Contemporary image of nursing profession: an explorative study of Bihar state

INTRODUCTION

It is difficult to find a person whose lives has not been touched by a nurse. They are with us at our birth, they are with us at times of wellness, illness, recovery, and loss. But the questions among people are still the same "what is nursing?", "who are nurses and what do they really do?", as it is never taught in schools, once you become a nurse you can save the lives of people. To answer these questions, many definitions in various ways have been given by many different experts around the world, where among them a complete and abbreviated definition of nursing provided by the ICN (2002) defines nursing as, providing care to all regardless of their age, gender, economic status, culture, illness, and well-being and contributes to promoting health and prevent illness among people.¹

Worldwide, nurses currently account for more than half of the health practitioner’s manpower and it has been seen that most of the time, they are the first and sometimes the only health professional who provides critical and primary care to the patients. But, still they are largely invisible, their capabilities are limited in the field of work that under-represents them and unfortunately it seems like nursing profession has developed but not the image of nursing. ^2,3

In the data of AISHE 2018 to 2019 report, it is mentioned that enrolment in the B. Sc. nursing program for UG has increased from 179,496 (2014-15) to 255,071 (2018-19) which can be identified as an increase in awareness related to the nursing profession.⁴

But in contrast to the above finding, the government data dated 3^rd March 2020 finds that there is still a large gap to fill the present strength of nursing health professionals than required strength in India. Presently India has 3.07 million (1.7 nurses/1000population) but the requirement is 3 nurses/1000population i.e., 43% less than the required strength of nurses according to the WHO norms in which nurses, midwives, women health visitors, and ANMs were included. ⁵

Whereas in the present study conducted in the state of Bihar, the researcher of the present study found that, according to the data given on Central Bureau of health intelligence-2020 and Bihar-National Health Mission (2008) shows that the number of nurses and midwives got increased in Bihar from 8,883 (2005) to 11,075 (2020) but still facing an immense shortage of nurses, as in 2008 the total 13,818 nurses were required to fulfill the nurses’ requirement which is not even fulfilled by the time of 2020.^6,7

The concern towards the image of nurses is new in research. These kinds of studies are newly emerging in India and also all over the world, as very limited studies have been conducted on the image of the nursing profession perceived by the people. However, the contemporary image of nursing perceived by the college students can provide a way to know how people perceive the nurses and what image of nursing, people have in their minds. Based on the outcome of this study people will get to know about the nursing profession and even can improve the contemporary image of the nursing profession by changing their attitude towards the nursing profession. In a social view, it can enhance the recognition of nursing as a respectful profession. Accordingly, the current study conducted to explore the contemporary image of nursing profession as perceived by college students.

METHODS

A descriptive cross-sectional study was conducted from December 2021 to February 2022 in the colleges and universities of Bihar that affiliated to UGC. Study participants were students of colleges and universities of Bihar. For sample size, total 420 students were included in the study which was calculated with reference of previous study. The study aimed to determine the college students’ perception towards the contemporary image of the nursing profession and was considered a significant association between the perceived image of the nursing profession and selected socio-demographic variables of colleges students. Study sample were taken with considering following study criteria:

Inclusion criteria

Students of Bihar colleges and universities comes under UGC. Students who were accessible at the time of data collection

Exclusion criteria

Colleges and universities in Bihar not affiliated to UGC. Students were not willing to participate in the study.

Approval for research was taken from institutional ethics committee before commencing the study and written permission was taken from the colleges that included in the study. Written informed consent was taken from each participant for their willingness to participate in the study. The confidentiality and autonomy of the participants was maintained throughout the study process.

The assessment tools were sent to the students via online based Google form. The instruments used for the study were socio-demographic tool and self-structured perception questionnaire on image of nursing profession tool. These instruments were developed with the taken validation from the various experts.

The first 420 students’ responses were taken for data analysis and the data was obtained and analysed by using descriptive and inferential statistics. The data were tabulated and analysed by using SPSS-20. On applying the tests of normalcy, the data were found to be normally distributed. P≤0.05 was taken as significant difference.

RESULTS

A total of 420 college students were included in the study based on the inclusion and exclusion criteria. The findings of the study showed that the contemporary image of the nursing profession perceived by the college students as positive in which 97.4% perceived as positive and 2.6% were perceived as negative (Table 1).

Response per statement provides the better view to understand what are the factors contributes to the supportive outcome to positive image of nursing profession and also tells about the negatory factors (Table 2).

Collectively, students having positive perception towards the image of the nursing profession related to most of the above mentioned statements except a few. In order to determine the association between the socio-demographic variables and the value of perceived image of nursing profession by students, the data was analyzed by applying inferential statistics. The table 3 shows that by applying chi-square test statistics, there was a statistically significant association between socio-demographic variables and the value of the perceived image of nursing profession as depicted in domiciliary (p= 0.010) and educational status of the father (p= 0.058), the p-value ≤0.05.

*Scores: 40-119 score indicates as negative image of nursing profession and, 120-200 score indicates as positive image of nursing profession (score per student).

X^a= Fisher exact value *p-value statistically significant at ≤0.05 level, Test statistics: Chi-square test.

