Professional Practice in Health: Towards an Essential Integration of Vocation, Ethics and Social Skills. A systematic review
Main Article Content
Abstract
Background: Contemporary healthcare practice, marked by technological advances and increasing complexity, requires care beyond mere technical competence. Vocation, professional ethics, and social skills, such as empathy and assertiveness, are fundamental pillars of comprehensive, person-centred care.
Objectives: This systematic literature review analysed the existing scientific literature on the interrelationship between vocation, ethics, and social skills (with an emphasis on empathy, assertiveness, and compassion) in healthcare professionals. The aim was to identify the most relevant findings and their implications for training and professional practice.
Methods: A systematic review was conducted following the PRISMA 2020 guidelines. The search was carried out in March 2025 on the EBSCOhost platform (accessing 23 databases), using key terms related to vocation/purpose, healthcare professions, and social/emotional skills. Eligibility criteria were applied to select articles published in peer-reviewed academic journals, with full text available in English, Spanish, or Portuguese. Information from the included studies was extracted and synthesised narratively and through thematic categorisation.
Results: Of 947 identified records, 24 studies met all the inclusion criteria. Qualitative analysis of these articles identified seven main thematic categories: 1) Vocation and Professional Motivation; 2) Educational Interventions and Models; 3) Ethics, Spirituality and Humanisation of Care; 4) Burnout, Self-Care and Resilience; 5) Cultural and Sociological Aspects; 6) Tensions between Technology and Human Values; and 7) Theoretical/Conceptual Studies. These findings highlight the interdependence of the constructs studied and their multifaceted impact on healthcare practice.
Conclusion: Vocation, ethics, and social skills are interconnected and essential pillars in healthcare professions, whose development and maintenance depend on a complex interaction of individual, educational, systemic, and contextual factors. Although vocation acts as a strong initial motivator, its persistence requires a deep sense of meaning, self-care strategies, resilience and a work and training environment that actively recognises and supports the well-being of professionals. Comprehensive educational approaches are needed that deliberately cultivate these dimensions, addressing the tension between technological advances and fundamental human values, to ensure ethical, competent, humanised and sustainable professional practice.
Article Details
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References
2. Dragan IF, Dalessandri D, Johnson LA, Tucker A, Walmsley AD. Impact of scientific and technological advances. European Journal of Dental Education. 2018;22(S1):17-20. doi:https://doi.org/10.1111/eje.12342
3. Meen T-H, Matsumoto Y, Hsu K-S. Selected Papers from 2019 IEEE Eurasia Conference on Biomedical Engineering, Healthcare and Sustainability (IEEE ECBIOS 2019). International Journal of Environmental Research and Public Health. 2020;17(8):2738.
4. Hays RB, Ramani S, Hassell A. Healthcare systems and the sciences of health professional education. Advances in Health Sciences Education. 2020/12/01 2020;25(5):1149-1162. doi:10.1007/s10459-020-10010-1
5. Faulkner E, Spinner DS, Ringo M, Carroll M. Are Global Health Systems Ready for Transformative Therapies? Value in Health. 2019;22(6):627-641. doi:10.1016/j.jval.2019.04.1911
6. Naidu T, Ramani S. Transforming global health professions education for sustainability. Medical Education. 2024;58(1):129-135. doi:https://doi.org/10.1111/medu.15149
7. Hernández-Xumet J-E, García-Hernández A-M, Fernández-González J-P, Marrero-González C-M. Vocation of Human Care and Soft Skills in Nursing and Physiotherapy Students: A Cross-Sectional Study. Nursing Reports. 2025;15(2):70.
8. Cerdio Dominguez D, Millán Zurita P, Cedillo Urbina AC, Félix Castro JM, Del Campo Turcios EC. Social intelligence, an elementary competence in the development of the doctor-patient relationship. Proceedings of Scientific Research Universidad Anáhuac Multidisciplinary Journal of Healthcare. 07/22 2021;1(1):52-61. doi:10.36105/psrua.2021v1n1.07
9. Ayala Garcia RJ, Huamaní Huamán LG. Medical vocation, beyond the duty of care: a review of literature from ethical and philosophical perspectives: Vocación médica, más allá del deber de cuidar: Revisión de la literatura desde el aspecto ético y filosófico. Revista de la Facultad de Medicina Humana. 12/06 2023;23(3):156 - 161. doi:10.25176/RFMH.v23i3.5635
10. Kulju K, Stolt M, Suhonen R, Leino-Kilpi H. Ethical competence:A concept analysis. Nursing Ethics. 2016;23(4):401-412. doi:10.1177/0969733014567025
11. Spitzer W, Ed S, and Allen K. From Organizational Awareness to Organizational Competency in Health Care Social Work: The Importance of Formulating a “Profession-in-Environment” Fit. Social Work in Health Care. 2015/03/16 2015;54(3):193-211. doi:10.1080/00981389.2014.990131
12. Hernández-Xumet J-E, García-Hernández A-M, Fernández-González J-P, Marrero-González C-M. Beyond scientific and technical training: Assessing the relevance of empathy and assertiveness in future physiotherapists: A cross-sectional study. Health Science Reports. 2023;6(10):e1600. doi:https://doi.org/10.1002/hsr2.1600
13. Mosalanejad L, Abdollahifar S. An investigation of the empathy with patients and association with communicational skills and compliance of professional ethics in medical students of Jahrom University of Medical Sciences: a pilot study from the south of IRAN. Future of Medical Education Journal. 2020; 10(1):28-31. doi:10.22038/fmej.2020.41823.1280
14. Gutiérrez Fernández R. La humanización de (en) la Atención Primaria. Revista Clínica de Medicina de Familia. 2017;10:29-38.
