Impact of nurses' uniforms on patient and family perceptions of nurse professionalism

What motivates young Arab Muslim women to choose nursing as a profession: A cross-sectional study

AIM

This study examines the impact of nurse uniforms, the coronavirus pandemic, and the image of nurses and the nursing profession on the career choice of young Muslim Arab women in nursing, with a focus on policy implications.

BACKGROUND

The global nursing shortage poses significant challenges, including in Israel. Attracting young Muslim Arab women to nursing careers is vital. Understanding how nurse uniforms, the pandemic, and perceptions of nurses and the nursing profession shape their career decisions can inform policy interventions.

METHODS

A cross-sectional study utilized digital questionnaires administered to 200 Muslim Arab women aged 20-30 in Israel. The study adhered to the EQUATOR checklist for cross-sectional studies.

RESULTS

Only 29.2% of participants expressed interest in studying nursing. Findings revealed a positive correlation between the pandemic's impact and intention to pursue nursing. A linear regression analysis shows the impact of the white uniform, the image of nurses, and the image of the profession on the choice of a career in nursing.

DISCUSSION

The study emphasizes the significance of nurse uniforms, the image of nurses, and the image of the nursing profession in shaping young Muslim Arab women's career choices in nursing. Policy interventions should raise awareness about nursing roles, expand responsibilities, and highlight nurses' contributions to society.

CONCLUSION

Strategies to attract young Muslim Arab women to nursing careers should address nurse uniforms, the image of nurses, and the image of the nursing profession.

IMPLICATIONS FOR POLICY

Policy interventions should prioritize diversity, promote positive images of nurses and the nursing profession, and raise awareness of nursing roles and contributions among young Muslim Arab women.

A scoping review exploring people's perceptions of healthcare uniforms

BACKGROUND

Healthcare staff uniforms are a subject of debate in the UK, and this is particularly true in the case of less understood roles such as advanced nurse practitioners. Aim: This review explores what is known about people's perceptions of health professionals' uniforms.

METHOD

A mixed methods scoping review following the Joanna Briggs Institute (JBI) methodology. Five databases (CINAHL, ASSIA, PsycINFO, and EMBASE) and several search engines were searched. Eligible reports were peer-reviewed English-language studies using any methodology to explore people's perceptions of different uniforms for health professionals.

FINDINGS

Forty-six studies (mainly from North America) were included, presenting a variety of perspectives on the uniforms worn by doctors, nurses and other health professionals.

CONCLUSION

Culture and context likely influence how uniforms are understood. Practitioners should consider how this may affect communication with both patients and colleagues. What health professionals wear matters, particularly in relation to less well understood roles.

Characteristics of a good nurse as perceived by nurses

BACKGROUND

Nursing is a humanitarian and social field that provides health services. It combines science and art and has a rich history. Despite fundamental changes in the provision of medical services and nursing education, the concept of "good nurse" is still unclear.

PURPOSE

The purpose of this article is to investigate the characteristics of a good nurse from the nurses' perspective.

RESEARCH DESIGN AND METHOD

A qualitative study was applied using conventional content analysis. The participants were 30 nurses that selected with purposive sampling method. Data were collected through unstructured interviews and simultaneously analyzed via the conventional content analysis approach of Graneheim and Lundman.

ETHICAL CONSIDERATIONS

This study was approved by the Research Ethics Committee of Hormozgan University of Medical Sciences, Iran.

FINDINGS

The study revealed that personal characteristics (Adherence to ethical and human principles, Physical health, Attractive appearance, and Ability to communicate properly); and professional characteristics (knowledge - clinical skill - nursing roles) are essential to being a good nurse.

CONCLUSION

Coming to know the distinctive features of a good nurse as perceived by nurses themselves creates an opportunity for nurses to rethink their profession and to reflect on the characteristics of the good nurse.

