicants focus on GPA and test-scores, the personal statement is a very important component of your application and should be carefully composed. This is your opportunity to highlight things about yourself that may not be mentioned in other sections of your application and to distinguish yourself from other applicants.

You should have several different people objectively read your personal statement and provide constructive feedback. In addition to the Health Professions Advisory Committee (HPAC) , your letter writers are often a great option. There are also resources on campus that can assist you, such as the UH Writing Center , University Career Services , and your major advisor. Consider the feedback you receive carefully, but be sure that the personal statement is still written in your voice!

Below we have outlined some advice and general guidelines to consider while writing your personal statement. Keep in mind that these recommendations are not restricted to medical/dental applications, but can be applied while writing essays for any healthcare professional program.

• See also UH University Career Services Personal Statement Tips
• Sign up for the UH Writing Center Personal Statement Workshops

Types of Prompts

Before beginning your personal statement, it is important you carefully review the specific question (or prompt) that is being asked and the character-limit, as there can be distinct differences between the application services.

TMDSAS ( 5000 characters ):

• Explain your motivation to seek a career in medicine. You are asked to include the value of your experiences that prepare you to be a physician.
• Explain your motivation to seek a career in dentistry. You are asked to discuss your philosophy of the dental profession and indicate your goals relevant to the profession.
• Personal Characteristics Essay - Learning from others is enhanced in educational settings that include individuals from diverse backgrounds and experiences. Please describe your personal characteristics (background, talents, skills, etc.) or experiences that would add to the educational experience of others. The personal characteristics essay is required to all applicants and limited to 2500 characters, including spaces.
• Optional Essay – The optional essay is an opportunity to provide the admissions committee(s) with a broader picture of who you are as an applicant. The essay is optional, however, you are strongly encouraged to take advantage of this opportunity. Consider briefly discussing any unique circumstances or life experiences that are relevant to your application which have not previously been presented. Optional Essay is limited to 2500 characters, including spaces.

AMCAS ( 5300 characters ):

• Why have you selected the field of medicine?
• What motivates you to learn more about medicine?
• What do you want medical schools to know about you that has not been disclosed in other sections of the application?

AACOMAS ( 5300 characters ):

• What motivates you to learn more about osteopathic medicine?

AADSAS ( 4500 characters ):

• Explain a defining moment that helped steer you toward a career in dentistry. Consider using that moment as the focal point of your essay.
• Be colorful, positive, imaginative and personal when discussing why you are a good candidate for dental school. Ask yourself—in a pile of 100 applications, would I enjoy reading my statement? Be sure to convey your passion for dentistry in your statement.
• Be yourself.  Don’t use jargon, clichés or big phrases that you would not use in daily conversation. Remember, dental schools want to know about the real you.
• Be original and thoughtful: Discuss how you would contribute to the profession and patient care, all of which will help you stand out from other applicants.

AACPMAS (4500 characters):

• State below why you are interested in becoming a Doctor of Podiatric Medicine. Provide information about your development for a career in Podiatric Medicine

CASPA (5000 characters):

• In the space provided write a brief statement expressing your motivation or desire to become a physician assistant.

OptomCAS (4500 characters) :

Essays can be customized for each individual Optometry program.  Most Optometry schools include this as their main essay question:

• Please describe what inspires your decision for becoming an optometrist, including your preparation for training in this profession, your aptitude and motivation, the basis for your interest in optometry, and your future career.

OTCAS (no character limit):

• Your Personal Statement should address why you selected OT as a career and how an Occupational Therapy degree relates to your immediate and long-term professional goals. Describe how your personal, educational, and professional background will help you achieve your goals.

PTCAS (4500 characters):

• Prompt: Every person has a story that has led them to a career. Since there are a variety of health professions that "help" others, please go beyond your initial interaction or experiences with physical therapy and share the deeper story that has confirmed your decision to specifically pursue physical therapy as your career.

PharmCAS (4500 characters):

• Your Personal Essay should address why you selected pharmacy as a career. How the Doctor of Pharmacy degree relates to your immediate and long-term professional goals. You should describe how your personal, educational, and professional background will help you achieve your goals.

VMCAS (1000 characters):

• There are many career choices within the veterinary What are your future career goals and why?
• In what ways do veterinarians contribute to society and what do you hope to contribute?
• Consider the breadth of society which veterinarians What attributes do you believe are essential to be successful within the veterinary profession? Of these attributes, which do you possess and how have you demonstrated these in the past?

When should I start writing?

You should begin working on your personal statement early in the spring semester prior to your intended application year and submitting your application materials to HPAC (if applicable).  Remember that the people who are helping you with your statement will need time to review it and you will need time to work through multiple drafts before submission.  In addition, some of your letter writers may want to see a copy of your personal statement before they write your letter, so you should strive to have a competent draft by mid-March.

What should be included?

It is important to treat the personal statement as an answer to a question (i.e., the prompt), rather than the opportunity to flex your creative writing muscles. Indeed, most applicants are STEM majors without much experience in creative writing; therefore, it is recommended that you avoid using the essay to practice your creative writing skills and stick to simply addressing the prompt in a direct, concise way. Some questions you may want to consider while planning your essay are:

• Why have you selected the field of medicine, dentistry, or other health profession?
• What motivates you to learn more about medicine, dentistry, or other health profession?
• How have you demonstrated your interest and commitment to your decision?
• What experiences have allowed you to develop the skills necessary to be successful in this program and to become an effective physician, dentist, PA, etc.?
• Did you have any exposure to role models who influenced your decision? Which of their attributes inspired you?
• Are your perceptions of this profession realistic?
• What are your professional goals?
• Is there anything you wish for your chosen health professional schools to know about you that has not been disclosed in other sections of the application?

Depending on the nature of the prompt, you may also wish to include information such as:

• Unique hardships, challenges, or obstacles that may have influenced your educational pursuits.
• Commentary on significant fluctuations in your academic record that are not explained elsewhere in your application.

What should NOT be included?

• Avoid clichés and over-using/mis-using terms : How many times do you think admissions committees have read the phrase, “I want to become a physician because I like science and I want to help people”? Similarly, words like empathy and passion are, while applicable, can become empty in meaning when overused or misused. Consider exemplifying these terms, rather than simply stating them.
• Avoid unnecessary drama: While you may feel compelled to "hook" the reader with a dramatic opening to your statement, doing so may detract from the overall purpose (i.e., describing your decision to pursue medicine/dentistry) and may induce many an eye-roll by committee members.
• Avoid being vague : "[Insert experience] was challenging and rewarding." What does that mean? Be specific about what was impactful and how it affected you.
• Avoid brash decision-making :  Your decision to become a doctor/dentist should be the result of a series of thoughtful, conscious, and reflective decisions. NOT an instantaneous realization or epiphany. Similarly, you have not “always known” that you want to be a physician/dentist. No one is "born to be a doctor." Nothing is innate, you have to work for it.
• Avoid excuses :  In general, there are better uses for your personal statement than explaining away and justifying poor grades, incidents of misconduct, etc. Indeed, TMDSAS offers additional essays and opportunities to discuss these issues. However, if you choose to address these subjects, be sure to focus on what you have learned from those incidents and how your experiences have made you a stronger person.  Always accept responsibility and avoid blaming anyone else for your decisions or mistakes.
• Avoid restating your resume or activities section :  Choose ONE or TWO significant and distinguishing experiences to elaborate upon when outline the reasons behind your decision to pursue a career in healthcare. There is no need to narrate completely your 4+ years of college or carefully detail your activities from year to year; indeed, there are other sections in the application where you can detail your experiences and what you learned from each.
• Avoid grandiosity :  Claiming that you plan to cure cancer (or HIV, or healthcare disparities, or anything else) shows a grave lack of understanding of whatever problem you are planning to solve. Similarly, avoid “I know what it is like to be a physician/dentist from [shadowing/clinical volunteer experience].”  No, you do not.  That is precisely why you are hoping to go to medical/dental school.
• Avoid inflammatory or controversial topics :  You do not know the values, beliefs, and background of the committee member reading your essay.  For these reasons, you are advised to avoid making any strong statements regarding politics, religion, and other polarizing topics.  Be extremely cautious to avoid expressing any views that could be construed as derogatory to any group.  Additionally, your beliefs are not the only “correct” beliefs. 
• Do not lie :  Honesty and ethical behavior are the hallmarks of being a healthcare professional. Do not include details anywhere in your application or essay that you are not prepared to talk about or that are simply untrue.

Additional Recommendations

• Use simple formatting : Avoid the use of bullet-points, italics, and symbols.
• Read your statement aloud : As you draft your statement, reading what you have written aloud can help you determine whether your writing "flows" well and is an easy read for a reviewer.

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Exploring the effective elements on the personal and professional development among health-care providers: A qualitative study

Shervin farahmand.

1 Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Elaheh Malakan Rad

2 Department of Pediatric Cardiology, Children's Hospital Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran

Fatemeh Keshmiri

3 Department of Medical Education, Education Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

BACKGROUND:

A new domain of “personal and professional development” was introduced as a core competency of health-care providers. This study aimed to explore the experiences of learners and faculty members about what competencies or skills were essential for the professional development and success of health-care providers.

MATERIALS AND METHODS:

This is a qualitative study using an inductive content analysis approach in 2019–2020. In the present study, 58 academic faculty members participated by purposeful sampling including ten associate professors (17.24%) and 24 assistance professors (41.37%), in addition to 23-year medical residents (20.65%) and 4 th -year nursing students (20.65%). Individual and group interviews were conducted. Data were analyzed by the inductive content analysis approach introduced by Graneheim and Lundman.

The qualitative data were classified in 953 open codes and eight categories, which were further divided into four main categories: “socio-emotional skills,” “life-long learning skills,” “coping skills,” and “well-being strategies.”

CONCLUSIONS:

The present results showed socioemotional and coping skills affect interpersonal and professional interactions that contributed to their improved health-care providers’ capabilities. Participants also considered lifelong learning as influential in developing professional capabilities and keeping their knowledge and skills up-to-date for accountability to duties. Moreover, using well-being strategies protects the mental and physical health of health-care providers. These skills are synergistic, and their combination can have a significant role in improving the personal and professional capabilities.

