International Journal of Africa Nursing Sciences 17 (2022) 100445

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International Journal of Africa Nursing Sciences

journal homepage: www.elsevier.com/locate/ijans

Perception towards nursing profession and associated factors among

patients at Jimma Medical Center, Ethiopia. A cross- sectional study
Lalisa Ayele Woldasemayat a, *, Leul Mekonnen Zeru b, Asresash Demissie Abathun c
a
School of Midwifery, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
b
Faculty of Health Science, Institute of Health, Jimma University Medical Center, Ethiopia
c
School of Nursing, Faculty of Health Science, Institute of Health, Jimma University, Ethiopia

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Nursing is a health-care profession that focuses on assisting individuals, families, and communities
Perception in achieving, maintaining, or regaining optimal health. Some studies show that the image of the profession is
Nursing damaged by misconceptions due to a misunderstanding of the facts of the profession. Thus, this study aimed to
Profession
assess the perceptions towards the nursing profession and associated factors among patients at Jimma Medical
Associated factors
Jimma Medical Center
Center, Ethiopia.
Methods: Institutional based cross-sectional study was conducted in Jimma Medical Center from April 3–15/
2019. A systematic sampling technique and face to face interviews were used to collect data. The data were
entered using Epidata version 3.1 and analyzed by SPSS version 23. Simple Linear regression analysis was done
and the significant variables were explained by using an unstandardized ß value and p-value of less than 0.05.
Results: The perception score, 99(42.4%) high perception, 61(26%) medium perception, and 74(31.6%) low
perception towards nursing profession. Age (41–60 years) (ß = − 1.172, p = 0.042), area of residence (ß = 1.853,
p = 0.008), social value and role (ß = 2.065, p = 0.0001) and nursing care satisfaction (ß = 1.769, p = 0.001)
were factors affected perception towards nursing profession.
Conclusion: The overall level of patients’ perception of the nursing profession was found to be low. Age, resi­
dence, social value and role characteristics, and nursing care satisfaction were significantly associated with the
perception of patients. Therefore, health education and awareness creation towards the nursing profession
should be given to the community.

1. Introduction
Nursing is a health-care profession that focuses on assisting in­
dividuals, families, and communities in achieving, maintaining, or
regaining optimal health (Ingwu, Ohaeri, & Iroka, 2016). Nurses
represent the largest proportion among Health Care Providers (HCP),
who are the most diverse workforce the strongest pillars in the health
care system and play a significant role in the hospital setting. Nursing
services aim to provide competent, safe, and ethical care which also
includes comfort, compassion, and collaboration with clients, family,
community, and the health care team (Zulu & Ngoma, 2015).
Nursing is a career that is rapidly expanding in developed countries.
The evolution of nursing as a profession to serve and advocate for people
to make life safer and to provide a health care system that is humane to
the end of life, as well as the practice of nursing care. The current public
opinion about the nursing profession varies from place to place based on
the educational status of the population and the practice of nursing care.
Due to this reason, it is incoherent that society may not have always
correctly evaluated how the nursing profession involves through inno­
vation and education and may not always be aware that modern nursing
is based on established theories and principles based on the health care
system of the country (Rubbi, Cremonini, Artioli, Lenzini, & Talenti,
2017). Nurses are the most important health care professionals in
Ethiopia, working as clinicians, educators, leaders, and researchers in
hospitals, clinics, universities, ministries of health, health centers, and
nonprofit organizations (Tilahun, Nasrabadi, Alemayehu, Teklu, Ali, &
Ali, 2016).
The community’s perception of nursing as a profession can affect the
recruitment and retention of nurses. The community’s positive percep­
tion of nursing attracts more people, while a poor community perception

* Corresponding author.
E-mail addresses: lalisa.ayele@ju.edu.et, lalisaayele@yahoo.com (L. Ayele Woldasemayat).

