Attitudes of Students at Sultan Qaboos University towards the Nursing Profession

Objectives: The aim of this study was to explore the attitudes of Sultan Qaboos University (SQU) students towards the nursing profession. Methods: A sample of 377 students (male = 130; female = 247) were selected from different colleges of SQU, including the College of Nursing. A questionnaire was constructed and validated to assess the attitudes of SQU students towards the nursing profession. Results: Findings revealed that both male and female students in all academic years and colleges had positive attitudes toward the nursing profession. The findings also revealed that gender and academic year created no significant differences (P <0.05) among the study participants, but that the students’ college affiliation did have a significant effect on their attitudes. In particular, nursing students had more positive attitudes than students of other colleges. Conclusion: Findings indicated that the attitudes of SQU students towards the nursing profession were positive, especially those of the nursing students. This means that serious efforts should be made to continue to promote the nursing profession and so ensure that it remains positively regarded by all concerned.


Advances in Knowledge
-The findings of this study will provide the foundation for additional future research regarding the attitudes of nurses and community members in Oman towards the nursing profession.

Applications to Patient Care
-The findings of this study will indirectly affect patient care in that nursing students with a positive attitude will provide better quality patient care.
-Caring for patients who have a positive attitude towards the nursing profession will encourage nurses to provide better quality nursing services.
clinical & basic research T hroughout its development, the nursing profession has faced different cultural challenges, including a negative image which may have resulted in discouraging people from joining the profession.Several studies have been conducted in various countries to explore the image of nursing and attitudes towards the profession.A positive image was found to be a result of people understanding the meaning of nursing as a profession and also of nursing career planning. 1][4][5] The results of these studies were varied.][13] Oman, as one of the Gulf countries in the Middle East, has made great progress in the development of professional nursing, and its nursing programmes have grown rapidly since the country began to modernise its healthcare system in 1970.Nursing has already overcome many challenges in the process of creating a more positive image.The government has encouraged students to study nursing by offering free education and increasing the number of educational institutions.In 2011, there were 12 nursing institutes which graduated nurses at diploma level and 3 universities offering bachelor's degrees in nursing. 14,15he Omanisation process in Oman is also providing more opportunities for high school graduates to take up a nursing career.The number of nurses in Oman has increased from 1,096 in 1980 to 14,238 in 2011. 15,16These figures may be seen as indicators of a positive attitude towards the nursing profession in Oman as well as a reflection of healthcare needs.
It was important to undertake this study in order to shed light on the attitudes of nursing and non-nursing students at Sultan Qaboos University (SQU) towards the nursing profession.This is because the students' attitudes may contribute to shaping the impression of the nursing profession among the wider population and also because a survey of these students' attitudes might provide a clearer picture of the status of the nursing profession in Omani society in general.There is still a shortage of Omani nurses, a fact that may be due to the negative attitudes towards nursing that were held in Omani society in the past.Moreover, given that the image of nursing was enhanced by the creation of a bachelor's degree level programme at SQU in 2002, exploring the attitudes to nursing of SQU students from different colleges is important because their opinions may play a significant role in making Omani society more aware of the value of nursing as a career.
The purpose of this study was to answer the following questions: First, what are SQU students' attitudes towards the nursing profession and, second, do any of the following factors affect SQU students' attitudes towards the nursing profession, and cause significant differences of opinion?These factors are: gender, academic year and type of college (Arts, Science, Economics, Education, Agriculture, Engineering, Medicine or Nursing).

