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Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
Implications of stereotypical self and public nursing image on performance
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Implications of stereotypical self and public nursing image on performance

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  • 1. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 151 IMPLICATIONS OF STEREOTYPICAL SELF AND PUBLIC NURSING IMAGE ON PERFORMANCE OF NURSES AND NURSING STUDENTS Gehan Mohamed Ahmed Mostafa Vise Dean of Post-graduate & Research, Nursing Administration Department, Faculty of Nursing, Helwan University, University Campus, Helwan, Egypt ABSTRACT Nowadays nurses’ public and self-images is important issue. A good image motivates nurses to role model. Therefore aim of study was to find out implications of stereotypical self and public nursing image on performance of nurses and nursing students. The study was conducted in the Faculty of Nursing in Helwan University and 5 affiliated hospitals using a triangulated design. It included 120 nursing staff and an equal number of nursing students. Data were collected using a self-administered tool with a Nursing Image Scale and a Staff Nurse Role scale, and 39 students participated in 5 focus groups. The perceptions of self- public image were generally high, with self being higher than public. More nurses viewed that they do not demonstrate expertise (p=0.002) or competency (p<0.001) in all tasks, while more students thought they could manage more responsibilities (p=0.004). More nurses had the feeling of not having much to offer (p=0.001), and not contributing sufficiently (p=0.002) to nursing profession. Nurses and students' scores of self and public image and their self- evaluation of task performance and self-esteem demonstrated statistically significant positive correlations. The qualitative data analysis identified 3 main themes: self-image along with career choice, public image with negative role of the media, and remedial approaches both from inside and outside the profession. Despite the seemingly improving public image of nurses, nursing stereotyping that stresses powerlessness is still prevalent, and may have a negative impact on task performance and self-esteem. The study recommends self-correction from inside the profession, which would lead to change in the public image. Keywords: nursing image scale, qualitative data analysis, staff nurse role scale, stereotypical self - public image, task performance. INTERNATIONAL JOURNAL OF MANAGEMENT (IJM) ISSN 0976-6502 (Print) ISSN 0976-6510 (Online) Volume 4, Issue 3, (May - June 2013), pp. 151-162 © IAEME: www.iaeme.com/ijm.asp Journal Impact Factor (2013): 6.9071 (Calculated by GISI) www.jifactor.com IJM © I A E M E
  • 2. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 152 1. INTRODUCTION An image is a picture representative of something real. It refers to the tangible or visible representations and/or perceptions resulting from a person’s conduct as a professional, linked to competence and ethical behavior [1]. In nursing, image refers to a person’s professional qualities and conduct, which represent the nurses’ competence as perceived by patients and by self [2]. Nurses are not perceived in the manner they wish to be. Their image appears to be blemished, as witnessed by the many negative messages in the media and the number of complaints about nurses received by employers. The image of nursing is vital to the profession, and is an important concept for future nurses to understand. It is also conveyed by how nursing students present themselves in every setting from classroom, to clinical, to professional meetings, to the workplace [3]. Self-image is how nurses perceive themselves, whereas the public image reflects the impression the public has of the nurse. Self-image is usually rated much higher than public image. Nurses should be aware of the fact that when consulting patients or caring for someone, patients are observing them and form impressions about their appearance, competence, character, and commitment. Whether good or bad, these impressions usually spread quickly around the health facility and community [4]. Improving nurses’ public and self-images is quite important. A good image motivates nursing students to enter the profession out of inspiration and enthusiasm, rather than job security, and influences the recruitment and retention of nurses. It is associated with more participation in decision making, high self-esteem and job satisfaction, and creates a sense of pride in what one is doing. Consequently, nursing practice standards will improve, with increased patients’ satisfaction [2]. Therefore, the present study aim was to find out implications of stereotypical self and public nursing image on performance of nurses and nursing students. 