Professional behaviours and factors contributing to nursing professionalism among nurse managers

Factors influencing the development of nursing professionalism: a descriptive qualitative study

BACKGROUND

The shortage of nurses threatens the entire healthcare system, and nursing professionalism can improve nurse retention and enhance the quality of care. However, nursing professionalism is dynamic, and the factors influencing its development are not fully understood.

METHODS

A qualitative descriptive study was conducted. Using maximum variation and purposive sampling, 14 southern and northern China participants were recruited. Semi-structured interviews were conducted from May 2022 to August 2023 in face-to-face conversations in offices in the workplace or via voice calls. The interviews were transcribed verbatim and analyzed via thematic analysis.

RESULTS

Three main themes emerged: (1) nourishment factors: promoting early sprouting; (2) growth factors: the power of self-activation and overcoming challenges; and (3) rootedness factors: stability and upward momentum. Participants described the early acquisition of nursing professionalism as derived from personality traits, family upbringing, and school professional education, promoting the growth of nursing professionalism through self-activation and overcoming challenges, and maintaining the stable and upward development of nursing professionalism through an upward atmosphere and external motivation.

CONCLUSION

We revealed the dynamic factors that influence the development of nursing professionalism, including "nourishment factors", "growth factors", and "rootedness factors". Our findings provide a foundation for future development of nursing professionalism cultivation strategies. Nursing administrators can guide the development of nurses' professionalism from many angles according to the stage they are in, and the development of professionalism deserves more attention. In the future, we can no longer consider the development of nursing professionalism solely as the responsibility of individual nurses; the power of families, organizations, and society is indispensable to jointly promoting nursing professionalism among nurses.

Nurse educators' professional practice attributes and its determinants

BACKGROUND

Professional practice attributes of nurses help to promote nursing as a profession and advance nursing education. Nursing professionals need to demonstrate a high level of professional commitment to their practices and must be professionally competent to perform their roles.

MATERIAL AND METHODS

Descriptive survey was conducted at the nursing educational institutes affiliated with the Indian Nursing Council and situated in the selected Northern Indian states. The sample included 343 nurse educators who were selected using simple random sampling. The self-reported method was adopted to collect data where three questionnaires including socio-demographic information, organizational characteristics of current place of work, and professional practice attributes assessment criteria were used. Descriptive and inferential statistics were used for data analysis.

RESULTS

Overall, the study's participants scored poorly on professional practice attributes (Mean, SD: 1.98, 2.03), which were linked to their personal (age and gender), professional (educational background, professional qualification, current designation), and organizational (duration of organization's establishment, courses provided, college management) characteristics.

CONCLUSION

The findings highlighted the need for nurse educators to be more competent and dedicated in their respective fields. The study also suggests that in order to raise the standard of nursing education, nursing regulatory bodies like nursing councils, universities, and governments must take the necessary steps to foster the professional development of nurse educators.

What is nursing professionalism? a concept analysis

BACKGROUND

Nursing professionalism plays an important role in clinical nursing. However, a clear conceptual understanding of nursing professionalism is lacking.

METHOD

Walker and Avant's strategy was used to analyse the concept of nursing professionalism. We searched electronic databases, including PubMed, Scopus, and CINAHL, for studies published from 1965 to 2021. Quantitative or qualitative studies published in English that focused on nursing professionalism were included in the study.

RESULTS

The three attributes of nursing professionalism are multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism is defined as providing individuals care based on the principles of professionalism, caring, and altruism.

CONCLUSIONS

This study offers a theoretical definition and conceptual model of nursing professionalism that may be applied to develop standardized assessment tools or nursing professionalism training programs.

Managing in Critical Care Settings: A Qualitative Study of South African Nurse Unit Managers and the Psychological Contract

Introduction

Little is written about the management of psychological contracts by nurse unit managers (NUMs) in critical care settings and how this perspective contributes to the performance, experiences, and views of nurses and nursing teams. Psychological contracts are important regulators of the employer-employee relationship, with managers (NUMs) being the embodiment of the employer in managing the contract.

Objectives

This qualitative study answers a call for research on the NUM perspective of the psychological contract given the role they play in the wellbeing of critical care nurses and quality of care provided. The study aims to understand the expectations and obligations that constitute the psychological contract NUMs have with their nursing teams, the nature of the contract, and how NUMs practically manage these aspects on their teams.

