Patients preferences for nurses gender in Jordan

International Journal of Nursing Practice 2007; 13: 237 242 RESEARCH PAPER Patients preferences for nurses gender in Jordan Muayyad M Ahmad RN PhD Associate Professor, Faculty of Nursing, University of Jordan, Amman, Jordan Jafar A Alasad RN PhD Associate Professor, Faculty of Nursing, University of Jordan, Amman, Jordan Accepted for publication February 2007 Ahmad MM, Alasad JA. International Journal of Nursing Practice 2007; 13: 237 242 Patients preferences for nurses gender in Jordan The purpose of the study was to examine patients preferences for nurses gender in Jordan. The public, private and university hospitals are represented by selecting one major hospital from each health sector. The sample size was 919 participants. Data were collected by a questionnaire through standardized individual interviews with patients. The findings of the study indicate that gender preferences are stronger among female patients than among male patients. Furthermore, two-thirds of female patients preferred female nurses, whereas only 3.4 preferred male nurses to care for them. In contrast, one-third of male patients preferred male nurses, and only 10 preferred female nurses. The authors recommend that the high percentage of male nursing students need to be reconsidered by health policy-makers in Jordan. Key words: Jordan, male nurses, nurses gender, patients preferences. INTRODUCTION The profession of nursing used to be seen as a femaledominated profession. 1,2 Men comprise 5.7 of all registered nurses in the USA. 3 The feminization of the nursing profession is potentially considered as a gender barrier for men to become nurses. 4 Historically both the gendered role of nursing and the sex of nurses were almost exclusively female. 5 Recent years have witnessed changes in the gender occupation bond. Evidences on occupations typed as women s occupations started to revolutionize this inequity. The reaction for the entrance of women into male-dominated professions was often one of admiration, whereas the opposite might be true of men entering female-dominated professions such as nursing. 6 However, there is still paucity in research on men who perform what could be seen as women s occupation. 7 Reducing gender Correspondence: Muayyad M. Ahmad, Faculty of Nursing, University of Jordan, Amman, 11942 Jordan. Email: mma4@ju.edu.jo doi:10.1111/j.1440-172x.2007.00633.x gap between male- and female-dominated occupational groups is considered a professional challenge. 8 Few studies have investigated patients preferences for male or female nurses. 1 In a study conducted by Kerssens et al. to explore patients preferences for genders of health professionals, they found that gender preferences are stronger among female patients than among male patients, and more explicit for the domains of nursing and obstetrics than for the domains of medicine and mental health care. 9 Empirical examination of individual differences in implicit gender preferences suggests that men and women might express gender-related judgements that are quite different from their implicit beliefs and preferences. 10 12 Greenwald and Farnham argue that individuals gender preferences are influenced both by their gender identity and by self-attitudes. 13 The patients overall experiences of their nursing care appear inconsistent before and after hospitalization. 14 The first university-based nursing programme in Jordan was established in 1972 at the University of

238 MM Ahmad and JA Alasad Jordan, in which only female students were allowed to be enrolled. In 1982, male students start to be accepted in the programme were they formed ª20 of students. However, during the last two decades, not only the high competition for entering nursing schools is considered unprecedented, but also nursing has moved from a female-dominated profession to one in which male nursing students have outnumbered female nursing students. In 2005, there are nine nursing programmes that award Bachelor degree in nursing. Male students form ª65 of the total 6106 students currently enrolled in these programmes. 15 This percentage is remarkably high in comparison with other countries in the world. 3,8 Furthermore, the revolution inflicted by the ratio of male nurses that resist the ideological image of the patriarchal feminine has necessitated conducting this study to explore this unique phenomenon from the patients perspectives. The purpose of this study was to explore patients preferences for nurses gender in Jordan. METHODS Sample and setting The heterogeneous sample of the study was recruited from seven hospitals located in the three largest cities in Jordan where 70 of the population resides. 16,17 The hospitals represent private, public and educational hospitals. The participants in the study were recruited from medical and surgical wards in each hospital. The eligibility criteria for the participants were being 18 years or older, not confused, and agree to give informed consent. The sample size in this study was 919 participants. Data collection Data were collected by trained research assistants through standardized individual interviews with patients using a two-part questionnaire. Part one consists of participants characteristics and part two consists of seven-item scale that examines patients attitude towards nurses gender. 