Health and Gender in Female-Dominated Occupations: The Case of Male Nurses

Beyond Wokeness: Why We Should All Be Using a More "Sensitive" Measure of Self-Reported Gender Identity

Gender plays a significant role in an individual's experiences and behaviors, as well as their expectations of others. Researchers have long operationalized gender using limited, mutually exclusive categories that fail to capture the rich variability within a gender-diverse population. While open-ended responses or multi-item scales may be a socially progressive approach and necessary for some gender-based research (e.g., Bauer et al., 2017), it may be unsuitable and statistically unfeasible for quantitative researchers in other areas. We analyzed responses from over 700 gender-diverse participants in the U.S. on a series of unipolar scales (i.e., gender identity, expression, and perception by others) that granted participants the flexibility of selecting a comprehensive self-definition while still enabling quantitative analysis of group differences as well as capturing maximum within-group variability. Using a cluster analysis, we found that participants' responses were best represented by five categories: Archetypical Men (n = 169), Archetypical Women (n = 168), Intertypical Men (n = 158), Intertypical Women (n = 126), and Nonconforming (n = 85). We explore the variability of characteristics and beliefs (e.g., gender norms, sexist beliefs) within and between traditional sex and these new gender categories. In this paper, we discuss theoretical considerations for future research and how using this comprehensive operationalization of gender can expand our understanding of "gender differences'' beyond the current scientific assumptions and barriers.

Attitudes of Healthcare Workers in Israel towards the Fourth Dose of COVID-19 Vaccine

Attitudes of healthcare workers (HCWs) toward vaccines are extremely important for increasing vaccination coverage. We conducted a cross-sectional study at the beginning of the fourth COVID-19 vaccination dose campaign among 124 HCWs to evaluate attitudes towards the fourth dose and willingness to get vaccinated. At that time, Israel was the first country to approve the fourth vaccine dose. Most women were unwilling to get the fourth vaccine dose compared to men; 53.9% of physicians were unwilling to get vaccinated compared to 83.3% of nurses and 69% of other HCWs professions. The most frequent concerns regarding the vaccine were its efficacy, benefit, and necessity. The perceived risk and perceived severity of the health risk involved with getting vaccinated with the fourth dose were higher among HCWs who stated that they would not get vaccinated compared to those who were vaccinated or intended to get vaccinated. In contrast, HCWs who were vaccinated with the fourth dose, or those who were planning to get vaccinated, gave higher scores to the perceived benefit of the booster, its advantages, its perceived safety, its ability to protect from severe illness, and the perceived extent of scientific information about the risk associated with the booster. A logistic regression model revealed that perception of the fourth dose's benefits and risk significantly predict the willingness of HCWs to get vaccinated. Willingness to vaccinate their own children, acceptance of a hypothetical annual booster vaccine, and having less severe adverse effects after prior vaccination were also associated with willingness to get the fourth dose. These findings could help policy makers in developing strategies to expand the acceptance and coverage of the COVID-19 booster doses.

Anxiolytic and Antidepressant Use and Burnout: Optimism as a Mediator in Spanish Nurses

The aim of this study was to analyze the relationship between burnout, the use of drugs (anxiolytics and antidepressants) and optimism in nurses. At the end of 2018, a cross-sectional descriptive study was carried out with a sample of actively employed nurses recruited by snowball sampling. The sample consisted of 1432 nurses in Andalusia (Spain), aged 22–58, who were working at the time of data collection, 83.2% of whom were women. Data were collected anonymously in an ad hoc questionnaire about sociodemographic information and use of anxiolytics and/or antidepressives: the Brief Burnout Questionnaire—Revised for Nurses (CBB-R) and the Life Orientation Test—Revised (LOT-R). Descriptive, mediation and moderation analyses were performed, with significant results having a p-value less than 0.05. The results on burnout showed significant relationships with use of the drugs. In particular, personal impact, job dissatisfaction and motivational abandonment were positively related to use of certain of the anxiolytics and antidepressants presented, while the correlation with the social climate was negative. Furthermore, optimism correlated negatively with drug use. Knowing that optimism can alleviate the repercussions of the use of drugs opens up new lines of research and the possibility of developing programs aimed at promoting a positive disposition in the face of complicated events.

