Nursing Status & Image

Prepared by:
Maqsooda sttar
Lecturer, snc
RN, RM, Post
RN BSN Dip in
paediatric health
nursing
 Objectives
At the end of this lecture the learner will be able to describe:
Define Status & Image
Define Nurse & Nursing
Significance Of Status And Image In Any Profession
Dynamics Involved
 Concepts Of Nursing In Past
 Development Of Nursing
 Foundation Of Nursing
 Nursing Development With Passing Era
 Cont…

 Dimension Of Nursing
• Nursing Scope
• Nursing Knowledge And Education
• Nursing Practice And Skills
• Nursing Administration
• Nursing Research
• Maintenance of nursing image and status in Pakistan
• Perspectives of nursing in future
 Status & Image
Status: Relative social or professional position;(standing, rank,
ranking, position, social position, station, level).

Image: The general impression that a person, organization, or

product presents to the public (public perception, public
conception, public impression, persona, profile, face, identity.
 Nurse & Nursing
Nurse: “A person trained to care for the sick or
infirm ,especially in a hospital.”

Nursing: “The unique function of the nurse is to assist the

individual, sick or well, in performance of those activities
contributing to health or its recovery (or peaceful death) that
he/she would perform unaided if he/she had the necessary
strength, will or knowledge.”
 Introduction to Nursing
Image
Nursing image is very important for nursing profession ,it is
the way the profession appears to others including to general
public.
Image of the nursing profession impacts to the recruitment of
students, the view of the public ,funding for nursing education
and research, relationships with healthcare administrators, other
health care professionals, government agencies and ultimately,
the profession self identity.
Image is defined as a mental picture representing a real object
or a more or less accurate likeness of a thing or person.
HISTORICAL DEVELOPMENT
OF NURSING IMAGE
Credit is given to Florence nightingale for the written history
and development of modern nursing.
The image of nursing may also have its roots in the Victorian
Age during which she lived .
At the time nursing perceived as ‘’Women s’ Work ‘’.
The expectations of nurses were altruism ,sacrifice, submission
and its not just encouraged but demanded
Periods Of Nursing Development
Period 1: Angels Of Mercy
Period 2: Girl Friday
Period 3: Heroine
Period 4: Mother
Period 5: Sex Object
Period 6: Careerist
PERIOD 1:ANGEL OF MERCY (1854_1919)
In the early 1900s nurses were viewed
as honorable ,moral, spiritual ,self-
sacrificing and ritualistic.
World war 1 media representations
continued the “angel of MERCY “
image.
Nurses appeared in a substantial
literary Endeavour's ,nurses heroines
were characterized as being involved
in dual search:
success and meaning through
nursing.
happiness and fulfillment through
love and marriage
PERIOD 2:GIRL FRIDAY
(1920-1929)
Women’s entered in new domains of
professional endeavors and activities .
1918s influenza epidemic created a vast
need for nurses.
As a results of all these factors ,efforts
toward increased regulation of nursing
education were hampered.
Nursing students were exploited as a cheap
labor ,literally staffing entire hospital.
Nurses were described as faithful,
dependent ,cooperative ,long-suffering and
subservient.
In films of this era nurse were not cast as
career nurses.
PERIOD 3:HEROINE
(1930-1945) Nursing was acknowledged as worthy and
important profession that enabled women to
earn an honorable living.
Nurses were identified as
educated ,courageous ,fearless,
reasonable ,clear-headed and humanitarian.
The only feature –length film ever produced
that focus entirely on the nursing profession
,these film stressed the education and work
of professional nurses.
Film on nursing profession ,nominated for
the 1934 Academy Award for best
picture ,the heroin of the film reject a
millionaire offer of marriage to continue her
career as a nurse.
PERIOD 4: MOTHER
(1946-1965)
It may have been natural
development after world war 2 that a
major goal for many American
women was to say home and care for
children.

Nurses during this period were

chronicled as
maternal ,compassionate ,unassertive
,submissive and domestic.

