Author for correspondence:
Blaženka Gorupić
Universitas Studiorum Catholica Croatica, Postgraduate study Sociology: values, identity and social changes in Croatian society, Zagreb, Croatia
E-mail: bgorupic@unicath.hr
https://doi.org/10.24141/2/8/1/5
Keywords: nursing, identity, profession, care, autonomy
This article presents the development of nursing identity with a brief review of the situation in the Re- public of Croatia. The focus is on the conceptual inter- pretation of identity and its impact on the formation of individual identity in the social context. The postu- late of contribution is manifested in the presentation of different authors’ perspectives on the concept of nursing identity, emphasizing the ambiguity of this term. Special emphasis is placed on the analysis of nursing identity development, exploring the influ- ence of traditional and modern social frameworks. The historical evolutionary path of nursing and the way in which gender stereotypes limit its progress are presented. Additionally, key components of con- temporary nursing are highlighted, emphasizing the importance of academic education, research and the- oretical development within nursing. Finally, the cur- rent issues of nursing within the Republic of Croatia were addressed, emphasizing the need for inclusive and modern nursing based on academic knowledge and social engagement.
The excessive frequency of using the term “identity” in everyday interaction has resulted in its vague- ness and multiple meanings. Numerous authors have devoted themselves to understanding and defining identity, whereby Rade Kalanj (2010), according to Brubaker, emphasizes the complexity of the term “identity”, marking it as a term which is too ambigu- ous, oscillating between solid and fragile meanings, essentialist and constructionist nuances (1).
In the same tone, Kalanj (2010), according to Cas- tells, emphasizes:
“Identity, regardless of changes in life-historical cir- cumstances, is always what ‘I’ or ‘we’ think about ourselves or others and what others think about us, and to that extent it is a fundamental, indeed, a primordial category of human experience, so pri- mordial that it would not be an exaggeration to characterize it as an identity ontology. It has its strength regardless of our will or contestation, and therefore it is no coincidence that some authors thematize it as “the power of identity” (1).
This view emphasizes the key role of identity in the formation of human experience and points to its un- deniable importance despite the changes and chal- lenges of life.
The development of an individual’s identity is a com- plex process which includes social and cultural as- pects, such as racial, professional and gender identity. These identities often derive from others’ assump- tions about us, shaping our perception of ourselves. Through the process of socialization, the individual builds their identity as part of the social whole (2).
Nursing, as a profession which has evolved since the 19th century, acquired an autonomous status only in the 1960s, after long-term efforts aimed at shaping its own identity. During the 1980s, nursing proac- tively incorporated nursing practices, moving toward qualitative methods in the humanities. The path from a controversial and marginalized profession to complete social and professional affirmation was a challenging process. Emphasis should be placed on the fact that today nursing is unavoidable and neces- sary for modern society and is an integral part of the healthcare system (3).
The turning point in attempts to define the identity of nursing rests in the 20th century, when the sense, meaning and values of nursing began to be strength- ened in the academic environment, which represents a stronghold for the formation of unique knowledge and skills necessary for the development of a pro- fessional identity. In other words, the art of nursing encompasses the care about the sick as well as the care about the healthy, and in recent decades, spe- cial attention has been paid to building the identity of nursing, which would contribute to the develop- ment of theories and research in nursing (3).
Furthermore, the nursing profession has its own his- tory, which makes it much more difficult to build a pro- fessional identity precisely because of the knowledge that no education was necessary to perform nursing work, and women of lower social status and without education were the ones who practiced nursing. How- ever, an individual’s perception of themselves in a pro- fessional role affects professional development, but also the promotion of their own profession, and the acquisition of characteristics, values and experience of nurses is important for developing the attractive- ness of the profession, especially for younger genera- tions who have not yet formed an opinion about the identity of a particular profession (4).
In recent years, the vision of the development of the nursing profession has been expanding in order to improve the health culture of the entire population. Considering that nurses represent patients and their families in the social community, their well-being is based on the construction of social determinants of health in the provision of quality healthcare (5).
