• Users Online: 347
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 138-143

Evaluating the formation of professional identity in Iranian nursing students after implementation of a new curriculum


1 Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Medical Ethics and Law Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
4 Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Submission20-Jan-2019
Date of Acceptance13-Apr-2019
Date of Web Publication11-Jul-2019

Correspondence Address:
Dr. Fariba Borhani
School of Nursing and Midwifery, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2345-5756.231386

Get Permissions

  Abstract 

Context: The nursing education program in Iran has been reformed over the past years with the aim of enhancing the moral capabilities and formation of positive professional identity in graduated nurses.
Aims: The purpose of this study was to investigate the degree of formation of professional identity in nursing students in Iran.
Setting and Design: This was a descriptive cross-sectional study. Two hundred and twenty-one students studying in the last three semesters were selected using convenience sampling.
Materials and Methods: The Professional Identity Scale for nursing students was used for data gathering. The questionnaire was translated into Persian by the forward-backward translation method. The study was conducted in 2017 in three of Iran's capital's nursing and midwifery school.
Statistical Analysis Used: The data were analyzed using independent t-test, one-way ANOVA, Pearson's correlation, and linear regression.
Results: The mean age of the subjects was 23. 15 ± 2.71 years and 50.7% of them were female. The average score for professional identity was 55.61 ± 12.75, and the score for professional self-image was 20.68 ± 4.82; the benefit of retention and risk of turnover was 11.94 ± 3.70; social comparison and self-reflection was 10.06 ± 2.50; independence of career choice 6.80 ± 1.82; and social modeling 6.42 ± 2.30.
Conclusion: The average score of professional identity was higher than half of the expected score, but it was lower than the maximum score. The nursing education program in Iran failed to advantageously shape the professional identity of nursing students.

Keywords: Quality of life, Ischemic heart diseases, Myocardial infarction, Coronary artery bypass graft, Percutaneous transluminal coronary angioplasty


How to cite this article:
Haghighat S, Borhani F, Ranjbar H, Naseri P. Evaluating the formation of professional identity in Iranian nursing students after implementation of a new curriculum. J Nurs Midwifery Sci 2019;6:138-43

How to cite this URL:
Haghighat S, Borhani F, Ranjbar H, Naseri P. Evaluating the formation of professional identity in Iranian nursing students after implementation of a new curriculum. J Nurs Midwifery Sci [serial online] 2019 [cited 2019 Sep 22];6:138-43. Available from: http://www.jnmsjournal.org/text.asp?2019/6/3/138/231386


  Introduction Top


Professional identity is one of the main consequences of the education program and the socialization process in academic disciplines. It is also one of the most important factors, which is effective in the commitment of employees to their jobs.[1],[2] In nursing, professional identity is an essential element that effect on the performance of nurses who have various roles. It is effective in providing a higher quality of care for patients, as well.[1] For this reason, the formation of students' professional identity in the education program and schools is one of the main goals in nursing education.[2],[3]

Professional identity is defined as a professional self-perception based on attitudes, beliefs, feelings, values, motivations, and experiences that are related to a specific profession.[4],[5],[6] Having a positive professional identity is an important factor in increasing self-confidence, self-esteem, and interpersonal communication among students. It is also one of the most important factors in job satisfaction, and it is one of the predictors for nurses staying in the profession. The results from previous studies showed that there is a greater willingness to leave the profession among nurses who have negative professional identity and ones who have lower job satisfaction.[7],[8],[9] In addition, if professional identity does not form positively in a career, it can threat the profession's legitimacy, public trust, and occupational independence endanger.[10]

The literature review showed that one of the most important challenges of nursing education is related to the formation of negative professional identity among nursing students.[11],[12],[13] Nurses' professional identity forms throughout life even before entering nursing education. Clinical experience and work as a nurse have a great effect on the formation of the professional identity of nursing students. College years are very essential in the formation of professional identity because, during this time, students acquire knowledge and skills that distinguish them from laypersons.[4],[14],[15]

Nursing student's professional identity formation is under the influence of many factors, including general image of the profession, workplace environment and values, educational system, and culture of society.[16],[17] Professional identity in nursing students develops through internalization of codes of ethics, learning protocols, and instructions. Sharing work experiences are another way of promotion of professional identity in nursing students. Clinical work helps nursing students to create professional identity because they experience their own professional future realities and compare them with what they have learned in theoretical classes.[18] Promotion of professional identity is a dynamic and lifelong process in nursing, and it is not only limited to college years but also this phase is an important era.[19]

