Professional identity of Japanese nurses

INTRODUCTION

Studies that examined nursing practice in Japan revealed several problems about nurses.Suzuki (1993),using grounded theory methodology,found that nurses had dif?culties in achieving goals because they had many problems with knowledge,common sense,attitude and responsibility.As a result of the study,Suzuki concluded that they were not accom-plished in their roles as nurses.Kameoka (1994) observed that Japanese nurses made their assigned tasks a higher priority than a patient’s immediate needs and relied on family members to provide care. These problems revealed a lack of value in the job.How can Japanese nurses solve these problems and improve the quality of nursing care? Establishing individual nurses’ professional identities could be the key to answering this question.

Kahn and Steeves (1988) recognized professional identity as one of the ideological contexts of caring. It is a part of the structure of caring and is a result of the training and socialization of nurses.As this study showed,professional identity is essential to caring because caring is the essence of nursing (Leininger, 1984;Watson,1996).Understanding the process of establishing the professional identity of Japanese nurses contributes to the improvement of nursing practice.Although there are studies to measure Japanese nurses’ professional identity (Onodera & Hatano,1991;Hatano & Onodera,1993;Sasaki,1997), no research has been reported about how individual nurses establish their own professional identity.The purpose of this study was to explore the process of establishing the professional identity of Japanese nurses.

Nursing and Health Sciences(2001),3,47–55

Research Article

Professional identity of Japanese nurses:

Bonding into nursing

Misuzu F.Gregg,rn,p h d1and Joan K.Magilvy,rn,p h d,faan2

1Gifu College of Nursing,Gifu,Japan and 2School of Nursing,University of Colorado Health Sciences Center,

Denver,Colorado,USA

Abstract The purpose of this study was to explore the process of establishing the professional identity of Japanese nurses.Following a grounded theory design,data were generated by interviews,

multisite participant observations and theoretical memos.Eighteen Japanese nurses who were

selected by theoretical sampling were formally interviewed.Data were analyzed using methods

of constant comparative analysis.

Six categories emerged from the data:(i) learning from working experiences;(ii) recognizing

the value of nursing;(iii) establishing one’s own philosophy of nursing;(iv) gaining in?uence

from education;(v) having a commitment to nursing and (vi) integrating a nurse into self.The

core category,‘bonding into nursing’,incorporated the relationship between and among all cate-

gories and explained the process of establishing the professional identity of Japanese nurses.

‘Bonding into nursing’ was described as an initial substantive theory,which is de?ned as the

process by which each nurse established her/his professional identity as a nurse.

Key words grounded theory,Japanese nurses,professional identity.

Correspondence address:Misuzu F.Gregg,Gifu College of Nursing,

3047-1 Egira-cho,Hashima-shi,Gifu-ken 501-6295,Japan.Email:

Misuzu.Gregg@gifu-cn.ac.jp

Received 9 March 2000;revised 7 December 2000;accepted 26

February 2001.

48M.F.Gregg and J.K.Magilvy

Background

Antonek,McCormick,and Donato (1997) analyzed the working portfolios of student teachers and found two unique identities as professionals:(i) identity focused on their students and (ii) identity focused on self.Volkmann and Anderson (1998) used the year-long teaching journal of a ?rst-year chemistry teacher to describe the process that the teacher underwent to create a professional identity in order to resolve the con?icts between personal identity and expectations.

Fagermoen (1997) investigated Norwegian nurses and found that a transcultural common core of nurses’ professional identity was the actualization of the values of dignity,self,humanity and reciprocal trust.I n psychology,Watts (1987) studied the charac-teristics of professional identity in doctoral students and found the ‘value integration’ aspect of profes-sional identity.Carpenter and Platt (1997) found that social workers have managed to maintain a balance between their personal and professional values,which indicates professional identity throughout an average of 10years since graduation.

I n a study about vocational identity without speci-?ed occupations,Waterman and Waterman (1976) found that the identity achievers had higher levels of education and intrinsic motives to select their jobs.A study about the in?uence of clinical education on pro-fessional identity in nursing students found that the longer the nursing student was in the clinical arena, the more likely they are to be signi?cantly in?uenced by others in their attitudes toward the profession (Dalme,1983).The older the person and longer the time in active practice made the nurse more secure in her identity.Thus,con?dence in claiming identity appeared to increase as the level of education in-creased (Sneed,1981).