Introduction

Health-care providers have to deal with various challenges and crises that can affect their professional performance and success during their careers. Health-care providers are faced with stresses such as physical tiredness, lack of sleep, high job pressure, emotional tensions related to work, improper performance of the system at work, and shortage of time for their personal life, which decrease the well-being of health-care providers.[ 1 , 2 ] Change in the balance between stress and coping strategies leads to fluctuation of well-being during professional work.[ 3 ] It has been suggested that in order to overcome these stresses, providers should improve personal and professional development competencies.[ 4 ] Therefore, it is vital to consider the competencies that help the medical doctors cope with the challenges and protect their physical and mental health. In this regard, besides to improvement of professional abilities, there has been an emphasis on skills such as management capabilities, the ability of team membership, committing to professionalism, interpersonal communication skills, informatics, education, and accountability.[ 5 ]

Hicks et al . have introduced the new domain of “personal and professional development” (PPD) as a core competency which was introduced as a successful element of health-care providers. The goal of PPD is to ensure the quality of health services.[ 6 ] Considering the growth of knowledge in the field of healthcare, there is essential for various health-care professionals to improve their abilities in order to provide efficient services continuously. Several studies indicate that skills in PPD are also fundamental for the provision of high-quality health care and success in medical profession especially in crisis periods.[ 4 , 6 ] Self-management abilities in stressful situations, identifying and managing ambiguity, increasing self-confidence in relation to patients, and the degree of help seeking based on self-reflection and conflict management between personal and professional life were vital elements in health-care providers’ professional development.[ 6 ] Health-care providers are constantly faced with crises and difficult situations. Therefore, it is necessary to provide the necessary skills to provide services in this situation. It expects growth of the competencies that can protect the personnel from serious problems, which threaten their health or adversely affect their professional performance. Previous studies on the factors affecting personal and professional development were mainly based on the opinions of experts or descriptive studies on one of the dimensions of the phenomenon. The aim of the present study was to explore the experiences of faculty members in medical and nursing schools and regarding the essential skills through which they need to achieve professional development and success in healthcare systems.

Materials and Methods

Study design and setting.

This was a qualitative study that was conducted by inductive content analysis approach of Graneheim and Lundman.[ 7 ]

Study participants and sampling

In the present study, the participants have entered by purposeful sampling. Learners and academic faculty members in medical and nursing schools, who were well known as multi-dimensional and successful individuals in their professional careers, with a willingness to participate in the study, were enrolled.

Data collection tool and technique

In the present study, ten individual interviews and five group interviews were conducted to explore the experience of the participants about the effective underlying factors and skills for personal and professional development. Experiences of the senior faculty members (associate professors) were obtained using in-depth, individual, and semi-structured interviews. Each interview took 60–90 min. In addition, we have used group interviews for the collection of experiences of junior faculty members and learners. Each group interview took about 4 h. The total duration of individual and group interviews was 30 h. All the interviews were performed face to face in the quiet and calm environment of the conference hall of the medical school. The first author performed the individual interviews, facilitated, and guided the group interviews. As well, she wrote the field notes during and after the sessions. All the interviews were audio-recorded. Each interview was started with the following question “What are your most important personal experiences regarding personal and professional development in your own life?” and “Could you describe what were the most effective factors to your professional success in difficult situations and crises?” Probing was performed according to the reflections of each participant about his/her prior experiences of PPD, facilitators, barriers, skills, and perceptions.

Data were analyzed using the inductive content analysis approach described by Graneheim and Lundman.[ 7 ] The process of analysis included “ code, subcategories, categories, and theme .” All the audio-recorded files were transcribed word for word. To become immersed in the data, the transcripts were read several times. Then important words were highlighted and written as notes in the text during the reading of the transcripts. We used the original words of the interviewees for initial coding. Relevant codes were collected together to form sub-categories. Categories were developed by collecting the subcategories. Themes were emerged by putting together the relevant categories.

The data have obtained through several methods including reflection on the aim of the study and the main research question, using open-ended questions, reflection on meaning units in order to conduct in-depth analysis of data, spending adequate time on data gathering and analysis, and review and revision of categories by the research team were done if required. Member checking was used to determine the accuracy of the qualitative data. In order to these criteria, we gave five of the transcripts back to the interviewees to ensure of accuracy of codes and categories. The interviews were performed in a defined time interval, with stringent emphasis on following the same subject and questions throughout all the interviews. We spend prolonged time to analysis process to obtain an in-depth understanding of the phenomenon. All the steps of the research, in particular, the steps of analysis of data were written in detail. This enabled other researchers to continue this study based on the documents of interviews and based on the categorization and coding process. We presented a clear description of the context, selection criteria, and characteristics of the interviewees, data collection, and analysis to increase the transferability of the findings.

Ethical considerations

Before starting the interview, the purpose of the research, the method of interview, and the right of the participants to decline to participate were explained to all the interviewees. They were informed that we would record the interviews with consideration of confidentiality. Informed consent was obtained from all the interviewees. Only the first author had access to the recorded voices. The transcripts were anonymous and saved as confidential information. The present study was approved by the Ethics committee in Shahid Sadoughi University of Medical Sciences (ID: IR.SSU.REC.1399.044).

Fifty-eight academic faculty members and learners of the medical and nursing schools of the Tehran University of Medical Sciences and Shahid Sadoughi University of Medical Sciences were enrolled in this study. The demographic data of the participants are shown in Table 1 . The participants in different specialties included internal medicine, cardiology, orthopedics, psychiatry, emergency medicine, internal medicine, sports medicine, general surgery, geriatrics, neurology, forensic medicine, ophthalmology, infectious disease, gynecology, urology, pediatrics, anesthesia, pathology, radiology, radiotherapy, and occupational medicine were entered in the present study.

Basic demographic characteristic of participants

SD=Standard deviation

Analysis of the qualitative data, including 953 open codes, eight categories were classified into four main categories including: (a) Socio-emotional skills, (b) Life-long learning skills, (c) Coping skills and (d) Well-being [ Table 2 ].

Categories and themes of essential skills for healthcare providers’ success at difficult situations and crisis

Cognitive and meta-cognitive skills

Socio-emotional skills

In this theme, we classified the effective skills for develop and maintaining professional competencies in dealing with stressful and challenging situations. This theme encompasses four subcategories, as below:

Self-awareness

Participants in this study believed that self-awareness of one's capabilities and limitations enables one to plan an effective program for the improvement of professional performance. One of the associate professors said:

“ If we accept that we are not the knower of everything and we have limitations, then we plan for becoming better .”(Participant 3).

Emotional management

Competencies which enable health-care providers to recognize and manage emotions were described to be an effective factor for surviving in difficult situations. One of the learners said:

“ When someone cries, you may cry too, when one shouts, you may shout too or you may be dominated by him/her. However, sometimes you have learned what the appropriate way of dealing with these situations is. You should know how to behave when a resident, a professor, or a patient, shout at you. I need to learn how to control, manage and guide my emotions and anxieties in order to be able to work efficiently during our career .” (Participant 5).

Communication skills

Participants considered communication skills including interpersonal, inter-group and inter-professional communication as an important factor in managing in difficult situations. An assistant professor mentioned.

“ To achieve peace of mind, my family members were very helpful to me. In my view, communication with others provides emotional support. Family is the most important supportive unit .” (Participant 14).

Responsibility and accountability

Responsibility and accountability were described as critical skills. Participants believed when the professors or peers delegate the responsibility of doing a task to the individual, it causes a feeling that one can do it and one should try to do it to the best of his/her ability. One of the assistance professors said:

“ As I remember, I always did my best to accept the full responsibility of a delegated task to me and to do my job as perfect as possible, regardless of being a resident, an academic staff, a manager or a physician. In every role, I did my best .” (Participant 12).

Well-being strategies

In this theme, skills on application of methods for protection of personal health and for keeping balance between personal and professional commitments are included. Two categories were included in this theme:

Striking the balance

Participants believed that skills causing happiness, hopefulness, optimism and resilience in personal and professional life set the appropriate stage for improvement of personal and professional competencies of a physician. One of the assistant professor said:

“ One important point is to keep balance between work and personal life that I tried to do that. I believe the doctors need to learn how they can make balance between personal life and professional and educational commitments. I should be able to manage these situations .” (Participant 22).

The “being at the present moment” technique was another practical tip for success in my professional life. One of the learners said:

“ At the time of rest, we should rest with peace of mind and at the time of work and study, we should dedicate ourselves to the work and the study. People, who are always worried, neither can have a good rest nor can do a perfect job .” (Participant 15).

Preservation of physical and mental health

The participants emphasized the importance of preservation of physical and mental health. One of assistant professors said:

“ I found that too much work and sleep deprivation can increase the risk of various diseases. Therefore, I decided to counteract this work overload by planning some vacations, entertainment and hobbies such as going to cinema, going to theater and spending time with my friends and family. This leisure time helps me to reconstruct my body and soul .” (Participant 19).

Coping skills

This theme addresses the competencies that make the healthcare providers capable of managing difficult situations. It includes two subcategories of “stress and conflict management” and “resilience.”

Stress and conflict management

There are different sources of stress and conflict in professional healthcare environments. Participants showed that the ability to manage stress and the conflicts could foster success in stressful situations. One of the assistant professor said:

“… I thought that the challenges occur only in our hospital. However, later, I learned that challenges are facts that exist everywhere. Now, I have learned to empower myself to know how to deal with and how to manage the challenges .” (Participant 13).

In the present study, participants believed that resilience helps health-care providers efficiently handle difficult situations by applying their skills in showing flexibility in dealing with and managing difficult situations. This trait enables the person to bounce back to his/her original level of stability after encountering a difficult and unfavorable event. One of the learners said:

“Many times, we do not have the optimal conditions and we face challenges. We should know how to cope with these hard circumstances. This means how much you break with a challenge or how much you can spring back to your original point of balance after the challenge. This skill helped me a lot.” (Participant 26).

Life-long learning skills

These are the constellation of skills that enable the healthcare providers to seek to learn what they need to know in terms of knowledge, skills, and attitudes to perform their professional role with high quality. One of the associate professors said:

“ I found I need to learn how to search for up-to-date information, how to do critical appraisal of the literature, I learn how to achieve my needs .” (Participant 29).

This theme includes two categories of “self-directed learning” and “cognitive and meta-cognitive skills.

Self-directed learning

Micro-skills such as goal setting, determining strategies to achieve the goals, reflection and self-evaluation are included in this category. One of the associate professor mentioned:

“ I believed that I should maintain my competencies at the high level up to the end of the period of my career that will be at least 30 years, of course, if no events happen. Thus, I should learn up-to-date knowledge and skills by various methods, including self-study, participation in continuing professional development programs and so on in order to be able to provide efficient health care to my patients. This needs discipline and planning at the very first step .” (Participant 32).

