A total of 551 participants took part in the study (Table 1), however, we only included data for nurses and midwives (511 participants) in the analysis. Majority were females (n=316, 61.8%), aged 30-39 years (n=172, 34.2%) and registered nurses/midwives (n=234, 45.8%), followed by registered community health nurses (n=121, 23.7%), and enrolled nurse/midwife (n=48, 9.4%). A majority of the respondents were from Kenya (n=203, 39.7%) and Uganda (n=168, 32.9%). Among the respondents from Kenya, the mean age was 38.5 years (SD: 9.4 years) and average years of practice was 14.4 (9.7) years.
Table 1. Characteristics of the study participants by Country
|
Kenya (n, %)
|
Uganda (n, %)
|
Tanzania (n, %)
|
Total (n, %)
|
p-value
|
Nationality / Sample
|
203 (39.7)
|
168 (32.9)
|
140 (27.4)
|
511
|
|
Age, years
|
|
|
|
|
|
Age (Mean, SD)
|
38.5 (9.4)
|
39.4 (13.1)
|
37.5 (10.6)
|
|
|
20–29
|
38 (19.1)
|
47 (28.3)
|
41 (29.2)
|
126 (25.0)
|
|
30–39
|
73 (36.7)
|
54 (32.5)
|
45 (32.1)
|
172 (34.2)
|
0.099
|
40–49
|
55 (27.6)
|
30 (18.1)
|
27 (19.2)
|
112 (22.3)
|
|
50+
|
33 (16.6)
|
35 (21.1)
|
25 (17.9)
|
93 (18.5)
|
|
Gender
|
|
|
|
|
|
Male
|
79 (38.9)
|
46 (27.4)
|
70 (50.0)
|
195 (38.2)
|
0.000
|
Female
|
124 (61.1)
|
122 (72.6)
|
70 (50.0)
|
316 (61.8)
|
|
Professional Groups
|
|
|
|
|
|
Enrolled nurse/midwife
|
1 (0.5)
|
31 (18.5)
|
16 (11.4)
|
48 (9.4)
|
|
Registered nurse/midwife
|
40 (19.7)
|
92 (54.8)
|
102 (72.9)
|
234 (45.8)
|
0.000
|
Registered Community Health nurse
|
116 (57.1)
|
5 (3.0)
|
0 (0.0)
|
121 (23.7)
|
|
|
|
|
|
|
|
Highest Qualification
|
|
|
|
|
|
Certificate
|
1 (0.5)
|
34 (20.2)
|
15 (10.7)
|
50 (9.7)
|
|
Diploma
|
105 (51.7)
|
58 (34.5)
|
45 (32.1)
|
208 (40.7)
|
0.000
|
Degree
|
72 (35.5)
|
50 (29.8)
|
47 (33.6)
|
169 (33.1)
|
|
Master/PhD
|
25 (12.3)
|
26 (15.5)
|
33 (23.6)
|
84 (16.4)
|
|
Years of Practice
|
|
|
|
|
|
Mean (SD)
|
14.4 (9.7)
|
15.6 (12.8)
|
12.1 (10.3)
|
|
|
0–5
|
43 (21.6)
|
40 (24.2)
|
47 (35.1)
|
47 (35.1)
|
|
6–10
|
44 (22.1)
|
37 (22.4)
|
33 (24.6)
|
33 (24.6)
|
|
11–15
|
33 (16.6)
|
22 (13.3)
|
16 (11.9)
|
16 (11.9)
|
0.084
|
16–20
|
30 (15.1)
|
23 (13.9)
|
8 (6.0)
|
8 (6.0)
|
|
20+
|
49 (24.6)
|
43 (26.1)
|
30 (22.4)
|
30 (22.4)
|
|
Direct patient care
|
|
|
|
|
|
Yes
|
172 (84.7)
|
141 (83.9)
|
108 (77.1)
|
421 (82.4)
|
0.158
|
No
|
31 (15.3)
|
27 (16.1)
|
32 (22.9)
|
90 (17.6)
|
|
Does public perception of nursing and/or midwifery determine how nurses and/or midwives conduct their work
|
|
|
|
|
|
Yes
|
89 (55.3)
|
68 (44.4)
|
37 (36.6)
|
194 (46.7)
|
|
No
|
72 (44.7)
|
85 (55.6)
|
64 (63.4)
|
221 (53.3)
|
0.010
|
Nurses/Midwives Professional View
In Table 2, most nurses/midwives strongly agree or agree that nursing and midwifery is a calling (87.2%), and that they are powerful (87.5%) and trusted professions (82.5%). Nurses also strongly agreed that they have a level of control over how their image was portrayed (84.9%) and that they are effective advocates for their profession (71.1%).
