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Explor Res Clin Soc Pharm
Explor Res Clin Soc Pharm
Exploratory Research in Clinical and Social Pharmacy
2667-2766
Elsevier

S2667-2766(24)00094-5
10.1016/j.rcsop.2024.100497
100497
Article
Performance, interpersonal relationships and professional satisfaction: determinants to support pharmaceutical reengineering
Araújo-Neto Fernando de Castro fcaneto0@gmail.com

Dosea Aline Santana alinedosea2@gmail.com

Lyra-Jr. Divaldo Pereira de lepfs.ufs@gmail.com
⁎
Health Sciences Graduate Program. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
⁎ Corresponding author at: Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária “Prof. José Aloísio Campos”, Avenida Governador Marcelo Déda Chagas S/N, Jardim Rosa Elze, São Cristóvão, Sergipe 49100-000, Brazil. lepfs.ufs@gmail.com
22 8 2024
9 2024
22 8 2024
15 1004976 6 2024
31 7 2024
21 8 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).
Professionalism represents the ethical contract that binds professionals and society. Its technical aspects, such as the professional practice model, form the foundation for attitudinal and behavioral characteristics, including the fiduciary relationship between pharmacists and patients. Despite significant interest in the topic, contextualizing professionalism proves to be a challenging endeavor, relying on collaboration among formal leaders, academics, and practitioners in the field. Consequently, defining, understanding, teaching, and evaluating pharmaceutical professionalism contribute to shape societal perceptions and the understanding of pharmacists and students, who may occasionally struggle to grasp the underlying rationale behind professional practices. Moreover, contextualizing professionalism entails addressing various challenges, such as fostering support for professionalism and its adaptation, which encompasses pharmacists' performance across diverse clinical services, their interpersonal interactions with patients, families, communities, and fellow healthcare professionals, as well as personal job satisfaction amidst obstacles as job insecurity, ethical dilemmas, and compromised autonomy.
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pmc1 Introduction

According to the literature, the professions emerged from the evolution of social interactions between man and work.1, 2, 3 Professionals are those who use knowledge there is unreachable to the public and produce consumer goods and services due to society demands.3, 4, 5, 6. Professions such as pharmacy and medicine are also characterized by some elements, for example, autonomy, self-regulation, and code of ethics.1,7, 8, 9, 10, 11, 12

As an alternative to this concept, professionalism came up to organize the division of labor and define how the professions should use their knowledge, abilities, and competencies to consolidate their interests and control the provision of services.3,9,12 The literature highlights that there is no consensus between these concepts.8,10,13 Professionalism is interpreted in different ways.12,14 Besides the definition of how professionals use their knowledge in exchange for autonomy, there are definitions that explore the theme from behaviors and attitudes that are taught and preserved through the professional career.14

In this context, professionalism is characterized by responsibility, honor, pride, and altruism.10,12 The professional identity emerges as an allied, because of the interaction between the person and the profession, and it is formed in the professional socialization.8,14, 15, 16, 17 Beyond the gain of technical competencies, people re-signify their personal identities incorporating elements and attitudes of the profession, which ends in the sense of belonging and in the action before ethical demands and dilemmas.8,14 To pharmacists, the challenges are in how professionalism can be contextualized to help the re-signification of the professional practice.

1.1 Contextualization of pharmacy professionalism

In Pharmacy, the interest in professionalism has intensified based on the philosophical conception that the model of professional practice should be centered on the patient.8,18,19 The call for the professional resocialization of pharmacists emerged from the expectation that professionalism would be a moral compass for these professionals no matter what.10 Leaders of this profession, academics, and practitioners should search for alternatives that enable the professional practice supported by these values.

Historically, professionalism in pharmacy has been questioned through some fragilities as the subordination of pharmacists to other professionals, anti-ethical interests on the drugs commerce, and loss of ownership monopoly of community pharmacies. Another factor is the professional identity crisis that was intensified since the industrialization of medicines which submitted the pharmacist to sellers in detriment of the role of clinical decision maker.7,20, 21, 22, 23, 24

In previous studies of our research group, we investigated sensitive topics to professionalism that have an impact in scenarios of professional devaluation and dissatisfaction of pharmacists.7, 8, 9,13,20,25,26,112 To bring up this theme makes possible to students, academics, formal leaders, and practitioners be sensitized and re-signify attitudes that strengthen how the professionalism is operationalized from the social role of the profession, with a clinical focus on academic formation and strategies to strengthen the autonomy and self-regulation of pharmacists. Thus, it is possible to suggest that the pharmaceutical professionalism is contextualized through four elements: definition, how it is understood, how it is taught, and how it is evaluated.8,10,13

For Pharmacy, professionalism is defined by the fiducial relationship between pharmacists and patients.8,27, 28, 29 In pursuit of this objective, pharmacists demonstrate responsibility, ethics, proper communication skills, integrity, and a profound sense of professional pride. Moreover, professional conduct entails autonomy, adherence to appropriate clothing, self-regulation, and the embodiment of leadership qualities. Within academic discourse, definitions are systematically delineated using scientific frameworks such as the umbrella model, bicycle wheel model, or pyramid model, among others.27,29,30