This includes skills that a physician needs for personal development to perform his/her professional role in a society with diverse needs. The skills classified in the category include searching for information, problem-solving, time management and critical thinking. These skills set the stage for changing the resident to a life-long learner. One of the learners said:

“ When I was a resident, I realized that a physician came and said one therapeutic approach for the patient, and then another resident came and offered a different approach. I got confused on which one I should follow. This situation pushed me to study the evidences and to learn about evidence-based medicine and problem-solving skills. All of these skills helped me to have a better performance .” (Participant 16).

Reflection was another main skill that was stated by the participants. One of the assistant professors said: “ At the end of the shift, I always thought with myself what I did wrong, what to do to make fewer mistakes, what I did well and how can I reinforce them .” (Participant 42) [ Appendix 1 ].

The present results showed socioemotional and coping skills affect interpersonal and professional interactions that contributed to their improved healthcare providers’ capabilities. Participants also considered lifelong learning as an influential in the development of professional capabilities and keeping their knowledge and skills up-to-date for accountability to duties. Moreover, using well-being strategies protects the mental and physical health of the health-care providers. These skills are synergistic, and their combination can have a significant role in improving the personal and professional capabilities.

According to the socioemotional intelligence model, people with emotional intelligence are able to effectively express themselves, to understand and to communicate with others, to have flexibility in decision-making, and to overcome problems.[ 8 ] The interpersonal component in emotional intelligence deals with the individual's ability to live with others peacefully, and includes empathy, social responsibility, and interpersonal relationships.[ 8 ] The present results showed that socioemotional skills such as communication skills, self-awareness, emotional control, and accountability were necessary for achieving success in personal and professional life. Participants believed that establishing effective communication is one of the strategies for understanding the situation, empathizing, improving resilience, and reducing stress among health-care providers. They also considered the effective communication important in performing the delegated tasks to them by other team members. They stated that the mastering interpersonal skills enable them to have effective communication with other team members in stressful situations. Effective interpersonal communication skills are introduced as a core feature in various definitions of emotional intelligence.[ 9 , 10 ] In our study, self-awareness was explained as one of the factors affecting professional success in difficult circumstances. Self-awareness, defined as the ability to know one's capabilities and limitations, enables individuals to plan to improve their performance and facilitate personal and professional development. Furthermore, recognition of one's limitations, results in timely requests for help from other team members. Hicks defined the capability of personal and professional development as the ability to create self-awareness in relation to one's knowledge, and emotions, and limitations, which leads to appropriately asking for help. In his study, “identity development” is introduced as a key feature in professional development of a physician. He believes that recognition of personal and professional capabilities and limitations, positive attitude, and ability to “ ask colleagues and peers for help ” are important elements in PPD.[ 6 ] Our findings are in accordance with this study.

Emotional management includes recognition and control of emotions has been emphasized in various emotional intelligence models.[ 8 ] To acquire this skill, the individual should be able to perfectly understand other people's feelings and emotions and to control them appropriately. In a systematic review of a three-decade literature, Arora et al . reported positive correlation between emotional intelligence and teamwork, communication skills, improved empathy, stress management, organizational commitment, and leadership in the context of competencies of the Accreditation Council for Graduate Medical Education.[ 11 ] Similarly, in the present study, participants believed that their socioemotional skills have improved their communications, teamwork, stress management, and resilience.

Stress and conflict, induced by professional responsibilities, workplace, and personal life, among members of the health profession are multifactorial.[ 6 ] The synergy of sources of stress also causes stress and worsens physical and mental pressures.[ 6 , 12 ] The ability to use coping mechanisms in response to stress has been explained as an essential capability for professional development.[ 6 ] Our participants also recognized coping skills such as problem-solving skills, social support, and the individual's flexibility for change. People try to cope with stress by combining problem-solving activities to change stressful situations and emotion-based activities to reduce emotional factors and stressors. In addition, support from colleagues and outside interests have been recommended as coping strategies.[ 13 ] Participants conferred that stressful and conflicting situations among medical team members and peers are factors causing impaired personal-professional interactions. They believed personal distress, factors disturb mental peace and adversely affect individual's performance in treating patients. In addition, the inability to use stress and conflict management strategies to control one's performance has adverse implications for personal performance and professional relationships. Fothergill reported high levels of stress and burnout among personnel affect the efficacy of working with the patients. Therefore, training is necessary to help the providers to overcome work-related emotional stresses and challenging issues. Our findings are in accordance with their study.

In the present study, resilience was explored as a category of coping skills. Resilience has been defined as the process of dynamic flexibility in difficult situations[ 14 ] This skill enables the individual to be positively flexible in the face of adversities and resilient in dealing with many challenges in ongoing development.[ 15 ] Resilience skills include active problem-solving, structured understanding of difficulties, promoting positive interaction with others, and performing and understanding the meaning of events through spirituality and faith.[ 16 ] Resilience strategies s include creating and fostering positive communications and relationships, maintaining positivity, developing emotional insight, creating a balance in life, spirituality, and using reflective skill.[ 15 ] The development of resilience capability among health system personnel can reduce their vulnerability in the workplace and improve well-being and better outcomes in health care settings.[ 17 ] Grant believed improving sing emotional resilience for practice between health-care providers enhances well-being and job satisfaction.[ 16 ] In the present study, flexibility was essential an important feature of resilience that allows the individual to adapt to challenging and changing situations, which had been effective on participants’ resilience under challenging conditions during residency and professional development. In Hicks’ study, self-awareness, personal management, and self-confidence were considered as factors affecting flexibility. Flexibility and maturity in adapting to change were essential capabilities for personal and professional development.[ 6 ] In his study, resilience, confidence, self-efficacy, and adaptability were considered as effective components in flexibility,[ 6 ] which agrees with the present study results.

Applying well-being strategies emphasizes strategies such as preservation of physical-mental health of healthcare providers, mechanisms of happiness, creating peace of mind such as hobbies and entertainments, and being in friendly and family gatherings. Well-being is closely related to personal development,[ 18 ] professional success and leads to avoiding work pressures.[ 19 ] Well-being was defined as a balance between different area including professional development, communications, and physical and mental health. In line with our results, their results showed that the six themes affecting well-being include balance in different domains, professional development and temporary imbalance, professional satisfaction and achievement, maintaining a sense of self, stress management and coping skills, and role of residency programs.[ 20 ] Similar to the present study, in Hicks’ study, conflict management between personal and professional responsibilities was determined as the essential capability for personal and professional promotion.[ 6 ] In this study, personal recognition, interaction with family and friends, hobbies and interests, and maintaining physical health through exercise and nutrition, awareness of personal limitations, the and use of defensive mechanisms such as humor, determining and pursuing goals, and self-care explored as stress coping activities.[ 6 ] In the present study, in the theme of well-being, a balance between personal and professional life, strategies for preservation of physical and mental health and methods such as interaction with family and friends, hobbies, and interests have been emphasized.

In the present study, the last theme, “lifelong learning,” was explained as a factor affecting professional development in crisis. Lifelong learning has been defined as a dynamic process that enables learners to progress in core skills for obtaining expertise.[ 4 ] The goal of lifelong learning is defined to develop learners’ potential capabilities through ongoing support by stimulating and empowering them to acquire necessary knowledge, values, skills, and attitude. Core competencies of lifelong learning include the ability to recognize one's performance, manage learning in action, search for information and create and answer questions, evaluate and improve performance and motivation.[ 4 ] Acquiring meta-cognitive skills, self-directed learning, self-evaluation, and reflection were proposed as the most important features of lifelong learning.[ 21 ]

In the present study, in the category of self-directed learning, skills such as personal planning skills, evaluation and reflection, and effective learning strategies have been emphasized. Self-directed learning is regarded as one of the key lifelong learning strategies that defined as a process in which learners are actively involved in recognizing their learning needs, set learning goals, gather resources, develop, and implement appropriate strategies, plan and evaluating learning outcomes independently or with others’ help.[ 22 ] Self-directed learning increases self-confidence, independence, motivation, and readiness for lifelong learning.[ 22 , 23 ] In the present study, recognition of self-performance, management of learning, evaluation, and reflection were explained as factors affecting self-directed learning. Participants believed that planning, self-evaluation, setting goals, personal reflection, and effective learning strategies empower the learners to design a proper program for developing their capabilities. Using self-directed learning and keeping up-to-date were described as professional development strategies.

Moreover, the present results showed that cognitive skills such as problem-solving, critical thinking, proactive thinking, and meta-cognitive skills meaning learning how to learn are factors affecting individuals’ dynamics and direction of the learner's ongoing learning for personal and professional development. Meta-cognitive and self-directed learning skills are regarded as features of lifelong learning.[ 21 ] Cognitive skills, critical thinking, creativity, problem-solving, reflection, and self-regulation skills have been defined as skills needed in preparation for life-long learning, which have an effective role in professional achievements.[ 24 , 25 ] The present study participants believed that self-directed learning and using cognitive-metacognitive skills such as critical thinking and problem-solving can direct a physician in successful learning and toward lifelong learning, and this has a major role in professional development. Similar to our results, improving problem-solving, interpersonal communication skills, and self-directed learning activities have been emphasized for coping in our results. Improving problem problem-solving, interpersonal communication skills, and self-directed learning activities have been emphasized for coping with stressful situations.[ 6 ] In addition, developing skills such as self-awareness, emotional intelligence, time management, and life-long learning were emphasized for physicians.[ 26 ]

Limitations and recommendation

The present qualitative study provided the viewpoints of physicians and nurses on essential elements of personal and professional development in difficult and stressful situations. The qualitative method may limit the application of these findings to other contexts with different cultures. Therefore, we recommend further studies to explore the contributive elements to professional success and development under stressful circumstances from the perspective of a broader range of health care professionals.

Conclusions

In this study, the experiences of successful people who were famous for their personal and professional development were explained. The experiences of successful people can provide a better description of the phenomenon and its dimensions. The study showed socio-emotional and coping skills affect interpersonal and professional interactions and improve healthcare providers’ capabilities. Participants also considered lifelong learning influential in developing professional capabilities and keeping their knowledge and skills up-to-date for accountability to duties. Moreover, using well-being strategies protects the mental and physical health of health-care providers. These skills are synergistic, and their combination can significantly improve personal and professional competencies.

Financial support and sponsorship

The present study was conducted with the financial support of the Vice-Chancellor for Research and Technology of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (ID code: 7633).

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

We would like to express our sincere thanks to participants who contributed in the study.

