From angels to handmaidens: changing constructions of nursing's public image in post-war Britain

How the public perceives the "good nurse" in China: A content analysis of national newspapers

INTRODUCTION

Newspapers are a predominant channel through which the Chinese public learns about nurses and the nursing profession. However, little nursing research has been performed in China to investigate the newspaper portrayal of nurses, and how the public perceives the role of nurses in the Chinese context is still an ambiguous phenomenon. This study aimed to clarify the public portrayals of nurses in China, and to analyze whether there are changes over time in news content related to nurses in the national newspapers.

DESIGN

A content analysis of the newspaper articles citing nurses that have been published since each newspaper was established.

METHOD

We selected two national daily newspapers as sources to systematically search for articles about nurses from 1949 to 2022. A coding instrument was developed to quantitatively extract the contents of the articles identified. Then, using a mixed methods approach, we analyzed newspaper content to show the roles of nurses presented to the public by the media.

RESULTS

A total of 317 articles were analyzed. Nurses have been depicted with heterogeneous images in both newspapers with positive wordings and up to 28 types of public images. More than half of the articles portrayed two, three, or more types of images. Among the images of nurses identified, "overworked" appeared the most frequently, followed by "dedicated," "philanthropic and benevolent," and "with a sense of responsibility," and then "technically skilled." By analyzing the image of nurses in both newspapers over time, we found that images related to virtue have largely increased with time, while images about professionalism have decreased.

CONCLUSION

Nursing continues to be depicted as a virtuous caregiving profession, often forgetting the wide need for knowledge, skill, and expertise required in the occupation. The public image of nurses portrayed in the national newspapers does not accurately match their actual roles.

CLINICAL RELEVANCE

The public image of nurses portrayed in the national newspapers does not accurately match their actual roles. To actualize a professional role and increase social status of nurses, intentional image management is needed. Nursing schools, nursing associations, and nursing professionals should be more proactive in overcoming the stereotypical image portrayed of them and use the news media as a tool to invite attention from and dialogue with the public about the value of nursing to reframe the public's understanding of the expert role of the professional nurse in health care and to create a new and more professional image for nursing.

[Images of Nurses Appeared in Media Reports Before and After Outbreak of COVID-19: Text Network Analysis and Topic Modeling]

PURPOSE

The aims of study were to identify the main keywords, the network structure, and the main topics of press articles related to nurses that have appeared in media reports.

METHODS

Data were media articles related to the topic "nurse" reported in 16 central media within a one-year period spanning July 1, 2019 to June 30, 2020. Data were collected from the Big Kinds database. A total of 7,800 articles were searched, and 1,038 were used for the final analysis. Text network analysis and topic modeling were performed using NetMiner 4.4.

RESULTS

The number of media reports related to nurses increased by 3.86 times after the novel coronavirus (COVID-19) outbreak compared to prior. Pre- and post-COVID-19 network characteristics were density 0.002, 0.001; average degree 4.63, 4.92; and average distance 4.25, 4.01, respectively. Four topics were derived before and after the COVID-19 outbreak, respectively. Pre-COVID-19 example topics are "a nurse who committed suicide because she could not withstand the Taewoom at work" and "a nurse as a perpetrator of a newborn abuse case," while post-COVID-19 examples are "a nurse as a victim of COVID-19," "a nurse working with the support of the people," and "a nurse as a top contributor and a warrior to protect from COVID-19."

CONCLUSION

Topic modeling shows that topics become more positive after the COVID-19 outbreak. Individual nurses and nursing organizations should continuously monitor and conduct further research on nurses' image.

A Foucauldian discourse analysis of media reporting on the nurse-as-hero during COVID-19

This study uses a Foucauldian discourse analysis to explore media reporting on the role of nurses as being consistently positioned ‘heroes’ during COVID‐19. In so doing, it highlights multiple intersecting discourses at play, with the caring discourse acting as a central one in negatively impacting nurses' ability to advocate for safe working conditions during a public health emergency. Drawing on media reports during the outbreak of COVID‐19 in Ontario, Canada in the spring of 2020 and on historical information from SARS, this study seeks to establish caring as a discourse and examine if the caring discourse impedes nurses' ability to protect themselves from harm. The results of this analysis explicate how public media discourses that position nurses as caring, sacrificial and heroic may have impacted their ability to maintain their personal safety as a result of the expectations put upon the nursing profession.

