Assessment of Difficulties of Male Nurse Students in a Profession Traditionally Perceived as a Female Domain at Sulaymaniyah Kurdistan Region

INTRODUCTION

The ongoing developments in healthcare, as well as the gender imbalance in nursing personnel, remain consistent (Mohamed & Mohamed, 2015). Even in academic contexts, there is evidence of a gender disparity in nursing. Today, men's involvement in the job needs to be more acknowledged and appreciated (Terry et al.,2020). Labor is frequently separated into unique and different jobs for men and women throughout many civilizations worldwide. According to the social role hypothesis of sex and behavior, when labor is split along gendered lines, behavioral consistency that results from these differing social roles is frequently misattributed to gender variations in behavior. Furthermore, repeated social observation of men or women engaged in specific hobbies or jobs leads to the social assumption and stereotype that one's gender gives them a unique personality that makes them suitable and appropriate to those activities or vocations (Bartfay &Bartfay, 2017). The forces shaping males' roles and scope in nursing are most likely multifaceted. There can be little doubt that an interplay of some deep-seated socio-cultural elements that impact males' inclinations to pursue nursing as a vocation exists and should be investigated in order to target better or open up nursing to men in communities (Terry et al.,2020). Several initiatives have been made to broaden the public's perceptions of the requirements for becoming a nurse. The absence of gender diversity and the presence of gender problems are not exclusive to nursing; other professions confront similar challenges (Harrison et al., 2018). In nursing, structural obstacles due to gender occur: the majority-gendered group makes assumptions about the minority-gendered group based on their beliefs about what they can or should do (for example, physical ability/inability for women in nursing). As a result of gender stereotypes, individuals in society dispute the ability of various genders to hold certain societal positions. Men in nursing, for example, are frequently viewed as more physically capable and, as a result, get assigned bariatric and combative patients (Schuck, 2014). It is known that Nurses are primary care providers and are responsible for the treatment, safety, and recovery of patients with acute or chronic illnesses (Arif & Khokhar, 2017). (. For centuries, nursing has been known as a profession only for females. Therefore, the history of nurses at an early age only states the curative role of females, although males also took part in patient care along with females (Kaya et al., 2011). Nursing was regarded as a profession for women alone since the caring and nurturing characteristics have been linked with women and femininity. Florence Nightingale also claims that nursing naturally comes for women and was an undesirable job for males. She is credited with developing contemporary nursing, transforming the nature and direction of nursing, and establishing nursing as a respected profession (Ross, 2017). Nursing in Western countries abandoned their undesirable system of racial and gender segregation in the mid-twentieth century, opening equal educational, professional, and career possibilities for all nurses (Arif & Khokhar, 2017). Furthermore, male students who choose to become nurses know that they are entering a women's profession and will have to deal with sexual preconceptions held by society and themselves. Despite these apparent challenges, the ratio of males in nursing has been steadily increasing (USDHHS, 2010). Male nurses benefit the nursing profession in a variety of ways. However, according to O'Lynn, the healthcare industry faces a nursing shortage (O'Lynn, 2012). One possible solution to the nurse shortage that deserves more attention is recruiting men into the field (McKinlay et al.,2010). In addition, it has been determined that recruiting male nurses may impact the continuation of nursing stereotypes among female students. More literature needs to address the advantages of men in nursing. Regarding the attributes outlined by sociologists as instrumental for males, males may be the strength of the nursing profession. There are several areas in the hospital where females are uncomfortable working due to extended working hours, such as operating rooms and critical care regions, where male nurses can be supportive. Still, there is a need to investigate further in this genre (Olson, 2014). The importance of gender diversity in nursing is highlighted as beneficial in many ways, such as increasing cultural competencies, ultimately improving the healthcare delivery system, and increasing patient satisfaction. Nursing shortages continue to be a global concern, emphasizing the importance of both male and female nurses (Abushaikha, 2014). However, according to the World Health Organization (WHO), only about 10% of the global nursing workforce is male (WHO, 2020; Liu & Li, 2017). The Kurdistan region is not immune to nurse shortages, nor is the male minority in health care. This study sheds light on the sociocultural constructs that influence male perceptions of nursing as they seek to work in and navigate the profession, the challenges they face once enrolled in the nursing college program, the challenges they face in the clinical setting, and identifying aspects such as difficulties that determine a male considering nursing as a career.

MATERIAL AND METHOD

A descriptive (cross-sectional) quantitative study, the study was conducted in three Universities in Sulaimani City: University of Sulaimani, Komar University of Science and Technology, and Sulaimani Polytechnic University, from (“November 2021 to December 2022)—non-probability (convenience sampling) of 276 students during the study period.