Table 2. Nurses and midwives professional view
|
Strongly disagree/ Disagree (n, %)
|
Not Sure (n, %)
|
Strongly Agree/ Agree (n, %)
|
Nursing and/or midwifery is my calling
|
43 (8.5)
|
22 (4.4)
|
441 (87.2)
|
My family wanted me to become a nurse and/or midwife
|
187 (37.0)
|
92 (18.2)
|
226 (44.8)
|
There is a shortage of nurses and/or midwives in my country
|
81 (16.0)
|
13 (2.6)
|
411 (81.4)
|
Nursing and/or midwifery are powerful professions
|
54 (10.7)
|
9 (1.8)
|
441 (87.5)
|
Nursing and/or midwifery are trusted professions
|
50 (10.0)
|
38 (7.6)
|
414 (82.5)
|
Nursing and/or midwifery are respected professions
|
165 (32.7)
|
46 (9.1)
|
294 (58.2)
|
Nurses and/or midwives can control how their image is portrayed
|
42 (8.3)
|
34 (6.8)
|
428 (84.9)
|
Nurses and/or midwives are affectively assertive
|
103 (20.6)
|
80 (16.0)
|
318 (63.5)
|
Nurses and/or midwives are effective advocates for their profession
|
115 (22.9)
|
30 (6.0)
|
356 (71.1)
|
Nurses and midwives have pride in their profession
|
109 (21.7)
|
63 (12.6)
|
330 (65.7)
|
Nurses/Midwives Impact on Others
As shown in Table 3, female nurses generally felt that how nurses present themselves to their patients mattered a lot (84.3%). Both male and female nurses felt that how nurses greet their patients had a great effect on the image of nurses/midwives (77.3% vs 76.5%). On the other hand, female nurses pointed out that having updated skills and knowledge on practice among nurses had a big effect on their image (80.1%).
Table 3. Nurses/Midwives Impact on Others by gender
|
No effect (n, %)
|
Little effect (n, %)
|
Great effect (n, %)
|
|
Male
|
Female
|
Total
|
Male
|
Female
|
Total
|
Male
|
Female
|
Total
|
How nurses and/or midwives present themselves to patients
|
2 (1.1)
|
9 (2.9)
|
11 (2.2)
|
39 (20.6)
|
40 (12.8)
|
79 (15.8)
|
148 (78.3)
|
263 (84.3)
|
411 (82.0)
|
Whether patients and families feel that nurses and/or midwives show compassion
|
5 (2.7)
|
12 (3.9)
|
17 (3.4)
|
61 (32.6)
|
123 (39.6)
|
184 (37.0)
|
121 (64.7)
|
176 (56.6)
|
297 (59.6)
|
How nurses and/or midwives dress and appear at work
|
8 (4.3)
|
17 (5.5)
|
25 (5.0)
|
39 (20.7)
|
52 (16.9)
|
91 (18.4)
|
141 (75.0)
|
239 (77.6)
|
380 (76.7)
|
How nurses and/or midwives are portrayed in the media
|
16 (8.5)
|
17 (5.5)
|
33 (6.7)
|
58 (30.9)
|
76 (24.8)
|
134 (27.1)
|
114 (60.6)
|
214 (69.7)
|
328 (66.3)
|
How nurse and/or midwives greet patients
|
7 (3.8)
|
16 (5.1)
|
23 (4.6)
|
35 (18.9)
|
57 (18.3)
|
92 (18.6)
|
143 (77.3)
|
238 (76.5)
|
381 (76.8)
|
Whether nurses and/or midwives keep their skills and knowledge up to date
|
7 (3.8)
|
10 (3.2)
|
17 (3.4)
|
48 (25.8)
|
52 (16.7)
|
100 (20.1)
|
131 (70.4)
|
250 (80.1)
|
381 (76.5)
|
How nurses and/or midwives behave professionally
|
3 (1.6)
|
9 (2.9)
|
12 (2.4)
|
32 (17.3)
|
47 (15.1)
|
79 (15.9)
|
150 (81.1)
|
256 (82.1)
|
406 (81.7)
|
How medical professionals interact with nurses and/or midwives
|
10 (5.5)
|
12 (3.9)
|
22 (4.5)
|
50 (27.3)
|
88 (28.5)
|
138 (28.1)
|
123 (67.2)
|
209 (67.6)
|
332 (67.5)
|
Moreover, as highlighted in Table 4, nurses in Kenya felt that factors such as how nurses/midwives greet patients (84.3%), nurses keeping their skills and knowledge up to date (85%) and nurses behaving professionally (93%) have a great effect on their image. Nurses in Uganda felt that how medical professionals interact with nurses/midwives had a great effect (74.9%) on their image.