18 The validity of the instrument was maintained following a translation and back-translation procedure by bilingual experts in English and Arabic languages. Patients participation in the study was voluntary and based on informed consent. Institutional Review Boards at relevant hospitals approved the study and granted access for researchers to collect data. RESULTS The study sample consisted of 484 (53) male patients and 435 female patients. The mean age of participants was 42.1 (SD = 14.12). Nineteen per cent of the participants came from private hospitals, 41 from educational hospitals and the remaining from governmental hospitals. Seventy per cent of participants had education of high school or above. Approximately, half of the participants considered their income as sufficient, whereas ª22 considered their income as insufficient. During their hospitalization, the majority of participants (72) had experiences with both male and female nurses, 21 had experiences with female nurses only and 7 had experiences with male nurses only (Table 1). Table 2 shows participants preferences for nurses gender. Interestingly, among all participating patients (n = 919), 43 have no preference for nurses gender (i.e. they do not mind being cared for by either male or female nurses), 38 prefer female nurses and only 19 prefer male nurses. However, 56 of male patients have no preference for nurses gender, and only 10 prefer female nurses. Furthermore, 69 of female patients prefer female nurses, and only 3 prefer male nurses. To examine the difference between male and female patients on the seven-item attitude scale, Mann Whitney U-test was conducted (Table 3). Although the majority of male and female patients agree that female patients prefer female nurses, male patients tend to disagree more than female patients (P < 0.001) that male patients prefer female nurses. Notably, female patients believe that women are better suited for the nursing profession as they have thoughtfulness and ability to boost patient morale more than men. However, men believe that most male nurses can avoid panic and live with emotional strain more than female nurses (P < 0.001). Kruskal Wallis test was used to compare the three groups of patients (those who prefer male nurses (group 1), those who prefer female nurses (group 2) and those who have no preference (group 3)). Responses on the seven-item scale are presented in Table 4. For post-hoc comparison, Mann Whitney tests on each pair of groups were used, and P-value was adjusted with the Bonferroni method. Differences between the three groups were found regarding male patients preferences for female nurses, women s ability to raise patients morale and men s ability to avoid panic situation. Significant differences were found between group 1 and 2, and between group 2 and 3 regarding female patients preferences for female nurses. Although group 3 differs significantly from groups 1 and 2 regarding the desirability for male

Patients preferences for nurses gender 239 Table 1 Sample characteristics (n = 919) Variable Male 484 () Female 435 () Total 919 () Patients experience with nurses gender Male and female nurses 419 (87) 242 (56) 661 (72) Male nurses only 58 (12) 5 (1) 63 (7) Female nurses only 7 (1) 188 (43) 195 (21) Health-care sectors Private hospitals 121 (25) 58 (13) 179 (19) University hospitals 193 (40) 182 (42) 375 (41) Governmental hospitals 170 (35) 195 (45) 365 (40) Age (years) Mean 43.9 40.2 42.1 SD 13.9 14.1 14.1 Educational level Less than high school 120 (25) 155 (36) 275 (30) High school 132 (27) 136 (31) 268 (29) Diploma 75 (16) 75 (17) 150 (16) BS, MSc and PhD 157 (32) 69 (16) 226 (25) Income Insufficient 89 (18) 117 (27) 206 (22) Some times sufficient 133 (28) 152 (35) 285 (31) Sufficient 262 (54) 166 (38) 428 (47) Table 2 Male and female patients preferences for nurses gender Patients gender Preferences for nurses gender Total Male nurse Female nurse No difference Male Number 164 47 273 484 within gender 33.9 9.7 56.4 100 Female Number 15 299 121 435 within gender 3.4 68.7 27.8 100 Total Number 179 346 394 919 within gender 19.5 37.6 42.9 100 nurses to be assigned to female patients, no differences were found between group 1 and 2. Further analysis was conducted, excluding participants who had experience only with nurses of their same gender, the results remained the same. DISCUSSION Consistent with Kerssens and colleagues study that explored patients preferences for genders of health professionals, this study found that gender preferences are stronger among female patients than among male

240 MM Ahmad and JA Alasad Table 3 Participants (male n = 484, female n = 435) preference response to gender scale using Mann Whitney U-test Items Patients gender Strongly agree Agree No opinion Disagree Strongly disagree Z Most female patients prefer female nurses Male 52.1 35.7 7.0 5.0 0.2-1.25 Female 58.6 26.9 6.0 6.2 2.3 Most male patients prefer female nurses Male 6.7 22.1 6.8 47.5 16.9-6.34** Female 14.0 23.4 27.8 22.4 12.4 It is not desirable professional practice for a male nurse to be assigned to a female patient Doctors generally show more respect for male nurses than female nurses Male 38.4 39.7 2.9 15.3 3.7-1.83 Female 40.5 24.4 6.0 21.8 7.4 Male 5.6 18.8 34.5 30.2 11.0-4.34** Female 8.0 9.7 25.3 39.5 17.5 Many male nurses tend to be effeminate Male 11.4 56.0 11.8 14.3 6.6-2.73* Female 20.5 49.2 14.9 11.0 4.4 Thoughtfulness and the ability to boost patient morale tend to make women better suited than men for the nursing profession Most men can avoid panic and live with emotional strain, which tends to make them better suited than women for nursing Male 9.3 33.9 15.9 34.9 6.0-8.21** Female 30.1 36.8 9.9 18.2 5.1 Male 14.7 52.1 12.2 19.2 1.9-7.90** Female 12.0 26.9 17.2 33.1 10.8 *P < 0.01, **P < 0.001. Table 4 Kruskal Wallis test for the differences among three groups on patients preferences Variable Mean rank c 2 Group 1 Group 2 Group 3 Most female patients prefer female nurses 450.9 532.4 400.6 57.1* Most male patients prefer female nurses 332.4 522.1 463.5 64.6* It is not desirable professional practice for a male nurse to be assigned to a 530.3 504.1 389.3 55.8* female