1182514 SMO0010.1177/20503121231182514SAGE Open MedicineAsante et al. research-article2023 SAGE Open Medicine Original Article SAGE Open Medicine Does the gender of nurses matter to Volume 11: 1– 12© The Author(s) 2023 Article reuse guidelines: patients? A qualitative analysis of gender sagepub.com/journals-permissions httpDs:O//dIo: i1.o0r.g1/107.711/2707/520351032122132131188225514 preferences of patients journals.sagepub.com/home/smo Akua Owusua Asante1 , Kwadwo Ameyaw Korsah2 and Clifford Amoako3 Abstract Background: This study argues that the gender of a nurse could give patients the emotional and psychological support they need in their healing process. Nonetheless, in many developing countries, these intricate preferences of patients are usually ignored due to poor staffing and logistical capacities of health facilities. As a contribution to this professional and operation gap, this paper explores patients’ preference for nurses’ gender in health care at the Komfo Anokye Teaching Hospital in Ghana. The paper further explores the importance of these preferences to the delivery of patient-centred care in Ghana and across Africa. Objective: The paper has two specific objectives: (a) to explore patients’ preferences for the gender of nurses who attend to them while on admission; and (b) to find out the range of factors that inform these preferences. Methods: Qualitative exploratory descriptive design was used to select adult patients who were not seriously ill and nursed by male and female nurses at the medical and surgical wards of the Komfo Anokye Teaching Hospital in Ghana for at least 5 days from January to March 2017 and before their discharge. Participants were recruited using purposive sampling technique. A semi-structured interview guide was used to elicit information from 14 participants after seeking their written informed consent. The data were analysed using content analysis. Results: Two major themes emerged. These were: the Preferred Gender of a Nurse in Nursing Care and the Reasons for the Preference or no Preference for Nurses’ Gender in Nursing Care. Under each of these themes, the associated aspects were also discussed. Patients had varying preference for a particular nurse during care but gender was not particularly significant in patients’ preference for nurses. Majority of the participants emphasized their preference for nurses with professional expertise and good virtues to determine a preferred nurse and both genders of nurses can possess these qualities. However, nurses of the same gender as the patient were preferred for intimate procedures to ensure privacy and satisfaction. Conclusion: The gender of a nurse is not on top of the preferences list of patients in the study context. This may be attributed to the long-term practice that the participants have not had the chance to be choosing a preferred nurse’s gender, so most patients are tolerant and familiar with both male and female nurses. Instead, patients’ preferences are determined by the performance and quality of service provided by nurses. Age, maturity and social connections were also found to influence patients’ preferences. Keywords patients, preference, nurses, gender, nursing care, male; female Date received: 31 December 2022; accepted: 31 May 2023 1Department of Nursing, Knutsford University College, Accra, Ghana Corresponding author: 2School of Nursing and Midwifery, University of Ghana, Accra, Ghana Akua Owusua Asante, Department of Nursing, Knutsford University 3 Department of Planning, Kwame Nkrumah University of Science and College, 10 Bamako Road East Legon, Accra, Ghana. Technology, Kumasi, Ghana Email: akuaowusuaasante@gmail.com Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open Medicine What is already known about the topic and what this patients. This is because women have been found to prefer paper adds to the literature female nurses for matters of reproductive, sexual health and intimate or psychosocial issues, whereas men also demon- •• Patients’ preferences for the gender of care providers strate a similar trend, but to a lesser degree. According to,10 have been studied in many jurisdictions around the younger females may care about female nurses more than world. older females because older women are used to receiving •• Factors that determine these gender preferences have care from male gynaecologists and some are reluctant to also been explored in developed countries where the admit they prefer women because much attention was not views of patients are taken seriously. paid to a patient’s preference in the prior years. Other studies •• This study extends the conversation by exploring the reported that most patients had no preference for their care patients’ preferences for the gender of nurses in providers and practitioners.11–13 A study by14 identified that Ghana, a country in which the respect for the wishes the level of intimacy in a clinical situation predicted same- of patients is still evolving and the general perception gender preferences. about clinical nursing and care-provision are the pre- Nursing and Midwifery code of professional conduct also serve of