Studies to measure the effects of interventions planned to strengthen professional identity have been reported.The professional group supervision was effective to strengthen an individual nurse’s professional identity (Segesten,1993).The career-development courses designed to increase the profes-sional identity of premedical students had some effect on their professional identity (Henry,1993).

Most professional identity studies of nursing in Japan were conducted with nursing students as sub-jects.The studies measured their identity status and identi?ed factors related to professional identity (Ando & Utsumi,1995;Fukumoto,1989;Matsushita, Araki & Kimura,1993).Studies about professional identity conducted with nurses are rare in Japan. Although a study was conducted with nurses,it focused on the nurses’ experiences as nursing stu-dents (Gregg & Takahashi,1990).The professional identity scores were measured using researchers’developed instruments to identify the difference in establishing the professional identity between nursing students and nurses (Onodera & Hatano,1991; Hatano & Onodera,1993).

Virtually no information exists about how individ-ual nurses establish their own professional identity. Grounded theory is most useful when little is known about a topic and few theories exist to explain a phenomenon (Munhall,1989).Therefore,grounded theory described by Glaser (1978,1992) was chosen to answer the research question,‘What is the process of establishing the professional identity of Japanese nurses?’.Professional identity for this study was de?ned as self-identi?cation with a profession.A Japanese nurse was de?ned as any individual who passed the national license examination and is licensed as a nurse,public health nurse or midwife by the Minister of Health and Welfare in Japan.The grounded theory methodology and procedures of the research are described in the following section. METHODS

Two major sources of data contributed to this inves-tigation:(i) semi-structured formal interviews and (ii) participant observations in natural settings.The semi-structured formal interviews lasted an average of 45min.Data were collected until reaching theoreti-cal saturation,in which no additional data are found. Only the ?rst few participants were selected purpo-sively,while the other participants were selected by theoretical sampling.

As a result,18 nurses including eight staff nurses, four teachers,one nurse counselor,one doctoral nursing student,one public health nurse,one midwife, one supervisor and one Director of Nursing were formally interviewed as primary participants.Twelve participants worked for hospitals,three for junior col-leges,one for a college,one for a care support center, and one participant was a full-time student.Sixteen participants were women and two were men.They ranged in age from 26 to 63years with an average age of 38years.Total years in the nursing profession varied widely from 3years to 41years with the mean of 15.6years.Regarding their basic nursing prepara-tion,nine of the participants had diplomas,?ve held Associate degrees and four had Baccalaureate de-grees.Eight had some kind of higher education other than basic nursing education including three master’s degrees and one doctoral degree.

An informed consent form,approved by the Colorado Multi-institutional Review Board,was signed before each interview.After consent was obtained,the following questions were the focus of the interviews:

(1)What does being a nurse mean to you?

(2)What is important for you as a nurse?

(3)What has in?uenced your beliefs about nursing?

(4)What kind of process did you undertake in order to establish identity as a nurse?

Other questions were formulated by following up on participants’ responses.

Participant observations were conducted to ob-serve the interactions between the nurses and other people such as patients,their families,physicians and other nurses at three wards and one visiting nursing department at three geographically diverse hospitals in Saitama prefecture,Chiba prefecture and Okayama prefecture.The participant observa-tions assisted in theoretical sampling and provided data that were integrated with the interview data and analyses.Twelve secondary participants,including 11 nurses and one physician,were interviewed infor-mally during participant observations or participated in the discussions to establish the credibility of the ?ndings.

All tape recorded interviews were transcribed in Japanese.Tapes and transcriptions were coded by use of pseudonyms of the participants’ choice.Data were read line by line and coded for each incident.Code names were written in Japanese and were translated into English.Throughout the analysis both Japanese and English were used to avoid losing the subtle nuances of the Japanese language.The accuracy of the translation was checked by another bilingual Japanese researcher.The codes were examined and compared for any similarities and differences in order to clarify codes and determine consistency.Each code was com-pared to other incidents within and across the inter-views and was re-evaluated and changed during this analysis.

The codes were sorted through constant compara-tive analysis to identify patterns or clusters of codes. These sorted codes formed a category.Theoretical sampling continued to check and re?ne the emerging hunches or hypotheses until reaching theoretical satu-ration.The relationship between the categories was examined and one core category was identi?ed.The theory that occurred around the core category was a substantive theory that explained how Japanese nurses establish professional identities.

