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Vol. 4 • January 2012 • ISSN: 2094-9537 Advancing Nursing Research doi: http://dx.doi.org/10.7828/anrj.v4i1.198 Advancing Nursing Research Perceptions of White Uniform in the Nursing Profession JEFFREY ALINO LORMA B. APROSTA RICCA MARIE I. LUGOD AMY RUTH G. MONTILLA JULIUS C. TABUAN JR. CHRISLYN B.UBA College of Nursing Liceo de Cagayan University Abstract - This study determined the perceptions of professional nurses towards the color white as the standard color for hospital uniforms. The specific objectives are the following: 1. To determine the profile of the registered nurses according to: age, gender, length of clinical experience, clinical area, position, hospital policy in terms of hair, shoes, and color; 2. To determine their perceptions whether ProWhite or not and their reasons. Using a descriptive design, personal interviews were conducted on 30 nurses- 10 each from Polymedic General Hospital, Maria Reyna Hospital, and JR Borja Hospital. Respondents are Generation Yers which according to studies prefer uniforms with print to make them look approachable. Regarding gender, majority of nurse-respondents are females consistent with the observation that nursing is in itself a female-dominated course and profession. A wide range of clinical practice in respondents could be noted. Majority served from less than a month to five years and assigned in the Medical Ward. Most are staff nurses and a few trainees and one senior nurse. Based on Benner’s model, it could be said that the staff nurses are competent. JR Borja strictly adheres with the policy of wearing white uniforms compared to Polymedic General Hospital and Maria Reyna Hospital. In PGH, nurses wear colored uniforms and 14 International Peer Reviewed Journal only trainees wear the traditional white uniform without cap. In MRH, station nurses wear white uniforms. In the ER, NICU, ICU, green or blue scrub suits are worn and no cap. The hospitals differed in their policy for hair. Hair should be kept tidy but not necessarily in a bun. Tying hair is very common in PGH. In the other two, hair must be fixed in a bun. Male nurses should sport a clean haircut. All hospitals mandate the wearing of white shoes. Personal views of the white uniform as standard attire in hospitals were associated with neatness or cleanliness. The respondents claimed that a white uniform is significant to the nursing profession for it represents virtues/attributes of effective nurses which include cleanliness/purity, respect, professionalism, passion for work and profession/commitment, trademark of profession, smartness, beauty, elegance, patience, nobility, pride, honor, self-discipline and honesty. In conclusion, white uniforms play a vital role in protecting the image of nurses. These views were constructed from culturallyand socially-based definitions and images of nurses which led patients to hold them at a highly-esteemed position for their professionalism and compassion. Keywords: white uniform, standard, Polymedic General Hospital, Maria Reyna Hospital, JR Borja Hospital INTRODUCTION A uniform is a set of standard clothing worn by organization members participating in their various activities. Modern uniforms are worn by armed forces and paramilitary organizations such as police, emergency services, security guards, in some workplaces and schools and by inmates in prisons. Workers sometimes wear uniforms or corporate clothing of one nature or another. Workers are required to wear uniforms as well. The wearing of uniforms is the organization’s effort of branding and developing a standard corporate image but also has beneficial effects on the wearer. However the term ‘uniform’ is misleading because employees are not always fully uniform in appearance and may not always wear the attire provided by the organization, yet still representing the organization in their attire. Academic work on organizational dress by Rafaeli and Pratt (1993) referred to uniformity (homogeneity) of dress as one 15 Advancing Nursing Research dimension, and conspicuousness as a second. Employees all wearing black, for example, may appear conspicuous and thus represent the organization even though their attire is uniform only in the color of their appearance not in its features. Pratt and Rafaeli, (1997) described struggles between employees and management about organizational dress as struggles about deeper meanings and identities that dress represents. Pratt and Rafaeli (2001) described dress as one of the larger set of symbols and artifacts in organizations which coalesce into a communication grammar. In the nursing profession, nurses are guided by the core values which include human dignity, integrity, autonomy, altruism, and social justice. Bacon, McKendrick, and McKendrick (2000), Kiger (1993) and Rossiter and Yam (1998) explained the persistence of the stereotypical images of nurses and the profession itself. More often, a nurse is portrayed a battleaxe, a sex symbol or in a subordinate role and handmaiden to the doctor. These persistent images discourage young