Measuring nurses' self-concept

Professional self-concept of BSN students: A cross-sectional correlational study

BACKGROUND

Professional self-concept consists of one's judgments, attitudes about oneself professionally, and one's own perception as a professional. A positive professional self-concept can support students and new nurses throughout their nursing careers.

OBJECTIVE

To describe levels of self-concept among pre-licensure undergraduate students.

PARTICIPANTS/SETTING

The participants were nursing students in a Bachelor of Science in Nursing program in the United States.

DESIGN/METHODS

This is a cross-sectional correlational study with self-report instruments, including demographics and the Professional Self-Concept of Nurses Instrument. Data (N = 103) were analyzed with SPSS/WIN 29.0. Descriptive statistics and professional self-concept scores were examined with independent t-tests, ANOVA, and Pearson's correlations.

RESULTS

Most participants were female (n = 90), with a mean age of 20 years (SD = 1). The mean professional self-concept of nurses score was 78 (SD = 7), ranging from 27 to 108, and professional self-concept was positively correlated with receiving tutoring through the university's program, working as a tutor for nursing students or students in prerequisite classes, transferring into the nursing program, and participating in campus nursing organizations. Professional self-concept was negatively correlated with advancement in semesters of the nursing program, being a first-generation college student, having a family member who is a nurse, GPA, and having clinical-related work experience in healthcare.

CONCLUSIONS

Higher levels of exposure to nursing may be related to lower professional self-concept. This is important to recognize and it may generalize to other nursing schools and health-related departments. Schools of nursing should enhance students' resilience by promoting self-concept. Our findings also shade light on self-care and the mental health of healthcare professionals.

Translation, cultural adaptation, and validation of the Nurse Self-Concept Questionnaire (NSCQ) for Portuguese nursing students

BACKGROUND

The professional self-concept of nursing students significantly influences their attitude and identity within the profession, ultimately impacting their mental health and overall well-being. Recent evidence underscores the importance of assessing students' professional self-concept to prevent adverse outcomes such as burnout and stress. Since there are currently no validated instruments available in Portugal for this purpose, our objective was to translate, adapt, and validate the Nurse Self-Concept Questionnaire (NSCQ) with nursing students in Portugal.

METHODS

A two-phase research study with a non-probabilistic sample of 216 undergraduate nursing students, using the QualtricsXM electronic platform for data collection. An exploratory factor analysis was performed to verify the validity of the theoretical construct and its internal consistency. Cronbach's alpha was calculated, and a confirmatory factor analysis was performed to assess the model fit.

RESULTS

The final instrument, designated as Questionário de Autoconceito dos/as Enfermeiros/as (Pt - NSCQ), is composed of 24 items distributed across five dimensions: "General self-concept", "Staff relations", "Leadership", "Communication-care" and "Knowledge", which explain 67.71% of the total variance. All dimensions and the global scale revealed good internal consistency values, ranging from 0.775 to 0.927. The resulting factorial structure is coherent with the theoretical framework.

CONCLUSION

The Pt - NSCQ proved to be a valid and reliable instrument to assess Portuguese nursing students' professional self-concept. Future studies should be carried out on larger samples and different educational contexts, aligned with the importance to ensure the continuity of the psychometric analysis of the instrument.

Development and validation of the Chiropractic Professional Identity Embodiment Scale (CPIES)

BACKGROUND AND PURPOSE

Chiropractic professional identity (CPI) encompasses diverse values, beliefs, experiences, and philosophies about one's work, specific to the chiropractic profession. Yet currently, there is no instrument available to measure CPI. This study aimed to develop and validate the Chiropractic Professional Identity Embodiment Scale (CPIES).

MATERIALS AND METHODS

A mixed-methods sequential exploratory design was employed where qualitative inquiry preceded quantitative analysis of survey items conducted in New Zealand in 2022. Expert key informants provided feedback on candidate items via one-to-one cognitive interviews. Candidate items were administered to Board-registered chiropractors or chiropractic students through an online survey. The suitability of candidate items was evaluated using a variety of psychometric analyses including conceptually guided exploratory factor analysis (EFA) and reliability testing.

RESULTS

Based on relevant professional identity literature and feedback from 15 expert key informants, a draft survey instrument with 92 candidate items (across six domains) was rated by 231 participants. Using EFA, the number of items was reduced to 15. The CPIES sum score exhibited significant correlations with individuals' philosophical self-categorisation and five of the six optional subscales.

CONCLUSION

The 15-item CPIES, either as a unidimensional score or with six separate subscale scores, has been demonstrated to provide valid and reliable measurement of CPI. Future research could utilise the CPIES to investigate how CPI influences clinical practice, patient outcomes, career satisfaction, and public perception of the chiropractic profession, further advancing professionalisation and recognition within healthcare.

Latent profiles of nurses' subjective well-being and its association with social support and professional self-concept

AIM

To identify latent profiles of nurses' subjective well-being (SWB) and explore its association with social support and professional self-concept.

DESIGN

This study used an online survey and cross-sectional latent profile analysis design.

METHODS

A total of 1009 nurses from 30 hospitals in Guangdong Province, China, were selected using convenience sampling. An online questionnaire survey comprising the following scales was distributed: Index of Well-Being, Nurses' Professional Self-concept Questionnaire and Multidimensional Scale of Perceived Social Support. Nurses' SWB was examined and categorized into profiles using nine Index of Well-being items as explicit variables and ordinal logistic regression analysis was performed to explore factors related to the distinct categories.

RESULTS

Nurses' SWB was divided into four latent profiles: extremely low, low, moderate and high. Regression analysis showed that social support and professional self-concept influenced SWB. There were statistically significant differences in age, title, working years, social support and professional self-concept among nurses in the different well-being categories. Ordered logistic regression analysis showed that social support and professional self-concept are associated with different SWB profiles.

Literature review of the research on nursing students' professional self-concept

OBJECTIVE

To understand the current situation and progress of nursing students' professional self-concept, this review aimed to perform a general analysis of research related to the connotation of professional self-concept, measurement tools, influencing factors, effects, and intervention experiments.

