Perceptions of nursing: confirmation, change and the student experience

Nursing in the 21st century: results of a pilot survey on attitudes towards nurses and nursing

Nursing is one of the most trusted professions, yet it is poorly defined. There are many definitions and characterisations of nursing. This study sought to pilot a survey exploring the views of nursing in the 21st century.

METHODS

This study piloted an electronic survey with open and closed questions. Descriptive statistics were collated for closed questions using Excel. Open-ended questions were analysed using the text analysis program Linguistic Inquiry and Word Count (LIWC) for tone, emotion and criticality.

RESULTS

This pilot study recruited 72 participants from professional and non-professional backgrounds. Respondents displayed diversity in their perceptions of nursing, the role of nurses and the role that nurses perform.

CONCLUSION

Nursing is a complex, multifaceted profession. The view of nursing was generally positive and authentic although not easy to define. Nursing was felt to be an inclusive profession; however, it is extremely diverse in nature. Further research is required to explore these concepts in greater depth.

Nurses Learning to be Powerful Leaders: What Will It Take?

The attention of the world has been on nurses in the past two years. Because of the pandemic, they have been applauded and their work featured on national news in many countries. However, nurses were not generally seen at press briefings, nor interviewed as experts on any aspect of pandemic control or treatment. Also in 2020, the World Health Organization (WHO) published the first State of the World's Nursing Report which highlighted present and future global shortages of nurses and called for nurses to be more visible leaders, present at the highest levels where health policy is made. This call was echoed in the WHO Global Strategic Directions for Nursing and Midwifery published in 2021. This article presents the challenges to nurses being accepted as leaders in the health system, showing the legacy of nursing being a gendered occupation, suggesting a gender-focused analytical framework to address the continuing challenges to women nurses becoming powerful leaders and exploring the need to disrupt the status quo in health systems leadership and nursing to achieve radical and sustainable change.

The Power of Mass Media and Feminism in the Evolution of Nursing's Image: A Critical Review of the Literature and Implications for Nursing Practice

Nursing has evolved, yet media representation has arguably failed to keep up. This work explores why representation has been slow in accurately depicting nurses' responsibilities, impacts on public perceptions and professional identity. A critical realist review was employed as this method enables in-depth exploration into why something exists. A multidisciplinary approach was adopted, drawing from feminist, psychological and sociological theories to provide insightful understanding and recommendations. One main feminist lens has been implemented, using Laura Mulvey's 'Male-Gaze' framework for content analysis of three nurse-related advertisements to explore how the profession's female status influences representation, public perception and how this might impact nursing. Nurse representation has important real-world consequences. It is essential to improve unnecessary negative portrayals and contest ingrained stereotypes as there are costs to public opinion and nursing's self-identity. Nursing's female status has an impact within a male-dominated media industry, with a leisurely approach adopted toward changing representation. Media images become societally ingrained, this reiterates the significance of accurate/positive depictions. Social media is an instant method of communication with the public to combat stereotypes and maintain engagement to provide better understanding of what nurses do.

Psychosocial work characteristics associated with distress and intention to leave nursing education among students; A one-year follow-up study

BACKGROUND

Dropout in later years of the nursing degree programme involves lost investment and is a particular problem for both students and educators. Reasons for late dropout seem to be related to the work and learning environment of the clinical placement.

OBJECTIVES

The aim of this study was to investigate associations between psychosocial work characteristics and distress and intention to leave nursing education among third-year nursing students.

DESIGN

A prospective cohort study.

SETTING

A Bachelor of Nursing programme of a University of Applied Sciences in the Netherlands.

PARTICIPANTS

363 third-year nursing students.

METHODS

Baseline and one-year follow-up measurements were used from a prospective cohort study. Third-year nursing students were invited annually in May between 2016 and 2018. Psychosocial work characteristics were psychological demands, supervisor and co-worker support, and acts of offensive behaviour. Logistic regression analyses were used to build multivariate models.

RESULTS

Frequent exposure to violence (OR = 2.52, 95% CI: 1.29-4.92) was univariately associated with distress. In the multivariate model for distress, psychological demands (OR = 1.63, 95% CI: 1.05-2.52) and frequent exposure to violence (OR = 3.02, 95% CI: 1.48-6.19) were associated with distress. Supervisor support (OR = 0.54, 95% CI: 0.36-0.80) and co-worker support (OR = 0.41, 95% CI: 0.24-0.72) were negatively associated with intention to leave (i.e. were protective) in the univariate model. In the adjusted multivariate model, only co-worker support (OR = 0.50, 95% CI: 0.25-0.97) was a protective factor for an intention to leave.

CONCLUSION

Psychological demands and frequent exposure to violence are risk factors for distress, and co-worker support is a protective factor reducing the intention to leave nursing education in the last stage of the programme. Improving the psychosocial working climate of nursing students may reduce the intention to leave at a late stage in nursing education, and hence actual late dropout.

Factors Affecting Students’ Preference for Nursing Education and their Intent to Leave: A Cross-sectional Study

Introduction:

Insufficient research has been conducted into the factors that prompt young students to select nursing education as a profession in Saudi Arabia.

Aim:

The aim of the study is to identify factors affecting students' preference for nursing education and their intent to leave.

Methods:

This study follows a descriptive cross-sectional research design, with data collected by adapting the Tan-Kuick questionnaire to measure second-year nursing students’ (n=162) preference for nursing education and intent to leave one academic institution in Saudi Arabia.

