Health Education and Health Promotion

The Iranians’ Attitude toward the Social Status of the Nursing Profession

Document Type : Original Research

Authors

A. Jadidi 1
E. Sadeghian 2
M. Khodaveisi 3
Z. Maghsoudi 4
M.R. Razavi 5

1 Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak Iran

2 Chronic Disease (Home Care) Research Center, Nursing Department, Hamadan University of Medical Sciences, Hamadan, Iran

3 Community Health Nursing Department, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran

4 Department of Nursing, Student Research Committee, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran

5 Department of Nursing, School of Nursing, Larestan Faculty of Medical Sciences, Larestan, Iran

Abstract
Aims: The social status of nurses is one of the factors affecting the professional identity and plays an important role in how people perceive this profession and also the tendency of people to this profession. So this study was conducted to determine the Iranian population's attitude toward the social status of the nursing profession.

Instrument & Methods: This descriptive-analytical cross-section study was conducted in public places in Hamadan from October to February 2019. Four hundred citizens participated in the study by available sampling method from 4 urban areas of Hamedan. The data were collected by a social status researcher-made questionnaire. Collected data were analyzed using SPSS 16 and, parametric statistical tests such as t-test and ANOVA and non-parametric tests such as Chi-square.

Findings: The mean age of participants was 34.30±9.98 years. The mean of the obtained score from the status questionnaire was 71.23±11.76, which was at a moderate level in qualitative leveling. Statistical tests showed that social status score was statistically significantly related to gender, education, and media relations (p<0.05).

Conclusion: Considering that individuals' attitudes on the social status of the nursing profession are moderate and people who had more contact with the media reported lower scores of social status, it is recommended that members of the media take action to reflect the true image of the nursing profession.

Keywords

Nursing
Respect
Social status
Mass media
Subjects
Introduction
Preservation of social status is one of the basic principles of human rights. The concept of social status overlaps with other human values such as privacy, respect, and independence [1]. Since the nursing profession is one of the most important professions in health care, the social status of nurses plays an important role in how people perceive this profession and also the tendency of people to this profession [2]. Despite recent attention to the concept of social status, this term is still a vague, complex, and interpretable concept that has not yet been provided with a comprehensive and specific definition agreed upon by experts [3].
The most important stresses of the nursing profession are the uncertain social status in society. With the daily increase in stress and workload of nurses, their social status is more threatened than before. On the other hand, social status is one of the factors affecting the formation and strengthening of professional identity, so any threat to social status causes damage to the professional identity of nursing that influences quality patient care and reduces workplace stress [4].
The formation of the social status of the nursing profession is due to various factors and contexts. Researchers state that various factors such as media and television, newspapers and magazines and clothing style, inter-professional communication, income, job importance, and nurses' behaviors can affect the formation of nursing social status in society [5, 6]. Various studies have shown that the general public has a stereotypical view of the nursing profession in which the nurse is seen as a person with more limited knowledge than physicians, incapacitated and dependent, and that nursing is a tedious and challenging profession, which does not require much skill [7-9]. Hoeve's study showed that the real image of the social status of nursing in society is different and heterogeneous. A part of this image is created by the nurses themselves due to their lack of participation in social discussions [10].
It seems that improving the social status of nurses and gaining a stronger position in health care organizations can be achieved by increasing their presence [10]. The study by Norman also shows that factors such as low salaries and job benefits, low job credit, and underestimating job services are effective in people's attitude toward the professional status of the profession in society [11]. In some studies, nurses believe that the social status of nursing in Iran is a relatively negative image that leads to several problems, including disregard for the reputation of nursing. Those also show that there is a relationship between social status and social health [12-14].
People's attitudes on the social status of nurses depend on various factors, including the level of familiarity with the profession through contact with health centers and the media, level of education, place of residence, and their perception of the field [9]. Although various studies have been conducted on the social status of different sections of society, including teachers and the military [4, 8], however, not much research has been done on the social status of nurses in the view of the public.
Considering the importance of the social status of nurses, this study was conducted to determine the Iranian population's attitude toward the social status of the nursing profession. By defining the Iranian attitude toward the status of the nursing profession, it is possible to improve the people's attitude toward the social status of nurses in various ways, especially through the mass media.