During the 1950s television

programs usually portrayed nurses as
worthy of respect and appreciated for
their skills.
Period 5:Sex Object (1965-1983)

After 1966,mother image change of the nurse change into

sex image
Nurses were increasingly depicted as being sexually,
promiscuous,
Self indulgent, superficial and unreliable.
Nurses became “ sexual mascots” for health care team and
were seen in X rated movies. Eventually nurses were
portrayed as cord, uncaring ,power hungry and unmotivated
person.
In films of these years, nurses were undervalued and
poorly represented, their contribution to health care were not
addressed.
Period6:Careerist(1983present)
The careerist has became the new
image for the mid 1980 and
1990s,portraying as
intelligent ,logical, progressive,
sophisticated, empathetic and
assertive.
Men and women both are
dedicated to providing the highest
standards of healthcare
Each one of us holds the
responsibility and the privilege of
making this image the common
place awareness in every
household.
 Cont…
An international production of a television series has helped
nurses connect with other nurse using the media to assist in
improving care.
Collaborative practice.
 Men And The Image Of Nursing
The literature that the nursing profession would benefit from a
large influx a large influx of men into the profession , but if a
man decides to enter the profession he is plagued by social
stereotypes.
Male nurse are often considered social misfits , unable to fit into
a “real man’s” job.
 Cont…
Men who choose a traditional female oriented career are
perceived as socially demoted.
Our understanding of the image of nursing has been mainly
based on other perspectives such as the public or media rather
than nurses themselves.
Foundation of Nursing
Ancient civilizations through the renaissance.
Illness had supernatural causes women delivered custodial
care to family
Medicine men treated disease
As civilization grew priests were seen as physicians
Male nurses vanished from profession
Home major locality for nursing care
Only poor hospitalized ,cared for by prostitutes and female
criminals
Significance of Nursing Image
The image of nursing is important. Public image creates a
frame-work by which others approach nursing as a profession,
as well as each nurse individually. ... Presenting a balanced
view of the nurse's role and contribution to healthcare is
essential. The impact of nursing's images comes to bear in
several important ways.
 Image Building
A Process Knowing Oneself Being Positive About One’s Self
Image, Leading To A Better Chance Of Increasing One’s Self-
esteem & Enjoying A Meaningful, Happy Life.
(Hugh Prather)
 Image Building
Remember:

“… no one can make you feel inferior without your

consent…”

(Eleanor Roosevelt)
Two Views of Nursing
1. Internal Image

2. External Image
 Two Views of Nursing

Internal Image External Image

 How nurses see  Views Presented To
themselves as individuals Impress Potential
 How nurses envision Students, Legislators, the
the profession Public...
Will nurses want to improve
their self-image
 Changing the Image of Nurses &
Nursing

• To change a large group requires a concrete plan that is

effective over time
• The basic image of the nursing profession has already been
established
• Changing the self-image of the individual nurse.
Components important for
building image
Experience
Heredity
Environment
Thoughts, Beliefs, Image&
Action Performance
Gender Socialization
Reference Groups
We always act like the person we believe ourselves to be

Everything we do is consistent with our self-image/self-

concept. if you think it, you can attain it?
If any idea enters your mind, you literally have the ability to
accomplish it.
The only factors that stand between you and your goals are
perseverance, hard work, and a willingness to take risks.
Current Image of Professional Nursing

Nursing shortage
The average age of nursing graduate is 33
The average age of nursing RN is 44
Average age of faculty is 50
By 2015, 50 % of the RNs are expected to retire
By 2016 , job opportunities are increased by 21%
Image Markers of Nurse
Nurses of America Campaign
 Convey To The Public That The Nurses Are The Expert
Clinicians

 Raising Consciousness Of Invisibility Of Nursing In The

News Media
 Public Concern with Nursing

What is the image of nursing being created today?

Saints vs. Sinner Image
Can I trust my life this RN nurse ?
Public want to believe that knowledgeable, caring , committed
and dedicated RNs will always be available for them.
What the Public believe about
Nurses…?

RN ranked highest among all professional standard of ethics

and honesty.
Public seek advice in 4 areas
a. Self-care or immediate post op care
b. OTC health care products
c. Admin and SE of prescription drugs
d. Interpreting physician provided – information
Why do RNs Deride
themselves in front of Public?
Sloppy Slothing

 Dirty, wrinkled

 Childish Symbol
 Evolution of Nursing and
Health Care:
Nursing is art and science by which people are assisted
in learning to care for themselves whenever possible
and cared for y others when they are unable to meet their
own need.
Nursing's early history was heavily influenced by
religious organization and the need for nurses to care for
soldiers during wartime.
Scope of Nursing Practice

The scope of nursing practice is the range of roles, functions,

responsibilities and activities which a registered nurse is
educated, competent and has authority to
perform. Nursing practice is underpinned by values that guide
the way in which nursing care is provided”.
Scope of Nursing Practice
Nursing provide three types of care:
Individual
Family
Community

