ORIGINAL ARTICLE/ ARTÍCULO ORIGINAL/ ARTIGO ORIGINAL

Assessment of nursing students' self-esteem at a university in the South of Minas Gerais (Brazil)

Evaluación de la autoestima en estudiantes de enfermería de una universidad del sur de Minas Gerais (Brasil)

Erika Cássia Lopes Chaves¹; Talita Prado Simão²; Iara Siqueira de Oliveira³; Isis Prado de Souza⁴; Denise Hollanda Iunes⁵; Denismar Alves Nogueira⁶

¹RN, Ph.D. Professor, Universidade Federal de Alfenas -UNIFAL- (MG), Brasil. email: erika.chaves@unifal-mg.edu.br.

²RN, Master. UNIFAL (MG), Brasil. email: tatipsimao@yahoo.com.br.

³RN. UNIFAL (MG), Brasil. email: iarinhacv@yahoo.com.br.

⁴RN. UNIFAL (MG), Brasil. email: isis_prados@hotmail.com.

⁵Physiotherapist, Ph.D. Professor, UNIFAL (MG), Brasil. email: deniseiunes@unifal-mg.edu.br.

⁶Zootechnician, Ph.D. Professor, UNIFAL (MG), Brasil. email: denismar@unifal-mg.edu.br.

Receipt date: October 8, 2012. Approval date: May 8, 2013.

Article linked to research: Avaliação da Postura Corporal em Estudantes de infermagem.

Subventions: none.

Conflicts of interest: none.

How to cite this article: Chaves ECL, Simão TP, Oliveira IS, Souza IP, Iunes DH, Nogueira DA. Assessment of nursing students' selfesteem at a university in the South of Minas Gerais (Brazil). Invest Educ Enferm. 2013;31(2):261-269.

ABSTRACT

Objective. To assess the self-esteem of nursing students and explore its relationship with professional training factors that could affect it. Methodology. Descriptive research, involving 135 nursing students at a university in the South of the state of Minas Gerais (Brazil). Data collection was performed between May and September 2011, using a self-report form that collected information about the sociodemographic characteristics and satisfaction with the career chosen, as well as the Rosenberg Self-Esteem Scale. Results. From the total, 90% of students were female, 41% were 20 years of age or younger, and 96% were single. One in each three was taking the first year of their program. Concerning the self-esteem level, 68% presented high self-esteem, 30% average and 2% low. A positive relationship was found between the level of self-esteem and professional perspective (p=0.011). Conclusion. Most nursing students presented high self-esteem, which was related to the professional perspective.

Key words: self concept; students, nursing; nursing.

RESUMEN

Objetivo. Evaluar la autoestima de los alumnos de enfermería y explorar la relación de la misma con factores de formación profesional que pudieran influenciarla. Metodología. Investigación descriptiva realizada con 135 estudiantes de enfermería de una universidad del sur de Minas Gerais (Brasil). La recolección de la información se hizo de mayo a septiembre de 2011. Se utilizó un formulario autoaplicado que recogía la información de las características sociodemográficas y de satisfacción con la carrera elegida, y la Escala de Autoestima de Rosenberg. Resultados. Del total, el 90% es de sexo femenino, 41% tiene 20 o menos, y el 96% es soltero. Uno de cada tres estaba matriculado en los dos primeros años de la carrera. Por nivel de autoestima se encontró que en un 68% fue elevada, un 30% fue media, y en un 2% fue baja. Se encontró una relación positiva entre el nivel de autoestima y la perspectiva profesional (p=0.011). Conclusión. La mayor parte de los alumnos de enfermería presentan autoestima elevada, la cual está relacionada con la perspectiva profesional.

Palabras clave: autoimagen; estudiantes de enfermería; enfermería.