DISCUSSION

The result showed that there is positive contemporary image of the nursing profession perceived by the students of selected colleges and universities of Bihar and there was statistically significant association between socio-demographic variables with the perceived image of nursing profession as depicted in domiciliary (p= 0.010) and educational status of the father (p= 0.058), the p-value <0.05. However, a study conducted by Islam et al, to assess the perception of college students towards nursing as career choice. Total 200 study sample were taken by the non-convenience sampling technique. The result of the study viewed as 66.5% of participants having positive and 33.5% having negative perception towards nursing. There was a significant association found between perception of the students towards nursing with education of parents, religion of students, occupation of the parents and family income.⁸

Another influencing factor, media that influence the image of nursing and also the recruitment and job choices. It is very important to know how the individual or people defines nursing because it says that “negativity can make people may feel depressed or less effective”. Similarly, the professionals can experience the same when their image is not carried out as in positive view. It impacts their every action and modifies the meaning of their practice and aims. But before that, an important concern is how nurses perceive their self-image as it influences both public and media perception towards the nursing profession.⁹

According to Ibrahim et al and Abdelrahman et al, the self-image among nurses is well-perceived in terms of patient care, hard work, job opportunities, salary, and professionalism, but not in terms of peer-support, collaborative work, and professional status. Nurses find themselves masked under doctors, their effort goes unnoticed, and as it is recognized that nursing requires both mental and physical strength in their work, which is never taken care of and nor kept in worry. The media portrayed them mostly unrealistic and even contrary to their actual working role. Nurses need to develop their position and improve leadership management in them. They need to speak out against their stereotypical disadvantages and to get respect and visible status for their profession because the self-made image or self-perceived image is also important for a person in a profession in response to work with a positive attitude.^10,11,12

Encouragement is very important to grow positively. For a profession like nursing, people not seem to be encouraged to support individuals for pursuing the nursing profession. However, in the majority of cases, it is not their first choice of career. But the result of the statement “I am in favor of encouraging the nursing profession to pursue” is surprisingly emergent that participants were agreeing to encourage the nursing profession to pursue with 86.2% of support.

Similarly, in the present study, majority of the statements obtained largely positive response such as nurses are knowledgeable (92.6%), hardworking (91.6%), core member of health system (90%), warriors of the healthcare system in pandemics (94.8%), powerful work force in improving health status (92.6%), play vital role in health care delivery system (95.9%), spent more time on patient care than physicians (90.7%), and having a nurse in family or as a relative is good thing (93.8%). The findings which shown contrary to the positive responses are nursing profession is stressful (57.4%), people neglect nurses in front of doctors (64.7%) and Nurses should be more educated than now (87.3%) and neutral in favor of preferring Nursing profession as a job (34%), all these outcomes indicate a negative image but the overall image of the nursing profession can be said to be positive as most of the responses were in favor of the nursing profession. The study conducted by Meiring et al, assess the perception of general public of South African on image of nurses in which 776 adults were selected as sample through convenience sampling which result showed that 70.4% of the participants were agreed with the statement that nurses are well educated, 80% were believed that nurses are extremely hardworking, 78.2% said yes to the fact that nurses are caring and understanding, 60.3% agreed with the fact that nurses have the right to take initiative in their work, 78.3% of participants believed that the nursing is not secondary to the doctors, 48.6% responded in agreed that nursing job is attached with a lot of social status, 70.9% are more concerned about their professional work than social life and 68.3% reckon with the statement that care of physical and mental health of the patient is equally important for the nurses and the another study of Wangdi et al, which was conducted in Bhutan to assess nursing students’ perception on nursing profession, academic and working stress, for which by purposive sampling technique 200 study participants were selected.¹³ The results of the study showed that 72% participants agreed that nurses and nursing has a good career ladder and advancement, 60% participants disagreed that nursing is only a women’s profession, 76.5% participants agreed that nursing is a dignified and respectful profession, 60.5% participants agreed to encourage the nursing profession by choosing to be a nurse as a career choice for their children, 68% were agreed that nurses never gets work appreciation from patients and 83% believed that nursing profession provides opportunities for personnel growth. And also found the high level of stress among nurses in relation to both academic and work areas in nursing.¹⁴

On focusing towards negative perception of image of nursing profession, determines that contemporary image of the nursing profession is still a critical issue of discussion as they are not being recognized in a way that can be accepted as a profession or not even the way nurses think it should be. At present as a part of health workers, nurses are dealing with great unnecessary issues which most of the time affect their physical and as well as mental health but they still trying tough to fight for their professional identity to prove that nursing is a respectful and well-appreciated profession and showing their resilience towards their profession.¹⁵

But there are many common positive factors from different research studies found which helps to understand that what are the influencing factors contributes to improve the image of nursing throughout the time and helps to sustain the good image of nursing such as having family member as a nurse, as a good job opportunity, hardworking profession, knowledgeable profession, caring and skilled and so on.

Which is also evidenced by the honour of getting first position to be awarded with the "Gallup Poll" award internationally from a 20-years history, which indicates that nurses have been rated as the most trusted profession by the people.¹⁶

As the study found that there is a positive contemporary image of nursing profession among college students but still need to improve in some areas to make it superior and effective than present, that is clearly in the hands of collaborative effort of both community and nursing profession itself.

Limitations of this study were difficulty in getting research permission from different universities, lack of interest from participants and difficulty in getting sample size. Hence the limited universities were the part of the study and sample size was obtained with the greater approach.

CONCLUSION

The study reveals that there is positive image of nursing profession perceived by college students. The college students were found to be supportive and well-aware to the facts related to the nursing profession which included in the study where as they have shown their negatory view also towards some of the aspects. If looked carefully, we can also found that college students were responded positively to the statements that represent the quality of nurses and the nursing profession whereas only some general aspects resulted on the contrary for the positive image of the nursing profession. These contrary factors can be overcome by improving the status of nursing at all levels which include hospitals, society, and media.

ACKNOWLEDGEMENTS

We would like to College of Nursing, AIIMS Patna, all the study participants, teachers, and their college administrators and tool validation experts.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee (AIIMS/Pat/IEC/ M.Sc.(N)/2021/07)

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