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    Topic review

    Social Image of Nursing

    Subjects: Others
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    Nursing is a discipline on which stereotypes have persisted throughout its history, considering itself a feminine profession and subordinated to the medical figure, without its own field of competence. All this leads to an image of the Nursing Profession that moves away from reality, constituting a real, relevant and high-impact problem that prevents professional expansion, and that has a direct impact on social trust, the allocation of resources and quality of care, as well as wages and professional satisfaction.

    1. Introduction

    “Care” is the essence of Nursing. This care is conducted by means of various actions aimed at improving or mitigating the discomforts caused by a disease process or to preserve health. For this reason, the individuals who exercise the Nursing Profession must possess the concrete skills, knowledge and intellectual ability that allow them to solve the real or potential problems of the people at which care is targeted, by resorting to critical thinking and effective communication [1]. An emphasis on care of an instrumental nature has been traditionally identified. The perception of patients differs from that of nurses; patients perceive a lower level of personal care than the one nurses believe that they deliver. Caring behaviors are affected by the working environment, nurses’ emotional intelligence and coping skills, and socio-demographic characteristics [2]. In fact, the perceived care in the nurse-patient relationship is high and instrumental in nature, and it can be stated that nurses consider that through their behaviors they transmit more care than the users perceive they receive [3].
    Throughout history, Nursing has been influenced by gender considerations, for being understood that care is an activity inherent to women. In this way, its evolution and development has been conditioned, giving rise to a profession that is struggling to attain the goals established. In our times, although in theory we should have overcome the sexist roles, we observe that the profession is still being marginalized in different ways and that there is a devalued image of the activities performed by female and male nurses, although they perform indispensable work [4][5]. In addition, as a consequence of the stereotypes about the gender roles, the male collective in Nursing is still a minority, thus limiting the development of its professionals, which, in turn, has a negative impact on their image [6].
    On the other hand, the communication media frequently reflects stereotypes that result in degrading and exerts a negative influence on the image of the Nursing Profession [7]. In this way, it is evident how in films, TV series, commercials, and more serious programs of greater repercussion such the news, a distorted image of the Nursing competences is projected, which has nothing to do with the true commitment of this collective towards the health of the population [8].
    Likewise, it can be asserted that the professional identity of Nursing does not coincide with the social image of the profession [9]. However, the first is influenced by the second, and vice versa. Consequently, social image has a negative impact on the construction of professional identity, because the population conditions the thoughts, beliefs and behaviors of female and male nurses [10]; and, in its turn, what the Nursing professionals convey through their actions is going to determine the existing public image of the profession. It is then spoken of as a “weak” identity of the Nursing Profession that has been shaped based on the stereotypes which have persisted throughout its history, so that its professionals are probably going to project an inadequate image of Nursing to the population, with a negative impact on the social conception regarding the Nursing discipline [11].
    It is a concept agreed upon by the members of a society about the social representations constructed in view of a reality that aims to visually summarize certain social discourse through the characteristics that best fit the ideological or moral content [12]. The public image of Nursing is given by its external aspect, by the mental scheme of the concept of the profession (which is determined by words or images), and to what it resembles when related to other professions. The set of characteristics that are repeated by means of the various mental representations of the individuals is what constitutes the social image of the profession [10].
    Nowadays, strengthening the image of Nursing supposes a challenge for its professionals. In countries such as Spain, many efforts have been made to manage appropriate tools to evaluate, during the undergraduate training period of future nurses, aspects such as academic satisfaction [13] or the perception of care that clinical instructors demonstrate to students, considering the strong impact it has on their future relationships with patients, relatives, and other health professionals [14]. However, the fact that the social image of Nursing does not coincide with the reality of the profession implies a series of repercussions ranging from high professional dissatisfaction or burnout to diversity of conflicts that reduce potential and work capacity in multidisciplinary-interdisciplinary teams and prevent the expansion and advancement of the profession, without overlooking the fact that this situation directly affects quality of care and users’ satisfaction. In addition, it also has an impact on the social trust deposited in the Nursing professionals, on resource allocation and work overload, as well as on the salaries of its professionals [15]. Consequently, it is a real and relevant problem, as well as one of high impact.

    2. Social Image of Nursing

    Male and female Nursing professionals show a common self-image, which, as already mentioned, is centered on care, which must be comprehensive and holistic [16]. Consequently, the terms used by the very individuals who exercise the Nursing Profession to refer to the benefits of being a nurse are diversity, privilege and compliance. Nursing professionals feel privileged of being present in all the important moments of people’ lives and consider themselves indispensable in the health system where they work since, without their performance, it would be impossible for that system to progress. The Nursing collective also feels privileged of being those who remain longest with the patients and, in addition, they are the first professionals who come into contact with the users when they arrive at the health institution. The Nursing professionals consider it negative that, to construct the social image of the profession, their own Nursing functions are related to unpleasant situations or to stress and believe that, among other factors, the conception that still persists in society about the Nursing Profession is a consequence of its image throughout history, as well as of the behavior of the Nursing professionals themselves since, in numerous occasions, they minimize their importance in the system and do not intervene to improve their image [9][17][18][19].
    The social image of Nursing is blurred and certain gender stereotypes about the Nursing Profession and its functions still persist [1][20]. However, predominantly in all the groups, Nursing is considered as a profession that can be practiced both by men and by women [17][18][21]. Therefore, a less stereotyped perception than some years ago is observed [22], even with one of the studies found making reference to certain masculinization accepted by the population, qualifying the care provided by male nurses as excellent [23]. All of the above contrasts another study found which addresses the image of Nursing in the population from the perspective of Iranian male nurses, since the study makes a reference to a feminized Nursing Profession, which, alongside with the social conception of Nursing as subordinated to the medical figure, results in a minimal percentage of men working in the profession. However, it is worth noting that, although the Iranian male nurses advocate that the Nursing Profession can be practiced in an adequate manner both by men and women, they intend to solve the gender issue by performing their functions in the scopes of management, armed forces, and in the emergency and intensive care services, because they believe that male Nursing professionals are more appropriate in services where more speed, high technology and less contact are required. On the other hand, they consider that female nurses are more qualified to develop their competences in the areas of pediatrics, maternity and community health [18].
    In its turn, the image of Nursing in the most renowned communication media frequently reflects stereotypes that are degrading for the profession; for that reason, the Nursing professionals consider it a factor that exerts a negative influence on the construction of the social image of the Nursing Profession [24]. Consequently, it is spoken of a distorted image of Nursing, since the Nursing collective is shown in a negative way because its skills are not reflected, whereas the medical professionals are portrayed in a positive manner [7][9][18][25][19].
    In summary and in order to respond to the proposed objectives, the  image of nursing has contributed, as main findings, several approaches:
    • Humanization and vocation as a requirement of Nursing Profession, since the reviewed bibliography largely emphasizes this aspect.
    • The duality between the internal and external image of the Nursing Profession. This includes the analysis that the revised bibliography carries out of the different images that are perceived of the Nursing Profession from different perspectives (population, health professionals, nursing students.) and also the analysis of the self-image of the professionals of nursing.
    • The strong component related to gender stereotypes in the Nursing Profession, very present in the findings of the reviewed bibliography.
    • The Nursing Profession in the media, which sometimes offers a distorted image, generating an erroneous vision of nursing that is highly accentuated in the technical component of the profession and in stereotypes.

    The entry is from 10.3390/nursrep11020043


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