Gender Effects on Professionalism in Nursing - Research Proposal Example

Gender Effects on Professionalism in Nursing   Summary The area of work of the nurses is vital both for the patients and for the doctors because nurses are the link between the two. The services rendered by them make the proper delivery of medical advice and line of treatment possible. Keeping this in mind it is important to improve professionalism in nursing as a career so as to provide the best medical care to the patients. So far nursing has been a female bastion and there has been a debate whether this is favourable or unfavourable for the medical care industry. Females have been accepted as the natural caregivers and that is why this profession finds majority of female workers. The same gender bias also makes this a lesser important profession on the lines of all female oriented professions. It gives rise to the power balance in the workplace, wage imbalance and most importantly lack of professionalism. This study is aimed to find out the ill-effects of this gender bias, if any. Once this fact is established then the solutions for neutralizing the gender gap can be implemented. Rationale for the study The medical profession has become much more important today then ever before. This brings the nurses in the limelight as they are accountable for proper and effective delivery of the medical care. A lack of which can pose legal and ethical threats. There have been instances where legal suits were filed due to negligence. Since nurses are directly in touch with the patients, the onus is on them. In spite of carrying out such responsible tasks neither the nurses nor the medical fraternity considers nursing as important as the doctor’s job. Gender seems to be an obvious reason for this but before any remedial steps are taken, it needs to be established by analyzing all the facts. This study is focused on finding various effects of gender in the medical arena in order to make it much more efficient. Literature Review According to the National Sample Survey of Registered Nurses, 1996, there were 2.1 million nurses in U.S., out of which 5.4% were men. The fact is that there is a progressively aging workforce and the need for getting more young people into nursing is the call of the hour. Gender is actually a set of beliefs pertaining to what is feminine and what is masculine. Although it is not true in many individual cases but it is a sociologically held view. Another important point is the difference of behavior in the case of an individual and in the case of a group. A study done by Vincent T. Rudan, does not show any bias but it shows a basic difference in the behavior and attitude of males and females especially in context of working as a team. As men find it difficult to be accepted as care givers, women find it difficult to be accepted as leaders or administrators. Rudan suggests that both the genders should make an effort to develop a combination of mixed gender behavior. At the work place both of them are needed and with focus on developing and acquiring the traits of either behavior, will help both the individual and the team to grow. It is believed that nursing has been a female bastion since its beginning but there are evidences that males have been the care givers ages back when the priests were associated with care giving.(Donahue, 1985, pg 124, nurse educator, vol 29) There was no distinction between the physician and the nurse in those times and this is an important point. Even today the physicians do not have any gender problem. Studies show that men have a different perception of themselves. Being in minority makes their position even more conspicuous and they feel as if they are “under a microscope”( Paterson, 1996,pg 34). There is a gender bias in nursing education itself. (Anthony, 2004, pg 124) Another study done to find out gender stereotypes says that it is very complex situation. Men as stereotype are seen as aggressors and it is difficult for them to be easily accepted as care givers. It becomes even more difficult when they have to provide intimate care.( Evans, 2002,pg 447) Sometimes male nurses are also labeled as homosexuals. It affects their career path also. Many a times they are bypassed by females for promotions. Sometimes they are denied equal employment opportunities because of the stereotype thinking. According to a study done to find the effect of nurse gender on nurse and patient perceptions of nurse caring, there was no difference in the actual caring provided but the expectation scores for male nurses were significantly low. This indicates the perception towards male nurses. (Ekstrom, 1998) They are not easily accepted as nurses. Another study has taken a new perspective of comparing the experiences of year 2000 with year 1984.