a mixed methods study to explore the self image

SCHOLARS WORLD -INTERNATIONAL REFEREED MULTIDISCIPLINARY JOURNAL
OF
CONTEMPORARY RESEARCH
Online: ISSN 2320-3145, Print: ISSN 2319-5789
A MIXED METHODS STUDY TO EXPLORE THE SELF
IMAGE PERCEPTION OF STUDENT NURSES
S. SRIDEVY,
PRASSANNA BABY,
Assistant Professor,
Mother Teresa Post Graduate & Research
Institute of Health Sciences, Pondicherry- India
Principal,
Sri Ramachandra College of Nursing,
Chennai - India
“Our self image, strongly held, essentially determines what we become”- Maxwell Maltz
INTRODUCTION:
Images are mental representations that influence how people see all aspects of life, including nurses and
nursing; they help people in achieving tangible goals, making judgments, and expressing themselves. There
is an inherent need to maintain positive personal self-esteem and self-concept within a professional nursing
paradigm (Takase, Kersaw and Bert, 2002) Students’ perceptions of nursing are based on visual images that
are often limited to bedside care and drug administration instead of that of a highly skilled and well-educated
nursing professional with an important role to play in healthcare.
For a long time, the nurse is depicted as a battleaxe, a sex symbol or in a subordinate role and handmaiden to the
doctor. These persistent images do not serve to encourage young people into the profession and do not indicate the
diverse career pathways that are available. Takase et al., (2002) asserts that it is important to encourage professional
socialization to create positive personal self-esteem to fight against these negative images on nursing practice.
The images that prospective nursing students may retain when seeing themselves as nurses; this factor was of
significance to this present study. Nurses regard their self-image as leaders much higher than their perceived
public image. Since prior studies on this subject are insufficient, the researcher as a nursing educator tried to find
out the perceptions of nursing students about their profession with a view that understanding their perception can
assist nurse educators in evaluating the educational programme’s strengths and weaknesses.
STATEMENT OF THE PROBLEM:
A study to explore the perceptions of the self image of the senior student nurses, studying in colleges in and
around Pondicherry.
OBJECTIVES:
1. To assess the senior student nurses’ perceptions of their self image.
2. To develop various strategies to promote a positive self image of nursing students.
METHODOLOGY:
Mixed Methods Design was applied for this study.
In the quantitative approach, questionnaires were used and the responses were collected. In the a qualitative
approach, focus group discussions and an open ended questionnaire were used to explore views about the
perceptions of the student nurses on the image of nursing.The study was conducted in the selected nursing
colleges (both Government and Private) located in and around the union territory of Pondicherry.
POPULATION: The population composed of all nursing students who are studying B.Sc (N) final year in
the selected nursing colleges located in and around the union territory of Pondicherry.
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SCHOLARS WORLD -INTERNATIONAL REFEREED MULTIDISCIPLINARY JOURNAL
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CONTEMPORARY RESEARCH
Online: ISSN 2320-3145, Print: ISSN 2319-5789
SAMPLE:
A sample of 357 nursing students, out of which 283 girls and 74 boys studying B.Sc (N) final year in the
selected nursing colleges located in and around the union territory of Pondicherry were selected for the
study. Non–probability convenience sampling technique was used for selecting sample for this study.
TOOL: Section- A – Demographic data, Section- B– Modified Porter Nursing Image Scale -to explore the self image
Tool II consisting of: A structured open ended questionnaire and focus group discussion guidelines
Modified Porter Nursing Image Scale
This scale was developed by Porter and Porter (1991) to measure nurses’ self image /Self-concept. Nurses
were told to use this scale to rate the items according to the image they held of them.
SCORING AND INTERPRETATION: Maximum marks- 100, Minimum score- 20
S. No.
1.
2.
3.
4.
Grade
Excellent image
Good image
Average image
Poor image
Percentage
75 – 100%
50 – 74%
25 – 49 %
Below 25%
Score
76-100
51-75
26-50
0-25
The researcher adapted another widely used technique in exploratory research that is the focus group. In a
focus group, a small number of individuals are brought together to study and talk about some topic of
interest. The discussion is co-ordinate by a moderator. The group usually is of 8-12 persons. While selecting
these persons, care has to be taken to see that they should have a common background and have similar
experiences. This is required because there should not be a conflict among the group members on the
common issues that are being discussed. Frequency and Percentage, Mean and SD were used to tabulate the
self image scores. Pearson Chi Square test was used to find out the association between demographic
variables and level of self-image. Thematic analysis was used to analyze the data of the open ended
questionnaire and the focus group discussion.
EACH QUESTIONWISE PERCENTAGE OF MODIFIED PORTER
NURSING SELF IMAGE SCALE SCORE: (N=357)
S. No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
As a nurse, I consider I am Mean score
A leader
3.43
Compassionate
3.75
Logical
3.20
Confident
3.58
Professional
3.33
In control
3.73
Compromising
3.39
Respectful
3.42
Intelligent
3.61
Patient
3.63
Organized
3.33
Responsible
3.32
Powerful
2.58
A follower
3.45
Competent
3.71
Rational
3.30
Nurturing
3.64
Independent
2.29
Warm
3.55
A Guide
3.55
TOTAL
67.78
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SD Percentage of mean score
1.27
68.6%
1.15
75.0%
1.21
64.0%
1.19
71.6%
1.29
66.6%
1.09
74.6%
1.13
67.8%
1.24
68.4%
1.17
72.2%
1.14
72.6%
1.35
66.6%
1.32
66.4%
1.22
51.6%
1.22
69.0%
1.07
74.2%
1.38
66.0%
1.26
72.8%
1.18
45.8%
1.20
71.0%
1.20
71.0%
6.17
67.8%
Volume. III, Issue II, April 2015 [49]
SCHOLARS WORLD -INTERNATIONAL REFEREED MULTIDISCIPLINARY JOURNAL
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CONTEMPORARY RESEARCH
Online: ISSN 2320-3145, Print: ISSN 2319-5789
The above table shows the Question wise percentage of mean score of the student nurses’ self image
perception. The student nurses obtained a maximum score for the statement that they are “Compassionate”
(75.0%) and minimum score in stating that they are “Independent” (45.8%). Overall they had a score of
67.8% which implies a good perception.