METHODS

Three databases (Web of Science, PubMed, and CNKI) were searched for relevant articles. Research articles that met specific criteria were included, with identified articles initially screened by title and keyword. Then the abstracts were screened for relevance, and the full text was read for validation before inclusion. Descriptive analysis was performed with relevant findings from data retrieved from various sources.

RESULTS

Finally, 54 articles that met the criteria were included, which organised the connotation of self-concept of nursing speciality, and introduced six measurement scales, such as Professional Self-Concept of Nurses Instrument and Nurse's Self-Concept Questionnaire. A total of 16 investigations on influencing factors were described, and the results showed that there were internal individual and external environmental factors. The professional self-concept was formed by analysing both factors. This paper described 17 effect surveys and found that professional self-concept had an important impact on students' mental health, academic performance, and professional values, and so on. Eight intervention experiments including attribution training and hierarchical teaching were evaluated.

CONCLUSIONS

Research articles on the professional self-concept included in this review were rich. These articles clarified the basic connotation of the concept, developed relatively mature measurement tools, found many influencing factors and effects, and proposed effective intervention strategies. They were of great value for understanding the professional self-concept and could provide a reference for scholars to conduct relevant research and practice. It also presents research prospects in this field, aiming to inspire future research.

The Moderating Role of Psychological Safety in the Relationship between Job Embeddedness, Organizational Commitment, and Retention Intention among Home Care Attendants in Taiwan

As Taiwan's population ages, the need for long-term care, such as home care, is increasing due to improved medical services and longer life expectancy; however, the current coverage rate for home care services is only 50%, highlighting the importance of retaining home care workers. This study applies job embeddedness, organizational commitment, and psychological safety as variables to explore the retention intention of Taiwan's home care workers. A questionnaire survey was distributed among home care workers using convenience sampling, resulting in 547 collected questionnaires, of which 458 were valid. Data analysis was conducted with SPSS 22.0 and AMOS 22.0, and a structural equation model (SEM) was used to test the hypotheses. Our findings suggest that job embeddedness has a positive impact on organizational commitment (γ = 0.649, γ = 0.607, and γ = 0.628; p < 0.001) and retention intention (γ = 0.253, γ = 0.242, γ = 0.271; p < 0.001), similar to organizational commitment (γ = 0.721, p < 0.001). Additionally, organizational commitment mediates job embeddedness and retention intention, while psychological safety moderated organizational commitment and retention intention (β = 0.639; p < 0.001). This study aims to provide information for the development of more effective human resource policies and contribute to practical advancements in the home care service environment and management structure of home care organizations. By analyzing and exploring the main factors contributing to home care workers' retention intention, we hope to enhance the overall benefits of home service organizations and the industry.

Translation, Cultural Adaptation and Validation of the Nurses Self-Concept Instrument (NSCI) to Spanish

Professional self-concept in nurses is understood as the way nurses think and feel about themselves in their nursing role and is both a predictor of quality of care and a protective factor against burnout. The aim of this study was to translate, culturally adapt and validate the Spanish version of the Nurses Self-Concept Instrument in a sample of 483 Spanish registered nurses. In addition, we analyzed gender differences in its dimensions in the same sample. Internal reliability was evaluated using Cronbach's Alpha, while construct validity was assessed using both exploratory and confirmatory factor analysis. The differences between groups were analyzed using the Mann-Whitney U test. Factor distribution was different from the original model. A gender gap was observed in the Nurse Thinking and Perception of Capabilities dimensions with higher values in the women group, while in the Leadership dimension, higher values were observed in the men group. While the Spanish version of the Nurses Self-Concept Instrument is a valid and reliable tool to measure this construct, the differences in its dimensions lead to a deeper understanding of the cultural differences in the construction of professional self-concept.

Nursing Professional Self-Concept: A Scoping Review Protocol

Nurses are considered one of the largest professional groups in healthcare, generating positive health outcomes for people at various stages of life. A significant impact on the construction of the professional self-or professional self-concept-is considered to exist through the educational process, influenced by factors such as the family and societal expectations often presented by teachers, tutors, and peers. Improving professional self-concept in nursing can offer specific gains in personal, relational, social, and interpersonal communication skills, favoring evolution in the academic and clinical path. This scoping review aims to map the literature related to the state of knowledge regarding professional self-concept in nursing. This scoping review will follow JBI recommendations with the PCC mnemonic and report its findings through PRISMA-ScR using a specific instrument made by the researchers. Providing healthcare complying with high scientific standards requires the professional to have enough self-confidence in his work and skills. The explicit acknowledgement of professional self-concept is essential for any educational tutor or experienced mentor to promote mental health and academic and professional performance.

Psychometric properties and latent profile analysis of the Nursing Brand Image Scale: a methodological study in the Chinese context

AIMS

To translate the U.S. version of the Nursing Brand Image Scale to Chinese (NBIS-C) and evaluate its psychometric properties when administered to a national sample of Chinese nurses, and identify nursing brand image profiles in Chinese nurses.

DESIGN

A cross-sectional study was conducted to validate the NBIS-C among nurses in China.

METHODS

The psychometric properties of the NBIS-C were tested in accordance with the COSMIN checklist. The reliability, validity, and responsiveness of the 42-item NBIS-C were examined in a national sample of 759 nurses recruited from 29 Chinese provinces. Latent Profile Analyses (LPA) were conducted to reveal nurses' perceptions of the brand image of nursing.

RESULTS

Results of this study demonstrated acceptable validity (content validity, structural validity, and construct validity), reliability (internal consistency and test-retest reliability), adequate responsiveness, and no floor/ceiling effect of the NBIS-C. LPA yielded five subgroups: Integrated, Traditional, Subordinate, Creative and Leader.

CONCLUSION

The psychometric properties of the NBIS-C are suitable for assessing the image of nursing among Chinese nurses. Future studies with a larger, more diverse sample are recommended. Although the role of nurses in China has evolved, nurses in general have failed to communicate a consistent, positive, and accurate brand image for the nursing profession.