Methods

Using an interpretive qualitative research design and a purposive sampling technique, semi-structured interviews were conducted with 10 of the 14 NUMs from a public health facility about critical incidents relating to their obligations and expectations of managing critical care nurses.

Results

A thematic analysis of their responses revealed five main themes that represent the contents of their psychological contracts with critical care nurses: professional commitment and obligation; leading by example; trust and support; teamwork; and on-the-job training and further development. In their discussion of these components, the NUMs also revealed how they manage the psychological contract with nurses.

Conclusion

Based on the expectations and obligations NUMs hold with their staff, their psychological contracts were found to be largely relational, with elements of the balanced type, suggesting that they rely on interpersonal connection and coordination, as well as knowledge dissemination, to uphold the contract. This contract appears to be effective in inculcating the commitment of nurses to their profession and professional standards through the building of trust and offering of support. However, recommendations are offered to ensure NUMs are best prepared to sustain these psychological contracts and continue to support nurse wellbeing and related patient care.

Relationship between professional attitude and compassion among nurses

BACKGROUND AND AIM

The aim of this study was to examine the relationship between professional attitude and compassion among nurses.

MATERIAL AND METHODS

The sample of the crossectional study recruited 202 nurses who accepted participation and working in a state hospital. Data were collected between 20 June 2019 and 2 August 2019 with a questionnaire form, Inventory of Professional Attitude at Occupation (IPA) and Compassion Scale. Data were collected via face-to-face method. Form and scales were completed by the participants. The study was reported according to the STROBE.

RESULTS

The mean IPA was 134.57 ± 15.43. The mean score of the Compassion Scale was 73.89 ± 11.54. The mean scores of the Compassion Scale's sub-dimensions were 16.17 ± 3.22 for kindness, 8.62 ± 3.44 for indifference, 15.45 ± 3.17 for common humanity, 9.02 ± 3.46 for separation, 15.95 ± 3.00 for mindfulness, 8.67 ± 3.44 for disengagement. There were positive correlations between kindness (r = .356), common humanity (r = .214), mindfulness (r = .297) subscales and there were negative correlations between indifference (r = -.441), separation (r = -.411) and disengagement (r = -.415) subscales and the Inventory of IPA. There was a negative correlation between IPA and total Compassion Scale scores (r = -.140). IPA scores were significantly different according to sex, age, working duration, weekly working time, satisfied with colleague relationships. Compassion scores were significantly different for weekly working time, satisfaction with colleague relationships, suitability of the nursing profession and working in emergency and outpatient clinics (p < .05).

CONCLUSION

As nurses' professional attitude scores increased, kindness, common humanity and mindfulness subscales scores increased, while indifference, separation and disengagement subscales scores of the compassion scale decreased.

RELEVANCE TO CLINICAL PRACTICE

Increasing the awareness about professional attitude and compassion in nursing should start with undergraduate education of nurses, and it is recommended to organise in-service training to develop professional attitudes and compassion in occupational life and to research patient perspectives about compassion.

Psychological Resilience and Career Success of Female Nurses in Central China: The Mediating Role of Craftsmanship

Background

Nurses’ career success is an important factor affecting the quality of nursing services and the stability of the nursing workforce, and enhancing nurses’ career success level is of key significance to the development of the nursing discipline. As psychological resilience and craftsmanship are important spiritual traits in the process of nurses’ career development, it is important to understand the mechanism of their effects on nurses’ career success level.

Objective

To explore the current situation of craftsmanship, psychological resilience and career success levels of female nurses in central China, and to verify the mediating role of craftsmanship between psychological resilience and female career success using structural equation model.

Methods

A cross-sectional study was conducted among 2359 female nurses from three hospitals in central China through an online questionnaire, including craftsmanship, psychological resilience and career success scale. The data were analyzed by Z-test and Spearman rank correlation with SPSS 23.0 statistical software, and the mechanism of the effect of craftsmanship and psychological resilience on career success was completed by AMOS 23.0 statistical software.

Results

The scores of career success, psychological resilience, and craftsmanship of female nurses in central China were 68.00 (61.00, 75.00), 74.00 (64.00, 84.00), and 83.00 (79.00, 95.25). Spearman rank correlation analysis showed that Chinese female nurses’ career success was positively correlated with craftsmanship (r = 0.511, P < 0.01) and psychological resilience (r = 0.595, P < 0.01). Craftsmanship played a mediating role between psychological resilience and career success, accounting for 39.3% of the total effect ratio.