Results:

Nursing image is identified as the major factor influencing the nursing students’ preference for nursing education in Saudi Arabia (69.89 ± 16.49), and parents' image of nursing is identified as the factor with the least amount of influence (34.52 ± 22.04). Additionally, more than half of the nursing students surveyed report intending to leave the nursing profession. Regarding the reasons for their intent to leave, a total of 70% of the surveyed nursing students report having no interest in the nursing profession. Family disagreement and societal image are also identified as common prompts to leave nursing.

Conclusion:

The study recommends the use of media to enhance the image of the nursing profession through the presentation of role models that talk to the students and encourage and motivate them to engage in the working life of a nurse. In addition, the study suggests replicating the longitudinal study for the same group in their third and fourth year of study to see if they leave the nursing profession.

The Moral Distress of Nurses When Patients Forgo Treatment Because of Cost

Nursing must recognize an ethical obligation to respond on behalf of these patients.

Exploration of service recipients' image of a perfect nurse: A qualitative descriptive study

AIM

The aim of this study was to explore the image of the perfect nurse from service recipients' perspective.

BACKGROUND

The public image of nursing is one of the long-term challenges of this profession. Specific cultures affect the views and satisfaction of nursing service recipients.

METHODS

This study was a qualitative descriptive study conducted in 2018. Purposive sampling was used and continued until saturation. Twelve semi-structured interviews were conducted with service recipients who had experience in using nursing services in the past six months. Participants were 5 men and 7 women. Interviews transcript verbatim and analyzed by qualitative content analysis.

RESULTS

Four themes emerged from the perspective and experience of the participants concerning perfect nurse including the followings: affable (compassionate, sympathetic and good-tempered), responsive (answering questions, answering requests), tower of strength (listener, being patient, understanding and attention) and efficient (providing careful care, providing timely care, providing proper care).

CONCLUSION

From the participants' perspective, a perfect nurse should be responsive to the patient and be well-mannered and patient with them in addition to providing expert care. Therefore, nurses should not only improve their skills in providing care but also focus on the communication dimension and respond to the patients. Identifying communication barriers with the clients in the context of the study is also suggested.

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.

Curriculum design and attrition among undergraduate nursing students: A systematic review

Attrition rates among nursing students are a global issue, and a possible factor in current nursing shortages. Numerous studies have been conducted to determine why students drop out of nursing programmes. The limitations of previous studies have included overly small sample sizes, being largely descriptive, and not focusing on attrition as an outcome. The aim of this study is to review the issue of attrition among undergraduate nursing students in relation to curriculum design. Five electronic databases, namely CINAHL, Medline, Cochrane Library, British Nursing Index, and PsycINFO, were adopted. Using the Population-Intervention-Comparison-Outcome model, search terms were identified, such as 'student nurse', 'undergraduate programme', 'curriculum design', and 'attrition'. Mixed Method Appraisal Tools were used to evaluate the methodological quality of the identified research papers. A total of 16 publications were reviewed and four themes were identified: pre-enrolment criteria for recruiting nursing students; curriculum content; clinical placement-related policies; and student support services. Institutional-level risk factors that could be reduced were identified, including academic failure, poor clinical performance, stress, and unrealistic expectations of nursing. This review gives insights into how a curriculum for undergraduate nursing programmes can be designed that will engage students and increase the nursing workforce.

Experiences of student nurses regarding the bursary system in KwaZulu-Natal province, South Africa

Background

During 2010, the South African nursing education system was restructured, changing student nurses from having supernumerary status to being bursary holders. Changes with the introduction of this new bursary system included institutional factors and benefits that could be removed from the students, potentially hampering students’ sense of belonging.

Aim

This study aimed to describe the experiences of students receiving bursaries in KwaZulu-Natal (KZN) province and to make recommendations for improving the system to bursary providers, educational institutions and practical settings based on these students’ experiences of the bursary system.

Setting

The experiences of student nurses regarding the bursary system are described within a specified setting comprising two nursing campuses in KZN.

Method

A qualitative study design was used and seven focus group interviews were conducted with purposively selected participants, representing the target population of first-, second- and third-year male and female nursing students registered for the Diploma in Nursing (General, Psychiatric, Community) and Midwifery.

Results

Two main themes and eight subthemes were identified. The findings indicated that some of the bursary system’s experiences were negative as opposed to students having supernumerary status. These experiences had negative socio-economic, psychological, clinical, academic and family impacts. Many concerns related to staff members’ attitudes, shortages of nurses and service demands during students’ clinical practice assignments.

Conclusions

The bursary system was not viewed as being beneficial to students as they did not receive all the benefits from being bursary holders. Support in clinical and academic areas was lacking as they were considered to be employees during their clinical assignments. There is an urgent need to review the bursary system.

The Profile of Saudi Nursing Workforce: A Cross-Sectional Study

Introduction

The Royal Monarchy in Saudi Arabia decreed that all sectors of the workforce would be subject to a policy of "Saudisation" to reduce the reliance on the expatriate workforce and to reduce the unemployment rate of Saudi nationals (Al-Mahmoud et al., 2012).

Methodology

A cross-sectional design was chosen to investigate the research questions. The population of this study comprised Saudi Registered Nurses working in MOH hospitals in Riyadh which is the main health care provider in Saudi Arabia (Aboul-Enein, 2002; MOH, 2009).

