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Excerpts from: Educating nurses to impact change in nursing's image1 Teaching and Learning in Nursing (2011) 6, 112–118-Reitha Cabaniss MSN, RN, C.N.E.⁎ -Thesis: The widely held view that nursing is not intellectually demanding or challenging is the result of media-representation of nurses. The television producers of dramas with a health care focus or new medical-dramas need a clear understanding of a nurse's function and the important tasks performed as essential-members of the health care teamThe invisibility of nurses on hospital dramas sends a-message to television viewers that nurses are unnecessary-because the role of physicians is presented as most valuable--The knowledge, clinical-judgment, and the demands of nursing care are not publicly-visible. The sentimental image of an inadequately educated-but nurturing and kindhearted assistant at the bedside is-outdated (Benner, Sutphen, & Leonard, 2010 ).— 1. The term image can be described as “ a personally-believed-in mental picture that is descriptive, evaluative-and predisposing in relation to some object (or group)”- (Crable & Vibert, 1986 , p. 58).--These imitations of the person, environment, or thing are-collective representations held in common by members of a-group and symbolic of basic beliefs, values, and orientation to social, political, and economic issues. Boulding (1956) Boulding (1956) continues to explain image classification-as public, self, and professional.--Role schema is a process of perceiving reality that-organizes knowledge about behaviors into categories, such-as gender and occupation. 2. The term schema is used to-describe recall of perceptual experiences, and the schematic-processing defines the practice of taking in information used-later (Taylor & Crocker, 1981 ). Schemas use general-knowledge about a subject and its attributes to categorize-subjects as well as situations. Schemas are also thought to-influence behavior or role expectations (Schank & Ableson,-1977 )--Stereotypes and socialization The problem with stereotypical images-is that judgments may be true of an entire group but do not-accurately portray individual group members. Stereotypes-are closely related to prejudice , defined as negative biases-directed at individuals in a group based on their group-membership (Niven & Robinson, 1994 ). 3. Socialization is a process of learning basic values and-orientations that prepare individuals to fit into their culture-(Kalisch & Kalisch, 1987 ). One can identify the assumptions-about a profession by analyzing the social structure and the-patterns of the social interaction that characterize the-imaginary world (Kalisch & Kalisch, 1995 ).--Promotion of image via television Television is viewed at close range and in a private-context; thus, the illusion it gives of being with others had-profound psychological implications. It is television, more-than any other medium, which provides false companionship-through a form of intimacy that is illusive and-pretend (Berger, 1998 ). 3. Media misperceptions The “ naughty nurse” or sexualized use of nurse characters-was first documented by Kalisch and Kalisch in the 1960s-and 1970s on the silver screen and television. Tabloid and-local newspapers were guilty of using this portrayal of-nurses, which coincided with the women's movement-(Bridges, 1990 ). Depictions of nurses wearing push-up-bras, low-cut blouses, short skirts, and high heels may excite-groups of men and physicians, but the message being sent is-that nurses primarily serve an erotic purpose.-In more recent years, Dentyne Ice gum, Gillette TAG-body spray, and Schich Quattro Titanium razors created-advertisements that lured sexy nurses into bed with men who-used their products. Pop star Christine Aguilera played a-sadistic naughty nurse in a print ad for Skechers shoes-(Cohen & Bartholomew, 2008 ). This type of advertisement-contributes to the devaluation of nursing and jeopardizes-patient confidence in nursing care. 4. The term angel- implies compliance and caring but communicates negative-connotations of uneducated, selfless, and with no career-ambitions (Bridges, 1990 ). Angel imagery suggests kindness-and benevolence. This description depicts nurses as motherly-martyrs with no human needs and infinite capacity for selfsacrifice-(Cohen & Bartholomew, 2008 ).--The angelic and little girl representation does-not appeal to sophisticated, discipline-oriented, educated-people who wish to be taken seriously as a professional-(Cohen & Bartholomew, 2008; Darbyshire, 2010 ).