Journal of Clinical Research & Bioethics

Community Participation to Break the Nursing Profession Stigma in Pakistan of Preoperative Cessation Programs: A Mini-Review

Sumaira Sharif¹, Mishal Liaqat^1* and Kashif Ali^{2 1}College of Nursing, Allama Iqbal Medical College Lahore, Lahore, Pakistan
²Allied Bank Limited, 208 Upper Mall Lahore, Lahore, Pakistan
^*Correspondence: Mishal Liaqat, Nursing Instructor, College of Nursing, Allama Iqbal Medical College Lahore, Pakistan, Tel: +923441481666, Email:

Received: 08-Sep-2020 Published: 29-Sep-2020, DOI: 10.35248/2155-9627.20.11.358

Introduction

Nursing is considering as caring profession; whose purpose is to provide continuum care to the patient and their family members. It is one of the emerging professions, declared as a profession in the late 90s. Historically women are primary caregivers to the patients and their families. The purpose is to provide Continuum care to the patient and their families. In history, Christianity has had a pivotal contribution to this profession. Florence Nightingale is considered the mother of modern nursing she brought an instrumental change in this profession. She opened her first Training School father nurses in 1860. The purpose of this scientific Training School was to give Professional qualification to those who entered this field [1,2].

Nurse’s image is not always clear and understood because of gender stereotypes.in the late 19s and early 20th-century nurse image was an angelic serving female. This image was built by Florence Nightingale, The mother of modern nursing. In the Crimean war, she used to go with the lamp to attend soldiers and treat their wounds at night [3]. Our society has a cognitive impression with this field that depicts some specific roles and characteristics with the nurses. Media has a strong influence in shaping the measurable image of nurses. Media offensive stereotyping build a negative image of nurses, as doctors maiden or subordinate, sex symbols, and authored battleax. This negative genotype overlooked the importance of nursing. Media depict the functions of nursing has bedside nurse doctor’s handmaiden [4].

Historical Perspective

Media portrayed six images of nurses e.g. from the angle of mercy to sex object, Friday’s girl, heroin, mother, and careerist. In the period 1854 to 1919, nurses were portrayed as Angle of Mercy. From 1920 to 1945, the nursing image was shaken by calling them as Girl Friday. From 1930 to 1945 nurses were called Heroine because of promoting the idealism, self-sacrifices in the black days of economics. Similarly, in 1946 to 1965 nurses were portrayed as Mother because of his caring nature. Like a mother, she is committed to providing care not only to the patient but also to their families as well. From 1960 to 1982 this profession was misrepresented nurses’ image was perpetuating them as Sex Object in movies and dramas. A study conducted to assess the media’s negative image, Study Conducted on 280 movies ease across the world, the result shows that the Nurses' image was destroyed and misrepresented and depicted them as sex objects [5-7].

Multiple factors are responsible for the negative image of nursing. A study conducted in Turkey school of Nursing to assess the factors behind this image highlighted the first reason that the public is not aware of what nurses are doing and what are their roles and responsibilities. Nurses are not powerful and autonomous in their decision making in the hospital setting and community areas. Their socioeconomic status is not good and most are from a poor background. Although nursing is a very old and advanced profession still there are numerous myths and misconceptions that are harming their image. There is a myth that nursing is only a female profession. Initially, there were significant females than males. But the trend changed and qualified males were entering this profession to fulfill the occasional physical demand of this profession [8].

There is another myth and misconception that nurses are confined to the hospital only. But according to the US dollar Bureau of Labor Statistics, more than 50% of nurses are working in government local and private sectors. They are not working in the hospital only but also in public areas, in community centers, and in residential care facilities, nurses are not on treating the patient but also working as a manager at the corporate level and also entering the teaching profession [9]. There is one another obnoxious myth in society that nursing is a dirty profession because nurses are hired only for cleaning dressing, changing bedpan, clearing sputum from the mouth, drawing blood and changing urine bag only. But infect, nurses are professional caregivers and providing holistic care to the patient where they are ready to provide continuum and head to toe care to the patients in the hospital setting [10].

In Pakistan, the Medical profession is flourishing and the nursing profession is ignored. According to a report, in Pakistan, there is an extreme dearth of nursing and this shortage is due to the stigmatization and negative stereotyping [4]. In tertiary hospitals, Nurse to patient ratio is 1:50, which is extremely very low. According to Pakistan Nursing Council set criteria there should be a 1:10 nurse-patient ratio. But, because of negative image building patients don’t give respect to their care providers which are extremely dreadful. Nurses are working in a highly stressful environment where they are facing multiple challenges. Non- supportive and an unhealthy environment can lead to Brain drain, high turnover and job burnout.

Different factors are responsible for the shortage of nursing. The nursing profession is considered a low profile, Low prestige profession. Negative images produce low self-esteem, Personal and professional growth Attitude expertise and quality of care is also affected. There is the public perception that nurses have low socioeconomic status, a female dominant profession where. Different studies are conducted on the job satisfaction level and it has been found that the majority of the nurses are not satisfied with their jobs because of the poor working conditions and lack career development or advancement opportunities [11-12].

The nursing profession is one of the vital professions and it is considered the backbone of the medical profession. A nurse is providing his services to the hospital and the community as well. Nurses are increasingly involved in many important health issues in the health care system. She is working for pain management, holistic care to the patient on their demand [13]. Apart from the care aspect, the nurse is also playing many important roles in the health care system, working as a manager, director, administrator, and entrepreneur. Nurses are playing many roles and have tough responsibilities. Above all, they are wearing different hats but the shorting of nurses is getting worse and it can be a major threat to the health care delivery system. Many nurses are leaving this field due to many reasons but topmost is our social behaviors. In hospitals, patients and their attendant’s attitudes are negative. They considered the nursing practice as submissive and low profile [14-15].