Table 4. Nurses/Midwives Impact on others by nationality
|
No effect (n, %)
|
Little effect (n, %)
|
Great effect (n, %)
|
|
Kenya
|
Uganda
|
Tanzania
|
Kenya
|
Uganda
|
Tanzania
|
Kenya
|
Uganda
|
Tanzania
|
How nurses and/or midwives present themselves to patients
|
0 (0.00)
|
1 (0.6)
|
10 (7.4)
|
16 (8.0)
|
18 (10.8)
|
45 (33.3)
|
183 (92.0)
|
148 (88.6)
|
80 (59.3)
|
Whether patients and families feel that nurses and/or midwives show compassion
|
7 (3.5)
|
4 (2.4)
|
6 (4.6)
|
54 (27.1)
|
61 (36.3)
|
69 (52.7)
|
138 (69.4)
|
103 (61.3)
|
56 (42.8)
|
How nurses and/or midwives dress and appear at work
|
6 (3.0)
|
5 (3.0)
|
14 (10.5)
|
28 (14.1)
|
27 (16.4)
|
36 (27.1)
|
164 (82.8)
|
133 (80.6)
|
83 (62.4)
|
How nurses and/or midwives are portrayed in the media
|
8 (4.0)
|
39 (23.8)
|
51 (38.6)
|
44 (22.1)
|
39 (23.8)
|
51 (38.6)
|
147 (73.9)
|
115 (70.1)
|
66 (50.0)
|
How nurse and/or midwives greet patients
|
4 (2.0)
|
7 (4.2)
|
12 (9.2)
|
27 (13.6)
|
23 (13.8)
|
42 (32.1)
|
167 (84.3)
|
137 (82.0)
|
77 (58.8)
|
Whether nurses and/or midwives keep their skills and knowledge up to date
|
3 (1.5)
|
5 (3.0)
|
9 (6.8)
|
27 (13.5)
|
29 (17.5)
|
44 (33.3)
|
170 (85.0)
|
132 (79.5)
|
79 (59.9)
|
How nurses and/or midwives behave professionally
|
0 (0.00)
|
2 (1.2)
|
10 (7.6)
|
14 (7.0)
|
25 (15.1)
|
40 (30.3)
|
185 (93.0)
|
139 (83.7)
|
82 (62.1)
|
How medical professionals interact with nurses and/or midwives
|
5 (2.5)
|
7 (4.3)
|
10 (7.6)
|
50 (25.3)
|
34 (20.9)
|
54 (41.2)
|
143 (72.2)
|
122 (74.9)
|
67 (51.2)
|
Image and perception of nursing and midwifery by other health care professionals’
Generally, nurses in the three study areas (Kenya, Tanzania, and Uganda) felt strongly that they were respected and valued (61.7%). Nurses in Uganda strongly disagreed (58.2%) that medical doctors have a high regard for them as nurses (Table 5).