15. H MRCA, J Enrique Empatía, relación médico-paciente y medicina basada en evidencias. Med interna Méx [online]. 2017;33(3):4.
16. Rodríguez Blanco S, Almeida Gómez J, Cruz Hernández J, Martinez Ávila D, Pérez Guerra JC, Valdés Miró F. Relación médico paciente y la eSalud. Revista Cubana de Investigaciones Biomédicas. 2013;32:411-420.
17. Fotaki M. Why and How Is Compassion Necessary to Provide Good Quality Healthcare? International Journal of Health Policy and Management. 2015;4(4):199-201. doi:10.15171/ijhpm.2015.66
18. Tehranineshat B, Rakhshan M, Torabizadeh C, Fararouei M. Compassionate Care in Healthcare Systems: A Systematic Review. Journal of the National Medical Association. 2019/10/01/ 2019;111(5):546-554. doi:https://doi.org/10.1016/j.jnma.2019.04.002
19. Nielsen CL, Lindhardt CL, Näslund-Koch L, Frandsen TF, Clemensen J, Timmermann C. What is the State of Organisational Compassion-Based Interventions Targeting to Improve Health Professionals' Well-Being? Results of a Systematic Review. Journal of Advanced Nursing. 2025;81(5): 2246-2276. doi:https://doi.org/10.1111/jan.16484
20. Taylor A, Bleiker J, Hodgson D. Compassionate communication: Keeping patients at the heart of practice in an advancing radiographic workforce. Radiography. 2021/10/01/ 2021;27:S43-S49. doi:https://doi.org/10.1016/j.radi.2021.07.014
21. Bray L, O'Brien MR, Kirton J, Zubairu K, Christiansen A. The role of professional education in developing compassionate practitioners: A mixed methods study exploring the perceptions xof health professionals and pre-registration students. Nurse Education Today. 2014/03/01/ 2014;34(3):480-486. doi:https://doi.org/10.1016/j.nedt.2013.06.017
22. Marckmann G, Schmidt H, Sofaer N, Strech D. Putting Public Health Ethics into Practice: A Systematic Framework. Methods. Frontiers in Public Health. 2015-February-06 2015;Volume 3 - 2015. doi:10.3389/fpubh.2015.00023
23. Thomas JC, Schröder-Bäck P, Czabanowska K, et al. Creating codes of ethics for public health professionals and institutions. Journal of Public Health. 2025;doi:10.1093/pubmed/fdae308
24. Athanasopoulos P, Tahzib F. The process of developing a framework for code of ethics. European Journal of Public Health. 2024;34(Supplement_3). doi:10.1093/eurpub/ckae144.1508
25. Alshareef MF, AF. How Preceptor Behaviour Shapes the Future of Medical Professionals. Adv Med Educ Pract. 2025;16:9. doi:https://doi.org/10.2147/AMEP.S481620
26. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71
27. Eley RE, Diann; Rogers‑Clark, Cath. Reasons for Entering and Leaving Nursing: An Australian Regional Study Nov. 2010, . Australian Journal of Advanced Nursing. 2010;28(1). doi:10.37464/2010.281.1688
28. Laura SM, Friedrich S, Mehdi G, Céline B. Calling: Never seen before or heard of – A survey among Swiss physicians. WORK. 2022;72(2):657-665. doi:10.3233/wor-205282
29. Loxterkamp D. Doctors’ Work: Eulogy for My Vocation. The Annals of Family Medicine. 2009; 7(3):267-268. doi:10.1370/afm.986
30. McManus IC, Jonvik H, Richards P, Paice E. Vocation and avocation: leisure activities correlate with professional engagement, but not burnout, in a cross-sectional survey of UK doctors. BMC Medicine. 2011/08/30 2011;9(1):100. doi:10.1186/1741-7015-9-100
31. Chen H, Liu C, Wu K, Liu C-Y, Chiou W-K. The effects of loving-kindness meditation on doctors’ communication anxiety, trust, calling and defensive medicine practice. BioPsychoSocial Medicine. 2024/05/10 2024;18(1):11. doi:10.1186/s13030-024-00307-7