Dress is a Fundamental Component of Person Perception

ACADEMIC ABSTRACT

Clothing, hairstyle, makeup, and accessories influence first impressions. However, target dress is notably absent from current theories and models of person perception. We discuss three reasons for this minimal attention to dress in person perception: high theoretical complexity, incompatibility with traditional methodology, and underappreciation by the groups who have historically guided research in person perception. We propose a working model of person perception that incorporates target dress alongside target face, target body, context, and perceiver characteristics. Then, we identify four types of inferences for which perceivers rely on target dress: social categories, cognitive states, status, and aesthetics. For each of these, we review relevant work in social cognition, integrate this work with existing dress research, and propose future directions. Finally, we identify and offer solutions to the theoretical and methodological challenges accompanying the psychological study of dress.

PUBLIC ABSTRACT

Why is it that people often agonize over what to wear for a job interview, a first date, or a party? The answer is simple: They understand that others' first impressions of them rely on their clothing, hairstyle, makeup, and accessories. Many people might be surprised, then, to learn that psychologists' theories about how people form first impressions of others have little to say about how people dress. This is true in part because the meaning of clothing is so complex and culturally dependent. We propose a working model of first impressions that identifies four types of information that people infer from dress: people's social identities, mental states, status, and aesthetic tastes. For each of these, we review existing research on clothing, integrate this research with related work from social psychology more broadly, and propose future directions for research.

Improving ambulance care for children suffering acute pain: a qualitative interview study

Background

Pain is a highly complex sensory and emotional experience. When a child suffers acute pain through illness or injury, they are often transported to hospital by ambulance. Pre-hospital pain management in children is poor, with 61% of children receiving suboptimal pain management. Consequences of poor pain management include the risk of developing post-traumatic stress disorder and altered pain perception. We aimed to identify clinicians’ perceptions of barriers, facilitators and potential improvements for the management of pre-hospital acute pain in children.

Methods

Qualitative face to face semi-structured recorded interviews were performed in one large UK ambulance service. Audio files were transcribed verbatim with thematic analysis used to generate themes. NVivo 12 was used to support data analysis. Findings were combined with existing evidence to generate a driver diagram.

Results

Twelve ambulance clinicians participated, including 9 registered paramedics and 3 emergency medical technicians. Median (IQR) age was 43.50 (41.50, 45.75) years, 58% were male, median (IQR) experience was 12 (4.25, 15.50) years and 58% were parents. Several themes relating to barriers and facilitators were identified, including physical, emotional, social, organisational, environmental, management, knowledge and experience. Improvement themes were identified relating to management, organisation and education. These data were combined to create a driver diagram; the three primary drivers were 1) explore methods to increase rates of analgesic administration, including utilising intranasal or inhaled routes; 2) reduce fear and anxiety in children, by using child friendly uniform, additional non-pharmacological techniques and more public interaction and 3) reduce fear and anxiety in clinicians, by enhancing training and optimising crew mix.

Conclusions

The quality of care that children receive for acute pain in the ambulance service may be improved by increasing rates of analgesic administration and reducing the fear and anxiety experienced by children and clinicians. Future research involving children and parents would be useful to determine the most important outcome measures and facilitate intervention development.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00648-y.

Mental health nurses in non-uniform: Facilitator of recovery process?