INTRODUCTION

Self-esteem can be defined as a personal consideration individuals have about their feelings and their value, that is, people analyze how much they like themselves, how they see and think of themselves.¹ Its meaning is quite subjective, but directly related to the psychological factor of wellbeing.² In other words, it is people's evaluation of themselves. Such evaluation is based on two components: self-opinion and self-knowledge.³ Therefore, assessing the self-esteem of university students is necessary, given that the transition to higher education can be considered a challenging period in which self-esteem can be compromised, since this is a period full of changes, and the responses shown may vary from person to person because they involve the developmental features of young people.⁴ In addition, it is in this phase of adjustments that feelings of anxiety, fear and insecurity emerge, due to the choice of a certain course, reflecting the decision about their future professional lives, so that a wrong option during this period can result in frustration throughout their lives.

The overload of tasks in daily school life is another factor that should be emphasized as students, in an attempt to correctly comply with the training process, become stressed and fatigued.⁵ In the undergraduate nursing program, these situations seem to be more often associated because, during the academic course, students deal with human beings in a continuous process of health-illness, during different stages of life, constantly facing difficult and diverse tasks, besides witnessing situations of suffering, pain and death.⁵ Thus, the sum of all these factors, or part of them, can indirectly affect the interpersonal relationships and self-esteem of nursing students.

The conjunction of a busy life, pressure and stress, increasingly more common in the daily life of students, results in the reduction of self-esteem which, in turn, constitutes a serious problem at present. Therefore, there is a need to invest in studies that seek to know the profile of nursing students, as well as the ways of dealing with selfesteem. The validation of instruments to assess self-esteem has greatly contributed to investigate this factor inBrazilian population. Among these instruments, the Rosenberg Scale was created by Rosenberg himself,⁶ adapted and validated in Brazil¹ with satisfactory psychometric qualities, showing to be a reliable instrument to assess selfesteem.⁷

It is known that it is important to be aware of, research and detect problems related to selfesteem, since this can be affected by several factors, including personal, psychological and emotional features. Based on the above, this study was aimed at assessing the self-esteem of nursing students and identifying whether there is a relationship between this and the period attended by the research participants, as well as with the factors related to personal, medical and professional training that could affect it.

METHODOLOGY

This is a descriptive, cross sectional and quantitative study, involving 154 Nursing students at a Federal University in the South of Minas Gerais, between May and September 2011. The inclusion criteria were to be students who were attending and duly enrolled in the year 2011. As for the exclusion criteria, they involved students who were not present in the classes during the period of data collection and who, after three attempts to contact them, refused to participate in the research. Thus, the sample consisted of 135 subjects, forming a convenience sample. This study received approval from the Research Ethics Committee under registration number 032/2011. All volunteers signed Informed Consent Forms.

For data collection, two self-reported instruments were used. The first, based on the literature,^8-10 serves to characterize the nursing students in relation to sociodemographic aspects, health status and aspects related to the professional education. The second instrument used was the Rosenberg Scale, which is considered a unidimensional instrument and is widely used in the literature to assess self-esteem.^8,10-13

The Rosenberg Scale consists of ten items, five of which assess positive feelings and five negative feelings of individuals in relation to themselves; their answers are divided according to a fourpoint Likert scale: 1=strongly agree, 2=agree, 3=disagree, 4=strongly disagree. To score the answers, the five items expressing positive feelings have inverted values which, when added to the others, result in one total score for the scale. The possible range of values varies from 10 to 40.⁶

The level of self-esteem was interpreted as low (10-20 points), average (21-30) or high (31-40). Data collection was performed after presenting information about the purpose and method of the study. The data collection instruments were distributed at the beginning of the academic activity of the day and collected at the end of school hours, so that they could be completed at a convenient time. After their completion, the instruments were returned in sealed envelopes to a previously determined location, ensuring the anonymity and privacy of the participants.

The collected data were organized and tabulated using Microsoft Excel 2007 and the analysis was undertaken with the help of Statistical Package for the Social Sciences (SPSS) software, version 17.0. Descriptive statistics were used to describe and summarize the quantitative data, and the qualitative variables were described using frequency analysis and contingency tables. The Chi-Square test was used with a 5% significance rate, along with Spearman's correlation coefficient.

