|Year : 2017 | Volume
| Issue : 3 | Page : 135-141
Knowledge, attitude and intention towards nursing profession among pre-clinical students
Wajed A Hatamleh, Erik Hans L Sorio
Department of Nursing, Center for Health Studies, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
|Date of Web Publication||12-Jul-2017|
Erik Hans L Sorio
F291 P.O. Box: 7897, Riyadh 11159
Kingdom of Saudi Arabia
Context: In Saudi Arabia, there is still an insufficient supply of nursing graduates to meet the growing demand for nurses to provide patient care. Aims: The aim of this study was to further investigate on the knowledge, attitude and intention towards nursing profession among pre-clinical students.
Settings and Design: A descriptive-correlational design was used in this study with a total of 128 pre-clinical male and female students from a nursing school in Riyadh.
Subjects and Methods: Data were obtained using an adopted survey instrument for describing the knowledge, attitude and intention among the participants. In the last two parts of the instrument, the participants answered the questions using 5-point Likert scale.
Statistical Analysis Used: Data were analysed using SPSS version 20.0. Descriptive statistics was utilised to describe the variables and Chi-square to show correlation between variables.
Results: In general, the participants had good knowledge of the nursing profession and a majority of the students disagreed that nursing is a job for females only. However, about 60% of the participants were not interested to study nursing.
Conclusions: The findings concluded that working with the opposite sex and people not respecting the nursing profession were found to have the highest influence in preventing the students from becoming a nurse. Moreover, positive attitude towards nursing would significantly result in students becoming more interested to the profession.
Keywords: Attitude towards nursing, knowledge on nursing, nursing intention, nursing profession, Saudi students
|How to cite this article:|
Hatamleh WA, Sorio EH. Knowledge, attitude and intention towards nursing profession among pre-clinical students. J Health Spec 2017;5:135-41
|How to cite this URL:|
Hatamleh WA, Sorio EH. Knowledge, attitude and intention towards nursing profession among pre-clinical students. J Health Spec [serial online] 2017 [cited 2017 Aug 17];5:135-41. Available from: http://www.thejhs.org/text.asp?2017/5/3/135/210433
| Introduction|| |
Nurses are viewed as the heart of the healthcare system. They comprise the largest percentage of labour force in any healthcare settings worldwide. In Saudi Arabia, there is an increasing involvement of men and women in the healthcare workforce nowadays. This is supported by the growth of schools offering nursing education that prepares the Saudi men and women to become the country's primary and leading providers of care.
The Ministry of Health allowed Saudi women to study in the nursing programme on condition that they remain covered, provide care to female patients only and not work with male physicians or even work afternoon or night shifts. However, because of spiritual and socio-cultural norms, Saudi females and even males who choose nursing as a career face many negative criticisms and difficulties.
The nursing profession is considered by the Saudi society with poor image as it is considered as a job for those with low standing in the society. Furthermore, men would be discouraged to consider nursing as a career when they see a male nurse being teased in the community. A study conducted in Saudi Arabia identified many reasons behind female students' choice in not choosing nursing as a career. These reasons include negative image of nursing career, family disagreement, long working hours, working with members of the opposite gender, and the worry of not getting married. The negative images and stereotypes about nurses in Saudi Arabia previously reflected similar situations in countries such as Australia, Europe and America and in other Arab countries which have led to and made shortage of nurses a global problem.
There is a chronic shortage of Saudi nurses and high turnover rates in Saudi Arabia. A research study found that most nurses perceived continuous education and advanced training as important elements of their motivation, satisfaction and retention in the hospital. The frustration, disappointment and regret among nurses due to increased workload, low pay, and lack of financial incentives, recognition and appreciation unfortunately influenced their work satisfaction and retention. Due to the effects of negative attitudes on nursing education, addressing the issue is important in resolving the nursing shortage. Despite the growing number of educational institutions that offer nursing programme in Saudi Arabia, there is still an insufficient supply of nursing graduates to meet the increasing demand for nurses needed to provide patient care in Saudi localities. Expatriate nurses comprised a large portion of the nursing workforce in Saudi healthcare facilities. Furthermore, the shortage of nurses can be associated with a shortage of nursing students in schools.