2. PARTICIPANTS AND METHODS 2.1. Research design and setting The study was conducted during the period from March 2012 to May 2012 using a triangulated design with a comparative analytic cross-sectional quantitative part, and a qualitative part to support it. The study setting was the Faculty of Nursing in Helwan University, Egypt and the five training hospitals affiliated to it. 2.2. Participants The study involved 120 nursing staff in all departments in the study setting, and an equal number of nursing students. The nursing staff sample included two nursing directors, nine floor supervisors, five head nurses, and 104 staff nurses. Their age ranged between 25 and 56 years (mean ± SD 34.4±7.6), with a female majority (95). Only five were having a bachelor degree in nursing, and the rest were diploma nurses: school (72), specialty (40), and Technical Institute (3). The second group included 120 nursing students from the four grades of the academic year 2011-2012. Their age ranged between 20 and 23 years (mean ± SD 20.6±1.5), with slightly more females (69), and 63 having secondary school certificates, while 57 had Nursing Technical Institute diploma. The sample size was calculated to detect any difference in positive image between staff nurses and students or between self and public of 20% or more, with 80% power and at
  • 3. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 153 95% confidence level. Using the sample size equation for the difference between two proportions (Epi-Info 6.04), the required sample size per group is 103. This was increased to 120 to compensate for a dropout rate of about 20%. For the nurses, a convenience sampling technique was used. For students, a systematic random sampling technique was used, with proportionate representation of the four grades. 2.3. Data collection tools A self-administered tool was used for quantitative data collection. It included a Nursing Image Scale, a Staff Nurse Role scale both guided by literatures [3, 5], and a socio- demographic part. 2.3. 1. Nursing Image Scale This was used to determine participants’ perception of self and public image of nursing. It includes 34 items grouped into three domains and two roles. The domain of interpersonal power factors includes 10 items such as confident, leader, intelligent, independent, scientific, etc. The interpersonal relations factors domain has seven items such as compassionate, warm, respectful, responsible, etc. The intrapersonal ability factors domain consists of five items such as organized, rational, controlled, etc. The two roles are decision- making and patient care each consisting of six items. An example of the decision making statements is: "participates in taking policy decisions that influence work conditions," and of patient care: "I feel I should spend most of the time in providing direct patient care." The tool reliability was assessed through measuring its internal consistency, which proved to be high with Cronbach alpha coefficient 0.807. 2.3. 2.Staff Nurse Role Scale This consisted of 13 items grouped into two subscales, namely self-evaluation of task performance (9 items) and self-esteem (4 items). The tool reliability was assessed through measuring its internal consistency, which proved to be good (Cronbach alpha coefficient 0.748). The respondents are asked to rate how they think the public view nurses, how they see themselves as nurses, and to self-evaluate their performance. The responses to the items were on a 6-point Likert Scale: strongly disagree, disagree, somewhat disagree, somewhat agree, agree, and strongly agree. These were scored from 1 to 6 respectively, with reversed scoring for the negative items. The scores of each scale and subscale were summed up and converted into a percent score. The participant’s perception was considered positive if the percent score was 60% or higher and negative if less. The tool was appended by a section for participant’s characteristics as age, sex, marital status, hospital name, department, grade (for students) and qualification and job for nurses. The scales were adopted and translated into Arabic, and evaluated through experts’ opinions by five academic staff members of nursing administration departments at Ain- Shams and Benha Faculties of Nursing, in addition to five nursing leaders from the study hospitals. The tool was then pilot-tested on groups of four nurses and four nursing students in the settings to identify ambiguous questions. Accordingly, minor changes were made for a few unclear words.