Effective factors on personal and professional development in medical education

• Open access
• Published: 28 March 2024

Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study

• Rachel Gilbert 1 &
• Daniela Lillekroken   ORCID: orcid.org/0000-0002-7463-8977 1  

BMC Nursing volume  23 , Article number:  216 ( 2024 ) Cite this article

72 Accesses

Metrics details

Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto’s theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its influence on caring within the nursing context, especially during the provision of end-of-life care. This study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

This study has a qualitative descriptive design. Data were collected by conducting five individual interviews and one focus group during a seven-month period between April 2022 and September 2022. Nine nurses employed at four Norwegian nursing homes were the participants in this study. Data were analysed by employing a qualitative deductive content analysis method.

The content analysis generated five categories that were labelled similar to Tronto’s five phases of the care process: (i) caring about, (ii) caring for, (iii) care giving, (iv) care receiving and (v) caring with. The findings revealed that nurses’ autonomy more or less influences the decision-making care process at all five phases, demonstrating that the Tronto’s theory contributes to greater reflectiveness around what may constitute ‘good’ end-of-life care.

Conclusions

Tronto’s care ethics is useful for understanding end-of-life care practice in nursing homes. Tronto’s care ethics provides a framework for an in-depth analysis of the asymmetric relationships that may or may not exist between nurses and nursing home residents and their next-of-kin. This can help nurses see and understand the moral dimension of end-of-life care provided to nursing home residents during their final days. Moreover, it helps handle moral responsibility around end-of-life care issues, providing a more complex picture of what ‘good’ end-of-life care should be.

Peer Review reports

In recent decades, improving end-of-life care has become a global priority [ 1 ]. The proportion of older residents dying in nursing homes is rising across the world [ 2 ], resulting in a significant need to improve the quality of end-of-life care provided to residents. Therefore, throughout the world, nursing homes are becoming increasingly important as end-of-life care facilities [ 3 ]. As the largest professional group in healthcare [ 4 ], nurses primarily engage in direct care activities [ 5 ] and patient communication [ 6 ] positioning them in close proximity to patients. This proximity affords them the opportunity to serve as information brokers and mediators in end-of-life decision-making [ 7 ]. They also develop trusting relationships with residents and their next-of-kin, relationships that may be beneficial for the assessment of residents and their next-of-kin’s needs [ 8 ]. Moreover, nurses have the opportunity to gain a unique perspective that allows them to become aware of if and when a resident is not responding to a treatment [ 9 ].

When caring for residents in their critical end-of-life stage, nurses form a direct and intense bond with the resident’s next-of-kin, hence nurses become central to end-of-life care provision and decision-making in nursing homes [ 10 ]. The degree of residents and their next-of-kin involvement in the decision-making process in practice remains a question [ 11 ]. Results from a study conducted in six European countries [ 12 ], demonstrate that, in long-term care facilities, too many care providers are often involved, resulting in difficulties in reaching a consensus in care. Although nurses believe that their involvement is beneficial to residents and families, there is a need for more empirical evidence of these benefits at the end-of-life stage. However, the question of who should be responsible for making decisions is still difficult to answer [ 13 ]. One study exploring nurse’s involvement in end-of-life decisions revealed that nurses experience ethical problems and uncertainty about the end-of-life care needs of residents [ 14 ]. Another study [ 10 ] reported patients being hesitant to discuss end-of‐life issues with their next-of-kin, resulting in nurses taking over; thus, discussing end-of-life issues became their responsibility. A study conducted in several nursing homes from the UK demonstrated that ethical issues associated with palliative care occurred most frequently during decision-making, causing greater distress among care providers [ 15 ].

Previous research has revealed that there are some conflicts over end-of-life care that consume nurses’ time and attention at the resident’s end-of-life period [ 16 ]. The findings from a meta-synthesis presenting nurses’ perspectives dealing with ethical dilemmas and ethical problems in end-of-life care revealed that nurses are deeply involved with patients as human beings and display an inner responsibility to fight for their best interests and wishes in end-of-life care [ 17 ].

Within the Norwegian context, several studies have explored nurses’ experiences with ethical dilemmas when providing end-of-life care in nursing homes. One study describing nurses’ ethical dilemmas concerning limitation of life-prolonging treatment suggested that there are several disagreements between the next-of-kin’s wishes and what the resident may want or between the wishes of the next-of-kin and what the staff consider to be right [ 18 ]. Another study revealed that nurses provide ‘more of everything’ and ‘are left to dealing with everything on their own’ during the end-of-life care process [ 19 ] (p.13) . Several studies aiming to explore end-of-life decision-making in nursing homes revealed that nurses experience challenges in protecting the patient’s autonomy regarding issues of life-prolonging treatment, hydration, nutrition and hospitalisation [ 20 , 21 , 22 ]. Other studies conducted in the same context have described that nurses perceive ethical problems as a burden and as barriers to decision-making in end-of-life care [ 8 , 23 ].

Nursing, as a practice, is fundamentally grounded in moral values. The nurse-patient relationship, central to nursing care provision, holds ethical importance and significance. It is crucial to recognise that the context within which nurses practice can both shape and be shaped by nursing’s moral values. These values collectively constitute what can be termed the ethical dimension of nursing [ 24 ]. Nursing ethos and practices are rooted in ethical values and principles; therefore, one of the position statements of the International Council of Nurses [ 25 ] refers to nurses’ role in providing care to dying patients and their families as an inherent part of the International Classification for Nursing Practice [ 26 ] (e.g., dignity, autonomy, privacy and dignified dying). Furthermore, ethical competence is recognised as an essential element of nursing practice [ 27 ], and it should be considered from the following viewpoints: ethical decision-making, ethical sensitivity, ethical knowledge and ethical reflection.

The term ‘end-of-life care’ is often used interchangeably with various terms such as terminal care, hospice care, or palliative care. End-of life care is defined as care ‘to assist persons who are facing imminent or distant death to have the best quality of life possible till the end of their life regardless of their medical diagnosis, health conditions, or ages’ [ 28 ] (p.613) . From this perspective, professional autonomy is an important feature of nurses’ professionalism [ 29 ]. Professional autonomy can be defined based on two elements: independence in decision-making and the ability to use competence, which is underpinned by three themes: shared leadership, professional skills, inter- and intraprofessional collaboration and a healthy work environment [ 30 ].

As presented earlier, research studies have reported that nurses experience a range of difficulties or shortcomings during the decision-making process; therefore, autonomous practice is essential for safe and quality care [ 31 ]. Moreover, autonomous practice is particularly important for the moral dimension in end-of-life care, where nurses may need to assume more responsibility in the sense of defining and giving support to matters that are at risk of not respecting ethical principles or fulfilling their ethical, legal and professional duties towards the residents they care for.

To the best of the researchers’ knowledge, little is known about nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents; therefore, the aim of this study is to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

Theoretical framework

Joan Tronto is an American political philosopher and one of the most influential care ethicists. Her theory of the ethics of care [ 32 , 33 , 34 ] has been chosen as the present study’s theoretical framework. The ethics of care is a feminist-based ethical theory, focusing on caring as a moral attitude and a sensitive and supportive response of the nurse to the situation and circumstances of a vulnerable human being who is in need of help [ 33 , 34 , 35 ]. In this sense, nurses’ caring behaviour has the character of a means—helping to reach the goal of nursing practice—which here entails providing competent end-of-life care.

Thinking about the process of care, in her early works [ 32 , 33 , 34 ], Tronto proposes four different phases of caring and four elements of care. Although the phases may be interchangeable and often overlap with each other, the elements of care are fundamental to demonstrate caring. The phases of caring involve cognitive, emotional and action strategies.

The first phase of caring is caring about , which involves the nurse’s recognition of being in need of care and includes concern, worry about someone or something. In this phase, the element of care is attentiveness, which entails the detection of the patient and/or family need.

The second phase is caring for , which implies nurses taking responsibility for the caring process. In this phase, responsibility is the element of care and requires nurses to take responsibility to meet a need that has been identified.

The third phase is care giving , which encompasses the actual physical work of providing care and requires direct engagement with care. The element of care in this phase is competence, which involves nurses having the knowledge, skills and values necessary to meet the goals of care.

The fourth phase is care receiving , which involves an evaluation of how well the care giving meets the caring needs. In this phase, responsiveness is the element of care and requires the nurse to assess whether the care provided has met the patient/next-of-kin care needs. This phase helps preserve the patient–nurse relationship, which is a distinctive aspect of the ethics of care [ 36 ].

In 2013, Tronto [ 35 ] updated the ethics of care by adding a fifth phase of caring— caring with —which is the common thread weaving among the four phases. When care is responded to through care receiving and new needs are identified, nurses return to the first phase and begin again. The care elements in this phase are trust and solidarity. Within a healthcare context, trust builds as patients and nurses realise that they can rely on each other to participate in their care and care activities. Solidarity occurs when patients, next-of-kin, nurses and others (i.e., ward leaders, institutional management) engage in these processes of care together rather than alone.

To the best of our knowledge, these five phases of caring and their elements of caring have never been interpreted within the context of end-of-life care. The ethics of care framework offers a context-specific way of understanding how nurses’ professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents, revealing similarities with Tronto’s five phases, which has motivated choosing her theory.

Aim of the study

The present study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

The current study has a qualitative descriptive design using five individual interviews and one focus group to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

Setting and participants

The setting for the study was four nursing homes located in different municipalities from the South-Eastern region of Norway. Nursing homes in Norway are usually public assisted living facilities and offer all-inclusive accommodation to dependent individuals on a temporary or permanent basis [ 37 ]. The provision of care in the Norwegian nursing homes is regulated by the ‘Regulation of Quality of Care’ [ 38 ], aiming to improve nursing home residents’ quality of life by offering quality care that meets residents’ fundamental physiological and psychosocial needs and to support their individual autonomy through the provision of daily nursing care and activities tailored to their specific needs, and, when the time comes, a dignified end-of-life care in safe milieu.

End-of-life care is usually planned and provided by nurses having a post graduate diploma in either palliative nursing or oncology nursing– often holding an expert role, hence ensuring that the provision of end-of-life care meets the quality criteria and the resident’s needs and preferences [ 39 ].