WHAT IS KNOWN ON THE SUBJECT?: Many Western countries have abandoned the wearing of nurse uniforms on inpatient mental health wards. The adoption of a non-uniform policy in Hong Kong was recently introduced in select rehabilitation units to align with the philosophy of the recovery model. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The findings suggest that nurses perceived wearing non-uniform might help to reduce the self-stigma of service users and develop better self-esteem. The perceived potential benefits of the introduction of a non-uniform policy seemed to outweigh the perceived drawbacks. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results further acknowledge the potential positive effects of nurses wearing non-uniform on facilitating psychiatric service users' recovery process. However, further research on service users' perspectives is required. The wearing of non-uniform may be considered to be extended to other psychiatric wards in Hong Kong and other similar Asian settings in order to potentially help promote patient's recovery and to reduce emotional distance between staff and service users. ABSTRACT: Introduction A non-uniform policy was recently adopted in selected Hong Kong rehabilitation wards to align with the philosophy of the recovery model. The change in policy is relatively novel in Asia, where no previous studies have reported how this may influence nursing care and service users' recovery. Aim To explore Hong Kong Mental Health Nurses' views about wearing non-uniform within an inpatient rehabilitation unit in regard to facilitating service users' recovery process. Method A qualitative descriptive study was conducted, utilizing individual in-depth semi-structured research interviews. Results A total of 12 interviews were conducted with nurse participants. The analysis process identified 3 main themes and 9 subthemes. Main themes were "building up rapport with service users," "non-uniform helps deinstitutionalization" and "different approaches to maximize the benefit and to minimize the risk." Discussion Despite some concerns, the majority of nurse participants positively viewed the policy of wearing non-uniform and felt it was potentially beneficial to service users' recovery process. Implications for practice Nurses perceived that wearing non-uniform may facilitate meaningful therapeutic engagement, and may help to reduce the self-stigma and develop the self-esteem of service users. Other inpatient units in Hong Kong and similar Asian settings might consider adopting the policy.

The nurses' uniform in pediatrics, the opinion of children and nurses

Background and aim:

The nursing uniform represents a non-verbal mean of communication which in the case of children can arouse positive or negative emotions. The first study conducted on a sample of 107 children, aimed to define their preferences on different models of decorated nursing uniforms; the second one conducted on 101 nurses to understand the preferences, the meanings attributed to the uniform and their availability to adapt it according to the preferences expressed by the children.

Methods:

We conducted an observational study with a qualitative approach. For the first objective with the children, a visual stimulus was used, showing 6 models of uniform: the traditional plus 5 models of different colors and themes (cartoons characters and videogames). For the second objective with the nurses, in addition to reproducing the same visual stimulus, a semi-structured questionnaire was used.

Results:

Children and nurses seem to be in perfect accord, because in both groups, color models were the most chosen. Nurses defined their uniform with terms of particular moral, intellectual and professional value and declared themselves available to align with the preferences of the children.

Conclusions:

This study leaves little doubt about preferences; it also represents the true originality of the study because almost never in the literature have been compared the point of views of children and professionals, generally favoring the comparison between children and care givers. Our findings could represent a further landmark for guiding the choices of health organizations on currencies to be adopted in the pediatric field. (www.actabiomedica.it)

The impact of street clothes among caregivers on residents with dementia in special care units: The STRECLO study

AIMS AND OBJECTIVES

To examine the impact of caregivers' street clothes on people living in special care units (SCUs). We hypothesised that caregivers wearing street clothes would improve residents' relationships with other residents and caregivers and, as a consequence, would improve their quality of life.

BACKGROUND

Environmental factors have been recognised as important elements in the care of people with dementia. Among these factors, the importance of the caregivers' appearance and more particularly their street clothes has been raised.

DESIGN

The Street Clothes study (STRECLO) was designed as a multicentre crossover observational study.

METHOD

This study was conducted in two volunteer nursing homes. It involved videotaping residents (N = 24) over a 6-month period: caregivers wore uniform and then street clothes for two consecutive three-month periods. Three outcome measures were observed as follows: (a) behaviours of residents, (b) contents of conversations and (c) proximal interactions between residents and caregivers. The STROBE checklist was used to ensure quality reporting during this observational study.

RESULTS

When caregivers wore street clothes, we observed the following: (a) greater solicitation and less anxiety in residents, (b) content of conversations between residents and caregivers included more personal and less health information, and (c) more proximal interaction between caregivers and residents.