females. indicates that nurses must recognize and respect the role of •• The study also adopts an exploratory descriptive patients as partners in their care.15 The nursing profession design and qualitative data collection methods that also lays emphasis on providing holistic care and ensuring describes the candid views of patients who hitherto that patient values guide all clinical decisions and also may not want to disclose their preferences for fear of emphasizes that patients have the fundamental right to be victimization. treated as individuals. This in turn enhances their personal •• Contrary to the dominant narrative from the devel- dignity and shows respect for their cultural, psychosocial oped world that gender is key on the preferences list and spiritual needs.16 According to nursing theorists Watson of patients, this study reveals that patients in the case and Leininger, a patient is a unique individual and should be context are more interested in the quality of health respected, nurtured, understood and assisted and provided service delivery, performance of nurses and the level with culturally competent care.17 As human beings, they of nurse–patient relationship developed as such, the have diverse beliefs, desires, values, needs and preferences. performance of nurses and the quality of health ser- To satisfy the needs of a patient and render proper and indi- vice delivered have nothing to do with gender. vidualized nursing care, one needs to appreciate the prefer- ences of patients and offer them accordingly to satisfy the Background needs of the patient. This study describes patients’ preference for the gender of The nursing profession focuses on the care of individuals their nurses in developing country settings. The study also and their families to help them recover from sickness and explores the range of factors that determine these gender- maintain optimum health and quality lifetime. Nurses are related preferences, in settings where the views of patients required to perform activities contributing to the patent are not critically considered in the overall health delivery health and recovery.1 system. The study is particularly timely due to the many These include intimate procedures that require constant lapses observed in the health care provision in Ghana. contact with the patients, no matter the body part involved in order to promote recovery.2,3 Although these procedures involve touches that are task-oriented, they might produce Method feelings of discomfort, anxiety, and fear or might be misin- Design terpreted as having a sexual purpose.4 These procedures include: bed bathing, examining the cervix for dilation, shav- The study adopted an exploratory descriptive design. This ing of the perineum, circumcision, examination of the breast, allows for in-depth exploration, understanding and narration giving an enema, inserting urinary catheters, bandaging the of patient’s preferences for their nurses’ gender. scrotum and sterilizing the vaginal area.5 Furthermore, pro- cedures that require intimate touch can cause feelings of Setting embarrassment, discomfort, anxiety and fear for both the nurse and the patient.6 Consequently, there may be the pref- Participant recruitment and data collection took place at a erence for a particular gender of a nurse to ensure comfort Teaching Hospital in Ghana. This Hospital is the second and relaxation of patients during such intimate procedures. largest hospital in the country and the only tertiary health Globally, existing researches indicate that patients have institution in the Ashanti Region. Besides, the Ashanti region varying preferences when it comes to the gender of their of Ghana is believed to be the region with the most diverse nurses.7,8 A study in Jamaica by9 indicates that gender prefer- culture, therefore, preferences of patients in this region may ences are stronger among female patients than among male represent preferences of a cross-section of Ghanaians. Asante et al. 3 Population different files. Unique names were then given to these files. Similar files were brought together during this process. Participants consisted of male and female patients, 18 years Initial codes were generated by organizing the data into and above admitted to the medical and surgical adult wards, meaningful units. The generated codes were combined to not bed ridden or seriously ill and nursed by both female and form themes. Field notes taken during the period of audio- male nurses for at least 5 days from January to March 2017. taped interviews were also read and analysed together with the transcribed data. Through the process of creating differ- Sampling and sample size ent files, themes and their subthemes were named to describe patients’ preference for nurses’ gender in nursing care in The purposive sampling technique was used to select the which descriptive report has been provided to capture the participants for this study. After gaining ethical approval responses of participants in the write up under the findings with the management of the hospital, the target population section backed by verbatim quotes from participants. The were introduced