An evaluation of undergraduate student nurses' gameful experience while playing an escape room game as part of a community health nursing course

BACKGROUND

The integration of innovative strategies to teaching and learning in higher education, such as escape room games, can enhance the acquisition of key professional competencies including communication, teamwork and critical thinking.

OBJECTIVES

This study aimed to evaluate undergraduate student nurses' gameful experience while playing an escape room game as part of a nursing course.

DESIGN

Cross-sectional descriptive study.

PARTICIPANTS

A total of 126 third year student nurses enrolled in the "Community Health Nursing II" course.

METHOD

The escape room game took place in a classroom at the Faculty of Health Ciences. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the student's outcome of scape room game immediately after the end of the activity.

RESULTS

The vast majority (99.21%) considered the escape room game to be an appropriate and an innovative teaching and learning strategy. The mean score for each of the GAMEX dimensions was over 3, with the exception of Absence of negative effects. Our results suggest that the students enjoyed playing the game (mean = 4.40; SD = 0.71), that escape room games should be integrated in nursing courses (mean = 4.54; SD = 0.74) and that playing the game increased their motivation for learning (mean = 3.06; SD = 1.09). Gender differences were observed in the GAMEX Dominance dimension (p < 0.005).

CONCLUSION

Gamification in general, and escape rooms in particular, have proven to be a valid tool for the acquisition of professional competencies in higher education.

Male and female nursing students' opinions about gender and nursing as a career in Turkey: A qualitative study

AIM

This study was conducted to reveal the feelings, thoughts and opinions of male and female nursing students about gender perception in nursing.

DESIGN AND METHODS

This descriptive study using qualitative methods sought to reveal gender perception among first- and fourth-year nursing students. The focus group interview (FGI) approach was used purposefully to obtain in-depth information about nursing students' gender perceptions and their underlying attitudes, beliefs and behaviours. There were 27 female and 17 male participants, of whom 23 were first-year and 21 were fourth-year nursing students.

RESULTS

The analysis revealed four themes: (1) reasons for choosing the nursing profession, (2) gender perception, (3) religion and cultural factors and (4) occupational gender perception. The students reported that in certain units, gender would make a more positive difference for patients and themselves. The responses of male students regarding their professional gender perceptions also differed depending on whether they were first- or fourth-year students.

CONCLUSIONS

Gender affects the perception of professional gender and to has a positive effect on the adoption of the profession during education by male students.

Does the glass elevator still work: A descriptive and cross-sectional study in the context of gender in Turkey

AIM

To analyse the glass elevator in nursing, evaluating this concept within the conceptual context of nurse managers' perceptions of gender.

BACKGROUND

Glass elevator is defined as the rapid promotion of men to upper positions in certain professions in which women comprise the majority, such as nursing.

METHODS

Data were collected from 134 nurse managers. Participants selected one of four resumes belonging to four virtual candidates for an open management position. They, then completed the Perception of Gender Scale.

RESULTS

Nurse managers mostly selected men among the four candidates submitted to them for promotion to upper positions. None of the nurse managers' characteristics caused a statistically significant difference regarding the gender of the candidate they selected. No statistically significant difference was found between the perception of gender scores of those who selected female or male candidates.

CONCLUSIONS

Men are two times more likely to be selected than women when selecting candidates for promotion with the same qualifications. This was not caused by the decision-makers' or nurse managers' personal and professional characteristics nor their perceptions on gender.

IMPLICATIONS FOR NURSING MANAGEMENT

The psychological mechanisms that operate the 'glass elevator' in favour of men should be analysed in greater depth.

The Association between Nursing Skill Mix and Mortality for Adult Medical and Surgical Patients: Protocol for a Systematic Review

Skill mix refers to the number and educational experience of nurses working in clinical settings. Authors have used several measures to determine the skill mix, which includes nurse-to-patient ratio and the proportion of baccalaureate-prepared nurses. Observational studies have tested the association between nursing skill mix and patient outcomes (mortality). To date, this body of research has not been subject to systematic review or meta-analysis. The aim of this study is to systematically review and meta-analyse observational and experimental research that tests the association between nursing skill mix and patient mortality in medical and surgical settings. We will search four key electronic databases—MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCOhost], and ProQuest Central (five databases)—from inception. Title, abstract, and full-text screening will be undertaken independently by at least two researchers using COVIDENCE review management software. We will include studies where the authors report an association between nursing skill mix and outcomes in adult medical and surgical inpatients. Extracted data from included studies will consist measures of nursing skill mix and inpatient mortality outcomes. A meta-analysis will be undertaken if there are at least two studies with similar designs, exposures, and outcomes. The findings will inform future research and workforce planning in health systems internationally.

