Symbols and traditions in Polish nursing

INTRODUCTION

The symbols of Polish nursing were created over many years. Many of them have transformed. These changes were caused by convenience or requirements connected with job safety and hygiene. However, the nurses’ cap, uniform, anthem, Florence Nightingale’s lamp, and the connected traditions are inseparable elements of the nurses’ profession. The only commonly cultivated tradition is connected with International Nurses Day, and the coverage of the ceremo-nies is available online or on television [1]. The majority of medical colleges have also reinstated the tradition of cap-ping. On the other hand, the tradition of attaching a ribbon to the cap has become a relic of the past [2]. Symbols shape the nurses’ image. They belong to the non-moral values. Together with traditions, they contribute to the identification of a person with an occupational group as well as giving a feeling of pride and unity. The nurses’ cap and uniform convey a message to society about the wearer’s occupational identification, and they participate in the process of upbringing [3-5]. In 2003, the International Council of Nurses presented a universal symbol of nursing. It is a white heart on a navy-blue background. It expresses the care, knowledge, and humanitarianism that arise from the nurses’ work. White colour means approval of all the people around the world, hygiene, care, and comfort. The heart symbolises a “humane” attitude, which should be of priority in performing nursing services [2, 6].

AIM OF THE STUDY

The objective of this paper is to get to know and compare the knowledge among the third-year undergraduate nurs-ing students of the Medical University of Warsaw as well, as the female/male nurses who have worked in their profes-sion for at least two years, about selected issues on the history and current information about the symbols and tradi-tions in Polish nursing.

MATERIAL AND METHODS

The research was conducted in March 2016 among 100 third-year undergraduate nursing students of the Medical University of Warsaw as well as 100 female/male nurses who have worked in their profession for at least two years. In order to obtain the research results, a diagnostic poll method was used. A proprietary questionnaire was used as a research tool. Participation in the research was anonymous and voluntary. About 60% of the surveyed third-year un-dergraduate students came from rural areas, while the remaining 40% of the respondents came from cities. Nurses and nurses working professionally with at least two years’ work experience resided in urban areas.
The dependence analyses were conducted using the statistical package PQStat ver. 1.4.2.324. The results of the analyses were presented in tables of descriptive statistics and in diagrams. The dependencies between the answers to the questionnaire and the age group as well as the professional status and education were analysed using the 2 test and Fisher’s exact test.