Nursing practice involves four areas:

1) Promotion of health and wellness
2) Prevention of illness
3) Restoration of health
4) Care of dying person
 Nurses workplaces
Nurses work in:
 Hospitals
 Acute care units
 Home care, and long-term care facilities
 Care for patients with general medical conditions, including
Infectious diseases, Asthma and Pneumonia.
History of Nursing Development
The Theoretical Foundation
Of Nursing
• Nursing theories provide the theoretical foundation of the
professional .
• Theory define what the nursing is ,what it does and the
goals or outcomes of the nursing care.
• Nursing is synthesis or many theories.
 Nursing Education
The three traditional educational avenues that prepare men and
women for registered nursing are:

1. Hospital-based diploma programs,

2. Associate degree programs (primarily found at junior and
community colleges),
3. Baccalaureate programs (offered at 4-year colleges and
universities). It is also possible for students to begin their
nursing education in programs that culminate in a master’s
degree, and several programs now exist in which a student
can earn a doctorate before being eligible to write the state
licensing examination for registered nursing.
At least two other groups of
caregivers are identified with
nursing: the nursing assistant,
who may be certified, and the
practical (vocational) nurse,
who is licensed through a
separate and different
examination from that taken
by the RN. We begin with a
discussion of those rules.
 Nursing Education
Diploma nursing
Associate degree nursing
Baccalaureate Education
Master’s and Doctoral Pre-licensure Programs
Doctoral Studies
Articulated Programs
Distance Education
 Diploma Education
The earliest type of nursing education in the United States took
place in diploma programs administered by hospitals, also
referred to as hospital-based programs. The early development
of these schools is synonymous with development of nursing as
a whole.
Development of Hospital-Based Diploma
Nursing Programs
The first hospital with a nurse training school was the New
England Hospital for Women, which accepted five probationers
on September 1, 1872.
 Cont…
By the late 1940s and early 1950s, many hospital-based nursing
schools had affiliated with nearby colleges and universities; these
schools adopted general education requirements, such as:
Anatomy
Physiology
Sociology
Psychology
As part of the curriculum. During this time, the national league of
nursing education—later to become two organizations, the national
league for nursing (NLN) and the national league for nursing
accrediting commission (nlnac)—assumed an active role in
curriculum guidance and accreditation.
 Cont…

Hospital-Based Programs Today

These programs vary in length from 27 to 36 months. Many
diploma schools are affiliated with a college or university so that
college credit can be awarded formally.
Graduates are provided with a foundation in the biologic and
social sciences and may have taken some courses in the humanities.
There is a strong emphasis in diploma programs on client
experiences.
The course of study includes experience in nursing management
(e.g., being in charge of a nursing unit). Graduates work in acute,
long-term, and ambulatory healthcare facilities, fulfilling the
responsibilities established by the scope of practice for RNs as
defined by the state in which they are licensed.
 Cont…..

The elimination of hospital-based programs has occurred

because hospitals could not sustain the costs of supporting the
programs and because students became more attracted to
programs located in colleges and universities.
 Associate Degree Nursing
Education

The movement toward associate degree education began in

1952. Today, associate degree nursing programs prepare more
graduates for licensure as RNs than do any of the other
programs and comprise over one half of all students enrolled
in prelicensure RN programs (NLN, 2009). Associate degree
programs have helped to solve the nursing shortages of the
1960s, 1980s, and today.
 Cont…
Characteristics of Associate Degree Education
In a typical program, approximately 40% of the credits needed
for the associate degree must be fulfilled by general education
courses such as English, anatomy, physiology, speech,
psychology, and sociology; the rest are to be fulfilled by
nursing courses. Clinical learning experiences are carefully
selected to correspond with the content delivered in classroom
lectures; the preconference's and post conferences help to
reinforce the relationship between the two. Some modifications
in this structure are occurring, as associate degree educators
strive to meet the expectations of employers and the
community while remaining true to the concept of associate
degree education
 Baccalaureate Education
Baccalaureate degree nursing education occurs in a 4-year college or
university and is championed by many to provide the minimum
educational preparation for professional practice.
Development of Baccalaureate Education in Nursing
The first school of nursing to be established in a university setting was
started at the University of Minnesota in 1909 as a quasi-autonomous
branch of the university’s school of medicine. The program was not very
different from the 3-year hospital-based program operating at that time;
nothing was required in the way of higher general education, and
graduates were prepared for the RN certificate only. Education took
place predominantly through apprenticeship, and students provided
service to hospitals in exchange for education. However, nursing
education did become a part of an academic organization, with 16
colleges and universities developing programs by 1916.
 Cont…
Characteristics of Baccalaureate Education
A baccalaureate nursing program is termed a basic or generic
program when it is a pre-licensure program leading to eligibility
to take the NCLEX-RN. It includes an upper division (junior
and senior years) nursing major that is built upon 2 years of
liberal arts and science courses taken during the freshman and
sophomore years.
Changes in Baccalaureate Education
In recent years, the nature of baccalaureate education has
changed. Many baccalaureate nursing programs have taken
steps to respond to the need for more RNs prepared for licensure
at the baccalaureate level. Innovative methods include the
development of accelerated programs and external degree
programs.
 Master’s and Doctoral
Prelicensure Programs