Professional Self-Concept and Self-Confidence for Nurses Dealing with COVID-19 Patients

Purpose: To identify the impact of dealing with COVID-19 patients in clinical areas on nurses’ professional self-concept and self-confidence. Background: Professional self-concept is considered a critical factor in the recruitment/retention process in nursing, nursing shortage, career satisfaction, and academic achievements. Professional self-confidence is also a crucial determinant in staff satisfaction, reducing turnover, and increasing work engagement. Design: Descriptive, comparative study. Methods: The study was conducted between February to May 2021 by utilizing a convenience sampling technique. A total of 170 nurses from two facilities were recruited from two COVID-19- and non-COVID-19-designated facilities. The level of professional self-concept and self-confidence was assessed by utilizing the Nurses’ Self-Concept Instrument and Self-Confidence Scale. Results: The professional self-concept level among the group exposed to COVID-19 patients was lower than the comparison group, while the professional self-confidence level among the exposed group to COVID-19 patients was similar to the comparison group. On the other hand, the satisfied staff and those who received professional training in dealing with COVID-19 patients reported a higher level of professional self-concept. Conclusions: Dealing with COVID-19 patients has an impact on professional self-concept; the exposure group was lower than those who did not deal with COVID-19 patients, while the professional self-confidence level among the exposed group was similar to the comparison group. Getting professional training in dealing with COVID-19 patients and being satisfied at work were significant factors in improving professional self-concept. Policymakers should create strategies that target the improvement of professional training in dealing with COVID-19 patients.

Relationship between clinical performance and professional self-concept in critical care nurses

Objective

To determine the relationship between clinical performance and professional self-concept in critical care nurses.

Methods

This study was conducted on 308 critical care nurses. Data gathering instruments were nurses’ clinical performance questionnaire (NCPQ) and nursing professional self-concept measure (NPSCM). Independent sample t-test, one-way analysis of variance (ANOVA), and Pearson correlation coefficient were used for data analyses.

Results

The average age of the nurses was 33.74 ± 7.01 years. The clinical performance score of female nurses was significantly higher than male nurses. In the domain of clinical performance, clinical judgment and clinical inquiry had the highest and lowest scores, respectively. In the nurses’ professional self-concept, the highest and lowest scores were awarded to the subscales of self-confidence and staff relations, respectively. In addition, there was a significant positive correlation between self-concept and clinical performance of nurses.

Conclusions

Increasing professional self-concept improves the clinical performance of critical care nurses. Professional self-concept enhancement measures are recommended to improve the clinical performance of nurses in critical care units.

The protective role of professional self-concept and job embeddedness on nurses' burnout: structural equation modeling

BACKGROUND

Job embeddedness and professional self-concept are among the important nursing components, the existence of which help decrease occupational burnout among nurses. This study aimed to determine the protective role of Professional Self-concept and Job embeddedness on nurses'burnout.

METHODS

This descriptive, correlational study had a predictive design and was conducted on nurses working in training and healthcare centers of Babol University of Medical Sciences in 2019. In total, 308 nurses participated in this study and were selected by stratified random sampling. In addition, data were collected using demographic characteristics questionnaire, Professional Self-concept questionnaire, Job embeddedness scale and nurses' burnout questionnaire. Moreover, data analysis was performed in SPSS version 25 and Smart PLS version 3.3 using correlational statistics and structural equation modeling.

RESULTS

Both the variables of professional self-concept and job embeddedness, had a significant effect on nurses' burnout at 99% confidence level (P < 0.001) and the negative beta value for these two variables shows the inverse relationship between both professional self-concept and job embeddedness with nurses' burnout. The value of the coefficient of determination for burnout indicates that both the variables of professional self-concept and job embeddedness, together explain 78% of the changes in the variable of burnout. The beta coefficient for professional self-concept (- 0.50) is higher than the same coefficient for job embeddedness (- 0.42). As a result, the role of professional self-concept in predicting burnout of clinical nurses has been more than the role of job embeddedness. The indirect effect of professional self-concept on burnout of clinical nurses mediated by job embeddedness has been equal to - 0.347. As a result, it can be said that nurses' professional self-concept has a significant effect on nurses' burnout through mediation of job embeddedness.

CONCLUSION

According to the results of the study, Professional Self-concept had an effective role in nurses' burnout. In other words, the higher the Professional Self-concept of nurses, the lower their burnout. Therefore, it is suggested that effective interventional strategies be designed by nursing managers through better planning and a supportive workplace be established to improve Professional Self-concept among nurses and decrease their burnout.

Psychometric Analysis of the Professional Identity Questionnaires in Croatian Nursing Student Context

Introduction: The identification of nursing students with their profession, as well as gained professional competencies, are the crucial factors of the quality of their future work activities and the level of safety of the patient they are taking care of. Therefore, it is of utter importance to estimate the nursing students' professional identity during their education. Objectives: The purpose of this study was to translate Professional Identity Five-Factor Scale and Identity questionnaire, to test their psychometric properties in Croatian practice and to identify more suitable instrument of measuring the level of nursing students' professional identity in Croatian context. Methods: Quantitative, cross-sectional two-phase study was performed. In the first phase translated questionnaires were administered to a sample of 432 nursing students. Based on the confirmatory factor analysis (CFA), which revealed poor model fit, the principal component analysis was conducted. In the second phase, CFA was used to test the Croatian version of the instruments' factor structure on a sample of 222 students with different study orientations. Results: The CFA results, conducted in first phase, do not support the original version of the factor structures of the Professional Identity Five-Factor Scale and Identity models. The exploratory approach showed that the translated Professional Identity Five-Factor Scale had three factors with good psychometric properties explaining 49.35% of the variance. Translated Identity questionnaire had a two-factor structure (63.46% explained variance) with good reliability properties. In the second phase, on another heterogeneous sample of students, the described factor structure was found to have a good model fit obtained by CFA. Conclusions: According to the findings, Professional Identity Five-Factor is more appropriate for evaluating professional identity of nursing students, and Identity is probably better suited to measure professional identity among working professionals.

Evaluation of a digital application to support internationally qualified nurses' communication and leadership skills

BACKGROUND

Internationally qualified nurses enrolled in Australian bridging programs to support professional registration lack confidence, and require support and time to develop communication and leadership skills in the clinical setting. Strategies that strengthen professional self-concept have been demonstrated to improve the nursing performance of internationally qualified nurses.