  • 4. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 154 2.4. Procedure Official permissions were obtained through letters addressed from the Dean of the Faculty of Nursing at Helwan University to designated hospitals directors. Then, the researcher met with the directors, explained to them the purpose and procedures of the study and started to select the samples of nurses and students. Meetings with the recruited samples were done in small groups. After explanation of the aim and procedures, each person was asked for consent to participate. Those who agreed were handed the questionnaire form and asked to fill it. Students were asked to participate in focus group discussions after analysis of the data obtained from the questionnaires. This was intended to help gain an in-depth understanding of the attitudes, beliefs, and perceptions, and provide a cost-effective way of deducing homogenous or heterogeneous groups’ opinions through prompting debates and encouraging disclosure in a supportive environment [6, 7]. After preliminary analysis of the filled forms, points were identified to be discussed in focus groups. The researcher prepared a schedule for discussion that involved six key topics. These were self and public image of the nursing profession, role of the nurse, reasons for selecting the nursing career, effect media on nursing image, causes of low image, and solutions to change society's perception of the nursing profession. The researcher posted an announcement of the time, place, objectives and procedures of the focus group discussion on the Faculty notice board, inviting students from various faculties or institutes of nursing to participate. Those who agreed were asked to register and select the suitable time according to the posted schedule. Thirty nine students participated in five groups. The number of students per group ranged from six to nine. Groups comprised a mix of males and females, from various grades and different types of secondary education. The researcher organized the meeting room with a video-camera, but all participants refused video recording and preferred reporting by one of the participants. The setting was neutral and comfortable. At the opening, the researcher explained to participants the research objective and topics of discussion, and played the role of facilitator encouraging group interactions, and motivating all attendants to participate, clarifying that there are no right or wrong opinions, and that each student was free to express his/her opinions with no restrictions. The duration of the session was between 60 and 90 minutes. At the end of the meeting, the researcher asked the group to summarize the debates, and check for agreements. Although validity is a relevant concept in both qualitative and quantitative research, it is conceived of, and arrived at, incompletely different ways [8]. The validity and reliability of qualitative research is different from quantitative research where there is one reality that is either objective or subjective [9]. In the current study, construct validity was established by triangulation, using quantitative and qualitative approaches to collect the same data, providing multiple sources of evidence. The quantitative survey was achieved during the period from February to April 2012. The qualitative part, including preparation, actual conduction of focus groups, and analysis was during May 2012. 2.5. Ethical considerations and human rights The researcher followed all principles of ethics in research. A written informed consent was obtained from each participant. Confidentiality of information was assured, and the forms were anonymous. Participants were informed about the right to refuse to participate or withdraw at any time with no reason given.
  • 5. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 155 2.6. Statistical analysis For the quantitative survey, data entry and statistical analysis were done using SPSS 16.0 statistical software package. Quantitative continuous data were compared using the non- parametric median test to compare the four categories of self-public image in nurses and nursing students. Qualitative categorical variables were compared using chi-square test. Whenever the expected values in one or more of the cells in a 2x2 tables was less than 5, Fisher exact test was used instead. Pearson correlation analysis was used for assessment of the inter-relationships among scores. Statistical significance was considered at p-value <0.05. The first step in qualitative analysis process, according to [10] , was to organize the data according to a systematic method of classification and indexing in order to cope with the chaotic and unconnected masses of raw data. This was followed by a process of comparing and contrasting descriptions of the