Volume 72, Issue 1 e12986

ORIGINAL ARTICLE

Open Access

Nursing students’ self-esteem levels and attitudes toward the nursing profession

Sude Yeşilyurt MSc,

Sude Yeşilyurt MSc

Nurse

orcid.org/0000-0003-1585-2970

Beylikdüzü State Hospital, Istanbul, Turkey

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Gülcan Kendirkiran BSN, PhD,

Corresponding Author

Gülcan Kendirkiran BSN, PhD

Assistant Professor

[email protected]

orcid.org/0000-0002-3243-9590

Faculty of Health Sciences, Department of Nursing, Halic University, Istanbul, Turkey

Correspondence

Gülcan Kendirkiran, Faculty of Health Sciences, Department of Nursing, Halic University, 5. Levent Mahallesi, 15 Temmuz Şehitler Caddesi, No. 14/12 34060, Eyüpsultan, İstanbul, Turkey.

Email: [email protected]

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Sude Yeşilyurt MSc,

Sude Yeşilyurt MSc

Nurse

orcid.org/0000-0003-1585-2970

Beylikdüzü State Hospital, Istanbul, Turkey

Search for more papers by this author

Gülcan Kendirkiran BSN, PhD,

Corresponding Author

Gülcan Kendirkiran BSN, PhD

Assistant Professor

[email protected]

orcid.org/0000-0002-3243-9590

Faculty of Health Sciences, Department of Nursing, Halic University, Istanbul, Turkey

Correspondence

Gülcan Kendirkiran, Faculty of Health Sciences, Department of Nursing, Halic University, 5. Levent Mahallesi, 15 Temmuz Şehitler Caddesi, No. 14/12 34060, Eyüpsultan, İstanbul, Turkey.

Email: [email protected]

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First published: 29 May 2024

https://doi.org/10.1111/inr.12986

Citations: 2

This study was presented as a master's thesis by Sude Yeşilyurt, under the supervision of Assistant Professor Gülcan Kendirkıran, at Halic University Graduate Education Institute, Department of Nursing.

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Abstract

Aim

This study aimed to examine nursing students’ self-esteem levels and attitudes toward the nursing profession.

Background

Although it is important to choose a profession that will make the person happy in many aspects such as one's abilities, interests, values, attitudes, personal goals, and social expectations, it has an important place, especially in a profession such as nursing, which involves intense emotional and physical load.

Methods

The study population was 390 nursing students at a foundation university in Istanbul, while the sample included 202 students. Data were collected between January 16, 2023, and February 15, 2023, with the Demographic Data Collection Tool, Coopersmith Self-Esteem Inventory, and the Attitude Scale for Nursing Profession. The data were analyzed using the SPSS 27.0 program. The STROBE checklist was used to report the study.

Results

The mean age of the participants was 20.79 ± 1.72 (years), among which 65.3% were in the 20–22 age range, 76.7% were female, and 29.7% were in the first grade. A positive but very weak relationship was found between the Coopersmith Self-Esteem Inventory and the Attitude Scale for Nursing Profession scores (p < 0.05).

Conclusion

The results show that professionalization and socialization processes greatly affect nursing students’ self-esteem. Considering the extended period that students spend in academic institutions under the guidance of faculty members, this matter deserves greater attention.

Implications for nursing

While developing the curriculum and education process, factors that support the development of self-esteem in nursing students should be taken into account and initiatives should be planned to increase positive attitudes toward the profession. Nursing students can gain different perspectives by spending more time with nurses in hospitals.

INTRODUCTION

The feeling of being valuable and significant forms the basis of self-esteem, and the feeling of being valued determines people's belief in themselves and their capacity to love themselves (Möbius et al., 2022). Feeling valuable is essential for the healthy development of self-esteem (Moradi et al., 2021). Self-esteem affects motivation and functional behaviors in people's lives (Harris et al., 2017). A healthy self-esteem contributes positively to living and motivates people (Güzel & Yanardağ, 2021). Self-esteem is shaped by experiences, relationships, and environmental factors at different stages of life (Morales-Sánchez et al., 2021). Some factors such as family, teachers, appearance, environment, success, and cultural level influence the development of self-esteem (Saiphoo et al., 2020). The level of self-esteem of nursing students is essential and affects clinical competence, professionalization, professional behaviors, and career identity (Brown & Crookes, 2016). An attitude is an idea, belief, or image that results from how we perceive or understand something (Orth et al., 2018). Attitudes shape people's thoughts, beliefs, and behaviors, and different attitudes are directly related to individuals’ experiences with their environment (De Vos et al., 2022). Professional attitude refers to the emotional, mental, and behavioral tendencies related to one's profession and professional activities (Yang et al., 2018). Considering gender, which is one of the factors affecting the professional self-esteem and attitudes of female nursing students, it is stated that the professional self-esteem of women is higher, and this may be because the nursing profession was a profession practiced only by women in the past (Kahraman & Fırat Kılıç, 2021). Nursing students’ attitudes toward the profession are a crucial consideration in developing nursing education and strategies and advancing the profession and the success of students (Çoban et al., 2015; Terzioglu et al., 2016). Identifying them helps to develop nursing education and take steps to promote the profession (Casale et al., 2022). In addition, the “Nursing Now Campaign” was established by the “World Health Organization” and the “International Council of Nurses,” which aims to improve health by raising the profile and status of nursing (Randolph, 2018). There are few studies in these areas and more research is needed (Efteli et al., 2023). Therefore, this study aims to examine nursing students’ self-esteem levels and attitudes toward the nursing profession.

