Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession

Undergraduate Nursing Students' Perception about the Image of The Nursing

Profession At Mukalla City
(1)
Gamalat Mustafa Abd El-Ghany, (2)Nawal S. Banafa, & (3)Abdulla S. Al-Hanshi
(1)
Lecturer of Community Health Nursing Department, Faculty of Nursing, Zagazig University.
(2)
Asso. Prof. of Community Medicine, College of Nursing, Hadhramout University (3)Asso. Prof. of
Nursing Family Health and Community, College of Nursing, Hadhramout University
.
ABSTRACT:
Background: Nursing profession is considered as one of the most important carriers in health care
delivery system. Aim of the study: To explore undergraduate nursing students' perception about the
image of the nursing profession at Mukalla City. Subjects & Methods: Research design. An exploratory
descriptive design. Setting: The study was conducted in College of Nursing, Hadhramout University,
Mukalla City, Yemen. Subjects: 242 (male and female) nursing students during the academic year 2013-
2014. Tools of data collection: Two tools were used 1- A questionnaire was designed to cover socio-
demographic characteristics and, the students' information about on nursing profession. 2- A five point
likert-scale was used to explore nursing image as profession among nursing students. Results: The results
of the present study revealed that more than half (53.3%) of the sample are male and three quarters
(74%) of nursing students belonged to age group from 20-24 years. While, (45%) of nursing
students were very good academic achievement in previous semester and about two third of them were
joined the college of nursing for the desire to help others. More than three quarters (79.3%) of students
feeling with proud about nursing profession when talking to others and the most (84.3%) of them perceived
strongly agree that nursing profession was a respectful profession. About three quarters (73.9% & 71.9%)
of students perceived strongly agree that nursing profession was a respectable profession in society and a
human profession. Furthermore, (13.2%, 35.5% & 11.6%) respectively of students reported that work
condition, clinical training & relationship with medical staff were the most contributing factors that improving
the reality image about the nursing profession and more than one third (38.8%) of them their imaged about
the nursing profession got change to worse related to working conditions. The majority (97.1%) of nursing
students had positive image toward nursing as a profession. Conclusion: Middle level of nursing students
have very good academic achievement in previous semester and the majority of them have positive image
toward nursing as a profession. Recommendations: Conduct a conference for newly admitted students to
guide them on the nursing profession, nursing history, and Nursing education programs and various clinical
experiences.

Key word: Undergraduate, Nursing Students', Perception, Nursing Profession, Mukalla, City, Yemen.