phenomena under study, where the transcripts of focus group discussion were grounded in the participant’s words, screened, filtered, and conceptually transformed from the pragmatic to the abstract. This would allow identification of themes repeatedly raised and the relationships among them [11] , through a process of guessing and confirmation, modifications, suggestions and arguments [12]. The qualitative data analysis was started in parallel to data collection. The researcher took notes of the important points related to nurse image right after the focus group discussions in order not to miss any details. Then analysis was done through reading and re-reading the transcripts. It was based on the mixed strategies approach [10, 13] , which involves data reduction, data display and conclusion drawing/verification. The data reduction involved re-organization of the collected data and re-arranging them together in different ways to produce an answer to the research questions. This was done through careful reading to extract significant and relevant statements, highlighting the main concepts, and coding them in words, sentences and paragraphs. Then, the researcher proceeded to copying and moving the bits of data from the original transcripts to specific categories or themes guided by the purpose of the study to provide a well-structured analytical framework. The themes and sub-themes were labeled on computer, and a coding scheme was created. The researcher clustered the data for each theme, and the content of each theme was summarized. During this process, the researcher took into consideration the commonalties, uniqueness, confusion, and contradiction, association the data and linking it to the content. The data display step involved organizing themes according to research questions and conceptual framework. The final step of drawing conclusion and verification encompassed strategies for generating meaning from the data collected such as noting patterns, making comparisons, noting relations, and making conceptual/theoretical coherence to allow supporting or contradicting existing theories or understanding on the topic. Linking was done between quantitative and qualitative data analyses by associating words with numbers to improve and support the evidence. 3. RESULTS Generally, the perceptions of stereotypical self-public nursing image among study participants were high. This was especially evident as regards interpersonal relations factors and intrapersonal ability factors both among nurses and students (Table 1). On the other hand, the perception of patient care roles were the lowest in both groups, particularly from the public viewpoint, 68.3% and 55.8% for the nurses and students, respectively. The self- perception was always higher than the public perception in all areas, with statistically
  • 6. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 156 significant difference in the inter- and intra-personal factors. Overall, more than 85% of both groups had high perception of nurse's public and self-image. Concerning self-evaluation of task performance, (Table 2) shows that all or almost all of the nurses and nursing students had a feeling of achieving work objectives, performance standards, carrying tasks as expected, and according to timetable. Meanwhile, statistically significantly more nurses viewed that they do not demonstrate expertise (p=0.002) or competency (p<0.001) in all job- related tasks required. Conversely, more students thought they could manage more responsibilities than typically assigned, compared to nurses (p=0.004). As regards self- esteem, the same table shows that all or almost all nurses and students felt themselves worthy member and cooperative participant of the nursing profession. However, significantly more nurses had the feeling of not having much to offer (p=0.001), and of not contributing sufficiently (p=0.002) to the nursing profession, although the percentages were low in both groups. The comparison of the total scores of self and public perception of nurses and students (Table 3) indicated statistically significant differences (p=0.016). It is evident the score of students' perception of public nursing image was the lowest (80.4%), bearing a significant difference with nurses' (82.8%) and students' (82.6%) self-perception scores. Nonetheless, no significant difference could be revealed between students' self and public image. The implications found out self and public nursing image on task performance as perceived by nurses' staff and nursing students' are presented in (Table 4) that demonstrated a number of statistically significant positive correlations. The strongest of these correlations were those between students' perception of self-image with task performance (r=0.75) and self-esteem (r=0.70), and