https://doi.org/10.1016/j.ijans.2022.100445
Received 5 October 2021; Received in revised form 6 June 2022; Accepted 11 June 2022
Available online 14 June 2022
2214-1391/© 2022 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
L. Ayele Woldasemayat et al.
and negative nursing image lead to insufficient numbers of people
entering the nursing profession (Saied, Beshi, Nafaie, & Anazi, 2016).
The different views show that the public sees nurses as feminine and
caring, but not necessarily as autonomous (Jansen, 2013). The nursing
profession should be improved by carefully structuring nursing courses
to recruit new nurses and sustain professionalism in nursing practice
(Fathi, Dalal, Akel, Wasil, & Alzghoul, 2015).
There are many factors impacting nursing career choices had a sig­
nificant impact on professional development and the provision of high-
quality nursing care (Aylin Aktas, Ozakgul, Atabek, Emrullah, & Nihan,
2017).
The societal worth of nursing is low due to misunderstandings about
the profession (Lim, Asyraf, & Muhtar, 2016). Where nurses have been
able to influence health policy development, there have been positive
benefits for health care, patients, and the community image of the
nursing profession. Nursing, on the other hand, has been perceived as an
oppressed group by other health care professionals and within health
care organizations, which has had an impact on the profession (Shariff,
2015).
The nursing profession has a problem as patients, families, and the
public become more aware of health care and their rights, as well as
their need for quality care. As a result, nursing professionals must stay
current and be prepared with all the answers (Side, 2015).
The nurse-patient relationship is a two-way street, in which both
parties interact to better understand one another. Patients’ perceptions
of nursing care are influenced by nurses’ spending time with them and
their respect for them, but a lack of adequate information about their
condition and treatment, kindness, cheerfulness, and the practice of
scientific nursing procedures creates a negative image of the nursing
profession (Shawa, 2017).
Gender stereotyping, subordination to doctors, low academic re­
quirements, limited career options, poor pay, and working conditions
are just a few of the negative societal opinions about nursing. Percep­
tions may influence nursing recruitment, with the result being a scarcity
of nurses, both in terms of qualification and in terms of number,
resulting in low-quality patient care and poor patient outcomes (Getu,
2015).
There was no research on patients’ perceptions of nurses in a study of
the literature. This study will be useful for nursing leaders and staff
nurses in confirming gaps and community perceptions of the profession,
as well as examining relevant issues. There are few studies in Ethiopia on
patients’ perceptions of nursing and related issues, and the outcomes of
this study will help scholars/researchers plan large-scale studies on this
topic in the future.
Thus, this study aimed to assess perceptions of patients towards the
nursing profession and associated factors in Jimma University Medical
Center.
2. Methods and materials
2.1. Study design, setting, and period
A facility-based cross-sectional study was conducted at Jimma
Medical Center hospital in Jimma town. Jimma is one of the oldest
towns which are found in the southwest Oromia Region of Ethiopia, 346
Km from Addis Ababa capital city of Ethiopia. Jimma Medical Center
hospital is one of the oldest hospitals in the Oromia region, southwest
Ethiopia, serves around 15–20 million people. The study was conducted
from April 3/2019 to April 15/2019.
2.2. Inclusion and exclusion criteria
The study included all patients who were at least 18 years old and
above and had been admitted for at least 24 h. Patients who were crit­
ically or psychologically ill and unable to communicate were excluded
from the study.
2
International Journal of Africa Nursing Sciences 17 (2022) 100445
2.3. Sample size determination and sampling procedure
The sample size was determined as single population proportion
formula (n¼ (Z α)/2) ^2P (1‫־‬P)/d2) by considering the assumption of
50% proportion, 95 % confidence level, and 0.05 margin of error, 10%
non-response rate. Calculated by the mentioned assumptions, the sam­
ple size was adjusted by correction formula due to the source population
which was the total admitted patients (4 9 3) in the study facility were
less than ten thousand, so the final sample sizes were 238. The study
participants were selected using a systematic sampling technique, and
selected at every two intervals from all selected wards such as medical,
surgical, gynecological, maternity, and ophthalmology wards. The
samples were drawn proportionally from each ward based on the
number of admitted patients.
2.4. Data collection tools
The semi-structured interviewer-administered questionnaire con­
tained eight questions for socio-demographic characteristics, twelve
questions for the perception of patients towards the nursing profession,
seven questions for nature of the nursing profession, five questions for
choosing the nursing profession as a career, nine questions for social
value and role characteristics of the nursing profession, and thirteen
nursing care satisfaction were used.
The tools for measuring perception were four points Likert scale(1 =
Strongly Disagree, 2 = Disagree, 3 Agree, 4 = Strongly Agree) (Alroq,
2017; Khalil, Bio, Gilani, & Lahore, 2017; Saied et al., 2016; Shawa,
2017). The reliability of the tools was checked by Cronbach’s alpha after
the pretest result for nature of the nursing profession, social value and
role characteristics, perception towards the nursing profession, choosing
as a career, and nursing care satisfaction were,0.857, 0.766, 0.788,
0.797 and 0.939 respectively.
2.5. Data collection procedures
The data was collected onsite using a pretested, structured, face-to-
face interviewer administered questionnaire. Some changes were
made to the questionnaire after the pretest result. The tools were clear
and suitable for the participants, with modifications made to improve
clarity, sequence, consistency, structure, and the total time it took to
finish the questionnaire. Data were collected by seven BSc nurses and
supervised by two MSc nurses after two days of training. The ques­
tionnaire was translated into local languages and then retranslated back
to English to maintain consistency by language experts of both lan­
guages. The data collectors completed the questionnaire for each
respondent interviews took about 25 min to complete the questionnaire.
Participants were interviewed in a private room to maintain confiden­
tiality and information provided by participants. Finally, the completed
questionnaires were checked by supervisors.
3. Measurement
3.1. Perception of Patients towards Nursing Profession
Patients’ decision to their perception of the nursing profession which
was measured by 3 items in the nursing profession having a 4-point
Likert (1 = strongly disagree to 4 = strongly agree) the sum score
ranging from a minimum of 3 to a maximum of 12 the higher the score
the higher patient’s perception in the nursing profession. Patients’
perception was done by using data-driven classification (tertile classi­
fication by rank order); the lower tertile represents low-level perception,
the middle tertile represents medium level perception whereas the upper
tertile indicates the higher level of patients’ perception.
L. Ayele Woldasemayat et al. International Journal of Africa Nursing Sciences 17 (2022) 100445