(Hansen, 2000,pg 198) It does not find any significant change. Although on a wider basis, male nurses have become more acceptable. The study found that in intimate care, patients prefer their own gender which may be male in many cases. The preference for same gender nurse has become stronger in the year 2000 as compared to 1984. In a way this suggests that many male patients would prefer a male nurse especially when it requires intimate care. In his work on nursing and the challenge of gender inequity Tim Porter- O’Grady points out that when a man is a nurse, it gives rise to many questions like whether he became a nurse because he could not get into the medical college, or why did he become a nurse although he is not so bright or is he a gay etc. All these questions show that nursing is seen as a woman’s job and also it is below a man’s dignity to serve as a nurse or in other words nursing is not an important job to be done by important people like “men”. An article by Nancy Girard mentions the factors that influence the decision of choosing nursing as a career are quite feminine like stability of a career, ease of getting a job, desire of care giving etc.( Girard, 2003, pg 728) According to Tim Porter, nursing is a field dominated by women and it has ill effects on both men and women. Being limited to one gender, it becomes difficult to get enough number of qualified nurses thus creating a shortage. Although there are men in nursing profession as well, but due to lesser numbers they do not get enough representation in any forum and that is what keeps them away from most of the leadership positions. We find similar interesting results from the readers’ response to an article by Thom Schwarz –“I am not a male nurse” and for “Men in Nursing: Still Too Few” (AJN Reports, February). The practice of calling a male nurse as “male nurse” itself indicated that nurses are perceived as females and males are exception to it. But there are some male nurses who have not found any difference in attitude of people based on gender. But there are others who have always felt it. They have faced the question –whether they wanted to be a physician and landed here – throughout their career. This has been a frustration for them all their life. Some of them have wondered if it is perpetuated by female nurses as they might be threatened by male nurses. A very valid point is raised by one of the readers who says that “When men can acknowledge the caring, compassionate aspects of themselves, they will be more able to embrace nursing as a career.” There are many male nurses who face the questions but take it in their stride like- I have been a nurse since 1964, and whenever I am asked if I am a “male nurse,” I reply, “last time I checked I was.” Some have suggested a change in the name ‘nurse’ and some have questioned why there should be a different perception for male nurses when the obstetricians and gynecologists do not have this gender problem. There are different view points and arguments but the fact that surfaces is that gender is an issue in nursing as a profession. Hine has said in “Black Women in White” that the classification has not just been gender based but also racial and class based. Till nineteenth and early twentieth century, nursing was the domain of white women and black women were engaged to do the work at slaves. White women started participating in the actual care giving work during World War I. That time it had patriotic connotations. But it brought some prestige to the work and more and women started taking it up as a profession without much opposition from the family or the society. The situation has changed quite a lot from those times but we do not find much change in the demography. There has been no change in the ratio of men and women in nursing profession between 1994 and 1997( Iliffe, 2002). According to Gene Tranbarger, associate professor of nursing at East Carolina University in Greenville, NC, it is deeply imbedded in the system. Few people like Ramon Lavandero of Sigma Theta Tau International have found their male gender to be their advantage. He says it is a similar situation when female nurses have to handle male patients. As a measure to neutralize the gender bias, he recommends developing a camaraderie with fellow female nurses and not to view them as opponents. An article by Carol S. Kleinman, takes a similar view on this issue and says that being a male nurse can be an advantage too. Men are found to respond better as increased visibility increases their performance pressure. Their isolation also benefits them as they assume a higher status due to gender. Their gender orientation makes them more inclined to empower themselves. They have more desire to rise up to administrative positions. According to MJ Fisher and RW Connell, who have done a study of Masculinity and men in nursing, it is a fact that women have entered more of male dominated professions but men have not been able to do so. This creates certain crisis like power relations for men in nursing. This study also mentions that very little research has been done on topics related to gender issue in nursing. The shortage of nursing makes it even more relevant to study the causes and find ways to remove them. All these studies establish a few facts. Various articles, studies and authors may