The Perceptions about Their Profession of Kosovo`s Nursing Students

Background and Aim: Nurses are key to the health of the nation. Nursing can be described as both an art and a science; a heart and a mind. The aim of this study is to evidence the students' perceptions about the profession of nursing. This is a cross-sectional study. Study Design: The research question is: "What are the nursing students’ perceptions about the profession of nursing?" Methodology: The study was realized during the period of JanuaryFebruary 2021. The study was conducted with nursing students in first, second and third year of study, in bachelor degree of University of Pristina "AAB College" Kosovo, Faculty of Nursing, Department of Nursing, Kosovo. In this study were included n=130 students, respectively (n= 29, 22.3% in first year, n=57, 43.8% second year and n= 44, 33.8% in third year of study). The questionnaire “Cockrell-Punter Nursing Perceptions Scale” used consisted of 25 perception statements related to nursing. These scores no longer reflected simply agreement/disagreement, but as positive or negative perceptions of nursing with a scale values ranged from 1=negative perception to 5=positive perception. The survey performed in classroom was anonymous. All data collected were elaborated with SPSS version 19. Original Research Article Haxhija et al; JPRI, 33(41A): 305-313, 2021; Article no.JPRI.71891 306 Results: In this study, 22.3% (n=29) of students were male and 77.7% (n=101) were female. Age ranged from 18 to 47 years old. The average age is 21.9 years old. The distribution of student’s age was: (8.5% were 18 years old, 18.5%, 19 years old, 27.7% 20 years old, 19.2% were 21 years old and 26.1% were over 21 years old) mean 19.8 years old, min 18 years old, maximum 47 year old, Std. Dev ± 4.19. According to the residence, 88 (67.7%) of students were from urban area and 42 (32.3%) from rural area. Conclusion: Nursing students have good perception about the nursing profession. With age the level of perception increases, so the oldest have more positive perception.


INTRODUCTION
21st Century nursing is the glue that holds a patient's health care journey together. Across the entire patient experience, and wherever there is someone in need of care, nurses work tirelessly to identify and protect the needs of the individual. Nurses are key to the health of the nations. Nurses are in every community, providing expert care from birth to the end of life. Nurses' roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems. Nursing can be described as both an art and a science; a heart and a mind. At its heart, lies a fundamental respect for human dignity and an intuition for a patient's needs. This is supported by the mind, in the form of rigorous core learning. Due to the vast range of specialisms and complex skills in the nursing profession, each nurse will have specific strengths, passions, and expertise [1].
Responsibilities can range from making acute treatment decisions to providing inoculations in schools. The key unifying characteristic in every role is the skill and drive that it takes to be a nurse. Through long-term monitoring of patients' behavior and knowledge-based expertise, nurses are best placed to take an all-encompassing view of a patient's wellbeing. Nurses have experienced great change in the last few decades in organizational and individual culture, which Begat et al. believe is 'putting extra pressure on nurses [2]. Such situations encourage nurses to have diverse life views and expectations, which can be truly ambivalent and heterogeneous, and influence their value system greatly. In multi-cultural societies, the cultural values of individuals already residing within a country can be substantial, and are reflected within certain work groups. These values also impact on the personal lives of nurses, influencing their decision making in family, religious and community environments [3].
A Korean study indicated nursing students' entry to the nursing profession with a higher desire for a professional job significantly had higher nursing professional values compared to those students who entered into the profession because of other reasons [4].
Studies carried out in Zambia, Jordan, Punjab and Poland showed positive perception towards the nursing profession and was perceived as an opportunity to serve humanity, receive blessings from people, has opportunity for personal growth and development, and achieve economic and job security [5,6,7,8].
Perception refers to the belief, views and understanding nurses have regarding the image of the nursing profession because of their past and present experiences in the course of their training. (9) The discipline of nursing traditionally holds as the most trusted healthcare profession. For instance, in the United States, nursing was awarded as the most trusted profession for decades and continues to be until date [10,11].
AAB College is the largest non-public institution of higher education in the Republic of Kosovo and in the region. AAB was founded in 2002 with a unique program, Journalism and Mass Communication, to further accredit study programs in the field of criminalistics in collaboration with the Sarajevo Public University. AAB continued to expand as an institution by continually offering study programs from other fields, thus becoming an important academic center in the country and region. AAB currently has a total of 14 faculties that offer study programs at BA and MA levels. AAB College operates in its main campus in Prishtina, and in two branches in Gjakova and Ferizaj accredited by KAA decision and licensed by MEST.
The Faculty of Nursing at AAB College is a relatively new faculty, initially accredited with the Bachelor program of Nursing in 2016. Through its study program, the Faculty provides guidance and prepares students for careers in an industrybased society. The Faculty of Nursing has as a strategic objective the preparation of nurses who will implement specialized practices in narrow areas of nursing directions and thereby contribute to the advancement of health services as a whole. Students of the Faculty of Nursing gain the basics of scientific knowledge for a comprehensive approach to the role of nursing in promoting health for individuals, families and the community at large aimed at preventing and controlling diseases, maintaining and promoting the health of the population. The Nursing Program is a combined program of theoretical and practical learning that impacts on raising the level of knowledge and skills in order to address the health needs of the population throughout the life cycle.
The curriculum of the Faculty of Nursing is designed to provide the general education needed to practice nursing at the Bachelor level. Students who have knowledge about the basic principles of nursing, acquire critical judgment skills based on education and experience and develop skills to use principles and competencies wisely in decision-making and problem-solving settings related to the provision of high-quality nursing services. Students enrolled in the Faculty of Nursing come from all cities in Kosovo, who have completed medical secondary education, or gymnasiums. Since its first year of accreditation, AAB College has received big enrolment requirements thus becoming the most competitive institution in the field of Nursing in the Republic of Kosovo. All staff and students carry out their teaching and learning activities in accordance with internal regulations concerning academic and administrative activities. All policies, regulations, terms of reference, and statements of responsibility regarding program management and delivery are reviewed at least once per year and are amended as necessary in certain circumstances.
The purpose of the Bachelor program in Nursing is to develop human resources for the needs of the Kosovo health system in order to meet the population's needs for health services. This program enables students to acquire the knowledge, skills and competencies related to the provision of the best quality health services in order to meet the demands of the population in maintaining and improving their health. The purpose of the nursing program is also to prepare students who are capable of providing health services in health institutions within the public or private health system in Kosovo and other European countries.

