Contemporary image of nursing profession as perceived among undergraduate students at selected college of Jamuhar, Rohtas (Bihar): an explorative cross-sectional study

INTRODUCTION

During their transition into nursing, newly graduated nurses are particularly vulnerable, and they perceive a greater likelihood of leaving the profession early on in their careers.¹ Among freshly graduated nurses, the prevalence of intention to leave tripled after 4 months, and three-quarters had different levels of intention after 12 months.²

The image of the nursing profession is not only the people's attitude towards the nursing profession but also represents nursing as a whole. Nursing plays a vital role in healthcare systems worldwide, providing care and support to individuals, families, and communities.³

Almost everyone has been touched by a nurse at some point in their lives. As well as being with us at the moment of our birth, He is with us in times of well-being, sickness, recovery, and loss. Despite this, people still ask “what is nursing?”, “what do nurses do?”, because nursing is not taught in schools. Many experts worldwide have given different definitions to answer these questions. Several experts have provided different definitions of nursing to answer these questions; the International Council of Nurses (ICN) (2002) definition summarizes nursing as providing care to anyone, regardless of their age, socioeconomic status, culture, disease, and well-being, and contributing to promoting health and preventing disease.⁴

It is difficult to find a person whose life has not been touched by a nurse. He is with us at the time of our birth, he is with us in times of well-being, sickness, recovery, and loss. But the questions among people are still the same “what is nursing?”, “who are nurses and what do they do?”, because it is never taught in schools, once you become a nurse you can save people's lives. To answer these questions, many definitions have been given in different ways by many experts worldwide.⁵

According to the All India Survey of Higher Education (AISHE) 2018-2019 report, enrolment in BSc nursing for undergraduates has increased from 179,496 (2014-15) to 255,071 (2018-19), which is indicative of an increased awareness of nursing image. In contrast to the above-cited results, the government data dated 03 March 2020 indicates that there is still a large gap in filling the current strength of nursing health professionals compared to the required strength in India. India currently has 3.07 million nurses (1.7 nurses per 1000 people), but the World Health Organization (WHO) nursing standards require three nurses per 1000 people, which is 43% less than the requirement, including nurses, midwives, women health visitors, and ANMs. In addition, the shortage of nurses has been predicted to grow and by the year 2020, there will be a need for 590,000 new nurses in Europe and by the year 2030 a need of 9 million new nurses globally. The phenomenon is often described as a demand and a supply problem.⁶

It impacts every action of the profession and modifies the meaning of their practice and aims. Considering that the younger generation is the future generation, their attitude towards nursing is an important factor in determining the perception of the nursing profession. A shortage of registered nurses, increased demands on healthcare systems, and the impact of new technology are just some of the challenges faced by nursing professionals. From the moment they decided to pursue nursing as a career, their lives were intertwined with stories of dedication, compassion, and sacrifice.⁷ In Bihar, according to the National Health Mission (2008), the number of nurses and midwives increased from 8,883 (2005) to 11,075 (2020), but the number of nurses remains extremely low, as in 2008, 13,818 nurses were required to fulfil the nurses' requirement, which won't even be met by 2020.⁸

The image of nursing is one of the factors affecting career choices. Recruitment of Nursing Officers largely depends on the image of the nursing profession. The image issue was the main concern from the 19th. For example, the image of a nurse in the media is viewed as less objective and unskilled than the nursing medical profession.⁹

Two goals must be achieved to eliminate the nurse shortage by 2030. One, the number of nursing students should increase by 8% every year. Two, those graduate students should be employed and encouraged to remain in the profession. If we can't attain and achieve, those two goals, first African, Southeast Asian, and Eastern Mediterranean countries and then America, Europe, and Western Pacific countries will have to face a shortage of registered nurses as they will need 36 million nurses and more as well.¹⁰

METHODS

Research design and setting

This was a cross-sectional, explorative-analytical study conducted at the colleges and universities of Rohtas (district), Bihar, from 02 January to 02 February. The study included and focused on the contemporary image of nursing among non-medico students. The study received ethical consideration from the Institutional Ethical Committee, Narayan Nursing College, Sasaram. The purpose and protocol of the study were presented to the participants. Consent ensured voluntary involvement, anonymity, and data confidentiality as well of study participants.

Participants of the study

The present study selected 488 study participants who were willing to participate, who could read Hindi and English, and, who presented at the time of data collection. The students who belonged to the medico stream like MBBS, Nursing, and Paramedics, and colleges and universities not accredited to UGC were not included in the study. The sample was selected by the use of a purposive non-randomized sampling technique.

Research sample and technique

A purposive non-probability sampling technique was used to recruit the 488 study participants who met the inclusive and exclusive criteria under study. A statutory sample calculator was used to calculate the study participants. This calculator allows for a 5% margin error, and 95% confidence interval and assumes that participants have a positive image. The sample size was 488 when the 10% non-response rate was included.