METHODS

Design

This study aimed to examine the self-esteem levels of nursing students and their attitudes toward the nursing profession. This study followed a descriptive and cross-sectional design. The STROBE checklist was used to report the results.

The study included the following research questions:

What are the self-esteem levels of nursing students?
What are the attitudes of nursing students toward the nursing profession?
Is there a relationship between nursing students' self-esteem levels and their attitudes toward the nursing profession?

Participants and setting

The population of the study was 390 nursing students at a foundation university in Istanbul, while the sample included 202 students. The value of the sample was calculated by the sampling method with a known population. Inclusion criteria were as follows: (i) being an active registered nursing student at the university where the study was to be conducted and (ii) being able to answer the data collection tools independently.

Procedure

The researchers collected data between January 16, 2023, and February 15, 2023, through face-to-face interviews with nursing students following the ethics committee and institutional permissions.

Data collection tools

Demographic data collection tool

It was a 16-question form created by the researchers with reference to the literature to determine the participants’ demographic characteristics (Hatamleh & Sorio, 2017; Coban & Kasikci, 2011).

Coopersmith self-esteem inventory (CSEI)

It was developed by Coopersmith (1967) to determine an individual's self-esteem level. The inventory contained 58 items, including “general self-esteem,” “social self-esteem,” “school-academic self-esteem,” “home/family self-esteem,” and “lying” items. Eight of the 58 items were not considered in evaluations as they were the wrong items. The remaining items were evaluated over 50 points, with higher scores indicating positive self-esteem (Pişkin, 1997). CSEI statements were answered as “Like me/Unlike me”. In the validity and reliability studies conducted in Turkey by Pişkin (1997), the reliability coefficients were found to be 0.83 and 0.76. In this study, the total Cronbach's alpha value was 0.75. Cronbach's alpha values for the general self-esteem, social self-esteem, home/family self-esteem, school-academic self-esteem, and lying subdimensions were 0.78, 0.69, 0.68, 0.64, and 0.6, respectively.

Attitude scale for the nursing profession (ASNP)

This scale was developed by Coban and Kasikci (2011). It had a Cronbach's alpha coefficient of 0.91. Each statement was scored from 1 to 5 on a Likert-type scale. Seventeen items of the 60-item trial scale included negative statements, which were reverse-scored. The higher the score obtained from the scale, the higher the positive attitude toward the nursing profession. The Cronbach's alpha value of the scale was 0.91, and the test–retest value was r = 0.90 (Coban & Kasikci, 2011; Zencir & Eşer, 2016). The Cronbach's alpha value in this study was 0.89. The Cronbach's alpha values for the properties of the nursing profession, preference to the nursing profession, and the general position of the nursing profession were 0.91, 0.8, and 0.78, respectively.

Data analysis

Statistical analyses were made using the SPSS 27.0 software package. Frequency tables and descriptive statistics were used to interpret the findings. For the values unfit to the normal distribution, the Mann–Whitney U test was used to compare two independent groups for nonparametric methods, and the Kruskal–Wallis H to compare three or more independent groups. Bonferroni correction was applied for pairwise comparisons of variables that differed significantly for three or more groups. The Spearman correlation coefficient was used to examine the relationships of two quantitative variables in cases where at least one was unfit for normal distribution.

Ethical considerations

The research conforms to the provisions of the Declaration of Helsinki. Ethical approval was obtained from Haliç University Non-Interventional Clinical Research Ethics Committee (November 30, 2022/No: 234), and to conduct the research, necessary permissions were obtained from Haliç University following the ethics committee permission (January 16, 2023/No: 60178). After the necessary permissions were obtained, written consent from all participants was obtained face to face before the study began.