RESULTS

In the opinion of more than half of the respondents (49%), the nurses’ cap is the most important symbol in nursing. The nurses’ uniform was indicated by 24% of the respondents, the nurses’ anthem by 12%, and Florence Nightingale’s lamp by 11%. The other 5% of the respondents indicated symbols that were not listed in the questions.
When analysing the differences depending on the age, a similar distribution of the answers was also recorded in the age groups: up to 25 years, 35-39 years, and 45-49 years. However, in comparison with the distribution of the an-swers depending on age, concerning the most important symbol in nursing, the survey revealed a significant relationship of the distribution in age groups 25-29, 30-34, 40-44, and 50 years and over in comparison with the other age groups (2 = 69.26, df = 24, p < 0.0001, Fisher’s exact test p < 0.0001). It should be added, however, that this is not a linear de-pendency. The nurses’ cap is the most significant nursing symbol in the group aged under 25 years (71% of the an-swers), similarly in the groups aged 35-39 (75%) and 45-49 years (75%). The nurses’ cap was much less frequently indi-cated by the respondents from the groups aged 25-29 (62%), 30-34 (56%), and 40-44 years (40% of the indications). On the other hand, nobody indicated this symbol in the age group of 50 years and over.
The nurses’ uniform came second in the group of respondents under 25 years old, with the number of indica-tions at 22%. In the group aged 25-29 years the lamp of Florence Nightingale came second (25%). The group aged 30-34 years (22%) indicated other symbols not listed in the questionnaire. The group aged 35-39 years indicated the nurs-es’ anthem in second place (25%), and in the group aged 40-45 years the lamp of Florence Nightingale (27%); the 46-49-year-old age segment indicated the nurses’ uniform (17%), and the lamp of Florence Nightingale came second in the oldest group, with the number of indications at 49% (Table 1).
The analysis of the distributions of the answers to the question about the most important symbol in nursing re-veals a significant dependence of this distribution on the professional status and education (2 = 54.59, df = 20, p < 0.0001, Fisher’s exact test p < 0.0001). In the group of undergraduate nursing students, 72% indicated the nurses’ cap, and the nurses’ uniform came second (21%). In the case of students and professional female/male nurses with secondary vocational education, everyone indicated the nurses’ uniform. However, in the group of students and profes-sional female/male nurses holding an undergraduate degree, 63% indicated the nurses’ cap, 24% indicated the lamp of Florence Nightingale, and 10% indicated the nurses’ uniform. In the group of professional female/male nurses with a secondary medical education, half (50%) indicated the nurses’ cap and the other half the nurses’ anthem (50%). In the segment of the professional female/male nurses holding an undergraduate degree, 48% indicated the nurses’ cap, and 16% indicated the nurses’ uniform and the lamp of Florence Nightingale. Among the professional female/male nurses with higher MA education, the nurses’ cap was regarded as the most important nursing symbol (60%), and 20% indicated the lamp of Florence Nightingale (Table 2).
Making the pledge was stated as the most important nursing tradition among 50% of the respondents. Second is the capping ceremony with 32% of the indications, followed by the ceremony of attaching a ribbon to the cap and the celebrations of International Nurses Day (9% each). The survey revealed a significant dependence (2 = 32.10, df = 18, p = 0.0214, Fisher’s exact test p < 0.0001) between the distribution of the answers and the respondents’ age. Together with the age increase of the respondents, from 25 years old and below to the group of 44-year-olds, the num-ber of indications of capping dropped (from 61% in the group of 25-year-olds and below to 33% in the group aged 40-44 years) and the number of indications of making the pledge increased (from 32% in the group of 25-year-olds and below to 60% in the group aged 40-44 years). In the opinion of 42% of the studied respondents from the group aged of 45-49 years, the most important tradition was capping. For 33% it was making the pledge, and for 25% it was the cele-bration of International Nurses Day. All the studied people aged 50 years and over chose only making the pledge (Table 3).
The opinions about the most important traditions in nursing are significantly diversified by professional status and education (2 = 37.67, df = 15, p = 0.0010, Fisher’s exact test p < 0.0001). In the group of students of nursing, the most important nursing tradition is capping (60%), followed by making the pledge (33%), the celebration of Interna-tional Nurses Day (5%), and the ceremony of attaching a ribbon to the cap (2%). Similarly in the group of students who are simultaneously professional female/male nurses with an undergraduate degree, the most important nursing tradi-tion was capping (48%), making the pledge (34%), the celebration of International Nurses Day (16%), and the ceremo-ny of attaching a ribbon to the cap (2%). The group of professional female/male nurses with a graduate degree chose capping (50%) as the most important tradition in nursing; however, among the professional female/male nurses, mak-ing the pledge was the most important symbol (52%). Half of the professional female/male nurses with secondary medical education mentioned making the pledge, and the other half, the ceremony of attaching a ribbon to the cap (Table 4).
One third of all the respondents (36%) declared that they were not familiar with the lyrics of the nurses’ an-them. Half of the respondents (50%) thought that they were rather familiar with the anthem’s lyrics, and 15% were of the opinion that they were definitely familiar with the lyrics of the nurses’ anthem. Age is a variable that significantly diversifies the level of evaluation of one’s familiarity with the lyrics of the nurses’ anthem (2 = 134.54, df = 24, p < 0.0001, Fisher’s exact test p < 0.0001). The respondents from the group aged 45 years and over declared the highest level of self-evaluation of familiarity with the lyrics of the nurses’ anthem; and the lowest was declared by the people aged 25 years and under. All the studied people aged 50 years and over said that they were familiar with or rather fa-miliar with the lyrics of the nurses’ anthem (answers: “Yes” 50% and “Rather yes” 50%). Similarly, in the group aged 45-49 years, everyone said that they were familiar with the anthem’s lyrics, and the prevailing opinion in this group was “Rather yes” (67%). In the group aged 25 years and under, 86% of the people were not familiar with the anthem’s lyr-ics, and in the group aged 25-29 years, 79% declared that they were not familiar with the lyrics of the nurses’ anthem (Table 5).
Professional status and education have a significant influence on the level of self-evaluation of familiarity with the lyrics of the nurses’ anthem (2 = 75.33, df = 20, p < 0.0001, Fisher’s exact test p < 0.0001). The level of familiarity with the lyrics of the nurses’ anthem among the undergraduate nursing students was lower (87% were unfamiliar with the anthem’s lyrics). The second group in terms of unfamiliarity with the anthem were the students who at the same time are professional female/male nurses with an undergraduate degree (58% among them were unfamiliar with the anthem’s lyrics), the third group were the professional female/male nurses with a graduate degree (40% among them were unfamiliar with the anthem’s lyrics), and the fourth group were the professional female/male nurses with an un-dergraduate degree (28% among them were unfamiliar with the anthem’s lyrics) (Table 6).