CONCLUSION

To our knowledge, this is the first study which investigated the long-term effects on residents of SCU caregivers wearing street clothes. Our study demonstrated the potential benefit of not wearing uniform on the quality of life of institutionalised people with dementia.

RELEVANCE TO CLINICAL PRACTICE

Given the budgetary constraints faced by nursing homes, wearing street clothes for caregivers could be readily applied to clinical practice and represents a promising way to increase the quality of life of dementia residents and their families.

The image of the profession in the mass consciousness

The issues of nursing staff shortage and quality of their work are relevant for the health-care management today. In this regard, the established image of the profession is important, as it can lead to the unpopularity of nursing profession and affect the effectiveness of the treatment process through the self-perception of nurses. So studying the image of nursing in social media is of particular relevance today. The role of social media in dissemination of opinions is increasing every day. Unloading (31613 messages) from social media was made using keywords for 2017. А random subsample (403 messages) was formed from them, coded manually by coders (authors). According to analysis of the obtained data, nursing is perceived as a “female profession,” a nurse is a Caucasoid woman in a white uniform. She works at public hospitals, her work is discussed primarily in the context of the specialties of obstetrics, gynecology and pediatrics. Her status is rather low, nursing is not perceived as an intellectual and promising profession. Messages about nurses are mostly neutral, emotionally colored messages are devoted mainly to the personal qualities of nurses. Autoimage (self-perception) of nurses is poor. In conclusion, there is given a number of recommendations for improving the image of nurses. Implementation of organizational changes may contribute to enhancing the prestige of the profession: introducing special insignia for nurses, designating career prospects. It is also possible for these purposes to conduct an information policy aimed at demonstrating the attractive aspects of nursing and emphasizing the gender neutrality of the profession.

Community-Based Mental Health Care: Stigma and Coping Strategies Among Professionals and Family Caregivers in the Eastern Region of Ghana

To a large extent caregivers perceive stigma through their social and community interactions by virtue of their association with persons with mental health problems. Meanwhile, evidence on their strategies for coping with potentially undesirable experiences linked with stigma is limited. Using a descriptive qualitative approach, the present study explored affiliate stigma among mental health professionals and family caregivers of persons with mental illness. Data, collected through one-on-one interviews with 10 mental health professionals and 10 family caregivers, were examined with content analysis. Findings revealed that, although stigma attached to mental illness was largely directed at sufferers and family caregivers, professionals sometimes had their fair share. To manage the negative impact of stigma, caregivers adopted various strategies including the use of realisation, tactical or planned ignoring, self-motivation, acceptance and religion. Implications of the findings necessitate the intensification of mental health education among the general populace, which must be targeted at demystifying mental illness.

Grooming and etiquette as part of nurse's professionalism: An essential curricular competency

Objective:

The B.Sc. Nursing has limited hours dedicated to grooming and personal development. A smartly turned out, trained empathetic and efficient nurse helps in alleviating the miseries of the patients. The objective of this study was to see the acceptability and perceived usefulness of a course on grooming and etiquette.

Methods:

A proforma based qualitative study was carried out at College of Nursing, AFPGMI & National University of Medical Sciences (NUMS), Rawalpindi, from Jan to Dec, 2017. An eight week course, with weekly lectures was conducted for first to fourth year classes. At the end a semi-structured proforma with simple open ended questions was administered. The questions were both in English and Urdu. The results were analyzed by finding percentages of positive and negative responses. The descriptive responses were grouped in recurring themes and analyzed for content and their constructive value.

Results:

There were 186 nursing cadets who completed the course and filled the proforma (55, 52, 45 and 34 from first year to fourth year, respectively). Out of 186, 98.9% (184) thought that this was a useful course. All topics were considered useful. Most liked were communication skills, teaching visits to wards, hostels and balancing home and work. About 7% disagreed about the strict dress codes, but agreed with the proper demeanor. Many suggested that senior nurses also have a dire need of these grooming lectures as many used derogatory language. Also pointed out was absence of a mechanism to report a lapse in ethical conduct seen in a colleague or a senior.