Conclusion

The scores of career success and psychological resilience of female nurses in central China are at a moderate level, and craftsmanship plays a mediating role between psychological resilience and career success. It is suggested that nursing managers should pay attention to the importance of career success to nurses’ self-development and nursing team stability, and improve their sense of career success by effectively improving nurses’ psychological resilience and craftsmanship.

Redefining the concept of professionalism in nursing: an integrative review

Objective

In today's world with sweeping changes, nurses are responsible for providing high-quality and cost-benefit care, which would almost be impossible unless they achieve their high professional status. To date, no precise and comprehensive definition of professionalism in nursing has been evidently proposed. In fact, many of the previously proposed definitions are either complicated or ambiguous. Moreover, there is no consensus in the literature on an exhaustive definition for “a professional nurse.” The present study aimed to illustrate the concept of professionalism in nursing and identify its defining characteristics.

Methods

In this study, concept analysis was conducted using Whittemore et al.'s method for the integrated review. A comprehensive search of electronic, scientific databases including Eric, PubMed, Scopus, Web of Science, EBSCO, PsychoINFO, Embass, MagIran, IranDoc, SID, and IRANMEDEX was carried out using the keywords such as professionalism, professional behavior, nursing professionalism (NP), professional attribute, and nursing.

Results

In the present study, a comprehensive search of 11 electronic databases retrieved 5738 articles. Then, 2837 duplicate articles were removed by endnote (version 8). Based on a preliminary examination of the titles and abstracts as well as the inclusion and exclusion criteria, 1517 articles were excluded. In addition, 137 articles were removed for scientific reasons. Finally, 52 articles in English and Persian were selected. Content analysis of the articles revealed four major themes, namely, individual prerequisite, professional prerequisite, appropriate structure, and socio-individual factors.

Conclusions

Professionalism in nursing is a major, multidimensional concept according to the literature that included individual prerequisites, professional prerequisites, appropriate structures, and socio-individual factors. In fact, professionalism in nursing comprises a wide range of personal characteristics, self-regulation, professional values, striving to acquire and enhance professional expertise, professional interactions, social, professional, and legal responsibility, and creation of a sense of belonging, and professional development.

Developing a Professionalism Manual for Nurse Managers to Improve Their Perception Regarding Professionalism and Professional Identity

Background

Developing a professional identity is rooted in the dimensions of professionalism and professional development. Moreover, the need for teaching professionalism has a mutual relationship with the formation of a desirable professional identity.

Aim

The current study aimed at developing a professionalism manual for the nurse managers to improve their perception regarding professionalism and professional identity.

Design

Quasi-experimental research design with pre-test, post-test, and follow-up was used.

Setting

The study was conducted at two different hospitals; Menoufia University hospital and Al-helal Insurance hospital, Menoufia Governorate, Egypt.

Subjects

The participants included all nurse managers at different levels from the two different hospitals (n =100).

Tools:tool 1: Professionalism Questionnaire and tool 2: Professional Identity Assessment Questionnaire were used to collect data.

Results

there was a statistically significant improvement in professionalism perception and professional identity level immediately after administering the professionalism manual and after three months in the follow-up phase than the pre-test phase. Additionally, there was a statistically significant positive correlation between two variables of the study at the post and follow-up phases, but not significant at the pre-test phase.

Conclusion

the professionalism manual was effective in improving nurse managers’ perceptions regarding professionalism and professional identity.

Recommendations: Incorporate the attributes of professionalism that were included in the professionalism manual as a guide for the performance review processes of nurses.

Impact of innovative education on the professionalism of undergraduate nursing students in China

AIM

To explore the relationships among innovative atmosphere, innovative behavior, professional self-efficacy, professional identity, and professionalism of undergraduate nursing students in China.

BACKGROUND

In lieu of the global shortage of nurses and low professional willingness of nursing students, innovative qualities are closely related to the professionalism of nurses.

METHODS

The participants of this cross-sectional study consisted of 320 nursing students recruited from the Nursing College of a comprehensive university in Jiangsu Province, China who voluntarily completed an anonymous questionnaire from May to October 2019. Structural equation modeling analyses were performed.

RESULTS

There was a positive correlation between all hypothetical pairwise variables (r = 0.496-0.795, p < 0.01). The final research model fits well. The results revealed that innovation atmosphere had a positive effect on innovative behavior and innovative behavior could affect nursing professionalism through self-efficacy and identity.

