Iranian Nurses Self-Perception – Factors Influencing Nursing Image

Journal of Nursing Management, 2012, 20, 551–560 Iranian nurses self-perception – factors influencing nursing image 1 1 SHOKOH VARAEI MScN, BScN , MOJTABA VAISMORADI MScN, BScN , MELANIE JASPER PhD,RN,MSc,BNurs, 2 3 BA, RHV, RM and SOGHRAT FAGHIHZADEH PhD 1PhD Candidate in Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran, 2Professor, Head of College, College of Human and Health Sciences, Swansea University, UK and 3Professor, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran Correspondence: VARAEI S., VAISMORADI M., JASPER M. & FAGHIHZADEH S. (2012) Journal of Nursing Shokoh Varaei Management 20, 551–560 Tehran Faculty of Nursing and Iranian nurses self-perception – factors influencing nursing image Midwifery Tehran University of Aim The purpose of this study was to describe the perspectives of Iranian nurses Medical Sciences regarding factors influencing nursing image. Eastern-Nosrat Street Background Nursing image is closely tied to the nurseÕs role and identity, influ- Touhid Square encing clinical performance, job satisfaction and quality of care. Images of nursing Tehran and nurses are closely linked to the cultural context in which nursing is practised, Iran hence, this study explores how Iranian nurses perceive the factors that influence E-mail: [email protected] their own image. Methods A descriptive study using a survey design was conducted with 220 bac- calaureate qualified nurses working in four teaching hospitals in an urban area of Iran. A Nursing Image Questionnaire was used and analysed using descriptive and inferential statistics. Results In the domains of Ôcharacteristics required for entry to workÕ, Ôsocial role characteristics of nursingÕ and Ôprestige, economic and social status, and self imageÕ the nurses had negative images. ÔRewardÕ and Ôopportunity for creativity and orig- inalityÕ were factors that least influenced choosing nursing as a career. The presence of a nurse in the family and working in the hospital had the greatest impact on the establishment of nursesÕ nursing image. Conclusion Improving the nursing professionÕs prestige and social position as well as providing the opportunity for creativity and originality in nursing practice will change the self-image of Iranian nurses, facilitating effective and lasting changes in nursingÕs image. Implications for nursing management Nurse managers are well-placed to influence nursesÕ perceptions of nursingÕs image. Given the finding that thinking about leaving a job positively correlates with holding a negative nursing image, nurse managers need to consider how they can work effectively with their staff to enhance morale and nursesÕ experience of their job. Keywords: descriptive study, Iran, nurses, nursing image Accepted for publication: 16 January 2012 DOI: 10.1111/j.1365-2834.2012.01397.x ª 2012 Blackwell Publishing Ltd 551 S. Varaei et al. another person, group or phenomenon. How a person Introduction presents in public and private, their appearance, com- The image of the nurse has developed throughout the munication style and conduct, and their associates, are past century from stereotypes of battle-axe/sex symbol, all referents in the definition of image (Roseann 2000). from doctorsÕ handmaiden to a worker in a separate Thus, nursing image is conveyed by how nurses present caring profession with a scientific theoretical basis themselves in every setting, from the classroom, to clin- (Stanley 2004). The work of Florence Nightingale dur- ics, to professional meetings and to the workplace (Na- ing the Crimean War in the 19th century initiated the tional StudentsÕ Nurses Association 2009–2010). Nurses professionalization of the nursing image by incorporat- therefore reveal a professional image to others observing ing education, discipline and the selection of trainees them, by their appearance and actions, which may or based on good character (Wallace et al. 2007) – elements may not be within a professional context (Stanley 2004). that remain current. In addition there has been the reg- AnurseÕs professional self-image is the aggregate of istration of qualified nurses, the development of codes of various individually held thoughts, principles, percep- professional conduct and the notion of a nursing career. tions, expectations and experiences. This describes how Nurses are considered the symbol of compassion, nurses perceive themselves in terms of competence and warmth, knowledge and trust, saving lives and giving reviews the repertoire of skills such as the instrumental- hope to injured or despairing people (Stanley 2004). technical, intellectual-cognitive, organizational, social While those qualities will always underpin nursing and communication skills framed by nursesÕ professional practice, the