The development of nursing throughout history reflects the evolution of the assumptions which shaped its concept. According to Virginia Henderson, healthcare is the core area of nursing, encompassing the care of the healthy and sick individuals who need help. Nursing is described as the art of providing healthcare, while emphasizing its vocational charac- ter, and is recognized as a profession (6).
By studying the history of nursing, we can identify key periods which shaped the role and significance of nurses. In the pre-modern period, caring for the
sick was predominantly the responsibility of female members of the family or community, who were us- ing techniques and plants with positive effects. In ancient cultures such as Egypt, Babylon and China, we find records of nurses in religious books. The Christian period saw the involvement of matrons and deaconesses in caring for the sick, encouraging edu- cation and laying the foundations for the develop- ment of educated nurses. The Renaissance brought an accelerated development of medicine, but the perception of nursing as a “religious” vocation stag- nated. In the “dark” 16th century, nursing became undesirable due to low wages and harsh conditions. Changes began with St. Vincent de Paul in the 16th century and Thomas Fliedner and Florence Nightin- gale in the 19th century (7).
Florence Nightingale, the founder of nursing, is a symbol of hope and compassion. She devoted her life’s calling to serving God and developing discipline in caring for the sick, laying the foundations of mod- ern nursing. Her work during the Crimean War em- phasized the importance of nurse education, and her greatest contribution is considered to be the intro- duction of the administrative role of the nurse (8).
The traditional portrayal of nurses has often depict- ed them as oppressed and marginalized by doctors, resulting in low self-esteem on a personal and pro- fessional level. These stereotypes, together with the determinants of working conditions, shared values and level of education, shaped the development of nurses’ professional identity (9).
Gender stereotypes, which consider women to be biological and rational, are also reflected in the nurs- ing profession. A historical review of various cultures attributes the reproductive role to the concept of woman, which is associated with care and concern for the family and the home. The assigned roles limit women and favor the discrimination of social values. Nursing has always been in collision with the vari- ables of gender which are manifested by the gap be- tween men and women through the assigned roles in nursing. In the same way, the mentioned stereotypes affect the nurses’ perception of themselves, which are focused on the social representation of the nurs- ing profession. At the end of the 20th and beginning of the 21st century, the nursing profession was not promoted, but public perception had negative con- notations, which was also influenced by the media, which “perpetuated stereotypes about the nurse as an angel of mercy, a doctor’s maid and a sexy nurse
or sexual object” (10) and the nurse became invisible to society (10).
The development of nursing education lays the foun- dations of modern nursing, setting high standards and ethical principles. In the 20th century, morality and virtue became key criteria for admission to nurs- ing schools (7). This continuous process of evolution is reflected in the contemporary understanding and professional identity of nurses.
Modern society implies the synergy of history and society through elements of nature which are con- stantly evolving. The shaping of society is inter- twined with science and the development of practi- cal skills, which is manifested through the work of the individual (11).
Professional work influences the construction of identity based on the characteristics which shape a profession, among which the following stand out: “its historical constitution, special occupational culture, specific knowledge and specific dialect” (12). The pa- rameters which make a profession “professional” are recognition of the status by the state, educational and public institutions and in defining the criteria necessary for its training (12).
Within nursing, the fundamental goal is to define the key elements of constructing a professional iden- tity, and the following are stated: “values and eth- ics, knowledge, nurse as a leader and professional behavior” (13), the implementation of which would benefit both nurses and patients. The mentioned elements are necessary in describing and bringing nursing closer to students, other nurses and society in general. Also, these elements can be used to fur- ther analyze the current situation and improve one’s own areas for progress (13).
Modern society realizes its arbitrariness through work and becomes useful for society as a whole, and highlighting the importance of science and art is a feature of sophistication that embodies greater free- dom and humanity (11).
Sociological research on the qualities needed in build- ing the profession culminated between the 1950s and 1980s, a period in which leading nursing officials sought guidance in the establishment of nursing. A university professor of sociology, Dr. Merton, helped
the nursing association understand the demands of the profession, which he described as: “an organiza- tion of practitioners who judge each other as profes- sionally competent and who have joined together to perform social functions that they cannot perform separately as individuals” (14).
