Abstract
In this study, the goal was achieved to examine the nursing image from the perspective of healthcare professionals in the post-COVID-19 period. This descriptive study was conducted with the participation of n = 264 healthcare professionals working in a training and research hospital. A personal Information Form and Nursing Image Scale were used to collect data. Descriptive methods, the Kruskal–Wallis test, and the Mann–Whitney U test were used in data analysis. Sixty-three point three percent of the healthcare professionals were women and 76.9% were nurses. Sixty-three point six percent of healthcare professionals had COVID-19 and 84.8% had worked without leave during the pandemic. In the post-COVID-19 period, 39% of the healthcare professionals were in partial anxiety and 36.7% were in constant anxiety. Personal characteristics of healthcare professionals did not have a statistical impact on nursing image scale scores. From the perspective of healthcare professionals, the total score of the nursing image scale was moderate. The lack of a strong nursing image may trigger poor care practices.
Keywords: COVID-19, Healthcare professionals, Nursing image
Introduction
Nursing image is the way the profession appears to others or the impression it leaves on others (Gunawan et al., 2018). The importance of having status and power to heal diseases, improve health, and save lives has once again come to light during the COVID-19 pandemic (Bennett et al., 2020). The difficulties experienced by Florence Nightingale in the previous times when modern nursing debuted are due to the inability to understand the importance of nursing as a profession and lack of a strong image (Pfettscher, 2021). The nursing image directly affects professional development opportunities, obtaining public funds, educational opportunities, social opportunities, attitudes of legislators, the salary system, and the relations of professional members with other health professionals (Varaei et al., 2012). A low nursing image may reduce the motivation and self-confidence of the members of the profession. In addition to this, it can negatively affect all the plans and behaviors of the members of the profession (Finkelman, 2017).
The International Council of Nurses (ICN) celebrates International Nurses Day worldwide on May 12, the anniversary of Florence Nightingale's birth, and sets a theme every year. The theme of the 2022 Nurses' Day was based on the necessity of investing in nursing and respecting its rights to secure global health (Catton, 2022). The failure of a healthcare professional to save a patient's life when faced with a complication or condition that did not exist before during their hospital stay is referred to as a “rescue failure”. The use of rescue failure as a measure of effective nursing care has been mentioned in nursing research for the last 30 years (Silber et al., 1992). In the United States in 2000, preventable medical errors were estimated to contribute to 44,000 to 98,000 deaths per year (Kohn et al., 2000). In 2013, it was reported that the number of preventable deaths increased even more, reaching more than 400,000 per year (James, 2013). There have been no reports of rescue failure and deaths caused by preventable medical errors in Turkey. Nursing Law (6283 numbered law 1954) was amended in 2007 in Turkey (Nursing Law in Turkey, 2007). With this law, nursing has gained the right not to carry out any non–evidence-based initiative. In this way, nurses gained the right to transform into "professional members who can make independent decisions and decide on their "practitioner" duties. This situation has highlighted the rights and responsibilities of nurses in reducing rescue failure. The educational level of the nurse now determines the authority and responsibility of the nurse. This law also acknowledges specialization in nursing.
Raising the nursing image plays a key role in professional advancement. There is no optimal number of studies in this field. In addition to these, it is necessary to define it in detail to raise the nursing image. Previous studies have investigated the perceived nursing image of nurses (Gunawan et al., 2018), nursing students (Olgun and Kaptan, 2022), and society (Şimşek and Alpar, 2019). In this study, it was aimed to examine the nursing image from the perspective of nurses as well as other healthcare professionals with whom they spend most of their time in the working environment.
Methods
This study was conducted with the participation of healthcare professionals working in a training and research hospital in western Turkey. In this study, the nursing image was examined from the perspective of healthcare professionals. This study was conducted as a descriptive and cross-sectional study.
Research Design and Participants
Data for this study were collected after ethical approval and informed consent of healthcare professionals. The questionnaire method was used for data collection. The population consisted of 278 healthcare professionals working in a training and research hospital. The purposive sampling method was used in sample selection. After the power analysis, at least n = 233 healthcare professionals who met the inclusion criteria in our study with a margin of error of 0.05 and a confidence interval of 95% were deemed appropriate. The sample group of this study consisted of n = 203 nurses, n = 13 midwives, n = 48 other healthcare professionals (physiotherapist, pharmacist, physician, dietitian, technician or technician). A total of n = 264 healthcare professionals was participated in this study.
