Implications of stereotypical self and public nursing image on performance

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
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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

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.

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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.

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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

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

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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*
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

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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

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

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.

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