Nursing News:
Cards present unrealistic image of nurses

By Andy Dworkin
Nursing students in Klamath Falls say the pictures on some get-well cards are unhealthy to their profession. For their senior-year research course, two classes of students at the Oregon Health & Science University campus studied how nurses are portrayed in greeting cards, both paper ones and those sent through the Internet. Almost every card featured characters straight from central casting.
³We saw two images,² said Linda Smith, the professor who led the project. ³This young, sweet thing with very pronounced secondary sex characteristics. And the other image was this battle-ax of a nurse, threatening you with a syringe.²
Smith and her students worry that this Nurse-Ratched-or-Nurse-Goodbody portrayal is not just fun and games. By presenting an unrealistic picture of nurses, the cards could spur some patients to either fear nurses or treat them as sex objects ­ neither of which, they say, helps the nurse-patient relationship.
³We donıt wear hats,² Smith said. ³OHSU hasnıt had an official hat for decades.² The studentsı research is attracting a lot of attention in the nursing world. An initial report on the research was published last week by the peer-reviewed Journal of Undergraduate Nursing Scholarship. Three journals, to date, have expressed interest in publishing the final version, Smith said. And the students will present their data at a national student nursing conference in April.
The study is interesting partly because student nurses rarely conduct original research. While all OHUS nursing students face a research course, Smith said, it usually involves studying how other people conduct research. The class can be dry and unpopular.
³It was just kind of a class you had to get through² traditionally, said Aubrey Sharp, a student in Klamath Falls. ³It wasnıt looked forward to like some of the clinical classes.²
Smith said she thought learning research by doing research might spice things up. But students werenıt in class long enough to create a study involving humans or animals, which need extensive review and approval by ethics committees. So Smith came up with the idea of studying images of nurses, which takes no board approval and is rarely done. And the image of nurses on greeting cards has never been studied, to her knowledge, Smith said. Students in Smithıs class started the project last year be designing what they call the GCAT: a ³greeting card analysis tool² used to categorize images of nurses. The GCAT considers more than 20 characteristics, from the cardıs size to the race, gender, age and mood of the characters it shows. Last yearıs students tested and refined the tool using Internet cards until different raters got the same results 95 percent of the time, showing he GCAT works, Smith said. OHUS has patented the GCAT.
This yearıs nursing class carried out the project by testing more cards, including cards bought in Klamath Falls area and those mailed by friends, relatives and follow nursing students from the across the United States. Any card was fair game if it showed a nurse, was in English and was not pornographic. They ended up with 127 cards ­ most get-well cards ­ and one very inaccurate picture of nursing.
€ 44 per cent of nurses on cards appeared to be middle aged or older. Nearly two-thirds of nurses are that age in real life.
€ 91 percent of greeting-card nurses wore hats, compared with 3 percent of real nurses.
€ 92 percent of card characters wore nursing uniforms, compared with 71 percent of actual nurses.
€ All but one of the greeting-card uniforms were white, while 12 percent of nurses wear white uniforms.
€ All but one of the greeting-card nurses were white, while minorities represent about 12 percent of U.S. nurses.
€ Nearly 40 percent of the nurses on cards had a Barbie doll figure verses roughly 9 percent of real nurses.
€ When patients were shown, they were male 92 percent of the time, not just under half the time.
About the only fact the cards got right, Smith said, was making most nurse female. About 5 percent of nurses were male on the cards and in real life.
³The image of the nurse depicted on Internet and paper greeting cards does not represent reality,² the students wrote. ³The nurse reflects a young, Caucasian female wearing a white uniform and cap, caring for male patients.²
That matters they said, because media images can ³affect individual and societal perceptions of nurses and nursing.² Of course, cards are just one type of media and are known for exaggeration and caricature, not for depicting reality. But the students point out that cards are widespread ­ each year, U.S. residents buy roughly 7 billion greeting cards and receive an average of 20 per person. And because cards showing nurses are often get-well cards, they may sit by hospital beds and be seen all day long by patients, some of whom would absorb the message. That could limit nursesı ability to work successfully with patients and doctors, the students said. A patient who expects a nurse to be mean or cause pain, for instance, might avoid interacting with nurses and end up with less or worse health care.
The skewed images could discourage people from becoming nurses, when the U.S. health system is suffering a shortage of nurses.
Some nursing students said their experiences have shown the power such popular images of nurses hold. ³Iıve had patients who have made references to their cards ­ıOh, are you going to give me a sponge bath now?ı ­ and they have a card on their nightstand that makes reference to that,² Sharp said.
Deborah James, a mother of six who was in Smithıs class this year, said views of nursing from popular images have hit home.
³My own son is 8 years old, and I asked one day if he would like to become a nurse,² she said. ³And he laughed at me.²
Printed with the premission of the Oregonian.