To obtain rich information to answer the research question, it was important to involve participants familiar with the topic of study and who had experience working in nursing homes and providing end-of-life care to residents; therefore, a purposive sample was chosen. In this study, a heterogeneous sampling was employed, which involved including participants from different nursing homes with varying lengths of employment and diverse experiences in providing end-of-life care to residents. This approach was chosen to gather data rich in information [ 40 ]. Furthermore, when recruiting participants, the first author was guided by Malterud et al.’s [ 41 ] pragmatic principle, suggesting that the more ‘information power’ the participants provided, the smaller the sample size needed to be, and vice versa. Therefore, the sample size was not determined by saturation but instead by the number of participants who agreed to participate. However, participants were chosen because they had particular characteristics such as experience and roles which would enable understanding how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

The inclusion criteria for the participants were as follows: (i) to be a registered nurse, (ii) had a minimum work experience of two years employed at a nursing home, and (iii) had clinical experience with end-of-life/palliative care. To recruit participants, the first author sent a formal application with information about the study to four nursing homes. After approval had been given, the participants were asked and recruited by the leadership from each nursing home. The participants were then contacted by the first author by e-mail and scheduled a time for meeting and conducting the interviews.

Ten nurses from four different nursing homes were invited to participate, but only nine agreed. The participants were all women, aged between 27 and 65 and their work experience ranged from 4 to 21 years. Two participants had specialist education in palliative care, and one was currently engaged in a master’s degree in nursing science. Characteristics of the participants are presented in Table  1 :

Data collection methods

Data were collected through five semistructured individual and one focus group interviews. Both authors conducted the interviews together. The study was carried out between April and September 2022. Due to the insecurity related to the situation caused by the post-SARS-CoV-2 virus pandemic and concerns about potential new social distancing regulations imposed by the Norwegian government, four participants from the same nursing home opted for a focus group interview format. This decision was motivated by a desire to mitigate the potential negative impact that distancing regulations might have on data collection. The interviews were guided by an interview guide developed after reviewing relevant literature on end-of-life care and ethical dilemmas. The development of the interview guide consisted of five phases: (i) identifying the prerequisites for using semi-structured interviews; (ii) retrieving and using previous knowledge; (iii) formulating the preliminary semi-structured interview guide; (iv) pilot testing the interview guide; and (v) presenting the complete semistructured interview guide [ 42 ]. The interview guide was developed by both authors prior to the onset of the project and consisted of two demographic questions and eight main open-ended questions. The interview guide underwent initial testing with a colleague employed at the same nursing home as the first author. After the pilot phase in phase four, minor language revisions were made to specific questions to bolster the credibility of the interview process and ensure the collection of comprehensive and accurate data. The same interview guide was used to conduct individual interviews and focus group (Table  2 ).

The interviews were all conducted in a quiet room at a nursing home. Each interview lasted between 30 and 60 min and were digitally recorded. The individual interviews were transcribed verbatim by the first author. The focus group interview was transcribed by the second author.

Ethical perspectives

Prior to the onset of the data collection, ethical approval and permission to conduct the study were sought from the Norwegian Agency for Shared Services in Education and Research (Sikt/Ref. number 360,657) and from each leader of the nursing home. The study was conducted in accordance with the principles of the Declaration of Helsinki of the World Medical Association [ 43 ]: informed consent, consequences and confidentiality. The participants received written information about the aim of the study, how the researcher would ensure their confidentiality and, if they chose to withdraw from the study, their withdrawal would not have any negative consequences for their employment at nursing homes. Data were anonymised, and the digital records of the interviews were stored safely on a password-protected personal computer. The transcripts were stored in a locked cabinet in accordance with the existing rules and regulations for research data storage at Oslo Metropolitan University. The participants did not receive any financial or other benefits from participating in the study. Written consent was obtained prior to data collection, but verbal consent was also provided before each interview. None of the participants withdrew from the study.

Data analysis

The data were analysed by employing a qualitative deductive content analysis, as described by Kyngäs and Kaakinen [ 44 ]. Both researchers independently conducted the data analysis manually. The empirical data consisted of 63 pages (34,727 words) of transcripts from both individual and focus group interviews. The deductive content analysis was performed in three steps: (i) preparation, (ii) organisation and (iii) reporting of the results.

During the first step—preparation—each researcher, individually, read the transcripts several times to get an overview of the data and select units of analysis by searching for recurring codes and meanings and to carefully compare the similarities and differences between coded data. These codes were labelled independently by both researchers and placed into an analysis matrix.

During the next step—organisation—the researchers met and discussed and then compared and revised the labels several times until they agreed about the preliminary findings. During the interpretative process towards developing an understanding of the empirical data, the content of the labels referred to nurses’ perceptions about how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents, revealing similarities with the five phases of Tronto’s theory of ethics of care [ 32 , 33 ], thus assigning them to the five phases of the theory. Following this final refinement, one main category and five categories, each supported by several subcategories, were identified, as presented in Table  3 .

Reporting the results was the last step in the analysis. To enhance the understanding of the study’s findings, the findings are presented with supporting excerpts from the participants.

In qualitative studies, trustworthiness is the main parameter for appraising the rigour of the study [ 45 ]. To enhance the trustworthiness of the study, four criteria—credibility, transferability, dependability and confirmability, as described by Lincoln and Guba [ 46 ]—were applied.

To support credibility, a detailed description of the sample and the sampling process was provided. Furthermore, the interview guide and the questions that the participants were asked during the interviews are made available to the readers. Moreover, although the data were collected from five individual interviews and one focus group, triangulation of two data collection methods allowed researchers to ensure that the study is based on diverse perceptions and experiences, strengthening the credibility and impact of the study’s findings [ 47 ].

Detailed information about the sample and setting supports the assessment of the transferability of the findings. In this way, the readers can recognise and evaluate whether the findings would be applicable to similar contexts with a similar sample. Quotes from the participants’ statements are given to support the findings. Each quote ends with a number representing the code that each nurse was given before conducting the interviews (i.e., Participant in interview 1, PI1 or participant 6 in focus group interview, P6FG).

To increase dependability, the same interview guide was used to ask all participants the same questions. Dependability was also increased by the researchers reading and analysing the interviews independently and then checking the consistency of the data analysis technique with each other and discussing the analytical process until a consensus was reached.

To enhance confirmability, excerpts from the participants’ statements were included when presenting the findings, thus verifying the concordance of findings with the raw data. This demonstrates that the data were not based on preconceived notions.

Trustworthiness was also supported by member checking, meaning that the researchers sent the participants the transcripts of the interviews immediately after data collection; then, the interviews were transcribed. The participants were asked to review the transcripts and check the accuracy of the data; hence, they had the opportunity to add, remove or clarify their statements. Only one participant answered this request, stating that the transcripts were accurate, and she did not have any further comments. Despite encountering a suboptimal response from participants, the authors remain confident in the trustworthiness of the study. Rich data, derived from a combination of individual and focus group interviews, yielded diverse and nuanced responses from participants, reinforcing the credibility of the findings.

Reflexivity is the researcher’s reflection on their position during the research process [ 48 ]. Both researchers have clinical experience in providing end-of-life care to nursing home residents. Therefore, it was critical to be aware of the impact that their clinical backgrounds might have on the research process from information seeking during the analysis of data and discussion of the findings. To avoid early interpretation of the data, the researchers were aware of their preunderstanding and tried to put it on hold. Both authors engaged in discussions regarding apprehensions and reflections, actively participating in the triangulation process throughout the study to prevent potential bias during data collection, analysis, and interpretation. The theoretical framework was brought in the end of the analysis process, which helped label the emerged findings.

The analysis of the empirical data combined with an ethical reflection helped researchers to identify and understand the moral dimension of nurses’ experiences with end-of-life care provided to nursing home residents. During the analysis, an overarching category emerged– ‘The moral dimension of the provision of end-of life care’– describing nurses’ perceptions about how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. The participants agreed that end-of-life care is a care process that undergoes several phases, with each phase having its own ethical quality or its own element of care, here according to Tronto’s moral qualities [ 34 ]. In the following section, the findings are described using Tronto’s identified moral qualities for each of the five phases of the care process [ 32 , 33 , 34 , 35 ].

Caring about—being attentive

For the participants, being autonomous was perceived as a feature that increased their awareness of the resident’s caring needs during their last days of life. The participants agreed that the caring process involves paying attention, listening and recognising residents’ unspoken needs. Moreover, it implies nurses being able to make autonomous decisions when deciding which needs to care about at one particular moment.

The participants agreed that the core values of providing end-of-life care were to alleviate suffering, maintain dignity and provide comfort care. The participants perceived caring about as having sufficient knowledge, along with the experience and autonomy in practice, as well as providing comprehensive end-of-life care for residents. For the participants, caring about during the end-of-life process means them being present and dedicated. This implies nurses carefully observing, autonomously acting, and making decisions based on their judgements, and thus, they can decide and choose their course of action promptly based on resident’s condition or side effects. Moreover, caring about involved participants being attentive to perceiving the residents’ needs when the residents could no longer articulate themselves. The participants expressed their worries about resident’s bodily deterioration, leading them to lose their ability to express needs, as shown by the following quote:

There is not much communication when residents go into their last stage of life. Well… some of them are consciously until their death, but most are sedated; therefore, it is necessary to use your knowledge and experience to assess not only their needs for food and liquids or bodily hygiene, but also, we have to monitor their response to pain killers and other medication, and if it’s too much or too little, we need to do what’s needed to reduce or increase the medication and not let them suffer (PI3).

Some of the participants expressed that attentiveness to the residents’ care needs was a skill based on their clinical gaze developed during their careers. Other participants discussed that building a close relationship with the residents while they still could walk and talk was a precondition that helped them develop a clinical gaze, hence facilitating the nurses’ being attentive. Attentiveness allowed the participants to do what was needed when knowing the residents’ needs during the provision of end-of-life care. This may be interpreted as the moral or ethical quality of caring about during the end-of-life caring process, as demonstrated by the following statement:

We have time to know the resident before their health condition worsens… We previously knew what they wanted and how they wanted… their stay at nursing home gives us the opportunity to know their preferences and needs. Morally, we are obliged to provide the same quality of care they received when they could express themselves (PI4).

Caring for—taking responsibility

According to several participants, another phase within the end-of-life caring process was taking responsibility to care for. The participants agreed that monitoring the residents in their last days implies assuming responsibility. Assuming responsibility was perceived as an autonomous caring activity. They also discussed taking this responsibility seriously, which is a moral dimension of the end-of-life caring process and, ultimately, of the nursing profession. Usually, this responsibility was taken by a nurse, but it also involved other healthcare personnel or even next-of-kin. Among these responsibilities, the participants mentioned that the end-of-life caring process included not only caring for the resident’s physiological and psychosocial needs, but also assigning permanent healthcare personnel to continuously monitor the resident. Although the participants were aware that they share responsibilities for the caring process, ‘who does what…’, they ultimately had the overall responsibility for the whole end-of-life caring process.