Instrument & Methods
This descriptive-analytical cross-sectional study was conducted in public places in Hamadan from October to February 2019. Four hundred citizens participated in the study by available sampling method from 4 urban areas of Hamedan. Urban public places including parks, shops, banks, bus stops, and public thoroughfares were selected as sampling places. The sample size was estimated based on an error rate of 5% and a confidence interval of 90% and based on the study of Tohidi et al. [12]. Inclusion criteria included age 18 to 70 years, having literacy, and living in Hamedan. Also, exclusion criteria included non-nativeness and non-response to the questionnaire or incomplete completion.
The data were collected based on two questionnaires; Demographic Characteristics (including questions about age, gender, education, marriage, TV viewing rate, etc.), and Social Status questionnaires. This questionnaire was developed by the researcher using a review of the relevant literature. It has 20 questions and its purpose is to evaluate people's attitudes toward social status from various dimensions including respect and influence (questions 1-6), income and wealth (questions 7-11), and questions 12-20 formed the dimension of value and importance. This scoring was based on the 5-point Likert scale from strongly disagree (score 1) to strongly agree (score 5). The total score of this tool was between 20 to 100, and higher scores indicated a higher social status from the respondents' point of view. To determine the validity of the research tool, a questionnaire was given to 10 faculty members of the School of Nursing and Midwifery to confirm its formal validity. After inserting their corrective opinions to determine the reliability of the instrument by Cronbach's alpha method, a pilot study was performed on 40 citizens were selected convenience sampling from the four urban areas, and after statistical analysis, a content validity index (CVI) of 0.92 and content validity ratio (CVR) in all items, were calculated higher than the standard (0.62). The overall reliability of the questionnaire questions was calculated to be 0.85 using Cronbach's alpha index. In the next step, the researcher, by attending the sampling places, provided the questionnaire to the people who were willing to participate in the study.
Its implementation license has been obtained by the Vice-chancellor for research and technology of Hamadan University of Medical Sciences. Participants in this study were provided with the necessary explanations regarding the confidentiality of personal information and not mentioning their names, as well as the purpose of conducting the research and their freedom to participate in the research. Written consent was also obtained from the participants to participate in the study.
So that the data were collected, entered into SPSS software version 16, and analyzed using central and dispersion statistical indices, parametric statistical tests for data with normal distribution such as T-test, ANOVA, and Pearson, and non-parametric tests for data with abnormal distribution such as Chi-square and Spearman.

Findings
Four hundred people with a mean age of 34.3±9.98 participated in this study, of which 231 (57.75%) were female and the rest were male. Of these, 234 (58.5%) were married and the rest were single. Other demographic characteristics are presented in Table 1.

Table 1) Socio-demographic characteristics of the participants

The mean nursing social status from the participant's point of view was 71.23±11.76 in the range of 20 to 100 (Table 2).

Table 2) Scores of the social status questionnaire and its dimensions


In addition, the results of the t-test and analysis of variance showed that the social status score of the nursing profession from the individual’s point of view had a statistically significant relationship with the participants' gender (p=0.011) and education (p=0.045) but did not have a significant relationship with other variables.
Spearman and Pearson's statistical tests showed that the nurses' social status score from the individual’s point of view has a statistically significant relationship with the amount of communication with the media (hours of watching TV per day, watching home movies per week, and going to the cinema per month). This means that people who had more contact with the media reported lower scores on the social status of nurses (Table 3).