3.2. Nature of nursing profession
The nature of the nursing profession was assessed by 7 items of a 4
Likert scale, measured as aware (if they scored 50% and above) and not
aware (scored less than 50%).
3.3. Social value and role characteristics
These were assessed by 9 items in a 4 Likert scale, measured as
positive (if they scored 50% and above) and negative (scored less than
50%).
3.4. Choosing nursing as a career
This was assessed by 5 items on a 4 Likert scale, and we measured it
as interested (if they scored 50% and above) or not interested (scored
less than 50%).
3.5. Nursing care satisfaction
This was assessed by 13 items which on a 4 Likert scale, measured as
satisfied (if they score 50% and above) or not satisfied (scored less than
50%).
a response rate of 98.3%. The mean age of the respondents was 39.75 ±
14.58 years, with a range of 18–80 years. About 188(80.3%) were
married, 81(34.6%) of the study participants had no formal education
and 130(55.6%) of them were living in urban (Table 1).
5.2. Perception of patients toward the nursing profession
Concerning the level of perception of patients, the perception score
was 99(42.4%) high perception, 61(26%) medium perception, and 74
(31.6%) low perception of the nursing profession. About 101(43.2%)
strongly agreed the nursing profession was prestigious, even though the
nursing profession was an extremely hard profession, 131(56%) of the
study participants strongly agreed that nursing didn’t receive enough
appreciation from the concerned bodies.
On the professional independence and decision-making process, 136
(58.1%) and 73(31.2%) of the respondents strongly agreed and agreed
respectively that independence and can decide by themselves. Seventy-
four (74 (31.6%)) and 51(21.8%) of the study participants strongly
agreed and agreed that nurses obeyed doctors’ orders or commands
without questioning them, 82(35%) and 27(11.5%) of them strongly
disagreed and disagreed that nurses obeyed doctors’ orders without
questioning them (Table 2).