Acute stress disorder, coping self-efficacy and subsequent psychological distress among nurses amid COVID-19

Purpose

Health care professionals, particularly nurses, are considered a vulnerable group to experience acute stress disorder (ASD) and subsequent psychological distress amid COVID‐19 pandemic. This study aims to establish the prevalence of acute stress disorder and predictors of psychological distress among Jordanian nurses.

Methods

A quantitative, cross‐sectional, descriptive and comparative design was used. Data were collected using a Web‐based survey. A total of 448 Jordanian nurses (73% females) completed and returned the study questionnaire.

Results

The majority of nurses (64%) are experiencing ASD due to the COVID‐19 pandemic and thus are at risk for PTSD predisposition. More than one‐third of nurses (41%) are also suffering significant psychological distress. Among our sample, age, ASD and coping self‐efficacy significantly predicted psychological distress. More specifically, younger nurses are more prone to experience psychological distress than older ones. While higher scores on ASD showed more resultant psychological distress, coping self‐efficacy was a protective factor.

Conclusion

Given that individuals who suffer from ASD are predisposed to PTSD, follow‐up with nurses to screen for PTSD and referral to appropriate psychological services is pivotal. Coping self‐efficacy is found to ameliorate the effect of psychological distress on nurses' traumatic experience. Such findings warrant intensive efforts from health care institutions to provide psychosocial support services for nurses and ongoing efforts to screen them for traumatic and psychological distress symptoms.

Implications for Nursing Management

Nursing leaders and managers are in the forefront of responding to the unique needs of their workforces during the COVID‐19 crisis. They need to implement stress‐reduction strategies for nurses through providing consecutive rest days, rotating allocations of complex patients, arranging support services and being accessible to staff. They also need to ensure nurses' personal safety through securing and providing personal safety measures and undertake briefings to ensure their staff's physical and mental well‐being, as well as providing referrals to appropriate psychological services.

Role expectations and workplace relations experienced by men in nursing: A qualitative study through an interpretive description lens

AIMS

The aim of this study was to investigate the lived experiences of male nurses in today's healthcare environment to understand the persistently low numbers of men in nursing.

DESIGN

This study used interpretive description methodology, which aligns with nursing's approach to knowledge discovery by acknowledging the evolution and complexity of shared and individual experiences.

METHODS

Participants, (N = 11), were recruited through the American Association for Men in Nursing using purposive sampling. Focused interviews were conducted between May 2018 - June 2018. Interviews were semi-structured, guided by open-ended questions and video and audio recorded. Data were analysed according to study design with categories and themes extracted using reliability measures.

RESULTS

This study's findings reflected the unique experiences of each participant in a primarily female dominated work environment in clinical and academic settings. Our study identified thematic categories of role expectations and workplace relations for the men in the study. Role expectations were influenced by sociocultural views, professional acceptance and patient/family perceptions. Workplace relations were associated with being male, social cliques and peer support.

CONCLUSION

Participants shared similar and distinctly individual experiences. Findings from this study indicate there has been progress toward improving male presence in nursing but additional efforts are needed to increase inclusivity. Findings can be used to make recommendations for professional change in nursing, strengthen diversity by refining ways to recruit more men, enhance patients' experiences and improve experiences for future male nurses.

IMPACT

This study addressed low numbers of men in nursing. Main findings included role expectations and workplace relations and how they are experienced by men in nursing. Findings from this research have a multidisciplinary impact in the workplace, and affect care of patients and their families.