RESULTS

Participants’ mean age was 20.79 ± 1.72 years. The subdimensions of the CSEI of general self-esteem, social self-esteem, home/family self-esteem, school-academic self-esteem, and lying items mean scores were 16.88 ± 3.99, 5.75 ± 1.67, 5.26 ± 1.86, 4.45 ± 1.73, and 2.68 ± 1.35, respectively, and CSEI-Total mean score was 32.34 ± 6.99. The mean scores for the subdimensions of the ASNP, including properties of the nursing profession, preference to the nursing profession, the general position of the nursing profession, and ASNP-Total, were 4.35 ± 0.6, 3.54 ± 0.71, 3.7 ± 0.43, and 3.94 ± 0.48, respectively.

By age, participants under the age of 20 had higher social self-esteem (6.21 ± 1.55) mean score, those aged 20–22 had higher school-academic self-esteem (4.76 ± 1.67) and CSEI-Total (32.95 ± 6.64) mean scores, and those over the age of 23 had higher lying items (3.04 ± 1.43) mean score (p < 0.05). By gender, men's lying item scores were higher (Z = −2.297; p = 0.022). By grade level, those in the first grade had higher general self-esteem (17.61 ± 4.33) mean score, and those in the second grade had substantially higher social self-esteem (6.25 ± 1.16), home/family self-esteem (6.02 ± 1.68) and CSEI-Total (34.56 ± 6.36) mean scores (p < 0.05). By family attitude, home/family self-esteem (6.81 ± 1.73) and CSEI-Total (35.49 ± 6.99) mean scores were higher in those who described their family as democratic (p < 0.05). By the graduated high school, regular/Anatolian high school graduates had higher general self-esteem (17.50 ± 3.96), home/family self-esteem (5.46 ± 1.93), and CSEI-Total (33.48 ± 6.91) mean scores (p < 0.05) presented in Table 1.

TABLE 1. Comparison of Coopersmith Self-Esteem Inventory subdimension scores according to findings.

