Knowledge and Attitude towards Nursing Profession among Adolescent Students of Sikkim

Prof. Mridula Das¹, Miss Barkha Devi²*, Mrs Ranjita Devi³, Sangay Doma Bhutia⁴

¹Principal, Sikkim Manipal College of Nursing, Gangtok, Sikkim.

²Lecturer, Sikkim Manipal College of Nursing, Gangtok, Sikkim.

³Associate Professor, Sikkim Manipal College of Nursing, Gangtok, Sikkim.

⁴Assistant Lecturer, Sikkim Manipal College of Nursing, Gangtok, Sikkim

*Corresponding Author Email: barkhadevi2@gmail.com

ABSTRACT:

The investigators assessed the knowledge and attitude of adolescent students in the school of urban and rural community. Investigator adopted the non experimental survey approach with descriptive comparative research design where 30 students from the schools of each community were selected who were within 14-19 years of age group belonging to the selected schools of rural and urban community of Sikkim studying in 11th and 12th class , who have taken commerce, science or arts as the stream of study in the academic session of 2012-2013 and who were willing to participate in the study and present at the time of data collection were included in the study. A probability cluster sampling technique was used for the selection of the district and schools from urban and rural community of Sikkim, and probability simple random sampling technique was used for the selection of the adolescent students from the selected schools of urban and rural community, Sikkim. .Validated structured questionnaire and attitude scale was used to collect the data to see the knowledge and attitude of students and compare the relationship and association. The finding of the study reveals that the knowledge of urban school students (352) found to be better than the knowledge of rural school students (319). However, the attitude score of adolescent students of urban school was lower than the rural school student. The study also revealed that there is an inverse relationship between knowledge and attitude of urban community (P<0.05) but no relationship found between knowledge and attitude in rural community (P>0.05). Regarding the association of knowledge with selected factors, it was seen with gender and stream of study in rural community and with religion in urban community as seen by x2 value (P<0.05). On the contrary, the association of attitude was seen with the gender in urban community whereas no association was seen in rural community with any selected factors. These findings have important implication for the recruitment of adolescent students into nursing.

KEY WORDS: Knowledge, Attitude, Nursing Profession, Adolescent Students, Urban Community, Rural Community.

INTRODUCTION:

Nursing is as old as human life itself. The sick and the infirmed had always been tended by family and friends. But nursing has grown into a vocation only a few decades ago.¹ The profession is said to have long suffered from public stereotyping and from being closely associated with feminity and powerlessness. The time has never been better for nurses to reach out to the public to change certain perceptions about nursing.

Various people have different understanding of the nursing profession based on prior events in their lives since perceptions are subjective.² However, survey shows that even today students do not join nursing education as eagerly as they join other educational courses.³

Previous research studies reported that more students decided to join nursing profession because they had a desire to help others, and they reached to do post graduation.³. Nursing profession is not attractive for meritorious as well as other high schools students. They usually do not see it as a good career option.⁴On the contrary Lai HL et al⁵ conducted a study in Taiwan and found that 65.4% of the nursing students would not choose nursing as a career after graduation. In India, the picture of nursing profession is changing day by day while nursing profession still suffers a mild degree of so called stigma in certain states of the country all of which make the profession a low profile in the study ⁶

In a society where people are status conscious many a times their choices are influenced by factor like who opt for science stream first prefer to be doctor or engineer. Thus, students joining the profession are influenced by this negative attitude of the society towards the profession. Thus, it is very essential that we must target a younger population.⁶ After the establishment of Trained Nurses Association of India (TNAI) and Indian Nursing Council (INC) in the year 1908 and 1947 respectively, nursing profession continued to grow over the past hundred years and the attitude towards nursing profession has changed to some extent, resulting in students asking “what is nursing?”⁷

Problem statement

“Knowledge and attitude towards Nursing Profession among adolescent students in selected schools of rural and urban community, Sikkim”.

Objectives

The objectives of the study are 1) Assess and compare the knowledge of adolescent students towards nursing profession in selected schools of rural and urban community. 2) Assess and compare the attitude of adolescent students towards nursing profession in selected schools of rural and urban community. 3) Identify relationship between knowledge and attitude among adolescent students towards nursing profession. 4) Determine association between knowledge and attitude among adolescent students towards nursing profession with selected factor.

Operational Definition

· Knowledge: It refers to the accurate information received through written responses from the participants regarding knowledge towards nursing profession as assessed by structured knowledge questionnaire.