nurses' perception of self-image with task performance (r=0.76) self-esteem (r=0.65), and public image (r=0.66). Meanwhile, no significant correlation could be detected between students' perception of public-image and self-esteem (r=0.18). Table 1: Perception of Stereotypical Self-Public Nursing Image among Study Participants Perception of X2 Test p-value Public image (n=120) Self-image (n=120) No. % No. % Among nurses staff Interpersonal power factors 97 80.8 115 95.8 13.10 <0.001* Interpersonal relations factors 108 90.0 120 100.0 12.63 <0.001* Intrapersonal ability factors 106 88.3 116 96.7 6.01 0.01* Decision-making roles 97 80.8 99 82.5 0.11 0.74 Patient care roles 82 68.3 88 73.3 0.73 0.39 Total nursing image: High (70%+) 104 86.7 115 95.8 Low (<70%) 16 13.3 5 4.2 6.31 0.01* Among nursing students Interpersonal power factors 100 83.3 118 98.3 16.21 <0.001* Interpersonal relations factors 106 88.3 117 97.5 7.66 0.006* Intrapersonal ability factors 106 88.3 118 98.3 9.64 0.002* Decision-making roles 96 80.0 105 87.5 2.48 0.12 Patient care roles 67 55.8 74 61.7 0.84 0.36 Total nursing image: High (70%+) 104 86.7 118 98.3 Low (<70%) 16 13.3 2 1.7 11.77 0.001* (*) Statistically significant at p<0.05
  • 7. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 157 Table 2: Self-Evaluation of Task Performance and Self-Esteem among Nurses and Nursing Students Category X2 Test p-value Nurses (n=120) Nursing Students (n=120) No. % No. % Task performance: as a nurse I evaluate my general performance as follows: I achieve required work objectives 119 99.2 120 100.0 Fisher 1.00 I fulfill the performance standards required 120 100.0 120 100.0 0.00 1.00 I do not demonstrate expertise in all job- related tasks required 42 35.0 21 17.5 9.49 0.002* I do not fulfill the job requirements 93 77.5 101 84.2 1.72 0.19 I could manage more responsibility than typically assigned 102 85.0 115 95.8 8.13 0.004* I feel my performance fits a higher job role 115 95.8 118 98.3 Fisher 0.45 I am not competent in all areas of the job and tasks required of me 42 35.0 14 11.7 18.26 <0.001* I perform well in the overall job by carrying out tasks as expected. 118 98.3 119 99.2 Fisher 1.00 I plan and organize to achieve my job goals according to timetable 119 99.2 119 99.2 Fisher 1.00 Self-esteem: as a member in the nursing profession I evaluate myself as follows: I am a worthy member of the nursing profession. 120 100.0 116 96.7 Fisher 0.12 I feel I do not have much to offer to the nursing profession 42 35.0 20 16.7 10.53 0.001* I am a cooperative participant in nursing profession 117 97.5 117 97.5 Fisher 1.00 I often feel I do not contribute sufficiently to the nursing profession 46 38.3 24 20.0 9.76 0.002* (*) Statistically significant at p<0.05 Table 3: The Relation between Self-Public Nursing Image Scores among Nurses and Nursing Students Nursing image scores N Mean S.D. Min Max > median Median test No. % Nurse (self) 120 82.8* 4.9 65.4 89.0 58 48.3 Nurse (public) 120 82.2 9.4 45.4 90.1 74 61.7 X2 =10.292 Nursing Student (self) 120 82.6# 4.8 64.6 89.3 50 41.7 P=0.016* Nursing Student (public) 120 80.4*# 10.1 38.1 89.6 57 47.5 (*) Statistically significant at p<0.05
  • 8. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 158 Table 4: Implications of Self and Public Nursing Image On Task Performance As Perceived By Nurses' and Nursing Students' Pearson correlation coefficients Nursing Students (n=120) Nurses (n=120) Task Self Image (Public) Image (self) Task Self Image (Public.) Image (self) Task performance Self esteem .53** .48** Image (Public) .21* .18 .68** .34** Image (self) .75** .70** .32** .76** .65** .66** (**) Statistically significant at p<0.01 The qualitative data analysis identified three main themes: the self-image along with career choice, the public image with the negative role of the media, and the remedial approaches both from inside and outside the profession. The self-image was high in all groups, with supporting expressions such as: "I am proud of being a nurse", "I have a high esteem of working in this profession," "I am honored to enter this career as it was my dream in secondary school." Only one statement was in the opposite direction: "I wished to be a doctor, but my grades did not allow me." The high self-image was substantiated by the "humane" character of the profession, as well as the associated compassion that would make the nurse "closer to God." Added to this is the "very high opportunities to be employed even during study," along with the "good income." The second theme was that of public image, which was overall gloomy. This was sometimes attributed to the "non-respectful" behavior of some nurses, and in other instances to the ambiguity of nurse role, considering the nurse as "a tool in physician's hands like other pieces of medical