Study on the Subjectivity of Nursing Students’ Perception of Professional
1 Associate Professor, Dept. Nursing, Hanseo Univ., 46 Hanseo1 Ro, Haemi-myun, Seosan-si, Chungcheongnam-do, 31962 South Korea
This study is intended to find out the subjectivity of nursing students‟ perception of professional, describe the characteristics of each type of subjectivity, and categorize the types of subjectivity. This study was applied the Q-methodology. 18 students in the nursing school at an anonymous university have been asked to categorize 48 statements on professional. The collected data have been analyzed by using QUANL PC Program. As result of this study, the types of the nursing students‟ recognition of professional were categorized into 2 types: „the type considering the characteristics of professional important‟ and „the type considering additional socio-economic benefits important‟. 2 factors were found and 39.17% of the total variance was explained. The first factor was 30.86% and the second factor was 8.31%. Since the first factor explains the highest 30.86%, it is the factor which explains the most about professionalism. Out of the total 18 participants, 14 people belonged to the first factor and 4 belonged to the second factor. This study has been served as the basic material for figuring out views and education of nursing students regarding professional.
Keywords:Professionals;Nursing student; Subjectivity; Q-Methodology; Nurses.
*Corresponding Author : Name :Sunyoung Jang Email :[email protected] Contact : +82-010-3451-2250 Fax : +82-041-660-1087
Date of Submission : 05-10-2020
As medical science and information technology develop over time, the level of expectation of the recipients of nursing service is ever getting higher. Accordingly, demand for nurses‟
professionalism is rising (Park H. J., 2015). Nurses take the largest portion in the field of the public health and are the core human resources who contact patients most frequently. They should provide high level of nursing services to patients within the limited time frame under the
circumstances of the rapidly changing public health sector (WongC. S.et al., 2002). It is important that the nursing students form correct professional perspective through their course of education. It can be said that professional perspective of nurses includes systematic opinion on nursing, the courses of nursing activities and the professional point of view of the mission.
Desirable professional perspective of nurses shall result in social appreciation of nursing as well as personal satisfaction as a nurse (Adams D.et al., 2001).
It is necessary to firmly establish nursing students‟ perspective regarding professional nursing during the period of nursing education so that they can perform the duty of nursing efficiently for recuperation and improvement of patients‟ health (Kang H. O., 2010). Nursing education is devoted to establishment of nursing professionalism through education of nursing ethics as well as nursing theories and practices (Song H. R., 2010).
The nursing professionalism begins to be created during the course of the nursing education and continues to be developed all through the practical careers (Kwon Y. M.et al., 2007; Schank M.
J. et al., 2001). Particularly, the clinical training is important among other courses of education (Choi J. Y., 2011). The clinical training not only provides opportunities to learn various practical knowledges and experiences that are required of nurses, but also helps to form perspective and attitude of nurses and learn the role of professional nurses (Seo W. H., 2007).
Positively formed nursing professionalism was found to enhance satisfaction of occupation, nursing capability and organizational engagement (Hallin K.et al., 2008; Hwang J. I.et al., 2009). Also, the subjectivity of nurses‟ recognition of nursing significantly influences their performances in their careers. Therefore, it is very important to find out the subjectivity of their recognition of nursing professionalism.
However, there has not been sufficient study regarding nursing students‟ recognition of professional nursing. Q-methodology is based on the perspectives of the behaving persons rather than researchers and makes it possible to structurally understand the characteristics of individual types of subjectivity (ParkH. Y.et al., 2007). Since the perception of professional is subjective and unique experiences, it is appropriate to use the Q-methodology - which is the methodology considering the subjectivity of respondents - to find out the types of nurses‟
perceptions of professional.
Therefore, this study is intended to find out the subjectivity structure of nursing students‟
perception of professional and use it as the underlying material for development of education program for nursing students which is differentiated based on the characteristics of each types of perception of professional.
This study is intended to find out the types of the nursing students‟ subjective perceptions of professional and characteristics of the types so that it can be used as the underlying material when preparing strategy for provision of education to nursing students. To reiterate the purpose of this study, they are as follows:
1) To categorize the types of nursing students‟ perception of professional
2) To analyze and describe the types of nursing students‟ perception of professional.