Methods
A convenience sample was selected by the following method.The list of elective courses offered in the semester was obtained from the Office of the Dean of Admission & Registration at SQU.Out of the 83 courses offered, 8 were chosen; this was done randomly by taking the courses numbered 10, 20, 30, 40, 50, 60, 70 and 80 on the admission and registration list.By chance, it turned out that the 8 courses selected were all from different SQU colleges.The sample size was 377, i.e. the students who had chosen to study these 8 courses.
To assess attitudes of SQU students towards the nursing profession, the authors designed a questionnaire containing 50 items.The items were rated according to a 4-point Likert scale (strongly agree = 4, agree = 3, disagree = 2, strongly disagree = 1).The maximum total score that could be obtained for all of the items was 200, while the minimum score was 50; the average score was thus 125.Any score above 125 indicated a positive attitude, while any score below 125 indicated a negative attitude.
The face validity of the questionnaire was assessed by submitting it to a panel of experts, each of whom had a Ph.D. in either nursing or counselling.They were asked to indicate the extent to which each item was adequate or inadequate in terms of two factors-the construct (attitude to nursing), which was defined operationally, and the language of the items.Inadequacy was determined by the inter-rater agreement (inter-rater reliability).The accepted range was from 0.7-1.If an item was deemed inadequate (below this range), it was deleted or modified.The raters were also asked to add any item they believed to be missing.The original version of the questionnaire consisted of 60 items.Most of these items (45) were judged to be highly adequate, but 5 items were modified and the other 10 items which were rated inadequate were deleted; this meant that the final version of the questionnaire consisted of 50 items.
The reliability of the questionnaire was estimated using two methods: test-retest reliability and internal consistency.For the first method, a pilot study was conducted with 30 SQU students, and the study was conducted twice with an interval of two weeks.The correlation coefficient between the first and second study was 0.743.Internal consistency was calculated using Cronbach's alpha, which gave a total Cronbach's alpha coefficient of 0.925.These values indicated appreciable and stable reliability for the scale scores.
After constructing the study scale and finding its psychometric characteristics, approval for conducting the study was gained from the Research Committee at the SQU College of Nursing.Based on this approval, the researchers then gained approval for data collection from the directors of administration in each college involved in the study.Ethical approval was also obtained, as it was decided that there would be no harm to participants except for the confidentiality issue, which was maintained by asking the participants not to write their names on the cover sheet of the questionnaire.No other ethical implications were present.All confidentiality issues were explained to participants in the cover sheet.Each participant's completion of the questionnaire was an indication of acceptance of participation in the study and was thus considered as informed consent to this study.After the approval of the Research Committee, the researchers obtained the consent of the faculty and went into each classroom to distribute the questionnaires to the students.Students were asked to return them to the researcher in the next class.A total of 350 questionnaires were returned within 4 weeks and, after a reminder, the remaining 27 questionnaires were returned.
In order to answer this study's research questions, the researchers computed both the mean and standard deviation (SD) of items and also participants' total scores.Analysis of variance (two or more independent variables with one dependent variable) and post hoc comparisons were used as well.The Statistical Package for the Social Sciences (SPSS), Version 18 (IBM, Corp., Chicago, Illinois, USA) was used to analyse the data collected from the participants.

Results
Table 1 shows how the participants were distributed by gender and college.Table 2 shows the results for the first research question, with results for the second research question being shown in Table 3. Table 2 illustrates the mean and SD of participants' total scores.Overall, both male and female SQU students in all colleges and at all levels of study had positive attitudes towards the nursing profession [Table 2].Male students had more positive attitudes than female students in all colleges except for the colleges of Science and Education, but they all held similar attitudes within the different academic years.Understandably, perhaps, nursing students had the most positive attitudes towards nursing, with a mean of 163.95 compared to students from other colleges, while education students held the least positive attitudes, with a mean of 144.09.Fourth year students, regardless of college affiliation, were most positive with a mean of 157.19; while fifth year students were least positive with a mean of 140.50.
Further results are shown in Table 3.The findings revealed that neither the students' gender (P = 0.87), nor their study year (P = 0.68) created any significant differences in attitude.However, there were significant differences in attitude depending on the student's college (P = 0.0001), which means that the extent to which SQU students held positive attitudes towards the nursing profession differed from one college to another.