DISCUSSION

The level of knowledge of the third-year undergraduate nursing students as well as the female/male nurses about the selected symbols and traditions in Polish nursing was low. One should consider undertaking actions that would ex-pand the knowledge about the nursing symbols and traditions among the youth, more classes, or putting more empha-sis on the interactive method of conveying knowledge. One should also analyse the reason for the students’ reluctance to study this subject [7].
The research revealed that familiarity with the nursing symbols and traditions does not grow with increasing qualifications. When influencing the development and upholding tradition in nursing, the significance and history of symbols should be remembered. It is worth learning the opinions about nursing values and symbols among nursing stu-dents, working female/male nurses, and also among people who have nothing to do with this profession [3]. This re-search shows that 72% of the third-year undergraduate nursing students of the Medical University of Warsaw and 58% of the professional female/male nurses claimed that the nurses’ cap was the most important symbol for the nursing profession. Second came the nurses’ uniform, chosen by the third-year students at the BBA nursing program (21% of the indications), and the female/male nurses indicated the lamp of Florence Nightingale (21%). According to the anal-yses conducted by Sposób et al. [8], which was held among 200 nurses who work at hospitals in the Lubelskie voivod-ship (province), the nurses’ cap is a symbol that is most of all associated with the nurses’ profession. About 65.5% of the female/male nurses expressed this opinion. Then they indicated the nurses’ uniform at 59.5%. Apart from that, 89.5% of them stated that the nurses’ cap best depicts a nurse. It was followed by a syringe at 37.5%. The majority of the female/male nurses (78%) regarded the nurses’ cap as a significant nurses’ symbol. However, they did not mention the lamp of Florence Nightingale. When surveying 100 high school first- and second-graders in Lublin about the value of the symbols and traditions in nursing, Ślusarska et al. [9] also obtained the answer that the most important nursing symbol was the nurses’ cap (70%), which was followed by the uniform (67%). The fewest respondents mentioned the lamp of Florence Nightingale and evaluated its symbolic value as low (56%). According to them, the nurses’ cap reflects best the nurses’ profession; this answer was marked by 66% of the respondents. Second came the nurses’ uniform, with 18% of the indications. In the studies of Gibas and Dębska [10] conducted with bachelor students of nursing, the ma-jority of respondents indicated that the nursing symbol is a nurses cap. However, according to the authors of the study, over half of the nurses surveyed indicated that when they wore a cap they were more recognisable. Janiga and Ślusarska [11] reached similar conclusions after studying 350 nursing students at various universities in Poland. The students pointed to the nurses’ cap as the main symbol of the profession. For those students, the most important tradi-tion was capping, and the next one was taking the oath.
When describing the significance of tradition, Wolska-Lipiec [12] refers to the norms of conduct and to convey-ing the messages to the younger generations. As indicated in this paper, the capping ceremony is the most important tradition in the nursing profession. Sixty per cent of the third-year nursing students of the Medical University of Warsaw were of this opinion, as were 44% of the female/male nurses. According to the nurses’ survey by Ślusarska et al. [9], the majority of the answers (87%) indicated this tradition.
On the basis of our own surveys, 77% of the surveyed third-year undergraduate nursing students of the Medi-cal University of Warsaw would like to wear a badge in the shape of a cap, and 30% of the surveyed female/male nurses do not wear it on their uniform. According to Ślusarska et al. [9], 53% of the female/male nurses were for the obligation of wearing a cap or a cap-shaped badge, and in the studies by (2008) Ślusarska et al. [9], 65% of the high-school youths were of the same opinion.