Those definitions argue that the focus of the professional practice should no longer be on the drug (product), but on the patient, through the provision of services.27 Although this philosophy is appliable today, most of this proposals were described between 2000 and 2011, being restricted to pharmaceutical education and based on the reality of countries such as the United States.8,10,13 Therefore, there is a suppressed demand for a broader definition of professionalism that includes realities where the clinical practice is less consolidated, as in South America and in the Middle East.7,20,31,32

Besides that, it is necessary to understand the perceptions of pharmacists and students about professionalism.7,33 Although the definitions proposed by professional organizations are emphatic in assuming that the core of the profession is patient care, pharmacists and students often disagree about what characterizes professionalism and even the responsibilities of pharmacists in health services.9,15,34 Indeed, professionalism elucidates how the field of Pharmacy is perceived differently, and depends on cultural, political, and attitudinal factors among professionals.

After these stages, teaching professionalism is also recommended.8 Such teaching occurs during the professional socialization where students are encouraged to develop behaviors as part of the competencies of professional practice. In the context of the professional resocialization to patient care, it would be important that pharmacists were also submitted to these strategies. Nevertheless, the literature says almost nothing about how such behaviors could be developed among pharmacists that are already inserted in the job market.8,35

Currently, the teaching of professionalism started to joint elements such as professional identity formation and the remediation of professionalism.36, 37, 38 The focus of these initiatives helps the formation of individuals that act like professionals, correcting non-professional behaviors.38, 39, 40 The professional identity formation is a longitudinal process in which the starting point is the professionalism. Therefore, it is broader and aggregates the values, culture, and ancestry of individuals subject to the process.38,41 These strategies must be standardized and proposed in scenarios that make them reproducible, faithful to the guiding principles of the profession and sustainable. Whether through professional or occupational socialization, the formation of authentic, autonomous, and responsible identities should be close to the ideals recommended in the definitions on the subject.8

Finally, the pharmacist or student is evaluated regarding their opinions or attitudes before moral or ethical dilemmas and based on elements that define professionalism.42,43 The most common form of implementation of studies on these perceptions is through frameworks of values, behaviors or attitudes. Assessments are carried out using different tools, such as self-report, direct observation, clinical meetings, simulation, and opinion of patients, managers or mentors.13,43

2 Performance, interpersonal relationships and professional satisfaction: determinants to support pharmaceutical reengineering

Starting from the contextualization of professionalism, it is also possible to approach and understand the operational challenges that Pharmacy faces in the 21st century, advocating for the restructuring of this scenario through collaborative efforts among various groups within the professional community, including formal leaders, academics, and practitioners. In community pharmacies, for example, pharmacists have been divided between guiding their patients, documenting this practice, and doing tasks that are originate from ethical grooming.7,44, 45, 46 On behalf of employability, professional identity is stained with the lack of identification with certain areas of activity, absenteeism, and the social ignorance regarding the pharmacist's duties, attitudes, and behaviors.47, 48, 49, 50, 51, 52

Coming from the theory of total quality, reengineering symbolizes structuring the execution of work processes, on behalf of organizational development.53, 54, 55, 56 In this proposal, the process is determined through the professional's performance, interpersonal relationships with other professionals and patients, as well as the pharmacist's satisfaction with their work. Therefore, in addition to the contextualization of professionalism, the demand for its operationalization is considered, which includes the various challenges that are imposed in the consolidation of the pharmaceutical role as a caregiver.9,57

2.1 Performance

Performance comprehends the work process of pharmacists. That is, how activities are carried out in health services, with emphasis on their structurers, processes, and outcomes.58, 59, 60. The ontology of work of these professionals is the patient care and the pharmaceutical care, through its components of practice; it is the re-professionalization of pharmacy towards this objective.61, 62, 63 The components of the work process are the work itself, that is, the service that is conducted; the work tools, and the instruments of work.64, 65, 66 Such division was always well defined when comes to nursing or medicine, where there is no doubt about the patient be the aim of the work.2,67 In pharmacy, historically, there was a switch of these principles, what provokes, until now, discussion among pharmacists regarding the propose of the profession: the drug or the patient.4,9,15,23

The success of pharmaceutical performance would be related to issues such as the development of drugs, the distribution process of drugs and other devices, and providing information to physicians and other health professionals.4,9,15,19 In countries like Brazil, there are regulated occupational areas that not even use the drugs as a work object. As an example, the water quality analysis and the ozone therapy. Nevertheless, about 80% of the 340,000 Brazilian pharmacists develop their activities in community pharmacies.68, 69., 70.