Results and Findings

A total number of 1,198 questionnaires were distributed and 61.2% (n = 741) were returned. The findings of the study showed that the questionnaires were collected from an equal portion of the study locale and that a sample of 741 is enough to create a strong conclusion and answer the problem set in this study and all the questions in the study have been provided with answers with enough data and literatures to supports its findings.

Conclusion and Recommendations

The results indicate that an increase in the recruitment of Saudi males may simply reflect cultural issues such as gender specific facilities and the Saudisation program's nondiscriminatory approach to employment of both genders into nursing.

Young peoples' perceptions of the nursing profession: An integrative review

OBJECTIVES

The purpose of this integrative review was to describe young people's perceptions of the nursing profession and to identify factors influencing the perception.

DESIGN

Integrative literature review.

DATA SOURCES

The CINAHL, PubMed and Medic electronic databases were searched for research publications between 2006 and 2016. The keywords used were: perception, attitude, belief, view, knowledge, image, nurse, nursing care, career, profession, role, teen, middle school student, high school student, adolescent and pupil. A manual search was conducted of the reference lists of the identified articles.

REVIEW METHODS

Whittemore and Knafl's method for conducting an integrative review was utilized. The quality of the chosen articles was assessed with Joanna Briggs Institute's quality appraisal tools.

FINDINGS

The search resulted in eight articles. Young people described the nature of nursing work with poor working conditions, shift work and a limited level of autonomy. Nursing work was mainly seen as caring for and helping patients which was considered inferior to doctors' work. Young people did not recognize the educational requirements or the career pathways in nursing and described the status of nursing as low in society. Nurses were considered as kind and caring people who work hard and are less intellectual. The factors influencing the perception were family and relatives, friends, media, significant others and personal factors.

CONCLUSIONS

Perceptions of young people do not reflect the reality of the nursing profession and the perceived image of nursing has not changed in the last ten years. Young people and the public need realistic information of the nursing profession and the actions to change the image should take place at all levels of the society. Further research is needed to understand how the perceptions of the young people can be influenced and changed to reflect a more realistic image of a contemporary nurse.

The Relationship Between Cultural Sensitivity and Assertiveness in Nursing Students from Turkey

Background: As foreigners live in and visit Turkey for various reasons, it is essential to provide culturally appropriate health care. Purpose: This study was conducted to determine the relationship between cultural sensitivity and assertiveness in university nursing students. Method: This descriptive, cross-sectional study was conducted at two universities in the cities of Kilis and Elazığ, Turkey. The study sample consisted of 444 nursing students. Data collection tools included a questionnaire about participant sociodemographic characteristics, Chen and Starosta’s Intercultural Sensitivity Scale, and the Rathus Assertiveness Scale. Results: The mean age of participants was 21.09 years. Most students (71.6%) were female and 34.7% of the students stayed at the hostel. Of the students, 44.4%, 27.5%, and 28.2% attended were the second-, third-, and fourth-year students, respectively. Participants were asked about problems related to caring for patients who speak different languages. The mean score for the Intercultural Sensitivity Scale was 89.42 ± 13.55 and the total score for all students for the Assertiveness Scale was 112.64 ± 15.61. We identified a positive relationship between total scores for the Intercultural Sensitivity Scale and the Assertiveness Scale ( p < .001). There was relationship between cultural sensitivity and gender and want to work overseas; assertiveness and year of nursing education and want to work overseas. Conclusions: Nursing students at both schools had a moderate level of cultural sensitivity and assertiveness. It has been determined that as assertiveness level of the students increased, intercultural sensitivity of them also increased. Implications for Practice: Consequently, it is concluded that training as assertive and self-confident individuals during the nursing education of students has a contribution to making patient-specific and culture-sensitive care.

Development and psychometric testing of an instrument to compare career choice influences and perceptions of nursing among healthcare students

BACKGROUND

With the availability of more healthcare courses and an increased intake of nursing students, education institutions are facing challenges to attract school leavers to enter nursing courses. The comparison of career choice influences and perception of nursing among healthcare students can provide information for recruitment strategies. An instrument to compare the influences of healthcare career choice is lacking. The purpose of this study is to develop and evaluate the psychometric properties of an instrument to compare the influences of healthcare career choice with perceptions of nursing as a career choice.

METHODS

The study was conducted in two phases. In phase one, two sets of scales with parallel items that measure the influences of healthcare career choice and perceptions of nursing as a career choice were developed through an earlier qualitative study, literature review, and expert validation. Phase two involved testing the construct validity, concurrent validity and reliability with a convenience sample of 283 first year healthcare students who were recruited at two education institutions in Singapore.

RESULTS

An exploratory factor analysis revealed 35-parallel items in a six-factor solution (personal interest, prior healthcare exposure, self-efficacy, perceived nature of work, job prospects, and social influences) that explained 59 and 64% of the variance for healthcare career choice and nursing as a career choice respectively. A high correlation (r = 0.76, p < 0.001) was obtained with an existing tool, confirming the concurrent validity. The internal consistency was sufficient with Cronbach's alpha of 0.93 for healthcare career choice and 0.94 for nursing as a career choice. The test-retest reliability was acceptable with an Intraclass Correlation Coefficient of 0.63 for healthcare career choice and 0.60 for nursing as a career choice.

CONCLUSIONS

The instrument provides opportunities for understanding the differences between influences of healthcare career choice and perceptions of nursing as a career choice. This comparative understanding of career choice influences can guide educator and policy-makers on nursing recruitment.