Table 3) The relationship between the social status score and the degree of communication with the media


Discussion
This study aimed to investigate the people's attitudes toward the social status of the nursing profession among the people. The results of this study showed that the mean of the obtained score from the attitude questionnaire regarding the social status of the nursing is an average level. Braganca and Nirmala also more broadly summarized the negative social perception of nursing in areas such as gender stereotypes, subordination to physicians, lower required academic standards, poor working conditions and income, and limited career advancement opportunities [15]. In this regard, the study of Mahmood in Pakistan showed that more than half of the participants in the study had a positive attitude towards the therapeutic, caring, and protective-supportive roles of nurses, and a quarter of them had a negative attitude towards the educational role of nurses [16]. Gill & Rocque also state that various factors such as media and television, newspapers and magazines, coverage style and inter-professional communication, and nurses' behaviors can affect the general attitude of nursing in society [7, 17]. However, the study by Carroll et al. in the United State showed that most of the participants in the study had a positive view of the roles of nurses so the average view of the nursing profession was higher than the nurses and nursing students themselves [18]. Abdelrahman also believes that the general public considers the nurse to be a knowledgeable person in health matters, respects her/his opinion and views, and seeks her/his opinion on issues related to their health [19].
In addition, the results of this study showed that the mean score of attitudes toward social status was not related to age, marriage, and job but was statistically significantly related to gender and education. So that the score of the questionnaire was higher among women than men. One of the reasons for this can be the higher incidence of women due to reasons such as pregnancy, childbirth, and more sensitivity to health status, followed by more women referring to health centers, which makes them more familiar with the nursing profession [20]. In addition, due to the greater contact of women, especially housewives, with the media and watching movies and TV series, whether on television or through the cinema and home film network (including health-related programs such as the health network), they are more likely to know this career [21].
Also, the results of this study showed that the obtained score from the status questionnaire is higher among people with higher education levels, which can be due to more connection with this profession through academic, educational, medical, and further studies in the field of the nursing profession. Also, can be due to more careful about the dimensions of the social status of professionals and comparing them with each other. In the study of Carroll et al. and the study of Nuntaboot, and the study of Abdelrahman, people's attitudes toward nursing were different based on demographic variables, so women and low-income people had a better attitude toward nursing [18, 22].
In order to determine the individual’s attitude toward the social status of nurses based on the level of communication with the media (radio and television, cinema and home movies) the results of this study showed a significant relationship between the level of communication with these media and the score of the status questionnaire. This means that more contact with the media resulted in a lower score on the questionnaire. Therefore, it can be understood that in our country, the media do not provide a good image of the nursing profession. In a study conducted by Kaur et al. in India, it was found that movies and TV series are the second most important reason for the formation of the image of nursing in people's minds [23]. Therefore, the media has an important role in shaping the public image of nursing in society. Ameri et al.'s study also shows that television does not show the realities of the nursing profession [24]. Qualitative and quantitative studies on the challenges of the nursing profession show that nurses are concerned about how their professional image is portrayed in the mass media [24-26].
Because the questionnaires were self-report, so illiterate people were not included in the study, on the other hand, sampling was available, which has some limitations in terms of generalization power compared to simple random sampling. In addition, samples have not been selected from across the country that can be extensively generalizable.

Conclusion
Attitudes of the Iranian population toward the social status of nursing are moderate, indicating a lack of awareness of the skills and competencies of the profession. Therefore, it is necessary for policymakers of the nursing profession, especially the nursing system, to constructively interact with the media to prevent the distorted image of the nursing profession in the media.

Acknowledgments: We would like to thank the Vice-chancellor for the research and technology of Hamadan University of Medical Sciences and all the citizens who participated in this study.
Ethical Permissions: This study is the result of a research project that has been approved by the University Ethics Committee with the code (IR.UMSHA.REC.1397.55)
Conflicts of Interests: There is no conflict of interests in this study.
Authors’ Contribution: Jadidi A. (First author), Introduction Writer/Methodologist/Assistant Researcher/
Statistical Analyst/Discussion Writer (50%); Sadeghian E. (Second author), Main Researcher (10%); Khodaveisi M. (Third author), Introduction Writer/Methodologist/
Assistant Researcher (20%); Maghsoudi Z. (forth author), Introduction Writer (10%); Razavi M. (Fifth author), Statistical Analyst (10%).
Funding/Support: This study is supported by Hamadan University of Medical Sciences.
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Health Education and Health Promotion
Volume 10, Issue 1
Winter 2022
Pages 123-127