الفهرس 
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Abstract
Nursing has been seen traditionally as a profession for women. Subsequently, nowadays females still represent the large majority in nursing and the manpower in both education and services.In fact males continue to represent only a very small minority. The stigma of nursing profession and negativestereotypes representing male nursesmay be one of the major obstacles for choosing nursing as a career. Moreover, this may have direct effect on males’ professional self-concept (Finnegan, M, 2019; Wang et al, 2011). It was also observed that a number of male nurses change their career after graduation from nursing colleges.
Despite the substantial evidence for the deleterious effects of stigma and poor professional self-concept, the development of appropriate interventions are relatively new. In this respect researches also scarce one of the new interventions to resolve this problem is narrative enhancement cognitive therapy (NECT) (Mittal et al., 2012). NECT is comprehensive, structured, group-based intervention that combines (a) psycho-education, (b) cognitive restructuring (c) narrative therapy.
Aim of the study:
This study aims to determine’’ the efficacy of narrative enhancement cognitive therapy on stigma of nursing and professional self-concept among male nursing students’’.
Research Design:
Pretest- posttest quasi-experimental research design was utilized.
Setting:
The study was conducted at the Faculty of Nursing, Damanhour University.
Subjects:
All students enrolled in the 3rd and 4th academic year (150 students) were surveyed to evaluate their stigma level, self -concept and professional self- concept. The studied subjects amounted to 36 students. All students with high level of stigma were 20 and 16 with the highest level of moderate stigma and with low self-concept constituted the total study subjects.
Tools of the study:
Data were collected using the following tools:
Tool I: Socio-Demographic and academic characteristics Structured interview Schedule.
Tool II:Male students’ stigma of nursing questionnaire:
It was developed by the researcher based on thorough review of all tools used to measure different aspect of nursing stigma.The tool is a self-report scale consisting of two parts. The first part is composed of 20 items that measure stigma of nursing among male nursing students. A four point – Likert scale with 1 representing ’’strongly disagree’’ and 4 representing ’’strongly agree’’. The second part of the questionnaire comprises five open ended questions to determine the nursing effect on students’ relationships, emotions, behavior and feelings toward nursing
Tool III:Self-Concept Questionnaire (SCQ)
The SCQ was developed by Robson (1989) to measure self-concept. It is a self-report scale that consists of 30 items including 16 ‘reversed’ items. The scoring is performed on scale, ranging from 0 to 7.
Tool IV:-The Nurses’ Self-Concept Questionnaire (NSCQ):
The Nurses’ Self-Concept Questionnaire (NSCQ) was developed by Cowin’s (2001) to measure professional self-concept among nursing students. The NSCQ consists of 36 items rated on 8 point Likert-type scale ranging from 1 (definitely false) to 8 (definitely true).
• Official written permission from appropriate authorities was obtained
• The researcher received online training on Narrative Enhancement Cognitive Therapy
The followings are the main results yielded by this study:
1- Socio demographic and academic data of male nursing students
- 27.8 % of the studied students aged less than 22 years
- The majority of the subjects were single.
- Eighty six point one percent were living in rural areas and 13.9% were living in urban areas.
- The percent of the studied subjects enrolled in the 3rd academic year amounted to 33.3% and 66.7% of the students were enrolled in the 4th academic year.
- At the time of the study, 19.4%were enrolled in obstetric and gynecological nursing specialty, 30.5% were in pediatric nursing specialty and 8.3% were in psychiatric and mental health nursing specialtyand 22.3% were in administration nursing.
- Twenty two point two percent had received excellent degree and 41.7% of the studied subjects received a degree of ’’very good
- Studied subjects who were working in hospital during their academic studies amounted to 52.8% of the total subjects.
- Studied subjects who reported having no relative or friends in the field of nursing amounted to 77.7% of the total studied subjects.
II- Distribution of the studied subjects according to male students’ stigma of nursing:
- Concerning levels of male students’ stigma 55.6 % of the studied students had high level of nursing stigma and 44.4% had high moderate level of nursing stigma.