32. Patestos C, Anuforo P, Walker DJ. Incorporating holism in nursing education through the Integrative Student Growth Model (ISGM). Applied Nursing Research. 2019/10/01/ 2019;49:86-90. doi:https://doi.org/10.1016/j.apnr.2019.05.001
33. Létourneau D, Goudreau J, Cara C. Humanistic caring, a nursing competency: modelling a metamorphosis from students to accomplished nurses. Scandinavian Journal of Caring Sciences. 2021;35(1):196-207. doi:https://doi.org/10.1111/scs.12834
34. Hur YL, K. Identification and evaluation of the core elements of character education for medical students in Korea. Journal of Educational Evaluation for Health Professions. 2019;16(21). doi:https://doi.org/10.3352/jeehp.2019.16.21
35. Kangasniemi M, Haho A. Human love – the inner essence of nursing ethics according to Estrid Rodhe. A study using the approach of history of ideas. Scandinavian Journal of Caring Sciences. 2012; 26(4):803-810. doi:https://doi.org/10.1111/j.1471-6712.2012.01010.x
36. Dahan S, Ducard D, Caeymaex L. Apology in cases of medical error disclosure: Thoughts based on a preliminary study. PLOS ONE. 2017;12(7): e0181854. doi:10.1371/journal.pone.0181854
37. Mahmoodishan G, Alhani F, Ahmadi F, Kazemnejad A. Iranian nurses' perception of spirituality and spiritual care: a qualitative content analysis study. J Med Ethics Hist Med. 2010;3:6.
38. Andrews H, Tierney S, Seers K. Needing permission: The experience of self-care and self-compassion in nursing: A constructivist grounded theory study. International Journal of Nursing Studies. 2020/01/01/ 2020;101:103436. doi:https://doi.org/10.1016/j.ijnurstu.2019.103436
39. Tempski P, Arantes-Costa FM, Kobayasi R, et al. Medical students’ perceptions and motivations during the COVID-19 pandemic. PLOS ONE. 2021; 16(3):e0248627. doi:10.1371/journal.pone.0248627
40. Tei S, Becker C, Sugihara G, et al. Sense of meaning in work and risk of burnout among medical professionals. Psychiatry and Clinical Neurosciences. 2015;69(2):123-124. doi:https://doi.org/10.1111/pcn.12217
41. Brown T, Yu M-L, Hewitt AE, Isbel ST, Bevitt T, Etherington J. Exploring the relationship between resilience and practice education placement success in occupational therapy students. Australian Occupational Therapy Journal. 2020;67(1):49-61. doi:https://doi.org/10.1111/1440-1630.12622
42. Mulligan JM, and Garriga-López A. Forging compromiso after the storm: activism as ethics of care among health care workers in Puerto Rico. Critical Public Health. 2021/03/15 2021;31(2):214-225. doi:10.1080/09581596.2020.1846683
43. Bastias F, Giménez I, Fabaro P, Ariza J, Caño-Nappa MJ. Social representations of nurses. Differences between incoming and outgoing Nursing students. Invest Educ Enferm. Feb 2020;38(1)doi:10.17533/udea.iee.v38n1e05
44. Redinger M. Enchantment in psychiatric medicine. Asian Journal of Psychiatry. 2020/01/01/ 2020;47: 101823. doi:https://doi.org/10.1016/j.ajp.2019.10.003
45. Jones AH. Images of physicians in literature: medical Bildungsromans. The Lancet. 1996;348(9029):734-736. doi:10.1016/S0140-6736(96)07315-1
46. Bryan-Brown CW, Dracup K. Professionalism. American Journal of Critical Care. 2003;12(5):394-396. doi:10.4037/ajcc2003.12.5.394
47. Betzler RJ. How to clarify the aims of empathy in medicine. Medicine, Health Care and Philosophy. 2018/12/01 2018;21(4):569-582. doi:10.1007/s11019-018-9833-2
48. Vearrier L. Enlightened Self-interest in Altruism (ESIA). HEC Forum. 2020/06/01 2020; 32(2):147-161. doi:10.1007/s10730-020-09406-8
49. Bradshaw A. Charting some challenges in the art and science of nursing. The Lancet. 1998; 351(9100):438-440. doi:10.1016/S0140-6736(97)09044-2