Table 1. Interview Questions
Open-ended questions |
Probing questions |
- Why did this happen?
- self-esteem or reduced your self-confidence? Explain
- what behaviors of your instructor annoy you? Why? |
|
Subcategory | Category | Theme |
Advocacy | Positive role model | Belongingness |
Professional enthusiasm | ||
Multidimensional capability | ||
The general belief about the value of nursing | The perception of society toward the nursing profession |
|
Professional dignity in society |
A theme is “belongingness affected by society”; with two categories of “positive Role model in education" (support, professional enthusiasm, and multidimensional competence) and “the perception of the society towards the nursing profession”; (understanding of professional dignity in society and public belief in the value of Nursing) explored.
Belongingness affected by society was explained as the theme, which emphasizes the influence of the nursing community and the public society in forming nursing students' identities. In the nursing community, implicit and explicit behavior of teachers and their role models have formed their identity. Also, society’s valuing the dignity of the nursing profession and honoring them has played an essential role in encouraging students to form the identity of a nurse among them.
1- Positive role model in education
The participants stated that in the socialization process, an influential factor in forming interest or lack of interest in nursing students is influenced by the teachers' behavior and appearance. The teachers' behaviors, especially during the clinical education process, played a fundamental role in forming students' professional identities. The students also stated that successful nursing teachers need more theoretical and clinical education and research abilities than other professions. Professional ethics must also be manifested in the teachers because the student learns the principles of respect for the patient’s independence, confidentiality, and privacy in the teachers' dealings with the patient. The interaction of teachers and patients, whether intended or not, can significantly impact the formation of students' professional identities in the future. The students believed that the teachers' communication skills motivated them. When nursing students understand their teachers' support, they feel comfortable and play a significant role in creating their interest in nursing. The wisdom of nurses in the department can also be effective in the socialization process of nursing students. When a nurse has up-to-date knowledge and takes care of the patient based on scientific principles, it will unconsciously create an interest among the student and facilitate their professional identity and socialization process.
1-1- Advocacy
“When the teacher advocates me, I had a good feeling, I calm down, I like my field, and I say, I am a great field.” (Participant 1).
1-2- Professional enthusiasm
“A stylish and well-groomed nurse is important. The appearance of some nurses increases my self-confidence in the profession.” (Participant 3)
“My clinical teacher is very cool and organized. She is continuously up to date. When we asked a question, she searched and found it. She assured us that our profession is a discipline, not a skilled field.” (Participant 12)
1-3- Multidimensional capability
“When I understand that my teacher is knowledgeable, polite, and friendly, he professionally treats the patients, nurses, and students, it makes me interested in staying in this field and trying.” (Participant 19).
“We have a nurse who knows seems as a doctor in the department, all trusted her and was involved in the decision-making process in different fields such as the nurse’s office, doctors, patients, and students, everyone consults with her.” (Participant 8)
2- The perception of society toward the nursing profession
The second category explored in this study explored the perception of society toward the nursing profession with two subcategories of “public belief about the value of nursing”; and “professional dignity in the society.” The participants in this study stated that the perception of society toward nursing affected their acceptance of the nursing profession. In fact, before entering the profession, the nursing student did not pay attention to the recognition of this profession by the counselor or other nurses and explore the nurse's role in society. The dignity of the profession, both in society and the clinical environment, has directly or indirectly affected the students’ socialization process. The participants stated that professional and unprofessional observations, interactions, and enthusiasm toward nursing among teachers had contributed significantly to nursing students' acceptance and socialization process.
2-1- General belief about the value of nursing
The third-year student stated, “I liked this profession because I found the respect for nurses. My neighbors spoke of our neighbor’s daughter, a nurse, and respected her.”
“Nursing is a profession, and you always understand that people in the community and on TV are talking about it. I think that nursing has a significant role in the healthcare system. I realized that one of the main deputies in healthcare Ministers is the nursing deputy. This means that Nursing has a high professional prestige”. (Participant No. 11).
“A person should care about his career and improve his capabilities is very important in accepting others. When I see that my teacher cares about himself and that the field is important to him, or when I see a nurse updating herself, I subconsciously become interested in nursing.” (Participant 19)
Discussion
Belongingness affected by society was explained as the theme. This central concept includes two categories, positive role models in the education process and society's perception of the nursing profession. The social factors, such as teacher and their role models and society's value viewpoints toward the nursing profession, influence their sense of belonging and are explored as the main factors in their socialization process.
In this study, belonging was explained as an influential factor in identifying nursing students. Belonging is a personal and context-dependent experience that forms in response to how much a person feels safe, accepted, respected, and valued by the group. Belongingness is defined as the need to be and the understanding of the importance of belonging to others at different interpersonal levels. The connection and integration with the group and the understanding of the harmony of personal values with the professional values of the group affected the belongingness of nursing students (25, 26). In line with the present results, Simmonds’ Study introduced belonging as an essential factor in the identification process in the nursing profession (27).