There is no demerit to the profession absorb occupational areas of technological or logistic scope. However, it is essential to the occupational survival of pharmacy that the clinical services are consolidated and integrated to health systems, as well as to stablish models that unify the activities related to the technology of drugs, the distribution process of these products, and the patient care.9,71,72

In this context, expand the clinical functions demands that pharmacists are ready to work in teams, provide services such as drug dispensing and pharmacotherapy review, and are also concerned about the clinical, economical and humanistic outcomes of their interventions.53,72, 73, 74, 75, 76, 77, 78, 79, 80 The literature reports indicators that determine the success of pharmacists in the most diverse health services.81, 82, 83 As an example, there are drug related problem solving, patient satisfaction, life quality, health education provision, drug reconciliation, and acceptance of pharmaceutical interventions by prescribers.82,83

With the demand for more qualified services, systems that do not work properly have been gradually replaced by other professions, or even suppressed by technology like the artificial intelligence.84,85 Other problematizations inherent to performance come from the absenteeism related to clinical responsibilities and dependency of other profession to evaluate the achievement of pharmaceutical interventions.4,48,86,87

Certainly, these questions are harmful to the efforts to operationalize professionalism and build the clinical professional identity of pharmacists.9,87 As strategies, regulating the market reserves, offering continuing education, revising curriculum guidelines, qualifying the faculty, and monitoring work and teaching conditions should be pointed out by professors, leaders, and workers. The effort must be collective and not restricted to individual aspirations or attitudes from some professionals before facilitators, but primary before the barriers inherent in any process of practice change.4,7,45,47,48

2.2 Interpersonal relationships

The interpersonal relationships are bounded to the training of clinical abilities and attitudes as communication and responsibility.88,89 As Pharmacy adapts to new models of practice, the pharmacists are more and more exposed to processes that evoke change of attitudes and generates conflicts among professional identities forged in a mechanicist paradigm.15,19,35,61

The relationship among pharmacists, patients, and other health professionals is frequently described in the literature.90, 91, 92 Currently, the interprofessional collaboration are encouraged by the World Health Organization, especially in primary care.93, 94, 95 Pharmacists that are insert in this context are fundamental to the effectiveness of health services, as they offer drug dispensing services, disease screening, and chronical conditions management.94 With the COVID-19 pandemic, there was a need for resizing the health systems, what brought more responsibility to these professionals in places such as community pharmacies and hospitals.20,94,96,97

However, in many cases, pharmacists tend to exempt themselves of functions that require interprofessional collaboration or care of patients, families, and community, nonetheless the positive outcomes related to their participation in multidisciplinary teams and shared decision making.4,18,35,48,74,98,99 Among the possible causes, there are pharmacists that consider their professional identity incompatible with the clinical responsibilities that the profession has been taking over.14,24 The excessive workload also impacts the interpersonal relationships and the quality of the professional performance.100 Pharmacists with exhaustive working hours tend to get angry with patients and other members of the team, besides feel disconnected from work.100

To secure the fulfillment of responsibilities of pharmacists balanced with health interpersonal relationships with patients and other health professionals, during the professional socialization, it is necessary to encourage students to interact with other professionals and work as a team.101,102 The clinical competency formation should stimulate the patient leading role, as well as thoughts about professionalism that must follow pharmacists during their entire career.103,104

2.3 Professional satisfaction

In Pharmacy, professional satisfaction has implications for the commitment of pharmacists with their work, and it is seen as a motivation to abandon the profession.105 The satisfaction of pharmacists with their work, according to the literature, is mostly influenced by their good relationship with patients, their professional autonomy, and their interactions with other professionals, therefore reflecting on the desire of promote improved services.4,86,105,106

Nevertheless, to demand revolutionary attitudes from professionals without concern about what they think about it would be irresponsible before the profound changes imposed by the division of work in health.54,106,107 Changes that remarkably strikes the pharmaceutical autonomy.7 Studies that comprehend perceptions of professionals about the implantation of Pharmaceutical Services regarding barriers and facilitators, raise questions that counterpoint thoughts that were approached in this topic.4,44,77,108

In this studies, important limitations to pharmaceutical practice are mentioned, whether in daily life or in catastrophic situations like the COVID-19 pandemic.7,20 Thus, burnout, alienation, and absenteeism use to be common issues among pharmacists. Obviously, this scenario brought losses to the professional performance, and a negative impact on interprofessional relationship and responsibilities that were assigned to these professionals in the last years.48,109, 110, 111

Such situation launches hypotheses about the population difficulty to recognize the pharmacist as a professional. This probably occurs, whether on purpose or not, because Pharmacy believes that isolate itself from the Health System is more appropriate, as it is different from other professions. However, decent working conditions, formal and attitudinal training facilitate its professional valuation and the change of this scenario.

3 Conclusion

In this commentary, Pharmacy professionalism was contextualized by its definition, the understanding of the topic by pharmacists and students, the teaching strategies, and their evaluation. By analyzing the current challenges faced by the profession, it is possible to infer that there is an uninterrupted call for the field of Pharmacy to subject its processes to continuous re-engineering, which can be determined based on the pharmacist's performance, their interpersonal relationships, and their professional satisfaction.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001 .

CRediT authorship contribution statement

Fernando de Castro Araújo-Neto: Writing – review & editing, Writing – original draft, Data curation, Conceptualization. Aline Santana Dosea: Writing – original draft, Visualization, Conceptualization. Divaldo Pereira deLyra-Jr.: Curation, Supervision, Review, Administration.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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