Conclusion:

Nursing is a demanding profession. It is important that our training includes sensitization to the non-technical attributes. They have to be groomed to become role models for young talented girls to join this noble profession. Even a short course may help to sensitize these young ladies to a very important aspect of their lives and profession.

Should nurses be role models for healthy lifestyles? Results from a modified Delphi study

AIM

To explore the expectation that nurses should be role models for healthy behaviours.

BACKGROUND

Nurses are expected to be role models for healthy behaviours. Whether this is a realistic and acceptable expectation has not been explored.

DESIGN

Modified Policy Delphi study with two rounds of data collection.

METHOD

Purposive sampling was used to explore areas of agreement and disagreement among six stakeholder groups who influence nursing roles: practising nurses, nursing students, service users, policy makers, workforce development leads and stakeholders working in nurse education. Two rounds of a modified Policy Delphi study were conducted between February - June 2015. The first round used telephone interviews for an open exploration of opinions. The second round used attitude statements to explore convergence and divergence of opinions across stakeholder groups. Responses were analysed thematically.

RESULTS

Policy and professional discourse that asserts that nurses should be healthy role models was seen as unrealistic and unhelpful. Contrary to the view that nurses should epitomize and demonstrate healthy behaviours to encourage patients and to be credible in advice, stakeholders agreed that it was more important to be seen as 'human' and understand the challenges of health behaviour change. Student and practising nurses did not see role modelling healthy behaviours as a reasonable professional expectation.

CONCLUSIONS

The findings challenge the assumptions underpinning the argument that nurses be healthy role models. Further research is needed to understand the views of frontline nurses and to further explore avenues by which health services staff health can be improved.

Psychiatric patients' perspective: nursing uniforms

This paper studied and determined the importance of the design and color of selected uniforms of psychiatric nurses and evaluate their effects and implications for patients. In this descriptive study, a questionnaire developed by the researchers and a nursing uniforms catalog were used during the data collection stage of the research. There were 40.9% of the participants who told that the design and color of a nursing uniform is important and 31.5% of the participants selected white uniform color from the catalog for psychiatric nurses and 33.9% of the patients expressed that they find white nursing uniforms comforting.

Preferences of dress and address: views of attendees and mental health professionals of the psychiatric services

Objectives: The aim of this study was to determine the views of both individuals attending the mental health services (attendees) and mental health professionals in relation to how attendees and staff should be addressed, how attendees should be described, and how staff should be attired.

Methods: We surveyed 132 attendees of the West Galway Mental Health Services and 97 mental health professionals in relation to how they prefer to be addressed (first name/ title and surname/ no preference) the description of attendees (patient / client / service user / no preference) and the attire of mental health staff (casual / smart / no preference). We also ascertained how mental health professionals believed attendees would view these issues.

Results: Attendees preferred to be described as patients rather than clients or service users by all mental health professionals, with 46-54% of attendees preferring this term “patient” compared to 14-17% preferring the term “client”, 11-13% preferring the term “service user” and 20-25% having no preference (p < 0.001). They preferred to address doctors by their title and surname (61%) but other mental health professionals by their first names (60-69%) (p < 0.001). Attendees had a strong preference for being addressed by their first names by all the mental health professionals (86-91%) (p < 0.001). Doctors preferred to be attired formally (88%), compared to nurses (50%) or other mental health professionals (42%) (p = 0.002). Attendees had no preference in relation to the attire of doctors but preferred other mental health professionals to be attired informally.

Conclusions: The study demonstrates that despite the increased use of several non-medical terms to describe attendees of mental health services; the preferred term of attendees of the psychiatric services in both in-patient and out-patient settings remains ‘patient’. However, this is not universally the case, and the ascertainment of the preference of the attendee at the first encounter with the health professional should be ascertained. We also demonstrated that attendees preferences in relation to both “dress and address” of doctors is significantly different to their preference for nurses or other allied mental health professionals; which may reflect a wish for a less familiar and more formal interaction with doctors.