--The image of an authoritative, overweight experienced-nurse boasting about with an overbearing personality describes-“ the battleaxe” stereotype. One may envision the Nurse-Ratchet character portrayed in the motion picture One Flew-Over the Cuckoo 's Nest (1975) as one who used excessive-power to mistreat doctors, novice nurses, and patients. This-representation of a battleaxe image emerged during the 1960s-and 1970s, when the feminist movement was becoming well-known. The battleaxe nurse can be viewed as one intended to-transmit female power and male dependency as the nurse who-does not comply with the stereotypical image of the ideal nurse-(Bridges, 1990; Darbyshire, 2010 ). 5. Men and nursing-Historically, men are not newcomers to nursing. Male-nurses are rarely portrayed in media except as misfits or-homosexuals.--the reasons for low numbers of men entering-nursing include role stereotypes, economic barriers, few-mentors, gender biases, lack of direction from early authority-figures, misunderstanding about the practice of nursing, and-increased opportunities in other fields (Meyers, 2003 , p. 18).--There is little to no-representation of nurses as managers, executives, or-educational leaders. A common belief supported in the-literature is that every nurse wished to be a doctor but either-lacked intelligence or opportunity. This notion is supported-by media portrayal of nurses being responsible for routine-and repetitive tasks. A lack of cultural diversity exists in the-literature, as nurses are usually portrayed as white females-(Bridges, 1990 ). 6. Physician and nursing characters in-entertainment media--The study reported findings from a content analysis of-670 nurses and 466 physician characters portrayed in novels,-films, and prime-time television series published or produced-from 1920 to 1980. Media nurses were found to be-predominately female (99%), Caucasian (95.6%), single-(71%), and barren (89.4%). 7. Television series nurse characters-were depicted as valuing service to others and being less-helpful to patients. Physician characters in a television series-were presented as more nurturing and more empathetic than-nurse actors.--Popular medical dramas such as ER , House , and Grey 's-Anatomy are well-liked medical shows with large-scale-national audiences. Each show fails to portray nurses with a-positive image. Fox's medical drama, House , does not-represent nurses of any kind.--(NurseAdvocacy.org).-Grey's Anatomy captures the glorified “secretaries” at the-nurses' station and constantly depicts nurses in the-background of Seattle Grace Hospital as they work on-computers and handle paperwork. During one of the three-episodes concerning a nursing strike in Season 2, Dr.-Shepherd asks the chief, “Who is going to fill out all of my-paperwork?” In addition, interns on Grey's Anatomy are-filmed performing many tasks that nurses would normally-do, as well as give orders to nurses. In the very first episode,-intern Meredith Grey is paged to the bedside of a patient who-has grand mal seizures. Meredith freezes because she does-not know what to do next; she looks at one of the five nurses-present, and one of them says, “You need to tell us what you-want to do!” 8. Scrubs, a television sitcom, exposes the work and-personal lives of three young physicians at Sacred Heart-Hospital. The show's representation of nursing has not been-impressive. The one nurse character, Carla Espinosa, has-revealed a little of her nursing expertise. Some of the show-plot has actually focused on nursing issues such as bigotry-toward male nurses, deciding to become a nurse, nurse–-physician tension, and nurses' informal teaching of residents.- Scrubs has not portrayed nurses in an overall positive light-but has done a better job than most current serial television-sitcoms. 9. A new health drama, Private Practice , was released-during the prime time in the 2007– 2008 television seasons. Dell, the nurse receptionist character seems to be-the least knowledgeable nursing character portrayed on-television in several years. Early episodes suggest the-midwife clinical studies as “ light weight New Age-kookiness.”--In the summer of 2009, a new nursing drama titled, Nurse-Jackie , premiered on Showtime … in the first episode, she snorted pills that she had-received from the pharmacist, had sex in the laboratory room,-forged an organ donor card, flushed a patient's ear down the-toilet, and took money from his wallet to give to a pregnant-woman. At the end of the episode, she slipped her wedding-band back on her hand and went home to her husband and-daughters (Knoploh, 2009 ). The Nurse Jackie fictional-character created by network executives provides a compelling-example of a dysfunctional nurse.-