Nursing education is one area that received considerable investment in response to an increase in the demand for nurses in Saudi Arabia. In 1958, the first formal training for nurses was initiated at a Health Institute in Riyadh by the Saudi Arabian Ministry of Health in collaboration with the World Health Organisation. Since then, nursing education in Saudi Arabia has gone through many different phases. The first Bachelor of Science in Nursing programme was established by the College of Nursing at King Saud University in 1976.
The Saudi universities and colleges have preclinical year or foundation year which is the period in health science education before the student formally enters in a programme of study, like for instance nursing or pharmacy, and becomes involved with patient and clinical work.
As nursing educators for several years, the researchers have an emergent concern over the decreasing number of students showing interest to join the nursing programme. In their review of literature, several similar studies have been conducted in Saudi Arabia, especially to high school students but little is known about preclinical students. Moreover, due to the low interest in nursing as a career and shortage of Saudi nurses, researchers realised the need to conduct a study that aims to further investigate the knowledge, attitude and intention towards nursing profession among pre-clinical students of a selected nursing school in Riyadh. Findings of this study will serve useful inputs in improving awareness and increasing recruitment to the nursing profession.
The major questions this research seeks to answer are:
- What is the level of knowledge of students about nursing and its relationship to their intention to study nursing and become a nurse?
- Does attitude towards nursing profession among the students influence their intention to become nurses?
- To what extent does the causes of preventing students from becoming a nurse affect their intention towards nursing as a career?
- What strategies may be proposed on the basis of the findings of the study which may help improve the image of nursing and encourage more students to show interest to the nursing profession?
| Subjects And Methods|| |
This study used a descriptive-correlational design to answer the research questions.
The study utilised convenience sampling to include all male and female pre-clinical students who were currently in the second semester of their foundation year in a government nursing school in Riyadh. A total of 128 students participated in the study. The other 32 students were absent during the data gathering period. The data gathering period finished in 2 days during the 1st and 2nd day of February 2016 for the female and male sections, respectively.
For the purpose of this study, data were obtained using nursing intent questionnaire with 3 parts. The first part was developed by the researchers including the socio-demographic data with 8 questions in which response alternatives were pre-specified to ensure comparability of the response and to facilitate analysis. The other two parts were adopted from a similar research work  including (a) the statements on knowledge with 12 questions, attitude with 10 questions and intention towards nursing with 5 questions and (b) the causes that prevent students from being nurses with 10 questions. The participants answered the items from the last two parts using 5-point Likert scale with (1 = strongly disagree; 2 = disagree; 3 = I don't know; 4 = agree; 5 = strongly agree). The internal consistency ('reliability') of the adopted instrument has a Cronbach's alpha coefficient of 0.83 for knowledge, 0.71 for attitude, 0.84 for intention, 0.70 for the causes that prevents students from becoming a nurse and has a 0.83 overall reliability coefficient. The instrument was written in English but to enhance understanding of the questionnaire and to achieve a more accurate data, the participants were guided by Arabic-English speaking male and female nursing faculties in the school as requested by the researchers.
The study was approved by the Director of Institute and the Nursing Department Ethical Committee. Students who agreed to participate were informed about the purpose of the study and that their participation is voluntary and the data will be treated with confidentiality.
The Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corporation, 1989, 2011, Armonk, NY, USA) was used for statistical analyses. Socio-demographic variables were analysed using descriptive statistics (mean, frequency, percentages and standard deviations). While the correlation between intention and knowledge, attitude and causes were analysed using the bivariate statistical tests (Chi-square). The significance level for the statistical tests was set at the P< 0.05.
| Results|| |
[Table 1] shows that the majority of participants were female students between 18 and 20 years of age and single. Furthermore, about 46.1% of them reside at the central region in Saudi Arabia. Among the diploma programmes offered by their school, only a small portion of the students showed interest in nursing. This data confirm that most of the students were interested in other professional disciplines. The table also revealed that 87.5% of the students' job preference were based from personal decision followed by parental influence at 10.1%. Despite the low interest in nursing, most of the students have relatives who work as nurses signifying a source of information about the profession. Moreover, 68% of the students confirmed being cared by a nurse and 94.3% found that the caring experience were good.