Nursing students' changing orientation and attitudes towards nursing during education: A two year longitudinal study

BACKGROUND

Previous studies have shown that nursing students' perceptions of nursing change over time. Little research has been undertaken in the Netherlands of students entering nursing programmes and of how they progress.

OBJECTIVES

The aims of this study were to explore whether nursing students' orientation and attitudes towards nursing changed over time, when these changes occurred, and what factors influenced the changes. We also aimed to identify the factors which prompted them to consider leaving their programmes, and what factors affected their motivation to stay.

DESIGN

The study used a longitudinal quantitative design.

PARTICIPANTS

Questionnaires were administered to all students enrolled in a Bachelor's of Nursing programme at four nursing universities of applied sciences in the Netherlands (n=1414). The data for this study were collected during the first two years of the programme, from September 2011 to June 2013. A total of 123 respondents completed the survey each year and this group was used to examine changes over time.

METHODS

At four time intervals respondents completed a survey consisting of 1) the Nursing Orientation Tool, 2) the Nursing Attitude Questionnaire and 3) background characteristics. Non-parametric tests were used to explore changes in factor scores over time.

RESULTS

The results showed an improvement in the students' orientation and attitudes towards knowledge, skills and the professional roles of nurses, while empathic behaviour decreased over time. Although the changes showed non-linear patterns over time, the results showed clear effects between the different time points. The reasons for attrition (24%) proved to be related both to problems with the educational programme and to personal problems. An important motivator for students to stay in the course was their passionate desire to become nurses, suggesting that the positive aspects of a nursing career dominated the problems they encountered.

CONCLUSIONS

Tutors and mentors should pay more attention to the individual perceptions and problems of first and second-year students, both in the classroom and during clinical placements. Knowledge of the students' perceptions from the very beginning could be vital to study success.

Predicting factors of positive orientation and attitudes towards nursing: A quantitative cross-sectional study

BACKGROUND

Previous studies have identified various reasons for students to choose a career in nursing. Students at the start of their programme hold a great variety of images and perceptions of nursing which can affect their orientation and attitudes towards their future profession.

OBJECTIVES

This paper aims to examine nursing students' orientation and attitudes towards nursing at the beginning of their educational programme, and to explore predictors of positive orientation and attitudes.

DESIGN

The study used a quantitative cross-sectional design.

SETTINGS

A survey was conducted among first-year nursing students at four nursing universities of applied sciences in the Netherlands.

PARTICIPANTS

Questionnaires were administered to all students enrolled in a bachelor of nursing programme (n=1414) at these universities.

METHODS

Respondents completed a survey consisting of: 1) Nursing Orientation Tool, 2) Nursing Attitude Questionnaire, and 3) demographic data such as gender, living status, nursing experience, preliminary training, first-choice programme, and career choice. Kruskal Wallis tests, with post hoc Mann Whitney U tests, were used to compare group scores. Multiple regression was performed to investigate predictors of positive orientation and attitudes towards nursing.

RESULTS

Students in this study sample (n=1244) strongly agreed with statements related to caring, nursing expertise, professional nursing knowledge and the application of this knowledge. Predictors of positive orientation and attitudes towards nursing include having nursing/caring experience, indicating nursing as the first choice for study, preliminary vocational training, and a desire to make a career in nursing.

CONCLUSIONS

Data from this survey suggest a link between personal and environmental characteristics and motivations to select nursing as a career. Understanding which factors predict positive orientation and attitudes towards nursing could offer educators a tool in the recruitment and selection assessment of new students.

Professional commitment and attributional style of medical-college nursing students in China: A cross-sectional study

BACKGROUND

The persistent shortage of nurses has become a common phenomenon around the world. Nursing students' professional commitment affects their decision to choose nursing as a professional career. However, there is little knowledge about the professional commitment of nursing students, especially its relationship with attributional style.

OBJECTIVES

To explore the professional commitment of nursing students and to identify the role of attributional style on nursing students' professional commitment.

DESIGN

Cross-sectional study design.

SETTINGS AND PARTICIPANTS

This study was conducted at three different medical colleges in Jinan, Shandong Province, China and included 1230 nursing students. A total of 1223 valid questionnaires were returned, yielding a response rate of 99%.

METHODS

The Professional Commitment Scale and the Multidimensional-Multiattributional Causality Scale (MMCS) were used to investigate nursing students' professional commitment and attributional style. Basic demographic information about the nursing students was collected. Stepwise regression analysis was used to analyze the data.

RESULTS

The mean scores on the Professional Commitment Scale were 3.54±5.29 (mean±SD). Professional commitment of first year students was higher than that of second year students. Their residence affected their affective commitment, ideal commitment, and continuance commitment which were the sub-dimensions of professional commitment. Effort and ability attribution positively influenced professional commitment; however, context attribution negatively influenced it.

CONCLUSIONS

It is imperative to take effective measures to improve nursing students' professional commitment. Our findings indicated that attributional style had a significant effect on professional commitment; thus, effort and ability attribution need to be emphasized.

The effect of a career activity on the students' perception of the nursing profession and their career plan: A single-group experimental study

BACKGROUND

Students' conceptualizations of nursing and their reasons for choosing the profession motivate them and affect their education, work performance and career plans. Nursing educators should support them to plan their careers consciously during their education.

OBJECTIVES

The study aimed to investigate the effect of career-planning event for nursing students on their conceptualizations of the nursing profession and their career plans.