express different view point but one common thread that runs across all of them is that there is a gender bias in this profession. It establishes that nursing is seen as a woman’s profession. It also establishes that it is seen as a less important profession. This notion has its roots in the gender based stereo types. This attitude creates a shortage of nursing work force and it also creates problems for those men who are in the field of nursing. Gender based thinking created friction in the workplace for female nurses too. The behaviour of other workers like doctors etc demonstrates this attitude. This discourages not only men but also young girls to come into this profession because they have the option of getting into other professions that are more respectable. Tranbarger who is the president of AAMN, American Assembly of Men in Nursing says that to attract more men in nursing it is important to speak well about the profession to give a positive feedback to the general public. Nursing should be viewed as a profession and not as a gender-based occupation. The diversity in the nursing workforce should be similar to the diversity in the patients. Research aims The goals for conducting research should include: • improvements in nursing care • credibility of the nursing profession • accountability for nursing practice, and • documentation of the cost-effectiveness of nursing care. (Nieswiadomy,1998:8) Understanding the role of gender helps in improving all the four areas. It helps us to understand the root causes and is the base for finding solutions to improve nursing care and make it more credible profession. When this profession becomes at par with any other profession then the accountability will also increase and so will cost-effectiveness. The gender bias makes it a not-so-important profession and it has adverse impact on the quality of service. Like all other professions, nursing also needs to be updated on a continuous basis. Nurses should be implementing the research findings into practice and also improve their knowledge base. In the current healthcare system, patients expect staff to be current in their practice and to know what the latest research has demonstrated. There are now ethical and legal implications in relation to the application of current research findings that nurses need to take into consideration within their practice. Research in nursing is a rapidly expanding area that is stimulating and exciting, as it pushes the profession of nursing to the forefront of the health care system. Nurses working in the healthcare system, need to apply up-to-date research findings in nursing practice and should also share these with nursing colleagues. Gender has been detrimental in bringing such professionalism. That is why this research has the following research questions: 1. Is nursing still a gender based profession? 2. Does it impart a casual approach in the female nurses? 3. Wherever there is participation of male nurses also, is there any improvement in the approach and in the quality of service? 4. What is the feedback from the patients on gender issue? 5. Will a 50-50 ratio of male and female nurses improve the quality of service? These research questions are aimed at improving professionalism in nursing by removing the gender orientation.   Research Design There are many different approaches and research methodologies used within research in nursing, and there has been a lot of discussion based on which methodologies are appropriate for examining nursing and nursing practice. Traditionally ‘hard’ scientific approaches have been utilised within the healthcare system, as these maintain objectivity, control over the research process and the ability to generalise the results. According to Schneider et al. (2003) p. 250, quantitative research refers to studies that ‘quantify’ the results and, as such, these approaches are seen as scientific or empirical methods that relate to something outside or external to the researcher. Control is an important feature of quantitative research. This means that the setting for the study, the population (sample), and the treatment are all controlled to greater or lesser degrees. Some nurses believe that qualitative approaches (sometimes described as ‘soft’ research) are appropriate because these are seen as humanistic and emphasis a more personal and subjective approach to research. Qualitative research appreciates the value of human experience and explores the meaning of experiences for people, be they nurses or patients. In qualitative research, control is not an issue. The study population involves people who have experienced the area/topic under investigation, the environment is usually wherever the participating person feels most comfortable, so this can vary from one person to another, and there is no treatment or intervention. Triangulation is an approach that helps to overcome the perceived deficiency of utilising one approach. This may involve combining quantitative and qualitative approaches in a study or it may be that the data collection