Table 5. Health care professionals’ perception of nursing and midwifery by gender as reported by nurses/midwives
Doctors’ and other health care professionals’ image and perception of nursing and midwifery
|
Strongly disagree / Disagree (n, %)
|
Not Sure (n, %)
|
Strongly Agree/ Agree
(n, %)
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
I feel respected and valued in my work as a nurse and/or midwife
|
65 (35.1)
|
87 (28.2)
|
17 (9.2)
|
20 (6.5)
|
103v (55.7)
|
202 (65.4)
|
Medical doctors have a high regard for nurses and/or midwives
|
104 (56.2)
|
140 (45.3)
|
17 (9.2)
|
31 (10.0)
|
64 (34.6)
|
138 (44.7)
|
Other health professionals have a high regard for nurses and/or midwives
|
71 (39.0)
|
117 (38.0)
|
32 (17.6)
|
48 (15.6)
|
79 (43.4)
|
143 (46.4)
|
Medical doctors regard nurses and/or midwives as equal partners in patient care
|
116 (63.7)
|
183 (59.2)
|
15 (8.2)
|
25 (8.1)
|
51 (28.0)
|
101 (32.7)
|
Advancing my nursing/midwifery knowledge and competencies improves my image as a nurse and/or midwife
|
11 (6.0)
|
15 (4.9)
|
1 (0.6)
|
4 (1.3)
|
170 (93.4)
|
289 (93.8)
|
Nurses and/or midwives have autonomy in making decisions regarding patient care
|
80 (44.0)
|
115 (37.6)
|
12 (6.6)
|
18 (5.9)
|
90 (49.5)
|
173 (56.5)
|
Collaboration between physicians and nurses and/or midwives improves patient health outcomes
|
6 (3.3)
|
10 (3.3)
|
1 (0.6)
|
0 (0.00)
|
175 (96.2)
|
298 (96.8)
|
Table 6. Public image by nationality as reported by nurses/midwives
|
Strongly disagree / Disagree (n, %)
|
Not Sure (n, %)
|
Strongly Agree/ Agree (n, %)
|
|
Kenya
|
Uganda
|
Tanzania
|
Kenya
|
Uganda
|
Tanzania
|
Kenya
|
Uganda
|
Tanzania
|
The public has a high regard for nurses and/or midwives
|
70 (36.3)
|
44 (26.8)
|
39 (31.7)
|
25 (13.0)
|
6 (3.7)
|
27 (22.0)
|
98 (50.8)
|
114 (69.5)
|
57 (46.3)
|
Nurses and/or midwives are not valued by society
|
108 (56.3)
|
103 (62.8)
|
34 (27.9)
|
14 (7.3)
|
10 (6.1)
|
24 (19.7)
|
70 (36.5)
|
51 (31.1)
|
64 (52.5)
|
My professional behavior affects my image
|
13 (6.8)
|
24 (14.6)
|
35 (29.4)
|
5 (2.6)
|
4 (2.4)
|
18 (15.1)
|
174 (90.6)
|
136 (82.9)
|
66 (55.5)
|
Showing compassion and care is important
|
2 (1.1)
|
1 (0.6)
|
4 (3.3)
|
0 (0.0)
|
0 (0.0)
|
1 (0.8)
|
189 (99.0)
|
163 (99.4)
|
117 (95.9)
|
It is important for nurses and/or midwives to have good customer service skills
|
5 (2.6)
|
1 (0.6)
|
3 (2.5)
|
3 (1.6)
|
1 (0.6)
|
1 (0.8)
|
183 (95.8)
|
161 (98.8)
|
117 (96.7)
|
Marketing nursing and/or midwifery to the public is important
|
9 (4.8)
|
12 (7.3)
|
4 (3.3)
|
5 (2.7)
|
6 (3.7)
|
6 (5.0)
|
174 (92.6)
|
146 (89.0)
|
110 (91.7)
|
Humanity is an essential component of my role
|
5 (2.6)
|
0 (0.0)
|
4 (3.3)
|
0 (0.0)
|
1 (0.6)
|
1 (0.8)
|
186 (97.4)
|
163 (99.4)
|
116 (95.9)
|
The public has a positive image of nursing and/or midwifery
|
70 (37.0)
|
56 (34.2)
|
45 (37.5)
|
30 (15.9)
|
17 (10.4)
|
32 (26.7)
|
89 (47.1)
|
91 (55.5)
|
43 (35.8)
|
Nursing and/or midwifery have varied career paths
|
34 (17.8)
|
14 (8.6)
|
15 (12.4)
|
8 (4.2)
|
6 (3.7)
|
20 (16.5)
|
149 (78.0)
|
143 (87.7)
|
86 (71.1)
|
Nursing and/or midwifery is challenging and rewarding
|
14 (7.5)
|
11 (6.7)
|
13 (10.7)
|
7 (3.7)
|
4 (2.4)
|
7 (5.8)
|
167 (88.8)
|
149 (90.9)
|
101 (83.5)
|
Table 7. Public image by gender
|
Strongly disagree/ Disagree (n, %)
|
Not Sure (n, %)
|
Strongly Agree/ Agree (n, %)
|