The formation of professional identity has been the subject of numerous studies. Shahidi et al. 2014 explored the development of professional identity in nursing students. They used Eisner's evaluation model. Their results showed that the change in nursing students' admission process, training of nursing educators and enhancement of their knowledge can play a significant role in the formation of professional identity.[11] Furthermore, Baraz Pordanjani et al., in 2014, in a qualitative study, investigated the barriers of the formation of professional identity in nursing students. The results showed that to develop a positive professional identity, students should be respected and their status should improve in the hospitals and in the community. They also found that the maintenance of professional independence has a positive effect on the positive professional identity of students.[1]

Arreciado Marañón and Isla Pera in 2015, in a qualitative study, examined the role of theoretical and clinical education in the formation of the professional identity of nursing students. Their results showed that clinical, theoretical, and practical education is necessary to create professional identity. They showed that the role of clinical educators in creating professional identity is very important.[18] In a longitudinal study by Hensel and Laux in 2014, the professional identity of 45 undergraduate nursing students was examined. Their results showed that personal spiritual growth and student perceptions of their competencies could predict that students are suitable for this profession. Furthermore, the quality of education, care, and spirituality during exercise are important in shaping the professional identity of students.[20]

In recent years, the nursing education program in Iran is reformed, and it focused on ethical and professional education. Due to this change in curriculum, there is an expectation of positive changes in the professional identity of nursing students. We did not find any study that was conducted on the measurement of the formation of professional identity in Iranian nursing students. This study was conducted to determine the degree of professional identity formation in nursing students of Iran's capital's nursing schools. In recent years, due to the international and national nursing shortage, there is a strong tendency to choose nursing as a career in Iranian youth. Men are also entering the profession more and more, because of the low unemployment rate in the profession. Nevertheless, the professional identity scores were lower than the desirable level. The possible reason for this is the increase in students who have entered this discipline without enough interest. In recent years, the number of these students increased due to unemployment and relatively higher income in nursing.


  Materials and Methods Top


This was a descriptive cross-sectional study which was conducted in 2017. Nursing students from Tehran University of Medical Sciences, Iran University of Medical Sciences and Shahid Beheshti University of Medical Sciences were enrolled in the study. The sampling was conducted using convenience method from undergraduate nursing students who had inclusion criteria. The criteria for entering this study included 221 students who were studying in terms 6, 7, and 8 and willingness to participate in the study.

Data collected were conducted using two questionnaires. The first one was demographic characteristic's questionnaire that included age, average score, gender, marital status, academic semester, student work and job satisfaction. The Professional Identity Scale for Nursing Students (PISNS), developed by Hao et al. was used to measure the professional identity of nursing students. It includes five dimensions: Social modeling; Independence of career choice; Social comparison and self-reflection; Benefit of retention and turnover risk, and Professional self-image.[21] PISNS has 17 items, and it rates on a 5-point Likert: Absolutely Disagree (1), Disagree (2), No opinion (3), Agree (4), absolutely agree (5). The minimum score in this questionnaire is 17, and the maximum is 85. Its reliability has been reported 83% by Hao et al.

The questionnaire was translated using the WHO process for translation and adoption of tools.[22] First, the author translated the questionnaires from English into Persian. In the second phase, an English-speaking person translated the questionnaire into English. A meeting was held in the presence of the research team and experts on the field of professionalism to review the translated scale in its backward translated version, in the third phase. In the next stage, the questionnaires were distributed among 30 students within the sample group to identify the ambiguities in the questions and words. The validity of the professional identity questionnaire was reported to be 89%. Cronbach's alpha was used to determine the reliability of the questionnaire (α = 0.787).

The present research is approved by Shahid Beheshti University of Medical Sciences committee of research ethics (IR.SBMU.PHNM.1395.71). After introducing and expressing the research goals and obtaining informed consent verbally, the study participants completed the scales. They were assured that all information obtained would be confidential and that all questionnaires will analyze anonymously.

Data were presented using descriptive statistics (mean, standard deviation and frequency). Data were analyzed with independent t-test, ANOVA, Pearson's correlation, and linear regression using SPSS for Windows, Version 16.0 (SPSS Inc., Chicago, USA).