Data collection was carried out by the researchers in June-September 2022 using the survey method. Healthcare professionals who volunteered to participate in the study were taken to the private interview room after their informed consent was obtained and they were requested to fill out the questionnaires within 15 minutes. The healthcare professionals who completed filling out the questionnaires handed the questionnaires to the researcher and left the private interview room. The participants were taken to the interview room one by one. Sample group inclusion and exclusion criteria were listed in Table 1 .
Table 1.
Inclusion and exclusion criteria
| Inclusion criteria | |
| i | Being a healthcare professional in the hospital where the study was conducted |
| ii | Having a minimum of 1 year of employment in the profession |
| iii | Not having communication problems and language barriers |
| iv | Agreeing to participate in the study was among the inclusion criteria of this study |
| Exclusion Criteria | |
| i | Not being a healthcare professional and/or not working in a place other than the hospital where the study was conducted |
| ii | Having less than 1 year of employment in the profession |
| iii | Not being able to speak Turkish and having a communication-language barrier |
| iv | Not volunteering to participate in the study was among the exclusion criteria of this study. |
Data Collection Tools
Personal information form and “Nursing Image Scale” were used as data collection tools in this study. Information about the questionnaires was presented below.
Personal Information Form
This form was prepared by the researchers by receiving expert opinions and supporting them with the literature. It was a questionnaire in which sociodemographic and personal characteristics of healthcare professionals such as age, gender, and marital status were asked.
Nursing Image Scale
The Nursing Image Scale (NIS) was developed by Dost and Bahçecik in 2015 and consisted of 42 items. This scale consisted of six dimensions including “Professional Qualifications, Working Conditions, Gender, Education, Occupational Status, and Appearance”. In the 5-point Likert-type scale, the statement “strongly agree” represented 5 points, and the statement “strongly disagree” represented 1 point. It is interpreted that as the score obtained from the scale increases, the perception of the nursing image increases positively (Dost and Bahçecik, 2015). In the original validity and reliability study of the scale, the Cronbach Alpha coefficient was found to be 0.91. In this study, the Cronbach Alpha coefficient was found to be 0.89.
Statistical Data Analysis
After data entry, Statistical Package for the Social Sciences (SPSS) 25.0 IBM (Armonk, NY) statistical program for statistical analysis was used to analyze the data. Descriptive statistical methods (number, percentage, mean and standard deviation) were used in data analysis. Kruskal–Wallis and Mann–Whitney U tests were used to determine the relationship between the variables. In the evaluation of the results obtained, the confidence interval was considered as 95% and the error level was considered as p < .05.
Findings
Table 2 demonstrated the sociodemographic characteristics and nursing image scores of healthcare professionals. Sixty-three point three percent of healthcare professionals were women, 48.1% were between the ages of 26 and 30, and 74.2% were single. Considering the professions, 76.9% of the participants were nurses. Seventy-three point five percent of healthcare professionals had been working for 1-5 years, and 69.7% of them were working both shifts of day and night. Sixty-three point six percent of healthcare professionals had COVID-19, 21.6% were hospitalized, and 84.8% had worked without leave during the pandemic.
Table 2.