Representations of the National Health Service (NHS) in UK print media

Generating negative news coverage of state welfare provision has been identified as a strategy designed to create public support for radical policies aimed to reduce such provision. To date, research of this kind has focused on scandals and crises. However, little is known about the complex relationship between media representations of specific events, and those of media representations in the lead up to these events, what we refer to as periphery representations. Employing a content and frame analysis, this paper analyses the frequency and intensity of peripheral representations of the National Health Service (NHS) in the British print media for 1 week a month before and for 1 week during three key events in recent NHS history: the official consultation period for the Health and Social Care Act; the publication of Five-Year Forward View, and the first Junior Doctor Strike. This article finds that negative NHS representations in articles that are peripheral to particular topical issues of controversy evidence fluctuations, amplifications and intensities across time periods, depending on the particular context. The paper concludes by arguing that repetition of negative themes in news helps to build a sensibility of 'inadequacy' of vital services. We hope that this focus on the ways in which amplifications and de-amplifications in negative intensity of peripheral NHS representations across time and content, helps to contribute to debate about the complex interplay between public health services, media representation and policy consent.

Qualitative study of socio-cultural challenges in the nursing profession in Pakistan

Background

In a patriarchal social system, a women-dominated profession like nursing is mostly seen as a disempowered group due to its stereotypical image and negative connotations. The low social prestige of this profession is based on the roles typically assigned to men and women to maintain gender identity according to their performance and embodiment. The aim of this study was to explore the social and cultural challenges faced by nurses while creating their professional image within the regional context of Lahore (Punjab) in Pakistan.

Methods

A qualitative research design was chosen to conduct one-to-one, in-depth interviews with twelve nurses. Recruitment was based on purposive sampling from three large public hospitals in Lahore to learn about nurses’ perceptions of social and cultural challenges in the nursing profession. A thematic analysis was conducted using the data analysis software package NVivo 12 Plus.

Results

Cultural values give preference for female nurses. We have identified four major themes related to the social and cultural challenges facing the nursing profession: 1) gender-segregated profession, 2) inappropriate portrayals by the media, 3) issues around marriage settlement, and 4) identity from a religious perspective. These conflicts are affecting the professional status and changing perceptions of nurses, who either do not choose to remain in the nursing profession or do not recommend nursing as a career option. These ongoing constraints are still perpetuating and increasing shortage of nurses within the Pakistani healthcare system.

Conclusion

The present study solely highlights nurses’ perspectives on redefining gender roles and gender integration within the nursing profession. It argues that there is a need for positive portrayals in the media for the removal of public misperceptions related to nursing. This would reduce the shortage of nurses along with increasing retention and improving the quality of healthcare delivered to the public.

The image of the profession in the mass consciousness

The issues of nursing staff shortage and quality of their work are relevant for the health-care management today. In this regard, the established image of the profession is important, as it can lead to the unpopularity of nursing profession and affect the effectiveness of the treatment process through the self-perception of nurses. So studying the image of nursing in social media is of particular relevance today. The role of social media in dissemination of opinions is increasing every day. Unloading (31613 messages) from social media was made using keywords for 2017. А random subsample (403 messages) was formed from them, coded manually by coders (authors). According to analysis of the obtained data, nursing is perceived as a “female profession,” a nurse is a Caucasoid woman in a white uniform. She works at public hospitals, her work is discussed primarily in the context of the specialties of obstetrics, gynecology and pediatrics. Her status is rather low, nursing is not perceived as an intellectual and promising profession. Messages about nurses are mostly neutral, emotionally colored messages are devoted mainly to the personal qualities of nurses. Autoimage (self-perception) of nurses is poor. In conclusion, there is given a number of recommendations for improving the image of nurses. Implementation of organizational changes may contribute to enhancing the prestige of the profession: introducing special insignia for nurses, designating career prospects. It is also possible for these purposes to conduct an information policy aimed at demonstrating the attractive aspects of nursing and emphasizing the gender neutrality of the profession.

Psychiatry's 'Others'? Rethinking the Professional Self-Fashioning of British Mental Nurses c. 1900-20

Despite facing manifold social and educational barriers, British asylum nurses across the long nineteenth century articulated distinctive professional identities as a means of leveraging their position in the medical hierarchy. This article draws upon a corpus of previously unattributed contributions to the Asylum News (1897-1919) - one of the first journals produced for the edification of asylum workers - to illustrate the diversity of medical personae developed and disseminated by these employees in the Edwardian era. Through scientific and creative works, nurses engaged with the pressing social and medical debates of the day, in the process exposing a heterogeneous intellectual culture. Moreover, as their writings attest, for some ambitious nurses these pretensions to intellectual authority prompted claims for medical autonomy, driving agitation on the hospital wards. The article thus strengthens claims for the 'cultural agency' of asylum workers and offers new insights into the cultural antecedents of professionalisation and trade unionism.