in the various wards, contact was made with main themes and the sub-themes are presented and supported the patients to gain their confidence, inform them about the with their anonymized verbatim quotations from the partici- purpose and processes involved in the study and written pants below. informed consent sought from those who met the inclusion criteria and willing to participate. Information sheet and con- sent form were provided to them to sign or thumbprint. The Trustworthiness sampling size depended on the data saturation when there was no new information forthcoming during interviews with Firstly, credibility was ensured by demonstrating that a true research participants. The data was saturated at the 14th picture of the phenomenon under scrutiny is being pre- participant. sented. A purposive sampling was used to select the required respondents who could share ideas on their gender preference in nursing care. Same questions were asked in Data collection different ways to ensure the honesty of responses. Besides, All guiding interview questions were pretested using two member check was conducted by verifying the responses (14%) participants at a university Hospital in Ghana and with the respondents after the interview to ensure that their analysis of their responses were used to effect changes in the stories have been well documented before conclusions interview guide before it was administered to the main par- drawn. The participants were assured of the confidentiality ticipants. A semi-structured interview guide (file attached) and anonymity of information provided. This made partici- was used to conduct a one-on-one face-to-face interview to pants talk freely without fear because they believed their explore the choice of the gender of a nurse that is preferred real names were not used for them to be identified. To by patients during nursing care. Most of the interviews were achieve transferability, the study sample taken was 14 conducted at the nurse manager’s office when they were not patients based on saturation. In addition, participants were in use and at the time when there were no routine medical or selected from different wards, tribes, religious background, nursing activity going on to ensure maximum privacy and educational level and age groups (see Table 1). Also, vivid relaxation of the participants. None of the patients approached description of the setting was done to provide sufficient refused to participate in the study. The interviews were detail of the context of the fieldwork for a reader to be able recorded on a voice recorder with the permission of the par- to decide whether the prevailing environment is similar to ticipants. Moreover, non-verbal responses and behaviour another situation. To achieve dependability of a study, clear including gestures and moment of confusion were also writ- questions were asked to elicit the responses that could ten down. The interviews lasted for at most 1 h and at least answer the research objectives as well as research ques- 45 min. The data collection and the data analysis were done tions. The participants expressed interest in the research concurrently. topic and joyfully responded to the questions asked. Also, the researchers identified correctly the themes and sub- Data analysis themes from the data. The researchers presented the find- ings that emerged from the data as a true reflection of the The data were analysed using content analysis,18 approach. respondents’ views and ideas about patients’ preference for The recorded interviews were transcribed verbatim. The nurses’ gender in nursing care. Moreover, the researchers researchers familiarized themselves with the data by reading bracketed their thoughts and values on the study. Also, the over and over for several times and paid attention to details participant’ responses were recorded, transcribed verbatim that captured their attention. Notes were made from the tran- and the themes that emerged were supported with direct scripts to identify phrases and sentences which captured the quotations from the participants to ensure confirmability. attention of the researchers. Statements and words which Transcripts were returned to the participants for comments were similar, same or common were grouped to form and corrections. 4 SAGE Open Medicine Table 1. Bio-data, medical condition and health needs of participants. Patient ID Age Gender/ Diagnosis Ward and time spent Procedure and type of care Gender (years) sex needed preference of nurse P01 18 F Pelvic Inflammatory disease Surgical special, 7 days Routine care Male P02 62 F Severe Hypertension Medical Special, 10 days Routine care Female P03 36 F Sickle cell Medical special, 5 days Routine care No Preference P04 35 M Gastritis Medical Special, 5 days Routine care Male P05 46 M Road traffic accident with Surgical B2, 7 days Routine/orthopaedic care No Preference multiple fractures P06 23 F Ruptured Appendicitis Surgical C4, 5 days Routine care/surgical Female procedures P07 36 M Hypertension Medical D3, 5 days Routine care Male P08 40 M Cellulitis Medical D4, 10 days Routine care Female P09 51 M Right inguinal hernia