CONCLUSION

Innovative education plays a very important role in the professionalism of undergraduate nursing students. Nursing educators can promote the development of professionalism in future nurses by fostering innovative behaviors.

Developing and validating the Japanese version of professional attitude scale for nurses

Aim

We developed and psychometrically tested the Japanese version of the Professional Attitude Scale for Nurses (PASN‐J).

Background

Nurses must recognize the importance of their professionalism; therefore, it is critical to quantitatively measure nurses’ professional attitudes.

Introduction

This instrument validation study was designed to generate an itemized scale and examine its content validity/psychometric testing using a sample of Japanese nurses.

Methods

Based on a trait approach focusing on the characteristic traits of the nursing profession, a 59‐item draft scale was generated. During November 2017, 2657 nurses from 29 facilities in Japan were surveyed. The questionnaire included demographics, the 59‐item draft scale, and a self‐report scale of nurses’ professional behaviour and nursing practice ability. Using exploratory and confirmatory factor analyses, we evaluated the construct, criterion‐related, concurrent, and known‐groups validity, and reliability of the PASN‐J.

Results

Data from 1716 participants were analysed. The analyses yielded a 38‐item, 3‐factor scale that adequately fit the data. PASN‐J scores were positively correlated with nurses’ professional behaviour and nursing practice ability.

Conclusion

The 38‐item PASN‐J has good reliability and validity, making it useful for measuring the current condition of nursing professionalism and evaluating nursing education. Implications for Nursing and Health Policy: This scale can evaluate nursing education and promote nurses’ professionalism. The PASN‐J will help identifying the elements of undergraduate nursing education that require further emphasis. Additionally, the PASN‐J could facilitate the development of nursing policies to promote professional development in nurses. Ultimately, evaluating nursing education with the PASN‐J enhances nurses’ professional attitudes and subsequently improves their quality of nursing, nursing efficiency and patient outcomes.

An Evidence-Based Approach to Increasing Nurses' Publication Rates

BACKGROUND

Writing for publication in peer-reviewed journals is one of the most important types of writing that nurses engage in. It is essential for advancing the nursing profession, health care organizations, and individual nurses. Despite its importance, however, the rate of publication remains very low among nurses. At one large academic medical center, a baseline assessment of dissemination practices found a low publication rate. To address this, an evidence-based writing-for-publication program was designed to support professional dissemination of scholarly work.

METHODS

A 12-week workshop was designed and writers were matched with a mentor. The workshop started with a four-hour kickoff session on the process of getting published, including choosing a journal, querying an editor, drafting a manuscript, and working with coauthors. Participants also began developing an outline for their manuscript. Drafts were due to the mentor every four weeks for editing and feedback. At the end of the 12 weeks a wrap-up session was held for participants to read each other's manuscripts and give peer feedback.

OUTCOMES

As of this writing, five cohorts have completed the program, and 89 nurses participated. Twenty-nine manuscripts were completed and submitted to peer-reviewed journals; of these, 22 (76%) were accepted, four (14%) are still under review, and three (10%) were recommended for submission to a different journal. Among the 89 nurse participants, 84% reported being likely or very likely to write for publication again, and 96% reported improvement in their writing skills.

CONCLUSIONS

Without more nurses acquiring the skills to engage in writing for publication, the body of advancing knowledge that drives clinical decision-making may wane as aging, experienced nurse authors leave the profession. To protect the future of nursing, a continuous commitment to developing nurse authors across all generations is necessary. Nursing leaders and health care organizations must commit to ensuring novice nurse authors are provided with the resources to engage in disseminating knowledge.

Ambivalent sexism of nursing students in Turkey and South Korea: A cross-cultural comparison study

Culture has become increasingly important concepts in nursing in the era of globalization. Nurses' cultural biases and prejudices are huge obstacles to their caring for patients from diverse cultural backgrounds. Therefore, this study examined sexism among nursing students from two patriarchal societies: Turkey influenced by Islam, and South Korea influenced by Confucianism. For this comparative study, we used the survey data from the sample of 560 nursing students, 309 from Turkey and 251 from South Korea. The findings showed that both samples showed high levels of sexism, both hostile and benevolent. When comparing the two samples, Turkish nursing students showed significantly higher sexism than did Korean students. Additionally, in both countries, male participants showed higher scores on sexism, especially hostile sexism. In terms of age, older students in Turkey showed lower levels of benevolent sexism. We hope the findings of this study can provide evidence to develop customized transcultural nursing education content in the context of different ethnicities and to help nurses and nursing students from specific cultural backgrounds in becoming aware of their own cultures.