methods are triangulated. It is seen that the positive qualities of both approaches can be achieved when using this method. Qualitative data can support quantitative data or vice versa. This study will require triangulation approach because the research question has both quantitative traits as well as qualitative traits. Since the research aim is to find the improvement in professionalism in nursing, a quantitative study needs to be done. At the same time it has some qualitative traits like change in the attitude of nurses, both male and female and comfort level of patients. This is a subjective study and it will require a qualitative approach. In the Quantitative method, a sample will be studied in controlled environment. For this study, ten hospitals will be selected in the same city. Five of these will be given equal strength of male and female nurses. Rest five will be the control group with a majority of female nurses. Refresher courses will be announced on a monthly basis for all the ten hospital nursing staff. A comparison will be done on the number of participants in the experiment group and the control group. If the study shows that more number of participants came from the hospitals where there is a balanced ratio of male and female nurses, the research hypothesis will be proven. Another comparison will be made at the recovery level of the patients. The stay period of the patients in all the ten hospitals will be studied and compared. Lesser period of stay will indicate faster recovery. If we find that the hospitals with a balanced ratio have faster recovery, it will prove the increased level of efficiency in nurses when there is a balanced ratio. This will again prove the research hypothesis. For the qualitative study, the participants will have to studied more closely and their emotional feed back will be recorded. The male and female nurses in the balanced groups will be interviewed to study their attitude towards their profession, their comfort level with male patients and female patients, their views on having a balanced number of male and female nurses. Qualitative researchers do not believe there is a single, objective truth; they are aware that people have multiple realities, because each individual views the world from their own, personal, perspective. This approach acknowledges that everyone has their own truth, so that the way patients and families deal with an illness experience is different, and the reality of what is happening for each individual is real to them but may be seen differently by others. Beliefs and feelings arising from past experiences influence people and make them the person that they are. Qualitative researchers also acknowledge their own beliefs and values and how these can influence their perceptions of the world. Within the research process they recognise these and state them to make it clear to the research consumer. In qualitative research, the relationship between the researcher and the participant is usually close, which is different to quantitative studies. This relationship may be maintained over a short or long period of time. This relationship needs to be close so that trust, and often some level of intimacy, can evolve within the relationship. For the researcher to gain deep, meaningful data there need to be these qualities in the relationship. The person is often studied in a natural setting; this may occur in their home or where they are comfortable to be observed or interviewed. This means that there is little, if any, control of the environment. Where quantitative research focuses on objective data, qualitative focuses on subjective data. A process of inductive analysis is used rather than deductive analysis. With phenomenology, the researcher may ask the participants to describe their experience, An audiotape or digital recording of the interview(s) is made so that the data can be transcribed verbatim. Usually only one interview is required, but there are some situations where more than one interview may occur. The aim of the researcher is to gain the trust of the participant so that he/she will feel comfortable expressing his/her feelings openly; it is in the situation of trust that the person relaxes and divulges their feelings. This level of intimacy is conducive to spontaneity and the expression of deep feelings. Phenomenological data are analysed by a process of reading and re-reading the transcripts of interviews. Themes are identified that provide insights into the phenomenon being studied. These provide meaning and expand on what is known of the phenomenon. Ethics In 1947 the American Medical Association developed a code of ethics called the Nuremberg Code. The criteria in this code included: • Researchers must inform subjects about the study. • Research must be for the good of society. • Research must be based on animal experiments, if possible. • Researchers must try to avoid injury to research subjects. • Researchers must be qualified to conduct research. • Subjects or the researcher can stop the study if problems occur. (Nieswiadomy 