DESIGN

The study was as single-group experimental study using a pre-test and post-test.

SETTINGS

The career-planning event was held in the conference hall of the university involved in the current study, and was open to the all students of the nursing school.

PARTICIPANTS

The sample of the study consisted of 105 students who participated in the "Nursing Career Symposium" held on 27 March 2015. Methods At the event, the importance of career planning and the opportunities of the nursing profession was presented. The data were collected using a questionnaire consisted of two sections including descriptive characteristics and the opinions of the students regarding their career plans and Perception of Nursing Profession Scale. The students completed the first section of the questionnaire before the career event began and the second section of the questionnaire and scale both before and after the event.

RESULTS

The participants had positive conceptualizations of the profession. Following a career event, the participants' opinions of professional qualities and professional status as measured through the Perception of Nursing Profession Scale showed a significant increase, and that the event had made an important contribution to their career plans.

CONCLUSIONS

In the light of these results, it is possible to suggest that such events have an important place during education in that they introduce the nursing profession, and they develop the students' positive thoughts regarding the profession in terms of both course content and teaching methodology.

Development and evaluation of an online, interactive information and advice tool for pre-registration nursing students

Attrition rates for student nurses on academic programmes is a challenge for UK Higher Education Institutions. Reasons for leaving a programme of study include personal, financial issues or practice placement experiences. Research has shown systematic and integrated support mechanisms may improve attrition rates and student experience. This project explored the sources of, and support needs of nursing and allied health students, develop and evaluate and interactive online tool: 'SignpOSt'. Enabling students to access 'the right support, at the right time, from the right place'. Focus groups were carried out with 14, 3rd year students and 8 academic staff including personal tutors, programme/module leaders. Thematic analysis of transcribed data under four key themes for support and advice: 1. Financial 2. Programme 3. Personal 4. Study/academic, found poor student knowledge and little clarity of responsibilities of academic staff and services leads to students sourcing support from the wrong place at the wrong time. Students valued the speed and accessibility of information from informal, programme specific Facebook groups. Conversely, there were also concerns about the accuracy of these. Further research into the use of informal Facebook groups may be useful along with additional evaluation of the SOS tool.

Becoming a nurse as a moral journey: A constructivist grounded theory

BACKGROUND

Nursing students, during their study, experience significant changes on their journey to become nurses. A major change that they experience is the development of their moral competency.

OBJECTIVE

The purpose of this study is to explore the process of moral development in Iranian nursing students.

RESEARCH DESIGN

A constructivist grounded theory method was adopted. Twenty-five in-depth, semi-structured, face-to-face intensive interviews with 22 participants were conducted from September 2013 to October 2014. All interviews were audio-taped, transcribed, and analyzed using writing memos and the constant comparative method. Participants and research context: The setting was three major nursing schools within Tehran, the capital of Iran. Nineteen nursing students and three lecturers participated in the study. Ethical considerations: The study was approved by the Tehran University of Medical Sciences Committee for Medical Research Ethics (92/D/130/1781). It was explained to all participants that their responses would be treated with confidentiality and that they would not be identified in any way in the research and any publication ensuing from the research. All participants agreed to be interviewed and signed written consent forms agreeing to the recording and analyses of the interview data gathered.

FINDINGS

Findings indicated three levels of moral development along with the formation of professional identity. The three levels of moral development, getting to know the identity of nursing (moral transition), accepting nursing identity (moral reconstruction), and professional identity internalization (professional morality), were connected to the levels of professional identity formation.

DISCUSSION

The proposed model added a new insight to professionalism in nursing.

CONCLUSION

From the findings, it was concluded that to enhance higher moral practice, nursing instructors should promote the professional identity of nursing students. Reinforcement of moral characteristics and professional identity within registered nurses occurs over a series of phases and, once fully integrated into the identity of nursing students, the moral characteristics that they acquire become part of their both professional and personal identities.

Career interest, self-efficacy, and perception in undecided and nursing undergraduate students: a quantitative study

Career choice variables of career interest, self-efficacy, and perception were chosen based upon Social Cognitive Career Theory concepts for study between nursing and undecided undergraduate student groups. Components of the Career Search Questionnaire and Perceptions of Professional Nursing instruments were combined and adapted to form the Career Choice Survey for use in this research. This web-based survey totaling 40 questions was sent to 577 undergraduate students with a 12% response rate (N=68). Due to the need to increase nursing recruitment and retention, hypotheses were developed that distinguish if any relationship existed between groups. Findings of this quantitative study resulted in statistically significant results on two of the three variable hypotheses (p=.006 for career interest, p=.002 for self-efficacy, p=.395 for perception), aligning with previous research and provide insight into the change in nursing perception. Overall, scores for each subscale were encouraging to current nurses and expected from undecided students. Implications for practice include increases in accurate nursing portrayal in the media and early career counseling to younger populations. Nurse educators can further research in career choice with focus on continuing education for current nurses and recruitment of young nursing hopefuls.

The society's view of nursing in Turkey

This study was conducted in order to ensure the educational transformation of a school of health at a state university, within the scope of the Bologna Process. A review of the literature suggests that dependent functions of nursing are studied more often than its independent functions, but independent functions of nursing are not properly understood by society. The population consisted of 458 people in Düzce. They were chosen using a stratified sampling method. The researchers developed a questionnaire form to use as the data collection tool. The data were evaluated by means of descriptive statistics. People living in Düzce region believed that nurses primarily perform care activities, that they act as assistants to doctors. Nurses who perform practical tasks were given positive ratings for their interpersonal communication skills, but the participants also expected nursing school to improve educational structuring to help nursing students acquire communication skills. Nursing education programs must be restructured to improve nursing students' communication skills. It is the first step for structuring education program to know what is nursing image within society. In light of this approach nursing program can be restructured to local tendencies.