Professionalism experiences of undergraduate learner nurses during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa

Background

Professional socialisation of student nurses needs to be integrated into the formal teaching and learning during the nursing programme. Embedded in the training programme are professional values that are used synonymously with nursing professionalism. Professionalism is the conduct, qualities, values, vision, mission and/or goals that characterise a profession, and describes behaviours that are expected within the profession’s members. However, one’s values are shaped by one’s experiences, influence one’s behaviour and interactions with others, and are manifested in many aspects of professional behaviour. New nurses to the profession are expected to display behaviours of professionalism, thus requiring nurse training schools to help students internalise these behaviours. Nurse educators therefore carry a responsibility to shape future nurses’ growth towards professionalism.

Objectives

This article reports on the experiences of undergraduate student nurses regarding nursing professionalism during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa.

Method

A qualitative, exploratory and descriptive design was applied. Eight focus group discussions were conducted with first- to fourth-year student nurses registered for the undergraduate nursing programme. Data were transcribed verbatim and analysed using open coding. Ethical principles and trustworthiness were maintained throughout the study.

Results

Six main themes indicated that undergraduate student nurses experienced issues with role modelling, language barriers, their own understanding of professional behaviour, reasons for students and practitioners’ unprofessional behaviour, prejudice towards degree students and students’ professional or unprofessional behaviour experienced as contributing to the image of the profession.

Conclusion

Student nurses received mixed messages leading to emotional turbulence. They needed clear guidance from role models to demonstrate how to behave professionally.

Influences of gender-related perceptions and experiences on nursing professionalism: A cross-sectional study

The purpose of this study was to examine the influence of gender-related perceptions and experiences on nursing professionalism among nursing students who grew up in a culture with strong gender norms. Data were collected through an online survey from a convenience sample of nursing students in South Korea. To examine gender-related perceptions, we assessed beliefs in gender stereotypes and the level of benevolent sexism. Direct and indirect experiences of gender violence were assessed by examining participants' histories of involvement in intimate partner violence and witnessing parental violence. Nursing students' gender-related perceptions were significantly related to their nursing professionalism, whereas their experiences of gender violence were non-significantly related. More specifically, those who had stronger gender stereotypes showed a weaker perception of nursing professionalism. In addition, benevolent sexism was a strong predictor of nursing professionalism. We strongly recommend that nursing educators address gender-related issues in their nursing education, as this might help to minimize gender-stereotyped thoughts among nursing students, which can hamper their growth as professionals.

Nurses' experiences of health concerns, teamwork, leadership and knowledge transfer during an Ebola outbreak in West Africa

AIM

To describe nurses' experiences of health concerns, teamwork, leadership and management and knowledge transfer during an Ebola outbreak in West Africa.

DESIGN

The study has a qualitative descriptive design.

METHODS

The 44 nurses who had worked in an Ebola Treatment Centre in Kenema in 2014 and 2015 were invited by email to respond to a questionnaire. The qualitative, open-ended answers were analysed using a thematic analysis. Data have been coded systematically, with the identification of semantic patterns presented in four themes.

RESULTS

The themes are as follows: personal health management-a way to feel safe and secure for delegates and affiliates; pre-deployment training-crucial for a joint value base and future collaboration; the importance of a professional democratic approach and being a good role model; and the value of timely in-depth knowledge transfer of experienced former delegates.

Clinical nurses' awareness and caring experiences for patients with cervical cancer: A qualitative study

To determine the degree to which nurses are aware of cervical cancer and to describe nurses' experiences of caring for patients with cervical cancer. To promote quality of nursing care of cervical cancer, we need to explore their perceptions and nursing experience in doing cervical-cancer care. This study was a qualitative descriptive design. Interviews were conducted with 14 registered nurses. The interviews were audiotaped, transcribed and analyzed. Content analysis was performed. Fourteen nurses who had been working at wards and cancer education centers were recruited in this study. Nine key themes emerged from three categories such as nurses' awareness of cervical cancer, awareness of cervical cancer patient and caring experience. Nurses expressed fear of cervical cancer and helplessness in the face of a life-threatening prognosis. Nurses stated that they might have prejudice about cervical cancer, since it is caused by a sexually transmitted disease. They also recalled that patients with cervical cancer were more sensitive and demanding. Our findings provide a comprehensive and in-depth perspective in understanding the experience of caring for cervical cancer patients. Clinical nurses showed complex emotional reactions to cervical cancer, and expressed prejudice against the sex life of cervical-cancer patients. More education is required to ensure that clinical nurses can provide a nurse-led intervention with patients by managing nurses' fear, prejudice, and the care burden.