The development of the professionalization of nurses is much discussed at the global level, but only the development of nursing guidelines and protocols has confirmed that nurses possess immense knowledge and skills, although the real core of nursing is still un- clear. The goal of nursing should be focused on the de- velopment of theories, research and skills so that the society recognizes the empirical and specialist devel- opment of nursing and its contribution to society (9).
On that track, the foundations and characteristics of the nursing profession were laid, which became the area of interest and the establishment of pro- fessional associations of nurses. The basic premise of the further development of nursing has become global networking and the availability of information related to the discipline of nursing (14).
In recent years, social changes caused by the occur- rence of events such as the COVID-19 pandemic and the declaration by the WHO of 2020 as the Year of Nurses and Midwives, as well as the development of various possibilities for the transmission of informa- tion sources, and the development of communication channels and social networks have improved the vis- ibility of the nursing profession. The influence of the mentioned events reduced gender stereotypes in nursing and improved the knowledge and attractive- ness of the nursing profession (10).
Nurses continue to develop their professional iden- tity by maintaining relationships with other nurses, promoting lifelong education, information exchange and developing common values in order to visualize the professional identity of nurses in the right way
(15). Dynamism and flexibility are the most impor- tant concepts in improving the provision of health care (16).
Étienne Wenger, a well-known theorist, believes that identity “…is to be lived, which means that identity is the core of human existence and is fundamentally an experience which involves participation and reifi-
cation” (17). He defines identity as the intersection between the individual and the collective. Wenger points out that creating one’s own idea about the profession can be crucial for establishing a profes- sional identity within the community (17).
Changes in the way and provision of modern nurs- ing care are conditioned by the integration of new health reforms and the use of different technologies in work, which changes the role and expectations of nurses, requiring rapid adaptation with the aim of achieving fluidity in work (16). Despite the fact that nursing is associated with the qualities of self-sacri- fice, honesty and moral integrity, the development of professional identity is associated with personal identity, which includes emotional and behavioral determinants in the process of self-acceptance and self-identification with the profession (17).
The development of a professional identity in nurs- ing is deeply rooted in personal values, attitudes and beliefs, and all of this is immersed in the context of the characteristics and deep understanding of the nursing profession. A key phase of professional iden- tity formation begins during undergraduate nursing education, where theory and practice align to shape a basic understanding of the role of the nurse. The initial steps in the formation of a professional iden- tity are experienced through the prism of theoretical concepts and their concrete application in the clinical environment. Novice nurses actively adapt and re- fine their professional identity as they gradually in- tegrate into the workforce. The adaptation process is not just a one-time event, but a continuous series of adaptations based on newly acquired knowledge, de- veloped skills, assumed roles, assigned responsibili- ties and changes in work environments. Through the accumulation of personal and professional experi- ences, nurses build their professional identity, result- ing in a dynamic and adaptive process of evolution. This dynamism enables adaptation to new standards of practice, technological innovations, ethical norms and contemporary challenges in the healthcare sys- tem. Professional identity becomes a kind of perma- nent version which reflects the constant effort of nurses to improve their own expertise (16).
Moreover, the development of the nursing profession is affected by the increased turnover and shortage of nurses due to the possibility of choice in seeking to achieve self-realization, a sense of belonging to an organization and satisfaction in work (17).
Migration of nurses is becoming a social problem mo- tivated by the desire to improve the standard of liv- ing and working conditions, as well as the possibility of advancement in the profession (18).
The decision to stay in a profession or organization is often associated with a sense of empathy towards oneself and patients, a key factor in the growth and development of nursing, and attracting new genera- tions of nurses to the profession (17).
The global migration of health professionals poses a number of moral, legal and political challenges that need to be addressed through additional initiatives aimed at developing strategies to retain qualified professionals (19).
Therefore, the continuous progressive development of the nurses’ professional identity not only pro- motes their personal growth, but also plays a key role in providing high-quality healthcare. This evolution- ary process supports a deep understanding and com- mitment to the profession, creating a foundation for excellence in nursing practice and contributing to the quality of the healthcare system (16).