Discussion
The findings relating to the first research question indicated that both male and female SQU students, in all academic years and in all colleges, had positive attitudes towards the nursing profession.Their answers also showed that they viewed the nursing profession as humane, noble, ideal and ethical.They saw it as creating a climate of intimacy, with strong communication and dynamic interaction among people regardless of social class or ethnic group.They generally perceived nurses to be egalitarian and able to work cross-culturally, not recognising any limits in who they would work with or care for.They also characterised nurses as having human and professional power, because nursing mainly depends on offering care unconditionally and at all levels, and is based on interpersonal skills.When interviewing newly admitted SQU nursing students, it was noticed that they (especially male students), stated these same factors as their main reasons for selecting the College of Nursing as their first choice.They also mentioned that they had been well-counselled by their school career counsellors.The students were motivated not only by the nature of nursing as described above, but also by the fact that it is a profession that would enable them to improve their standard of living in the future, which is a strong attraction.
4][5][6]12,17 One study indicated that nonnursing majors were similar to nursing majors in their attitudes towards nursing, and would consider nursing as an alternative career. 4American and Guatemalan nurses were also found to have positive attitudes towards nursing, because of its humanitarian nature and the job security it offered. 4,5Nursing students of Capella University in the USA viewed the public image of nursing as positive and also indicated that they had positive self-concepts, which is an interesting correlation. 6 study in China pointed out that nursing students' perceptions of nursing were positive because of their understanding of the meaning of nursing as a profession, and also their career planning. 1Two studies in Qatar and Canada showed that the most common reasons for joining the nursing profession were the humanitarian nature of nursing, job opportunity/security, helping others, working with people and an interest in science. 2,3The findings at SQU are at odds with the results of only one study, which was done in Turkey and showed that the Turkish students surveyed had fewer positive perceptions about nursing, and more negative attitudes towards it. 13he findings related to the second research question revealed that neither gender nor academic year made a significant difference to SQU students' attitudes towards the nursing profession.The findings for this question were compared with those from studies in other countries which had varied results.In Jordan, for instance, there was no significant correlation between gender and attitude towards nursing, and to the choice of nursing as a career. 10In comparison, a study in China yielded similar results to the one in Oman, showing no statistically significant differences in attitudes towards nursing due to gender or other demographic variables. 11A study about male attitudes, however, had different results: showing that male university students' attitudes were positive towards male nurses. 7n this study, there were significant differences in attitudes based on the college in which a student studied, with nursing students significantly more in favour of their own profession than students in other colleges.These results were consistent with the results of some studies, but not with those of others.For example, they were not consistent with the results of a study which showed that nonnursing and nursing majors had similar attitudes towards nursing. 4The findings of this study, in contrast, reflect the importance of the nursing profession for nursing students who have both theoretical and practical knowledge of nursing; their positive attitudes also reflect the fact that they chose to study nursing willingly, and emphasise the positive effects of qualification and experience on attitude.This is consistent with the results of a study conducted in West Virginia, USA, which showed that a number of nursing students changed their perceptions about nursing after joining a college of nursing; this happened especially while they were gaining clinical experience. 12In Turkey, too, nurses with a bachelor's degree or higher had higher mean scores in attitudes towards nursing than nurses who had graduated from a health occupational high school. 13t appears then that although there are negative factors associated with the nursing profession, such as the nature of the work, the target people and the future of the profession, nursing students at SQU have a positive attitude towards the profession.They may thus be able to a positive image of nursing and an awareness of its value to Oman society.
There are various limitations to this study.A larger sample size from each college would have enhanced its validity.A more equal proportion of male and female participants would also have been desirable.The choice of convenience sample reduced the validity of the study, introducing a bias that those who were most likely to respond were also the ones more likely to have positive attitudes.

Conclusion
There is no doubt that the nursing profession is developing rapidly in Oman.Although there are still many negative perceptions that result in some people avoiding nursing as a profession, many students in Omani high schools are motivated to choose nursing as a future profession, and are strongly attracted to it.The positive attitudes of Omani students, especially nursing students, towards the profession reflect the importance of continuing to increase awareness of the positive value of nursing so that this specialty becomes as attractive as other fields.Serious efforts should therefore be made to maintain and promote the positive image of nursing in Oman.c o n f l i c t o f i n t e r e s t The authors declare no conflict of interest.

Table 1 :
Distribution of participants according to gender and college

Table 2 :
Means and standard deviation of participants' total scores

Table 3 :
Analysis of variance in Sultan Qaboos University students' attitudes by gender, academic year and college