Stressors and rewards experienced by men in nursing: A qualitative study

This study explored men's experiences in nursing. A qualitative research design was utilized to examine (a) the stressors experienced by male nurses, (b) the strategies male nurses use to cope with these stressors, (c) the factors that motivate men to pursue a career in nursing and (d) what motivates men to remain in the profession. Six participants were conveniently and purposively selected from a range of nursing positions including cardiac, intensive care unit, theater, and general nursing to participate in semi-structured interviews detailing their experiences. Thematic analysis of the interview data revealed that male nurses still experience gender role conflict, feelings of exclusion, and numerous other stressors working in a female-dominated occupation. Despite these challenges, participants reported that they experienced a great sense of satisfaction in their nursing careers. Further development of educational programs aimed at challenging and breaking down the perceived social stigma regarding men entering the profession may assist in recruiting more men into nursing roles. At a broader policy level, the development of more effective strategies to prevent and manage stress may assist health care agencies to deliver more gender diverse care and retain more men in the profession.

Psychosocial Hazards in the Workplace as an Aspect of Horizontal Segregation in the Nursing Profession

The purpose of this article was to assess the influence of psychosocial hazards as a factor affecting the presence of men in the nursing profession. The article refers to the topic of particularly low representation of men among nursing staff in Poland, in comparison to what similar statistics show for other countries. The aim of the study was to assess whether the psychosocial hazards in the nursing profession constitute a significant factor in the small number of men present in this occupation. In this article psychosocial hazards are considered as all the aspects of management and work organization that may negatively affect the employee's mental and physical health. The research was conducted from September 2017 to April 2018 in the Podlaskie Voivodeship (Poland). A total of 640 respondents working as nurses in inpatient health care facilities, of which 87% were women and 13% were men, were included in the study. A standardized Work Design Questionnaire for an objective assessment of work stressfulness was used as a research tool. The research has been run by a group of experts, who explained the aim and the meaning of the particular questions to the surveyed group. Afterwards, based on the answers and observations of the responders, the experts filled in the questionnaire. The results of the study show that in almost all the evaluated aspects, the nursing profession was assessed more negatively by surveyed men than women. The most negative aspects reported by women included hazards (a score of 60), complexity (58.3), and haste (50.0), while those reported by men included haste (70.0), complexity (66.7), and hazards (65.0). As a conclusion it has been noticed, that results received from the research confirm that psychosocial hazards may have significant impact on the number of men present in the nursing profession in Poland. This study also suggests that the greater psychosocial hazards experienced by male nurses in the workplace may be an effect of the particularly low representation of men among practicing nursing staff.

Professional male caregiving: A concept analysis

The number of men in professional caregiving roles has increased. While still a small percentage, the numbers of men in these roles continues to expand. Too often, the methods that professional male caregivers use to provide care differ from their female counterparts. There has not been much research conducted to understand how males in the professional role differ from their female counterparts in terms of caregiving characteristics.

Complex Relationships Among Masculine Norms and Health/Well-Being Outcomes: Correlation Patterns of the Conformity to Masculine Norms Inventory Subscales

The Conformity to Masculine Norms Inventory (CMNI) is a widely used multidimensional scale. Studies using the CMNI most often report only total scale scores, which are predominantly associated with negative outcomes. Various studies since the CMNI's inception in 2003 using subscales have reported both positive and negative outcomes. The current content analysis examined studies ( N = 17) correlating the 11 subscales with 63 criterion variables across 7 categories. Most findings were consistent with past research using total scale scores that reported negative outcomes. For example, conformity to masculine norms has been inversely related to help-seeking and positively correlated with concerning health variables, such as substance use. Nonetheless, past reliance on total scores has obscured the complexity of associations with the CMNI in that 30% of the findings in the present study reflected positive outcomes, particularly for health promotion. Subscales differed in their relationships with various outcomes: for one subscale they were predominantly positive, but six others were mostly negative. The situational and contextual implications of conformity to masculine norms and their relationships to positive and negative outcomes are discussed.

Role strain among male RNs in the critical care setting: Perceptions of an unfriendly workplace

PURPOSE

Traditionally, nursing has been a female-dominated profession. Men employed as registered nurses have been in the minority and little is known about the experiences of this demographic. The purpose of this descriptive, quantitative study was to understand the relationship between the variables of demographics and causes of role strain among male nurses in critical care settings. The Sherrod Role Strain Scale assesses role strain within the context of role conflict, role overload, role ambiguity and role incongruity. Data analysis of the results included descriptive and inferential statistics. Inferential statistics involved the use of repeated measures ANOVA testing for significant difference in the causes of role strain between male nurses employed in critical care settings and a post hoc comparison of specific demographic data using multivariate analyses of variance (MANOVAs).