Surgical B1, 5 days Routine care/surgical Female procedures P10 25 F Bowel obstruction Surgical C3, 6 days Routine care/surgical Female procedures P11 24 M Severe Burns Surgical BICU, 14 days Routine care/wound dressing Male P12 31 F Diabetes Medical D5, 6 days Routine care No Preference P13 61 M Right lobar pneumonia Medical D3, 7 days Routine care No Preference P14 70 F Severe Burns Surgical BICU, 27 days Routine care/wound dressing No Preference Source: Field data collection, January–March, 2017. Results The preferred gender of a nurse in nursing care Although participants indicated that currently they were not This theme focuses on the choice of the gender of a nurse by asked of their preferred gender of a nurse when receiving patients during nursing care. Three sub-themes emerged nursing care, they mentioned the gender they would have from the data collected. These were: Patients’ Preference for preferred in case they were asked to choose. Two main Male Nurses in Nursing Care, Patient Preference for Female themes emerged from the data and these were: the preferred Nurses in Nursing Care and Patients with no Preference for a gender of a nurse in nursing care and the reasons for the pref- Particular Gender of a Nurse in Nursing care. erence or no preference for nurses’ gender in nursing care. The demographic characteristics of participants in the study Patients’ preference for male nurses in nursing care. Four par- will be discussed and this will be followed by the presenta- ticipants which included the two youngest participants indi- tion of the themes identified. cated their preference for a male nurse due to their unique characteristics of being smarter, healthier, energetic, hard- working and skillful in the management of conditions which Demographic characteristics of participants requires the use of medical equipment as compared to the Fourteen participants (patients) admitted to the Adult female nurse. This is how one of them verbalized it: Medical and Surgical Wards between January and March 2017 were sampled. Seven patients were interviewed from A male nurse will be chosen in some instances. . . A male nurse both the Medical and Surgical Wards for the study. The is energetic and skillful in the management of procedures department included Male Medical (D3 and D4) and female involving machines (PO1, 18 years, F, surgical special ward) medical (D5), male surgical (B1 and B2), female surgical (C3 and C4), Burns unit (B ICU) and Special Wards. Each A participant added that male nurses are smarter and patient had spent at least 5 days on the ward. The ages of hardworking. the participants ranged from 18 to 70 years. See details in You may be indifferent but will prefer a male nurse who is smart Table 1. and hardworking. . .. They were very, very smart in movement, compared to the women. Mostly the men are very energetic Organization of themes (PO3, 36 years, F, medical special ward) The analysis of the study revealed two themes and six sub- In a less straightforward manner on the issue of patients’ themes. See Table 2 for the details. preference of male nurses for nursing care, participants Asante et al. 5 Table 2. Themes, sub-themes and quotations. Themes Sub-themes Quotations The Preferred Patients’ Preference for Male “you may be indifferent but will prefer a male nurse who is smart and hardworking. . .. They were very, very smart in Gender of a Nurse Nurses in Nursing Care. movement, compared to the women. Mostly the men are very energetic” (PO3, 36 years, F, medical special ward) in Nursing Care. “A male nurse will be chosen in some instances. . . A male nurse is energetic and skillful in the management of procedures involving machines” (PO1,18 years, F, surgical special ward) Patient’s Preference for “I prefer a female nurse. The elderly female nurse is a woman and therefore a mother. My mother and my sisters take care Female Nurses in Nursing of me when I am not well. . .” (PO8, 40 years, M, medical D4) Care. “I feel so relaxed and comfortable when I am being nursed by a nice-looking young nurse” (PO8, 40 years, M, surgical B4) Patients with no Preference “A nurse may treat you well because she is in a good mood but, the next day her mood may change, and will be fighting with for a Particular Gender of a you. Human character is not static, it changes most of the time. As at now, I cannot say I prefer this gender of a nurse or Nurse. the other” (PO11, 24 years, M, surgical BICU. “I don’t have a preference. No ooo. In all situations, I will be indifferent. For almost every aspect of the hospital treatment I have met both the men and the women and almost in all situations, it depends on the person and not the gender. Whether a radiologist, a nurse or a doctor” (PO12, F, 31 years, medical D5). Reasons for the Patients’ Gender as a Reason “It feels more comfortable . . .It is easier to talk to them about several things than the opposite gender. Like, menstrual Preference or no for the Preference of the cramps. It feels like they understand you better because they also experience it” (PO6, 23 year, F, surgical C4). Preference for Gender of a Nurse in Nursing “In terms of privacy