equipment," with "powerless nursing directors," and lack of knowledge of the true role of the nurse limiting it to "giving injections," and "implementing physicians' orders." However, the negative role of the media recurred in all groups, derogating the nursing profession and stigmatizing it to the extent that a participant stated: "I hate the day I chose this career." The opinions about corrective approaches reiterated the role of the media in improving the nursing image in the society. However, more importantly the participants addressed remedial from within the profession itself, starting from "setting selection criteria for career entry." The role of the academia in "upgrading and improving nursing curricula" has been emphasized. Lastly, the nursing syndicate (union) was attacked for "not having a leading role in advancing the profession." A "true professionalism of the new graduates" is the way for this profession to regain its image. 4. DISCUSSION This study assessed nurses' and nursing students' perception of self and public image of the nursing profession. The study findings point to a generally high perception in both groups regarding self and public image, although the self-image was always higher than the public one. The quantitative part of the study is supported by the qualitative part findings in the discrepancy between the self and public image. The significant difference revealed between nurses' and students' perceptions of public image might be explained by the experience gained by nurses during actual work. In line with [14], was clarified that the differences between nursing students and nurses' beliefs may be explained by the fact that
  • 9. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 159 students' perceptions are usually acquired from the media and their families, which are gradually replaced by the reality of the profession. However, the perception of the public image is gloomier in the qualitative findings. This difference between quantitative and qualitative findings can be attributed to the nature of data evolving from the two sources, where the approach of focus groups emphasizes an interpretive approach to answer the questions, rather than just checking an answer on a scale. Hence, collecting various data by using different methods from multiple sources provides a wide range of rich data that in turn results in a clear understanding of the phenomena studied. The quantitative data may reflect a wishful perception, but the interactions and debates in the focus group certainly encouraged participants to go in more depth to explain the problem. The current study findings are in line with the low perception of public image of nursing, which seems to be universal, and most nurses are negatively influenced by the public view about nursing. In a survey of registered nurses in California, 23% of them perceived that the public portrayed them as handmaidens to physicians [15] . This is even more evident in the Arab world where nursing is still suffering from negative public image [16] . Despite the dark public image of nursing as identified in focus groups, the present study findings indicate that most participants selected this career by their own will, and were even proud with their selection. This may be explained by the high perception of self-image, which may be considered by them as more important than the public image. Hence, the choice of nursing as a career does not depend only on the public image, social prestige, media, role models, nursing educators, nurse preceptors, and nursing education programs as reported by [17] , but also on self-perception of the image. However, in disagreement with the foregoing, a study in Brazil showed that only about one third of the nursing students reported that the nursing career was their first choice and would change professions if possible [18] . The selection of a wrong career may be one of the important factors underlying low job satisfaction, which may lead to non-professional behaviors of some of the nurses, which in turn has a negative impact on nursing public image. The focus group debates have also demonstrated that male students were more enthusiastic and showed more pride with their choice of nursing career. This might be influenced by the financial assets and job security provided in this profession in a society where the rate of unemployment of university graduates is high. The finding is incongruent with [19] , who discussed the factors that continue to attract large numbers of women to nursing, while men choose other careers. The discrepancy between the two studies might be explained by the differences in the settings and the job opportunities. The present study has also identified other factors that may explain the low perception of public nursing