OBJECTIVE

To evaluate an interactive mobile application called mPreceptor, specifically designed to support internationally qualified nurses' communication and leadership skills during a 6 week clinical placement. The application facilitated weekly learning content and activities in the areas of clinical communication and leadership, including self-assessment, goal-setting, case studies, and weekly detailed reflections while on placement.

DESIGN

A quasi-experimental pre and post-test design with a non-equivalent comparison group was used to explore the effectiveness of mPreceptor on internationally qualified nurses' self-appraisal of professional self-concept, including leadership and communication skills, compared with standard clinical placement. The psychometrically tested Nurse Self-Concept Questionnaire, measured changes to perceived professional self-concept.

RESULTS

Overall, there was a significant increase in Nurse Self-Concept following the clinical placement, confirming that the bridging program for internationally qualified nurses in Australia improves leadership and communication skills. Leadership skills were significantly greater for those internationally qualified nurses who engaged with mPreceptor.

CONCLUSION

Further research is required to investigate the application of interactive mobile applications, as effective education resources to facilitate internationally qualified nurses' transition of skills and knowledge to the Australian healthcare context.

The relationship between professional self-concept and work-related quality of life of nurses working in the wards of patients with COVID-19

BACKGROUND

Nurses are at the forefront of providing health care services and their performance is largely determinant of the quality of health care. This study aims to investigate associations between professional self-concept (PSC) and WRQoL among nurses from selected hospitals in Bushehr and Shiraz cities (south of Iran), during the period of COVD-19 pandemic.

METHOD

This study is designed as a cross-sectional study. Available sampling was performed among active nurses in the care wards of patients with Covid-19 in public hospitals in Bushehr and Shiraz. Data were collected using demographic information form, along with the work-related quality of life and professional self-concept questionnaires. SPSS software and univariate and multivariate linear regression statistical methods with a significance level of 0.05 were used to analyze the data.

RESULTS

The mean scores of the PSC and the WRQoL Scale in nurses were respectively 202.32 ± 38.19 and 68.81 ± 19.12. There was also a significant direct relationship between PSC and WRQoL. PSC together with work location and working experience could thus explain 34.6% of the variance in WRQoL, which was 26.5% for PSC.

CONCLUSION

Considering the confirmation of the predictive role of nurses' PSC in their WRQoL in terms of planning and designing interventions to boost their WRQoL, attention to internal factors such as PSC is of utmost importance.

Trajectory of growth in Taiwanese nursing students' professional self-concept over two years and its association with critical thinking and class climate

BACKGROUND

Nursing is a practice-oriented profession, and the goal of education is to cultivate confidence and assertiveness for future clinical practice. Nurturing a professional self-concept at school is expecting to help students to approach their success in the nursing profession.

PURPOSE

Using a hierarchical model associated with critical thinking, academic achievement, class climate, and work experience, this longitudinal correlational study explored the growth trajectory of professional self-concept over two years in students attending 2- or 4-year baccalaureate nursing programs.

METHOD

This was a longitudinal and correlational study with five repeated measurements. Questionnaire data were collected by using the Chinese version of the Nurses Self-Concept Instrument (NSCI-C) and the California Critical Thinking Disposition Inventory (CCTDI).

RESULTS

Scores for overall professional self-concept ranged from 84.51 (standard deviation [SD] 12.34) when the students began this study to 89.28 (SD 11.23) at graduation. Hierarchical linear modeling yielded the growth trajectory of professional self-concept was significantly associated with time (β = 0.93, p < .01), CCTIDI (β = 0.13, p < .001), and class climate (β = 5.20, p < .01). An intraclass correlation coefficient was 55.48%.

CONCLUSION

This study confirmed the positive growth trajectory of the professional self-concept in the nursing students' two academic years. The continuous development of the professional self-concept of nursing students is encouraged. Development of critical thinking through their studies, feelings of belonging in their classes, and campus culture all contributed to this trend. To construct a comprehensive hierarchical model, future investigations should use large sample sizes from various classes and conduct multisite evaluations.

Cluster analysis of self-concept and job satisfaction in Chinese nurses with master's degree to identify their turnover intention: A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to implement cluster analysis of self-concept and job satisfaction to identify subgroups in nurses with master's degree and explore the associations of turnover intention with characteristics among these clusters.

DESIGN

A cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

METHODS

A convenience sample of 408 nurses with master's degree in China filled out the survey from 19 November 2019 to 30 December 2019. A sociodemographic questionnaire, the Nurses' Self-Concept Questionnaire (NSCQ), Job Satisfaction Scale (JSS) and Turnover Intention Questionnaire (TIQ) were adopted to collect the data. K-means cluster analysis was implemented on the R software, and data were analysed using SPSS 24.0.

RESULTS

Three subgroups were identified based on cluster analysis of NSCQ and JSS subscales in 405 nurses (99.3%) available for statistical analysis, among whom 30.9%, 17% and 48.1% were allocated to these clusters respectively. Turnover intention significantly differed among the three clusters, with cluster 2 having the highest turnover intention and cluster 1 having the lowest turnover intention. Working department, position, professional title, clinical nurse specialist and annual income were factors differentiating TIQ scores in each cluster.

CONCLUSIONS

This study identified three clusters of nurses with master's degree and showed that each cluster was associated with the level of turnover intention. The unique characteristics of the three clusters may be also helpful in identifying and providing specific managerial or social support to reduce turnover rates in nurses with master's degree.

RELEVANCE TO CLINICAL PRACTICE

Cluster analysis is s an unsupervised machine learning method to identify meaningful subgroups within heterogeneous population based on variables distributions and patterns underlying in the data set. Through clustering, nurses with multi-dimensional characteristics could be allocated into subgroups associated with turnover intention. As a result, nursing managers could provide approaches for each subgroup to reduce turnover intention.