Work values and intention to become a registered nurse among healthcare assistants

PURPOSE

To examine the work values of Swiss healthcare assistant students, who, at the end of their vocational education in hospitals and nursing homes, choose to pursue a registered nurse degree.

DESIGN

A prospective, cross-sectional survey was administered to a full cohort of healthcare assistant students in their last year of study in the canton of Bern (n=272).

METHOD

Multivariate methods (logistic regression) were applied to estimate the joint effect of work experience and work values in choosing to pursue a registered nurse education.

FINDINGS

Among work values, extrinsic values (regarding wage, career und educational perspectives) had a strong effect on the decisions of healthcare assistant students to pursue further education as registered nurses. Grades, socio-economic background and satisfaction during education also had an effect.

CONCLUSIONS

Higher valuation of income, career and further education affect the career intentions of nursing assistants who have already obtained a recognized healthcare education and nursing experience. Teachers and trainers should actively identify the work values and expectations of these students. Provision of adequate advice and suggestions for the career development of these students may be an important route by which to address the nursing shortage and recruitment problems.

International Nurses Day and press coverage in South Africa

BACKGROUND

In some countries, nursing's appeal as a profession is diminishing, partly due to poor press coverage and the media's portrayal of an over-loaded, poorly paid profession. The media is important for shaping public perceptions and raising policy issues. International Nurses Day gives nurses an opportunity to profile their critical contribution to quality health care.

AIM

To determine the influence of this commemorative day on press coverage about nursing by examining whether there was a difference in the proportion of South African press articles on nursing between January-April and May-June 2010.

METHODS

A quantitative content analysis was conducted of all press articles mentioning 'nursing' or 'nurse/s' in the South African lay press from 1 January-31 June 2010. Articles were coded for theme, slant and prominence, and inter-coder reliability was assessed. Descriptive statistics with chi square or Fisher's exact tests were used to compare the two time periods.

RESULTS

We identified 242 articles in 95 publications. The month of May had almost double the press coverage of January. International Nurses Day articles were mainly positive, and appeared in May to June in weekly community publications rather than in daily national and regional newspapers. When they were excluded, most articles portrayed nursing negatively.

LIMITATIONS

The 6-month period may not be representative of the entire year. Only the dominant topic was coded, which possibly influenced the analysis.

CONCLUSION

International Nurses Day positively influenced the extent and slant of press coverage. Efforts to sustain coverage beyond the event through strategic partnerships and media engagement should be strengthened.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The media's portrayal of nurses and nursing may influence the choice of nursing as a career. International Nurses Day is an opportunity to portray nursing positively. Media training may help nurses to advocate for their profession in the media.

Factors influencing the choice of a nursing or a non-nursing degree: a multicenter, cross-sectional study

Current literature has paid increasing attention to the factors influencing career decisions; nevertheless, few studies have compared candidates that have chosen a nursing versus a non-nursing degree. A multicenter, cross-sectional study design was performed to explore whether or not certain individual variables and having inaccurate data about nursing as a profession influenced the choice of a non-nursing degree. Six non-nursing and three nursing degree programs offered by two public Italian universities were involved. A total of 507 students who had just enrolled in non-nursing degree programs and 202 in nursing degree programs were invited to complete a questionnaire comprising 12 closed items. Overall, from 40.0% to 57.1% of the variation in choosing a degree other than nursing was explained by variables such as age, and having inaccurate data on the nursing profession. For each year over 19 years of age, the likelihood that the student would decide to enroll in a nursing degree program increases. For each wrong answer reported on the questionnaire evaluating knowledge on nursing profession, there was a reduction of approximately six times in the likelihood that the student would enroll in a nursing degree program. Information regarding the nursing profession should be offered in early stages of life; in addition, offering accurate data on the profession is a key factor in evaluating the congruence of the career with the individual's personal motivations, aspirations, and talents.

The image of nursing, as perceived by Iranian male nurses

The stereotypical public image of nursing is a major concern for male nurses around the world. In this study, we explored how Iranian male nurses perceived the public view of nurses, and their perceptions of themselves. A qualitative descriptive design and content analysis were used to obtain data from 18 purposely-selected male hospital nurses with a baccalaureate nursing degree in Tabriz, Iran. Semistructured interviews were conducted and analyzed. Two main themes emerged: (i) the outsider's view of nursing, which referred to the participants' perceptions of their public image; and (ii) the insider's view, which related to the male nurses' perceptions of themselves. Results included personal transition into a positive professional self-image through the educational process, and continued public perception of nursing as a female profession ill-suited for a man. Strategies to improve the insider's and outsider's views of nursing are listed to help recruit and retain more Iranian male nurses.

Factors influencing nursing career choices and choice of study program

In advance of a recruitment campaign, Israeli first-year nursing students of all ethnicities were surveyed to elucidate what factors had influenced them to make nursing their career and what sort of training track they preferred. The responses made it clear that different factors influence different groups differently. There were noticeable differences by gender, age, and ethnicity. Overall, training institutions were chosen for their closeness to the student's home but other factors also operated among particular groups, such as institutional prestige and flexible entry criteria. There was a blatant preference for academic, particularly university-sited, programs over diploma programs.