The familiarity with the nurses’ anthem among the third-year nursing students of the Medical University of Warsaw was low (5%), and it was higher among the female/male nurses – 24%. On the other hand, more than a half of the female/male nurses (54%) were familiar with the lyrics of the nurses’ anthem, according to the studies conducted by Ślusarska et al. [9].
When conducting an analysis among the selected 400ed first-, second-, and third-year undergraduate nursing students of the Medical University of Warsaw, Goworek et al. [7] found that the knowledge of the selected information about nursing history was insufficient. Only 50.7% of the answers to the questionnaire were correct. Similar studies were conducted at the Medical University of Białystok by Owczarczyk et al. [13]. As well as the knowledge of the selected issues on nursing history, they analysed questions on nursing traditions among the first-year nursing students on full-time undergraduate courses and 50 first-year full-time graduate students who were not active nurses.
The respondents in the survey conducted by Goworek et al. [7] provided 80.65% of correct answers by saying: “soldiers at a hospital in Crimea” to a question on who first called Florence Nightingale “the lady with the lamp”. Ac-cording to Owczarczyk et al. [13], 98% of the first-year BBA students and 78% of the first-year MA students gave cor-rect answers. On the other hand, in the current survey, 74% of the third-year undergraduate nursing students of the Medical University of Warsaw and 69% of the female/male nurses gave correct answers.
The survey by Goworek et al. [7] showed that 44.26% of the students of the Medical University of Warsaw an-swered that International Nurses Day was established to commemorate the birthdate of Florence Nightingale. Ninety-two per cent of the first-year nursing students of full-time undergraduate courses and 52% of the first-year graduate students provided correct answers according to the survey by Owczarczyk et al. [13]. This paper showed that 79% of the third-year undergraduate students of the Medical University of Warsaw and 65% of the female/male nurses gave the correct answer.
The photograph of Florence Nightingale was recognised by 83.28% of the interviewed students of the Medical University of Warsaw in the analysis by Goworek et al. [7], 94% of the first-year undergraduate full-time nursing stu-dents, and 90% of the first-year graduate full-time nursing students of the Medical University of Białystok according to Owczarczyk et al. [13], as well as 92% of the third-year undergraduate nursing students of the Medical University of Warsaw and 90% of the female/male nurses in the current research.
The feeling of pride in the nursing profession is associated with the past, which is the foundation for the future [7].
In foreign literature we find references to various nursing symbols; according to Calnan et al. the most im-portant symbol is a nurse’s cap. Another symbol of nursing is the rose [14].
Shetty et al. indicates that the medical professions including nursing in India were identified with the caduceus and the Rod of Asclepius [15]. It is important to emphasise that the symbols of nursing in the world, apart from the cap and nursing uniform, are very different, which is determined by multiculturalism.

CONCLUSIONS

The knowledge of history, symbols, and traditions in Polish nursing among the third-year undergraduate students and female/male nurses who have worked in this profession for at least two years is low. Half of the respondents regard the cap as the most important symbol, and one-third think that the capping ceremony is the most important tradition.
The level of knowledge of symbols and traditions in Polish nursing depends on age and education.
The familiarity with the nurses’ anthem is low; however, it grows with age, and it does not depend on education.

ACKNOWLEDGMENTS

I would like to thank Mrs Ilona Jaskólska for her help in carrying out the research.

Disclosure

The authors declare no conflict of interest.

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