An analysis of Richard Prince's "Lake Resort Nurse": using an image to expose and critically reflect on stereotypes in nursing

Our interactions with images, created and viewed within contexts, are a significant means through which we construct and interpret our values and beliefs. Nurses' efforts at monitoring images to encourage accurate portrayals of nurses' work have had little influence on the way nurses are represented or the inherent ability of images to shape perceptions of nurses' work. One explanation for this lack of influence is that viewers do not closely attend to the ways in which we make meaning of everyday images. This inattention creates passive viewers, vulnerable to and more likely to internalize messages (G. Dines & J. Humez, 2011). Misunderstandings about nursing leave nurses vulnerable to contexts and influence the outcomes of at least 2 issues, the nursing shortage and the provision of quality care. Prince, in his painting "Lake Resort Nurse," utilizes the artistic strategies of expressionism, appropriation, and reflexivity to expose stereotypes and provides an opportunity for reflection on the potential impact these stereotypes have on the profession. He provides a means through which we can recognize that images are significant contributors to how understandings of nursing and nurses are shaped. New understandings of nursing, gained through reflection and dialog, subsequently influences perceptions of the value of nurses' work and their contribution to health care.

Games, civil war and mutiny: metaphors of conflict for the nurse-doctor relationship in medical television programmes

Metaphors of medicine are common, such as war, which is evident in much of our language about health-care where patients and healthcare professionals fight disease, or the game, which is one way to frame the nurse-doctor professional relationship. This study analyses six pilot episodes of American (Grey's Anatomy, Hawthorne, Mercy, Nurse Jackie) and Australian (All Saints, RAN) medical television programmes premiering between 1998 and 2009 to assess one way that our contemporary culture understands and constructs professional relationships between nurses and doctors. Analysis shows that these popular television programmes frequently depict conflict, with games, civil war and mutiny between nurses and doctors over patient safety rather than professionals working collaboratively in teams to deliver health-care. Although the benefit of this televised conflict is the implication that nurses are knowledgeable, skilled professionals, the negative connotations include a dysfunctional and dangerous healthcare system, and also ongoing power struggles. Given that popular culture can sometimes influence the public's understanding of real-life nursing practice, it is important to explore what these metaphors of conflict are communicating about the nurse-doctor relationship.

Greek intensive and emergency care nurses' perception of their public image: a phenomenological approach

The public image of the nurse constitutes an important factor for recruitment into the profession, retention, and also for work satisfaction. The aim of this qualitative study was to disclose the way nurses internalize their professional public image and professional worth, as well as nurses' feelings about that image. Findings showed that although nurses have made a tremendous effort to improve the public image of their profession, negative nursing stereotypes still persist. Therefore, nurses have to actively participate in policy making and enhance their educational and cultural profile through the media.

Drug experts of the future, today?--depiction of the pharmacist profession in Swedish professional and lay print media

BACKGROUND

The Swedish pharmacy market is presently being reregulated. The state-owned pharmacy monopoly company was divided and sold during 2009, and certain nonprescription medicines are now allowed in nonpharmacy settings. The changes will likely affect the pharmacist's role and the image of the community pharmacist in society. This change may affect how pharmacists are seen by society at large, and therefore, a baseline showing how pharmacists are depicted before the reregulation is of great value.

OBJECTIVES

The aim of this study was to describe how the pharmacist profession is depicted in print media in Sweden, with a focus on community pharmacy.

METHODS

A deductive qualitative content analysis with material from print media was conducted, using professional criteria as a framework. Swedish print media from October 2005 to October 2008 were searched and all relevant articles included.

RESULTS

A total of 139 articles were included. Most articles came from professional journals, that is, journals directed toward pharmacist or related professions. The results show that the pharmacist profession is not highly visible and that this lack of visibility is disappointing to pharmacists.

CONCLUSIONS

Society, as reflected in print media, does not display an awareness of the pharmacist role in Sweden. Although this is disappointing for the profession, it allows pharmacists to influence the depiction and hence their position in society.

Gender, gender roles and completion of nursing education: a longitudinal study

The current worldwide nursing shortage and high attrition of nursing students remain a challenge for the nursing profession. The aim of this paper was to investigate how key psychological attributes and constructions differentiate between completers and non-completers of nursing education. A questionnaire including measures of gender role identity and perceived gender appropriateness of careers was administered to 384 students early in the first year of the course. At the end of the programme attrition rates were obtained. The findings indicate that males were more likely to leave the course than females. Furthermore, those who completed the course tended to view nursing as more appropriate for women, in contrast to the non-completers who had less gender typed views. The female-dominated nature of nursing, prevalent stereotypes and gender bias inherent in nursing education seem to make this an uncomfortable place for males and those with less gendered typed views. Whilst it is acknowledged that attrition is undoubtedly a complex issue with many contributing factors, the nursing profession need to take steps to address this bias to ensure their profession is open equally to both female and male recruits.