· Attitude: It refers to the opinion or way of thinking of participants towards nursing profession as measured by an attitude scale.

· Adolescent students: It refers to the male and female students studying in higher secondary classes, within the age group of 14-19 years and has taken arts, commerce or science as their stream of study.

· Selected factors: In this study, selected factors are gender, stream of study, family income, religion, and family member in health care profession.

· Schools: It refers to the schools having standard up to higher secondary.

Hypothesis : All hypotheses measured at 0.05 level of significance

H₁: There is a significant difference between knowledge score among urban and rural adolescent students towards nursing profession.

H₂: There is a significant difference between attitude score among urban and rural adolescent students towards nursing profession.

H₃: There is a relationship between knowledge and attitude of urban and rural adolescent students towards nursing profession.

H₄: There is a significant association between knowledge of adolescent students towards nursing profession with selected variables.

H₅: There is a significant association between attitudes of adolescent students towards nursing profession with selected variables.

Materials and Methods:

A non experimental survey research approach was considered to be the most appropriate for the present study as it was aimed at to quantify the knowledge and attitude of adolescent students The research design selected for the study was Descriptive comparative survey as it was mainly focused on assessing and describing the knowledge and attitude of adolescent students towards nursing profession as shown in Figure 1.

The study was conducted in two senior secondary school of east district in Sikkim that is Dickling senior secondary school of rural community, East Sikkim and Singtam senior secondary school of urban community, East Sikkim.

The population under study consisted of 60 adolescent students within 14-19 years of age group belonging to the selected schools of rural and urban community of Sikkim studying in 11^th and 12^th class, who have taken commerce, science or arts as the stream of study in the academic session of 2012-2013 and who were willing to participate in the study and present at the time of data collection were included in the study. A probability cluster sampling technique was used for the selection of the district and schools from urban and rural community of Sikkim, and probability simple random sampling technique was used for the selection of the adolescent students from the selected schools of urban and rural community, Sikkim.

Data collection tools and technique

Fig. 1: Schematic representation of descriptive comparative design

The instrument used for data collection was structured knowledge questionnaire on nursing profession among adolescent students and attitude scale on attitude of adolescent students towards nursing profession which was validated by five experts in the field. In this study the structured knowledge questionnaire, was a questionnaire that was filled up by respondents. The structured knowledge questionnaire had two sections. Section I consisted of part A as demographic data and part B as career profiles. Demographic data was composed of 12 items to collect the information regarding personal character and Career profile composed of 10 items to collect the information regarding career choice. Section II consisted of 20 multiple choice questions to collect the information from adolescent students regarding knowledge on nursing profession. Each correct response was given score of 1. The maximum score was 20.

Results and Discussions

Findings related to demographic data

In the present study 40% students in school of rural community belonged to 17 yrs and 7% belonged to 16 yrs whereas in school of urban community 50% students belonged to 17 yrs and 17% belonged to 19 yrs. The data also presents that most of the students in both the school belonged to science stream with 53% and 47% in rural and urban school respectively whereas only 20% belonged to commerce in rural school and 20% belonged to arts in urban school.

In rural school, 63% of students belonged to joint family and 7% belonged to extended family whereas in urban school the maximum number that is 80% belonged to nuclear and only 3% belonged to extended and single parent family respectively.

The data also depicts that the maximum number of students in both the school belonged to Hindu community with 63% and 67% in rural and urban community respectively whereas only 3% and 10% belonged to Christian community in rural and urban school respectively.

In rural school, 50% students’ family per capita income was reported to be below Rs 5000/month and only 17% students’ was above Rs 10,000/month whereas in urban school, 53% students’ family per capita income fall in the range between Rs 5000-10,000/month and 20% students’ were above Rs 10,000/month.

In school of rural community, 70% students family were having members more than 5 and only 30% had members less than 5 whereas in urban school 60% were having family members less than 5 and 40% more than 5.

In urban school all the students’ home community was urban whereas in rural school 70% students’ home community was rural and 30% was from urban.

In school of rural community, most of the students that is 80% didn’t have parents or guardian as a nurse whereas 20% had. Comparatively in school of urban community, 83% did not have parents or guardian as a nurse whereas 17% had.

The data also shows that maximum number of students in schools of both the community that is 80% of rural and 83% of urban were not personally known any nurse.