Another responsibility included communication, which included listening, providing information, and supporting the residents’ next-of-kin. One of the participants expressed this as follows:

When I observe that the resident’s health worsens, I inform the next-of-kin and invite the spouse or the children to a meeting together with the responsible doctor and I, and we inform the next-of-kin what they might expect. The end-of-life care is not only about the resident and their last days, but also is to care for their next-of-kin to meet their needs and to overcome guilt feelings, anger or sadness.… (PI1).

Another way to care for patients was to deliberately increase opportunities to exercise autonomy during the caring process. For instance, the focus group participants discussed issues around advanced life support during the resident’s last days of life. Being prepared and having knowledge were the preconditions that gave them the authority to identify and make decisions about residents’ needs in here-and-now moments, hence exercising their autonomy. Some participants shared their experiences with controversies between next-of-kins’ and nurses’ assessments of what is the best care for the residents during their last days of life. Therefore, the importance of taking the initiative to discuss and clarify the resident’s needs and preferences was emphasised during the focus group interview, as shown in the following quote:

Some next-of-kins express wishes for advance life support and hospitalisation for their loved ones… and sometimes, to meet their needs, we try this, but the resident is suffering. The resident comes back to us after one or two days… To avoid this, clear guidelines, and a dialogue between the resident, their next-of-kin and us at the very beginning [when the resident enters the nursing home] is important… I think that minimalising the occurrence of difficult or conflictual situations and relieving the sufferance is care for both resident and their next-of-kin (P8FG).

Care giving—knowing what, why, how and when

During the interviews, the participants also discussed the caregiving process and provided concrete examples of what their caregiving encompassed. Spending extra time with the resident, choosing to be in the room and holding their hand to maintain physical contact was perceived as an autonomous caring act and a deliberate choice. One participant described this as follows:

For me, it is important that the dying person feels or hears that I am here with him or her… how he or she feels in these moments matters to me. I do it because I want to do it.… (PI5).

Other participants said that being autonomous when they actually provided caregiving to residents helped them make continuous assessments based on knowledge about what , how , how much , when and why to care. Knowledge and skills were decisive factors in providing competent care and making autonomous decisions during the caregiving phase; hence, competence was perceived as a moral dimension of caregiving. One of the participants said the following:

Caregiving at end-of-life is not only about giving morphine according to the doctor’s prescription… it involves all the judgements you have to make, all the skills you have… from preventing the occurrence of bedsores to knowing when to stop feeding but preventing thirst… think about all this knowledge and experience you must have to be able to make autonomous bedside judgements about when , why and so on.… (PI2).

Care giving at the end-of-life was described as all the necessary activities a nurse does to provide comfort and compassionate care to a dying resident. Among these activities, providing fundamental care and keeping residents comfortable and free of pain were seen as parts of the caregiving process. Moreover, adequate pain relief and symptom management were described as the moral dimension of care giving at this stage of end-of-life care, as one of the participants from the focus group interview said:

You cannot be passive when you see that the resident is suffering. I cannot go home and think that I should have done one or the other. It is against the nurses’ code of ethics and my personal moral and ethical principles. You have to act… I have to do what is needed… first thing first… pain relief and then personal hygiene! (P9FG)

Some of the participants mentioned some challenges they encountered during the care giving process. They said that care giving implies also standing in demanding situations. The lack of healthcare personnel with necessary knowledge or formal palliative care education or handling ethical dilemmas was seen as demanding situations that influenced the provision of care giving. Most of the participants felt that they were alone during the decision-making processes, which increased their awareness of their professional autonomy:

Sometimes, during weekends or evenings, I am the only nurse among the healthcare staff, and I have an overall responsibility for all nursing home residents. I have to prioritise who gets my attention and who needs me the most. Things can happen, regardless of whether it is Friday evening or weekend. I have to make a decision and do what is needed: to be with the dying resident and to support his or her next-of-kin in that moment. (PI5)

Care receiving—assessing caregiving

Several participants stated that, during the care-giving process, it was important to assess how the resident receive the care provided at the end-of-life stage. This was possible by monitoring the resident’s state of being but to also assess the outcomes of their care giving activities. They also reflected on their assessments and how they subsequently dealt with those assessments.

All the participants were confident in their knowledge and with their care giving at the end-of-life stage. They were aware that their care activities had consequences for the residents’ physiological and psychosocial needs. The assessment of the resident’s state of being was made by nurses listening, observing and interpreting resident’s response to care giving as signs of comfort or discomfort. One of the participants explained this as follows:

When providing personal care, if the resident presents any signs that can be interpreted as discomfort, I think that priority number one is me not causing more pain or suffering. However, I also understand that this person needs more pain killers, so I have to make sure that this person receives adequate medicine. (PI5)

Some participants also discussed the importance of assessing their care giving activities. They mentioned the importance of their assessments of the benefits of all care giving against the burden of all interventions and treatments. Their professional autonomy allowed them to make decisions about how to eschew care giving that was inappropriately and burdensome and choose the best comforting care for the resident. The participants stated that knowledge and experience were important in making such decisions, and their professional autonomy facilitated making choices of the best and less burdensome care giving. One of the participants said the following:

We have to assess whether the care giving provided meets the resident’s needs or not, whether the care comforts or perceives it as a burden and how the resident responds to this provision of care. (PI4)

During the interviews, some of the participants revealed a feeling of guilt when assessing that care giving altered the resident’s state of being, thus leading to new needs for care. They also discussed that the moral obligation and intention to relieve the suffering of the resident should override the foreseen but unintended harmful effects of care giving, including medication or other care interventions. One of the participants shared her experience as follows:

I still remember the attitude some of us had for a while ago… too much or too often morphine depresses the respiration and leads to death… I was struggling with feelings of guilt and even moral distress when I observed residents were still suffering because the medication they received had little or maybe no effect. I called the doctor and explained the situation… usually, the experienced doctors listen to us… and he [the doctor] prescribed more morphine.… (PI3).

Documentation of the response to care giving was also an issue discussed during the interviews. Some participants emphasised the importance of keeping detailed reports for a proper assessment of the care giving and medication and its outcomes. All reports were digitally written. Informal discussions between nurses and next-of-kin were also documented, especially when next-of-kin evaluated the care their loved ones received. The participants indicated that the more written information there was, the better. One participant acknowledged the following:

There is no such thing as ‘too much information’… being open about the morphine’s side effects and what to expect in the next hours or days is important for them [next-of-kin]. It helps them understand that end-of-life care is a process, not a quick fix procedure. (PI5)

Caring with—It is a teamwork process

During the interviews, most of the participants reflected upon the end-of-life caring process and its occurrence within the context of care in nursing home. The participants discussed that end-of-life care is not only about the responsibilities nurses have towards residents and their next-of-kin, but also the responsibilities of others who may influence the caring process. They perceived the caring process as an interplay between residents, next-of-kin, and themselves, along with how they relate to each other, which influences the caring process. However, as several participants asserted, this process did not occur in a vacuum: it occurred within an organisational context, which then influenced the caring process from the very beginning. One participant emphasised the importance of stable healthcare personnel within a caring organisation:

High staff turnover does not facilitate good end-of-life caregiving. Both residents and their next-of-kin need continuity and predictability in caring for and among healthcare personnel. They need somebody they know and trust… being exposed to new people every day increases their stress levels. (PI1)

Other participants discussed the importance of the leadership style and how the leader’s support influenced the culture of end-of-life care at the ward. The participants revealed that, within a caring context where their natural potential was enhanced through an enabling leadership style, they felt that they could provide competent and compassionate end-of-life care. One of the participants from the focus group stated that a positive leadership style supports nurses’ professional autonomy, thus helping them control the caring process, to have independence and to increase their ability to make clinical decisions and competent judgements regarding resident’s end-of-life care. One participant shared her experience as follows:

My leader gives me the freedom to make decisions when it comes to deciding what is best for the resident… She [the leader] enables me to be autonomous during the caring process, and this makes me aware of what and how to care.… (PI2).

The participants from the focus group interview also discussed how the nursing home’s caring culture influences care practice. They perceived the nursing home’s caring culture as positive, enabling good end-of-life care but also defective and an obstacle to care. They emphasised the importance of providing dignifying end-of-life care for residents. During the focus group interview, two of the participants engaged in a dialogue:

End-of-life care is providing care to the most vulnerable people, and it should be dignified… To do so, I have to provide care in a ‘caring room’ filled with dignity. (P7FG) Although next-of-kin and I have different perspectives of what good end-of-life care might be, we care together, we are a caring team which ensures in our own way that the resident receives competent care.… Yes, you [P7] mentioned this ‘caring room’… maybe we should open the door more often into this room and invite next-of-kin. (P6FG)

The aim of the present study was to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. In the following, we discuss these perceptions in relation to Tronto’s [ 32 , 35 ] ethics of care framework and other supporting literature. To identify the moral dimension of these perceptions, we have related them to the moral qualities corresponding to each phase of the care process, as described by Tronto [ 33 , 35 ].

In the first phase of the care process—caring about—the participants discussed the importance of being attentive to which type of care needs to be provided, which is the moral quality of the first phase of care. Similar to findings from another study [ 49 ], findings from the present study revealed that some participants perceived autonomous practice as carrying out actions based on their decisions. Caring about entails detecting the resident’s needs, hence obliging nurses to ‘do something’ [ 50 ]. This particular skill was seen as an autonomous caring activity, that is, the nurses’ deliberate choice of putting on hold their self-interest and/or agenda and ‘a capacity genuinely to understand the perspective of the other in need’ [ 35 ] (p.34) , here nursing home resident.

In Tronto’s view [ 33 ], nurses’ attentiveness contributes to building up a caring relationship with a patient. The findings from the current study reveal that nurses perceived the provision of competent and compassionate end-of-life care as a result of their clinical gaze developed through certain activities, attitudes and knowledge of the patient, and through mutual relationships between the residents, next-of-kin and them. These results are supported by findings from previous studies that emphasise the importance of the nurse’s past experiences with the resident [ 51 ] and the significance of developing a good relationship with the resident and their next-of-kin [ 8 , 23 , 52 , 53 , 54 ] to provide adequate care. Moreover, similar to findings from other studies [ 55 , 56 ], the present study reveal that, to respond to the resident’s end-of-life care needs, nurses must bring not only their professional knowledge, clinical experience and ability to work autonomously but even ethical sensitivity. These findings enforce Gastman’s [ 50 ] view on caring, in which caring should respond to the patient’s care needs. This involves nurses having empathy, capacity of judgement and the ability to see what is required in a specific situation (here, end-of-life care), which, according to Gastmans [ 50 ], is inherent in the moral dimension of nursing practice.