Variable (n = 202)	n	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]
		Coopersmith Self-Esteem Inventory
		General Self-Esteem		Social Self-Esteem		Home-Family Self-Esteem		School-Academic Self-Esteem		Lying items		CSEI-Total
Age
<20 ⁽¹⁾	47	17.13 ± 4.34	17.0 [7.0]	6.21 ± 1.55	6.0 [2.0]	5.19 ± 2.10	5.0 [3.0]	3.79 ± 1.84	3.0 [3.0]	2.23 ± 1.11	2.0 [2.0]	32.31 ± 7.71	32.0 [11.0]
20–22 ⁽²⁾	132	17.12 ± 3.88	17.0 [6.0]	5.75 ± 1.65	5.0 [2.0]	5.33 ± 1.84	6.0 [3.0]	4.76 ± 1.67	5.0 [2.0]	2.78 ± 1.38	3.0 [2.0]	32.95 ± 6.64	33.0 [11.0]
≥23 ⁽³⁾	23	15.00 ± 3.46	13.0 [4.0]	4.83 ± 1.77	4.0 [3.0]	4.96 ± 1.49	5.0 [2.0]	4.04 ± 1.46	4.0 [2.0]	3.04 ± 1.43	3.0 [2.0]	28.83 ± 6.63	25.0 [9.0]
Statistical analysis^a		χ²= 5.946		χ²= 10.522		χ²= 1.219		χ²= 12.541		χ²= 7.657		χ²= 7.514
Probability		p = 0.051		p = 0.005		p = 0.544		p = 0.002		p = 0.022		p = 0.023
Difference				[1–3]				[1–2]		[1–2.3]		[2–3]
Gender
Female	155	16.62 ± 4.07	16.0 [7.0]	5.85 ± 1.65	6.0 [2.0]	5.26 ± 1.90	5.0 [3.0]	4.34 ± 1.74	4.0 [3.0]	2.55 ± 1.30	2.0 [1.0]	32.06 ± 7.18	32.0 [12.0]
Male	47	17.72 ± 3.60	18.0 [6.0]	5.42 ± 1.73	5.0 [3.0]	5.26 ± 1.76	6.0 [3.0]	4.83 ± 1.66	5.0 [2.0]	3.13 ± 1.42	3.0 [2.0]	33.23 ± 6.29	33.0 [10.0]
Statistical analysis		Z = −1.807		Z = −1.681		Z = −0.146		Z = −1.549		Z = −2.297		Z = −1.110
Probability		p = 0.071		p = 0.093		p = 0.884		p = 0.121		p = 0.022		p = 0.267
Grade level
First ⁽¹⁾	60	17.61 ± 4.33	18.0 [7.0]	5.96 ± 1.76	6.0 [2.8]	5.25 ± 2.01	5.0 [3.0]	4.00 ± 1.73	4.0 [2.0]	2.58 ± 1.23	3.0 [1.8]	32.83 ± 7.74	32.5 [11.0]
Second ⁽²⁾	51	17.59 ± 3.79	18.0 [6.0]	6.25 ± 1.16	6.0 [2.0]	6.02 ± 1.68	7.0 [2.0]	4.71 ± 1.97	4.0 [3.0]	2.71 ± 1.51	2.0 [1.0]	34.56 ± 6.36	34.0 [10.0]
Third ⁽³⁾	48	17.15 ± 3.83	17.0 [7.8]	6.06 ± 1.49	6.0 [2.0]	5.14 ± 2.05	6.0 [4.0]	4.73 ± 1.63	5.0 [2.8]	2.92 ± 1.56	3.0 [2.0]	33.08 ± 6.61	34.0 [10.8]
Fourth ⁽⁴⁾	43	14.69 ± 3.14	14.0 [5.0]	4.51 ± 1.71	5.0 [3.0]	4.49 ± 1.28	4.0 [2.0]	4.47 ± 1.44	5.0 [2.0]	2.53 ± 1.01	3.0 [1.0]	28.16 ± 5.23	25.0 [6.0]
Statistical analysis		χ²= 17.159		χ²= 27.579		χ²= 18.758		χ²= 5.700		χ²= 1.520		χ²= 23.658
Probability		p < 0.001		p < 0.001		p < 0.001		p = 0.127		p = 0.678		p < 0.001
Difference		[1.2.3–4]		[1.2.3–4]		[2–4]						[1.2.3–4]
Family attitude
Democratic ⁽¹⁾	69	17.81 ± 3.98	18.0 [6.5]	6.03 ± 1.58	6.0 [2.0]	6.81 ± 1.73	6.0 [2.5]	4.84 ± 1.75	5.0 [2.0]	2.65 ± 1.40	2.0 [1.5]	35.49 ± 6.99	35.0 [11.5]
Overprotective ⁽²⁾	34	16.59 ± 3.90	16.5 [7.3]	5.21 ± 1.61	5.0 [1.6]	4.73 ± 1.73	4.0 [2.0]	4.09 ± 1.64	4.0 [2.0]	2.56 ± 1.14	3.0 [1.0]	30.62 ± 5.68	30.5 [10.3]
Oppressive ⁽³⁾	22	15.32 ± 3.43	14.0 [6.0]	5.45 ± 2.01	5.5 [3.0]	4.00 ± 2.23	3.5 [3.5]	3.82 ± 1.74	3.5 [3.0]	2.82 ± 1.40	3.0 [1.3]	28.59 ± 7.31	27.0 [11.8]
Indifferent ⁽⁴⁾	6	18.33 ± 5.27	18.0 [7.0]	6.00 ± 1.26	5.5 [2.3]	6.00 ± 1.67	5.0 [2.0]	5.17 ± 1.47	5.0 [1.8]	3.17 ± 0.98	3.5 [2.0]	34.50 ± 7.76	34.0 [8.3]
Free ⁽⁵⁾	19	17.53 ± 3.59	17.0 [5.0]	6.32 ± 1.57	6.0 [2.0]	5.84 ± 2.14	5.0 [4.0]	4.68 ± 1.91	5.0 [3.0]	2.89 ± 1.45	3.0 [1.0]	34.37 ± 6.30	34.0 [11.0]
Mixed ⁽⁶⁾	52	16.08 ± 4.03	16.0 [7.0]	5.63 ± 1.70	6.0 [2.0]	5.09 ± 1.55	5.0 [2.0]	4.27 ± 1.63	4.5 [2.0]	2.62 ± 1.42	3.0 [3.0]	31.08 ± 6.76	32.0 [10.8]
Statistical analysis		χ²= 10.315		χ²= 9.071		χ²= 20.363		χ²= 10.632		χ²= 2.190		χ²= 19.209
Probability		p = 0.067		p = 0.106		p = 0.001		p = 0.059		p = 0.822		p = 0.002
Difference						[1–2.3]						[1–2.3]
High school
Regular/Anatolian ⁽¹⁾	132	17.50 ± 3.96	18.0 [6.8]	5.93 ± 1.66	6.0 [2.0]	5.46 ± 1.93	6.0 [3.0]	4.58 ± 1.79	5.0 [3.0]	2.75 ± 1.42	3.0 [1.0]	33.48 ± 6.91	33.0 [11.0]
Health vocational ⁽²⁾	44	16.18 ± 3.52	16.0 [6.0]	5.43 ± 1.71	6.0 [3.0]	4.95 ± 1.71	5.0 [2.0]	3.98 ± 1.75	4.0 [2.0]	2.36 ± 1.10	2.0 [2.0]	30.55 ± 6.88	28.5 [12.5]
Other ⁽³⁾	26	14.88 ± 4.13	13.0 [8.0]	5.38 ± 1.60	5.0 [2.3]	4.73 ± 1.69	4.0 [2.3]	4.58 ± 1.41	5.0 [1.0]	2.85 ± 1.31	3.0 [2.0]	29.58 ± 6.32	27.5 [9.8]
Statistical analysis		χ²= 10.945		χ²= 5.542		χ²= 6.143		χ²= 4.605		χ²= 3.475		χ²= 11.021
Probability		p = 0.004		p = 0.063		p = 0.046		p = 0.100		p = 0.176		p = 0.004
Difference		[1–3]				[1–3]						[1–2.3]