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
The public has a high regard for nurses and/or midwives
|
52 (29.6)
|
101 (33.2)
|
21 (11.9)
|
37 (12.2)
|
103 (58.5)
|
166 (54.6)
|
Nurses and/or midwives are not valued by society
|
83 (47.4)
|
162 (53.5)
|
22 (12.6)
|
26 (8.6)
|
70 (40.0)
|
115 (38.0)
|
My professional behavior affects my image
|
22 (12.6)
|
50 (16.7)
|
8 (4.6)
|
19 (6.3)
|
145 (82.9)
|
231 (77.0)
|
Showing compassion and care is important
|
3 (1.7)
|
4 (1.3)
|
0 (0.0)
|
1 (0.3)
|
172 (98.3)
|
297 (98.3)
|
It is important for nurses and/or midwives to have good customer service skills
|
3 (1.7)
|
6 (2.0)
|
3 (1.7)
|
2 (0.7)
|
167 (96.5)
|
294 (97.4)
|
Marketing nursing and/or midwifery to the public is important
|
9 (5.2)
|
16 (5.4)
|
2 (1.2)
|
15 (5.0)
|
162 (93.6)
|
268 (89.6)
|
Humanity is an essential component of my role
|
2 (1.2)
|
7 (2.3)
|
2 (1.2)
|
0 (0.0)
|
170 (97.7)
|
295 (97.7)
|
The public has a positive image of nursing and/or midwifery
|
60 (34.5)
|
111 (37.1)
|
29 (16.7)
|
50 (16.7)
|
85 (48.9)
|
138 (46.2)
|
Nursing and/or midwifery have varied career paths
|
22 (12.6)
|
41 (13.6)
|
11 (6.3)
|
23 (7.6)
|
141 (81.0)
|
237 (78.7)
|
Nursing and/or midwifery is challenging and rewarding
|
16 (9.3)
|
22 (7.3)
|
8 (4.7)
|
10 (3.3)
|
148 (86.1)
|
269 (89.4)
|
PERCEIVED ROLES OF NURSES AND/OR MIDWIVES
Nurses/Midwives perception of their role
Nurses/midwives perceive their role as that of advocating for the patient, taking care of patients, promoting health, nursing and supervisory as well as policy making (Table 6).
Perception of the role of nurses and/or midwives by other health care professionals as reported by nurses/midwives
Most nurses/midwives reported that other healthcare professionals perceive the role of nurses as being professional, offering care in an assertive and compassionate manner. They perceive nurses to be provider of patient care and timely communication. They believe nurses are knowledgeable, competent, experienced, and respected.
How do members of the public perceive the role of nurses and/or midwives?
The public perceive the role of the nurses as that of providing care to patients in a compassionate, caring, kind, respectful and professional manner. Specifically, nurses are perceived to have good knowledge, customer care skills, approachable, kind, and competent and have effective communication skills (Table 7).
ATTITUDES TOWARDS NURSES AND MIDWIVES
The attitude toward nurses and midwives was explored using semi-structured questions from our questionnaire. The following sub-headings present the findings.
Attitude of healthcare workers towards nurses and/or midwives
The nurses/midwives surveyed believe that other healthcare workers are perceived to have varying attitudes about nurses/midwives. While some healthcare professionals view nurses/midwives as professional, knowledgeable, and caring. Some healthcare workers view nurses/midwives as inferior, rude, lazy, lacking, less, dirty and maids.
Public attitude of members of the public towards nurses and/or midwives
Similar to the perception of other healthcare workers, the members of the public also have both positive and negative views about nurses and midwives. The public views them as trustworthy, educated, respected, savers and helpers. However, they also view them as doctors, rude, thieves, failures, less, cruel, unkind, corrupted, harsh, poor and maids.