Introduction: which affects the condition, strength and

Nursing profession is a field of nursing
slowly evolving from the traditional role of
women, humanistic goals, religious ideals,
common sense, theories, research as well as
the multiple influences of medicine,
technology, politics, economics and
education.[1] Profession is any job where you
need to knowledge and training specialists.
Nursing combines science and technology
with people's skills such as communication,
problem solving, teaching and empathy.[2]
The unique function of nurses is to help
individuals, whether ill or well, engage in
activities that contribute to their health or
recovery (or facilitate peaceful death) that
they will be without assistance if they have
the strength, the will or the knowledge
needed, and the achievement. This function
helps individuals to gain independence.[3]
Despite significant advances in
nursing profession, nurses continue to face
significant challenges regarding their image,
121
ability to influence changes in health care.
Where the negative image of nursing has a
number of negative outcomes, it affects the
quality and quantity of people choosing
nursing as a profession. The public that is
often frequently presented with an inaccurate
and negative nursing image will see the
nursing profession as undesirable.[4]
The image of nursing as a profession
has been influenced by several factors, thus
affecting the choice of nursing as a
profession. These include: media, public
image, marital status, nurses themselves,
family members, relatives or friends who are
nurses, model emulated, nurse interaction
with a physician, nursing teachers, risk of
violence.[5] The image refers to concrete or
visual representations and / or concepts
resulting from a person's behavior as a
professional, linked to competence and moral
behavior.[6] Put differently, the feeling and
[7]
opinion we leave with others. Image is
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession
particularly visible in our lives, because it
affects our cooperation and expectations
towards those around us, and moves to
messages about how they are seen.[8]
Choosing a profession is a complex
process that is influenced by many factors
that vary from one country to another and
from one culture to another. In addition to the
characteristics of the profession and the
individual characteristics of the person, the
environmental conditions, the political,
economic, legal, methodological and legal
characteristics, customs, values and social
attitudes affect the choice of profession. In
choosing a profession, if a person adapts to
the profession and maintains a productive
career, he / she must have a positive opinion
[9]
and attitude towards the profession.
Nursing has been a major advance
towards professionalism in recent decades
and produced a scientific basis through the
preparation of its academic programs. Now is
the time when nurses are familiar with the
images they portray as professionals for
themselves and others.[5]
Significance of the study:
The image of nursing as a profession
in Yemeni society was not properly improved
even after the nurse was trained at the
university level. Therefore, in order to recruit
and retain nurses, there is a need to
strengthen the image of nursing professionals
to enhance their position in the community
particularly for undergraduate nursing
students because this is the only nursing
college in Yemen.
Aim of the study:
The aim of the study is to explore
undergraduate nursing students' perception
about the image of the nursing profession at
Mukalla City.
Research questions:
- Do undergraduate nursing students' have
perception about the image of the nursing
profession?
Subjects & Methods:
Design:
This study was carried out using an
exploratory descriptive design.
Setting:
The study was carried out in College of
Nursing, Hadhramout University, Mukalla
City, and Hadhramout Governorate, Yemen.
Subjects:
The study was conducted on 242
male and female nursing students (215 from
122
Nursing College) who had accepted to
participate in this study out of 450 nursing
students enrolled in the four levels from
College of Nursing, Hadhramout University
during the academic year 2013-2014 and (27
internship year) within the same academic
year.
Tools of data collection:
Two types of tools were used for data
collection:
1- A questionnaire sheet was designed by
the researcher to cover data about students'
socio-demographic data as; age, sex,
residence, academic year, academic
achievement in previous semester, reason for
enrollment to the college of nursing, family's
reaction to students' enrollment with college
of nursing, and feeling about nursing
profession when talking with others and
Nursing image as a profession questionnaire
(NIPQ) was used for the students' information
about nursing profession as; having
information about nursing before joining the
college of nursing, source of information,
effect of such information on nursing image,
and type of effect. And Changing in Nursing
Image as; changing in nursing image after
joining college of nursing, factors contributing
to the change to better, and factors
contributing to the change to worst. 2- A five
point likert-scale format was used to
explore perception of nursing students about
nursing image as profession (14 perception
statement) as; a respectful profession, an
occupation is not a profession, a profession
of women, similar to that of the servants' job,
a respectable profession in society, a
prestigious profession, a serious profession,
a difficult profession does not get enough