people into taking the nursing course. For some time, nursing organizations have concerned themselves the positive projection of nurses. Unfortunately the stereotypical image still remains and these are the images that are usually retained by prospective nursing students when they see themselves as nurses; this factor is of great significance in this study. In 2000, Bacon and McKendrick reported a change in how nurses are being perceived in public. Now, nurses are regarded as well-educated and independent thinkers and this perspective may reflect that vision that the nurse is now a major player within a high-tech medical world. In various industries, a strict dress code and design is imposed especially the uniforms being worn which are not only appealing to clients/consumers but also convey professionalism. In health care, the nurse’s uniform makes the first impression on the clients and believe that the ideal choice is functional, but outfit should also inspire patient confidence. Nursing leaders in medical facilities, conscious of how patients associate professionalism with appearance, ponder implementing dress codes to require all-white nursing uniforms. Critical care nurse specialist Lucia Wocial, Ph.D. and others (2010) report that patients identify nurses by the color of nursing uniform and associate all-white uniforms with caregiver competency and professionalism. However, Wocial observes that patients also associate 16 International Peer Reviewed Journal “smallprint uniform tops” with “caring, attentiveness, cooperation (and) empathy” in their caregiver. The study indicates that nursing uniforms do not have to be all white to convey positive attributes of caregiving (Breeze, 2011). By using a variety of methodologies with patients and their significant others, researchers were able to determine if the nurse uniforms play the essential role in the delivery of care or nurse professionalism. Interviews conducted by Campbell et al. (2000) revealed important factors in nurse uniforms. Families preferred nurses who can be easily identified and for the uniform to encourage a relaxed atmosphere. Families also wanted more casual uniforms that increase the nurse’s approachability, like colored polo shirts which distinguishes staff by role and rank with trousers, shorts, or navy skirts. In 1991 and 1997, Mangum and colleagues examined the effect that nurse uniforms have on the perceptions of image and professionalism. The researchers made use of 10 professional traits in nurses according to literature (empathic, cooperative, reliable, professional, caring, approachable, efficient, attentive, competent, and confident) and surveyed patients utilizing the Nurse Image Scale. Both studies revealed that the patients’ scores in the NIS were not significantly related to the color and style of the nurse’s uniform. FRAMEWORK The study was anchored on the person–environment fit theory. The person–environment fit denotes that the characteristics of the employees are compatible with the work environment, or between the occupational needs of the employees and the organizational capability in reinforcing these needs (Dawis & Lofquist 1984, Walsh & Holland, 1992). The theory states that when the employees perceive a fit between the person and environment, they more likely show more favorable occupational behaviors, like better job performance and job satisfaction, and low intention to leave their vocation (Dawis & Lofquist 1984, Walsh & Holland, 1992 as cited in Walsh, Craik, & Price, 1992). When a misfit is perceived (i.e. incompatibility between their characteristics and those of the environment/job), employees become frustrated and dissatisfied with their job. To correct the incompatibility, employees should adjust their characteristics to the environment or attempt to 17 Advancing Nursing Research modify their environment. The ultimate solution to this burden is leave the organization or occupation and search for a more compatible environment or job (French & Kahn, 1962; Dawis & Lofquist, 1984). The uniform worn by a nurse powerfully symbolizes professionalism (Spragley & Francis, 2006). This is particularly true among adults who perceive that a nurse’s professional is based partly on the color and style of the uniform (Albert et al. 2008). In the pediatric ward, the more traditional, all-white dress or pant suit is replaced by brightly colored uniforms; however, it is not known whether or not the color and style of uniform affects adult and pediatric perceptions of the nurse as a professional. Skorupski and Rea (2006) revealed that wearing a white uniform conveys efficiency, professionalism, competence, reliability, and confidence and uniforms with small printed tops conveyed traits of approachability, empathy, cooperation, attentiveness, and caring. A study of adult patients showed that nurses donning uniforms with small-print were the preferred caregiver, and a nurse wearing a white uniform can be easily identified. It is also significant to determine if the uniform of the nurse is a meaningful indicator of being approachable and other