Sociodemographic characteristics and nursing image scores of healthcare professionals (n = 264)
| Characteristics | n | % | NIS total |
|---|---|---|---|
| Gender | |||
| Female | 167 | 63.3 | 139.74 ± 12.37 |
| Male | 97 | 36.7 | 136.75 ± 12.89 |
| Test and sig. | U = 6.992, p = .084 | ||
| Age | |||
| Between 18 and 25 | 102 | 38.6 | 140.39 ± 11.31 |
| Between 26 and 30 | 127 | 48.1 | 137.50 ± 12.99 |
| Between 31 and 40 | 23 | 8.7 | 138.73 ± 13.30 |
| 41 years old and above | 12 | 4.6 | 135.91 ± 17.11 |
| Test and sig. | KW = 3.365, p = .339 | ||
| Marital Status | |||
| Married | 68 | 25.8 | 138.41 ± 14.74 |
| Single | 196 | 74.2 | 138.73 ± 11.83 |
| Test and sig. | U = 6345, p = .597 | ||
| Education | |||
| Secondary Education | 38 | 14.4 | 137.43 ± 14.83 |
| Associate Degree | 43 | 16.3 | 136.60 ± 14.68 |
| Bachelor's Degree | 159 | 60.2 | 139.85 ± 11.23 |
| Postgraduate | 24 | 9.1 | 136.20 ± 13.53 |
| Test and sig. | KW = 2.036, p = .565 | ||
| Profession | |||
| Nurse | 203 | 76.9 | 138.46 ± 12.06 |
| Midwife | 13 | 4.9 | 139.38 ± 15.09 |
| Other (Physiotherapist, pharmacist, physician, dietitian, technician, or technician) | 48 | 18.2 | 139.25 ± 14.38 |
| Test and sig. | KW = 1.525, p = .288 | ||
| Experience | |||
| 1-5 years | 194 | 73.5 | 139.34 ± 11.75 |
| 6-10 years | 44 | 16.7 | 137.25 ± 15.52 |
| 11-15 years | 11 | 4.2 | 132.45 ± 14.31 |
| 16 years and over | 15 | 5.6 | 138.2 ± 12.81 |
| Test and sig. | KW = 2.824, p = .42 | ||
| Income | |||
| Income is less than expenses | 153 | 58.0 | 139.02 ± 12.12 |
| Income equals the expenses | 86 | 32.6 | 137.56 ± 13.18 |
| Income is more than expenses | 25 | 9.5 | 140.08 ± 12.62 |
| Test and sig. | KW = 0.600, p = .741 | ||
| Work Type | |||
| Night | 12 | 4.5 | 139.00 ± 18.33 |
| Day | 68 | 25.8 | 136.91 ± 14.30 |
| Day and night shift | 184 | 69.7 | 139.30 ± 11.66 |
| Test and sig. | KW = 2.264, p = .322 | ||
| Presence of Nurse in Family | |||
| Available | 77 | 29.2 | 138.75 ± 13.24 |
| Unavailable | 187 | 70.8 | 138.32 ± 12.47 |
| Test and sig. | U = 6071, p = .303 | ||
| COVID-19 Status | |||
| Yes | 168 | 63.6 | 138.36 ± 12.57 |
| No | 96 | 36.4 | 139.20 ± 12.72 |
| Test and sig. | U = 7274, p = .520 | ||
| Status of Inpatient Treatment in the Hospital | |||
| Yes | 57 | 21.6 | 137.25 ± 18.15 |
| No | 207 | 78.4 | 138.94 ± 10.73 |
| Test and sig. | U = 5492, p = .659 | ||
| Active Working During the Pandemic | |||
| Yes | 224 | 84.8 | 138.47 ± 12.32 |
| No | 40 | 15.2 | 139.34 ± 13.76 |
| Test and sig. | U = 3.141, p = .773 | ||
| Concern About COVID-19 | |||
| Yes | 97 | 36.7 | 139.05 ± 16.04 |
| Partially | 103 | 39.0 | 138.35 ± 9.46 |
| No | 64 | 24.2 | 138.51 ± 11.34 |
| Test and sig. | KW = 3.352, p = .187 | ||
| Economic Loss During the Pandemic | |||
| Yes | 178 | 67.4 | 137.95 ± 12.98 |
| Partially | 63 | 23.9 | 139.96 ± 12.60 |
| No | 23 | 8.7 | 140.40 ± 9.65 |
| Test and sig. | KW = 1.358, p = .507 | ||
| Death of a Relative Due to COVID-19 | |||
| Yes | 102 | 38.6 | 136.99 ± 14.72 |
| No | 162 | 61.4 | 139.80 ± 11.03 |
| Test and sig. | U = 7.488, p = .378 |
NIS = nursing image scale; U = Mann–Whitney U test; KW = Kruskal–Wallis test.
Statistical significance p < .05.
In the post-COVID-19 period, 39% of the healthcare professionals exhibited partial anxiety and 36.7% were in constant anxiety. It was determined that 67.4% of healthcare professionals experienced economic loss during the COVID-19 pandemic period, and 38.6% died due to COVID-19. It was determined that sociodemographic variables did not cause a statistical difference in NIS scores (Table 2).
The scores of the total and dimensions of NIS were presented in Table 3 . It was determined that 38.84 ± 6.90, 16.09 ± 1.97, 22.16 ± 3.66, 34.65 ± 3.75, 15.72 ± 5.76, and 11.17 ± 3.41 were obtained from the Working Conditions, Education, Gender, Professional Qualifications, Professional Status, and Appearance dimensions, respectively. The total score of NIS was determined to be 138.65 ± 12.62.
Table 3.