appreciation, an indispensable profession in
any society, nursing is a human profession,
an independent profession, a significant in
patient's recovery, helping to promote health
and prevent disease, and provide self-
realization. Guided of Abdel El-Halem, et al.
[5]
Scoring:
A scoring for perception of nursing
students' toward nursing image as a
profession was consisted of given five for
strongly agree, four for agree, three for
neutral, two for strongly disagree and one for
disagree. A scoring was given to each
statements and a total of perception score
was 70 points. A total score of 42-70 conveys
a positive perception toward nursing image
as a profession, while a total score of 14-41
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession
conveys a negative attitude toward
perception toward nursing as a profession.
Pilot study:
A pilot study was conducted prior to
the beginning of data collection on 10% of the
study sample (24 male and female students)
who were excluded from the main study
sample to test the feasibility of the study and
the clarity and applicability of the tools.
Content validity and Reliability:
The tools were tested for content validity
by panel of experts of community health
nursing department. These experts assessed
the tools for clarity, relevance, applicability,
comprehensiveness, and understanding of
the tools, all recommended modifications on
the tools were done. Reliability of the
proposed tools was done by Cronbach's
Alpha test; it was 0.297 for tool I and 0.519
for tool II.
Fieldwork:
The data collection procedure for this
study was carried out in two months, from
December 2013~January 2014. The
researcher began by explaining the purpose
of the study briefly to nursing students during
a break between lectures. Each student was
asked to respond to a questionnaire sheet
under the supervision of the researcher. The
time taken to answer each question sheet
ranged from 20 to 25 minutes and collected
on the same day.
Administrative and ethical considerations:
A written permission was obtained
from the dean of the college to search this
subject. The agreement for participation of
the topics was taken orally after explaining
the objective of the study for them. They were
given the opportunity to refuse or participate
in the study. The collected data was
confidential.
Statistical analysis:
For statistical analysis the SPSS 14.0
statistical package is used. From statistical
parameters the following are used; mean,
stander deviation, frequency table with
percentage and Chi-square test.
Results:
Percentage distribution of the study
subjects towards their Socio-demographic data
are summarized in table 1. From the table,
53.3% of the sample are male and 74% of
nursing students belonged to age group from
20-24 years and 66.5% of them were come
from urban area. 25.2% of students were at
third academic year, 22.7% at second
123
academic year, 21% at first academic year,
while 19% at fourth academic year and only
11.2% of the subjects were at the internship
year. As regard to the academic achievement
in previous semester, 45% from nursing
students reported were very good and 32.2%
were good, while 21.1% of them reported
were excellent achievement in previous
semester.
According to the data in table 2.
62.4% of the nursing students were joined
the College of Nursing according for the
desire to help others, while 16.1% of them
reported did for both secondary school grade
and advice from family member. Few
percentage 2.9% & 2.5% of them mentioned
that the availability of work in other countries
and during undergraduate were the reason
for the enrollment with college of nursing
respectively. As regard to the feeling about
nursing profession when talking to others,
79.3% of nursing students mentioned were
proud and few percentage 5.8% & 2.1% of
them attack nursing profession and defensive
about nursing respectively.
It is clear from Figure1 that 73.1% of
the subjects family have positive reaction for
students' enrollment of the College of Nursing
and 21.1% of them have neutral reaction,
while the least (5.8%) of them have negative
reaction.
Table 3. Reveals that 67.8% of
nursing students had information about
nursing. The main source of such information
was family and friends 45.9%. Additionally,
21.5% & 20.7% of them got such information
from schools and health setting respectively.
Only 12% of them got information from
media. 63.2% of nursing students mentioned
such information had effect on nursing image
and 56.6% of them reported positive effect to
this information on nursing profession.
Table 4. Shows the students
perceptions of Nursing as a Profession, from
the table indicated that 84.3% of nursing
students perceived strongly agree nursing as
a respectful profession, 29.8% of them
perceived disagree nursing as an occupation
is not a profession and, 31.8% of them
perceived disagree nursing as a profession of
women. Few percentage 6.2% of students
perceived strongly agree nursing as a similar
to servants' job. Additionally, equal
proportions 46.4% of them perceived agree
nursing as a respectable profession in society
or a prestigious profession and 45.9% of
students perceived agree nursing as a
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession
serious profession. While, 24.4% of them
perceived strongly agree nursing as a difficult
profession does not get enough appreciation
and 73.9% of students perceived strongly
agree nursing as a respectable profession in
society. Furthermore, 71.9% of the students
perceived strongly agree nursing as a human