patient Doctors generally show more respect for male nurses than female nurses 479.6 437.1 471.2 4.6 Many male nurses tend to be effeminate 474.7 444.9 466.6 2.3 Thoughtfulness and the ability to boost patient morale tend to make 333.9 564.9 425.1 109.2* women better suited than men for the nursing profession Most men can avoid panic and live with emotional strain, which tends to make them better suited than women for nursing 545.3 394.6 478.7 45.4* Group 1: patients who prefer male nurse (n = 179); group 2: patients who prefer female nurses, (n = 346); group 3: patients who have no preference, (n = 394). * P < 0.001, the post-hoc Mann Whitney test adjusted with Bonferroni method (P < 0.01). Difference between patients who prefer male nurses and patients who prefer female nurses. Difference between patients who prefer male nurses and patients who have no preferences. Difference between patients who prefer female nurses and patients who have no preferences.

Patients preferences for nurses gender 241 patients. 9 In our study, 68.7 of female patients preferred female nurses, whereas only 3.4 preferred male nurses to care for them. In contrast, 33.9 of male patients preferred male nurses, and only 9.7 preferred female nurses. Therefore, one could argue that ª90 of male patients either prefer or do not mind to be cared for by male nurses; however, 66 of male patients also would accept female nurses to care for them. Moreover, 97 of female patients would either prefer or do not mind female nurses to care for them. Hence, the current percentage (65) of male nursing students enrolled in nursing programmes would not be justified. Unless this ratio is balanced, it might lead to male nurses overcoming the number of female nurses. The literature reports that female patients prefer female nurses. 19 Women have been found to prefer female nurses for matters of reproductive, sexual health and intimate or psychosocial issues, whereas men also demonstrate this trend, but to a lesser degree. 9,20 About two-thirds of female patients in this study were found to believe that thoughtfulness and the ability to boost patient morale tend to make women better suited than men for the nursing profession, ª 45 of male patients share the same agreement. This might reflects the inherited Jordanian society view that nursing is more of a feminine profession. Beliefs and ideologies of gender have a crucial role to play in identifying and promoting the social definition of tasks as either women s work or men s work. Conventionally held attitudes and assumptions concerning male and female work are challenged by men and women who move into gender-atypical areas. 21 Male and female patients in general agree that it is not desirable professional practice for a male nurse to be assigned to a female patient. This agreement is also true for patients who only prefer male nurses and those who only prefer female nurses. Given that patients preferences for nurses gender are clearly established, it was reasonable to avoid contamination of the Kruskal Wallis findings in the comparison between the three groups presented in Table 4. Although little is known about the motivations and experience of men in female occupations and how men manage any potential conflict between the feminine nature of the job and their gender identity, 21 our results showed that two-thirds of male participants consider men to be better suited than women for nursing as they can avoid panic and live with emotional strain. Consistent with Hallam who found that nursing with images of caring professionals who possess generous compassion and selfsacrifice is also generally viewed with the ideological feminine nature in caring for people, the current study found that two-thirds of both male and female participants think that male nurses tend to be effeminate. 22 Recent literature has reported certain barriers for enrolment of male students into nursing education. 23 25 These barriers are summarized as social isolation, failure to address men s learning needs, role strain and lack of acknowledgement of men as part of nursing profession. Sherrod and Rasch suggest modifying these barriers to increase the proportion of men in nursing. 4 Although this could be true in most countries in the world, the situation in Jordan is exceptional. However, the increasing number of men entering nursing programmes in Jordan necessitates further studies to explore the essence of this phenomenon. CONCLUSION AND IMPLICATIONS The current percentage (65) of male nursing students enrolled in nursing programmes would predict that the direction of future distribution of nurses gender in Jordan will make male nurses dominate the profession. Although patients preferences for nurses gender can be investigated in several ways, the present study was concerned only in presenting the general theme of the patients view for nurses gender and to explore if the high percentage of male nursing students in Jordan is justifiable. Therefore, the authors recommend further studies to explore the essence of this phenomenon. ACKNOWLEDGEMENT The authors would like to thank the Deanship of Academic Research at the University of Jordan for funding this study. REFERENCES 1 Chur-Hansen A. Preferences for female and male nurses: The role of age, gender and previous experience. Journal of Advanced Nursing 2002; 37: 192 198. 2 Sharon C. Women s work, dirty work: The gynaecology nurse as other. Gender, Work and Organization 2005; 12: 169 186. 3 US Department of Health and Human Services. The Registered Nurse Population: National Sample Survey of Registered Nurses. Preliminary findings. 2006. Available from URL: http://bhpr.hrsa.gov/healthworkforce/ reports/rnpopulation/preliminaryfindings.htm. Accessed 19 August 2006.