^a Mann–Whitney U test (Z-table value) was used for comparison of measurement values of two independent groups in nonnormally distributed data, and Kruskall–Wallis H test statistics (χ²-table value) to compare three or more independent groups.

By age, those in the <20 age group had a higher mean score for preferring the profession (3.82 ± 0.72) (p < 0.05). By gender, a difference was found in properties of the nursing profession (Z = −2.817; p = 0.005), preference to the nursing profession (Z = −2.458; p = 0.014), and ASNP-Total (Z = −2.904; p = 0.004), with women having higher mean scores. By grade level, the mean score of choosing a profession (3.85 ± 0.66) was higher in the first-year students (p < 0.05). By family attitude, the mean score of choosing a profession (3.71 ± 0.59) was higher in those who described the family attitude as mixed (p < 0.05). By the graduated high school, properties of the nursing profession (4.58 ± 0.52) and ASNP-Total (4.07 ± 0.37) scores were higher in health vocational high school graduates (p < 0.05) presented in Table 2.

TABLE 2. Comparison of Attitude Scale for Nursing Profession scores according to the findings.

Variable (n = 202)	n	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]	${\bar{\mathrm{X}}} \pm {\mathrm{S}}.{\mathrm{S}}.$	Median [IQR]
		Attitude Scale for Nursing Profession
		Properties of nursing profession		Preference to nursing profession		General position of nursing profession		ATNPS-total
Age
<20 ⁽¹⁾	47	4.39 ± 0.55	4.4 [0.9]	3.82 ± 0.72	3.8 [1.1]	3.69 ± 0.42	3.8 [0.7]	4.05 ± 0.49	4.2 [0.8]
20–22 ⁽²⁾	132	4.29 ± 0.64	4.4 [0.8]	3.45 ± 0.70	3.3 [1.0]	3.69 ± 0.46	3.8 [0.6]	3.88 ± 0.49	4.0 [0.6]
≥23 ⁽³⁾	23	4.57 ± 0.42	4.8 [0.8]	3.48 ± 0.59	3.3 [0.5]	3.79 ± 0.24	3.8 [0.4]	4.04 ± 0.30	4.1 [0.5]
Statistical analysis^a		χ²= 4.910		χ²= 10.457		χ²= 0.301		χ²= 4.788
Probability		p = 0.086		p = 0.005		p = 0.860		p = 0.091
Difference				[1–2.3]
Gender
Female	155	4.41 ± 0.59	4.6 [0.7]	3.60 ± 0.68	3.6 [1.0]	3.73 ± 0.43	3.8 [0.4]	3.99 ± 0.47	4.1 [0.7]
Male	47	4.17 ± 0.60	4.3 [0.9]	3.32 ± 0.76	3.2 [0.9]	3.63 ± 0.45	3.8 [0.7]	3.77 ± 0.49	3.8 [0.6]
Statistical analysis		Z = −2.817		Z = −2.458		Z = −1.184		Z = −2.904
Probability		p = 0.005		p = 0.014		p = 0.236		p = 0.004
Grade level
First ⁽¹⁾	60	4.39 ± 0.52	4.4 [0.8]	3.85 ± 0.66	3.9 [0.9]	3.71 ± 0.39	3.8 [0.6]	4.06 ± 0.47	4.2 [0.6]
Second ⁽²⁾	51	4.22 ± 0.66	4.4 [0.8]	3.44 ± 0.71	3.4 [1.2]	3.67 ± 0.51	3.8 [0.7]	3.84 ± 0.43	3.9 [0.8]
Third ⁽³⁾	48	4.34 ± 0.77	4.6 [0.8]	3.38 ± 0.78	3.3 [1.0]	3.68 ± 0.51	3.8 [0.4]	3.88 ± 0.56	3.9 [0.7]
Fourth ⁽⁴⁾	43	4.47 ± 0.38	4.4 [0.7]	3.38 ± 0.56	3.3 [0.5]	3.74 ± 0.26	3.8 [0.3]	3.95 ± 0.29	4.0 [0.4]
Statistical analysis		χ²= 3.251		χ²= 18.318		χ²= 0.352		χ²= 6.822