RESULTS

Of the 135 participants, 25.2% were attending the first year of the undergraduate nursing program, 24.3% the second, 26.0% the third and 24.5% the fourth year. The profile of the students, according to sociodemographic data, is shown in Table 1, revealing the predominance of female (89.6%), white (77.0%), age group between 20 and 30 years (56.2%) and single (96.3%). Regarding the socioeconomic status of the participants, most of them (76.3%) live in rented accommodation and 95.6% were not formally employed. In relation to family income, 42.2% of the participants gained a monthly family income between one and three minimum wages (Table 1).

Upon checking the housing status of the students, most participants (54.1%) lived in shared accommodations, 17.0% lived with their parents and 28.9% lived alone in boarding houses, with other family members or with their spouses. Concerning the source of information used by the participants, from television, radio, Internet and magazines, most students (76.3%) chose the Internet. When investigating the students' perception of specific aspects in the undergraduate nursing program, most students (97.8%) were satisfied with the course chosen and 75.6% considered themselves a successful professional, although a large part of them (59.3%) had not chosen this course as their first professional option. Thus, only 37.8% chose nursing because they had the skills required for the course, while 25.2% stated that their choice for this course resulted from the fact that they did not manage to be admitted into their preferred courses, as shown in Table 2

The instrument chosen for the study, the Rosenberg Scale, showed to be appropriate, since it presented good internal consistency (Cronbach's alpha = 0.861) and allowed the analysis of the participants' self-esteem, with scores between 15 and 40 points, and with an average and standard deviation of 34±4.7 points, which indicated high personal self-esteem among the students. As a result, the 135 nursing students presented the following self-esteem profiles: 1.4% low, 30.3% average and 68.3% high. When correlating the year attended by the participants with selfesteem, a significant correlation was not found (r=0.009, p=0.918).

At the time of the interview, 34.8% of the participants presented an illness. Among them, 23.0% suffered from anxiety, stress and depression, while 11.8% had migraines, constant headaches and general bodily pain.

No relationship was found between self-esteem and the variables resulting from the personal factor. However, there was a statistically significant relationship between self-esteem and the professional perspective (p=0.011). The largest proportion of high self-esteem was found among students who wished to become successful professionals with 70.6% (Table 3).

DISCUSSION

The predominance of female students (90%) observed in this study is characteristic of most nursing courses in Brazil and worldwide.^13-18 This seems to be a behavioral and cultural issue, given that nursing has been a predominantly female profession since its appearance.¹⁷ Most participants (56%) were in the age group between 21 and 30 and 96% stated that they were single. This information confirms the literature¹⁴ and reflects the fact that people first seek to have their own income and personal status in order to be personally satisfied and, for this reason, start a higher education course before committing to marriage. In relation to the family income presented in this study, there was a minimum difference in the minimum monthly wage, and 42% of the interviewed participants reported an income of one to three minimum wages and 41% of four to six minimum wages. Also, 96% of the students were not formally employed and, consequently, did not contribute to the family income. This fact is also identified by other researchers,¹⁴ who consider that their employment is compromised due to the nursing course being held during the day and the students' spending most of their time studying. It is known that the nursing course at public universities is full time and, as a result, students have activities throughout the day, which prevents them from committing to work and, consequently, makes them financially dependent on their families.

The choice for the nursing course was a relevant fact to understand the students' relationship with their professional education because, among the 135 participants in the study, more than half were not motivated to choose this professional field. According to the present study, the second main reason for students to choose the nursing course is related to the fact that they did not manage to be admitted into other courses, being this data consistent with the literature.¹⁹ Therefore, it can also be noted that the choice for the nursing course is indirect, as most students had chosen this course because they failed previous university exams to be admitted to other courses of interest, which left them frustrated,²⁰ or even opted for the nursing course in order to solve the issue of preferably joining a public university.²¹ This might be due to the students' belief that, once following a career in the healthcare field, it is easier to change to another of interest or due to the fact that nursing, even nowadays, is a profession that is little known and recognized as a higher education course, so that students do not get support from their families because of its low social prestige.¹⁵

Although the nursing course was not the first choice for more than half of the students who participated in this study, most of them (98%) were satisfied with the course chosen, a fact that has also been observed in recent studies, which verified the high level of student satisfaction with the nursing course.^22,23 This may be an important aspect of nursing, as it is a profession that requires academic experience for satisfaction. Thus, the author of the second study²³ believes that the opinion of the students is influenced by the academic courses, as well as by the opportunities presented to students. In assessing whether the year being attended by nursing students would be a factor influencing self-esteem, it could be noted that this assumption was not evidenced in the study, considering that their correlation was not significant.