Materials and Methods
Design of this study
In order to achieve the purpose of this study, we reviewed literatures, media materials and the existing studies and conducted survey of nursing students to find out the types of their subjective recognition of professional.
Q population and selection of Q sample
Q population was drawn through review of domestic and international literatures, open questionnaires, individual in-depth interviews etc. to get comprehensive statements regarding the effects of professionalism from the nursing students. Through this process, we have drawn about 200 Q populations and have drawn about 100 Q populations by integrating collected domestic and foreign literatures. We have selected the final 48 samples which have high level of differentiation through review and correction of Q samples drawn from this study.
Method for selection of P-sample
Q-methodology is the qualitative research method which emphasizes personal tendency by focusing on personal implication or significance rather than personal differences. It is based on the small sample doctrine that says if P-sample gets large, too many people get concentrated in one factor, thereby making it hard to find out the characteristics among themselves (Whang S.
M.et al., 2006). For selection of P-sample, we have fully explained the purpose of this study to the students of the nursing department in an anonymous university and selected 18 students who agreed to participate in this study.
Q-classification and method for analysis of materials
Q-classification is the process in which the participants who belong to P-sample make voluntary definition of professionalism by classifying the statements of Q-sample into forced normal distribution (Whang S. M.et al., 2006). This process was conducted for the 26 students of the nursing department in an anonymous university by using Q-card. Most of the students consumed 30-45 minutes to complete the Q-classification. The distribution of Q-sample is classified into from strongly agree to strongly disagree depending upon the opinions of the
participants on the statements selected for Q-sample. The statements on professionalism (Q1) were classified on 12 points scale. Subsequent interviews were conducted regarding the statements classified at both extreme ends. Principle Component Factor Analysis (varimax) was used for Q-factor analysis. Classification of types were determined by considering results, which are calculated by entering various numbers of factors with more than Eigen value 1.0, and the total explanation variants. For collected materials, conversion scores of 1~12 are assigned for scoring based on the card which have forced distribution on Q-sample distribution table. The converted scores assigned were encoded in the sequence of Q-sample numbers and were processed by Principle Component Factor Analysis of QUANL PC Program. Analysis of the materials were processed by using QUANL PC Program.
Ethical consideration of respondents of this research
We obtained voluntary consents of the participants for our research and explained that any of them may discontinue to participate at any time during the research. All the information collected from this research were processed without identification of participants and were coded for Q-sorting to guarantee confidentiality of personal information.
Results and Discussion
Characteristics of types regarding professionalism
This study has described characteristics of the types of professionalism based on the statements that belong to individual types to analyze the subjectivity of nursing students‟ perception of professionalism by the types. Q-responses of P-sample (participating respondents) were classified into higher questions and lower questions and 2 factors were drawn. In the Q- methodology, the participant with higher factor weight is the typical or ideal person who represents the concerned types.
To analyze the characteristics of individual types of the perception of professionalism, the study interpreted each type with statements having z-scores at least ±1. Our study had 14 participants with factor weight at least 1.0 in the type 1, and 4 participants in the type 2.
As result of the analysis of the subjectivity of professionalism by using PC QUANL Program, 3 factors were found and 39.17% of the total variance was explained. The first factor was 30.86%
and the second factor was 8.31%. Since the first factor explains the highest 30.86%, it is the factor which explains the most about professionalism as shown in table 1. Out of the total 18 participants, 14 people belonged to the first factor and 4 belonged to the second factor. It implied that the people belonging to the same factor show the similar response as shown in table 1.
Table 1: Eigen Value, Variance, and Cumulative Percentage
Type Ⅰ Type Ⅱ
Eigen Value 5.5548 1.4964
Variance(%) 0.3086 0.0831
Cumulative 0.3086 0.3917
Analysis of individual types
The subjective types of professionalism which are induced by categorized analysis are explained in the following as table 2.