In line with the present results, Wang and colleague recognized clinical environment, atmosphere, organizational culture, and interpersonal relationships as the main factors affecting social belonging (28). In Jarvis-Selinger’s Study, professional identification was defined as an adaptive development process that coincides on two levels. The individual level includes individual psychological development, and the collective level comprises the socialization of people to play appropriate roles and the formation of their participation in society (29). The current results showed that the identification process of the participants was more dominant through societal valuation. The participants believed that society's perspectives on nursing as a valuable profession and the nurse’s professional dignity have led to the growth of their belonging to this profession and have encouraged them to be and stay as nurses. In our study, from the student's perspective, the social level is critical in their identification process, which can be caused by organizational culture and class distinction. Social communication was introduced as an influential factor in nursing students' belongingness (30). Alharbi et al. have addressed the role of social media in the professional identity of nursing students. This study showed that students used social media to learn about the nursing profession and develop a sense of belonging to the nursing profession. Students also used social media to share their experiences as nursing students and increase the community's understanding of the importance of the nursing profession. This study explained three main categories of learning, including learning related to the professional identity of nurses through social media, acceptance of nursing identity and sharing among students, and understanding of the professional identity of nursing through social media were explained. They believed that undergraduate nursing students should be encouraged to develop their professional identity through socialization, which impacts the development of society’s understanding of the nursing profession and better identification of students. Social media facilitated the process of socialization of undergraduate nursing students by connecting them with members of the nursing community (31). In the current study, the socialization of the learners was influenced by the society that values the nursing profession, and the community's awareness about the role of the nursing profession in the health system is essential in this process.
Teachers have been introduced as influential in accepting the profession, understanding professional responsibilities, and adhering to its principles (32). In line with the present study, the students believed that belonging to the nursing profession was more influenced by their teachers. Professional enthusiasm for the profession, scholarship perspective, and supportive behaviors as role models developed a sense of worth among them. Wang’s review also showed that teachers' behaviors as role models in the clinical education environment influence nurses’ belongingness (28). In this study, the training course in nursing has been introduced as a turning point in recognizing and creating belongingness in the nursing profession. In a grounded theory study, Baldwin and colleagues explored the role of teachers as role models in identifying nursing students. Three categories of creating a context for learning, creating a context for practice, and reflecting on identity were explored in their study. Their results indicated that the influence of role models in the interactions with nursing students who learn and imitate the behaviors of the role model is essential, and it affects their performance in the work environment and their intention to stay in the nursing profession (33). Role models and mentors influenced learners in two paths. Firstly, learners consciously acquire the necessary knowledge through observation, imitation, practice, and reflection. In the second path, learners learn indirectly from role models and teachers, which is recognized as learning tacit knowledge (34). Thus, teachers' implicit and unconscious behaviors significantly impact the identification of learners, which should be taken into account (34). The present results showed that the teacher's behavior and enthusiasm for the nursing profession affected students' identification process. Also, the teachers' scientific mastery and professional ability were explored as influential factors directing them to belong to the nursing profession. Levett-Jones's study showed that belongingness is influenced by various individual, interpersonal, contextual, and organizational factors. In this study, belongingness has been introduced as an individual and context-dependent experience, and interpersonal relationships between students and nurses are the most important factors affecting students’ sense of belonging (35), which is inconsistent with the present results. In the current study, the role of society and teachers were introduced as essential elements in the identification process.
The current study discussed the positive aspects of nursing students' professional identification. It is suggested to explore negative or inhibiting factors in future studies. It is also suggested to explore the experiences of the socialization process from the viewpoints of clinical nursing teachers and nurses with different working experiences.
Limitations
Since the researchers were faculty members, many students were afraid that their words would be told to the teacher and this would interfere with their educational process, so the researcher tried to talk to and assure them of the confidentiality of this information. Of course, some students have not expressed some of their experiences due to this fear or the common cultural compliments in the country.
Conclusion
The results showed that the identification of nursing students is influenced by the sense of belonging to the nursing community and the general society. The participants believed that implicit behaviors of teachers, such as professional enthusiasm and advocacy of teachers, as well as explicit behaviors, such as professional mastery and competencies, have led to better acceptance of the nursing profession. Moreover, society values the nursing profession, and the community's recognition and respect of the nursing profession are explored as essential factors for nursing students to be encouraged to become a nurse. Considering the importance of developing belongingness and a better understanding of professional identity by nursing students during their education, it is recommended to develop teachers' abilities as role models and create platforms for recognizing the professional identity of nursing among society and students in different professions in universities of medical sciences.
Ethical considerations
The ethics committee has approved the present research of the Tehran University of Medical Sciences (ID: IR.TUMS.VCR.REC.1397.852). The goals and methods used in the research were fully explained to the participants. The participants were assured of confidentiality and anonymity. In addition, the purpose of using the audio recorder was explained to the participants. They were assured that participation in the research is optional, and they have the option to withdraw from the study.
Conflict of Interests
The authors have no conflict of interest in any research stages.
Acknowledgment
This Study was supported by the Tehran University of Medical Sciences. (ID: 97-03-214-39337). The authors express their gratitude to this Education Development Center and the students participating in this study.
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