Knowledge, attitude and intention
In general, the participants have good knowledge of the nursing profession as presented in [Table 2]. The table shows that the students strongly acknowledged that nurses assist doctors in caring for patients; nursing involves caring for patients; nurses provides comfortable environment for patients; and that nurses need skill and knowledge to provide care. However, only 57% recognised that nurses educate patients about their illness and that nurses plan individual care in collaboration with patients (63.4%).
|Table 2: Knowledge, attitude and intention toward nursing profession (n=128)|
Click here to view
Regarding attitude, the table revealed that the participants only scored above 50% in four statements. Majority agreed that it is very fulfilling to see patients getting better with 77.3% and about 73.5% enjoy caring and being with people. The participants also believed that nursing is a challenging career and nursing jobs can be found wherever they go. Remarkably, around 76.6% of the participants disagree that the nursing profession is a job for females only.
On the other hand, the intention towards nursing as a career is low. About 60% were not interested to study nursing and a little over 50% said that their family does not encourage them to be a nurse. Furthermore, the participants dislike studying nursing courses and also feel that their character is not appropriate for nursing.
It can be seen from [Table 3] that 71.1% of the pre-clinical students agreed that the down grading of nurses by majority of people and the high workload in nursing as compared to other jobs have caused them not to become nurses. About 68% of them reflected that night shifts and long working hours were also contributory factors. On the other hand, most of the participants disagreed that the sight of blood prevented them to become nurses. [Table 3] summarises the causes that prevent students from being nurses.
Statistical significance between variables
The substantial factors influencing the intention of becoming a nurse among pre-clinical students were analysed using Chi-square. [Table 4] revealed the independent variables that have displayed statistical significance with intention as the dependent variable. The attitude (P ≤ 0.001) and job preference (P = 0.001) have shown the highest influence on intention to become a nurse. These results suggest that the students would most likely choose nursing if optimism and job preference are demonstrated towards the profession. With a P = 0.025, the participants who have been cared for by a nurse were also most likely to choose the nursing profession. This proposes that the more experience being cared by a nurse, the more the participants become interested in nursing. Regarding the causes that avoid them to become a nurse, 'requires working with the opposite sex' (P ≤ 0.001) was found with the greatest influence on intention. In consideration of the existing provision on males and females working together in Saudi Arabia, the students found this condition as a hindrance in deciding on the nursing profession as a career. Moreover, careers such as nursing that unintentionally permits working with the opposite sex would make them become disinterested in the profession. Furthermore, it was pointed out that because the people do not respect the nursing profession (P = 0.030), the students choose not to become a nurse and perhaps escape from the negative consequences. Therefore, since nurses in reality are exposed to sick people, the students think that disease transmission can happen between them. On the other hand, attitude (P = 0.006) and being cared for by a nurse (P = 0.023) have shown significant relationship with job preference. These findings suggest that students with positive attitude on nursing and caring experience with a nurse would more likely prefer the profession.
| Discussion|| |
The first research question in this study sought to determine the level of knowledge of students on nursing and its relationship to their intention to study nursing and become a nurse. The results revealed that a large majority of the participants showed high level of knowledge on nursing profession. This is reinforced by having nurse relatives, about 49.6%, which served as their major source of information about nursing. Furthermore, this study revealed that despite the high level of knowledge, there was no significant relationship with job preference and intention towards the nursing profession. This implies that level of knowledge does not influence their intention and preference towards nursing as a career. However, research findings reported that having more knowledge about nursing would probably result in more students getting attracted to and choosing nursing as their job., This further suggests that students from different educational levels have varied viewpoints about the nursing profession.
The second research question regarding the attitude towards nursing profession, on the other hand, presented significant relationship with job preference (P = 0.006) and intention to become a nurse (P ≤ 0.001). This is an indication that positive attitude and not the level of knowledge about nursing influenced the preference and intention of pre-clinical students in choosing nursing as a career. Surprisingly, this finding is consistent with other studies which stated that with more positive attitude towards the profession, the more likely the student will be attracted to nursing and choose to become a nurse., In India, however, there is a negative attitude towards the profession among nursing students. In addition, the job preference and intention to take nursing revealed a statistical significance (P = 0.001) which point out that those who prefer nursing are more likely to be interested in the profession and become a nurse. Furthermore, the participants who have been cared for by a nurse in a hospital, clinic or home also significantly demonstrated preference in taking a nursing job (P = 0.023) and intention to become nurses (P = 0.025). This illustrates that being cared for by a nurse gave the participants a chance to create their personal views of the nursing profession thus influencing their job preference and intention towards nursing. Similarly with a previous study, these findings may have been supported by 94.3% of the participants who revealed that their caring experience with a nurse was good.
