The Professional Image of Nursing and Patients’ Perceptions of Caring: An Integrated Literature Review Alexis L. Farrington, BSN, RN MSN Candidate University.

The Professional Image of Nursing and Patients’ Perceptions of Caring:

An Integrated Literature Review

Alexis L. Farrington, BSN, RN

MSN Candidate

University of Central Florida

Think about a time when….

…you were a patient in a

hospital

… you visited a friend or loved one that was

hospitalized

When you met and interacted with your nurse, how confident

were you that you were in good hands?

Did the nurse’s behavior and or

appearance affect your ability to convey your

needs?

Image Matters

Research Question

In hospitalized adults, how does the nurses’ professional

image affect patient perception of caring compared to

practice knowledge?

Background• Caring is often

described in the form of acts, behaviors and conveyed through interaction.

• Defined as what patients equate as caring from their own perspectives (culture, ethnicity, gender, generation).

• Researched by theorists and psychologists• Hospitalization creates

vulnerability and fear• The nurse-patient relationship is

influenced by patients’ perceptions of the nurses providing care and the degree of caring.• Health care produces a market

for caring

Significance• Historically, the image of the nurse has been highly

regarded in the eyes of the public and described as saintly and compassionate. • The public image or illusion of the nurse has been

influenced by various portrayals in the media and television that reflect both positive and negative depictions (Price & McGillis Hall, 2014).

• Patients view the nurse’s professional image by the way in which the nurse presents themselves that is often conveyed through non-verbal cues that are decoded by patients as either welcoming or repelling (Skorpuski & Rea, 2006).

Significance

• The Institute of Medicine (IOM) issued reports explicating the state of decline in American Health Care (IOM, 1999).

• Nursing’s response was the implementation of Quality and Safety Education in Nursing (QSEN) to improve the quality of care through the platform of education (QSEN, 2014).

• Patient satisfaction scores and hospital quality and performance ratings are greatly influenced by nursing encounters.

Purpose of Review

To investigate the affects of nurses’ professional image on patients’

perception of caring compared to practice knowledge

Methods

“Professional Image,

appearance”, “attire, uniform”,

patient perception,

Professionalism, nurse-patient

relations, nurs*, advanced

practice, health habits, health

behaviors

CINHAL

Psych INFO

Cochrane

Libraries

MEDLINE

Academic

SearchPremier

MethodsInclusion Criteria

-Research on practice behaviors that influence patient’s perception of quality

- Patient perception of attributes based on nurse attire

- Patients’ views on caring and quality vs. skill and knowledge

- Publication dates > 2000- Depiction of nursing image- Research on nursing attributes- Education and leadership related to practice, contribution and guidance

MethodsExclusion Criteria

Methods

Search#

Number of

Studies

Total Sample

SizeNumbe

r

StudyDesign

Levels of Evidence

1 380 -- 2 Quantitative Level II

2 122 -- 4 Qualitative Level IV

3 106 16 6 Mixed-MethodDescriptive

Level VI-VII

Findings

Theme I

Image Based on AttireAppearance of nurses and perceived level of skill and

caring

USA: Inpatients (n= 105)

RN’s (n=227)

• Descriptive/Replication study

• Ease of identification

t(133)= 4.67; p= 0.00

• Uniform color

t(332)=2.83; p=0.01

• Id badges

t(332)=0.72; p=0.47Wittmann-Price, R., Celia, L., Conners, C., Dunn, R., & Chabot, J. (2011).

Findings

Theme II

Health PracticesEvaluate nurses’ concerns regarding their own weight

management and its effects on the delivery of patient

education• USA: 1 K bed-Acute care Inpatient

• RN’s (n=112)

• Teaching for HP: HPLP II/Phys. activity

(CC: 0.20; P=0.003)

• Teaching/Physical activity

(cc: 0.20; p=0.007)

• Mean BMI: 27.2

• 54% sample overweight/obese

• Nat'l pop: 66% overweight/obese

(Esposito & Fitzpatrick, 2011).

Findings

Theme III

Communication

To determine the caring behaviors perceived as most

important by oncology patients and RN’s.

Iran: Inpatient, oncology center

Selected: Nurses/pts. (n=200)

Nurses and patients perceived ‘accessibility’ and ‘follow through’ as more important attributes than comfort and trusting relationships

• Significant differences in 2 of 6 scales:

• 1. Being accessible: (P=0.04)

• 2. Explains and facilitates (P=0.03)

Zamanzadeh, V., Azimzadeh, R., Rahmani, A., & Valizadeh, L. (2010).

Gaps and

Limitations

• Ongoing ambiguity related to patient perspectives in care

• Limited studies available emphasizing patient perceptions of the caring

• Lack current of RCT • Scarcity of literature addressing professionalism

in nursing• Limited guidelines for acceptable professional

appearance

Image retrieved from: http://media-cache-ec0.pinimg.com/736x/77/99/7f/77997fe287bc7a712bf397b4d0ea4f67.jpg

RecommendationsNursing

• Nurses to re-evaluate personal limitations and boundaries

• Revisit caring through the eyes of patients

• Strive to discover each individual patient’s needs

• Identify our own definitions of professional image

• Improve communication skills: both verbal and nonverbal

• Pay closer attention to personal health behaviors and practices that influence role modeling and health promotion

RecommendationsEducation

Educators among other APN’s are encouraged to emphasize:

• importance of professional behaviors

• cultural sensitivity

• Reestablish baseline attributes, morals and ethical principles consistent with nursing

• healthy lifestyle habits and behaviors

• the necessity of a strong sense of self (prior to entry and during nursing practice)

ConclusionIn hospitalized adults, how does the nurses’ professional image affect

patient perception of caring compared to practice knowledge?

• The current available evidences suggests that patients draw conclusions based on the appearance of the nurse.

• Nurses communicate details about themselves nonverbally.

• Patients decode transmission through visual cues.

• How the patient perceives the nurse affects the course of the nurse-patient relationship.

Reflection“ I think one’s feelings waste themselves in words;

they ought all to be distilled into actions which bring results”

~Florence Nightingale~

Final Thoughts

• Patients do not choose their nurses.

• When nurses are aware of their own health concerns, practices, interests and lifestyles, they possess a greater capacity to serve their patients

• Perhaps the greatest nursing responsibility adjacent to advocacy is listening, in which requires time and energy.

• Remember: Just as we assess our patients, so do they assess us……

You are an 80 year old now…and you have just awakened from a procedure that

required anesthesia and are meeting your nurse for the first time…. Retrieved from: www.dreamstime.com.

What if this was your nurse?Feel any different?

Questions??