- A significant positive relation was found between academic year and level of stigma among studied male nursing student before receiving NECT intervention(p=0.009).
- A significant statistical relation between level of stigma and nursing specialty at study time p= (0.042).
- Before intervention 55.6% of the studied subjects had high level of stigma before implementation of the narrative enhancement cognitive intervention (NECT), this percent dropped to 5.6% immediately after applying the intervention and this percent was the same after two months of applying narrative enhancement and cognitive therapy with a statistically marked difference (Fr=51.774, p<0.001).Before applying intervention , 44.4% of the studied subjects had high moderate level of stigma and this percent decreased immediately after intervention and two months after to 25% &19.4% respectively, with statistically marked difference (p<0. 001).
- The mean scores of the total stigma among studied subjects were significantly decreased immediately after and after two months of conducting narrative enhancement and cognitive therapy (mean score pre intervention 59.11±4.43, immediately after intervention 45.33 ± 8.84, after 2months 45.44±9.28) (p<0. 001).
III- Distribution of the studied subjects according to self-concept and professional self-concept
- The studied students’ experienced low levels of self-concept were 97.2% while 2.8 % had high self-concept.
- In pre intervention phase 2.8% of the studied subjects had high self-concept this percent increased immediately after applying the therapy to 91.7% and dropped slightly after 2 months to 83.3% with a highly statistical significant difference ( p<0.001). Additionally the mean score of the total SCQ was significantly increased immediately after and after two months of applying the therapy ( value= 92.50 ± 8.40 ,136.2 ± 23.52 and 135.03± 27.50) (p<0.001).
Distribution of the studied subjects according to professional self-concept
- The studied subjects had low professional self-concept were 80.6% in the pre intervention phase and this percent was decreased immediately after and after two months of applying the therapy to 8.3%, and 16.7% respectively. On the other hand 19.4% of studied subjects had high professional self-concept before therapy. This percent increased to 91.7% immediately after the therapy and to 83.3% among subjects after two months follow up with high statistical significant difference (p<0.001).
- The mean score of all the domains of professional self-concept, increased with statistical significant difference was found among the studied subjects after applying the program (p<0.001).
- The mean scores for the domain of general self-concept, increased from16.22 ±8.19 to 30.69 ± 10.65 and 32.03 ± 11.72 immediately after and after two months of program respectively with a statistically significant difference (p<0.001).
- The mean scores ofcaring domain increased immediately after and after two months (pre mean=25.47 ±7.45, immediately after mean=37.97 ± 8.55 and after two months mean=37.22 ± 9.98)with statistically significant difference (p<0.0 01).
- The mean scores of staff relation domain raised from 22.89 ±10.31 to37.92± 8.43post-intervention with statistically significant difference p<0.0 01.
- The mean scores of communication raised from27.36 ± 8.76 to 38.86 ± 7.42 post-intervention with statistically significant difference p<0.0 01.
- The mean score of knowledge and leadership self-concept domains increased from 26.86 ± 9.80 and 24.22 ± 8.75 to 38.86 ± 7.29 and 35.06 ± 10.07 immediately after and after two months 37.89 ± 9.95 and 34.25 ± 12.02 with statistically significant difference (p<0.001).
The main recommendations are:
- Males nursing students should be distributed equally together in different groups(more than one in group) and in clinical experiences.
- Nursingcurriculum should include educational subjects that elaborate the importance of male role in practicing nursing and decrease the gender link of female to nursing.
-First-year students should be introduced to the value of nursing profession, its history and importance worldwide. Orientation of the different education program and various clinical experiences should be made using handouts and other printed materials.
- Workshops for newly appointed instructors to teach them how to deal with the psychological problem and how to enhance their self-concept of male students.
- Regular visits to secondary school should be encouraged to change stereotypes of nursing profession as only female linked profession and male nurses in particular
- Improving society’s view of nursing work through television programs and interviews, films, and respected nursing models in Egyptian society.
- Agreeing on a title for professional nursing male graduate.