Findings related to career profile

Table 1: Frequency and Percentage Distribution of students in terms of their career profile. N=60

Sl No	Career profile	Rural (n=30)		Urban (n=30)
		f	%	f	%
1	Have you Made a career
1.1	Yes	29	97	30	100
1.2	No	1	3	0	0
	If Yes
1.1.1	Medicine	4	14	5	17
1.1.2	Engineering	7	23	5	17
1.1.3	Nursing	7	23	3	10
1.1.4	Teaching	4	14	3	10
1.1.5	Business	4	14	8	26
1.1.6	Any Other	3	10	6	20
2	Is Nursing a profession
2.2	Yes	25	83	24	80
2.2	No	5	17	6	20
3	Do you consider nursing as a career
3.3	Yes	21	70	26	87
3.2	No	9	30	4	13
4	If you obtain good grades in higher secondary examination, would you consider nursing as a career choice in future
4.1	Yes	15	50	9	30
4.2	No	15	50	21	70
5	If you don’t get good grades in higher secondary examination, would you consider nursing as a career choice in future
5.1	Yes	20	67	13	43
5.2	No	10	33	17	57
6	Is it worth to spend money on nursing education
6.1	Yes	16	53	15	50
6.2	No	14	47	15	50
7	Is sponsorship a strategy for career choice
7.1	Yes	20	67	9	30
7.2	No	10	33	21	70

The data presented in table 1 revealed that 97% and 100% of the students’ of schools of rural and urban community respectively have made the career choice which is almost equally distributed in all the fields. The table also shows that 83% and 80% of students in rural and urban community respectively consider nursing as a profession. It also shows that 70% students of school of rural community and 87% students of school of urban community consider nursing as a career. In school of rural community, half of the students consider nursing if grades are good whereas in urban community only 30% consider it if grade are good. Comparatively, 67% students of school in rural community and 43% in urban community consider nursing if grade are not good. In school of urban community half of the students agrees that nursing education is worthy of spending money whereas in rural school 53% agrees to the same. In school of rural community, maximum no of students 67% consider sponsorship a strategy for career choice whereas 70% in urban school do not consider it.

Fig. 2 Distribution of students in terms of times they have talked about career

The figure 4 indicates that 50% have talked about the career more than few times in both the schools of urban and rural community respectively whereas 7% in urban community have talked about it only once and in rural community it is about 17% who had done the same.

Fig. 5 Distribution of students in terms of major influence in their career choice in both the schools.

The figure 5 depicts that majority (50%) of students in school of rural community were influenced by their parents whereas in urban community majority 57% had self decision regarding their career choice.

Fig. 6 Distribution of students in terms of the suggestions to be made more attractive in nursing

The figure 6 says that most of the students in schools of both the community had made the suggestion in the increase in job opportunity and improvement in nursing education for making the nursing profession attractive for students.

Findings related to knowledge towards nursing profession among adolescent students in schools of urban and rural community

Table 6: Area wise mean percentage score of Knowledge towards nursing profession N=60

Sr. No:	Area	Maximum Score Rural Urban	Mean % Score Rural Urban
1.	Definition of nursing	23 22	230 220
2.	Nursing profession	72 80	144 160
3.	Nursing as a career	18 17	180 170
4.	Qualities of a nurse	20 26	200 260
5.	Requirement of nursing	85 110	170 220
6.	Scope and expanded role of nursing	65 74	162.5 185
7.	Factors affecting nursing	35 24	116.66 80

The maximum gain in terms of knowledge score of adolescent students in school of rural community is in definition of nursing and qualities of a nurse and minimum score is in factors affecting nursing, whereas in school of urban community the maximum gain is in definition of nursing and requirement of nursing and minimum gain is in factors affecting nursing as seen from mean percentage score.

Findings related to attitude towards nursing profession among adolescent students in schools of urban and rural community

Table 8 : Area wise mean percentage score of attitude level on nursing profession N=60

Sr. No:	Area	Maximum Score Rural Urban	Mean % Score Rural Urban
1.	Definition of nursing, career and nursing profession	354 351	78.66 78
2.	Qualities of a nurse	331 341	73.5 75.77
3.	Requirement of nursing	325 326	72.22 72.44
4.	Expanded role of nursing	335 330	74.44 73.33
5.	Image of nursing	445 453	74.1 75.5
6.	Factors affecting nursing	408 387	68 64.5

The maximum gain in terms of attitude score of adolescent students in schools of both rural and urban community is from definition of nursing, career and nursing profession and minimum gain is in factors affecting nursing as seen from mean percentage score.

Findings related to comparison of knowledge score and attitude score among adolescent students in schools of rural and urban community.