Image is more than a uniform: the promise of assurance

OBJECTIVE

The purpose of this qualitative study was to explore the meaning of the phrase "image of the nurse" in the context of the desired brand experience of assurance.

BACKGROUND

A brand is a promise that lives in the minds of consumers. Nurses play a key role in delivering on the brand promise of a hospital.

METHODS

Using focus groups, the authors applied a deductive approach to generate data. Discussion transcripts were analyzed by establishing codes and identifying themes.

RESULTS

The most frequent comment from participants was that for nurses to communicate assurance, they must 1st be clean, well groomed, and understated in overall appearance. Nurse behaviors that reassure patients include being present with patients, helping patients know what to expect, and demonstrating a consistent team approach.

CONCLUSIONS

Overall appearance and behaviors define the image of nurses and contribute significantly to the brand of assurance.

Patient perception of contemporary nurse attire: a pilot study

Patients have expressed difficulty accurately distinguishing registered nurses (RNs) from other hospital personnel because standardized uniforms are no longer worn by RNs. According to American studies, such complaints are widespread; moreover, patients' perceptions of nurse caring and competence and of other traits associated with nurses' professional image have been negatively affected by casual, non-conventional attire. As there are no published Canadian studies, we conducted a pilot study to examine patient perception of the nurse uniform. Adult patients viewed photographs of the same RN dressed in eight different uniforms and rated each uniform according to 10 traits associated with nurses' professional image. The white pantsuit scored higher for professionalism than uniforms with small print, bold print, or solid colour, and most patients preferred that the RN dress in white. Our preliminary findings suggest that RN attire warrants further investigation, and we are planning a large-scale, fully powered study to inform patient-driven change to existing uniform policies.

Judging a book by its cover: uniforms and quality of life in special care units for people with dementia

OBJECTIVES

In certain health care facilities, the staff commonly wear uniforms for dementia care. Wearing uniforms are often believed to improve the well-being of institutionalized people with dementia (PwD) by facilitating orientation and preserving hygiene. However, when studied more thoroughly, it appears that their use counters to person centeredness. This study aims to investigate the impact of wearing uniforms on the quality of life (QoL) of institutionalized PwD.

METHOD

A natural experimental design was operated in 4 special care units (SCUs) in France. Two SCUs served as an experimental group (caregivers wearing street clothes except when performing hands-on physical care; N = 13) and 2 served as a comparison group (caregivers wearing uniforms; N = 14). The QoL of PwD was measured using the QoL-Alzheimer's Disease scale, and focus groups were carried out with caregivers.

RESULTS

Overall and significantly enhanced QoL scores were observed for the experimental street clothing staff group when compared to the uniform group. Caregivers also reported subjective impressions of overall beneficial outcomes for PwD when the caregivers were not wearing uniforms and reported feeling more at ease when interacting with them.

CONCLUSION

Results are discussed in terms of intergroup relationships, living and working conditions, and ethical issues.

Nursing professional attire: probing patient preferences to inform implementation

OBJECTIVE

The aim of this study was to increase understanding of patient perceptions of nursing professional image, appearance, and identification to inform implementation of professional clinical attire.

BACKGROUND

There is growing evidence of patient preference for and organizational implementation of professional clinical attire.

METHODS

A total of 350 randomly selected inpatients were surveyed using the professional image and patient preferences survey prior to a revision of the dress code for nursing.

RESULTS

Patients gave high scores for nursing image, appearance, and identification, with no support for color-coded uniforms.

CONCLUSIONS

Organizations should assess patient perceptions before implementation of a dress code for nursing.