The rigor of this study was assessed based on the criteria of credibility,applicability,consistency,and con?rmability proposed by Lincoln and Guba (1985). To establish credibility,members checking was con-ducted by sending the results to the primary partici-pants.They were asked if the categories and emerging theory described their experience of the process in establishing professional identity.All of them agreed with the results.Furthermore,the ?ndings and inter-pretations of this study were reviewed by a Japanese mentor who has 45years experience in nursing.To establish applicability,this study provided suf?cient descriptive data for someone to judge whether the results are transferable.To establish consistency,the decision trail during the whole process of this study was kept and was discussed between the researchers. Con?rmability was established by discussions with the secondary participants.

RESULTS

A systematic analysis of the participant data identi-?ed six categories,11 subcategories and one core cat-egory.Table1 presents the identi?ed categories and subcategories.These categories re?ect the major con-cepts and patterns that led to the identi?cation of the basic social process ‘bonding into nursing’.The ?rst category is learning from working experiences. Learning from working experiences

The participants had 11 different job titles and had working experiences at 43 different institutions.

Professional identity49

Table1.Bonding into nursing:The process of establishing

the professional identity of Japanese nurses

Categories and subcategories

Category I:Learning from working experiences

Gaining in?uences from other nurses and clients

Having own experiences in?uence view of nursing

Category II:Recognizing the value of nursing

Becoming aware of the value of a nurse’s work

Recognizing the meaning of being a nurse

Category III:Establishing one’s own philosophy of nursing

Having an ideal nurse image

Clarifying important aspects of practicing nursing

Category IV:Gaining in?uences from education

Evaluating basic nursing education positively

Gaining a positive in?uence from education

Category V:Having a commitment to nursing

Continuing working as a nurse

Having a commitment to care

Having self-con?dence as a nurse

Category VI:Integrating a nurse into self

50M.F.Gregg and J.K.Magilvy

Although their experiences may have been different, they all learned from their working experiences.Most study participants talked about at least one incident in which they were in?uenced by other nurses and clients including students,patients,people in the community and family.Through experience with interaction with clients and other nurses,they learned about nursing and themselves.Furthermore,the study participants’ own experience affected their view of nursing.For example,Goroh,a male supervisor of a psychiatric ward for 10years,had worked at six different wards in another hospital for 10years. Goroh’s experiences at different wards taught him that patients were basically the same in a psychiatric ward as in an internal medicine ward.They are human beings and the only difference is the location of the problem.I t is therefore very important to try to understand a patient’s concern regardless of their diagnosis.

Recognizing the value of nursing

The participants recognized that a nurse’s work is worthwhile because it contributes to their personal growth or satisfaction.Being a nurse was recognized as an important part of their personal self and a way to measure their existence as a human being.For example,Chitose,a part-time assistant lecturer at a junior college,expressed her feelings toward nursing.

feel that being a nurse gives me something which I can live for...I had many chances to think about myself in relation to other people.It

is not a joy to do something for other people,but

I can always think to myself,what I want to do and what I want to be by doing something for other people.

The meaning of being a nurse for Chitose was not merely altruistic,it was a way to consider her exis-tence as a human being.How nurses recognize the value of nursing is crucial to the process of establish-ing professional identity.

Establishing one’s own philosophy of nursing

I n this category,the study participants stated their strong beliefs in nursing.Having an ideal image and clarifying important aspects of practicing nursing were two important ways to establish their philoso-phies of nursing.For the study participants,an ideal nurse image is a vague notion of how nurses should be or what kind of nurse they want to be.Clarifying important aspects of practicing nursing was a more concrete way of thinking about what is important for practicing nursing than having an ideal nurse image. The participants established their own philosophy of nursing based on their working experiences;there-fore,different philosophies existed.One common point is that they strongly believed in their philoso-phies of nursing.Yoshiko,who stated that she could not ?nd any value of nursing so far,responded to a question of what she thought about the differences were between herself and nurses who found value in nursing.

They all have something that they can tell,such as this is what I think about nursing or this is what I think about doing this job.There is a core. They have a strong belief such as this is a way I believe even though other people say something critical about it,and this is a way I do this because I have been doing this way in my experi-ence....they say that I will not change my way because I believe it.