3.6. Data processing and analysis 5.3. Associated factors with the perception of patients toward the nursing
profession
The collected data were checked for completeness and accuracy
before analysis. The collected data were entered into Epidata version 3.1 On simple linear regression, age, sex, educational status, residency,
and then exported to SPSS version 23 for analysis. Descriptive statistics nursing profession nature, social value and role characteristics, career,
were calculated and results were presented using texts and tables. and nursing care satisfaction were significant at a p-value of 0.25 and
Before fitting the linear regression model, the assumptions were were put into the multivariable linear regression model.
checked. The assumption of linearity and multi-collinearity was checked
and satisfied. A simple linear regression analysis was done to see the Table 1
association between dependent and independent variables. Those vari­ Socio-demographic characteristics of participants at Jimma Medical Center,
ables which were significant with a p-value of less than or equal to 0.25 Jimma, Ethiopia, April 2019.
were run for multivariable linear regression and a p-value of <0.05 was Variables Category F (%)
declared as statistically significant factors in multivariable linear Sex of respondent Male 101 (43.2%)
regression. Female 133 (56.8%)

3.7. Data quality control Age 18–40 years 135 (57.6%)

41–60 years 75 (32.1%)
Data quality was assured by a pretest of the questionnaire at the >=61 years 24 (10.3%
Shenen Gibe hospital on 5% (12 participants) of the total sample before
the actual data collection period. Based on the findings, the question­ Marital status Single 37 (15.8)
naire was assessed and modified in a clear context. Trained data col­ Married 188 (80.3%)
Widowed 6 (2.6%)
lectors collected the data. The supervisors collected the questionnaire Divorced 3 (1.3%)
every day and checked each part of the instrument for missed values
before data entry, and incomplete data were discarded.
Residence Urban 130 (55.6%)
Rural 104 (44.4%)
4. Ethical consideration Level of education Not attended any school 81 (34.6%)
Primary school 72 (30.8%)
Ethical approval was obtained from the Ethical Review Board of the Secondary school 44 (18.8%)
Higher education. 37 (15.8%)
Institute of Health (IHRPGD/466/2019), Jimma University. A permis­
sion letter was obtained from Jimma Medical Center and communicated
Occupation Housewife 74 (31.6%)
to concerning bodies. Each respondent was asked for voluntary partic­
Farmer 56 (23.9%)
ipation and verbal informed consent was obtained from them. Each Government worker 40 (17.1%)
study participant was also informed that they could withdraw at any Merchant 41 (17.5%)
time if they were not interested in the questionnaire. To maintain Others* 23 (9.8%)
confidentiality, the information obtained from the participant data was
kept anonymously. Family monthly income <1000 birr 39 (16.7%)
1000–5000 birr 167 (71.4%)
5. Results >5000 birr 28 (12%)

5.1. Socio-demographic characteristics Previous admission Yes 79 (33.8%)

No 155 (66.2%)

A total of 234 admitted patients participated in the study, which gave Keys: *= Students, Tailor, and Private worker, F = Frequency.