nurse professionalism traits to patients and visitors. A common yet poorly delineated concept in organizational and industrial psychology is job performance. It is defined as whether the individual has performed his or her job well. Despite no clear and exact definition has been given to the term, performance is a very significant criterion in relation to organizational success and outcomes. A widely acknowledged theory is from Campbell and colleagues (1990). These workers described job performance to be a variable at the individual level. That is, performance is anything a person or an employee does on the job. This sets it apart from more encompassing constructs like organizational or national performance which are higher level variables. Maslow (1943) introduced a theory that determines how individuals are able to satisfy personal needs in the context of their respective jobs. Basing on his observations being a humanistic psychologist, he claimed that a general pattern of recognizing and satisfying needs exists and that this same sequence is generally being followed. His theory also suggested that a person’s needs are arranged hierarchically and in order for a person to address the next level of needs, those 18 International Peer Reviewed Journal below it must be substantially or completely satisfied. This concept is known as prepotency. In other references, it is presented as a pyramid with the survival need occupying the bottom while at its peak is self-actualization. The first level is physiological (thirst, sex, hunger), followed by safety (security, stability, protection), love and belongingness (to escape loneliness, love and be loved, and gain a sense of belonging), then esteem (self-respect, the respect of others), and self-actualization (to fulfill one’s potentialities). According to Herzberg’s original study, motivation factors produce job satisfaction. Nelson and Quick said: “Motivation factors lead to positive mental health and challenge people to grow, contribute to the work environment, and invest themselves in the organization, and they directly affect a person’s motivational drive to do a good job. Job dissatisfaction occurs when the hygiene factors are either not present or not sufficient. The hygiene factors relate to the context of the job and may be considered support factors. They do not directly affect a person’s motivation to work but influence the extent of the person’s discontent. The hygiene factors cannot stimulate psychological growth or human development. They may be thought of as maintenance factors, because they contribute to an individual’s basic needs” (2003, p. 160). Clayton Alderfer of the Yale University in 1969, recognizing the value of Maslow’s hierarchy of needs theory and evolutionary development, developed the ERG Theory. Contained in the ERG Theory are human needs classified into Existence, Relatedness, and Growth needs. Nelson and Quick (2007) said, “Alderfer classified Maslow’s physiological and physical safety needs in an existence need category; Maslow’s interpersonal safety, love, and interpersonal esteem needs in a realness need category; and Maslow’s self-actualization and self-esteem needs in a growth need category” (p 156). Robbins (2003) as cited in Politis (2006) believed that “In contrast to the hierarchy of needs theory, the ERG theory demonstrates that (1) more than one need may be operative at the same time, and (2) if the gratification of a higher-level need is stifled, the desire to satisfy a lower-level need increases” (p 161). The theory of Maslow maintained that it is only when a certain need level is met that the individual progresses to the next need level. The ERG theory implied that individuals increase their lower-order needs with remoteness of the attainability of higher-order needs. 19 Advancing Nursing Research Article IV, section 8 or Nursing practice of RA 9173 states: “A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. Members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to: (a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established; (b) Establish linkages with community resources and coordination with the health team; (c) Provide health education to individuals, families and communities; (d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and (e) Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice;” A hospital is an institution that provides medical services to the sick, injured, and pregnant. With its support, nursing, and medical personnel, the institution cares for both in- and outpatients. Caring plays an essential part to ensure that human beings survive and 20 International Peer Reviewed Journal develop their fullest potentials (Skott & Lundgren, 2006). In the health profession, caring seems to be widely debated most especially among nurses (Boykin & Schoenhofer, 2001). The brilliant work of Watson (1985) said that caring is the moral ideal in the nursing profession. He added that caring is closely tied to the preservation of human dignity in curative health care systems and considered the gold standard in which