Methods of data collection: -

This study used the direct interview technique with the male student. Required data were gathered through a constructed questionnaire. The questionnaire was conducted through face-to-face interviews. The questionnaire was carried out on paper by going to the mentioned Universities and handing the papers to the students. It takes an average of 4 minutes to respond to the questionnaire. Data were obtained anonymously and independently using a created questionnaire. The questionnaire comprises demographic data, experienced challenges on campus and in clinical settings, social and cultural difficulties, and attraction and retention in the profession.

Tools and Measurement: -

The researchers developed this tool to study the role strain faced by male nurse students during their learning experiences in Nursing education programs, resulting from their perception of incompatibility between their roles as Nurses and males as perceived by community members, colleagues, patients, and instructors. It was divided into four sections. The first section is about the student's socio-demographic data, which consists of four items: age, academic stage, residence area, and marital status. The second section is about the difficulties that male students face in college. It includes the following: (Do you believe that female or male lecturers made explaining processes in the lab more challenging? Which female and male lecturers worked to eliminate challenges without excluding either gender from the opportunity to learn in the lab? Do you feel discriminated against compared to your female colleagues during practical lessons on female anatomy and procedures? Whom do you believe is more successful in the nursing field?). It highlights clinical setting difficulties experienced by male students during the practical time in the hospital, such as (rejection from patients, less participation in intimate procedures, and the hospital being more prone to embarrassment. The third part mentions social and cultural difficulties and their effects on entering the Nursing profession and the identity of the Nursing career itself. The last part relates to an attraction for Nursing College and remaining in the profession, including (What motivated you to choose a nursing college? Was your nursing college education program at the level of your expectation? After graduating from nursing college, would you choose nursing as your leading lifelong career? If not, why?

Administrative arrangement:

The Nursing College council accepted the study project and approved by the Nursing College / University of Sulaimani scientific committee.

Statistical Analysis:

After data was automatically registered in the survey's Excel file and imported into SPSS, statistical analysis was performed using SPSS version 22. For descriptive analysis, the frequency with percentage was used. As an inferential analysis, the T-test was utilized to evaluate for significance.

RESULTS

Table1. Demographic information regarding age group shows most of the respondents (189) were between 19-21, which constitutes %68.5of all the respondents. As for the academic year, the largest subgroup comprised 191 students in the second stage and constituted %69.2 of all the respondents. Regarding Residential areas, nearly half of the respondents live in urban areas %49.3 and in suburban areas %46.4. Concerning marital status, the most significant number (191) of the respondents were single, that is, %69.2 of the respondents. Table 2. shows that almost half the respondents' %47.8believes that none of the genders among the lecturers created any difficulties in the campus facilities. As for those lecturers who try to eliminate the difficulties, 138 respondents, that is, %50 of the total, believe that both genders try to eliminate the difficulties. Regarding discrimination, most of them, about %68.5 of the total sample, said they felt they were discriminated against compared to their female colleagues in the practical lectures concerning female anatomy and procedures.  Regarding feeling ashamed, more than half (151, i.e., %54.7) said they do not feel ashamed or embarrassed because it is part of the profession and there is no shame. Most of the respondents (%62.7) believe that both genders can be successful as nurses.  Regarding Table 3, cultural and social difficulties, the first two items of the table showed that many of the students 52.5and %56.5 of them, approved that religion/culture, society’s perception, and portrayal of mass media have a significant influence on fewer men enter in the profession and facing stigmas.

Table 4 is about the interest and motivation to select nursing colleges. Half of the sample %59, stated that they were forced into this profession because of the 12th-grade average.

Table (1) Frequency and Percentage of the students’ demographic information

Table 2: Frequency and percentage of clinical and campus difficulties (Number = 276)

Table 3: Frequency and percentage of cultural and social difficulties

Table 4: Frequency and percentage Interest and motivation to select nursing college

  DISCUSSION

The previous finding regarding role strain experienced from clinical learning environment contacts with instructors is consistent with the study; this similarity may be due to gender-related bias in obstetric rotations, a lack of nursing programs that prepare men to work primarily with women, and a lack of male faculty staff or practicing male nurses in the clinical learning environment (MacWilliams et al., 2013). In addition, approximately 61.6% percent of the total faced rejection from female patients when caring for and implementing procedures. This finding is confirmed by a study conducted in the Kingdom of Saudi Arabia that indicated patients' rejection of male classmates ((Al-Momani,2017). Their suspicion and unwillingness lower male pupils' self-esteem and limit their prospects of performing procedures and gaining more qualifications.