[Nursing profession in Lebanon through a study on professional self-image]

Nursing education in Lebanon has integrated the academic world since 1979, but the profession is experiencing difficulties related to the retention of nurses at work and the lack of attraction to the profession. In this context, a study on the professional self-image was conducted among nurses working in hospitals. The results show that nurses have a positive professional self-image, but they find that their image in society is negative and only 20.4% would recommend this career to their children or their entourage.

Nurse spiritual self-care: A scoping review

BACKGROUND

The health care research on spirituality has focused on patients. Less is known about the spiritual self-care of nurses who work with these patients in all types of challenging environments. Nurse spiritual self-care may be helpful in reducing workplace stress and burnout.

PURPOSE

The purpose of this review was to provide a comprehensive understanding of the conceptual definitions, theory and measurement of nurse spiritual self-care as reflected in the current literature.

METHODS

The review framework was aligned with the recommendations consistent with the Joanna Briggs Institute guidance for scoping reviews.

FINDINGS

Ten studies were included. Three included explicit definitions and five explicitly stated theories. Five quantitative, four qualitative, and one mixed measurement of concept were found.

DISCUSSION

This scoping review identified conceptualizations, theoretical frameworks, and measurements that can be foundational to future research in this area. Our paper highlights the need for further research on nurse spiritual self-care.

The Validity and Reliability of Professional Self-Concept in Nursing in Accelerated Bachelor's and Master's Nursing Students

BACKGROUND AND PURPOSE

Accelerated bachelor's and master's nursing students supported through the New Careers in Nursing program were surveyed (n = 3,506) using subscales from Arthur's Professional Self-Concept in Nursing Instrument (PSCNI). Reliability and validity of the instrument was assessed.

METHODS

Factor analysis using a random split-half design were conducted and differences investigated based on characteristics.

RESULTS

Four factors were revealed: leadership (α = .85), skill (α = .89), career positivity (α = .72), and career negativity (α = .72), with acceptable confirmatory fit. Gender and race/ethnicity differences were found in self-perceived leadership and skill and in career positivity by race/ethnicity. Accelerated bachelor's and master's students were different on skill and career positivity.

CONCLUSIONS

Self-perceived leadership, skill, career positivity, and career negativity are distinct PSCNI concepts.

The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study

The aim of this study is to examine the influence of nurses’ self-concept (NSC) on clinical decision-making (CDM) among nursing students and hospital nurses. A further aim is to examine whether there is a difference in CDM and NSC between hospital nurses with various levels of experience and nursing students. A cross-sectional study was conducted during 2018 in the Faculty of Dental Medicine and Health and the University Hospital Center, in Osijek, Croatia, EU. The respondents consisted of 568 hospital nurses, and 129 BSc nursing students. Data were collected with the clinical decision-making in nursing scale (CDMNS) and the nurses’ self-concept questionnaire (NSCQ). There was no correlation between CDM and NSC in either students or hospital nurses. Hospital nurses generally had significantly higher scores in CDM than nursing students. On the other hand, students had a significantly higher total NSC level. The results of this study suggest that experience has a positive impact on nurses’ CDM skills. The high NSC estimated by students enables them to easily take up their clinical roles and approach the patient in a holistic manner, which is an attitude that gradually develops during studies and with clinical experience.

Psychometric Testing of the Persian Version of Macleod Clark Professional Identity Scale

BACKGROUND

Professional identity (PI) is a key factor behind nurses' ability to provide quality care. PI assessment requires valid and reliable tools.

AIM

This study aimed to translate into Persian the 9-item Macleod Clark Professional Identity Scale (MCPIS) and evaluate its psychometric properties among Iranian nursing students.

METHODS

In this methodological study, SMCPIS was translated into Persian through forward-backward translation. The face and content validity of the translated scale were respectively assessed by 10 nursing students and a panel of 10 experts. Then, 171 nursing students completed MCPIS and Nurse Self-Concept Questionnaire. Collected data were used for construct validity assessment through confirmatory factor analysis and criterion validity assessment through correlation analysis. Reliability assessment was also performed through the internal consistency and the test-retest methods.

FINDINGS

Confirmatory factor analysis revealed good fit model for the scale. Criterion validity, measuring convergent validity, assessment also showed a significant correlation between the scores of MCPIS and Nurse Self-Concept Questionnaire (r = -0.2, P = .07). Cronbach's alpha and test-retest correlation coefficient were .87 and .72, respectively. Students' MCPIS scores ranged from 15 to 54 with a median of 44 (in the possible range of 9-54).

CONCLUSION

The Persian MCPIS is a valid and reliable tool for PI assessment. Further studies are recommended to produce evidence supporting the validity and reliability of the scale.

Professional identity measures for student health professionals - a systematic review of psychometric properties

BACKGROUND

Professional identity is critical to the safe and effective clinical practice of all health professions. University programs play an important role in the formation of professional identity of students, and so it essential to understand professional identity at this stage of students' development. However, the majority of research into professional identity has been conducted using the qualitative paradigm so further quantitative analysis through the use of psychometrically-sound professional identity measures is required. This study aimed to identify professional identity measures used with university students enrolled in health programs and synthesise the evidence of their psychometric properties.

METHODS

The systematic review was conducted in two phases. Phase 1 involved searching five online databases for studies that used professional identity measures with student health professionals. These studies were assessed against a priori criteria for inclusion and a list of measures was identified. Phase 2 involved searching the same databases for psychometric evidence of the measures identified in Phase 1. The psychometric properties of each measure were compared against the Consensus-based standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Data were narratively synthesised, and comparisons were made between measures.

RESULTS

Phase 1 identified eight professional identity measures. Phase 2 identified a total of 15 studies that evaluated the psychometric properties of at least one of the professional identity measures. There was a paucity of psychometric evidence for the measures. The revised Nurses' Professional Values Scale and Macleod Clark Professional Identity Scale had the greatest volume of psychometric evidence. None of the measures fulfilled all criteria in the COSMIN checklist.

CONCLUSION

There is a paucity of evidence underpinning the psychometric of professional identity measures. Evidence which uses these measures should be interpreted with caution. Further research is warranted to ensure that the results of quantitative professional identity studies are valid and reliable.