Nursing image scale total and dimension scores (n = 264)
| Characteristics | Items | Number of questions | Score range | Mean ± sd | Min-max |
|---|---|---|---|---|---|
| Working Conditions | 1-10 | 10 | 10-50 | 38.84 ± 6.90 | 14-46 |
| Education | 11-15 | 5 | 5-25 | 16.09 ± 1.97 | 9-23 |
| Gender | 16-22 | 7 | 7-35 | 22.16 ± 3.66 | 11-31 |
| Professional Qualifications | 23-34 | 12 | 12-60 | 34.65 ± 3.75 | 25-52 |
| Professional Status | 35-39 | 5 | 5-25 | 15.72 ± 5.76 | 5-25 |
| Appearance | 40-42 | 3 | 3-15 | 11.17 ± 3.41 | 3-15 |
| NIS Total | 1-42 | 42 | 42-210 | 138.65 ± 12.62 | 100-168 |
Discussion
COVID-19, which causes the severe acute respiratory syndrome, emerged in Wuhan, China in late 2019, causing a global pandemic (Pleasure et al., 2020; World Health Organization-WHO, 2020; Zhang and Xie, 2020). In the early days of the pandemic, COVID-19 had a lethal rate of 4.6% worldwide (World Health Organization-WHO, 2020). COVID-19 is significantly associated not only with lung problems but also with the development of psychiatric and neurological problems. It was reported that individuals with especially advanced age, weak immune systems, comorbidities, or chronic diseases also increase psychoneurological vulnerability (Altun et al., 2022; Bulbuloglu and Gurhan, 2022). The COVID-19 pandemic caused economic losses worldwide as well as loss of life. People suffered material and moral losses. During the COVID-19 pandemic, healthcare professionals did not get enough rest and worked under constant and harsh conditions. In this study, 63.6% of healthcare professionals worked without leave during the COVID-19 pandemic and 84.8% during the pandemic. In the post-COVID-19 period, 39% of healthcare professionals were in partial anxiety and 36.7% were in constant anxiety. In this study, the percentage of healthcare professionals who experienced economic loss was 67.4%, and the percentage of those whose relatives died was 38.6%.
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. 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 (Bulbuloglu et al., 2021). During the pandemic process, the severity of stress for nurses increased exponentially. In addition, it was reported that nurses felt less burnout and higher motivation when their work was appreciated by the public and they had a positive image from the public's perspective (Alhakami and Baker, 2018; Baljoon et al., 2018). It was determined that a positive nursing image increased the quality of care (Grinberg and Sela, 2022).
The perspective of health professionals is of great importance in understanding the nursing image. This is because the working conditions and professional dynamics of nurses are witnessed by their colleagues and other healthcare professionals with whom they cooperate and work multidisciplinary. In this study, it was determined that the nursing image was at a moderate level. This finding provides an idea about raising the nursing image. This is because the low nursing image can damage the confidence of the members of the profession, increase their anxiety about the future, and cause them to isolate themselves from the profession. The unhappiness caused by the pandemic may have weakened the nursing image from the perspective of healthcare professionals. This study is single-sided and, therefore, cannot be generalized. Nurses were the majority in the sample group. All these were accepted as the limitations of this study.
Conclusion
In this study, it was aimed to reveal the nursing image from the perspective of healthcare professionals in the post-COVID-19 period. 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. During the COVID-19 pandemic, nurses have struggled to heal patients at the forefront, and this struggle continues during the post-COVID-19 pandemic period. In this study, it was determined that the nursing image from the perspective of healthcare professionals was moderate. This may hinder the increase in the quality of care and may reduce the professional confidence and motivation of nursing. In this regard, there is a need for strategies to increase the nursing image.
CRediT authorship statement
Funda Topuz: Investigation; Semra Bülbüloğlu: Authorship criteria; Zekiye Filizli: Investigation; Doğan Zayin: Investigation.
Footnotes
There is no conflict of interest about authors or the article. The authors didn't receive institutional support, noncommercial grants, or commercial support.
Ethical Considerations: Before starting the study, necessary legal permissions were obtained from the Clinical Research Ethics Committee of Bakırköy Dr. Sadi Konuk Training and Research Hospital (Decision Date: 20.06.2022, Decision No: 2022-12-09). In line with the Declaration of Helsinki, healthcare professionals were provided with written and verbal information about the study, and they were asked to fill in the volunteer information form. Healthcare professionals who volunteered to participate in the study were included in the study after their written consent was obtained.
Declaration of interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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