Another question this study tried to answer was to know the extent on which the causes preventing the students from becoming a nurse affect their intention towards the nursing profession. This study revealed that, among the causes listed, there has been a very strong statistical significance between intention and 'requires working with the opposite sex' (P ≤ 0.001) and 'people do not respect nursing profession' (P = 0.030). The Saudi Labour code that prohibit male and female from working together and the negative image that the Saudi society regarding nursing would explain why this aspect turned out to have high influence on the student's poor intention to choose nursing. It can be seen in [Table 3] that 40.6% of the participants exhibited agreement versus disagreement with 45.3% if they were afraid of getting diseases. Thus, the participants thought that this factor may or may not contribute in preventing them from becoming nurses since their individual standpoints varied. It is important to note that this study revealed that the intention towards nursing profession was low and was consistent with similar research works.,, This study also demonstrated poor interest and preference in nursing as compared to other professional disciplines such as emergency medical technician, pharmacy technician, renal dialysis technician and operating department practitioner which the participants preferred. Correspondingly, a study in Tanzania reported that of all medical related professions, nursing was the least popular. It can be gleaned from [Table 2] that only 27.4% of the participants have shown interest to the nursing profession. Furthermore, only about 30.5% of the participants' families encouraged them to become a nurse. This finding is similar with a study reporting that joining nursing will cause embarrassment to the family., In another study, it was found that family support and encouragement played a significant role in the decision to take up nursing as a career among the 1st year students.,,, Therefore, this area needs more attention in order to address the issue on low interest in nursing among the students.
A limitation of the study was attributable to the relative small sample size represented by pre-clinical students in the nursing diploma programme only and there was no randomisation that may reduce the generalisability of the findings.
| Conclusions|| |
From the salient findings of this study, it was concluded that (a) the intention of the participants towards nursing is low; (b) positive attitude towards nursing would significantly results in students becoming more interested in the profession; and (c) working with the opposite sex and people not respecting the nursing profession were found to have the highest influence in preventing the students from becoming a nurse.
This research also aimed to identify strategies which may be proposed on the basis of the findings of the study which may help improve the image of nursing and encourage more students to show interest to the nursing profession. In light of the significant findings and conclusions of this study, it is strongly proposed that:
- An innovative programme must be developed and implemented to increase interest in nursing as a career among pre-clinical students
- Career guidance and counselling opportunities must be provided to the pre-clinical students on a regular basis
- Enhancement and sustenance of positive attitude towards nursing among pre-clinical students
- Intensification of public awareness about the nursing profession through proper media usage results in better image of nursing among individuals and families
- Issues on working with the opposite sex must be addressed properly in hospital institutions, and
- Additional similar research with bigger sample size that also includes the pre-clinical students of baccalaureate programmes to enhance generalisability of the findings be conducted by future researchers.
In nursing practice, the study would encourage the nurses to exhibit positive image of the profession by acting as role models and serve as good example in hospitals where the nursing students are affiliated. In this way, nursing students would observe optimistic picture of nursing which would make them encourage future students to enrol in the nursing programme.
In nursing education, the study would serve as a basis in developing programmes that would increase the interest of students in nursing by allowing them to actively participate in nursing activities and exposing them to various clinical experiences and nursing skills laboratory activities. Furthermore, nursing faculty would be encouraged to introduce the nursing profession to the students through mentoring and career advising.
In nursing research, the study would open ideas to future researchers regarding the need to further investigate on the different factors affecting the low interest of students in the nursing profession and its realistic resolutions which is a major concern in majority of countries like Saudi Arabia.
In nursing policy, the study would seek the attention of policy and decision-makers to develop strategies to address the problem on nursing shortage by starting the transformative change in the nursing school. In other words, the more students enrolled in nursing, the more nursing graduates would provide healthcare services to the people.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
El-Sanabary N. Women and the nursing profession in Saudi Arabia. In: Bryant NH, editor. Women in Nursing in Islamic Societies. Oxford: Oxford University Press; 2003. p. 56-89.