- Type considering the characteristics of professional important: 14 respondents belonged to this type. The statements which were strongly agreed by these respondents were: “Knowledge and practical capability is required to be professional (z=2.33)”, “Professionals can make use of their expert knowledge and technology (z=2.32)”, and “Professionals should have correct views on their jobs (z=1.42)”. No. 8 was the respondent who had the highest factor weight in this 1st type (1.6327) and the respondent strongly agreed with the statement 10 and 17. The statements which were strongly disagreed by these respondents were: “Professionals show low rate of quitting jobs and moving jobs (z=-1.80)”, “Professionals have less conflicts of roles (z=-1.78)”, and “Professional jobs show low rate of self-motivation (z=-1.66)”. No. 17 (0.3967) was the respondent who had the lowest factor weight in this 1st type and the respondent strongly disagreed with the statement 16 and 47 in table 2.
The characteristics of the 1st type lies in the fact that they think professionals should have expert knowledge, practical capability, and the ability to make use of the expert knowledge and technology. They think professionals should have dedicated view on their jobs and should regard interactions among colleagues of same profession important. They think professionals conduct their activities autonomously and establishment of self-identity is important. They think professionals have higher level of self-motivation and experience conflicts of roles since professionals tends to work with people of various occupations. Due to such difficult working environments and competitive capabilities, the respondents of this category assumed, the professionals‟ rate of moving and quitting jobs will be high. From the context of the abovementioned, we name this type of subjectivity as “the type considering the characteristics of professional important”.
- Type considering additional socio-economic benefits important: 4 respondents belonged to this 2 nd type. The statements which were strongly agreed by these respondents were:
“Professional jobs are more stable than regular occupations. (z=1.94)”, “Reasons for selection
of professional jobs are mostly good paying jobs. (z=1.76)”, and “Efficiency of professional jobs tend to increase with less outside control. (z=1.69)”. No. 3 was the respondent who had the highest factor weight in this 2nd type (1.1846) and the respondent strongly agreed with the statement 20 and 39. The statements which were strongly disagreed by the respondents were:
“Only professional jobs have national licenses. (z=-2.21)”, “Professional jobs tend to increase job satisfaction. (z=-1.93)”, and “Professional jobs are more diverse than regular jobs. (z=-1.75)”
No. 4 (0.3009) was the respondent who had the lowest factor weight in this 2nd type and the respondent strongly disagreed with the statement 1 and 3 in table 2.
The characteristics of the 2nd type respondents emphasized additional benefits coming from professional jobs rather than the characteristics of professional jobs. They agreed that professional jobs are more stable than regular jobs and are easier to get the jobs. They thought efficiency of professional jobs shall be enhanced when there are less outside control and assumed that the income of professional jobs will be higher than regular jobs. They did not think national licenses do not guarantee professional jobs and high level of job satisfaction.
They assumed that professional jobs shall encourage high level of self-motivation. In this regard, we named this 2ndtype as “the type considering additional socio-economic benefits important”.
Table 2: Representative Question on Professionalism and Z-score(N=18)
Representative items of type
Factor No Representative items Mean(SD) Z-score
10 Professional job requires knowledge and practical capabilities. 10.93(1.940) 2.33 17 Professional job can make use of professional knowledge and
technology. 11.00(1.468) 2.32
40 Professional job requires dedicated views on the job. 9.71(2.199) 1.42 15 Interactions among colleagues of the same profession is important. 9.43(2.377) 1.38 11 Autonomy and establishment of self-identity is important for
professional jobs. 8.86(2.656) 1.26
16 The rate of quitting and moving job is low for professional jobs. 2.50(1.557) -1.80 47 Professional jobs experience less conflicts of roles. 3.86(2.179) -1.78 34 Professional jobs lack encouragement of self-motivation. 4.00(1.881) -1.66 38 Professional jobs lack communication with colleagues. 4.21(1.888) -1.60
6 In case of professional jobs, personal capability is more important than
teamwork. 4.36(2.405) -1.34
20 Professional jobs are more stable than regular occupations. 9.75(2.217) 1.94 39 Reasons for selection of professional jobs are mostly good paying
jobs. 9.00(3.916) 1.76
12 Efficiency of professional jobs tend to increase with less outside
control. 9.5(2.517) 1.69
46 Job performing capability is most important for professional jobs. 10.00(1.826) 1.65
19 Income of professional jobs are high. 9.50(1.291) 1.51
1 Only professional jobs have national licenses. 4.25(3.304) -2.21 3 Professional jobs tend to increase job satisfaction. 3.00(1.732) -1.93
32 Professional jobs are more diverse than regular jobs. 4.25(3.304) -1.75 2 If a job gets professionalized, efficiency of the job also improves. 5.00(2.944) -1.75 34 Professional jobs lack encouragement of self-motivation. 5.50(2.517) -1.40
As result of the research, two types of the nursing students‟ subjective perception of professional were found: the 1st type which considers the characteristics of professional important and the 2nd type which considers additional socio-economic benefits important. Now, let us discuss the characteristics of the types in the following.