cure is measured. Watson (1979) defined caring as the process which involves knowledge, action, and consequences and enumerated ten “carative” factors which can be incorporated into practice in any hospital setting. To ensure that Filipino nurses adhere to the ideals required by the profession, the Philippine Board of Nursing (PNA) together with the Commission on Higher Education (CHED) on Nursing Education in April 2001 created a committee on Core Competency Standards Development. The principal objective of this initiative is develop competency standards by which nursing practice will be grounded in the Philippines which is stipulated in Article 3 Sec. 9 (c) of R.A. 9173 or the “Philippine Nursing Act of 2002” stating that PNA will examine and enforce standards of quality nursing care. This enables the nurse to uphold efficient, ethical, technical, moral, and professional standards of nursing practice taking into consideration of nation’s health needs. These standards will be the unifying framework in nursing education, regulation and practice. In the context of nursing practice which is this research’s area of concern, the standards protect the public from incompetent nurses and a yardstick for ethical and professional nursing practice. By conducting this research, a host of problems in the nursing profession will be reduced. The Philippine health care system is predominantly comprised of nurses working 24 hours a day, 365 days in a year and patients come to the hospitals seeking care. The purpose of this study is to evaluate the perceptions of registered nurses on using the color white as the standard color of uniforms in the hospital. The researchers find it important to address this issue amid the many images of nurses portrayed by the media. Unfortunately, advertising and media companies depict nurses in an inaccurate and unflattering manner. In the 40s and 50s, nurses are portrayed as “angels of mercy” - selfless professionals dedicated to their chosen vocation and loyal to their nation. Then during the 60s, when medical films and dramas began to emerge, nurses are shown 21 Advancing Nursing Research as “doctors’ handmaidens,” “battleaxes,” and most popularly, “sex kittens” – images that still exist today. As members of the Philippine Nursing Association, registered nurses are duty bound to behave in a manner which is in keeping with the role of the nurse and the PNA’s standards. Nurses from all around the world wear different uniforms; most countries wear the traditional white uniform consisting of a cap and dress. For males, a tunic with a V-neck is often used. Colors differ according to grade, area of work, and hospital; however, the male equivalent of charge nurse is bluish or dark greenish: often, this color is often associated with authority. OBJECTIVES OF THE STUDY This study determined the perceptions of professional nurses towards the color white as the standard color for hospital uniforms. The specific objectives of this research are 1.) To determine the profile of the registered nurses according to age, gender, length of clinical experience, clinical area, position, hospital policy in terms of hair, shoes, and color; and 2.) To determine their perceptions whether ProWhite or not and their reasons. RESEARCH FLOW 22 International Peer Reviewed Journal SIGNIFICANCE OF THE STUDY This study will be beneficial to the following groups: Nursing Service. The findings of the study would be a reference to healthcare professionals to be guided on how to teach future nurses to provide best care possible to their patients making them respectful of their responsibilities toward society; thereby giving dignity to the negative image of nurses. Nursing Staff. The findings of this study will provide evidence on how professional nurses perceive the significance of wearing white uniforms in their hospital responsibilities. Student nurses. The findings of this study would be a help among nursing students to learn more about the comprehensive strategy of the DOTS program as well as conduct counseling and observation of patient’s regular intake of medicines. Future researchers. This research will foster a sustained curiosity and interest on how the wearing of white uniforms can affect the competency and performance of professional nurses. Moreover, this study will also help in updating and enhancing perceptions of the beneficiaries. SCOPE AND LIMITATIONS OF THE STUDY This study was limited to how nurses perceive the white uniform as standard attire for hospital nurses and their reasons and the significance of the white uniform in the nursing profession. Data gathering was for a period of two weeks. Respondents were limited to 30 professional nurses; ten in each of the following hospitals Polymedic General Hospital, Maria Reyna Hospital, and JR Borja Hospital. Profile of the respondents included age, gender, length of clinical experience, clinical area, position, and hospital policy in terms of hair, shoes, and color. 