public often still holds a stereotypical, attitudes and brought to patient care (Milisen et al. outdated view of nursing, nurses and the role they play 2010). As a complex and multidimensional phenomenon, in health care. Moreover, the hierarchical structure nursing image has been shaped by tradition, educational between doctors and nurses in the clinical arena seen by preparation, and socialization. Some other factors con- the public, and reinforced in media presentations, fuels tributing to nursing image are interprofessional (e.g. be- this image (Roberts & Vasquez 2004), with little public tween physicians and nurses), the history and role of recognition of nursing accountability for their care, nursing, and media perceptions and maintenance of specialist and advanced practice, and independence in nursesÕ traditional roles (Takase et al. 2001, Tzeng 2006). decision-making. NursingÕs subservient, and gender- Despite the multitude of perceptions, it is believed that stereotyped image is partly responsible for a perception professional image has not been clearly described by of oppression in nursing (Roberts & Vasquez 2004) nurses (Milisen et al. 2010), although the professional resulting in nurses receiving less respect from the com- nursing organisations globally would dispute this claim. munity in comparison with physicians and other occu- pational groups in health care (Zarea et al. 2009). Significance of nursing image Nursing and nursesÕ image is known to have cultural and contextual variation, and these images are often Nursing image is closely tied to the nurseÕsroleand rooted in the socio-cultural underpinnings of different identity, and differs depending on the cultural group. In societal structures. Notions of gender roles extant in professional contexts, nursing tends to convey a profes- different societies have great influence on perceptions of sional image, one that motivates trust and expectations nursing and nurses. In addition, Foong et al. (1999) for accountability (Roseann 2000, Tzeng 2006). Positive suggest there is no clear understanding of how nurses images reflect high-quality nursing care, recognized by perceive a nurseÕs image. It is against this backdrop that nurses and other groups for the difference it makes to this study of Iranian nursesÕ perceptions of factors that patient wellbeing, and will contribute to empowerment of influence nursingÕs image is presented as contributing to the profession (Ulmer 2000). Maintaining an intrapro- a global picture of nursing. fessional positive image is significant in attracting new recruits to the profession, contributing to morale and job satisfaction, and influencing social status, economic value Definition of image and its components and career development (Takase et al. 2006). According to TaborÕs Encyclopedic Medical Dictionary, Positive public images reinforce the professionally held image is defined as Ôa mental picture representing a real images and are reflected in stereotypes such as Ôangels of object or a more or less accurate likeness of a thing or mercyÕ, and the words used to describe the ideal nurse, personÕ (Thomas 1993, p. 965). In addition, it is how for example, caring and compassionate. Conversely, people, their peers, the general public and, in nursingÕs poor public images of nursing, often media-generated case, patients, their families and supervisors perceive rather than based in fact, result in negative consequences. ª 2012 Blackwell Publishing Ltd 552 Journal of Nursing Management, 2012, 20, 551–560 Nursing image in Iran Nursing is often portrayed as too inferior and inadequate ences reduce the scope of patient care, affect the ability of an undertaking to be regarded as a profession (Sussman teams to function effectively and efficiently, call for bet- 2000, Thupayagale & Dithole 2005). Indeed, in the UK, ter management and leadership, and question the societal the recent decision to move to all-graduate initial prep- perception of the value of nursing and nursing care aration for registered nurses produced a public outcry, (Siebens et al. 2006, Milisen et al. 2010). suggesting that ÔinnateÕ nursing qualities and the type of Improving both the public image and self-image of people holding these are not commensurate with the nurses is important, because the image influences nursesÕ intellectual ability required to study for a degree. Nega- recruitment and retention, motivation to work, self- tive phrases such as Ôtoo posh to washÕ or Ôtoo clever to image, self-esteem and job satisfaction, customer careÕ were promulgated, suggesting a complete lack of satisfaction, and policy making (Fletcher 2007, National public and media understanding of the knowledge base StudentsÕ Nurses Association 2009–2010). underpinning

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