  Results Top


The mean age of the study participants was 23.13 years. Most of the participants were female (50.7%), single (84.2%). The demographic characteristics of the study units are presented in [Table 1].
Table 1: Characteristics demographics of the nursing students (n=221)

Click here to view


Based on the results, the average score for professional identity was 55.61 ± 12.75 and the score for professional self-image was 20.68 ± 4.82; the benefit of retention and risk of turnover was 11.90 ± 3.70; social comparison and self-reflection was 10.06 ± 2.50; independence of career choice 6.80 ± 1.82; and social modeling 6.42 ± 2.30 [Table 2].
Table 2: Mean and standard deviation of professional identity score and its categories (dimensions) in nursing students

Click here to view


There was no significant correlation between age and professional identity score (R2 = 0.215). The mean of grades of student mean was 16.32, and it had a significant correlation with professional identity [Table 3]. The score of professional identity in women was higher than male students. The professional identity score in married students was higher than single students. Furthermore, the score of professional identity in students who had children and ones who were more satisfied with the job was higher. Job satisfaction and marital status had a high effect on professional identity scores and gender had a moderate effect [Table 4]. Overall satisfaction with the occupation, gender, and marital status predicted professional identity scores [Table 5].
Table 3: Correlation between “professional identity” and “age and average score” of the students under study

Click here to view
Table 4: Comparison of mean professional identity and students' demographic information

Click here to view
Table 5: The relationship between variables effecting on professional identity in nursing students

Click here to view



  Discussion Top


The aim of the current study was to measure the professional identity of Iranian nursing students. It showed that the Student's professional identity scores were higher than half of the expected score. However, it was far from ideal. This result demonstrates the relative success of nursing education program in Iran in shaping the Student's professional identity. Overall satisfaction with the nursing profession, being a woman and being married had a positive effect on the professional identity of students. Students who were in the last semester had higher professional identity scores in comparison with other students.

The results of the two previous studies showed that students who chose nursing as the first choice in the university entrance exam and were satisfied with the discipline had a better professional identity. The professional identity has a strong relationship with staying within the career. In the present study, there was a significant relationship between satisfaction with profession and professional identity, which confirms the results from previous studies.[8],[23] Roxburgh et al. also argued that nursing students need a high professional identity for learning and development.[24]

The result of a study on Iranian nursing students showed that the students acquired different experiences during clinical courses. These experiences were a mixture of pleasant and unpleasant feelings, perceptions, perceptions, and abilities. They were faced with deficiencies, limitations, failures, and deprivations. By gaining knowledge, attitudes and other competencies, they began to overcome the unpleasant clinical aspects. By gaining the necessary skills and moving along the path to professional development, they also found a more active role in the clinical field and promoted their professional identity. Although unpleasant clinical aspects exist throughout their college years, those aspects weaker in the last years.[25] In the present study, some of the study samples were in the 3rd year of their education. Nursing students in Iran have complete independence in clinical education in the 4th year. It is possible that the lower professional identity scores were related to the 3rd years' students.

One of the important results from this research was the higher Student's professional identity score in the final semester. Since, in the final semester, nursing students in Iran work independently in the hospital under the supervision of the head nurse. This factor can be particularly important in shaping the professional identity of students. In line with the results of the present study, Marañón and Pera (2015) in their study stated that nursing students had a low level of professional identity before entering full-time clinical education. Their professional identity shaped in clinical courses. The role of clinical instructors is undeniable in this phase.[15] One of the aspects of professional identity which examined for this study was social dimensional modeling, it had a moderate average. The results from the studies showed that nursing instructors are the most important role players in the clinical setting, and they are a key factor for the development of the professional identity of students who gradually adapt themselves to professional nursing roles. Clinical instructors are directly involved in real work education. They can influence students' worldview and performance. Therefore, nursing Students' learning of their instructors affects the formation of their professional identity.[26],[27],[28] In this study, there was a significant relationship between gender and marital status with professional identity. There is no consensus regarding the effects of demographic factors on professional identity. While Fairfield Artman stated, there is a relationship between the underlying characteristics (sex and marital status) and the professional identity of nurses.[29] Allahyari Bayatiani et al. in their study stated that there was no significant relationship between professional values and demographic characteristics. Perhaps, the reason behind the difference in of our results with Allahyari Bayatiani et al. results is because of the difference in the sampling population. In the current study, the sample was recruited from nursing students, while in their study nurses formed the study sample.[30] Demographic characteristics may be more effective in the professional identity of nursing students than nurses.