Table No. 9Mean, SD, SE_D, t value of Knowledge score of adolescent students in schools of urban and rural community N= 60

Schools	Mean knowledge score	Mean Difference of knowledge score	SD	SED	‘t’ value
1.Urban community 2.Rural community	11.76 10.76	1	2.05	0.53	42.49

‘t’ _(58), =2.00, *P <0.05

The knowledge score is significantly higher in students of urban school than rural school.

Table 10 : Mean, SD, SE_D, t value of attitude score of adolescent students in schools of urban and rural community N=60

Schools	Mean attitude score	Mean Difference of attitude score	SD	SED	‘t’ value
1.Urban community 2.Rural community	73.35 73.5	0.15	8.736	2.25	0.06

‘t’ _{(58),= 2.00} , P >0.05

There is no significant difference in attitude score between students of urban and rural schools.

Findings related to relationship between knowledge and attitude among adolescent students in schools of rural and urban community.

Table11 : ‘r’ Value Between knowledge score and attitude score among adolescent students in school of urban community n= 30

Variables	Mean score	r	‘t’ value
Knowledge Attitude	11.76 73.35	-0.094	14.57

‘t’_(29),=2.05, P <0.05

There is an inverse relationship between knowledge and attitude in school of urban community.

Table 12 ‘r’ Value Between knowledge score and attitude score among adolescent students in school of rural community n=30

Variables	Mean score	r	‘t’ value
Knowledge Attitude	10.76 73.5	0.113	0.6

‘t’₍₂₉₎ = 2.05, P>0.05

There is no relationship between knowledge and attitude in school of rural community.

Findings related to association between knowledge among adolescent students in selected schools of rural and urban community towards nursing profession with selected factor.

The table 13 depicts that there is no association between the knowledge score towards nursing profession with gender (x² =0.45)_, stream of study(x² =1.17), total family income (x² =1.54) and family members in health care profession (x² =0.07) of adolescent students in urban community. There is an association between the knowledge score towards nursing profession with religion (x² =13.16) of adolescent students in urban community.

Table 13 Chi square value for association between knowledge and selected factors N=60.

Sl. No	Variables	Knowledge Score
		Urban					Rural
		>Med	<Med	df	x2	p- value	>Med	<Med	df	x2	p- value
1	Gender
1.1	Male	6	8	1	0.45	P>0.05	3	10	1	4.13	P<0.05
1.2	Female	12	4				9	8
2	Stream of study
2.1	Arts	5	1	2	1.17	P>0.05	1	7	2	7.24	P<0.05
2.2	Science	8	6				10	6
2.3	Commerce	3	7				1	5
3	Total family income
3.1	<5000/mnth	4	4	2	1.54	P>0.05	7	8	2	0.41	P>0.05
3.2	5000-10,000/mnth	10	6				4	6
3.3	>10,000/mnth	2	4				2	3
4	Religion
4.1	Hindu	9	11	2	13.16	P<0.05	8	11	2	0.96	p>0.05
4.2	Buddhist	5	1				5	5
4.3	Christian	2	2					1
5	Family members in health care profession
5.1	Yes	4	1	1	0.07	P>0.05	3	3	1	0.01	P>0.05
5.2	No	12	14				10	14

There is no association between the knowledge score towards nursing profession with total family income (x² =0.41), religion (x² =0.96) and family members in health care profession (x² =0.01) of adolescent students in rural community. There is an association between the knowledge score towards nursing profession with gender (x² =4.13) and stream of study (x² = 7.24) of adolescent students in rural community.

Findings related to association between attitude among adolescent students in selected schools of rural and urban community towards nursing profession with selected factor.

Table No 14 Chi square value for association between attitude and selected factors N=60

Sl. No	Variables	Attitude Score
		Urban					Rural
		>Med	<Med	df	x2	p- value	>Med	<Med	df	x2	p- value
1	Gender
1.1	Male	4	10	1	4.95	P<0.05	4	8	1	2.47	P>0.05
1.2	Female	10	6				10	8
2	Stream of study
2.1	Arts	2	4	2	0.72	P>0.05	3	5	2	1.35	P>0.05
2.2	Science	7	7				9	7
2.3	Commerce	5	5				2	4
3	Total family income
3.1	<5000/mnth	10	10	2	4.56	P>0.05	11	8	2	4.97	P>0.05
3.2	5000- 10,000/mnth	4	2				2	8
3.3	>10,000/mnth	0	4				1	0
4	Religion
4.1	Hindu	4	4	2	0.54	P>0.05	6	9	2	2.68	P>0.05
4.2	Buddhist	8	8				4	6
4.3	Christian	2	4				4	1
5	Family members in health care profession
5.1	Yes	3	2	1	0.27	P>0.05	1	5	1	1.92	P>0.05
5.2	No	11	14				13	11