'Angels in nursing': images of nursing sisters in a Lutheran context in the nineteenth and twentieth centuries

This article examines Catholic nursing orders in Denmark. In 1849, 300 years after the Reformation, freedom of worship was introduced in Lutheran Denmark. In 1856 the first Catholic nursing order in modern times settled in the country. Others followed, and in 1940 the nursing orders owned 17 general hospitals and had a share of 10% of the hospital beds in Denmark. The purpose of this article is to identify images in the public media text of these Catholic nursing orders in Denmark from 1856 to the present, and to deconstruct the existing angel image the nuns and sisters in nursing have obtained. The assumption is that the public image is an important indicator of how a profession is valued in society. Six images - three positive and three negative - are identified, and it is demonstrated that these images were closely connected to the nursing sisters' professional activities and confessional affiliation. Until the 1950s the image of nursing sisters as representing a counterculture in Lutheran Denmark persisted. This image was succeeded by one of professional nurses of high standards. The shift was caused by increased secularisation and the renewal of religious life, as a result of the Second Vatican Council in the 1960s.

Image: changing how women nurses think about themselves. Literature review

AIM

This paper presents a review of the public and professional images of nursing in the literature and explores nurse image in the context of Strasen's self-image model.

BACKGROUND

Nurses have struggled since the 1800s with the problem of image. What is known about nurses' image is from the perspective of others: the media, public or other healthcare professionals. Some hints of how nurses see themselves can be found in the literature that suggests how this image could be improved.

METHOD

A literature review for all dates up to 2006 was undertaken using PubMed, Medline and CINAHL databases. Additional references were identified from this literature. Sentinel articles and books were manually searched to identify key concepts. Search words used were nurse, nursing, image and self-image. The findings were examined using the framework of Strasen's self-image model.

FINDINGS

Public image appears to be intimately intertwined with nurse image. This creates the boundaries that confine and construct the image of nursing. As a profession, nurses do not have a very positive self-image nor do they think highly of themselves.

CONCLUSION

Individually, each nurse has the power to shape the image of nursing. However, nurses must also work together to change the systems that perpetuate negative stereotypes of nurses' image.

The image of the nurse on the internet

The media image of the nurse is a source of concern because of its impact on: recruitment into the profession; the decisions of policy makers who enact legislation that defines the scope and financing of nursing services; the use of nursing services by consumers; and the self-image of the nurse. This article reports on the results of a study of the image of nursing on the Internet utilizing content analysis methodology. A total of 144 Websites were content-analyzed in 2001 and 152 in 2004. Approximately 70% of the Internet sites showed nurses as intelligent and educated and 60% as respected, accountable, committed, competent, and trustworthy. Nurses were also shown as having specialized knowledge and skills in 70% (2001) and 62% (2004) of the Websites. Scientific/research-oriented, competent, sexually promiscuous, powerful, and creative/innovative increased from 2001-2004 while committed, attractive/well groomed, and authoritative images decreased. Doctoral-prepared nurses were evident in 19% of the Websites in 2001 and doubled in 2004. The results of this study suggest that there are important opportunities to use the Internet to improve the image of the nurse.

Pilot exploration of the association between self-esteem and professional satisfaction in Hellenic Hospital nurses

AIM

To explore potential associations between nurses' self-esteem and professional satisfaction.

BACKGROUND

Professional burnout and moderate job satisfaction have been reported consistently among nurses. However, potential associations of the above elements with personality characteristics have not been adequately addressed.

METHODS

A random sample of 154 adult healthcare nurses completed the Maslach Burnout Inventory, the Berger's Scale and the Index of Work Satisfaction. Associations and comparisons across different settings and background variables were explored.

RESULTS

Moderate to positive levels of self-acceptance (mean Likert rating: 3.95 +/- 0.51) and acceptance-of-others (mean Likert rating: 3.7 +/- 0.43) and low to moderate levels of professional satisfaction (mean Likert rating: 3.69 +/- 0.63) were observed. Positive correlations were detected between professional satisfaction and self-esteem indices (r = 0.249-0.313, P < or = 0.008). A mediating effect of burnout was implied.

CONCLUSIONS

A potential interaction between personality and professional attitudes of Hellenic Hospital nurses was observed. The present study is limited within the correlational frame. Further study is needed to investigate a potential causal relationship between self-esteem indices and professional satisfaction, in order to inform nursing retention and support policies.