The second phase of care—caring for—refers to nurses taking on the burden of meeting the needs identified in the first phase, that is, caring about. There was no ambiguity, and the participants had no doubts regarding who had the responsibility for the provision of end-of-life care to nursing home residents. The nurses’ responsibility was seen as a moral dimension of care. In line with Pursio et al.’s study [ 30 ], the present findings indicate that the freedom to make patient care decisions and work independently has a positive impact on the moral dimension of end-of-life care for nursing home residents. However, nurses’ work was not only about meeting residents’ needs, but also to create a safe milieu, a communicative space together with each other and with the resident’s next-of-kin, thus sharing power and control over the care process. Similar findings are displayed in an integrative literature review [ 53 ], demonstrating that a positive culture of collaborative and reciprocal relationships, a willingness to engage and become engaged and nurses communicating with intent to share and support rather than inform all lead to facilitating decision-making in nursing homes. According to Tronto [ 35 ], to facilitate end-of-life decision-making, nurses must take the initiative to allocate responsibilities; otherwise, the nurses withdraw themselves from their responsibility. By exercising their professional autonomy to assign responsibilities, nurses strive to mitigate the power imbalance among residents, their next-of-kin, and themselves, thereby preventing the occurrence of potential power struggles in their relationships [ 34 ]. This proactive approach helps prevent the emergence of end-of-life care dilemmas that could undermine the moral dimension of end-of-life care.

The third phase of care—care giving—requires, according to Tronto [ 35 ], the moral quality of nurses’ competence, meaning nurses directly engaging with care. The findings revealed that the nurses provided end-of-life care, and to do so, they needed to have competence, which implies the nurses having the knowledge, skills and values necessary to know what, why, how and when to provide end-of-life adequately. In addition, good end-of-life care requires the competence to individualise care—to provide competent care based on the resident’s physical, psychological, cultural and spiritual needs [ 57 ] while considering the resident’s context of care. Nurses’ competence is crucial for their autonomy; however, to effectively utilize their competence, nurses must be capable of assessing care needs and responding promptly [ 30 ]. Otherwise, delays in assessing residents’ care needs could undermine the moral dimension of end-of-life care. To provide individualised competent care, it is necessary that nurses make continuous assessments. As the findings reveal, the nurses were concerned with providing competent care, that is, adequate pain management. If the care provided was incompetent and led to more pain for the resident, the nurses perceived psychological distress—a state of being that resulted in response to a variety of moral events—leading to the nurses feeling anger, frustration, guilt, powerlessness and stress [ 58 ]. According to Tronto [ 34 ] (p.17) , ‘incompetent care is not only a technical problem, but a moral one’; however, as the findings reveal, the provision of competent care also depends on the nurses’ ability to prioritise decision-making when standing alone. Although nurses’ professional autonomy enabled them to make decisions and choose the right what , how , how much , when , and why , the lack of adequately educated healthcare personnel make the decision-making process a technical problem, which could weaken the moral dimension of end-of -life care.

The fourth phase—care receiving—involves the moral quality responsiveness. This means nurses being responsive to the reaction of the nursing home residents to end-of-life care process. As the findings have revealed, nursing home residents are vulnerable to nurses’ act of care or lack of care. According to Gastmans [ 59 ], care is a reciprocal practice that occurs within the framework of a relationship between the care provider (nurse) and care receiver (resident). The reciprocity consists of nurses assessing that the care provided actually meets the resident’s needs for pain management and other physiological and spiritual needs. The nurses had to make autonomous end-of-life care decisions to meet the resident’s needs. This involved the nurse’s attention to care giving to not be perceived as power abuse, which could have negative consequences for the moral dimension of end-of-life care provision.

According to Tronto [ 33 ], vulnerability may lead to unequal relationships where power abuse may occur. Nursing home residents are in a vulnerable position because they rely on nurses’ competence and ability to alleviate suffering and assess and reassess the residents’ responsiveness to pain management. To avoid an unequal relationship between resident and nurse, nurses must assess whether the care provided is competent or incompetent. Besides assessing and documenting the care provided and its outcomes, informal discussions between the resident’s next-of-kin and nurses were also assessed as important for next-of-kin perceiving a balanced power and equal position within the relationship. However, because each end-of-life act of care may alter the resident’s state of being, responsiveness requires more attentiveness [ 34 ]. Nurses must therefore meet the resident’s new needs for care with compassion and a commitment to maintaining the highest quality of life throughout the evolving stages of the resident’s end-of-life journey.

The final phase of care—caring with—requires that solidarity and trust are the foundation of all care giving to meet caring needs [ 35 ]. The moral quality of this caring phase is solidarity. The findings from the present study suggest that the nurses felt solidarity with both the residents and their leaders. The nurses felt that they were given the support and freedom to act autonomously when making decisions regarding end-of-life care, but similar to findings from a previous study [ 22 ], they also recognised the impact that organisational factors, such as leadership and care culture, may have on the justice and equality of the care provided when they prioritise care to whom needed it the most. Similar to findings from another study [ 49 ], participants in the present study described autonomy as the ability to make independent decisions and prioritise care for those who needed it most. However, according to Tronto [ 35 ], all nurses have a responsibility to help determine how care activities and responsibilities should be allocated. Residents, their next-of-kin and other healthcare personnel may have different views on how they may perceive appropriate, compassionate and dignified end-of-life care [ 20 , 21 ].Therefore, it is important to have transparency in nurse–resident–next-of-kin relations if the element of power within the relationship should be replaced by trust. Otherwise, the nurses’ autonomy may negatively influence the moral dimension of end-of-life care provided to nursing home residents. By opening the door of the “caring room” and inviting next-of-kin to participate in the care process, nurses may contribute to a greater reflectiveness around what may constitute ‘good’ end-of-life care.

Strengths and limitations

One of the strengths of the study is the use of Joan Tronto’s theory of the ethics of care [ 32 , 34 , 35 ] and its five phases and elements of care to discuss the study’s findings. This allows a deeper understanding of how nurses’ professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. Another strength lies in the utilisation of two distinct methods of data collection: individual and focus group interviews. These approaches provided diverse datasets that shed light on various aspects of how nurses’ professional autonomy impacts the moral dimension of end-of-life care. Furthermore, the inclusion of participants with varying work experiences from four nursing homes enhances the richness and depth of the data generated from the interviews, further strengthening the quality of the study. Member checking ensures that the researcher’s interpretations accurately reflect the participants’ experiences and perspectives, thereby enhancing the validity of the study. This practice can be considered one of the methodological strengths of the study.

The current study has also some limitations that need to be considered. First, a limitation may be related to the size of the participant sample. The sample consisted of only nine nurses, a number that may be seen as a limitation in data collection. To challenge this limitation, the researchers posed follow-up questions during the interviews, thus offering the participants the opportunity to provide rich descriptions of their experiences with end-of-life care. Even though the sample consisted of only nine nurses, these participants reflected on and described their everyday work experiences. The participants’ rich descriptions were evaluated as possessing sufficient information power [ 41 ], thereby enhancing the overall quality of dialogues during interviews– a notable strength.

Second, the findings are limited to these nine participants and their personal work experiences in four different Norwegian nursing homes. This means that the sample is small and context dependent, which may limit the transferability and generalisability of the findings.

A third limitation pertains to the potential influence of the chosen theoretical framework on researchers’ preunderstanding during data analysis. To avoid bias, the theoretical framework was introduced at the end of the data analyses and after the coding process was conducted. The theoretical framework contributed to situating the knowledge from the empirical data into theoretical knowledge and vice versa. However, to be certain about interpretations and knowing that the qualitative nature of the study cannot completely exclude the impact of the preunderstanding on the analysis of the data, both researchers were aware of their theoretical preunderstanding and tried not to make conclusions beforehand.

The ethics of care framework provides opportunities for nurses to analyse their own caring activities during the provision of end-of-life care to nursing home residents. The exploration of the moral dimension of the provision of end-of-life care, utilising Tronto’s theory, revealed that moral qualities, such as attentiveness, responsibility, competence, responsiveness, and solidarity are influenced to a certain extent by nurses’ autonomy. What is crucial for the provision of competent end-of-life care is the nurses’ awareness of acting properly in accordance with the moral qualities to each of the phases of caring. Therefore, to provide competent end-of-life care nurses must be attentive to residents’ care needs, take on the responsibility for the care provided to ensure that residents’ needs are met, provide competent care based on knowledge, skills and values and assess how residents respond to the care provided. In other words, this is the basic nursing process in action, and this problem-solving approach is needed for the provision of competent end-of-life care.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Oslo Metropolitan University.

Abbreviations

Participant in interview [number of the individual interview

Participant [number] in Focus Group interview

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Acknowledgements

We would like to express gratitude to the nurses who participated in this study, thereby contributing to the data collection. Additionally, we extend our thanks to the Oslo Metropolitan University Library for granting approval and for their support in covering the publication fee of this article.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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D.L. contributed to the study conception, data collection, and analysis, and wrote the main manuscript text. R.G. was involved in data collection, analysis, reflection, and manuscript writing. D.L. was responsible for administrative work related to journal submission and was also involved in reviewing and editing the manuscript. R.G. and D.L. have read and approved the manuscript before submission.

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The Norwegian Agency for Shared Services in Education and Research approved the study protocol (Sikt/Ref. number 360657) and concluded that the study was not subject to the Norwegian Health Research Act (LOV-2008-06-20-44; https://lovdata.no/dokument/NL/lov/2008-06-20-44 ). An English version of the Norwegian Health Research Act can be found at: https://www.uib.no/en/med/81598/norwegian-health-research-act . This study does not aim to get insight into participants’ health status, sexuality, ethnicity, and political affiliation (sensitive information), therefore, no additional approval from a local ethics committee or institutional review board (IRB) was necessary to be obtained to conduct the study. This study was performed according to principles outlined in the Declaration of Helsinki, and in accordance with Oslo Metropolitan University’s guidelines and regulations. Data were kept confidential and used only for this research purpose. The researchers provided verbal and written information about the study. Informed consent was obtained from all participants prior data collection.

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Gilbert, R., Lillekroken, D. Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study. BMC Nurs 23 , 216 (2024). https://doi.org/10.1186/s12912-024-01865-5

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So, Should You Trust Andrew Huberman?

The wildly popular podcaster and scientist claims he can help you live a healthier life. but we should think of him as a dr. oz type..

We live in a world of misinformation and fearmongering. Headlines bombard us with claims about cancer, chronic illness, the dangers of our food, “toxins.” Health anxiety seems to be at an all-time high.