The table 14 depicts that there is no association between the attitude score towards nursing profession with stream of study(x² =0.72)_, total family income (x² =4.56)_, religion (x² =0.54) and family members in health care profession (x² =0.27) of adolescent students in urban community. There is an association between the attitude score towards nursing profession with gender (x² =4.94) of adolescent students in urban community. There is no association between the attitude score towards nursing profession with gender (x² =2.47), stream of study(x² =1.35)_, total family income (x² =4.97)_, religion (x² =2.68) and family members in health care profession (x² =1.92) of adolescent students in rural community.

The findings of the present study shows that there is an inverse relationship between knowledge and attitude of students towards nursing profession in urban community which is statistically significant by ‘t’ value of 14.57. The finding of the present study is consistent with the findings of the study of Al Omar BA³ where the high school students scored a reasonable level on the knowledge dimension, but did not achieve high score in the attitude dimension. The finding of the present study shows that there is an association between knowledge of the students towards nursing profession with gender and stream of study in school of rural community. The findings of the study is consistent with the findings of the study of Ozdemir A, Akansel N and Tunk G C⁸ where male students have a role tension regarding nursing because almost half of them (48.6%) saw nursing as a female profession and 82% of the male high school students did not prefer nursing as a career as they believed that nursing should only be a female profession.The study was limited only to those who could read and write English and who were present in the school at the time of data collection. therefore, generalization of the findings was limited to population under the study. On the basis of the study findings the following recommendations can be offered for future research.

- can be replicated on a larger sample.

- can be conducted in a different setting.

- can be conducted in comparison with gender male and female.

- can be reviewed and taken for reference in future studies in imparting planned teaching program among pre-university students regarding nursing profession.

Conclusion:

Most of the students were of 17 years of age with a female to male ratio of 1.5 in rural and 1.13 in urban area indicating a female predominance in school education in both the communities. Joint families are still prevalent in rural areas with majority of families having members more than five whereas nuclear families have largely replaced them in urban areas. The number of students living with their guardians is more in rural area. Per capita income was less than Rs 5000/month in most of the families in rural area. Job profile was entirely different between the communities as the most of the students’ fathers are in government job in rural area while in urban area; most of them are associated with non-government jobs. Mothers of most of the students in both the communities are housewives. Majority of the parents of the students in both the communities had attained the education level of higher secondary or less. Most of the students in both rural and urban area neither have any of the parents or guardian in nursing profession nor they know anyone personally who is a nurse. The career choice made by majority of the students in both the areas is almost equally distributed in all the fields. Half of them have talked about career more than once in both the communities. Decision making about career was influenced by their parents in case of most of rural area students however it was not the same for urban area students as most of them were free to decide their own field of work. Almost a similar number of students in both the communities have suggested increase in job opportunities and improvement in nursing education. A very less number of students have suggested scholarship in nursing education in both the areas. The total knowledge score of students in schools of urban area was more than those in rural area and the finding was statistically significant. Though the total attitude score of the students of rural area was higher than those in the urban area however the finding was not significant statistically. There is inverse relationship between knowledge and attitude in students of schools of urban community but a relationship could not be established between knowledge and attitude in students of schools of rural community. Religion was significantly associated with knowledge of the students in the urban area but no association could be established between the two in case of rural area students. Community is a factor which can influence the knowledge as well as the attitude of students. Though an association was established between the level of knowledge and the gender of students in rural area the same could not be established in urban area. However in case of attitude, an association could be established between the attitude and gender in students of urban community but not in the rural community. Furthermore the strength of association could not be found because of small effect size. The stream of study had a statistically significant association with the knowledge of the students in the rural area but the same was not found in case of students of urban area. No association was found between the attitude and stream of study in students of both the communities.

Acknowledgement:

We are thankful to the Sikkim Manipal College of Nursing for giving us an opportunity to conduct this research study.

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Received on 03.06.2014 Modified on 02.07.2014

Accepted on 15.07.2014 © A&V Publication all right reserved

Asian J. Nur. Edu. & Research 4(3): July- Sept., 2014; Page 357-364