Nurses' uniform color and feelings/emotions in school-aged children receiving health care

Children may fear nurses wearing white uniforms. When emotions and uniform color were studied in 233 children, many positive emotions were most often associated with blue, bold pink-patterned, or yellow-patterned tops (all p ≤ .002). Negative emotions were not associated with uniform top colors (all p < .001). However, after excluding "uniform color does not matter," 8 negative emotions were most often associated with white uniform color (p < .001-.04), and 2 others were most often associated with the yellow-patterned top. Bold pink-patterned and solid blue uniform tops were preferred. In conclusion, children's emotions were associated with nurse uniform color.

The professional appearance of registered nurses: an integrative review of peer-refereed studies

BACKGROUND

There is a paucity of research examining the impact of standardized uniform style and color for registered nurses (RNs).

OBJECTIVE

The aim of this study was to appraise published peer-refereed studies on the effect of a standardized uniform style and color for RNs.

METHODS

Seven peer-refereed studies exploring standardized uniforms for RNs were identified. Using the Oxford Centre for Evidence-Based Medicine evidence hierarchy, each study was assigned a level of evidence and overall rating.

RESULTS

Data suggest that patients felt that RNs appeared professional and were easily identified by a standardized uniform style and color. No strong evidence supports a patient's preference for a specific style and color of uniform.

CONCLUSIONS

Findings are inconsistent but demonstrate that a standardized uniform style and color increased the perception of professionalism and recognition of RNs among patients.

Undergraduate nursing students caring for cancer patients: hermeneutic phenomenological insights of their experiences

BACKGROUND

The care of patients suffering from cancer and especially those facing the death trajectory appears to be complex and demanding not only for student nurses but for professional nurses as well. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. These "worst case scenarios" can be traumatic experiences that can leave the student hopeless and disappointed of themselves and in many cases can "scar" their subsequent professional career. The literature demonstrates that this can be the result of the students' ill-preparation to care for cancer patients and deal with death and dying. The purpose of this study was to interpret the students' experiences of coming face-to-face with cancer care during their clinical placements.

METHODS

This is a hermeneutic phenomenological study influenced by the ideas of the French Philosopher Paul Ricoeur. Based on this philosophical enquiry the interpretation process included three stages: 1) naïve reading, 2) structural analysis and 3) comprehensive understanding. Data were collected through reflective/narrative diaries from the 4th grade undergraduate (pre-registration) nursing students practicing at oncology, hematology, pediatric oncology departments and hospices. Diaries of twelve students met the inclusion criteria and were included in the interpretation process. The study took place during January and May 2011.

RESULTS

The interpretation yielded the following themes: a) Being part of the center's life, b) Being sympathetic, c) Being confronted by others, d) Being self-reflective, e) Being trapped in the system, f) Being caring towards the family and g) Being better in clinical practice.

CONCLUSIONS

The students emphasized the need for appropriate preparation both at a theoretical and at a clinical level, as to better confront situations involving death and dying as well as learning techniques for crisis management. The students perceived the importance of adopting a policy that is both patient and family-centered in order to provide better care.

Reflections on the practice of facilitating group-based antenatal education: should a midwife wear a uniform in the hospital setting?

The first author of this paper, a Thai midwife, conducted a feminist action research project aimed at collaboratively developing a model for group-based antenatal education in Thailand. Should a midwife wear a uniform when facilitating midwife-led group-based antenatal education sessions in the hospital setting? This paper reports on a single example of reflection in and on midwifery practice that aimed to answer the guiding question. The practice and reflection occurred over a number of months at the beginning of the feminist action research project. The midwife should wear normal clothes when facilitating group-based antenatal education as a symbol of equality in power relationships within the group. When power relationships between women and the midwife are equalized, women are more able to take responsibility for their health as they are less likely to defer to the 'expert'. Reflection in and on practice is a powerful tool to allow the midwife to understand and change her own practice as required to meet those goals. Self-change is a critical first step because there can be no change in the way maternity care is provided without each midwife being willing to be self-aware and open to appropriate self-change.