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Perception of Nurse Caring, Skills, and Knowledge Based on Appearance

Thomas, Christine M. PhD, RN; Ehret, Abigail RN; Ellis, Briana RN; Colon-Shoop, Sara RN; Linton, Jean RN; Metz, Stacie PhD

JONA: The Journal of Nursing Administration: November 2010 - Volume 40 - Issue 11 - p 489-497
doi: 10.1097/NNA.0b013e3181f88b48

Objective: The objective of the study was to assess differences among perceptions of patients, nurses, nursing faculty, and nursing students regarding nurse caring, skill, and knowledge based on attire and level of visible body art.

Background: People often make judgments (positive and negative) based on how a person appears. Given somewhat more flexible dress codes for nurses, we wondered what type of perceptions a variety of stakeholders would have of nurses in different levels of attire.

Method: A descriptive comparative design was used. A convenience sample of 240 patients, nurses, students, and faculty were surveyed regarding their perceptions of a nurse based on appearance. Multivariate analyses of variance were calculated to determine if participants' perception of nurse caring, skill, and knowledge differed by scrub type or level of body art.

Results: For the entire sample, the nurse wearing the solid scrub was rated significantly more skilled and knowledgeable than a nurse wearing print or T-shirt attire. Students rated the nurse wearing the solid scrub and print scrub significantly more skilled and knowledgeable. They rated the print scrub higher, with faculty rating it lower. Nurses rated the T-shirt attire more caring than faculty. Patients rated the T-shirt attire more skilled than faculty and students. All subjects rated the nurse with the most body art (piercings and visible tattoo) the least caring, skilled, and knowledgeable. Nurses rated the most amount of body art more caring than patients and faculty. Students rated the most amount of body art more caring than patients and faculty.

Conclusion: The conflict between the right to self-expression and professional role expectations during nurse and patient interactions is a difficult one. However, because a nurse's appearance can impact perceptions during an encounter, dress codes in the acute care setting should take this into account. To be perceived as skilled and knowledgeable, nurses should wear a solid colored uniform with limited visible body art.

Supplemental Digital Content is available in the text.

Authors' Affiliation: Associate Professors, Nursing and Health (Drs Thomas and Metz), Registered Nurses (Mss Ehret, Ellis, Colon-Shoop, and Linton), West Chester University, Pennsylvania.

Corresponding author: Dr Thomas, Department of Nursing, 222H Sturzebecker HSC, West Chester University, West Chester, PA 1938 (

Funding: Two small research grants supported this study: one from West Chester University College of Health Sciences and another from Xi Delta Chapter of Sigma Theta Tau International Nursing Honor Society.

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