Probability		p = 0.355		p < 0.001		p = 0.950		p = 0.078
Difference				[1–2.3.4]
Family attitude
Democratic ⁽¹⁾	69	4.30 ± 0.63	4.5 [0.8]	3.54 ± 0.67	3.5 [1.0]	3.79 ± 0.38	3.9 [0.6]	3.93 ± 0.48	4.0 [0.6]
Overprotective ⁽²⁾	34	4.51 ± 0.39	4.5 [0.6]	3.57 ± 0.64	3.4 [1.0]	3.71 ± 0.41	3.7 [0.5]	4.02 ± 0.35	4.1 [0.7]
Oppressive ⁽³⁾	22	4.24 ± 0.65	4.4 [0.8]	3.48 ± 0.77	3.2 [1.4]	3.49 ± 0.53	3.6 [0.8]	3.82 ± 0.56	3.7 [0.8]
Indifferent ⁽⁴⁾	6	4.56 ± 0.55	4.8 [1.0]	2.58 ± 1.24	2.2 [1.7]	3.57 ± 0.48	3.7 [0.8]	3.69 ± 0.63	3.7 [0.7]
Free ⁽⁵⁾	19	4.13 ± 0.98	4.4 [1.4]	3.36 ± 0.79	3.1 [1.4]	3.53 ± 0.62	3.7 [1.0]	3.74 ± 0.73	3.8 [1.4]
Mixed ⁽⁶⁾	52	4.43 ± 0.46	4.4 [0.7]	3.71 ± 0.59	3.7 [0.9]	3.74 ± 0.35	3.9 [0.6]	4.04 ± 0.39	4.1 [0.5]
Statistical analysis		χ²= 3.977		χ²= 12.088		χ²= 7.857		χ²= 5.937
Probability		p = 0.553		p = 0.034		p = 0.164		p = 0.312
Difference				[4–1.6]
High school
Regular/Anatolian ⁽¹⁾	132	4.33 ± 0.59	4.4 [0.8]	3.54 ± 0.76	3.6 [1.2]	3.70 ± 0.43	3.8 [0.4]	3.93 ± 0.50	4.0 [0.7]
Health vocational ⁽²⁾	44	4.58 ± 0.52	4.6 [0.6]	3.62 ± 0.62	3.4 [0.9]	3.79 ± 0.34	3.9 [0.3]	4.07 ± 0.37	4.1 [0.4]
Other ⁽³⁾	26	4.18 ± 0.71	4.3 [0.9]	3.38 ± 0.55	3.3 [0.7]	3.55 ± 0.54	3.5 [0.7]	3.77 ± 0.49	3.8 [0.5]
Statistical analysis		χ²= 7.346		χ²= 1.581		χ²= 4.352		χ²= 7.454
Probability		p = 0.025		p = 0.454		p = 0.114		p = 0.024
Difference		[2–1.3]						[2–3]

^a Mann–Whitney U test (Z-table value) was used for comparison of measurement values of two independent groups in non-normally distributed data, and the Kruskall–Wallis H test statistics (χ²-table value) to compare three or more independent groups.

A positive and very weak relationship was found between ASNP-Total and CSEI-Total scores (p < 0.05) presented in Table 3.

TABLE 3. Examining the relationships between scale scores.

Correlation^a (n = 202)		Properties of nursing profession		Preference to nursing profession	General position of nursing profession	ASNP-total
		Attitude Scale for Nursing Profession
Coopersmith Self-Esteem Inventory	General Self-Esteem	r	0.102	0.221	0.119	0.182
	General Self-Esteem	p	0.151	0.002	0.092	0.010
	Social Self-Esteem	r	0.125	0.230	0.151	0.222
	Social Self-Esteem	p	0.076	<0.001	0.032	0.001
	Familial Self-Esteem	r	0.244	0.188	0.197	0.249
	Familial Self-Esteem	p	<0.001	0.007	0.005	<0.001
	School-Academic Self-Esteem	r	0.040	0.050	0.112	0.054
	School-Academic Self-Esteem	p	0.574	0.478	0.112	0.447
	Lying items	r	−0.136	−0.095	−0.188	−0.160
	Lying items	p	0.054	0.179	0.007	0.023
	CSEI-Total	r	0.163	0.235	0.174	0.231
	CSEI-Total	p	0.020	<0.001	0.013	<0.001

^a The Spearman correlation coefficient was used in cases where at least one of the two quantitative variables did not fit the normal distribution.