3
L. Ayele Woldasemayat et al. International Journal of Africa Nursing Sciences 17 (2022) 100445

Table 2 that determine patients’ perception of the nursing profession (Table 3).
Perception of patients towards a nursing profession in JMC, Jimma, Ethiopia,
April 2019. 6. Discussion
S. Statement Strongly Disagree Agree Strongly
no disagree agree The overall perception of patients toward the nursing profession was
The nursing profession 17(7.3%) 15 101 101 52.77 percent in this study. In this study, participant age (41–60 years)
is prestigious (6.4%) (43.2%) (43.2%) was found to be a significant predictor of patients’ perception of the
The nursing profession 11(4.7%) 10 82 131 nursing profession. This finding is in line with a study conducted in
is an extremely hard (4.3%) (35%) (56%)
Northeast Ethiopian referral hospitals, which found that overall patient
profession that does not
receive enough satisfaction was 52.5 percent (Eyasu, Adane, Amdie, Getahun, & Biwota,
appreciation 2016).
The nursing profession 2(0.9%) 5(2.1%) 66 161 This result is consistent with the study conducted in Kenya, in which
is essential in any (28.2%) (68.8%) study participants aged (18–59 years) were very satisfied with the
society
The nursing profession 12(5.1%) 13 73 136
nursing profession during their hospitalization (Shawa, 2017). The
is an independent (5.6%) (31.2%) (58.1%) finding of the study was a little higher than the study conducted in
profession by which Benishangul Gumuz, Ethiopia in which the perception of patients of the
nurses decide for nursing profession was 49.3% but indicated that age wasn’t an associ­
themselves
ated factor (Care, Hospitals, Gumuz, & State, 2018).
The nursing profession 1(0.4%) 4(1.7%) 66 163
is a significant in- (28.2%) (69.7%) The possible difference may be due to socio-demographic charac­
patient recovery teristics, study period personal attitude differences, and the professional
In nursing, professional 9(3.8%) 11 72 142 quality of nurses that provided nursing care have great power to influ­
nurses are given a (4.7%) (30.8%) (60.7%) ence patients’ perception of the nursing profession.
chance to use their
In another study conducted at Felegehiwot Referral Hospital,
initiative in their work
Nurses obey doctors‟ 82(35%) 27 51 74 Ethiopia, patients’ satisfaction had no significant association with age
orders without (11.5%) (21.8%) (31.6%) (Mulugeta, Wagnew, Dessie, Biresaw, & Habtewold, 2019). This may be
questioning them due to when the study was conducted, the sample size different study
In the nursing, 143 25 42 24
designs and personal attitudes, and the quality of nurses that provided
profession nurses waste (61.1%) (10.7%) (17.9%) (10.3%)
a lot of time being busy the nursing care.
doing nothing This study also identified participants’ residence (being rural) as a
Anyone could be a nurse 137 27 37 33 positive predictor of patient perception of the nursing profession. In the
(58.5%) (11.5%) (15.8%) (14.1%) study conducted in Ethiopia at Felegehiwot Referral Hospital, Amhara
The nursing profession 23(9.8%) 10 82 119
Regional State residence was not a significant predictor of perception
has an opportunity for (4.3%) (35%) (50.9%)
personal growth towards the nursing profession (Mulugeta et al., 2019).
The nursing profession 4(1.7%) 5(2.1%) 72 153 The social value and role characteristics were significant predictors
is a caring profession in (30.8%) (65.4%) of perceptions of the nursing profession in the study. This finding is
which an ethical
inconsistent with the study conducted in the Saudi community (Saied
standard of care is
maintained
et al., 2016). This may be because in any health care system the nursing
The nursing profession 16(6.8%) 10 58 150 profession played a great role by giving care to patients continuously for
is equal to other (4.3%) (24.8%) (64.1%) 24 h, the patients’ understanding of the nursing profession and com­
professions munity perception of the nursing profession is good.
The other significant predictor revealed by this study was the nursing
At a p-value of (p < 0.05), age, place of residence, social value and care satisfaction of the patients. This study finding was high (59.4%)
role traits, and nursing care satisfaction were all significant in multi­ when compared with the study conducted in Felege Hiwot referral
variable linear regression analysis.
Those ages 41–60 years were significantly associated with the Table 3
perception of patients towards the nursing profession at (ß = − 1.172; Multivariable linear regression analysis of factors affecting the perception of
95%CI (− 2.300, − 3.364), p = 0.042) which indicated that as the age patients towards the nursing profession in Jimma Medical Center, Jimma,
increased by one unit, perception towards the nursing profession Ethiopia, April 2019.
decreased by 1.172 times. Variables Category Unstandardized ß 95% P-
Living in the rural area was a positively associated predictor and coefficients confidence value
significant to the perception of patients towards the nursing profession interval of ß
at a value of (ß=1.853; 95%CI (0.479,3.227), p = 0.008), which indi­ Age of 18–40 Ref
cated that those who were living in the rural area had 1.853 times more respondents in 41–60 − 1.172 (-2.300, 0.042*
increased perception towards the nursing profession from that of study years − 3.364)
participants who were living in the urban area. >=61 − 1.517 (-0.043, 0.330) 0.107