Rogers Used a Model to Understand Public Perception

Rogers used a model to understand the public perception, image, their understanding, and impression about the nursing Image. The nursing image is all about public perception and this can be due to stereotypical images either positive or negative. Rodger’s model has three parts Antecedent, attributes, and consequences.

The Antecedent of Nursing Image

Multiple factors come under this term and the salient factors are media, communication, nursing dressing, behavior, visibility, and organization.

Media: Media created very strong effects on the nursing image. In different eras, media has shown different images from the angle of mercy to negative stereotyping. However, media can play a very important role in portraying the professional image building.

Communication gap and reluctance: Nursing profession remained invisible in past years that can be threatened for its wellbeing. Because of its female dominancy and silent nature put them forward on the ignorance and communication gap [16]. Nurses are knowledgeable, competent, and skillful but still, their reluctant behaviors are responsible for negative stereotyping.

Dressing style: literature has shown that nurses dressing issues are a controversial and debatable issue. Although white uniform create identity and professionalism, nurses are stigmatized because of their appearance [17-18].

Behaviors: Nurses are working in an extremely stressful environment where they are providing care to minors to complicated patients and their families. Nurses’ behaviors vary from patient to patient e.g. futile caring behavior to supportive and passionate caring behaviors [19].

Gender issues: The nursing profession is suffering from gender issues. It is a general perception that nurses are females. Males are the power of profession and females are considered as providing care only. Management and administrative powers are usually in the hands of males so they are policymakers and decisions are also done by the hands of males and in this fashion nurses' role has decreased. Nurses are stigmatized on the base of gender and in- hospital setting gender-based violence is predominating in the past few years (Figure 1) [20].

Figure 1: The antecedent, characteristic, consequences of nursing image.

Nursing image is affected due to multiple reasons e.g. staff shortage, salary issues, nurse public trust, recruitment problems, and most important human resource and allocations problems.

Nursing shortage: Abandon studies are conducted to assess the staff shortage. It is observed that in Pakistan staff recruitment is inadequate. Recruitment of the right staff for the right job is a crucial step to eliminate the staff shortage.

Allocation of scarce resources: In the health care delivery system minute amount of resources are allocated to the nursing department, which is not enough to fulfill the nurses' requirements. Due to the poor image of nursing, this profession has a lack of funding and resources [21]. Our nursing profession has been exhausted due to the scarce availability of resources and it is creating stress and burn out among nurses [22].

Interdisciplinary image: Due to poor public perception about nurses, their relations with other professionals are also affected. Poor public image, communication problems, and behaviors are affected. For creating positive image building, effective communication is the key element. Nurses caring behaviors and satisfaction with patient care also perpetuate their relationships [23].

Public trust: Derogatory stereotyping has demolished nursing image and decrease the respect for nursing. Public knowledge about this profession is limited. Poor knowledge and working environmental stress create distrust and dissatisfaction, which ultimately cause distrust and negative image of nurses [24]. This model intended to improve public image and perception of nursing and confidence.

Fewer salaries: Due to altruistic and self-sacrificing stereotyping and devotional services their salaries are lower [25]. In the health care system, there is a remarkable difference between doctors' and nurses' salaries. This can harm patients as well as nurses. This can lead to a significantly negative impact on patient care as well as the health of nurses.

Community Participation Framework as a Tool to Explain Stigma in Nursing

The health department should involve the community to improve the stigmatized image of nursing (Figure 2).

Figure 2: Community participation framework ledder.

Community Participation Framework Ledder

Health department initiation and actions: The health department should identify the population who are stigmatizing nursing and have a negative image. They should focus on their behaviors and blaming as well. Then, made such policies and standards that may enhance nursing prestige and respect. the health department should give the best positions and ranks so that, they feel powerful and satisfied. Ministery of Health should provide career opportunities to the nurses and with collaboration with other ministry educational opportunities should be provided and provide study based scholarships for higher education.

Health department informs and education community: The health department should involve the local department to play its role in positive image building in the community. Printed material, brochures, and banners with pose slogans should be raised for community image building in their local areas. Health departments work in collaboration with electronic and social media to provide awareness at the mass level. Media Literacy is another important strategy in problem-solving, critical thinking, and image building. Social media should also play a pivotal role in defending and educating the community to change its thought and negative image.

Limited community input and consultation: By using this strategy, the Local health department should communicate to the community by conducting surveys or interviewing the clients, the local department can also contact to the public by focus group discussion and can change their views and perception about nursing stigmatization. Then communicate these issues to the higher level e.g. policymakers and legislators to initiate the change.

Comprehensive community consultation: In this strategy, the local department uses public perception on a broad range and involves the local community. By involving the community local department can prioritize the planning points and then use allocated resources for solving or changing the image.

Bridging: It is a type of shuttle service where a resident lay health educator creat a bridging between local government and community. By using this strategy we health department can use layman from the community and train them and send them to the community to provide education-related nursing images and issues related to the negative portrayal. Lay health educators provide feedback to the health department. This can be successful because in Pakistan there is diversity in cultures and had cultures barries and hindrance.

Power sharing strategy: This is a combined effort strategy in which, both the community and health department are involved in highlighting and solving problems.

Community initiation and direct action: By using this approach, the community is involving in decision making independently without involving the local health department. In this scenario, community members will highlight the causes of nursing image perception, shortage of respect, and will defend or advocate its concerns.

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