DISCUSSION

The positive progress of the education process helps nursing students to better adapt to their future professional lives and find satisfaction in their profession (Jubas & Knutson, 2012). Megahed and Mohammad (2014) argue that academicians knowledgeable about the self-esteem of nursing students will support students in developing self-esteem and a positive approach to the profession.

In this study, nursing students’ self-esteem (32.34 ± 6.99) and their attitudes toward the nursing profession (3.94 ± 0.48) were found to be above average. In the studies conducted by Dinçer and Öztunç (2009) on 409 nursing and midwifery students, the level of self-esteem were above average. This was a positive finding because it means that the individuals perceive themselves as skillful, successful, and valuable as their self-esteem increases and self-esteem in nursing students is as essential as the education received in forming career identity (Min et al., 2021), but there is room for improvement in this area.

In this study, the CSEI scores of the 20–22 age group were found to be higher than those in the ≥23 age group (χ² = 7.514; p = 0.023). In their study with nursing students, Seval and Sönmez (2020) found that students over age 23 had high self-esteem scale scores. Self-esteem is dynamic, can change over time, and is affected by many factors (Reitz, 2022). The study by Dinçer and Öztunç (2009) on nursing and midwifery students aged 20–22 years found that high self-esteem levels of the participants could be related to their more positive perspective on life due to their young age.

In this study, the CSEI scores of the first-, second-, and third-grade students were higher than the fourth-grade students (p < 0.001). Farhan and Khan (2015), in their study on 300 students from different departments, found that students’ stress levels and self-esteem increased as they progressed to higher grades. This might be attributed to the stress associated with the increasing responsibilities that graduating students anticipate in their professional lives, potentially affecting their self-esteem negatively.

In this study, the students with a democratic family had higher CSEI scores. Baumeister et al. (2003) studied university students from various departments and found that children of parents with a democratic attitude positively influence their children's self-concept. Families with a democratic attitude boost their children's self-esteem by increasing their autonomy, independent thinking, and decision-making potential.

In this study, those who graduated from a regular/Anatolian high school had high CSEI scores. Likewise, in Dinçer and Öztunç’s (2009) study on nursing students, self-esteem levels of students who graduated from regular/Anatolian high schools were higher than the others. Graduates of health vocational high schools start the profession early after graduation, leading to early burnout, which may have lowered their self-esteem.

Those aged <20 years had higher scores for preference to the nursing profession. In the study conducted by Seval and Sönmez (2020) with nursing students, as the age of the students increased, their perceptions of the characteristics of the nursing profession and the general situation of the nursing profession became positive, and more of them chose the nursing profession. Family, financial reasons, and personal characteristics can all have a positive impact on a person's preference for a profession.

This study showed that ASNP-Total (Z = −2.904; p = 0.004) scores were higher for women. According to the study conducted by Basaran and Kosgeroglu (2023) with nursing students, the lower number of men in the profession causes social isolation in men, and they experience gender discrimination the most in the profession and nurses of the same gender as the patients are given priority during treatment and care. Wang et al. (2019) reported in their study with nursing students that male students were exposed to gender discrimination while providing care in the clinic because of which they could not work in some services. Additionally, male students experienced certain events not encountered by their female counterparts, and female students were not happy with men being in the nursing profession. According to Tang et al. (2020), male nurses were more likely to experience gender discrimination. Since the nursing profession is associated with women, it can be thought that the attitude toward the nursing profession can only increase positively in women.

In this study, the scores of those who preferred the nursing profession were higher than those in the first year. According to Alesi et al. (2012), students who choose nursing departments unwillingly begin to see nursing as an ideal profession owing to the new vision they developed as they came to the fourth grade. Although students may initially choose this department for immediate job prospects, they seem to continue for other motivations, such as building a strong career, helping others, and becoming skilled nurses.

In this study, individuals from families with a democratic and mixed background had higher scores in choosing a profession. Kaya et al. (2012) noted that the social and cultural conditions in the place where they live shape the attitude of the family. Lechasseur et al. (2011) stated that family attitudes shaped by sociocultural perceptions had a significant impact on the academic achievement of girls. Families want their children to secure their future by providing them with a good education.

In this study, the ASNP-Total scores of those who graduated from health vocational high school were higher. The attitudes and perceptions of students toward their chosen profession affect their psychological health and mental health, and colleague solidarity is higher in nurses with higher professional self-esteem (Kahraman & Fırat Kılıç, 2021). Students' adoption of the nursing profession in health vocational high schools may have made it easier for them to adjust when they start university.