The 1st type found in this study was the type which considers the characteristics of professional important. They think the unique knowledge and expertise are important. They think the experts need to establish self-identity and have dedicated views on their jobs based on their expertise, in order for the jobs to be socially recognized as professional jobs. Also, they think communications and interactions are essential elements of professional jobs since professionals usually work with people of various kinds of jobs. However, they assume that professionals tend to quit or move jobs more frequently than others since they have socially much burden and experience conflicts of roles.
Self-esteem is indispensable for happiness of human being and significantly influences social adaptation, behaviors, target achievement and integration of self-identity. Therefore, self- esteem is a factor that plays an important role in evaluation and attitudes of nursing professional. If self-esteem of a nurse is relatively high, the nurse usually tends to have positive concept of self-identity as a professional. So, higher self-esteem contributes to development of nursing profession (Kwon Y. M.et al., 2007). Cho & Lee (2006) conducted the study between self-esteem and career identity and found that self-esteem significantly influences career identity for nursing professionals (Cho H. et al., 2006). Han (1994) verified the significant correlation between self-esteem and professional attitudes of nursing students and assumed that self-esteem has something to do with the professional attitudes pursuing benefits on behalf of society (Han A. K., 1994).
Clinical internship of nursing students can influence development of professional self-identity.
If the clinical internship does not satisfy the expectation of nursing students, they might be dissatisfied with the clinical internship and such dissatisfaction may cause problem in creation of professional self-identity of nursing students (Kang H. O., 2010). If clinical internship falls short of the expectation of nursing students, the students might be disappointed, and negative notion of nursing profession might be created due to realization of differences between ideal nursing profession and actual reality of nursing profession (Kwon Y. M.et al., 2007).
Dissatisfaction with clinical internship may hurt professional self-esteem of nursing students and may act as cause of insufficient dedication in their future nursing profession (Kang H. O., 2010). Park & Ha (2003) researched nursing students‟ experiences with clinical internship.
Their research found that the students were given roles during the clinical internship that usually were not clear and that circumstances made them think they were not competent enough. Therefore, the study concluded that the students‟ professional self-esteem was often tarnished during the clinical internship due to experiences of lethargic circumstances without any clear-cut assignment of roles(Park J. W.et al., 2007).
Self-esteem is the evaluation of oneself and is the critical factor which determines individual‟s behaviors and adaptation to circumstances. In this regard, it can be understood that students‟
self-esteem influences not only academic performance but also social relationship(An K. S., 2006). Therefore, if careful consideration is given to support the self-esteem of nursing students during clinical internship period, it shall be much easier for nursing students to psychologically adapt themselves to various clinical circumstances and readily exert their ability so that they can be fairly satisfied with their experiences with the internship.
The 2nd type found in this study was the type which considers additional socio-economic benefits important. The respondents of this type think professional jobs have relatively high employment rate, stable employment conditions and higher income than regular jobs. They think capability of performance is critical for professional jobs and there should be less outside control to maintain efficiency of professional jobs. They suppose self-motivation of professionals are relatively high but think national licenses do not imply professionalism and job satisfaction level of professional jobs may be rather low than commonly expected.