Statistical significance was not observed when correlating the year being attended by the participants with their self-esteem, and it is known that the pressures put on students throughout the course, as well as the various pressures in their daily lives, such as excessive sleepiness, lack of leisure, lack of concentration, fatigue, stress and excessive demand⁵ can be caused by the overload of tasks, the full time course, the lack of time to perform extracurricular activities, the high degree of expectation during the curricular traineeships, the lack of time for leisure, among others²⁴, which are factors that were shown in the present study not to affect the self-esteem of nursing students in the different stages of the course.

However, self-esteem had a considerable relationship with professional education. The first relationship was observed in the variable related to clinical factors, in which students who had any illnesses also had a reduced average self-esteem. In line with another study,⁵ it can be concluded that the different illnesses the students reported, such as anxiety, stress, depression and constant headaches, can be a consequence of these various concerns they experienced throughout the course, including concerns related to the future, which directly or indirectly affect their self-esteem.

The other relationship observed was in the variable related to the perspective of students, concerning their future as nursing professionals, which presented a positive relationship with selfesteem. Based on this, it could be noted that most participants, who see themselves as successful professionals, had high self-esteem. This is certainly due to the fact that personal satisfaction, motivation and professional achievement are important conditions for personal self-esteem, given that human beings, throughout their lives, are always seeking to accomplish something and establish ways to achieve their goals.²⁵

In order to meet the needs that may affect the training of students, educators can use instruments that assist them to recognize this feature, such as the Rosenberg Scale used in this study, which is easy to use and had a good internal consistency level (0.86), and also in other studies reported in the literature.^10,13 Through the assessment of selfesteem, teachers can give students more attention, regardless of the year they are attending, so they can use different strategies in order to intervene in the personal, clinical and professional factors, among others, which affect the self-esteem and may also affect their academic performance. Therefore, the importance of using instruments that are adapted and validated for the culture in which the study is undertaken is also highlighted, because then it is possible to measure the issue in question and be aware of their reliability, which will ensure the reliability of the results obtained.

The high self-esteem presented by the research participants leads to the conclusion that the limitations they experienced throughout the course and their indecision regarding the choice of the course, which could have negatively affected their self-esteem, were overcome by the satisfaction they felt after starting the course. Therefore, it can be stated that self-esteem is related to the development of the profession because, together with the acquisition of skills, knowledge and independence, students also acquire social, cultural and emotional adjustment, together with the desire to enter into the professional field and make a difference, and this may increase high self-esteem. It is also known that high self-esteem can help nursing students to develop greater self- Assessment of nursing students' self-esteem at a university in the South of Minas Gerais (Brazil) confidence and self-satisfaction which, in turn, can lead to more confidence in their professional identity when they become nurses.¹³

Nursing is a profession that requires dedication, care and attention from professionals in the field. Therefore, it is important that future professionals are aware of this fact during the course, so that they can seek to find satisfaction in what they do. This fact was found in this study, where a large part of students (98%) stated being completely satisfied with the course chosen, and this was probably one of the factors that led to their high self-esteem. It can be emphasized that self-esteem and satisfaction with the nursing profession are important aspects in the training of nurses, so that they are able to meet the new demands of the healthcare field.

Although a large part of the students in the present study showed high self-esteem, regardless of the year they were attending, different influential factors were observed. Thus, the influence that is present in the professional perspective may result from the students' satisfaction with the course, as this is an important factor that will affect their professional lives. This is an important aspect in Nursing, because this is a profession that requires a high level of cognitive involvement and care skills.

Nursing deals with various conditions that may influence the students' professionalization process, in particular some specific features of the profession, such as dealing with human beings during moments of weakness and often suffering, facing different performance situations and usually working under challenging conditions. Therefore, studies like the present may help to identify factors that assist in the professional training of nurses, in order to prepare them for the challenges posed by clinical practice, as well as by educational and administrative practices.

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