profession and 24.5% of them perceived
strongly agree nursing as an independent
profession, while 55.8% of them perceived
strongly agree nursing as a significant in
patient's recovery. Moreover, 52.5% &57%
respectively of students perceived strongly
agree nursing as helping to promote health
and prevent disease, and provide self-
realization.
It is clear from Figure 2. Reveals that
97.1% of the students had positive image
toward nursing as a profession, while only
2.9% of their image was negative.
Table 5. Clarifies the change in
nursing image after joining college of Nursing,
from the table 27.3% of nursing students,
image of nursing was improved after
enrollment; the image of 61.2% of the got
worse and only 5.8% had no change. As
regard to students image improvement,
35.5% got change to better related to clinical
training and 13.2% related to working
conditions while, 11.6% related to relationship
with medical staff. Additionally, 38.8% got
change to worse related to working conditions
followed by 13.6% related to relationship with
medical staff.
Discussion:
Nursing offers significant progress
towards professionalism in recent decades
compared to previous decades, and a
scientific base is produced through its
academic preparation programs. Now, this is
the time nurses are familiar with the images
they portray as professionals for themselves
and others. Ago, these images are formed
during the study and interested in the way the
formation of perceptions (image profession).
Therefore, the aim of the present study was
to explore undergraduate nursing students'
perception about the image of the nursing
profession at Mukalla City.
The current study revealed that more
than half of nursing students were males and
three quarters of them belonged to age group
from 20-24 years in, this finding agreement
with study in Kingdom Saudi Arabia by
Mahran and Al Nagshabandi[10] who revealed
that the majority of student's age ranged from
124
22 to 25 years and disagree with the study
conducted in Jordan by Al Jarrah.[1] who
mentioned that (69.1%) of the subjects were
males and more than half are in the aged 18-
20 years. From view the researchers, this
result with age group may be because of
Yemeni students should not enrollment with
University after secondary grade immediately
and the students at four levels were
participated in this study; this is a wonderful
thing and denotes perceptive awareness
among nursing students about nursing
profession.
The finding of the present study
indicated that forty five percent from students
academic achievement in previous semester
were very good and about one third were
good, this result in the same line with the
study conducted in Egypt by Abdel El-Halem
et al[5] who reported that 39% from male
nursing students reported were very good
and 24.6% were good.
The result of current study revealed
that about two third of Yemeni nursing
students were joined the college of nursing
according for the desire to help others, while
sixteen percent of them reported did for both
secondary school grade and advice from
family member and the least of them
mentioned that the availability of work in other
countries. This result demonstrates the noble
goals that nursing students have found in
nursing college. These results in agreement
with study in Bahrain by Eman et al[11] who
mentioned that the majority of respondents
identified the desire to care for others as one
important factor for their choice to study
nursing. But, in contrary to the studies
conducted in many countries, which were the
most important reasons for registration of
students are jobs and occupation. A study by
Streubert
[12]
in Pennsylvania that was
engaging because of nursing jobs, security
and availability. This is also confirmed by by
the AbdlKarim et al[13] in Egypt. The
researchers revealed that nearly two-thirds of
the threads haven chooses nursing as it
represents a good chance for them to work.
Buerhaus et al[14] (USA) joined a little more
than three-quarters of the subjects because
of the availability of nursing work. Sand-
Jecklin and Scheffer[15] at added that
students often choose nursing because of the
availability of jobs, safety, salaries and
attention to the field of nursing. Another study
by Williams et al[16] indicated that students
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession
choose to study nursing because it provides
their work abroad and opportunities for further
professional development.
The present study showed that the
majority of the subjects' family reaction to
students' enrollment to the college of nursing
was positive. From view of researchers this is
a great result indicates a high level of
students enrolled of nursing college and the
importance of the nursing profession to
Yemeni society figure 1. These results in
agreement to studies conducted in several
countries; study in (Egypt & Jordan) by
Ibrahim et al[17] who found that for the family
reaction and enrollment in nursing faculty, the
major positive view percentage was belonged
to the Jordanian male students. From view
the researchers, this results clarifies the
strong impact of families on encouraging or
suppressing career desires. On the same
line, Abdel El-Halem et al[5] discussed that
there is a significant relation between the
presence of family support and entering the
nursing profession. Moreover, Al Jarrah[1]
stressed that the family members had a
considerable collision in deciding nursing as a
career.
As regard to a feeling of nursing
student about the nursing profession, the
result of the present study showed that the