Enter Andrew Huberman. He has a Ph.D. in neuroscience, with research expertise in optic nerve signaling. His wildly popular podcast claims to make science more understandable while giving you simple, “zero-cost” protocols for your health. The appeal Huberman offers is obvious: control over our health when it feels like we have none.

In reality, his podcast is focused on pseudoscience: He often makes claims that appear scientific but lack evidence, plausibility, and validity. Pseudoscience presents unsubstantiated conclusions, but it can be incredibly hard to distinguish from conclusive evidence. It contains grains of truth, but those grains of truth are exaggerated beyond the point of usefulness, even so far as to lead away from the truth. Huberman fills his podcast with confident displays of pseudoscience, topped with the appeal to authority he garners by regularly repeating his academic credentials to gain your trust.

The March 25 New York magazine cover story laid out a stunning tale about Huberman—that he was seeing six women simultaneously. Further, that story says, his lab at Stanford, “according to knowledgeable sources, barely exists.” Whether or not you care about infidelity and hosts’ personal lives, listeners to Huberman’s podcast should not sweep aside the contents of the New York mag story as mere gossip. As a biomedical scientist who has spent a lot of time considering what Huberman has to say, I can tell you that he is leading his podcast audience astray, too.

If you’re not a fan of his work, let me give you an indication of what his show is like. His episodes are exceedingly long, often over 2 hours. He fills them with scientific-sounding jargon, stringing together names of genes or proteins that a listener might hear and think, “Hey, he is using complex lingo, he must really know his stuff.” But jargon gives the illusion that Huberman intimately understands topics he doesn’t. (Scientists, for all their knowledge, are trained to know a lot about a relatively narrow field.) He inserts widely held generalizations—sleep is important, exercise is beneficial, and lifestyle can impact our health—to add legitimacy. If you agree with some of his statements, then why not everything?

Huberman frequently supports his assertions by saying things like “supported by peer-reviewed research,” or “science-backed,” and he includes links to papers in show notes. But it’s important to know that not all studies are created equal. Some studies are done on cells in a Petri dish ( in vitro ), or on animals ( in vivo ). In others, scientists ask people to fill out surveys recalling details from their days or weeks, or they observe human participants’ behavior in a lab. Neither of these methods creates particularly reliable results for humans. Other studies are controlled clinical research—like studies where some people receive a treatment, others a placebo. That is the kind of research you want to see before undertaking a health intervention. But even there, study design matters. It dictates how strong the data can be, and how much you can conclude.

Think about yourself, and then think about a layer of cells growing on a piece of plastic. There’s a big difference. Things that happen to cells in a plastic dish—say, when you add an ingredient found in a dietary supplement to them—aren’t representative of what will happen to a person consuming those supplements. We have to consider the physiological relevance and limitations of a study when we analyze the data (findings which are often used by scientists to determine further avenues of exploration, or to add, piecemeal, to the picture of how biology works).

Huberman often doesn’t do that. Instead, he extrapolates non-human data to people, using in vitro studies, or in vivo studies on non-human animals, to make prescriptive recommendations for lifestyle changes. He cherry-picks weak or irrelevant studies while discarding larger and more robust studies that demonstrate something different. If you’re not conducting research or regularly dissecting scientific studies, this might not be obvious. But to scientists, it is.

Take an episode on how cortisol and adrenaline can boost energy and immune function . He calls sleep “the ultimate reset” for the body following a stressful day (who can disagree?). Then, he goes on to tout ashwagandha supplements as basically a miracle panacea for stress. According to him, it “has a profound effect on anxiety,” and can reduce stress, cortisol, and even depression. He goes further, extrapolating cellular mechanisms to suggest ashwagandha may trigger a range of downstream effects, improving vision, cardiovascular health, sleep, and memory. These are a lot of bold claims.

Upon my own literature review, I found in vitro studies using rat neurons , rat studies that included behavior assessment, and some other in vitro studies . Human data provides a conflicting and more limited picture: A 2012 study that suggested it can improve chronic stress had just 64 participants. A meta-analysis, pooling data from five small randomized controlled trials , found that it might help with sleep, particularly in people with insomnia, but found “no significant effect on quality of life.” Another noted the supplement “significantly reduced anxiety,” which refers to statistical significance, not clinical relevance. If you look at the data, the sample sizes are small and outcomes rely on self-reported symptoms. The overall assessment concluded that there is weak confidence in the link to ashwagandha, which warrants “further high-quality studies.” I wouldn’t suggest anyone bank their health on this stuff. It also has documented evidence of harm . But Huberman tells his listeners that ashwagandha “comes through as the heavy hitter,” alongside a liability caveat: “You’re responsible for making sure [supplements are] safe for you if you decide to use them.”

In another episode, there was an error so obvious that it would have been comical if it hadn’t been so misleading. Huberman was joined by Robert Lustig, a pediatric endocrinologist with a history of making hyperbolic claims about nutrition, like calling sugar a “poison.” Lustig references a study to claim ultraprocessed food consumption inhibits bone growth. Huberman asks, “Was this in vitro or in vivo?,” to which Lustig replies, “In vivo.” Huberman exclaims: “So these are people that are eating high amounts of highly processed food; exactly how did [the researcher] find those in the Middle East?” Lustig answered: “In Israel.”

While “in vivo” can technically refer to a study done in people—we are animals— the study Lustig was referring to was actually in rats. To claim that the results have a direct relevance to people is a wild misinterpretation of data. (And the truth around ultraprocessed foods is complex .) But Huberman presents his conclusions as if they are facts, and so his listeners trust him.

Huberman also uses false balance: the fallacy that equal and opposite sides always exist. Take his thoughts on fluoride . While fluoride has been used for decades to prevent dental disease , Huberman gives the impression that there is an ongoing debate among experts about its use, and reasons for his listeners to be careful of how much fluoride-containing tap water they consume .  During his oral health podcast episode, Huberman undermines consensus data on fluoride, endorses fluoride-free toothpastes as well as a yerba mat é tea company that uses fluoride-free water ( and which he is a business partner of ), and cites a dentist who spreads fear about fluoride as his expert reference. Huberman positions this for his listeners as “information to make the best decision,” as though we all need to be carefully thinking about our fluoride levels.

An episode he did on colds and flu was so littered with falsehoods that I dissected it in a four-part newsletter on my Substack, ImmunoLogic. He advertised the episode as “science-backed” methods to prevent colds and the flu, but he announced he does not get the flu vaccine, the No. 1 thing that prevents flu . A scientist waving aside the most science-backed measure to prevent the flu is not providing credible advice. Huberman claimed that the flu vaccine can be “completely ineffective” if it does not protect against the strain of flu circulating that year, noting that he often does not get the shot himself. Here’s how those vaccines actually work, though: Flu vaccines include four different flu strains: two influenza A and two influenza B viruses, which are selected from flu virus surveillance. While there are more possible flu virus strains, vaccination still provides broad protection against illness, hospitalization, and death from any flu viruses because of the polyclonal memory immunity we generate . Even if you get infected with a different strain of the flu, if you’ve been vaccinated, it will make illness easier to weather than it would have been otherwise.

From basic Immunology 101 to how vaccines work, virology, and the public health impact of influenza, that episode was littered with falsehoods. He even—in that same episode—botched the relationship between exercise, cortisol, and immune function , and said antibodies are produced by stem cells in bone marrow. They are actually produced by B cells in our lymphoid organs, a fact which is fundamental to immunology. (He publicly replied in an Instagram comment that he consulted three MDs for the podcast episode , which is not actually that relevant; doctors know a lot—but they’re not inherently experts in immunology.)

This brings us to the conflicts of interest: his sponsors. Having a paid sponsor isn’t a disqualifier in and of itself. But when your financial conflicts of interest seem to dictate your content, it should be. After dismissing legitimate data in the flu episode, his lengthy “science-backed” discussion to prevent colds and the flu boiled down to an extended commercial for taking supplements. Huberman is sponsored by Athletic Greens, which sells a supplement powder called AG1, which promises to “support immunity” and “promote gut health.” One easily gets the idea listening to Huberman that taking supplements of all sorts is very, very beneficial to your health.

But steering your listeners into the wide and unregulated world of supplements is bad. At best, most supplements do nothing. At worst, they can be harmful, potentially fatal . Supplements, thanks to a fun legal loophole, can be sold without the burden of safety and efficacy data that Food and Drug Administration–approved medications must generate. Aside from certain instances where a specific supplement would be recommended by a doctor for a medical issue, there is no body of evidence to support supplements. No credible scientist should repeatedly tell you to buy and consume a special supplement drink, just in case.

The problem with health misinformation is that it often misleads people to do things that are ineffective or potentially harmful—while discouraging them from evidence-based interventions. Those who believe in one piece of health misinformation are more likely to believe others. There is a direct relationship between wellness behaviors like buying supplements and believing medical conspiracies. Though, yes, Huberman actively promotes medical conspiracies too. On the episode with Lustig, he suggests that 93 percent of Americans are “inflamed” and have leaky gut, a pseudoscience diagnosis promoted by the wellness industry. ( I have discussed the issues with that here .) His endorsement will only propagate that misinformation.

Biology is complex, and we don’t have every answer to everything. Issues with our health care system compound the frustration, and even desperation. But wellness products aren’t a solution: They are an exploitation. Wellness influencers like Huberman pit their solutions against conventional science and medicine to sell unproven interventions that are expensive, have no benefit, can lead you to delay real medical treatment, or be actively harmful.

As a scientist and science communicator, it saddens me. Huberman could be improving health outcomes, science literacy, and critical thinking, but instead, he chased fame and wellness fortune, à la Mehmet Oz. The $5.6 trillion global market of wellness persuaded Huberman to contribute to misinformation, not combat it.

Huberman has a massive following and influence. He doesn’t use the responsibility as someone trained in science to be accurate and reliable. Instead, he promotes pseudoscience while eroding public trust in legitimate science and robust scientific agencies.

There isn’t an easy fix. We must shift the paradigm. Too many people confuse celebrity with expertise. Rebuilding trust and science literacy will be an ongoing effort, especially when falsehoods spread faster than facts. Further, we need people to understand that scientific expertise doesn’t transfer to every field. If someone presents themselves asan expert in too broad a topic range or topics outside their expertise, be wary. We need good scientists and medical professionals sharing robust data, and we need resources to do that, and for those with platforms and influence to elevate it. In the meantime, listeners should be wary of anyone rocketing up the podcast charts by sharing easy, simple fixes.

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