image. Among these factors is the nurse's role ambiguity, which may lead to misconceptions of the true role of the nurse as an active member of the healthcare team. In congruence with this, a study in Hong Kong analyzed the perception of secondary students about nursing; the perceived roles of the nurses were helping patients with hygiene and medication; helping the doctor; obeying orders; cleaning; and teaching new nurses [20] . Although the public image of nurses appears to have been slowly improving, nursing stereotyping that stresses nurses’ subordinate and powerless position is still prevalent as revealed in the present study focus groups analyses, which also identified the negative role of the media. The persistence of this negative nursing stereotyping is produced by public opinion influencing the media and media portrayal of nursing reinforcing that stereotyping. Images of nurses as being feminine and subordinate are consistent with a review of contemporary medical dramas in the UK and US media [21] , This negative public image
  • 10. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 160 would affect the role of nursing and as well influence the characteristics of the health care environment of nurses in terms of the behavior of other team members toward the stereotyped group [22] . The present study found out moderate to strong significant implications between self and public image on one side and self-evaluation of task role and self-esteem on the other side, both among nurses and nursing students. This implies that a low nursing image may have a negative impact on task performance and on self-esteem. The finding is consistent with that of [23] , who found that there was a moderate effect between them (r=.54). On the same line [24] mentioned that nurses and the nursing students receive the impact of the negative social appraisal at work and in the community. Therefore, efforts to improve this image would lead to improvement in role. An important theme that emanated from the current study qualitative part is the emphasis on self-correction from students, new graduates, as well as academia and union. In congruence with the [3] , confirmed that student nurses can lead the way in changing nursing public image. On the same line, it has been suggested that nurses should shape their own media portrayals, identify outstanding nursing role models to address the public in the media, and practice a positive image [2] . 5. CONCLUSION AND RECOMMENDATIONS The study indicates a generally high perception of nurses and nursing students regarding self and public image with self-image being higher, with significant differences between them in public image perception. The study demonstrated a number of statistically significant positive correlations of the implications stereotypical self and public nursing image on their self-evaluation of task performance and self-esteem nurses and nursing students' scores. The strongest of these correlations were those between students' perception of self-image with task performance. Public image would implicate the performance of nursing and as well influence the characteristics of the health care environment of nurses in terms of the behavior of other team members toward the stereotyped group; these factor is the nurse's role ambiguity, which may lead to misconceptions of the true role of the nurse as an active member of the healthcare team. The quantitative part of the study is supported by the qualitative part findings in the discrepancy between the self and public image although the latter is gloomier. Despite the seemingly improving public image of nurses, nursing stereotyping that stresses powerlessness is still prevalent, and may have a negative impact on task performance and self-esteem. The study recommended that nurses should be have self- confidences from inside themselves to reflect it for public and patients which would lead to change in the public image, improve negative nursing images through the media and marketing for the genuine nursing roles through the public and stakeholders. 6. Acknowledgements I would like to express my deep thanks to nursing students Faculty of Nursing, Helwan University and nursing staff works in affiliated hospitals for your participate in study. I would like to thank dean of faculty, medical directors and nursing directors in studied hospitals for facilitate to apply this work. Finally, deep thanks to my dear husband and my lovely sons for their cooperation, encouragement and sustained moral support at the home during work study.