23 Advancing Nursing Research MATERIALS AND METHODS The design of the study was descriptive. According to Polit and Beck (2004), the purpose of descriptive studies is to observe, describe, and document aspects of a situation as it naturally occurs and sometimes the starting point for hypothesis testing or theory development. Thus, the design was appropriate for the study because knowing the phenomenon during the span of treatment would lead to the evaluation of their present condition. It is qualitative since it used content analysis in analyzing significant data of the study. Primary data were collected by employing a semi-structured interview guide. The data gathering for this particular study proceeded as follows. Prior to data collection, approval was obtained from the Dean of the College of Nursing, Liceo de Cagayan University. After which, a letter was written and submitted to the Hospital Administrator of Polymedic General Hospital, Maria Reyna Hospital, and JR Borja Hospital, seeking permission to interview ten professional nurses. The letter stated the nature and purpose of the study and was approved by the Research Adviser. After permission was granted, data gathering commenced. The selected respondents were asked to sign an informed consent to ensure their willingness to participate in the study. The whole interview was transcribed. Content analysis was done on collected data. Krippendorff (2004) defined that in content analysis, content of text is explored in which values, interests, and attitudes were revealed. During the analysis, the researchers described text elements which could be words, sentences, connotations, associations, and metaphors. Interpretation of these elements then followed. These elements were counted then deductively assigned to predefined categories (Weber, 1990). RESULTS AND DISCUSSION The respondents are mainly 30 years old and below which meant that they belong to Generation Y. It was identified that younger generation nurses would prefer uniforms with print to make them look approachable. It is also deduced that older nurses more likely want to retain tradition through wearing white uniforms (Skorupski & Rea, 2006). Regarding gender, majority of nurse-respondents are 24 International Peer Reviewed Journal females (N=22 or 73.33%) and only eight or 26.67%. This frequency is consistent with the observation that nursing is in itself a femaledominated course and profession. There seemed to be a wide range in the clinical practice of respondents (less than a month-25 years). Twenty-six out of 30 (86.67%) served from less than a month to five years; 10 percent (N=3), six to ten years; and 3.33 percent (N=1), 25 years. Nineteen (63.33%) are assigned in the Medical Ward; 20 percent (N=6), OB Ward; 10 percent (N=3), DR; 3.33% each (N=1) in Neonatal Intensive Care Unit and Pediatric wards. Most respondents are staff nurses (N=27, 90%). Trainees composed 6.66% of the total distribution. Only one is a senior nurse (3.33%). Based on Benner’s model, majority are competent, while very few belong to the proficient and expert categories. In Polymedic General Hospital, nurses wear colored uniforms (tan, yellow, blue) while only the trainees wear the traditional white uniform without cap. Hair should be kept tidy but not necessarily in a bun. Tying hair is very common. Earrings may be worn but should not be dangling. In Maria Reyna Hospital, station nurses are to wear white uniforms. In special areas such as ER, NICU, ICU, green or blue scrub suits are worn and no cap. For the females, hair must be fixed in a bun; males should sport a clean haircut. Wearing of jewelry is strictly prohibited by the management. JR Borja Hospital strongly mandates their nurses to wear white uniform; only DR Nurses are allowed to wear scrub suits. Hair should be in a bun among the females and must wear a cap. Male nurses should have clean, neatly trimmed hair. Jewelry should not be worn while inside the hospital. All hospitals mandate the wearing of white shoes. When respondents were asked about their personal views of the white uniform as standard attire in hospitals, 22 reacted positively while 5 maintained a non-affirmative position on this. Three elicited conditional responses to the query. The positive perceptions of the respondents stem from the meaning of the color white. Based on the claims of respondents, representations associated with wearing a white uniform include neatness or cleanliness (1st), Identity and Compliance to standard/appropriate (2nd), Good and Respect (3rd), symbol of profession (4th), while good grooming, Professionalism, good-heartedness, dignity, decency and fits profession (5th). Wearing a uniform appears to contribute to the image being projected by 25 Advancing Nursing Research an organization or profession and generally acknowledged by the public. As suggested by Craik (2005), uniforms serve both social and psychological impact to the one wearing it and society in general. The conclusion of Joseph (1986) states, “The uniform serves several functions: it acts as a totem, reveals and conceals status, certifies legitimacy and suppresses individuality”. According to Major et al. (2005), the color white is chosen