Motivation for selecting the nursing as major may vary among nursing students but some of them have selected nursing upon recommendation of others in consideration of stability of employment. In such a case, level of major satisfaction is influenced during the academic period by motivation for selection of major. As result of the analysis of factors influencing the identity of professional jobs, satisfaction of major was found, as were the existing studies, to have influence on the identity of professional jobs(Kwon Y. M.et al., 2007; Ham Y. S., 2011).
Some of the existing studies which analyzed influences of several kinds of satisfaction in major over the identity of professional jobs revealed that satisfaction in the aspect of social recognition of the major and satisfaction in the aspect of academics were major factors influencing the identity of professional jobs(Kwon Y. M.et al., 2007). Many nursing schools are pursuing improvement of students‟ satisfaction in their major through various curricular and non-curricular activities, and due to implementation of the system for certification of nursing
education by the government, the schools are recently conducting activities for improvement of education based on students‟ evaluation of school education. So, the schools should do their best to enhance students‟ satisfaction in their major.
Most of the respondents to this research recognized the professional job from the point of view of nurses. They think the underlying substance of nursing profession is positive, but meanwhile they assume that nurses are not receiving appropriate compensation and recognition of the society(Ko Y. J.et al., 2011). When considering the image of nurses recognized by nursing students significantly influences self-esteem and the identity of nursing professional during undergraduate years in nursing education, it is indispensable to establish positive image of nurses during the period of nursing education(Choi J.et al., 2009). The image of nurses should be considered from the point of view of the public and from the point of view of the nurses themselves. Since patients‟ satisfaction in nursing service influences the value of nursing perceived by the public and the image of nurses, it is necessary that nurses should have desirable identity of nursing profession. Park & Yang (2012) concluded that the best method of propaganda for nursing profession is to provide professional nursing services to the public and establish desirable professional role of nurses rather than monitoring mass media regarding nursing services or conducting active propaganda for the profession(Park M. H.et al., 2002).
When nurses themselves exhibit positive images of nurses and nursing profession, nursing students and the general public shall have positive images on nursing profession. The research of Karaoz (2004) reported that nursing students think nurses have the responsibilities to change the general public‟s notion on nursing profession(Karaoz, S., 2004).
This study analyzed the subjectivity of nursing students‟ perception of professional by categorizing them into 2 types. Many factors were reported to have influence on establishment of identity of nursing profession – volunteering, academic satisfaction, satisfaction in the social aspect, leadership, socializing, nursing image, satisfaction with clinical internship etc.Ko Y. J.et al., 2011; Bunkenborg G.et al., 2013). Since desirable identity of nursing profession improves nursing service, significantly contributes to the health of patients and promotes interactions among related medical professions (Bunkenborg G.et al., 2013), it is necessary to develop various ways to help establish desirable identity of nursing profession.
The 1st type recognizes various characteristics of professional jobs important and the 2nd type recognizes additional socio-economic benefits important. This kind of study on the subjectivity of perception of professional job can be used as the basic information for education program to be provided to new nurses embarking on the profession of nurses. In addition, we anticipate that this can be used also as the basic information for the development of differentiated education
program to be provided to nursing students in undergraduate years.
However, this study has limitation in generalization of the results since the research was conducted only one certain university and could not select respondents in consideration of factors influencing the perception of professional jobs. Therefore, it is necessary to subsequently verify the 2 types by drawing Q-sample from various backgrounds.
This study was conducted to provide the underlying information for promotion of professional jobs by applying Q-methodology to subjective materials obtained through survey of nursing students. As result of this study, the subjectivity of nursing students‟ perception of professional jobs was categorized into 2 types - the 1st type that considers characteristics of professional job important, and the 2nd type that considers additional socio-economic benefits important.
This study categorized the subjectivity of nursing students‟ perception of professional jobs and thereby it shall provide the underlying basic information for preparation of policy promoting professional jobs. Also, we anticipate that this study can be used as the base for the development of education programs to be provided to nursing students in consideration of the characteristics of the individual types. In addition, we also suggest subsequent studies to further analyze the two types by drawing more samples from varied background and to verify more various factors influencing the nursing profession.
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