Research progress on professional identity assessment tools for nursing students in China

Hui-Ping Wang,Lv Cheng,Yan-Qiu Huang,Chang-De Jin

1Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China; 2School of Nursing, Tianjin University Traditional Chinese Medicine,Tianjin,China.

Abstract

Keywords:Nursing students,Professional identity,Research tools,Progress

Introduction

Nursing students’ professional identity refers to nursing students’ views and emotions on nursing profession, and it is a psychological state that can determine their occupational behavior tendency [1].The professional identity of nursing students is a dynamic process that begins with professional education and develops volatility with the entire career[2].It is closely related to the resignation rate after employment and the quality of nursing work[3-4].As part of the cultivation of nursing students’competence,professional identity has been included in the standards of nursing professional certification [5].Studies showed that occupational identity is an important moderating variable that influences nursing students'learning process and plays an important role in nursing students’professional[6].

At present, there are many types of scales used in the quantitative research on the professional identity of nursing students,but the standardized scale has not yet been formed, at the same time, the scale has the problem of using clutter [1].This makes the literature analysis is not easy to compare horizontally and is not conducive to the analysis of large statistics.Therefore,this study introduced and compared the commonly used assessment tools of professional identity of nursing students in China.

Search strategy

A literature search was conducted by using the China National Knowledge Infrastructure, WanFang and VIP database.The search included relevant publications from databases are created to March 2018.After repeating preretrieval to determine search words, the MeSH terms and keywords as following “nursing student” “professional identity” were used.In order to avoid missing detection and guarantee recall ratio, the references of included articles were manually searched to find any new relevant studies.

Nine hundred and ten researches were obtained in the initial examination, and 128 duplicates were removed.After reading the title and abstract, 667 researches were excluded and 243 were included;after careful study of the full text, 175 studies were included.

The concept of nursing students'professional identity

Professional identity is the self-concept of professional people which is the psychological basis for people to do their job well and achieve organizational goals [7].It is generally formed in the process of long-term occupation of a professional activity, when people are familiar with and recognized the nature,content,social value and personal meaning of professional activities[7].

Professional identity is the professional self or self-concept of nursing that represents how nurses or nursing students perceive the nursing profession[8].

Common assessment tools for nursing students’professional identity

Universal scale

Brown,et al.compiled and te sted the construct validity for many times, the final scale was a single-dimensional structure.The scale consists of 10 items (5 positive and 5 negative questions) and uses a Likert 5 which ranging from 1 (never) to 5 (almost always) [9].The scale is one of the most widely used measurement tools for organizational and professional identity at home and abroad.The Cronbach’s alpha=0.71 in the original scale.The Chinese version of the scale was revised by Lu H,et al.,who took 512 nurses as the participants.Cronbach’s alpha=0.82,which had a high reliability and validity and supported the one-dimensional structure of the original scale[10].

The study participants of the original scale were 137 employees of the department store, and the study participants of the Chinese scale were nurses that was mainly used to study the job satisfaction of nurses and its influencing factors.Therefore, the measurement of the professional identity of nursing students by the scale was not targeted and could not reflect the characteristics of the nursing students.There are only 10 items in this scale, which is easy to answer.Among 175 articles in this study, Brown’s occupational identity questionnaire was cited in 14 articles.

Targeted scales

Professional identity questionnaire for nursing students compiled by Hao YF.The questionnaire was compiled by Hao YF in 2011 based on the interview method.Cronbach’s alpha=0.827 and split-half reliability=0.842 [11].The scale consists of 17 items and the scale consisted of five factors:retention benefit and turnover risk, career self-concept, social comparison and self-reflection, autonomy of career choice and social persuasion.There was a reverse scoring question in the questionnaire.The scale is a forced choice 5-point Likert type scale.The full score of the questionnaire is 105.A higher score indicated a higher level of professional identity.The results of factor analysis showed that the questionnaire had a high construct validity and internal consistency.

The questionnaire was based on the literature review and the understanding of the current situation of nursing students’ occupational psychology, which combined with the history and current situation of nursing education in China.At the sam time,the author of the scale conducted expert consultation.The items of the questionnaire are simple and easy to understand.At the same time, the study participants of the questionnaire are 815 nursing students who can represent the nursing students.The scale is targeted.The scale was designed from the perspective of self-education of professional identity of nursing students and based on the current situation of professional psychology of nursing students.It is the most widely used tool in the evaluation of professional identity of nursing students.In this study, a total of 42 articles applied the questionnaire, and another 2 articles [12-13] explicitly proposed to design based on the questionnaire.

The nursing professional identity questionnaire compiled by Hu ZH.Hu ZH formulation of nursing professional identity questionnaire consists of 30 items[14].It including six dimensions:professional knowledge (6 items), professional emotion (5 items),professional will(6 items),professional skills(5 items),professional expectations (4 items) and professional values (4 items), each with a 5-point scale.In this questionnaire, non-positive answers were assigned a value of 5, which was successively decreased, while non-negative answers were assigned a value of 1.A higher score indicated a higher level of professional identity.

A score from 25 to 50 indicate disagreement, 51 to 99 indicate general agreement, and 100 to 125 indicate high agreement.Cronbach’s alpha=0.87.The questionnaire includes both the process of professional identity and the status of professional identity.The study participants of this scale were nursing students.At the same time, the scale items are easy to understand and easy to answer.The scale is targeted.But compared with Hao YF’s, the items are more numerous.Among the 175 articles in this study, 19 adopted this scale which accounting for 10.9%.