Academic burnout and professional self-concept of nursing students: A cross-sectional study

BACKGROUND

Nursing students' academic burnout affects their learning behaviour and academic performance, which ultimately affect whether they will become a qualified nurse. However, little is known about the academic burnout of nursing students, or about its relationship with professional self-concept.

OBJECTIVES

The purpose of this study was (1) to assess the academic burnout of nursing students and (2) to evaluate the impact of professional self-concept on academic burnout among nursing students.

DESIGN

A cross-sectional survey.

SETTINGS

The survey was carried out at a 3-year vocational medical college and a 4-year undergraduate medical college in Anhui province, which is located in east-central China.

PARTICIPANTS

From March to May 2018, a total of 1139 full-time nursing students were investigated by convenient sampling, and 1083 valid questionnaires were recovered in this study.

METHODS

Basic information of students were collected. The Academic Burnout Scale (ABS) and the Nurses' Self-Concept Instrument (NSCI) were used to evaluate students' academic burnout and professional self-concept.

RESULTS

The average of the overall score of the Academic Burnout Scale was 2.77 ± 0.53, which closed to the median of the scale (median = 3). Whether class leader students or not has significant influence on influence students' academic burnout. Nursing students' professional self-concept had negative effect on their academic burnout.

CONCLUSIONS

Nursing students' academic burnout level was close to the median on the Academic Burnout Scale, and improper behaviour was most severe. Positive professional self-concept can reduce the level of academic burnout. It is meaningful for nursing educators to take measures to decrease nursing students' academic burnout and enhance their professional self-concept.

Adaptation of the Turkish version of Nurses' Self Concept Questionnaire

Objectives

Nurse's self-concept is significant for professionalism. We aimed to determine the reliability and validity of the Turkish version of a Nurses' Self Concept Questionnaire.

Methods

A methodological study was conducted with the participation of a group of nursing students and nurses. For the statistical analysis, structural equation models, convergent validity analyses, discriminate validity analyses, internal consistency analysis, and test-retest reliability analyses were used.

Results

Correlation-coefficient for the test–retest reliability of the Turkish version of Nurses' Self-Concept Questionnaire was 0.87. The internal consistency of this questionnaire was calculated with Cronbach's α coefficient and it was found high across the six subscales from 0.83 to 0.91. The goodness of fit indices was determined as acceptable.

Conclusions

According to results, this Nurses' Self-Concept Questionnaire is a valid and reliable instrument for assessing nurses' and nursing students’ self-concept in Turkey.

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The scales that used to assess the professional self-concept must be specific to the profession.

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The development of professional self-concept is important for nursing students.

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Nursing professional self-concept is important for the development nursing profession and change.

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The scale of professional self-concept can be measured both students and nurses in different cultures.

Differences in Gender-related Profile Characteristics, Perceptions, and Outcomes of Accelerated Second Degree Nursing Students

BACKGROUND

The New Careers in Nursing (NCIN) program provided scholarships and other supports to accelerated degree students at 130 nursing schools and collected data from the scholars at three time-points.

PURPOSE

The NCIN database was analyzed to identify gender-based differences in scholars' profile characteristics, program experiences, and post-graduation outcomes.

METHOD

An adaptation of Jeffreys's Nursing Universal Retention and Success Model guided the analysis. Gender differences were assessed after multiplicity adjustments for false positive rates.

RESULTS

Differences based on gender were found for profile characteristics, student affective factors, academic factors, professional integration factors, environmental factors, as well as academic, psychological and NCIN program outcomes. Results suggest that males were influenced by economic factors more than females when choosing nursing as a career. They had fewer concerns about financial aspects associated with being a student again yet secured employment sooner after graduation than female scholars. They did not view support services as important as did female students. They expressed confidence in their leadership competence more than their female counterparts.

CONCLUSION

Efforts are needed to better understand and address the nuanced gender-based perceptions and needs of nursing students who are male.

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

BACKGROUND

Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

METHODS

The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers.

RESULTS

A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

CONCLUSIONS

The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.

Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015

Undergraduate nursing students experience significant stress and anxiety, inhibiting learning and increasing attrition. Twenty-six intervention studies were identified and evaluated, updating a previous systematic review which categorized interventions targeting: (1) stressors, (2) coping, or (3) appraisal. The majority of interventions in this review aimed to reduce numbers or intensity of stressors through curriculum development (12) or to improve students' coping skills (8). Two studies reported interventions using only cognitive reappraisal while three interventions combined reappraisal with other approaches. Strength of evidence was limited by choice of study design, sample size, and lack of methodological rigor. Some statistically significant support was found for interventions focused on reducing stressors through curriculum development or improving students' coping skills. No statistically significant studies using reappraisal, either alone or in combination with other approaches, were identified, although qualitative findings suggested the potential benefits of this approach do merit further study. Progress was noted since 2008 in the increased number of studies and greater use of validated outcome measures but the review concluded further methodologically sound, adequately powered studies, especially randomized controlled trials, are needed to determine which interventions are effective to address the issue of excessive stress and anxiety among undergraduate nursing students.

Swedish-Registered Nurse Anesthetists' Evaluation of Their Professional Self

PURPOSE

This study aimed to explore how the nurse anesthetist values their professional self, compared with their peers, and also to explore whether professional self is affected by age, work experience, and/or gender.

DESIGN

An explorative and prospective cross-sectional design.

METHODS

During April 2011, a total of 108 registered nurse anesthetists from three different hospitals were surveyed using the Professional Self-Description Form with questions covering 21 items.

FINDINGS

A total of 87 (80%) responded: 21 men and 66 women with a mean age of 45 years (range, 28 to 64 years) and mean professional experience of 12 years (range, 1 to 41 years). Four factors were found: professionalism, trait of character, scientific knowledge, and empathy, with Cronbach alpha of 0.96 overall. Analysis showed that perceived professional self depends on age and amount of work experience, but not on gender.

CONCLUSIONS

The Professional Self-Description Form exhibits satisfactory internal consistency. Work experience and age influenced the development of professional self of nurse anesthetists.