Gaining in?uences from education

Regardless of their basic nursing educational pro-gram,most participants evaluated their education positively to some extent.They stated,‘I had good teachers’ or ‘I had a good education and I learned how to think’.They valued what they learned and how they learned.Sharon,an associate professor,who stated that she might not have a professional identity as a nurse did not ?t this subcategory,evaluating basic nursing education positively.She acquired her educa-tion at a diploma school.Sharon stated,‘I just wanted to get a license.It was like a moratorium for 3years, really.The education that I received was not great at all.I felt it was such a low level.’ Analysis of Sharon’s interview suggested how nurses can evaluate their basic education related to their present feelings toward nursing.Finding the value in basic nursing education related to ?nding the value in nursing. Many study participants gained positive in?uences from their education,which included basic nursing education,graduate education and continuing educa-tion after becoming a nurse.

Having a commitment to nursing

When the study participants started working as nurses,they did not have strong desires to continue working;however,they continued for different reasons,including gaining an understanding of and interest in nursing and to not waste senior nurses efforts.The important thing is not the reason they work but the fact that they continue to work.As they

continued working as nurses,their commitment became more focused on care.The study participants felt that they could not leave nursing because taking care of their clients was not just for clients,but also for themselves.For example,Yukari stated,‘I taught something to patients,but I was saved by them.I realized that I was healed by patients,so I cannot leave bedside nursing anymore.’ Although Japanese culture values modesty,many study participants expressed their self-con?dence as a nurse by stating that they were close to their ideal of what a nurse should be.

The category,‘having a commitment to nursing’, in?uenced and was in?uenced by other categories including ‘learning from working experiences’,‘recog-nizing the value of nursing’,‘establishing one’s own philosophy of nursing’ and ‘gaining in?uences from education’.These mutual in?uences lead to the next category,‘integrating a nurse into self’.

Integrating a nurse into self

The last category,‘integrating a nurse into self’,can be described as the study participants having an identi?-cation as a nurse through integrating a nurse into self. Yukari explained her feeling about the integration between a nurse and self.

It is not a nurse and I.A nurse is in myself and I was woven into a nurse.It is like braids.I am this way by weaving a nurse and myself together round and round.So I cannot think and I do not try to think separately from being a nurse and me.I as a nurse and I by nature are woven.... When they are woven,it becomes as if I am one piece of yarn.I f I were not working as a nurse, I would be a different person.I would not be like I am.

Sunako,a staff nurse with 15years experience,did not ?t this category.She responded to a question of the relationship between herself and nurse.

Well,it may not be consistent.I do not always live for other people,but it is different when I work.In my work,I think that I become a differ-ent person.It is like I become myself for the job ...I get tired if I have to work for the sake of other people all the time.When I work,I do it because it is my job.

Sunako thought separately about herself when she worked and when she did not work.The analysis of her interview suggested that she had not established her professional identity yet at the point of interview. Hinako,who was working for a system development at a hospital,expressed a totally different aspect from Sunako.Her hospital moved to a new location right before the second interview.

Even though I do a different work in the hospi-tal,I think that I see it with a nurse’s eye.I co-ordinated the moving this time.I think that I did

it without any problems because I knew how to solve a problem or a nursing process.It is a kind

of job action,the teamwork that I had.My occu-pation as a nurse in?uenced it.I am not working

as a bedside nurse,but I can work at a bedside soon if I were told to do so.

Although Hinako did not wear a uniform like the other nurses at the hospital and did not take care of patients at all for about 2years,she felt that she was a nurse.Unlike Sunako,Hinako did not change herself from a nurse to a non-nurse.However,Hinako did have time when she needed ‘the magic of a uniform’, which means that she roused herself to work as a nurse by wearing a nurse’s uniform.She stated that she became a nurse with her uniform in the ?rst and second years,then by spending day after day at work she became a nurse without her uniform.She was a nurse any time with or without a uniform and with or without working with a patient because being a nurse was integrated into herself.

DISCUSSION

Bonding into nursing as an initial

substantive theory

The core category,‘bonding into nursing’,is the basic social process.This core category is the overriding cat-egory which explains the interrelationship among all the categories.‘Bonding into nursing’ as a beginning substantive theory is illustrated in Figure1.This sche-matic model was based on the analysis of the relation-ships between categories.As Glaser and Strauss (1967) and Glaser (1978) stated that a theory must ?t the data and it must work to explain what has hap-pened,the model was revised by discussions with the primary and secondary participants to assure that it can explain how Japanese nurses establish profes-sional identity.