Data collection tool and procedure

The data were collected using a self-structured five-point Likert scale. It took about 15-20 minutes for participants to complete the questionnaire. This data collection tool was divided into two sections; the first section consisted of a questionnaire that asked about the participants' demographic profile, including age, gender, educational background, occupational status, present course, and whether any member of their family is in the medical field. The second section consists of 40 items related to their perception of nursing. Responses ranged from strongly agree (1) to strongly disagree (5) about participants' perceptions. Items no. on the self-structured Likert scale were negatively framed and scored in reverse order. the data was collected by using the Google form survey.

Data processing and analysis

The data was analyzed with the help of IBM statistical package for the social sciences (SPSS) (26-version). The researcher created an Excel master sheet to compute the data and used both descriptive and inferential statistics to calculate the results based on the objectives and hypothesis of the study. The demographic profile data, which included sample characteristics was analyzed with frequency and percentage. The chi-square test determines the significant association between the image of the nursing profession and certain demographic variables with a significance threshold of p value >0.05. Based on mean and SD, the total score of the questionnaire was divided into two categories and were classified as a negative image (40-119), and a positive image of the nursing profession (120-200).

RESULTS

Table 1 depicts that out of 488 study participants, half of the majority 59% students belonged to the 18–20-year age group, 58.6% of students were male, 41.2% of students were female, nearly full of the majority, 91.2% belonged to the Hindu religion, 56.4% have belonged to the rural area, 34% belonged to the urban, 59.6% of college student were stream course of science, 28.7% of mothers had primary education and 26.4% of mothers had diploma/undergraduate education, 36.9% of fathers had farming and 23.2% of fathers had others education, 21.7% of fathers had private sector, 84.8% mothers are homemaker, and 67.6 % family member have belonged to others profession.

Among the study group, out of 488 study participants, a maximum of 77% have a positive image of the nursing profession, and, 23% of college students have a negative image of the nursing profession (Table 2).

Table 3 depicts that there was a significant association between the contemporary image of the nursing profession and demographic variables such as the present stream of course.

There was no association between the age of students, gender, occupational status of mothers and fathers, educational status of mothers and fathers, area of residence, family members’ profession in health care sectors regarding the contemporary image of the nursing profession (p>0.05).

DISCUSSION

Among the study group, out of 488 study participants’ maximum of 77% have a positive image of the nursing profession, and, 23% of college students have a negative image of the nursing profession. A similar study was conducted by Cirik et al to assess the image of nursing, the results of a study that the second-year participants were higher than those of fourth-year participants, and the total scores of 18–20-year-olds were higher than those of 21–23-year-olds.¹¹ Young people's perception of the nursing profession has not changed over the last ten years.¹² This study The perception of young people about the nursing profession repeats the historical image of a nurse as a caring helping and altruistic woman nursing continues to be seen as a virtuous caregiving profession for females, often forgetting the wide need for knowledge, skills, and expertise required in the occupation.² The image of nursing is tightly linked to the nurses’ identity and role, the cultural context, the clinical practice, work satisfaction, and the quality of care. One of the long-term challenges of the nursing profession is maintaining its public image and a favorable attitude from the public. The various research suggests that the title of a World Bank blog was “The nursing workforce is critical to COVID-19 (coronavirus) and global health”. Finally, many artistic pictures of nurses’ bravery and dedication were published on social media, which made them a myth during the war against COVID-19. Tokac et al found that public perceptions on social media appear to portray an image of nurses, which reflects the professionalism and values of the profession.¹⁰ According to Barrett and Heale (2021), the public and media profile of nursing has never been higher. Across the globe, we have seen nurses and other practitioners applauded, praised, and honored for their work during the pandemic.¹¹ There is no question that the contribution of nurses, along with other healthcare professionals and key workers, should be acknowledged by the wider society.¹² However, the raised and changed profile of the nursing profession within society is something of a double-edged sword.

The results of the study that a significant association between the contemporary image of the nursing profession and demographic variables such as the present stream of course, and there was no association between the age of students, gender, occupational status of mothers and fathers, educational status of mothers and fathers, area of residence, family members’ profession in health care sectors, regarding the contemporary image of nursing profession (p>0.05). Therefore, the hypothesis (H₂) was accepted. In contrast to the study, in this study, the total score of NIS was determined to be 138.65±12.62. It was determined that the lowest score obtained from the scale was 42 and the highest score was 210. It can be interpreted that the nursing image from the perspective of healthcare professionals was moderate.¹³ Healthcare professionals felt lonely during the COVID-19 pandemic period. People were inclined not to wear masks and not to maintain social distance despite the restrictions and measures around the world. This reduced the motivation of healthcare professionals. In a study conducted with the participation of nurses before the pandemic, nurses stated that they were under stress due to the lack of wages, busy working hours, and organizational weaknesses.¹⁴

CONCLUSION

A professional and positive nursing image will provide great advantages in the development and advancement of the profession. A positive nursing image enhances professional prestige and builds self-confidence in members of the profession. In this way, the power of nurses worldwide will increase. This may hinder the increase in the quality of care and may reduce the professional confidence and motivation of nurses. In this regard, there is a need for strategies to increase the nursing image. It is important to continue to explore which factors affected and changed the image of nursing during the pandemic, and to design strategies to preserve the improved image of nursing among the public on an ongoing basis.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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