LEVEL OF SELF IMAGE SCORE N=357
LEVEL OF IMAGE
Poor
Average
Good
Excellent
Total
NO. OF NURSES
0
20
291
46
357
PERCENTAGE
0.0%
5.6%
81.5%
12.9%
100%
OVERALL LEVEL OF PERCEPTION OF STUDENTS NURSES’ SELF IMAGE
The above table and figure, shows the overall level of nursing students self image perception score. In general
none of the student nurses had a poor self image, 5.6% of them had an average self image, 81.5% of them were
having a good self image and 12.9% of them were having an excellent perception of their self image.
PARTICIPANTS’ FEELING OF BEING A NURSING STUDENT
S.No
1
Questions
Themes
How do you feel
about being a
nursing
Student?
Empathetic/ caring
Self confident
Satisfied/proud
Under pressure/burning
out/ stressful
Others
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Open
ended(N=357)
n
%
63
17.6%
64
17.9%
43
12.0%
Focus
group(N=24)
n
%
8
33.3%
6
25.0%
3
12.5%
116
32.5%
6
25.0%
71
19.9%
1
4.2%
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Chi-square
Test
χ2=6.92
p=0.14
Volume. III, Issue II, April 2015 [50]
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CONTEMPORARY RESEARCH
Online: ISSN 2320-3145, Print: ISSN 2319-5789
RESPONSE STATING THE PARTICIPANTS’ FEELING OF BEING A NURSING STUDENT:
The qualitative analysis led to the emergence of the five themes from the open ended questionnaire and
focus group data. From the students' point of view," empathetic /caring", "self confident", “satisfied”, “
under pressure/burning out"," others (challenging, busy/no time, enjoyable, hate clinical), were considered
as important factors as their feeling as a nursing student.
The above table and figure reveals that majority of the students (32.5%) responded in OEQ, that they felt
under severe pressure, burned out or very stressful, while from focus group, majority of responses (33.3%)
indicated empathetic and caring as the important feeling. 25% of students felt self confident and 12% were
fully satisfied of being a nursing student. Few students felt that being a student of nursing is challenging,
few others told that it was enjoyable, while few other students stated that they hate going to clinical.
The first objective of the study was:
1. To assess the senior student nurses’ perceptions of their self image.
The above Table shows the results of the assessment findings of the self image of the student nurses. It was
found that the student nurses were having a maximum score in the aspect of perceiving themselves as
“Compassionate” (75.0%) and obtained a minimum score in in stating that they are “Independent” (45.8%).
A good number of students had also rated more of the aspects of being in control, being competent, being
intelligent, patient, warm, nurturing and a guide.
The findings of the study were consistent with the study by Kret DD (2011). Compassion is thought of as a
nursing quality that impacts patient care. In this study, the complexities of compassion, its effect on patient care,
and the historical roots of compassion are explored. Attempts are made to measure levels of compassion rendered
by the health care team, including physicians, physician's assistants, and nurses. This descriptive study is designed
to explore the qualities of compassionate nurses as perceived by patients in medical-surgical units.
2012, Nursing Standard, a weekly news review, reported on a small study that found student nurses have a
strong desire to provide compassionate care for patients, despite claims to the contrary in the media.
However student nurses did report a perceived lack of time for nurses to ‘be with patients’; citing other
activities such as medication administration, paperwork and liaising with other healthcare professionals as
taking up a lot of their time.
CONCLUSION:
Cultivating student nurses’ self-image as being caring further helps them to cope with the potential pressure
from the public’s high expectation of nursing care. Through this perspective it’s necessary to review
concepts, update values and make choices to a critical-reflective professionals’ formation, socially
committed with group and individual works in the health area. Based on the findings of this research, the
researcher framed the following strategies to enhance a positive self image of nursing.
Continuing education for faculty incorporating not only cultural competence but also information on
learning strategies and successful methods to retain nursing students
Arranging for peer tutoring, mentoring, and increasing faculty development.
Offering stipends and identifying potential nursing students in high school.
REFERENCES:
1. A.Bushy, B Leipert (2005), “Factors that influence students in choosing rural nursing practice: a pilot
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David Arthur, Alice Lee, Yong Loo Lin & Jacqueline Randle (2007) “The Professional Self-Concept
of Nurses: A Review of the Literature from 1992-2006” Australian Journal of Advanced Nursing,
Volume 24 Number 3 pp 60-64
Gwen Hartrick and Rita Schreiber(1998) “ Imaging Ourselves Nurses' Metaphors of Practice” Journal
of Holistic Nursing , vol. 16 no. 4 pp 420-434
Jeffries, E. (1998). “Hearing the call to nursing. Nursing”’, vol.28 (7), pp34-35.
Bengt Sivberg and Kerstin Petersson (1997) “Self-Image, Self-Values and Interpersonal Values
among Newly Graduated Nurses” Nursing Ethics, vol. 4 no. 5 pp407-423
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