This model has six stages.The stage of gaining in?u-ences from education is more like an in?uential factor in this process.The stage,‘having a commitment to nursing’,directly relates to other stages,which means that commitment changes as other stages evolve.

Professional identity51

52M.F.Gregg and J.K.Magilvy

These stages are based on the occurrence of certain events,not the passing of time.However,the speci?c events are not the same for all nurses.For example, gaining in?uences from other nurses and clients occurred in daily care for some study participants. However,there were study participants who worked more than 10years and did not experience gaining in?uences from other nurses or clients.Therefore, how they experienced those events is important in the process of ‘bonding into nursing’.

The stages are related to one another in a complex way.Some kind of sequence exists among the stages; however,the direction of movement from stage to stage is not linear.The process starts with ‘learning from working experiences’.Nurses learn about nursing and consider their existence as a nurse from these working experiences.I n this learning experi-ence,nurses recognize the value of nursing.This experience helps them establish their philosophies of nursing.While they work,they have many opportu-nities to learn more,which in?uences their recogni-tion of the value of nursing.This recognition helps them realize the different aspects of nursing and may also lead to a deeper level of philosophical belief.

These three stages proceed in the form of a spiral progression,which represents constant evolution. Once a nurse goes through a stage,she/he never turns back to the exact same stage.The spiral nature means that it is possible for a nurse to return to a previous stage;however,the change occurs at a higher level. This situation occurs and recurs many times in the process and each stage of this process is directed to ‘bonding into nursing’.The ?nal stage of the ‘bonding into nursing’ process is reached by integrating being a nurse into self.

Relationship of ?ndings to relevant literature

The relationship of the ?ndings to relevant reports was examined to identify how this substantive theory ?ts in with existing theories and empirical studies. No theory or empirical study exists to identify directly the process of establishing the professional identities of nurses.However,the importance of the cate-gories in the process was emphasized by the extant reports.

I n the ‘bonding into nursing’ process,commitment was identi?ed as an important stage.

Reichers (1985) Figure1.Schematic model.

indicated identi?cation,a psychological variable,as an antecedent of commitment.He also noted that the set of identi?cation and the commitments an individual experiences is an integral part of the self.This indi-cates an important relationship between commitment and identi?cation,which is the de?nition of profes-sional identity used in the present study.The ?ndings of the present study also acknowledged the insepara-bility of identi?cation with nursing and commit-ment to nursing.When considering the relationship between identi?cation and commitment,it seems that nurses have a strong career commitment and self-identi?cation with nursing while they experience the process of bonding into nursing.

The process of establishing professional identity as a nurse can be understood as career development. Hall (1971) constructed a model of post-entry career development,which indicates the psychological devel-opment of the individual throughout the process of a career.In this model,career growth involves personal development,which is de?ned as the actual creation of new aspects of the self in the career area.The ?nd-ings of the present study ?t Hall’s (1971) model of post-entry career development.The study participants gain more competencies and motivation relevant to being a nurse while they are learning from working experiences,recognizing the value of nursing and establishing their own philosophies of nursing.

The cognitive-developmental model of career de-velopment was proposed by Knefelkamp and Slepitza (1976).It has nine stages.Toward the last stage,indi-viduals experience the integration of the self and career role and begin to truly experience the meaning of their commitments.The last stage involves the expansion of the self-created role and the recognition that the role interacts with all aspects of life,not just career.The ?ndings of the present study also acknowledged the integration of self and career role as a nurse,the last stage of the ‘bonding into nursing’process.The study participants who experienced the integration of self and being a nurse recognized how the role interacts with their life in general.

I n Japan,Kobayashi (1998) conducted an ethno-graphic study to identify career awareness in nurses. Comparing the period after employment to the pre-sent time,Kobayashi reported that nurses expressed more ideas about ‘identi?cation with a nurse and nursing’ and ‘commitment to clinical nursing’.The nurses stated that nursing was part of their lives and nursing was representative of their existences. Although Kobayashi’s study focused on changing thoughts about a nurse’s work and its in?uential factors,the same categories were found in the present study.The conduct of both studies within the culture and context of nursing in Japan may explain some of the similarities of ?ndings.