One of the limitations of the current study is the lack of longitudinal design and to achieve a comprehensive view of the changes in the professional identity of nursing students during their education.

Furthermore, the study sample only covered the capital city of Iran. If the results of the research are available from other cities, then it might be better to look at the outcome of the new curriculum.


  Conclusion Top


Based on our result the average score of professional identity was higher than the half of the expected score, but it was far from the maximum score of the scale. On the basis of this, although the Student's professional identity score was acceptable, it was far from the desired level, which would require more attention. For this reason, faculty and clinical educators should be assisted by planning and taking steps to develop the professional identity of nursing students. Furthermore, using modern methods of nursing ethics education and improving the social status of nurses can help to enhance the professional identity of students. The lower grade of professional identity of male students also requires special attention.

Also it seems that there is a need to increase the educational content related to the professional identity in the curriculum. Due to the importance of individual characteristics, more detailed studies should be conducted in this field. This can help in choosing the more appropriate person to enter the discipline who can better shape positive personal identity. Another important issue is the impact of independent work as a nurse in the health system that has been shown can have a positive effect on the formation of the professional identity of nursing students. In designing a nursing education program, the more students can enter the clinical field sooner, the better the professional identity will form in them. Due to importance of development of professional identity in nursing students it seems that future studies are needed to clarify more factors which affect the development of it. Furthermore, new methods of education should be considered in the nursing curriculum.

Conflicts of interest

There are no conflicts of interest.

Author's contribution

Sahar Haghighat and Fariba Borhani Wrote the proposal and draft of the manuscript Sahar Haghighat did the daata gathering Parisa Naseri did the data analysis Hadi ranjbar drafted the final version of the manuscript.

Financial support and sponsorship

Nil.

Acknowledgment

The researchers thanked nursing students who contributed to this study. The present study is part of an MA thesis approved by the Research Council and Ethics Committee of the Shahid Beheshti University of Medical Sciences.

 
  References Top

1.
Baraz Pordanjani SH, Memarian R, Vanaki Z. Damaged professional identity as a barrier to Iranian nursing students' clinical learning: A qualitative study. J Clin Nurs Midwifery 2014;3:1-15.  Back to cited text no. 1
    
2.
Shinyashiki GT, Mendes IA, Trevizan MA, Day RA. Professional socialization: Students becoming nurses. Rev Lat Am Enfermagem 2006;14:601-7.  Back to cited text no. 2
    
3.
Cho SH, Jung SY, Jang S. Who enters nursing schools and why do they choose nursing? A comparison with female non-nursing students using longitudinal data. Nurse Educ Today 2010;30:180-6.  Back to cited text no. 3
    
4.
Johnson M, Cowin LS, Wilson I, Young H. Professional identity and nursing: Contemporary theoretical developments and future research challenges. Int Nurs Rev 2012;59:562-9.  Back to cited text no. 4
    
5.
Slay HS, Smith DA. Professional identity construction: Using narrative to understand the negotiation of professional and stigmatized cultural identities. Hum Relat 2011;64:85-107.  Back to cited text no. 5
    
6.
Hallam J. Nursing the Image: Media, Culture and Professional Identity. London: Routledge; 2012.  Back to cited text no. 6
    
7.
Hood K, Cant R, Baulch J, Gilbee A, Leech M, Anderson A, et al. Prior experience of interprofessional learning enhances undergraduate nursing and healthcare students' professional identity and attitudes to teamwork. Nurse Educ Pract 2014;14:117-22.  Back to cited text no. 7
    
8.
Sabanciogullari S, Dogan S. Relationship between job satisfaction, professional identity and intention to leave the profession among nurses in Turkey. J Nurs Manag 2015;23:1076-85.  Back to cited text no. 8
    
9.
Awases MH, Bezuidenhout MC, Roos JH. Factors affecting the performance of professional nurses in Namibia. Curationis 2013;36:E1-8.  Back to cited text no. 9
    
10.
Severinsson E, Sand A. Evaluation of the clinical supervision and professional development of student nurses. J Nurs Manag 2010;18:669-77.  Back to cited text no. 10
    