Beyond dualism: leading out of oppression

PURPOSE

To reexamine our beliefs about our gender identity in order to identify new possibilities for leading in nursing.

SOURCES OF INFORMATION

Leadership is complex. This article is the result of a lengthy iterative process of exploring the empowerment, image, leadership, feminist, and oppression literature. All of this was distilled in the context of the author's experience as a nurse and nurse leader.

CONCLUSIONS

Moving beyond dualism creates new possibilities for leading nurses out of oppression.

Cancer patients' descriptions of their nursing care

AIM

This paper reports a study of cancer patients' descriptions of nurses and nursing care.

BACKGROUND

Nurses lament their poor representation in the media, and campaigns to improve their portrayal have been initiated. Media portrayal of nurses might be more realistic if patients' descriptions of nursing care were incorporated.

METHOD

Qualitative data from an instrument development study were analysed. A total of 461 patients answered the question, 'In general, how do you feel about nurses?' The data were analysed by the constant comparative method and grounded theory coding techniques.

FINDINGS

A typology of four concepts reflecting cancer patients' descriptions of their nursing care emerged from the data. The concepts were: laudable, caring, professional and outcomes. The concept laudable refers to commendable qualities of the nurse and nursing care. Caring refers to the nurse showing compassion, concern and kindness. Professional refers to the nurse as meeting expected standards of knowledge, skill and demeanour. Outcomes refer to the affective, cognitive, or physical effects attributed to nursing care. Both positive and negative instances of the concepts were included in the analysis. Examples of each concept using patients' own words are given.

CONCLUSIONS

These cancer patients held nurses in relatively high esteem. These findings could be disseminated to the public press as an example of what patients' value about nurses and nursing care. They also could be used in media efforts to recruit and retain nurses.

'The good nurse': visions and values in images of the nurse

BACKGROUND

The various ways in which the nurse has been publicly portrayed do not merely reflect the value of nursing in society, but also define the boundaries of nursing, and reveal the ideologies and systems of power-brokerage at work in shaping nursing. Therefore, it is of profound interest to the profession to continue to examine the ways in which the nurse is and has been portrayed.

AIM

This paper aims to present a historical analysis of the image of the nurse in public discourses in Ireland.

METHODS

Using a framework of critical discourse analysis within the method of historical research, the paper draws on documentary primary sources to present an analysis of discourse concerning the 'good nurse'.

FINDINGS

In exposing the diverse ways in which the nurse has been depicted in Irish public discourses, the origins of the 'good nurse' ideal are identified, the reasons for its continued promotion are critically examined, and the effects of the ideal on the development of nursing in Ireland are considered.

CONCLUSIONS

While the ways in which Irish nurses have been depicted in public discourses have similarities with international nursing imagery, the 'good nurse' ideal has a uniquely Irish expression, indicating that the image of the nurse is both culture-specific and changes to reflect the underlying sociocultural context, and prevailing system of political power and influence.

Does public image of nurses matter?

The nursing profession is said to have long suffered from public stereotyping and from being closely associated with femininity and powerlessness. This descriptive correlational study was performed to identify the relationships between nurses' perception of common public stereotypes of their profession, nurses' self-concept, self-esteem, job satisfaction, and performance. Eighty registered nurses were invited to participate in this study by completing six types of questionnaires. The results suggest that nurses' perception of the public stereotyping of nursing is related to the development of their self-concept, collective self-esteem, and job satisfaction, all of which are associated with their performance. The results also indicate the importance of encouraging professional socialization and cultivation of positive, personal self-esteem to ward off the negative influences of public stereotypes on nursing practice. This study is tentative and requires further investigation with a more diverse sample.

Nurse education in higher education: understanding cultural barriers to progress

Nurse education is established in higher education but nurse academics remain concerned about nursing's lack of equal status within the academy. This paper reports findings of a small study of nurse lecturers' views which support other published studies. It argues that cultural factors which contribute to nursing's problems gaining equal status include anti-intellectualism within nursing and academic denigration of practice. These cultural factors are linked to the history of women in higher education, the separation between intellectual education and practical, skill-based training, the low status of caring courses and the resulting mutual denigration of culturally opposed groups. Anti-intellectualism in nursing can be seen as a defensive reaction against an academic culture that defines practical activity as inferior to abstract thinking skills. This can lead to limited educational opportunities to examine the structural and cultural context of nursing. In Freire's view, this is a necessary part of education for freedom. Current cultural change, in nursing and higher education, including an emphasis on learning outcomes and transferable skills, provides new opportunities for nursing to contribute to educational change. Removing cultural barriers to the educated nurse is a responsibility shared by universities and by the nursing profession.