Most of the graduates of these programs are engaged in

teaching and research.
Such programs reflect the thinking of some nursing leaders
that the minimum preparation for professional nursing should
be the master’s degree. The programs also provide a higher
degree to those people who possess basic baccalaureate
preparation in another area of study.
 Cont…
Master’s Preparation
Master’s preparation is recommended for leadership positions in
nursing, for clinical specialization, and is generally the
minimum preparation required to teach nursing. The AACN has
outlined roles for graduates at the various educational levels.
Their vision is for a generalist at the baccalaureate level and an
advanced generalist at the master’s level that includes the
clinical nurse leader.
 Doctoral Studies
Before doctorates in nursing were offered, doctoral study in
other fields allowed nurses to benefit from post-master’s
preparation. A doctorate outside the area of nursing was often
the only doctorate available to persons seeking further
education; doctorates in nursing are relatively new to the
educational milieu.
Doctoral programs in nursing offer various degrees, such as:
The doctor of nursing science DNS),
The doctor of science in nursing (DSN),
The doctor of nursing education (DEd),
The more traditional doctor of philosophy in nursing (PhD)
 Cont…
Non-nursing doctorates are available to nurses, such as:
The doctor of education (ED)
The doctor of public health (DPH).

In 2004, the AACN proposed a doctor of nursing practice degree

(DNP).
The DNP is designed for nurses seeking a terminal degree in advanced
nursing practice, as opposed to working in research (AACN, 2006a).
The DNP was developed with the premise that the challenges of
today’s healthcare demanded a higher level of preparation for advanced
practice nurses (APNs) who could design and assess care and provide
leadership. Some universities are changing their nurse practitioner
programs from master’s degree programs to this type of clinical practice
doctorates.
 Nursing Responsibilities
Recognize that an image problem does not exist and that each
individual nurses has a responsibility to improve the profession
image
Become politically active and politically
knowledgeable ,nurses should run for office.
Document activities.
Write and submit features stories on nurses for local media.
 Cont…

Demand that nurses authors to considered for editing health

columns.
Provide technical assistances to media.
Provide ongoing public services announcement.
Create a public forums, "spend a day with a nurses”.
 Cont…

Share the positive aspects of the nursing profession with other.

Learn to describe alternative nursing education programs.
Continue to develop alternative nursing education programs.
critically asses the action you take , that might impact the
image of nursing.
 Cont…

Remember nursing image is you.

Be self-confident, self-confident behavior respect.
Increase staff involvement in scholarly activities .
Be positive.
 Strategies For Improving The Image Of
Nursing

The nursing profession faces some difficult issues and

challenges as it related to image building.
Collective bargaining.
Computer technology .
Elimination of internal sexism .
Development of internal media.
External media committees
Education
 Nurses Image of Itself
Our greatest advocate is the client ,as we reach out to care for
them heart to heart, they will reach out to work with us hand
in hand.
Collectively, these individuals nurses attitude ,behavior and
interaction constitute nursing self image.
Nurses who verbalize comments such as “I am only a staff
nurse "I was just following the physician order ,are not
improving the image of nursing
 Cont…

It is the challenge for each nurses to extend the best image

possible and offer the utmost by substantiating the value of
that service.
 REFERENCES
 From The ICN Code of Ethics for Nurses, International
Council of Nurses, 2006,
 Nisha clement ,Nursing ethics ,concepts , trends and
practices
 Kozier & Erb's Fundamentals of Nursing: Concepts,
Process and Practice, 11th edition
 ACA Ethics Standerds case book (7th Edition)