RESULTS

Data from 37 male nurses in critical care settings from the northeast of the United States were used to calculate descriptive statistics standard deviation, mean of the data analysis and results of the repeated ANOVA and the post hoc secondary MANOVA analysis. The descriptive data showed that all participants worked full-time. There was an even split from those participants who worked day shift (46%) vs. night shift (43%), most the participants indicated they had 15 years or more experience as an registered nurse (54%). Significant findings of this study include two causes of role strain in male nurses employed in critical care settings which are: role ambiguity and role overload based on ethnicity.

CONCLUSION

Consistent with previous research findings, the results of this study suggest that male registered nurses employed in critical care settings do experience role strain. The two main causes of role strain in male nurses are role ambiguity and role overload.

The influence of perceived prejudice on willingness to be a nurse via the mediating effect of satisfaction with major: A cross-sectional study among chinese male nursing students

BACKGROUND

The gender-based stereotype of nursing as a female profession has been a large obstacle to men entering the nursing profession. However, there is little quantitative research on the influence of prejudice induced by this stereotype on male nursing students' willingness to be nurses.

OBJECTIVES

To examine the effect of perceived prejudice on willingness to be a nurse via the mediating effect of satisfaction with major among Chinese male nursing students.

DESIGN

A cross-sectional survey was used.

METHODS

Four hundred and sixty male nursing students who were enrolled either in bachelor's programs in universities or advanced diploma programs in colleges in Jinan, China, were surveyed using questionnaires measuring perceived prejudice, satisfaction with major, and willingness to be a nurse. Structural equation modeling with bias-corrected bootstrapping was employed to determine the influence of perceived prejudice on willingness to be a nurse with major satisfaction as a mediator.

RESULTS

Male students who were in an advanced diploma nursing program and those for whom nursing was the first-choice major reported significantly less perceived prejudice, greater satisfaction with major, and greater willingness to be nurses than did those in a bachelor's nursing program and those for whom nursing was not the first-choice major, respectively. Moreover, although perceived prejudice had no significant direct effect on willingness to be a nurse (β=0.07, p>0.05), it did have a strong indirect effect (full mediation) via satisfaction with major (β=-0.59, p<0.001).

CONCLUSIONS

Perceived prejudice strongly influenced male nursing students' willingness to be nurses via the full mediating effect of satisfaction with major. Because this obsolete stereotype of nursing as a female occupation gives birth to prejudice against male nursing students, effective measures should be taken to change this stereotype to recruit more men as nursing staff.

A Comparative Study of Australian and New Zealand Male and Female Nurses' Health: A Sex Comparison and Gender Analysis

The aim of this research was to compare the health and lifestyle behaviors between male and female nursing professionals. Biological, workplace, and lifestyle factors as well as health behaviors and outcomes are reported as different between male and female nurses. Although male nurses show distinct health-related patterns and experience health disparities at work, few studies have investigated health differences by sex in a large cohort group of nursing professionals. This observation study of Australian and New Zealand nurses and midwives drew data from an eCohort survey. A cohort of 342 females was generated by SPSS randomization (total N=3625), to compare against 342 participating males. Measures for comparison include health markers and behaviors, cognitive well-being, workplace and leisure-time vitality, and functional capacity. Findings suggest that male nurses had a higher BMI, sat for longer, slept for less time, and were more likely to be a smoker than their female nurse counterparts. Men were more likely to report restrictions in bending, bathing, and dressing. In relation to disease, male nurses reported greater rates of respiratory disease and cardiovascular disease, including a three times greater incidence of myocardial infarction, and were more likely to have metabolic problems. In contrast, however, male nurses were more likely to report feeling calm and peaceful with less worries about their health. Important for nurse workforce administrators concerned about the well-being of their staff, the current study reveals significant sex differences and supports the need for gender-sensitive approaches to aid the well-being of male nurses.