Recruitment, selection and retention of nursing and midwifery students in Scottish Universities

BACKGROUND

High attrition rates from pre-registration nursing and midwifery programmes have been reported in both the UK and in other countries.

OBJECTIVES

A study was conducted to identify best practice in recruitment, selection and retention across Scottish Universities providing pre-registration programmes.

DESIGN

A survey of all universities providing pre-registration programmes in Scotland was conducted. Semi-structured interviews were conducted with key personnel in each university. Documentary evidence was collected to supplement interview data and evidence recruitment, selection and retention practices.

SETTINGS

All universities in Scotland providing pre-registration nursing and/or midwifery programmes.

PARTICIPANTS

All 10 identified universities agreed to take part and a total of 18 interviews were conducted.

METHODS

Semi-structured face to face and telephone interviews were conducted. Relevant documentary evidence was collected. All data were subject to thematic analysis.

FINDINGS

Universities are predominantly concerned with recruiting to the institution and not to the professions. Interviews are widely used, and are a requirement in the United Kingdom. However, there is no evidence base within the literature that they have predictive validity despite creating scales and scoring systems which are largely unvalidated. The study identified initiatives aimed at addressing attrition/retention, however most had not been evaluated often due to the multi-factorial nature of attrition/retention and difficulties with measurement.

CONCLUSIONS

Recruitment selection and retention initiatives were rarely evaluated, and if so, adopted a relatively superficial approach. Evidence from existing studies to support practices was mostly weakly supportive or absent. The study highlights the need for a coordinated approach, supporting the development of a robust evidence base through the evaluation of local initiatives, and evaluation of new strategies. Evaluation strategies must take account of the local context to facilitate transferability of findings across different settings.

Measuring the qualities of nurses: development and testing of the Qualities of Nurses Scale

AIM

This paper reports on the creation, development and testing of a new instrument to measure qualities of nurses, known as the Qualities of Nurses (QON) scale, applicable to student nurses.

BACKGROUND

High attrition rates within nursing programs and during early postgraduate years are an international phenomena. Mismatches between idealized perceptions of nursing and the realities of education and clinical experiences have been identified as contributing factors.

METHOD

A survey method was used to elicit responses to scale items from 678 first-year nursing students at a large university.

RESULTS

A one-factor 12-item solution explaining 47 percent of variance in the construct was demonstrated.

CONCLUSION

The QON can assist in the initial assessment and ongoing monitoring of changes in students' perceptions of nurses. Using the QON, researchers and educators can identify initial student nurses' perceptions and any changes associated in educational or other events that ultimately could be manipulated to reduce attrition.

The negative influence of significant others on high academic achieving school pupils' choice of nursing as a career

The International Council of Nurses proposes that the shortage of nurses is global in scale and is expected to become much worse in the years ahead. A major factor impacting on the worldwide nursing shortage is the diminishing number of young people choosing nursing as a career (International Council of Nurses, 2008). One important dimension of the school pupils' career choice process is their interactions with significant others and the influence of these significant others (Hodkinson and Sparkes, 1997). As Schools/Departments of Nursing endeavour to attract more intellectual school leavers it is important to examine what advice and opinions are significant others giving regarding nursing as a career choice and how influential is this advice. This paper is based on interview data from 20 high academic achieving 5th and 6th year school pupils in Scotland, paradigmatic cases from a larger sample, who had considered nursing as a possible career choice within their career preference cluster, but then later disregarded nursing and decided to pursue medicine or another health care profession. The data was particularly striking in revealing the negative influence of significant others on high academic achieving school pupils' choice of nursing as a career. The influence of significant others, these being specifically parents, guardians, guidance teachers and career advisors was very apparent in the data in that they had a very negative view regarding nursing as a career choice for high academic achieving school pupils.

What are reasonable expectations? Healthcare student perceptions of their programmes in the North West of England

BACKGROUND

Concerns about current levels of attrition from some healthcare programmes have emphasised the need to gain a greater insight into students' expectations and experiences.

OBJECTIVES

The aim of this study was to determine how students in the North West of England perceived their studies and to identify the factors that could contribute to students' dissatisfaction.

DESIGN

A mixed methods sequential exploratory study.

SETTINGS

Nine universities in the North West of England.

METHODS

Phase one used narrative interviews with a purposive sample of 24 students to investigate their expectations and experiences. Data from these interviews were analysed using a thematic framework and direct quotes from key themes were incorporated into online survey for phase 2. Survey respondents were asked to rate their agreement to statements on a four-point Likert-type response format. There was also an opportunity to leave comments through open questions relating to each theme.

RESULTS

A total of 1080 respondents completed the online survey in phase 2. The majority of students reported positive experiences of their course. There was strong agreement in the importance of the role of the personal tutor and of a supportive placement mentor. Some students indicated that the workload and academic level were a shock at first. Students identified difficulties around the cost of placement travel and the impact of placements on family life. Financial hardship was a frequently cited issue that students attributed to thoughts of discontinuation.

CONCLUSIONS

Most students had positive learning experiences which meet their expectations. Students who have unmet expectations report poor placement experiences, lack of support, unexpectedly high workloads and financial difficulties. Clear guidance on the role of personal tutor and placement mentor is recommended.