Most respondents believe that maternity hospitals are the most likely to cause embarrassment. According to the findings of a study on the role strain of undergraduate male nurse students during learning experience in nursing education programs, gender-related bias in obstetric rotations, lack of male faculty staff, or practicing male nurses in the clinical learning environment are the most common sources of instructors' role strain as reported by the male students ((Mohamed & Mohamed, 2015).

More than half of the respondents reported difficulty due to the patient herself. This data finding is consistent with the study's findings, which found that Iranian female patients prefer to be cared for by nurses of the same gender, and many of them are shocked when they are cared for by male nurses (Vaismoradi et al., 2011). This could be because they believe in the same things and have the same culture and religion.

Regarding cultural and societal challenges, it was agreed that religion/culture, society's view, and mass media representation significantly influence fewer males entering the field and facing stigmas. This discovery is supported by the Journey of Saudi Male Nurses Studying in the Nursing Profession, which reached a similar conclusion: community faith and religious beliefs or specific religions were regarded as a significant difficulty for specific nursing techniques (Alasmee, 2021).

Most respondents think the current portrayal of nursing in the mass media (e.g., television, movies, and magazines) as a profession for women discourages men from studying nursing as a career. Similarly, the study stated that the mainstream media reinforces this perception by promoting nursing as a feminine specialty (Meadus &Twomey, 2011).  Because nursing lacks a distinct identity, most of the sample believes society views it as subordinate to doctors. Similarly, the study revealed that one of the significant barriers for males entering or being an active participant in the nursing profession is the idea that nursing is perceived as an inferior future profession compared to other health-related professions, such as Medicine (Magoteaux, 2013).  This might be due to a lack of concrete explanations of nursing and being overshadowed by the popularity of medicine; however, the current finding is more likely to be the cause. More than half of those surveyed said they would not encourage a male family member (e.g., brother, son) to pursue nursing as a rewarding chosen profession.

Less than half of those respondents said they had contemplated dropping out of nursing school. The findings highlighted the reasons for the lack of males in the profession and considering leaving it because of an inherent belief in the naturalism of women as nurses, poor working conditions, and males' inability to shake off the low reputation men in nursing had acquired. Most respondents stated that their nursing duties would be acceptable in their marriages (including working night shifts and processing) (Ma, 2013).

They were concerning the desire and motivation to attend nursing school. Half the respondents said they were forced into this career due to their 12th-grade average. This finding is similar to the findings of the study, which concluded that nursing was not the participants' choice and that they were forced into it due to their low 12th-grade average in the preparatory year program and that this plays a significant role in creating a shortage of students with motivation who identify with the nursing profession (Al-Momani,2017).

Discusses interest in nursing as a means of assisting and serving people. This finding is also highlighted in a study that found that regardless of other people's perceptions, caring among men was deemed personally rewarding and essential for them to be a part of and stay in the nursing profession (Harding, 2009). However, the same individual does not want to be a nurse since the profession's salary is not at the level of its weariness, which is consistent with the study regarding financial concerns that were found to be a primary motivator for men quitting the nursing profession (Stanley,2016).

CONCLUSION

In this study, researchers concluded that sociocultural challenges were the most significant difficulty male students had in making nursing their first career choice, as well as the concept that nursing is seen as a less desirable career option in comparison to other health-related professions like medicine, Although males have worked in the industry for many years, there are possible hurdles for men considering a career in nursing. However, the shortage of men in the field was caused by their ingrained idea that nurses were born to be nurses, by the unfavorable working conditions and low pay, and by their failure to overcome the negative reputation that men in nursing had developed.

Another conclusion that participants agreed that Nursing continues to be represented as a female-dominant position by Mass Media (e.g., TV, films, magazines...etc.) is that Nursing is perceived from a societal perspective as a terrible career choice compared to other health-related professions. Half of the male students indicated they were required to attend nursing school due to their 12th-grade average. Most participants stated that the nursing program did not match their expectations.

RECOMMENDATION

The present study recommends changing the public eye, including guidance counselors, and removing the stigmas around males entering the field through TV shows, workshops, and seminars, disrupting the current enrollment norm of 1:3 male to female candidates to 50:50 possibilities.

FUNDING:

The authors received no special funding to perform this study.

CONFLICT OF INTEREST

The writers announce that there is no conflict of interest between them.

The methodological quality of the included studies was assessed using the Cochrane Collaboration's Risk of Bias tool for RCTs, the Newcastle-Ottawa Scale for cohort studies, and other relevant quality assessment tools. The risk of bias varied across studies, with common issues including lack of blinding, incomplete outcome data, and selective reporting.