most of the students feel proud because they
belong to the nursing profession, while
distributed ratios other between those who
feel modesty and change the subject when
talking about nursing and those who defend
and attack the occupation. Moreover, the
result of current study revealed that the
majority of nursing students were positive
perceptions associate the image of the
nursing profession figure 2. These results
accordance to this result with many of the
[18]
studies in Belgium in 2010 by Milisen et al ,
[19]
Egypt in 2016 by Fouda et al , Abdel El-
[5] [20]
Halem et al , Fatema Baddar , Abdlkarim
et al[13], Bahrain, in 2012 Eman et al[11]
The current study reveals that about
two thirds of nursing students have
information about nursing before joining to
the college of nursing and forty six percent
mentioned the main source of such
information was family and friends and only
twelve percent of them got information from
media. Additionally, about two thirds of
students reported that such information had
effect on nursing image and more than half of
125
them reported positive effect to this
information on nursing profession; These
results were in the same line with study done
in America, by Mendez & Louis[21] which
reported that 50.5% have information and
49.5% do not have it and 72.8% positive
effect on image of nursing profession and
disagree with study conducted in Egypt by
[22]
Gamal who reported that media is one of
the most important factors that have
influenced, and continue to affect, and will
likely continue to affect the public image of
nursing.
Concerning with perception of nursing
students about the image of nursing
profession in table 4 the results of present
study reveals that the majority of students
perceived strongly agree nursing as a
respectful profession, and about forty seven
percent of them perceived agree nursing as
well respectable profession in the society or a
prestigious profession and about three
quarters of them perceived strongly agree
nursing as an indispensable profession in any
society and as a human profession, while
more than half of them perceived strongly
agree nursing as a significant in patient's
recovery and as helping to promote health
and prevent disease, and provide self-
realization. These results in the line with
study conducted in Jordan by Al Jarrah[1]
show that nursing is a prestigious profession
occupied the 1st rank with mean as (4.87).
Nursing is a respectful profession occupied
the 2nd rank with mean as (3.6). And in line
with study by Fouda et al[19] in Dakahlia
Governorate who found that positive
perception regarding most items of the four
dimensions of the nursing image as
profession; nursing profession description,
social perspective, benefits of nursing
profession and different roles of nurse in the
health care setting. From view the
researchers, this might be attributed to the
fact that nursing as a career became more
valued and treasured. This is the same
viewpoint of Abdlkarim et al[13] who found out
that the nursing profession was seen prized,
valued and secure so it became striking. The
result of this study is in accordance with
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession
Abdel El-Halem et al[5] who concluded that
the greater part of nursing students held a
positive perception of the nursing image as a
profession.
Current study shows that one third of
nursing students image was improved after
enrollment; the image of about two third of
them they got worse and more than one third
got change to better related to clinical training
and thirteen percent related to working
conditions. While, few percentage were
related to relationship with medical staff.
Furthermore, more than one third got change
to worse relate to working conditions and
about fourteen percent related to relationship
with medical staff. These results disagrees
with study conducted in Egypt by Gamal[22]
Who mentioned that the highest percentage
of her subjects were negatively affected by
faculty members because of the negative
relationship between teacher and student.
From view the researchers, this results may
be due to some Yemeni teachers encourage
students to self-confidence and encourage
them to ask questions freely and feeling of
warmth between teaching staff members and
the students. Additionally, in the same
[5]
viewpoint with Abdel EL- Halem et al who
reported that Work conditions have had a
negative impact on less than five study
subjects, and this can be attributed to an
126
uncomfortable working environment, and
exposure to both physical and emotional
risks. Moreover, the lack of facilities and
resources, the gap between the theories that
have been taught and actual practices in
government hospitals.
Conclusion:
In the light with the main study
findings, it might be concluded that middle
level of nursing students have very good
academic achievement in previous semester
and the majority of students have positive
image toward nursing as a profession. Work
condition, clinical training, and relationship
with medical staff were the most contributing
factors that improving the reality image about
the nursing profession to better.
Recommendations:
Based on the results of the study the
following recommendations can be
detected:
1- Conduct a conference for newly admitted
students to guide them on the nursing
profession, nursing history, and Nursing
education programs and various clinical
experiences.
2- Workshops for newly appointed teachers
to teach them how to deal with nursing
students.
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession

Table (1). Percentage Distribution of the Study Sample According to

their Socio-demographic data (No. 242)

Socio-demographic data Frequency Percent

Sex:
 Male 129 53.3
 Female 113 46.7
Age:
 15+ 8 3.3
 20+ 179 74.0
 25 year and more 55 22.7
Residence:
 Rural 81 33.5
 Urban 161 66.5
Academic year:
 First year 52 21.5
 Second year 55 22.7
 Third year 61 25.2
 Fourth year 47 19.4
 Internship year 27 11.2
Academic achievement in previous semester:
 Excellent 51 21.1
 Very good 109 45.0
 Good 78 32.2
 Satisfactory 2 0.8
 Weak 2 0.8

Table (2). Distribution of the Study Sample According to Reasons for Enrollment to
the College of Nursing and Feeling about Nursing as a Profession (No. 242)

Variables Frequency Percent

Reasons for enrollment to the College of Nursing:
 Secondary school grade 39 16.1
 Desire to help other 151 62.4
 Advice from family member 39 16.1
 Availability of work in other countries 7 2.9
 Availability of work during undergraduate 6 2.5
Feeling about nursing profession when talking to
others:
 Proud 192 79.3
 Shy 16 6.6
 Change topic 15 6.2
 Defensive 5 2.1
 Attack nursing profession 14 5.8

127
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession

Family reaction for students enrollment to the College of Nursing

5.8%

21.1% Positive

Neutral
73.1%
Negative

Figure 1: Distribution of the study sample according to family reaction

for students' enrollment to the College of Nursing

Table (3). Percentage Distribution of the Study Sample According to their Information
about Nursing and Source of such Information (No. 242)

Information Frequency Percent

Presence of information about nursing before
joining the college of nursing:
 Yes 164 67.8
 No 78 32.2
Source of information:
 Family and friends 111 45.9
 School 52 21.5
 Health setting 50 20.7
 Media 29 12.0
Effect of such information on nursing image:
 Yes 153 63.2
 No 89 36.8
Type of effect:
 Negative 105 43.4
 Positive 137 56.6

128
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession

Table (4). Distribution of the Study Sample According to their Perceptions

of Nursing as a Profession

Strongly Agree Neutral Strongly Disagree

Nursing profession is agree Disagree

No % No % No % No % No %

 A respectful profession 204 84.3 30 12.4 5 2.1 2 0.8 1 0.4

 An occupation is not a 29 12.0 30 12.4 43 17.8 68 28.1 72 29.8
profession
 A profession of women 30 12.4 35 14.5 40 16.5 60 24.8 77 31.8
 Similar to that of the 15 6.2 27 11.2 25 10.3 108 44.6 67 27.7
servants' job.
 A respectable 68 28.1 113 46.7 39 16.1 8 3.3 14 5.8
profession in society
 A prestigious profession 70 28.9 113 46.7 35 14.5 13 5.4 11 4.5
 A serious profession 57 23.6 111 45.9 30 12.4 13 5.4 31 12.8
 A difficult profession
does not get enough 59 24.4 44 18.2 43 17.8 40 16.5 56 23.1
appreciation
 An indispensable 178 73.6 34 14.0 17 7.0 8 3.3 5 2.1
profession in any
society
 Nursing is a human 174 71.9 50 20.7 7 2.9 6 2.5 5 2.1
profession
 An independent 59 24.4 47 19.4 49 20.2 32 13.2 55 22.7
profession
 A significant in patient's 135 55.8 83 34.3 13 5.4 10 4.1 1 0.4
recovery
 Helping to promote
health and prevent 127 52.5 100 41.3 11 4.5 4 1.7 0 0.0
disease
 Provide self-realization 138 57.0 76 31.4 21 8.7 4 1.7 3 1.2

120

97.1 %
100

80

60 Negative image
Positive image
40

20
2.9 %
0
Nursing image as a profession

Figure 2. Distribution of the study sample according to their nursing image as a profession

129
Gamalat Mustafa Undergraduate Nursing Students' Perception about Image of Nursing Profession

Table (5). Distribution of the Study Sample According to the Change in Nursing ImageAfter Joining College
of Nursing (No. 242)

Changing in Nursing Image Frequency Percent

Changing in nursing image after joining college of
nursing:
 No 14 5.8
 Yes 66 27.3
 Yes to better 14 5.8
 Yes to worst 148 61.2
Factors contributing to the change to better:
 Working conditions 32 13.2
 Clinical training 86 35.5
 Relationship with College members 15 6.2
 Relationship with medical staff 28 11.6
 Relationship with friends 21 8.7
 Family member opinion 7 2.9
 Public view about nursing 8 3.3
 More than one answer 45 18.6
Factors contributing to the change to worst:
 Public view about nursing 22 9.1
 Relationship with College members 20 8.3
 Working conditions 94 38.8
 Clinical training 22 9.1
 Relationship with medical staff 33 13.6
 Relationship with friends 9 3.7
 Family member opinion 5 2.1
 More than one answer 37 15.3

References: of Wisconsin Oshkosh. Published Master Thesis.

1-Al Jarrah IAT. (2013). Associate Nursing
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