I denti?cation with nursing is categorized as social identity.Turner and Onorato (1999) conceptualized social identity as the aspect of a person’s self-concept based on their group memberships.One important factor affecting people’s readiness to use a social category for self-de?nition in speci?c situations is the extent of their identi?cation with the group. Another in?uence is the degree to which group identi?cation is central,valued and involves ego.For the study participants,nurses and to respect nursing was considered an important factor in establishing professional identity.How nurses recognize the value of nursing was crucial to the process of establishing professional identity.These ?ndings are consistent with how people use a social category for self-identi?-cation.

?hlén and Segesten (1998) clari?ed the concept of professional identity of nurses in Sweden.As a result of the study,they identi?ed personal and interper-sonal dimensions and socio-historical aspects of the professional identities of nurses.The personal dimen-sion in their study is similar to the ?ndings of the present study.The study participants who established professional identities had feelings of being a nurse while the study participants who struggled with estab-lishing their professional identities focused on the aspect of working as a nurse.Another attribute of the personal dimension identi?ed by ?hlén and Segesten (1998) is a feeling of self-con?dence in one’s role as a nurse.Many participants in the study expressed their self-con?dence as a nurse by stating that they were close to their concept of an ideal nurse.As a ?nal analysis,they stated,‘Out of the analysis of the pub-lished literature and the interviews,a comprehensive description of the concept emerges:a professional identity of the nurse is integrated with the personal identity of the nurse’.Socio-historical aspects of the professional identity of Japanese nurses might be dif-ferent from nurses in Sweden.However,the profes-sional identity of nurses in Sweden appears to be similar to the Japanese nurses in this study.I n the process of ‘bonding into nursing’,nurses complete the process when they integrate being a nurse into self. Studies in Japan and Sweden suggest that the integra-tion of personal self and being a nurse indicated a professional identity as a nurse.

Regarding the implications,this study indicated the importance of working experiences.Administrators should create an environment for nurses to continue working and provide opportunities for nurses to con-sider the meaning and value of each experience.For education,teachers who have well-established pro-

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54M.F.Gregg and J.K.Magilvy

fessional identities as nurses should teach about the value of nursing during basic nursing education. Regarding future research,increasing the numbers of the study participants who are male nurses would be desirable in order to add new dimensions of knowledge.Situational aspects,including organiza-tional environments,need to be studied.Furthermore, a study that applies both interviews and observations is required to identify the relationship between pro-fessional identity and nursing practice,and to also identify the impact of social interaction to the process of establishing professional identity.

Nurses have the responsibility to educate other nurses to help establish their professional identities. Nurses as educators and role models are essential to the process.By monitoring the process of nursing education and administration,and conducting further research in this area,we can greatly improve the quality of care,retention of nurses and the profession-alization of nursing in Japan. ACKNOWLEDGEMENTS

express my sincere gratitude to the dissertation committee members at the University of Colorado Health Sciences Center—Dr JoAnn Congdon,Dr Richard Redman,Dr Kay Daugherty and Dr Robin Harvan—who provided thoughtful feedback that greatly strengthened my research. would like to thank my Japanese mentor and consultant,President Midori Sugimori,Gunma Prefectural College of Health Sciences.

REFERENCES

Ando S,Utsumi K.Studies on the ego identity of nursing students:Especially on the occupational identity forma-tion in?uenced within the nursing educational context. J.Jpn.Soc.Nurs.Res.1995;18:7–19.

Antonek JL,McCormick DE,Donato R.The student teacher portfolio as autobiography:Developing a profes-sional https://www.wendangku.net/doc/993552013.html,nguage J.1997;81:15–27. Carpenter MC,Platt S.Professional identity for clinical social workers:Impact of changes in health care delivery systems.Clin.Soc.Work J.1997;25:337–350.

Dalme FC.Nursing students and the development of professional identity.I n N.L.Chaska (ed.) The Nursing Profession:A Time to Speak.New York:McGraw-Hill, 1983;134–145.

Fagermoen MS.Professional identity:Values embedded in meaningful nursing practice.J.Adv.Nurs.1997;25:434–441.

Fukumoto M.Research on identity formation in nursing education:Focusing on the areas of occupation and value consciousness.Master’s thesis,Chiba University,Japan, 1989 (unpubl.).Glaser BG,Strauss AL.The Discovery of Grounded Theory: Strateg ies for Qualitative Research.New York:Aldine de Gruyter,1967.