Translation and validation of the Nurses Self-Concept Instrument for college-level nursing students in Taiwan

Nurturing a professional nursing self-concept is crucial in nursing education. To determine whether it has been achieved, a reliable and valid measurement tool is necessary. This study therefore aimed to translate the Nurses Self-Concept Instrument (NSCI), and then ascertain the content and construct validity, and test-retest and internal consistency reliability in the Chinese version of the NSCI (NSCI-C). A methodological design was conducted with 1239 nursing students of a university recruited as the sample frame and 540 randomly selected. The results showed the content validity index of 0.81 overall, alpha of 0.92 overall, and correlation coefficient of 0.87. The mean score of the NSCI-C was significantly higher in freshman than in senior (p<.01). The hypothesized four-factor model did not fit the data well. After restructuring, two factors were explored, with 69.04% explained variance. The findings suggest that the NSCI-C is reliable and valid in nursing students.

The role of high-involvement work practices and professional self-image in nursing recruits' turnover: A three-year prospective study

BACKGROUND

The retention of young graduate nurses has become a major management challenge among hospitals in Western countries, which is amplified in a context of aging of populations and an increasing demand for services from patients. Moreover, as it has been reported that 50% of experienced nurses do not recommend a career in nursing, it is likely that retention problems occur not only at the level of the organization, but also at the level of the nursing profession. Although research has identified some predictors of nurse turnover, it is unclear which factors influence nurses' turnover from the organization and from the profession and how these factors interrelate with one another over time.

OBJECTIVE

The present study extends previous research on nurse turnover by looking at the combined effects of nurses' pre-entry expectations, perceived high-involvement work practices, and professional self-image, on intended and actual turnover from the organization and the profession.

DESIGN AND METHODS

A prospective, longitudinal study of a sample of 160 graduated nurses affiliated with the Quebec Nurses' Association, Canada, was conducted. Participants were surveyed at three points in time, spread over a 3-year period. Graduated nurses' pre-entry expectations and professional self-image were surveyed at graduation (Time 1), while perceived high-involvement work practices, professional self-image, and intention to leave the organization and the profession were captured six months following nurses' entry into the labor market (Time 2). Finally, participants were surveyed with respect to organizational and professional turnover three years after the Time 2 survey (Time 3). Structural equations modeling was used to examine the structure of the measures and the relationships among the constructs.

RESULTS

Although pre-entry expectations had no effect, perceived high-involvement work practices were positively related to Time 2, professional self-image (controlling for pre-entry professional self-image). Moreover, high-involvement work practices exerted an indirect, negative effect on organizational and professional turnover through intention to leave the organization, and an indirect negative effect on intention to leave the profession through professional self-image. Nonetheless, professional self-image did not affect turnover.

CONCLUSIONS

The current study indicates that hospitals and nurse directors can take advantage of developing high-involvement work practices as these practices foster a stronger professional self-image among nurses, thereby contributing to their sense of value as care providers, and indirectly reduce intended and actual turnover from the organization and the profession.

I am only a nurse: a biographical narrative study of a nurse's self-understanding and its implication for practice

BACKGROUND

The personal is a vital part of professional nursing practice. From a psycho-social perspective, nurses produce and reproduce conceptions of the Self through experience. A literature search on nurses' self-understanding in a psycho-social perspective yields no results. Hence, the aim of this study was to investigate personal and professional experiences that may have formed the self-understanding of a nurse, and how this self-understanding may have influenced her professional practice.

METHODS

Using a single case approach, I conducted a Biographical Narrative Interview with a 50-year-old experienced Norwegian nurse. I asked the nurse to tell me the story of her life and how her work has affected her and possibly changed the way she saw herself. The overall aim of the interpretation was to understand the historically situated subjectivity in terms of the nurse's personal, social and professional constraints and chosen options.

RESULTS

The nurse's narrative of her life story made it possible to trace a common theme throughout her experiences, the experience of being "only a nurse". The nurse experienced a low status, as well as a downgrade in the competence needed to deliver quality care in professional relationships. She felt it difficult to identify with the experience of being on the bottom of the social ladder and to identify with the female, mothering ideal connected to nursing. She desired a better position, and wanted to identify with strong women. In contrast to reality, her self-understanding influenced her relationship with her patients, her professional pride and her further professional development.

CONCLUSIONS

This study shows that the professional practice of a nurse was informed by her self-understanding. This study suggests that the individual nurse must be given the opportunity to explore her professional vulnerability based on the assumption that it is both personally and socially constituted. This study indicates that the exploration of a nurse's self-understanding is one way to contribute to professional development.

The effect of perceived organisational support on burnout among community health nurses in China: the mediating role of professional self-concept

AIM

To examine the mediating effect of professional self-concept on the association between perceived organisational support and burnout among community health nurses in Chengdu, China.

BACKGROUND

Burnout is a common phenomenon among nurses and previous studies have focused on work environmental factors contributing to burnout. Limited studies have examined the effects of perceived organisational support and professional self-concept on burnout among community health nurses.

METHODS

This was a cross-sectional study with 551 community health nurses in Chengdu, China, which included a two-stage sampling method. Structural equation modelling was used to examine the relationships among perceived organisational support, professional self-concept and burnout.

RESULTS

The final sample included 456 nurses (82.7%). Perceived organisational support was a significant positive direct predictor for professional self-concept and a significant negative direct predictor for burnout. Professional self-concept was a significant negative direct contributor to burnout. Professional self-concept had a mediating effect on the relationship between perceived organisational support and burnout.

CONCLUSIONS

Perceived organisational support may result in reduced burnout by facilitating the development of positive professional self-concept.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies such as establishing a supportive work environment and professional competence training may be effective methods for burnout prevention and management among community health nurses.

How do nurses in palliative care perceive the concept of self-image?

BACKGROUND

Nursing research indicates that serious illness and impending death influence the individual's self-image. Few studies define what self-image means. Thus it seems to be urgent to explore how nurses in palliative care perceive the concept of self-image, to get a deeper insight into the concept's applicability in palliative care.

AIM

To explore how nurses in palliative care perceive the concept of self-image.

DESIGN

Qualitative descriptive design.

METHOD

In-depth interviews with 17 nurses in palliative care were analysed using phenomenography. The study gained ethical approval.