Miller-Rosser K, Chapman Y, Francis K. Historical, cultural, and contemporary influences on the status of women in nursing in Saudi Arabia. Online J Issues Nurs 2006;11:8.
Mu K, D'Silva JJ, Lobo JM, Sequera SK. A study to assess the attitude towards nursing profession among the nursing students in the selected college at Mangalore. Int J Health Sci Res 2015;5:217-20.
Achilles K. Image of nursing profession as viewed by secondary school students in Ilala district, Dar Es Salaam. Dar Es Salaam Med Stud J 2009;17:12-8.
Al-Omar BA. Knowledge, attitudes and intention of high school students towards the nursing profession in Riyadh city, Saudi Arabia. Saudi Med J 2004;25:150-5.
Darbyshire P. Heroines, hookers and harridans: Exploring popular images and representations of nurses and nursing. In: Daly J, Speedy S, Jackson D, editors. Contexts of Nursing: An Introduction. Sydney, Australia: MacLennan and Petty Pty. Ltd.; 2000. p. 39-50.
Abu-Zinadah S. Nursing situation in Saudi Arabia. Riyadh: Saudi Nursing Board, Saudi Commission for Health Specialities; 2006.
Lamadah SM, Sayed HY. Challenges facing nursing profession in Saudi Arabia. J Biol Agric Healthc 2014;4:20-5.
Rothrock JC. Attracting and keeping new graduates. AORN J 2007;85:1063-4.
Hathorn D, Machtmes K, Tillman K. The lived experiences of nurses working with student nurses in the clinical environment. Qual Rep 2009;14:227-44.
Almalki M, FitzGerald G, Clark M. The nursing profession in Saudi Arabia: An overview. Int Nurs Rev 2011;58:304-11.
Tumulty G. Educational needs of nurse administrators in the Middle East. J Nurs Adm 2001;31:386-90.
Tumulty G. Professional development of nursing in Saudi Arabia. J Nurs Scholarsh 2001;33:285-90.
Miligi E, Selim A. Saudi nursing students' attitudes towards the nursing profession. Eur J Bus Manage 2014;6:197-208.
Koushali AN, Hajiamini Z, Ebadi A. Comparison of nursing students' and clinical nurses' attitude toward the nursing profession. Iran J Nurs Midwifery Res 2012;17:375-80.
Gillis A, Jackson W, Beiswanger D. University nurse graduates: Perspectives on factors of retention and mobility. Nurs Leadersh (Tor Ont) 2004;17:97-110.
Alexander H. Upper secondary male students' perception of nursing as a career choice. Int J Adv Sci Arts 2010;1:46-62.
Al-Kandari FH, Lew I. Kuwaiti high school students' perceptions of nursing as a profession: Implications for nursing education and practice. J Nurs Educ 2005;44:533-40.
Kikwilu EN, Mugonzibwa EA, Rugarabamu PG, Ntabaye MK. Tanzanian high school students' attitude towards five university professional courses. East Afr Med J 2000;77:143-6.
Mohammed MK, Abdo LM. Identifying knowledge and attitude of secondary school students toward nursing profession in Cairo governorate. Med J Cairo Univ 2015;83:443-7.
Abdel-Halim S. Effect of a Nursing Awareness Program on Preparatory School Students' Perception toward Nursing Profession. Master Degree Thesis Submitted to Faculty of Nursing. Ain-Shams University; 2012.
Ward C, Styles I, Bosco AM. Perceived status of nurses compared to other health care professionals. Contemp Nurse 2003;15:20-8.
Al Jarrah IA. Associate nursing students' perceptions toward nursing profession in Jordan. Eur Sci J 2013;9:147-66.
El-Sharkawy F, El-Hadad A. Factors affecting students' choice of nursing as a career in Egypt and Syria. New Egypt J Med 1996;15:435-40.
Kelly NR, Shoemaker M, Steele T. The experience of being a male student nurse. J Nurs Educ 1996;35:170-4.
[Table 1], [Table 2], [Table 3], [Table 4]