Glaser BG.Theoretical https://www.wendangku.net/doc/993552013.html,l Valley,CA: Sociology Press,1978.

Glaser BG.Basics of Grounded Theory https://www.wendangku.net/doc/993552013.html,l Valley,CA:Sociology Press,1992.

Gregg MF,Takahashi M.The in?uence of curriculum in the identity formation of nursing students:A follow-up study with a semi-structured https://www.wendangku.net/doc/993552013.html,c. 1990;22:96–108.

Hall DT.A theoretical model of career subidentity develop-ment in organizational https://www.wendangku.net/doc/993552013.html, anizational Behav. Hum.Performance1971;6:50–76.

Hatano K,Onodera T.Professional identity of student nurses and graduates.J.Jpn.Acad.Nurs.Res.1993;16: 21–28.

Henry P.Effectiveness of career-development courses for nontraditional premedical students:mproving profes-sional identity.Psychol.Rep.1993;73:915–920.

Kahn DL,Steeves RH.Caring and practice:Construction of the nurse’s world.Sch.Inq.Nurs.Prac.1988;2:201–216.

Kameoka T.Clinical nursing activity for the recovering patients: A theoretical sampling study by grounded theory https://www.wendangku.net/doc/993552013.html,c.1994;3:1–21. Knefelkamp LL,Slepitza R. A cognitive-developmental model of career development—An adaptation of the Perry Scheme.Counseling Psychologist1976;6:53–58. Kobayashi Y.Nurses’ career awareness and its in?uential factors:Nurses who are in their 30s and 40s working at urban general hospitals (Master’s thesis).St Luke’s College of Nursing,Tokyo,1998.

Leininger MM.Care:The essence of nursing and health care.I n:Leininger MM (ed.) Care:The Essence of Nursing and Health Care.Torofare,NJ:Slack,1984; 3–15.

Lincoln YS,Guba EG.Naturalistic Inquiry.Newbury Park, CA:Sage,1985.

Matsushita Y,Araki M,Kimura S.A study on the develop-ment of occupational identity among nursing students: An analysis based on the occupational identity status interview.Bull.Kana awa Prefectural Junior Colle e Nurs.Med.Technol.1993;26:15–22.

Munhall PL.Qualitative designs.I n:Brink PJ,Wood MJ (eds) Advanced Desig n in Nursing Research.Newbury Park,CA:Sage,1989;161–179.

?hlén J,Segesten K.The professional identity of the nurse: Concept analysis and development.J.Adv.Nurs.1998;28: 720–727.

Onodera T,Hatano K.The job trends and the professional identity of nurse graduates from a junior college.Bull. Saitama College Health1991;16:35–44.

Reichers AE.A review and reconceptualization of organi-zational commitment.Acad.Manage.Rev.1985;10: 465–476.

Sasaki M.Development of the professional identity scale for nurses:part I I.J.Jpn.Academy Nurs.Sci.1997;18: 202–203.

Segesten K.The effects of professional group supervision of nurses:Utilizing the Nurse Self Description Form.Scand. J.Caring Sci.1993;7:101–104.

Sneed EB.Perceptions of the professional identity of reg istered nurses in Louisiana(Doctoral dissertation). University of Southern Mississippi,1981.

Suzuki S.Nursing care analysis in clinical nursing activity: Focus on nursing https://www.wendangku.net/doc/993552013.html,cation1993; 2:14–31.

Turner JC,Onorato RS.Social identity,personality,and the self-concept:A self-categorization perspective.I n:Tyler TR,Kramer RM,John OP (eds) The Psycholog y of the Social Self.Mahwah,NJ:Lawrence Erlbaum Associates, 1999;11–46.Volkmann MJ,Anderson MA.Creating professional iden-tity:Dilemmas and metaphors of a ?rst-year chemistry https://www.wendangku.net/doc/993552013.html,c.1998;82:293–310.

Waterman AS,Waterman CK.Factors related to vocational identity after extensive work experience.J.Appl.Psychol. 1976;61:336–340.

Watson J.Watson’s theory of transpersonal caring.n: Walker PH,Neuman B (eds) Blueprint for use of Nursing Models,Education,Research,Practice and Administration. New York:National League for Nursing,1996;141–184.

Watts RJ.Development of professional identity in black clinical psychology students.Prof.Psychol.Res.Prac. 1987;18:28–35.

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