242 MM Ahmad and JA Alasad 4 Sherrod B, Rasch R. From the bedside to the boardroom, nursing needs to increase the number of men in its ranks. Men in Nursing 2006; 1: 34 39. 5 Zelek B, Phillips S. Gender and power: Nurses and doctors in Canada. International Journal for Equity in Health 2003; 2: 1 5. 6 Ekstrom D. Gender and perceived nursing care in nurse patient dyads. Journal of Advanced Nursing 1999; 29: 1393 1401. 7 Simpson R. Men in non-traditional occupations: Career entry, career orientation and experience of role strain. Gender, Work and Organization 2005; 12: 363 380. 8 International Council of Nurses. ICN Workforce Forum Report 29 30 September 2003. Oslo, Norway: International Council of Nurses, 2003. 9 Kerssens J, Bensign J, Andela M. Patient preference for genders of health professions. Social Science and Medicine 1997; 44: 1531 1540. 10 Banaji MR, Hardin CD. Automatic stereotyping. Psychological Science 1996; 7: 136 141. 11 Blair I, Banaji M. Automatic and controlled processes in stereotype priming. Journal of Personality and Social Psychology 1996; 70: 1142 1163. 12 Rudman L, Greenwald A, Mellott D, Schwartz J. Measuring the automatic components of prejudice: Flexibility and generality of the Implicit Association Test. Social Cognition 1996; 17: 437 466. 13 Greenwald AG, Farnham SD. Using the Implicit Association Test to measure self-esteem and self-concept. Journal of Personality and Social Psychology 2000; 79: 1022 1038. 14 Shattell M. Nurse patient interaction: A review of the literature. Journal of Clinical Nursing 2004; 13: 714 722. 15 Jordanian Nursing Council. Amman, Jordan: Jordanian Nursing Council, 2005. 16 Department of Statistics. Amman, Jordan: Jordan Department of Statistics, 2004. Available from URL: http://www.dos.gov.jo/dos_home/jorfig//jor_f_a.htm. Accessed 25 May 2005. 17 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ, USA: Erlbaum, 1988. 18 Lynn N, Vaden A, Vaden R. The challenge of men in a woman s world; a two part survey on the changing nursing profession. Public Personnel Management 1975; 4: 4 17. 19 BaÈck E, Wikblad K. Privacy in hospital. Journal of Advanced Nursing 1998; 27: 940 945. 20 Brooks F, Phillips D. Do women want women health workers? Women s views of the primary health care service. Journal of Advanced Nursing 1996; 23: 1207 1211. 21 Simpson R. Masculinity at work: The experiences of men in female dominated occupations. Work, Employment and Society 2004; 18: 349 368. 22 Hallam J. Nursing the Image: Media, Culture and Professional Identity. London: Routledge, 2000. 23 Anthony A. Gender bias and discrimination in nursing education: Can we change it? Nursing Education 2004; 29: 121 125. 24 O Lynn C. Gender-based barriers for male students in nursing education programs: Prevalence and perceived importance. Journal of Nursing Education 2004; 43: 229 236. 25 Simpson R, Sturges J, Woods A, Altman Y. Gender, age, and the MBA: An analysis of extrinsic and intrinsic career benefits. Journal of Management Education 2005; 29: 218 247.