11.
Shahidi LH, Vahidi M, Mahram B, Namdar H, Zarghi N. Professional identity development in nursing students: Eisner's evaluation model. Res Dev Med Educ 2014;3:37-43.  Back to cited text no. 11
    
12.
Willetts G, Clarke D. Constructing nurses' professional identity through social identity theory. Int J Nurs Pract 2014;20:164-9.  Back to cited text no. 12
    
13.
McKenzie K, Murray A. E-learning benefits nurse education and helps shape students' professional identity. Nurs Times 2010;106:17-9.  Back to cited text no. 13
    
14.
Del Prato D. Students' voices: The lived experience of faculty incivility as a barrier to professional formation in associate degree nursing education. Nurse Educ Today 2013;33:286-90.  Back to cited text no. 14
    
15.
Kaya H, Işik B, Şenyuva E, Kaya N. Personal and professional values held by baccalaureate nursing students. Nurs Ethics 2017;24:716-31.  Back to cited text no. 15
    
16.
Ranjbar H, Joolaee S, Vedadhir A, Abbaszadeh A, Bernstein C. Becoming a nurse as a moral journey: A constructivist grounded theory. Nurs Ethics 2017;24:583-97.  Back to cited text no. 16
    
17.
ten Hoeve Y, Jansen G, Roodbol P. The nursing profession: Public image, self-concept and professional identity. A discussion paper. J Adv Nurs 2014;70:295-309.  Back to cited text no. 17
    
18.
Arreciado Marañón A, Isla Pera MP. Theory and practice in the construction of professional identity in nursing students: A qualitative study. Nurse Educ Today 2015;35:859-63.  Back to cited text no. 18
    
19.
Crigger N, Godfrey N. From the inside out: A new approach to teaching professional identity formation and professional ethics. J Prof Nurs 2014;30:376-82.  Back to cited text no. 19
    
20.
Hensel D, Laux M. Longitudinal study of stress, self-care, and professional identity among nursing students. Nurse Educ 2014;39:227-31.  Back to cited text no. 20
    
21.
Hao YF, Niu HJ, Li LP, Yue SJ, Liu XH. Measurement of professional identity in Chinese nursing students. Int J Nurs Sci 2014;1:137-44.  Back to cited text no. 21
    
22.
World Health Organization. Process of Translation and Adaptation of Instruments. Available from: http://www.who.int/substance_abuse/research_tools/translation/en/. [Last accessed on 2017 Feb 21].  Back to cited text no. 22
    
23.
McCrae N, Askey-Jones S, Laker C. Merely a stepping stone? Professional identity and career prospects following postgraduate mental health nurse training. J Psychiatr Ment Health Nurs 2014;21:767-73.  Back to cited text no. 23
    
24.
Roxburgh M, Conlon M, Banks D. Evaluating hub and spoke models of practice learning in Scotland, UK: A multiple case study approach. Nurse Educ Today 2012;32:782-9.  Back to cited text no. 24
    
25.
Dinmohammadi M, Ramezanibadr F, Peyrovi H, Mehrdad N. Final year experience of BSN students in the clinical environment: Professional pride. J Med Educ Dev 2014;7:39-48.  Back to cited text no. 25
    
26.
Borhani F, Alhani F, Mohammadi E, Abbaszadeh A. Professional ethical competence in nursing: The role of nursing instructors. J Med Ethics Hist Med 2010;3:3.  Back to cited text no. 26
    
27.
Felstead I. Role modelling and students' professional development. Br J Nurs 2013;22:223-7.  Back to cited text no. 27
    
28.
Masoumpoor A, Borhani F, Abbaszadeh A, Rassouli M. Nursing instructors' perception of students' uncivil behaviors: A qualitative study. Nurs Ethics 2017;24:483-92.  Back to cited text no. 28
    
29.
Fairfield Artman P. Narratives of Female ROTC Student-Cadets in the Postmodern University. University of North Carolina at Greensboro; 2010.  Back to cited text no. 29
    
30.
Allahyari Bayatiani F, Fayazi S, Jahani S, Saki Malehi A. The relationship between the personality characteristics and the professional values among nurses affiliated to Ahwaz University of Medical Sciences in 2014. J Rafsanjan Univ Med Sci 2015;14:367-78.  Back to cited text no. 30
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  Materials and Me...
  In this article
Abstract
Introduction
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed137    
    Printed9    
    Emailed0    
    PDF Downloaded26    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]