I would prefer a male nurse (same gender) because I will feel shy before a female nurse when I am Nurses’ Gender in care. naked. The male nurse is my fellow man and will not gossip about my private parts” (P08, 40 years, M, medical M4). Nursing Care. “When the nurse of the opposite gender dressed the wound on my penis it wasn’t well done. She couldn’t take her time to clean the wound around the penis and scrotum. She also couldn’t hold the penis well enough to bandage. It didn’t take much time for the bandage to loosen and remove. But the male nurse took his time to clean around the scrotum and the penis and bandaged them properly the previous day” (P09, 51 years, M, surgical B1). Health Status and as a “I remember at my initial stay at the ward I was always naked and it got to a time that the female nurses told me to cover determinant for Patients’ my nakedness and stop scaring them but I never mind them because that time the pains were unbearable and I did not Preference for Nurses’ notice anybody as a female or a male, my main concern was with my injury and the pains and how to recover” (PO11, Gender. 24 years, M, surgical BICU). “If you are unconscious, what can you do? Look at this man (he pointed to the ward). He has been soiling himself. The nurses bath him every morning and change his diaper, do you think he will be able to tell them that he wants a male or a female nurse?” (P05, 46 years, M, Surgical B2). Qualities of Nurses not “My preference is not about the gender of a nurse but about the good qualities in a nurse such as expertise, caring, efficient, Gender as a determinant for empathetic, neat and attentive because that shows the difference” (PO12, F, 31 years, medical D5). Patients’ Preference of Nurses “The things that I will look out for in a good nurse are not gender based. . . .Someone who is tolerant, compassionate and in Nursing Care. pays attention to patients. Yes, that is what I look out for. It is just the person’ s behaviour that makes the difference and not the gender” (PO3, 36 years, F, medical special ward). 6 SAGE Open Medicine revealed their preference for male nurses after intensive Patients with no preference for a particular gender of a nurse in probing about their preference for nurses’ gender in nursing nursing care. This sub-theme describes participants who had care but three of them including a female participant were no preference for a particular gender of a nurse. That is, par- not consistent with their preference. ticipants who preferred both genders equally or do not prefer Two of the participants had this to say: any of the genders of nurses. Five participants emphatically stated that no matter the situation they were indifferent. I prefer a male nurse only when I am asked about my preference Firstly, they disclosed that the gender of a nurse does not (PO4, 35 years, M, medical special ward) determine the attitude of a nurse. They preferred any gender of a nurse with the characteristics such as nice and good. One I will prefer a male nurse but not in all instances (PO7, 36 years, of them remarked: M, medical D3) I don’t have a preference for a particular gender of a nurse. From participants’ views, it looks like a lot of male nurses Some female nurses are good and some male nurses too are are needed in the nursing profession especially, to comple- good so, the gender does not tell who is good and who is not ment the services of female nurses due to their greater good. I prefer a good nurse (PO13, 61 years, M, medical D3) strength and technical know-how. Likewise, a participant said this boldly: Patients’ preference for female nurses in nursing care. Five out of the fourteen participants boldly indicated that they pre- I don’t have a preference. No ooo. In all situations, I will be ferred “elderly” female nurses and young beautiful nurses to indifferent. For almost every aspect of the hospital treatment I take care of them when ill. This points to the age as a factor have met both the men and the women and almost in all situations, that defines their gender preferences. Such preferences could it depends on the person and not the gender. Whether a radiologist, be attributed to the socio-cultural structure in Ghana, where a nurse or a doctor (PO12, F, 31 years, medical D5). elderly women are seen as mature and caring, when it comes to health care provision. Some participants revealed that, they have also observed that Some participants specified that they prefer elderly human character is unstable, it depends on the sentiment of female nurses who are mothers, more tolerant and polite in the person at the time of interaction. This was how two of the dealing with patients. This is what one of them had to say: participants expressed it: A nurse may treat you well because she is in a good mood but, I prefer a female nurse. The elderly female nurse is a woman and the next day her mood may change, and will be fighting with therefore a mother. My mother and my sisters take care of me you. Human character is not static it changes most of the time. when I am not well. . . (PO8, 40 years, M, medical D4) As at now, I cannot say I prefer this gender of a