for it symbolizes purity. Historically, white uniforms facilitate patient identification and portrayed a clean and neat image. Image and belongingness are yearned for the intrinsic value to both the nurse and the institution and extrinsic significance to the public. Literature showed that uniforms worn by nurses enable patients and staff to readily recognize their role. When care is provided by nurses, patients are inclined to believe they look more professional and competent in white uniform with cap (Newton & Chaney, 1996). Nurses’ appearance affects interactions with family members and may shape patient family perceptions of nurse’s profession and image. Additionally, non-standardization of uniform color in a single unit or throughout the hospital may increase difficulty in differentiating nurses from other hospital personnel (Albert et al., 2008). The narratives pertaining to the significance of white uniform in the nursing profession specifically centered on virtues/attributes of effective nurses- cleanliness/purity (1st), respect (2nd), identity, professionalism, passion for work and profession (3rd), smartness, trademark of profession, beauty (4th), elegance, patience, nobility, pride, honor, honesty, self discipline (5th). Albert et al. (2008) revealed that white nursing uniforms consistently scored very highly in ten traits which include empathy, cooperativeness, reliability, professionalism, caring, efficiency, attentiveness, competence, and confidence. In the health communication model of Northhouse and Northhouse (1998), nurses’ uniform plays an important role in promoting a healthy nurseto-patient relationship. In like manner, image projected by wearing white uniforms makes the public trust nurses. This comes from the legitimacy that the nurse’s uniform symbolizes from the eyes of the general public. Craik (2005) postulated, “Uniforms are extremely effective indicators of the codification of appropriate rules of conduct and their internalization”. What is more important is the set of rules governing the institution of caring instead of the uniform itself. The nurse’s white uniform enables the performance of legitimate activities 26 International Peer Reviewed Journal closely tied to the occupation. In healthcare, this legitimacy enables the nurse to approach and assess patients. The white uniform signifies that the expertise and knowledge were formally earned through education and training. If nurses behave in a manner which is not in tune with society’s expectations, this may cause reduction in patient trust and confidence (Castledine, 2004). CONCLUSIONS White uniforms play a vital role in protecting the image of nurses. These views were constructed from culturally- and socially-based definitions and images of nurses which led patients to hold them at a highly-esteemed position for their professionalism and compassion. Based on the findings, majority still are in favor of wearing white uniform. RECOMMENDATIONS Based on the findings of the study, the following recommendations are derived: 1.That Student nurses should be reminded during orientations about the standard uniform for nurses to uphold it during their entire life and that there may be modification according to the policy of the institution. 2.That further research should be done on patients’ perceptions with nurses wearing white uniform and according to nurses’ age bracket and gender. LITERATURE CITED Albert, NM et al. 2008 Impact of nurses’ uniforms on patient and family perceptions of nurse professionalism. Applied Nursing Research, 21, 181190. Bacon, K., KE. McKendrick, & JH. McKendrick 2000 Tomorrow’s nurses. 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(2005) Attitudes regarding surgeon’s attire. The American Journal of Surgery, 103-106. Mangum, S. et al. 1997 First impressions of the nurse and nursing care. Journal of Care Quality, 11, 39–47. 28 International Peer Reviewed Journal Mangum, S. et al. 1991 Perceptions of nurses’ uniforms. Journal of Nursing Scholarship, 23, 127– 130. Maslow, A. 1943 A theory of human motivation. Retrieved from http:// psychclassics.yorku.ca/Maslow/motivation.htm. Nelson, DL. & JC. Quick, 2007 Understanding Organizational Behavior. New York: Cengage Learning. Newton, M., & J. Chaney 1996 Professional image: enhanced or inhibited by attire. Journal of Professional Nursing, 12, 240-244. Northhouse, L.J. & P.G Northhouse, 1998 Health communication strategies for health professionals. Stamford, Conn: Appleton & Lange. Politis, JD. 2006 Self-leadership behavioral-focused strategies and team performance: The mediating influence of job satisfaction. 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Price, 1992 Person-environment psychology: models and perspectives. Hillsdale, NJ: Erlbaum. Watson, J. 1979 Nursing: The philosophy and science of caring. Boston: Little, Brown. Watson, J. 1985 Nursing: Human science and human care: A theory of nursing. Norwalk, CT: Appleton-Century-Crofts. Wocial, L. et al. 2010 Impact of pediatric nurses’ uniforms on perceptions of nurse professionalism. Pediatr Nurs, 36, 320-326. 30