  • 11. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 161 7. REFERENCES [1] The Free Dictionary. 2003. Image. Retrieved November 11, 2003, from http://www.thefreedictionary.com [2] NAB-Nurses Association of Botswana 2010. professional image of a nurse, international year of the nurse. Image campaign Flyer Number 2, Sun Design / Impression House. pp 2 [3] NSNA, National Student Nurses' Association, 2012. In: Guidelines for Planning Image of Nursing Projects. Celebrating 60 Years Sharpening Our Image Over The Generations: In Honor of NSNA’s 60th Diamond Anniversary. . nsna@nsna.org, www.nsna.org, .www.nsnaleadershipu.org. pp 1:19. [4] Hall C., and Ritchie, D. 2009. What is Nursing? Exploring Theory and Practice. Dean Garratt Britain, Institute of Education, Framework over three main phases three years from time of report seven an ethnographic study of coaches and their relationship with processes of professionalization ,exploring tensions. From 2009: 2012. d.garratt@mmu.ac.uk. [5] Takase, M. Maude, P. and Manias, E. 2006. Impact of the perceived public image of nursing, nursing and healthcare management and policy. Journal compilation Blackwell Publishing Ltd. Journal of Advance Nursing,.53:333–343 [6] Greenbaum T. 1997. The Handbook for Focus Group Research. 2nd edition. California: Sage. [7] Wong LP. 2008. Focus group discussion: a tool for health and medical research. Singapore Med J; 49(3):256-60. [8] Avis M. 1995. Valid arguments? a consideration of the concept of validity in establishing the credibility of research findings. J Adv Nurs.; 22(6):1203-9. [9] Kisely S, Kendall E. 2011. Critically appraising qualitative research: a guide for clinicians more familiar with quantitative techniques. Australas Psychiatry; 19(4):364- 7. [10] Polit DF, Hungle BP 2001. Nursing research. Principles and methods. 6th ed. Methods for analysing talk, text and interaction. London: Sage Publications. [11] Brink P J. and Wood MJ. 2008. Advanced design in nursing research. 2nd ed., London: Sage Publications, 1998, Original from the University of Michigan, Digitized 22 Jul 2008. [12] Morse J M. and Field PA. 2008. Qualitative research methods for health professionals. 2nd Edition, London: Sage Publications, 1995. Original from the University of Michigan, Digitized 20 Aug 2008. [13] Huberman AM. and Miles MB. 2002. The Qualitative Researcher's Companion. India: Sage. [14] Brodie D, Andrews G, Andrews J, Thomas G, Wong J, Rixon L. 2004. Perceptions of nursing: confirmation, change and the student experience. Int J Nurs Stud.; 41(7):721- 33. In Luchesi L, Mendes I, Shiniyashiki G, and Costa M.: An instrument to analyze secondary-level students’ images about nurses. www.ee.usp.br/reeusp/Approved: 07/01/2008. USP 2009; 43(2):272-8 [15] Gray B. 2004. Public opinion consumer pools reveal consumer attitude about nursing. Available at http://www.nurseweek.com retrieved on August 14, 2004. [16] Shukri R. 2005. Status of nursing in the Arab world. Ethnicity & Disease;15 (Suppl 1): 88-89 28.
  • 12. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 4, Issue 3, May- June (2013) 162 [17] Abdel El-Halem G , El Hawashy Z, Gamal El-Dein A, Taha E. 2011. Undergraduate Male Nursing students' Perception about the Image of the Nursing Profession Journal of American Science, http://www.americanscience.org.;7(3): 614-23 [18] Shinyashiki G , Mendes I, Trevizan M, Day R. 2006. Professional socialization: students becoming nurses. 14(4):601-7.in Luchesi L, Mendes I, Shiniyashiki G, and Costa M. 2009. An instrument to analyze secondary-level students’ images about nurses. www.ee.usp.br/reeusp/Approved: 07/01/2008. USP 2009; 43(2):272-8 [19] Catalano, J. 2009. Nursing now Today's issues, tomorrow’s trends. 5th (ed). Philadelphia: F.A. Davis Company Chapter 2., p. 23 - 38. [20] Luchesi L, Mendes I, Shiniyashiki G, and Costa M. 2009. An instrument to analyze secondary-level students’ images about nurses. www.ee.usp.br/reeusp/ Approved: 07/01/2008. USP 2009; 43(2):272-8 [21] Hallam, J. 2000. Nursing the image: Media, cultural and professional identity. London: Routledge. In Wikipedia, the free encyclopedia: Nursing profession. From Wikipedia Foundation, Inc. Last modified on February 2012 at 21:55. [22] Walsh, K. and Craik R. 2004. Person-environment psychology: New directions and perspectives 2nd ed. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. pp. 61- 85. [23] Takase, M. Kershaw, E. & Burt, L. 2002. Does Public Image of Nursing Matter? Journal of Professional Nursing; 18(4): 196-205. [24] Dimitriadou A, Lavdaniti M, Sapountzi, D, Psychogiou M, Konstadinidou-Stafkou A, Benos A. 2008. the identity of the nursing staff in Northern Greece, www.hsj.gr, health science journal, volume 2, issue 4. pp:206-218 ISSN:1108-7366. [25] Sathyajith S and Dr. R. Haridas, “Job Satisfaction Among Nurses of Private Hospitals in Kerala”, International Journal of Management (IJM), Volume 4, Issue 2, 2013, pp. 176 - 179, ISSN Print: 0976-6502, ISSN Online: 0976-6510.

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