The nurse professional identity rating scale compiled by Liu L.The professional identity questionnaire for nurses compiled by Liu L is divided into 3 dimensions,5 factors and 30 items [15].The three dimensions are occupational self-cognition, occupational,self-experience and occupational self-control.The five factors are occupational cognitive evaluation (9 items),occupational social skills (6 items),occupational social support (6 items), occupational frustration coping (6 items) and occupational self-reflection (3 items).The scale is a forced choice 5-point Likert type scale.And all items are positive.The full score of the scale is 150.The higher the score is, the higher the professional identity level of nurses will be.Cronbach's alpha=0.938.This scale mainly analyzes the occupational characteristics of clinical nurses and their internal pressure sources.Its items are easy to understand.Because the subject of the study is nurses, if it is used for nursing students, the expression of its entries should be further clarified.

The professional identity scale for nursing students developed by Palida·Mamati.The scale was compiled by Palida·Mamati [16], including five dimensions:professional attitude of nursing students (6 items),contribute to the career of nursing students will (4 items), nursing students professional sense of benefit(5 items), nursing students' motivation (4 items) and nursing students professional values (4 items).There are 23 items, and the scale is a forced choice 7-point Likert type scale which ranging from 1 to 7.The higher the score, the higher the professional identity level of nursing students.The cumulative contribution rate of the scale was 71.36%,Cronbach's alpha=0.942,the test-retest reliability=0.738 and the split-half reliability=0.883.The correlation coefficient between the total score of the scale and the scores of each dimension was 0.598-0.856.

The dimensions of nursing students' occupational attitude, occupational contribution willness and occupational sense of benefit were not mentioned in other scales.The study involved 1, 315 participants,mainly including Hui, HaSaKe, MengGu, KeErKeZi,TaTaEr and other ethnic minorities.Due to the large number of nursing students from ethnic minorities in Xinjian and the professional identity of nursing students from different ethnic groups also varies greatly due to different living customs, languages and cultural environments, this scale is more suitable for investigating the professional identity level of nursing students from ethnic minorities.

Other occupation identity scale of nursing students.In this study, it was found that there were a wide variety of assessment instruments for nursing students'occupational identity.In addition to the assessment tools that were frequently used,the scales compiled by scholars such as Zhao H[17],Jiang AL[18],Chen XL,Liu SH and Shi RH were also cited to varying degrees[19-21].At the same time,the study also found that the most commonly used tools for the assessment of nursing students' professional identity were the relevant questionnaires or scales developed by themselves.Among the 175 articles in this study, 55 were self-compiled scales, accounting for 31.4%.However,the quality of self-designed questionnaires or scales are various.The questionnaire used in the study simply introduces the contents of the questionnaire,but its reliability and validity are not verified, Such as Zhou Y and Huang YX [22-23].So, if use this kind of questionnaires or scales, we need to contact the author to consult a clear reliability and validity of the questionnaire or scale and then further to consider whether to use it.

Summary and outlook

A reasonable choice of assessment tools for nursing students’professional identity

This paper reviewed the commonly used evaluation tools of professional identity of nursing students in China.The research and development of these tools provided a basis for researchers to evaluate the professional identity of nursing students, provided a reference for the study of professional identity of nursing students and a basis for intervention to improve the level of professional identity of nursing students.

The existing instruments have their own advantages and disadvantages, so the instruments should be selected according to the actual situation:(1)Participants in the scale development process include nurses and other industry workers, whose professional identity level is different.Therefore, special attention should be paid to the selection of the scale.(2) The compilation of relevant scales in China lacks the support of theoretical basis

To sum up, the focus of each tool's assessment is different.Clinical workers and researchers should think dialectically when choosing tools and understand the original research objects, reliability and validity,number of items and scoring methods.On this basis,professional identity evaluation tools suitable for nursing students should be selected.

Prospect of assessment tools for nursing students'professional identity

At present, the assessment tools for professional identity of nursing students in China are mainly self-designed questionnaires or scales.For example,the questionnaire for professional identity of clinical male nursing students compiled by Zeng ZD is mainly used to measure the professional identity of male nursing students [24].The questionnaire designed by Han YJ is mainly used to analyze the influence of clinical practice on the professional identity of nursing students [25].Some scholars have translated the nursing professional self-concept scale developed by Authur et al.into Chinese to measure nursing students'professional identity [26-28].There are many tools used to evaluate the professional identity of nursing students in China, but no standardized scale was formed.Therefore, it is necessary to further study and develop more suitable tools for measuring the professional identity of nursing students in China.

Suggestion:on the one hand, introduce foreign evaluation tools.There are many assessment tools for nursing students’ professional identity in foreign countries, but due to the large gap between domestic and foreign cultures, social backgrounds, different religious beliefs and teaching modes, the sinicization and debugging of foreign scales need to be dialectically selected according to China's national conditions and cultural characteristics.Secondly, the preparation of assessment tools for nursing students'professional identity needs to be carried out based on relevant theories.Therefore, relevant questionnaires or scales cannot be prepared and used.Relevant theories need to be constructed according to the characteristics of Chinese research population and the preparation standards of scales or questionnaires should be strictly followed.Thirdly, it is particularly important to develop the professional identity assessment scale for nursing students and improve its pertinence and scientific.