Social value and role characteristics of the nursing profession were

another positively associated significant predictor with the value of Residence Urban Ref
Rural 1.853 (0.479,3.227) 0.008*
(ß=2.065; 95%CI (1.064,3.066), p = 0.001), where the score of social
value and role characteristics increased by one unit being positive to­
wards the profession increased by 2.065. Another independently asso­ Social value and Positive Ref
role Negative 2.065 (1.064,3.066) 0.001*
ciated predictor was nursing care satisfaction with a value of (ß=1.769;
characteristics
95%CI (2.771,0.291), p = 0.001). When the patients’ nursing care
satisfaction increased by one unit, their perception of the profession
Nursing care Satisfied Ref
increased by 1.769 times. This indicated that patients who had satis­ satisfaction Dissatisfied 1.769 (2.771,0.291) 0.001*
faction with the care that the nurses provided were one of the factors
Key: * = Variable statistically significant at P-value < 0.05.

4
L. Ayele Woldasemayat et al.
hospital, Ethiopia, where the overall satisfaction level of patients to­
wards nursing care services was 44.9 % (Mulugeta et al., 2019).
The study was conducted in Benishangul Gumuz public hospitals,
Ethiopia (49.3%) of the study participants had a good perception of the
overall nursing care quality they received (Care et al., 2018). This might
be due to the differences in professional work experiences, ward set up
and the number of patient flows in each area.
This finding is inconsistent with the study conducted in Govern­
mental Hospitals, Ha’il City, Saudi Arabia Patients’ satisfaction with the
standard of nurse care revealed that the level satisfaction of among
patients was 74.92% (Ansari, 2016). The difference may be differences
in health facility set up, health policy, infrastructure advancement of
technology, professional qualification, the number of patient nurses care
for other factors differ across the country.
6.1. The limitation of the study
This study’s findings were limited to this institution, and the findings
were not generalized to other hospitals. A cross-sectional study can’t
prove a cause-and-effect relationship or look at behavior over time.
7. Conclusion
The overall level of patients’ perception of the nursing profession
was found to be low in this study. This study showed that as the
perception score increased, the perception of the patients toward the
profession also increased. Patients’ perceptions of the nursing profession
were strongly influenced by their age, residency, social value, role
characteristics, and nursing care satisfaction. As a result, responsible
bodies must pay close attention to improving patient perception. That
means Jimma Medical Center has to give attention to the development
of the nursing profession by providing continuous refreshment training
for nurses as the provision of quality nursing care for the patients.
More research is needed to better understand the total patient
experience through qualitative research, as well as the perceptions of
care professionals, and community awareness should be raised.
Knowing the level of a patient’s perception and the factors that influence
it can help with high-quality nursing care, patient satisfaction, and a
positive view of the nursing profession. Nurses, on the other hand,
should do a better job of communicating their professionalism to the
public and patients. It’s possible to use social media to show the public/
community what they’re up to.
Author contributions
LAW, LMZ, and ADA participated in proposal writing, designed the
study, coordinated and supervised data collection, data analysis, and
supervised data entry. LAW wrote the draft of the manuscript. LAW,
LMZ, and ADA performed the statistical analysis and critical revision of
the manuscript. All authors read and approved the final manuscript.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
International Journal of Africa Nursing Sciences 17 (2022) 100445
Acknowledgments
We would like to thank Jimma University Institute of Health for the
support for the realization of these findings. We are also grateful to the
health facility of the Jimma Medical Center for the provision of the
needed data for our study. Special thanks and appreciation to all those
who agreed to participate in this study, mainly the respondents, data
collectors, and supervisors.
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