MATERIALS AND METHODS
This is a cross-sectional study. The study was realized during the period of January-February 2021. The study was conducted with nursing students in first, second and third year of study, in bachelor degree of University of Pristina, AAB College, Department of Nursing. The aim of this study is to evidence the students' perceptions about the profession of nursing. The research question is: "What are the nursing students' perceptions about the profession of nursing?" The objectives of the study are: Part I of questionnaire used is composed by the demographic data and the students are asked about the first choice of study branch, the reason of choice, the influencing such as: the presence of family members in health care system, the previous experiences with nurses. Part II of the Cockrell-Punter Nursing Perceptions Scale consisted of 23 perception statements related to nursing to which respondents were asked to indicate their level of agreement on a five-point Likert-Type Scale ranging from 1=Strongly Disagree to 5=Strongly Agree. The survey performed in classroom and was anonymous. All data collected were elaborated with SPSS version 19 program. The data obtained from the questionnaire were processed through SPSS program, version 19. It is used Pearson Correlation in order to explore the correlation between students' age and their perception about nursing profession. It is used ANOVA Table in order to explore the relationship between students' course of study and their perception about nursing profession and the relationship between having family members in health care and students' perception about nursing profession. This is a cross-sectional study. The study was realized during the period of January-February 2021. The study was conducted with nursing students in first, second and third year of study, in bachelor degree of University of Pristina "AAB College" Kosovo, Faculty of Nursing, Department of Nursing, Kosove.

RESULTS
In this study were included n=130 students, respectively (n= 29, 22.3% in first year, n=57, 43.8% second year and n= 44, 33.8% in third year of study). In this study, 22.3% (n=29) of students were male and 77.7% (n=101) were female. Age ranged from 18 to 47 years old. The average age is 21.9 years old. The distribution of student's age was: ( This research, however, is subject to several limitations. Considering that the study was conducted during a COVID-19 pandemic period, the study was organized according to the rules set by the Ministry of Health, but the form of our questionnaire is face to face. The first limit is that we had a short time available but we managed to take in the study the designated number of students that our study was effective and reliable, we managed to increase the intensity of our work to achieve the finalization of the questionnaires.
The second limit consists of the refusal to complete the questionnaire by a number of students, they refused to participate in the completion of the questionnaire for study purposes.
In Table 1 we can see that the mean is 83.47, the median is 84.50 and the mode is 85, the minimum is 51 and the maximum is 105. So, students have good perception about the nursing profession. More detailed information we can obtain from Fig.1.
In Table 2 we can see the evaluation according to the 23 items. The most part of students disagree about that popular media is the primary source by which individuals define nursing. It is important to evidence that 20% of students from rural areas are undecided to return to their hometown to work after the graduation, but 59.2% are decided to return. More than 67.7% of students admit that are more likely to choose nursing if family members or friends are in healthcare careers. 88.5% of them admit that patient education is a major part of the role of nurses. They are well informed about the duties, role and obligations of nurses. 54.6% admit that high school graduates make the decision to enter nursing based on accurate information about nursing. More than 70% of students admit that the Chamber of Nurses position is that Baccalaureate nursing education should be the standard for entry into professional nursing.