European nursing students' academic success or failure: a post-Bologna Declaration systematic review

OBJECTIVES

The aim of this systematic review is to synthesise the available evidence in the European scientific literature produced after the Bologna Declaration and to evaluate studies that quantify and examine the factors associated with the academic success or failure of nursing students.

DESIGN

A systematic review of the literature was conducted.

DATA SOURCES

Major health literature databases were searched for studies published from 2000 to 2011.

REVIEW METHODS

This review includes only European observational studies that were submitted to a quality assessment by two researchers before inclusion.

RESULTS

Only five studies were included in this review. There are discordant results regarding the predictors of success or failure, which were common objects of study (gender, age, qualification on entry, ethnic group). other factors were studied individually (student personality, gendered view of nursing careers, intention to leave, family commitments, working while on course, student performance, clinical learning environment) need to be confirmed in additional studies. Although the predictors may be relevant at the local level, given their low external validity and the conflicting results, it is not possible to state with certainty that these factors are effectively predictive of success or failure in the context of post-Bologna Declaration Europe.

CONCLUSIONS

This review showed that over the last ten years, in the European context, only a few high-quality observational studies have been performed. In this regard, given the small number and heterogeneity of the available studies, there is little useful evidence available for Higher Education Institutions (HEIs) to effectively address the problem. In the future, European researchers should focus not only on the documentation of the predictors but also on the documentation of the outcomes produced by the HEI strategies that have been implemented to prevent avoidable academic failure and contain physiological academic failure.

The nurses' self-concept instrument (NSCI): a comparison of domestic and international student nurses' professional self-concepts from a large Australian University

Professional self-concept is a critical driver of job satisfaction. In Australia, as international nursing enrolments rise, nursing is increasingly characterised by a professional body of international nurses who may differ from domestic Australian nurses in their nursing self-concept. At present, little is known about the extent to which domestic and international students nurses' self-concepts may differ. The present study aimed to elucidate and contrast domestic and international nursing students' self-concepts from one large Australian university. A total of 253 domestic (n=218) and international (n=35) undergraduate nursing students from a large public university in Sydney, Australia completed the Nurses' Self-Concept Instrument (NSCI). Multiple-Indicator-Multiple-Indicator-Cause (MIMIC) modelling was used to assess the effects of student group (domestic and international) on the latent self-concept factors of the NSCI. Domestic and international students' professional self-concepts were similarly high. MIMIC modelling demonstrated that domestic students had a higher patient care self-concept in comparison to international students. Results imply that it may be useful for Australian universities to foster strategies that enhance specific domains of self-concepts (e.g., care) which may be underdeveloped for at least some cultural groups within the international nursing student population compared with domestic nursing students.

Nursing Challenges in Motivating Nursing Students through Clinical Education: A Grounded Theory Study

Nurses are the first role models for students in clinical settings. They can have a significant role on students' motivation. The purpose of this study was to explore the understanding of nursing students and instructors concerning the role of nurses in motivating nursing students through clinical education. The sampling was first started purposefully and continued with theoretical sampling. The study collected qualitative data through semistructured and interactive interviews with 16 nursing students and 4 nursing instructors. All interviews were recorded, transcribed, and analyzed using grounded theory approach. One important pattern emerged in this study was the “concerns of becoming a nurse,” which itself consisted of three categories: “nurses clinical competency,” “nurses as full-scale mirror of the future,” and “Monitoring and modeling through clinical education” (as the core variable). The findings showed that the nurses' manners of performance as well as the profession's prospect have a fundamental role in the process of formation of motivation through clinical education. Students find an insight into the nursing profession by substituting themselves in the place of a nurse, and as result, are or are not motivated towards the clinical education.

Support for nursing and midwifery students: a special case?

In order to address attrition amongst nursing and midwifery students, three Scottish universities were funded to employ Pastoral Care Support Advisers (PSA). This paper presents the findings of an evaluation which explored nursing and midwifery students' support needs and their experience of the PSA service. Telephone and focus group interviews were carried out with staff (n=14) and students (n=25). Based on the findings of these interviews two on-line surveys were developed and completed by 88 members of staff and 525 nursing and midwifery students. A majority of staff indicated that students had more complex problems than in the past, and would benefit from access to a dedicated source of support. Levels of anxiety and depression amongst students were found to be above a desirable level, and three quarters of students who completed the survey reported having experienced problems. Some members of staff believed that the PSA had had an impact on attrition, and students that participated reported that they would have left had they not received this support. The PSA service not only benefitted the students it also reduced staff time spent with students on non-academic issues. A source of independent support would benefit students, university staff, and the National Health Service.

The case for graduate entry to the United Kingdom nursing register

AIM

The recent decision of the United Kingdom Nursing and Midwifery Council to make nursing a degree profession is contentious and has generated debate among nurses and other stakeholders. We argue why nurses need a degree to nurse and what the implications of making a degree in nursing obligatory at the point of registration will be.

BACKGROUND

Nurses work at the forefront of any healthcare system. The complexity of their role and demands on them are increasing. To fulfil demands and expectations of employers, the public and the profession, and to be able to work collaboratively with other healthcare professions, nurses need critical thinking, problem-solving and decision-making skills, which can help them to work as independent practitioners. We argue that this can only be assured if the level of education for nurses is raised from diploma to degree, making this a prerequisite for registration as a nurse.

CONCLUSIONS

The increasingly complex role of nurses, the changing landscape of the healthcare needs and a need to improve the image and status of nursing as a profession to make it an attractive career choice are some of the important reasons that justify nursing in becoming a degree-only profession.