In the past decades, we have witnessed signifi-
This approach represents a key element in the devel- opment of modern nursing in the Republic of Croa- tia with an emphasis on adequate management of complex health interventions, including the applica- tion of advanced technology and effective disease management. In accordance with modern standards of nursing practice, the main role of nurses is to iden- tify and meet the specific needs of patients, develop comprehensive nursing care plans and evaluate the outcome of interventions within the framework of primary, secondary and tertiary healthcare (20).
Given the evolution of the healthcare sector, nurses today are taking on additional responsibilities, requir- ing a diverse set of skills. Education is focused on rais- ing the expertise of nursing staff to facilitate the pro- vision of patient-centered care. Integration of patients into interdisciplinary teams, evidence-based practice, continuous improvement of the quality of care and op- timal use of health information technology are becom- ing key elements of modern nursing (20).
This comprehensive approach not only promotes the expertise of the nursing staff, but also supports fur- ther progress in the provision of high-quality health- care in the Republic of Croatia.
cant progress in the development of nursing in the Republic of Croatia. A key step towards the profes-
sionalization of nursing was achieved through the establishment of regulations through legislation, es- pecially the adoption of the Act on Nursing. This law precisely defines the competencies of nurses, mark- ing a turning point in the regulation of the profession and providing clear guidelines for the performance of their tasks.
Despite the achievements, we face nursing chal- lenges in the Republic of Croatia, aligned with global trends. Lack of nurses and difficult working condi- tions are key problems. Research by the authors Kurtović, Friganović, Čukljek, Vidmanić, Stievano (2021) emphasizes the need for urgent measures to solve the issue of staff shortages and improve the working environment of the profession (20).
Through the development of the identity of nursing, especially through strengthening the reputation of nurses by encouraging self-determination and self- confidence, the research lays the foundations for the further development of the profession (20).
Through studying the development of the identity of nursing throughout history, we observe the complex- ity and dynamics that shaped this profession. The excessive use of the term “identity” in today’s eve- ryday interaction points to the challenges we face when defining this complex category. The identity of nursing, like any other identity, arises from the inter- play of individual and collective experience.
In pre-modern society, nursing evolved from the tradi- tion of caring for the sick, and the identity of nurses was shaped through religious and social norms. Fe- male gender stereotypes and low social status created challenges for the development of nurses’ professional identity. Throughout history, nursing has gone through phases from marginalization to affirmation, with chal- lenges such as lack of education and low self-esteem, leaving their mark on the profession’s identity.
In modern society, the professionalization of nurs- ing brings a new context in the formation of iden- tity. Respect for the state, educational institutions and the public is essential for the recognition of the status of nurses as professionals. The development of knowledge, ethical values and management in ac- cordance with the changes in the healthcare system contribute to the formation of the modern identity of nursing.
Ultimately, nursing identity is a complex entity which has evolved throughout history, adapting to social changes and reflecting various challenges. Modern nursing requires flexibility, expertise and the promo- tion of autonomy in order to respond to the demands of a complex healthcare system. Improving the pro- fessional identity of nurses is essential for achieving high standards of care and preserving the vital role of nursing in society.
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U radu je prikazan razvoj identiteta sestrinstva s kratkim osvrtom na stanje u Republici Hrvatskoj. Fo- kus je stavljen na konceptualnu interpretaciju iden- titeta te njegov utjecaj na formiranje individualnog identiteta u društvenom kontekstu. Doprinos se ma- nifestira u prikazu različitih autorskih perspektiva na koncept identiteta sestrinstva, naglašavajući vi- šeznačnost tog pojma. Poseban naglasak stavljen je na analizu razvoja identiteta sestrinstva, istražujući utjecaj tradicionalnih i modernih društvenih okvira. Prikazan je povijesni put sestrinstva te način na koji rodni stereotipi ograničavaju njegov napredak. Dodatno, istaknute su ključne komponente suvre- menog sestrinstva, naglašavajući važnost akadem- skog obrazovanja, istraživanja i teorijskog razvoja unutar sestrinstva. Na kraju, obrađena je aktualna problematika sestrinstva unutar Republike Hrvatske, naglašavajući potrebu za inkluzivnim i suvremenim sestrinstvom temeljenim na akademskom znanju i društvenom angažmanu.
Ključne riječi: sestrinstvo, identitet, profesija, skrb, autonomija