Fig. 1. Data about the Perceptions of Future Nurses regarding the Nursing Profession
So 68.5% of them agree that mentoring is for success in nursing, 59.2% admit that nurses are called on to fulfill multiple roles as nursing professionals. 64.7% of students think that t majority of currently employed licensed nurses work in a hospital setting. Only 23.1% of students admit that high salaries are the primary reason students choose nursing as a career. that observing and "shadowing" nurses influences an individual`s perceptions of the nursing profession.
The students are not conscious that understanding the nursing profession is a primary concern of high school graduated. Only 36.9% are conscious but 63.1% aren't. Also only 36.9% of them admit that high school graduated understand the roles and responsibilities of professional nurses. 70.1% of them admit th career information about nursing is readily available to all students on the university campus. that high school graduated would benefit from a pre nursing orientation course (83.1%). About the item if the nurses are regarded a highly ethical and honest professionals 82.3% of students agree and strongly agree.
Also 85.4% of students think that completion of an introduction to nursing class before entering nursing school would have a strong influence on student`s perceptions of nursing. 82.3% that the majority of currently employed nurses have positive perceptions about nursing. According the answers we can evidence that students have a positive perception about the nursing profession.
When the students are asked about the first choice of study branch, 85 (65.4%) of them claim

Fig. 1. Data about the Perceptions of Future Nurses regarding the Nursing Profession
So 68.5% of them agree that mentoring is critical for success in nursing, 59.2% admit that nurses are called on to fulfill multiple roles as nursing professionals. 64.7% of students think that the majority of currently employed licensed nurses work in a hospital setting. Only 23.1% of students mit that high salaries are the primary reason students choose nursing as a career. 63.9% claim that observing and "shadowing" nurses influences an individual`s perceptions of the The students are not conscious that nursing profession is a primary concern of high school graduated. Only 36.9% are conscious but 63.1% aren't. Also only igh school graduated understand the roles and responsibilities of professional nurses. 70.1% of them admit that career information about nursing is readily available to all students on the university campus. They think that high school graduated would benefit from a pre nursing orientation course (83.1%). About the item if the nurses are regarded a highly ethical and honest professionals 82.3% of students Also 85.4% of students think that completion of an introduction to nursing class before entering nursing school would have a strong influence on student`s perceptions of nursing. 82.3% admit that the majority of currently employed nurses have positive perceptions about nursing. According the answers we can evidence that students have a positive perception about the When the students are asked about the first choice of study branch, 85 (65.4%) of them claim it was their first choice and 45 (34.6%) refer that it was not the first choice. If they had the opportunity to choose another branch of study, some of them would like to choose: medicine (14.7%), dentistry (8.6%), physiotherapy (6.9%) and psychology (6.9%), but 11.5% were not decided if they want another choice. Is fact that they want to choose medicine, physiotherapy; dentistry and psychology because all these branch are human sciences similar with nursing sciences and the opportunity for a good job. So we can see this opinion in different studies. In the study 80% (n=104) admit that observing a nurse in action didn`t influence them to choose nursing as a career. The reasons of choosing nursing as the profession were expressed by them such as: the desire to help the others (89.3%), diversity of job opportunities (37.7%), Desire to take care of family and friends (70.8%) and individual professional fulfillment, interested in research of health and human sciences (64.3%). So 16.7% of them like the nursing profession, diversity of job opportunities abroad 50%. In this study we can conclude that between the age and the perception exist a non-significant and positive correlation (see Table 3). This means that with age the level of perception increases, so the oldest have more positive perception.
There is no significant relationship between students'course of study and their perception about nursing profession ( Table 4).
As we can see, the students' perception of the third academic year is more positive, but this difference is not significant.