1998:42) Several other international standards followed this code. In 1964 the Declaration of Helsinki was adopted by the World Medical Assembly and then later revised in 1975 and 1989 (Beanland et al., 1999). The Australian Nursing Federation is currently developing standards for nursing research which will include ethical conduct for research conducted by Australian nurses (Schneider et al. (2003) p. 130). ‘Human rights’ and ‘informed consent’ are two important concepts while deciding the ethical issues. There are specific guidelines developed for anyone involved in research that these concepts must be adhered to. These concepts basically relate to privacy, anonymity, full disclosure of information, and fair treatment. Participants should feel free to leave a study if they wish to, without any sense of retribution and they must not be coerced at all. This sounds obvious, but patients can feel that they should support a research study because their treatment may not be optimum if they decide not to participate or to leave a research study. The possible concerns of patients and vulnerable groups like children, the elderly and the disadvantaged should be taken care of. These people may not fully appreciate the implications of what may be involved when participating in a research project. Explaining things to them in detail should be a part of the research. This will not only help the patients and take care of the ethical issues but will also strengthen the research with proper findings. Conclusion Role of gender and its adverse effects are important to be studied because it is an age old tradition that has kept nursing away from its due importance. Nursing is an important part of health care and gender bias related to this profession has neglected its value and importance. The most crucial point is that gender bias has made it a less than important profession and that has reduced the quality of service. It has also created a scarcity of needed numbers. In other words, due to gender bias there has been a decline in both quality and quantity in this profession. To improve health care service standards, its due importance has to be restored. The studies so far show that gender has been the root cause for this neglect. Once we have quantitative and qualitative evidence on this, some measures can be taken to bring the balance in this area.    Reference : Anthony, A.S., Gender Bias and Discrimination in Nursing Education Can We Change It? NURSE EDUCATOR Volume 29, Number 3 May/June 2004 Evans, J.A.Cautious caregivers: gender stereotypes and the sexualization of men nurses’ touch, Nova Scotia, Canada,Submitted for publication 28 February 2002 Beanland, C., Schneider, Z., LoBiondo-Wood, G., Haber, J., 1999, Nursing research: methods, Critical Appraisal and Utilisation. Burgio, L.D., Butler, F.R., Roth, D.L., Hardin, J.M., Hsu, C., Ung, K., 2000,Gender and social context, International Psychogeriatrics, (2000), 12: 495-511 Cambridge University Press Chung, V., Men in Nursing., http://www.minoritynurse.com/features/nurse_emp/08-30-00c.html Retrieved on August 26, 2007 Donahue, MP, Nursing the finest art, St Louis, Mo: Mosby, 1985 Ekstrom, David N. RN PhD, Assistant Professor, Lienhard School of Nursing, Pace University, 861 Bedford Road, Pleasantville, NY 10570, New York, USA Accepted for publication 26 August 19981This study was supported in part by the Martha E. Rogers Scholarship Award of Upsilon Chapter, Sigma Theta Tau, New York University Fisher, M.J., Connel, R.W. , Masculinities and men in nursing, Dept. of Clinical Nursing, Faculty of Nursing, University of Sydney1; School of Policy and Practice, Faculty of Education, University of Sydney http://www.chs.usyd.edu.au/conf2002/minipost/gx-fishe.pdf ; Retrieved on August 26, 2007. Girlie Men? Manly Girls? The Governator and nursing’s gender issues, February 2005, The center for Nursing Advocacy, http://www.nursingadvocacy.org/news/2005feb/22_cnn.html Retrieved on August 26, 2007. Girard N.J., men and nursing, april 2003, vol 77, no.4, FAAN Hansen, A., Preferences for female and male nurses: the role of age, gender and previous experience ± year 2000 compared with 1984 University of Adelaide, South Australia,Submitted for publication 24 November 2000 ,Accepted for publication 31 October 2001 Illife, J., 2002, Time to address nursing gender imbalance, Australian Nursing Journal, June, 2002. Nieswiadomy, M.,1998; Foundations of Nursing Reasearch. Paterson B, Crawford M, Saydak M,et al. How male nursing students learn to care. J Advan Nurs. 1996;22: 600-609. pg 34 Porter-O'Grady, T., 1998, Nursing and the Challenge of Gender Inequity , Reflections on Nursing Leadership. The impact of gender on nursing, http://www.unc.edu/courses/2006spring/nurs/096/001/week7/index.html Retrieved on August 26, 2007. Rudan, V.T., EdD, RN The Best of Both Worlds,A Consideration of Gender in Team Building, , JONA, Volume 33, Number 3, pp 179-186 ©2003, Lippincott Williams & Wilkins, Inc. Schneider, Z., et al. (2003), Approaches in quantitative research in nursing, p. 130 . Read More