RESULTS

The concept of self-image was perceived as both a familiar and an unfamiliar concept. Four categories of description with a gradually increasing complexity were distinguished: Identity, Self-assessment, Social function and Self-knowledge. They represent the collective understanding of the concept and are illustrated in a 'self-image map'. The identity-category emerged as the most comprehensive one and includes the understanding of 'Who I am' in a multidimensional way.

CONCLUSION

The collective understanding of the concept of self-image include multi-dimensional aspects which not always were evident for the individual nurse. Thus, the concept of self-image needs to be more verbalised and reflected on if nurses are to be comfortable with it and adopt it in their caring context. The 'self-image map' can be used in this reflection to expand the understanding of the concept. If the multi-dimensional aspects of the concept self-image could be explored there are improved possibilities to make identity-promoting strategies visible and support person-centred care.

A cross-sectional study of drinking patterns, prelicensure nursing education, and professional identity formation

BACKGROUND

Professional identity has been described as being an important outcome of nursing education, but how this identity forms is not well understood. Even less is known about how students' personal substance use/abuse patterns factor into their professional identity formation.

OBJECTIVES

The purpose of this study was to describe drinking behaviors and professional identity formation among baccalaureate of nursing students.

DESIGN

This cross-sectional, descriptive study used a survey design.

SETTING

The study took place on three campuses of a large system university in the Midwestern United States.

PARTICIPANTS

The convenience sample consisted of 333 students enrolled in the first semester of the second, third, and last year of a traditional baccalaureate of nursing program.

METHODS

Data were collected using the Nurse Self-Concept Questionnaire and the Student Alcohol Questionnaire. ANOVA and Pearson r statistical tests were used to analyze data.

RESULTS

Self-perceptions related to leadership were found to be the weakest aspect of the students' self-concepts, and the only dimensions of professional self-concept that differed significantly among students enrolled at varying program levels were knowledge and communication. A negative relationship was found between increased alcohol use and general self-concept and communication, but the associations were very weak.

CONCLUSIONS

More research is needed to understand how best to facilitate the acquisition of an identity consistent with the profession's values and how to recruit candidates that embody nursing's preferred future.

Addressing the nursing shortage: a critical health care issue

This article explores factors that influence a nurse's choice between working in a rural and an urban area. Understanding how nurses make the choice of which type of environment is critical to addressing this shortage, especially in these hardest hit rural areas. A comprehensive literature review suggested a number of factors worthy of investigation. These factors were assessed through six focus groups and a survey. Results suggest that native geographic preferences dominate, but that value congruence, economics, work facilities and stress all play a significant role in the decision when choosing between an urban and rural work environment.

Typologies of professional identity among graduating baccalaureate-prepared nurses

PURPOSE

The purpose of this study was to identify patterns of professional identity arising from the Quality and Safety Education for Nurses (QSEN) attitudes among students completing their prelicensure education.

DESIGN

This mixed-method study used a modified Q-methodology design with a purposeful sample of 36 baccalaureate students graduating from three campuses of a large Midwestern university. Data were collected near the end of the spring semester of 2013.

METHODS

Participants rank-ordered their agreement or disagreement with a set of subjective statements reflecting the 46 QSEN attitudes. Data were analyzed using a standard three-step approach that included generating a correlation matrix, completing factor analysis followed by varimax rotation, and calculating the factor scores.

FINDINGS

Twenty statements represented consensus among the participants, and there was strong agreement that patient safety was both an individual and a team effort. Three professional identity typologies emerged: champions, collaborators, and individualists.

CONCLUSIONS

Evidence was found that these students internalized the QSEN attitudes to varying degrees, but more work may be needed to internalize all attitudes, especially those related to patient-centered care. Future research is needed to evaluate how students with different perspectives transition to practice and to explore other factors that comprise professional identity.

CLINICAL RELEVANCE

This study expands on what is known about patterns of professional identity among nurses and helps provide a beginning framework for understanding the values new graduates bring to practice.

Career development: graduate nurse views

AIMS AND OBJECTIVES

To explore recent Singapore nursing graduates' experience of and views about their career development and progress.

BACKGROUND

The recruitment and retention of an adequate number of registered nurses is a continuing workforce issue in Singapore and other major cities.

DESIGN

Survey of recent nursing graduates.

METHODS

Recent nursing graduates from the Bachelor programme (n = 147) were sent an individual survey; a response rate of 54% was achieved.

RESULTS

Findings show that nurses rated their self-concept in a positive manner and were most satisfied (moderately to very) with helping patients and providing effective care, and the level of patient involvement. They were least satisfied (moderately to only a little) with prestige among the general medical community and the general public, hours of work, lifestyle factors and research opportunities. The following four factors were identified as significant impediments to career development; lack of support in the work place; perceived insufficient clinical career development opportunities; excessive work hours; and limited access to merit-based places in further education.

CONCLUSIONS

Suggestions made to overcome perceived career development barriers are as follows: broad multifactorial healthcare system changes; decreased and more flexible working hours; and fairer access to further clinical and higher education.

RELEVANCE TO CLINICAL PRACTICE

Results highlight the value clinical nurses place on having access to career development opportunities, merit-based further education and work place supports. These factors also have the potential to influence patient care and impact on the retention of nurses in their present job and satisfaction with their nursing career.

The effect of a pedagogy of curriculum infusion on nursing student well-being and intent to improve the quality of nursing care

AIM

The aim of this study was to determine if a pedagogy of curriculum infusion promotes nursing student well-being and intent to address quality care indicators of Quality and Safety Education for Nurses (QSEN) and American Association of Colleges of Nursing.

METHODS

This mixed-method experimental design study is based on 86 students' experiences with curriculum infusion as an intervention in two undergraduate nursing courses from August to December 2011. Student reflections, case analyses, and narrative evaluations were examined.

FINDINGS

Students experiencing curriculum infusion demonstrated intention to provide quality care as evidenced by case analysis and personal reflections.

CONCLUSION

Students acknowledged the importance of self-care and demonstrated intention to provide quality nursing care in five of the six QSEN competencies. Educators must be mindful to educate the whole student.