Fig. 1. Data about the Perceptions of Future Nurses regarding the Nursing Profession
it was their first choice and 45 (34.6%) refer that it was not the first choice. If they had the opportunity to choose another branch of study, like to choose: medicine (14.7%), dentistry (8.6%), physiotherapy (6.9%) and psychology (6.9%), but 11.5% were not decided if they want another choice. Is fact that they want to choose medicine, physiotherapy; dentistry and psychology because all these nch are human sciences similar with nursing sciences and the opportunity for a good job. So we can see this opinion in different studies. In the study 80% (n=104) admit that observing a nurse in action didn`t influence them to choose nursing he reasons of choosing nursing as the profession were expressed by them such as: the desire to help the others (89.3%), diversity of job opportunities (37.7%), Desire to take care of family and friends (70.8%) and individual ested in research of health and human sciences (64.3%). So 16.7% of them like the nursing profession, diversity of In this study we can conclude that between the age and the significant and positive elation (see Table 3). This means that with age the level of perception increases, so the oldest There is no significant relationship between students'course of study and their perception about nursing profession (Sig=0.38) As we can see, the students' perception of the third academic year is more positive, but this difference  (2-tailed) There is no significant relationship between students'gender and their perception about nursing profession (Sig=0.99) ( Table 6), but it should be noted the fact that in this study program nursing is a women-dominated profession. As we can see, the female nurses have more positive perception about nursing profession.
There is a non significant relationship between students'residence and their perception about nursing profession (Sig=1) ( Table 7). The mean is higher among the students that are borned in the city.

DISCUSSION
Nursing students have good perception about the nursing profession. Between the age and the perception exist a non-significant and positive correlation (see Table 3). This means that with age the level of perception increases, so the oldest have more positive perception. Compare with the Albanian students about this subject we have different perception. This means that with age the level of perception decreases, so the younger Albanian students have more positive perception [12].
There is no significant relationship between students'course of study and their perception about nursing profession (Sig=0.38) ( Table 4). As we can see, the students' perception of the third academic year is more positive, but this difference is not significant.
The same results are evidenced in Albanian study that is a significant relationship between having family members in health care and students" perception about nursing profession [12]. Also a study conducted in Turkey in 2017 shows the same results, for choosing the nursing profession, it was found that most of those who had at least one person in their family in the nursing profession had positive opinions about nursing before to come to nursing school and already knew about the nursing profession before attending nursing school [13]. Another study conducted in Turkey shows that students have voluntarily chosen the nursing profession because it is a humane profession and have more opportunities to find a job, these reasons were effective in choosing the nursing profession [14]. It is important to evidence that 20% of students from rural areas are undecided to return to their hometown to work after the graduation and more than 20% have decided to not return at their home. The most part of students admit that are more likely to choose nursing if family members or friends are in healthcare careers, but only 36.9% of them are well informed about the duties, role and obligations of nurses and also 36.9% are not conscious that understanding the nursing profession is a primary concern of high school graduated. So, most of them agree that mentoring is critical for success in nursing, most of them admit that nurses are called on to fulfill multiple roles as nursing professionals and claim that observing and "shadowing" nurses influences an individual`s perceptions of the nursing profession. It is positive the fact that nurses are regarded a highly ethical and honest professionals for most of the students. They think that high school graduated would benefit from a pre nursing orientation course. About the item if the nurses are regarded a highly ethical and honest professionals 82.3% of students agree and strongly agree. Also the most part of students 85.4% of them, think that completion of an introduction to nursing class before entering nursing school would have a strong influence on student`s perceptions of nursing.

CONCLUSION
Nursing students have good perception about the nursing profession. With age the level of perception increases, so the oldest have more positive perception. There is no significant relationship between students'course of study and their perception about nursing profession (Sig=0.38). The students' perception of the third academic year is more positive, but this difference is not significant. It is a significant relationship between having family members in health care and students" perception about nursing profession. In general, the findings of the study are similar to the findings of similar studies in Albania, at the University of Shkodra and in the world. The inclusion of the subject "Introduction to nursing" in the high school curriculum should be considered, because a considerable part of the students think that most high school graduates make the decision to enter nursing based on accurate information about nursing. We think that the inclusion of this subject should be considered. Also for the fact that only 36.9% of the studies participants think that high school graduated understand the roles and responsibilities of professional nurses, so, they need this kind of information. Most of the study participants think that a primary concern of high school graduates understand the nursing profession and the vast majority of them think that high school graduated would benefit from a pre nursing orientation course. So, we can conclude that the results of our study are similar with those of our international colleagues and in Albanian context.

CONSENT
As per international standard or university standard, participants' written consent has been collected and preserved by the authors.

ETHICAL APPROVAL
The permission has been obtained for the development of the questionnaire to the governing authorities of the faculty. Students are assured of maintaining anonymity and confidentiality. Students have been free to participate or not in the study.