The correlation between CSEI-Total and ASNP-Total was positive in this study (r = 0.231; p = 0.001). In a study with nursing students, Bölükbaş (2018) found that as their attitude toward the nursing profession increased, so did their self-esteem. Çeçen et al. (2020) reported in their study with nursing students that positive thoughts and perspectives on the general state of the nursing profession also positively affected the individual's self-esteem. Juraschek et al. (2012) found with nursing students that the higher the status of the nursing profession, the greater the self-esteem of those who choose it. Although self-esteem is highly related to perceptions of social self and social confidence, self-esteem reflects a person's social status, social recognition, and social participation (Oh, 2021). It can be thought that nurses' attitudes toward the nursing profession will progress in a more positive direction as they become adequately equipped with social recognition, social confidence, and value, starting from undergraduate education. In the study conducted by Santos et al. (2021) in Brazil, more effective results were obtained in nursing education and development in the working groups formed within the scope of the “Nursing Now Campaign,” including academicians and graduate nursing students. To realize various campaigns or events and achieve the goals, it is necessary to strengthen the education and development of nursing, strengthen the interaction between educational institutions and health services, increase self-value, and invest in the evaluation of nursing and teaching staff (Oliveira et al., 2020).

Limitations

The study was conducted with students at a single university; its results are limited to this sample group and cannot be generalized.

CONCLUSIONS

As the students’ self-esteem levels increased, their attitudes toward the profession also increased positively. Developing strategies to improve students’ self-esteem levels and attitudes toward the profession in nursing education programs is recommended. In addition, nurses in hospitals can plan training or activities to strengthen students’ self-esteem to ensure that future nurses are not only competent individuals but also confident and happy in the way they decide to be. Strategies such as increasing students’ professional knowledge, introducing role models in the profession, and having them do applied work to solve the problems encountered in the profession can be used for them to develop a positive attitude toward the profession. It is also recommended to conduct two-sided studies that address the perspectives of nurses and nursing students.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

In order for nursing students to have positive attitudes toward the profession, they should be guided in education processes, both through courses in the curriculum and clinical practices, to increase their self-esteem levels, interact with patients/healthy individuals, collaborate with health professionals, etc. In addition, planning approaches to students within the framework of joint cooperation not only with academics but also with nurses in the clinic will yield positive results. In addition, initiatives should be planned to improve the self-esteem of nursing students both in their educational processes and clinical practices.

AUTHOR CONTRIBUTIONS

Study design: Sude Yeşilyurt and Gülcan Kendirkiran. Data collection: Sude Yeşilyurt and Gülcan Kendirkiran. Data analysis: Sude Yeşilyurt and Gülcan Kendirkiran. Study supervision: Gülcan Kendirkiran. Manuscript writing: Sude Yeşilyurt and Gülcan Kendirkiran. Critical revisions for important intellectual content: Gülcan Kendirkiran.

ACKNOWLEDGMENTS

We wish to thank the participants for their valuable time and insights.

CONFLICT OF INTEREST STATEMENT

The authors declare that there are no conflicts of interest.

FUNDING INFORMATION

No support was received from any institution or organization during the study.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Volume72, Issue1

March 2025

e12986

Nursing students’ self-esteem levels and attitudes toward the nursing profession

Abstract

Aim

Background

Methods

Results

Conclusion

Implications for nursing

INTRODUCTION

METHODS

Design

Participants and setting

Procedure

Data collection tools

Demographic data collection tool

Coopersmith self-esteem inventory (CSEI)

Attitude scale for the nursing profession (ASNP)

Data analysis

Ethical considerations

RESULTS

DISCUSSION

Limitations

CONCLUSIONS

IMPLICATIONS FOR NURSING AND HEALTH POLICY

AUTHOR CONTRIBUTIONS

ACKNOWLEDGMENTS

CONFLICT OF INTEREST STATEMENT

FUNDING INFORMATION

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Information

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Nursing students’ self-esteem levels and attitudes toward the nursing profession

Abstract

Aim

Background

Methods

Results

Conclusion

Implications for nursing

INTRODUCTION

METHODS

Design

Participants and setting

Procedure

Data collection tools

Demographic data collection tool

Coopersmith self-esteem inventory (CSEI)

Attitude scale for the nursing profession (ASNP)

Data analysis

Ethical considerations

RESULTS

DISCUSSION

Limitations

CONCLUSIONS

IMPLICATIONS FOR NURSING AND HEALTH POLICY

AUTHOR CONTRIBUTIONS

ACKNOWLEDGMENTS

CONFLICT OF INTEREST STATEMENT

FUNDING INFORMATION

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

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