Psychometric evaluation of the Chinese version of the Snizek-revised Hall's Professionalism Inventory Scale

Objective

This study was performed to assess the reliability and validity of the Chinese version of the Snizek-revised Hall’s Professionalism Inventory Scale (C-SR-HPIS).

Methods

Exploratory factor analysis and confirmatory factor analysis were used to evaluate the construct validity of the C-SR-HPIS. The average variance extracted (AVE) and square root of the AVE were calculated and correlation analyses were performed to test the convergent validity and discriminant validity, respectively. Cronbach’s alpha (α) coefficient was used to test the internal consistency reliability.

Results

Data for 355 clinical nurses in mainland China were collected. Five factors were extracted, accounting for 58.86% of the total explained variance, and 20 items were selected for the C-SR-HPIS. The confirmatory factor analysis suggested good fitness of the modified model. The AVE was acceptable for convergent validity. The square roots of the AVE of the five factors were larger than their correlation coefficients with other factors, showing suitable discriminant validity. Cronbach’s α coefficient of internal consistency reliability of the overall scale was 0.76, indicating good reliability of the scale.

Conclusions

This study demonstrated good reliability and validity of the C-SR-HPIS and provides a quantitative tool for the assessment of nursing professionalism in China.

The role of the psychological contract in the motivation of nurses

Purpose Although private health care is regarded as providing a premium quality experience for both patients and staff alike, it is not without its daily challenges for health professionals. This study aims to explore the psychological contract of nurses to develop a greater understanding of how employee-employer interaction impacts motivation levels. Design/methodology/approach Data were gathered through semi-structured interviews with thirteen nurses at a private hospital in South Africa. Five nursing managers were interviewed to provide a management perspective. Thematic analysis was used to identify the salient elements of the psychological contract and to establish connections with motivational features. Findings The psychological contract of nurses was balanced in nature, contained predominantly relational elements and was characterized by the need for manager support, leadership and autonomy. Motivation was a by-product of fulfilment and was enhanced by a combination of tangible and intangible rewards. Practical implications Nursing managers should recognize their role in caring for the wellbeing of their staff and should be trained accordingly. Equipping nurses with the necessary tools to work autonomously, as well as acknowledging their skills, will stimulate confidence and improve motivation. Originality/value This study makes an important contribution to the existing literature on the psychological contract of nurses within the health-care system. It provides insight into relationship-based mechanisms that can be used to improve the motivation of nurses and thus impact the overall quality of patient care.

A concept analysis of professional commitment in nursing

BACKGROUND

The concept of professional commitment is being widely studied at present. However, although it is considered an indicator for the most human part of nursing care, there is no clear definition for it, and different descriptors are being used indiscriminately to reference it.

OBJECTIVE

The aim of this study is to clarify the concept of professional commitment in nursing through the Rodgers' evolutionary concept analysis process.

DESIGN

Systematic search using English and Spanish descriptors and concept analysis. Studies published between 2009 and June 2015, front-to-back analysis of the Nursing Ethics journal and manual check of articles cited in studies related to the Nijmegen Professionalism Scale.

RESEARCH DESIGN

The procedure of concept analysis developed by Rodgers was used.

ETHICAL CONSIDERATIONS

Although the topic was not labeled as sensitive and subject to ethical approval, its realization was approved by the Ethical Committee of Clinical Research of Aragon (CEICA) approved the study on 18 March 2015 and also careful procedures have been followed according to ethics expressed in the Declaration of Helsinki.

FINDINGS AND DISCUSSION

A total of 17 published studies. A clear definition of the concept was made, and surrogate terms, concept dimension, differential factors related to the concept, sociocultural variations and consequences for nursing practice were identified.

CONCLUSION

There is a need for continuous advancement in the development of the concept, specific actions to encourage this and the improvement of evaluation methods for its study.