nurse or the other (PO11, 24 years, M, surgical BICU. Two participants added the following expressions: Hmmm! I cannot prefer one to the other because, human beings I prefer elderly female nurses who have patience. Especially the cannot be predicted. It depends on the mood of the person when old women they have respect for patients. . . because they are interacting with you (PO3, 36 years, F, medical special ward) mothers and they have children who can get the same problem (PO14, 70 years, F, surgical BICU) Reasons for the preference or no preference for From participants’ voices, elderly female nurses have the nat- nurses’ gender in nursing care ural tendency to render proper nursing care to patients because of the care-giving role of elderly females in the society. Three sub-themes emerged from this theme. These included: However, two male participants revealed that they always Patients’ Gender as a Reason for the preference of a particu- preferred a female nurse who is young and attractive. They lar gender of a nurse in nursing care, Health status as a deter- said that with smiles on their face. minant for Patients’ Preference for Nurses’ Gender and Qualities of a nurse as a determinant for Patients’ Preference I prefer young, beautiful nurses. . .I would like to see beautiful of a nurse in Nursing Care. ladies with nice faces and converse with them (PO9, 51 years, M, surgical B1) Patients’ gender as a reason for the preference of the gender of a nurse in nursing care. Participants revealed that the reasons I feel so relaxed and comfortable when I am being nursed by a for preferring a particular gender of a nurse for nursing care nice-looking young nurse (PO8, 40 years, M, surgical B4). were because of their gender. Some participants had a prefer- ence for the nurse of the same gender whiles others have a According to the participants, it appears that being nursed by preference for a nurse of the opposing gender. a young good-looking female nurse makes them relaxed and Participants indicated that it feels more comfortable to relieved from their illness. be nursed by the same gender. It is easier to open up and Asante et al. 7 communicate to them about several things and ask ques- sexual context then, it’s ok. He is going about his duty. I felt the tions because they understand them better. Additionally, same way as a female nurse would have done it. I mean I am still they were relaxed during procedures requiring them to talk naked (PO3, 36 years, F, medical special ward). about sensitive issues or exposure of the nakedness without feeling shy when a nurse of the same gender was providing Participants who preferred the opposite gender for nursing the care than the opposite gender. care were all males. One participant indicated that, a nurse The participants had this to say: with the opposite gender shows a lot of attention and com- passion to him when performing procedures but the same It feels more comfortable . . .It is easier to talk to them about gender nurses do not. several things than the opposite gender. Like, menstrual cramps. It feels like they understand you better because they also Because you are a man and he is also a man he doesn’t look at experience it (PO6, 23 year, F, surgical C4). your face during the procedure but the female nurses show a lot of concern. . . (PO4, 35 years, M, medical special ward). Usually, it’s ok to relate to a female nurse . . . But if it was a male nurse, I wouldn’t feel comfortable to tell him. . . so I might keep The expressions of participants give the impression that it to myself until I get a female nurse to help me because, they some patients consider attentiveness of a nurse as a necessity understand my emotions . . . (P10, 25 years, F, Surgical C3). and not just going about the duty. Another participant also indicated that by the nature of his In terms of privacy I would prefer a male nurse (same gender) work he hardly comes across females so he preferred to be because I will feel shy before a female nurse when I am naked. nursed by a female nurse. Secondly, the beauty, the therapeu- The male nurse is my fellow man and will not gossip about my tic touches and the tender loving care of female nurses private parts (P08, 40 years, M, medical M4). enhance his recovery. In a similar way, it was found that a nurse with the same With the nature of my work, I hardly come across women so, I gender was able to perform procedures around the genitals would like to see beautiful ladies with nice faces and converse better than the opposite gender because the nurse of the with them. Also, when female nurses touch me or hold any part opposite gender becomes nervous when handling the of my body, it serves as a massaging point and sends chemical genitals. messages, positive ones to enhance the healing of my body. (P13, 61 years, M, medical D3). When the nurse of the opposite gender dressed the wound on my penis it wasn’t well done. She couldn’t take her time to clean the Health status as a determinant for patients’ preference for wound around the penis and scrotum. She also couldn’t hold the nurses’ gender. Participants pointed out that the reason behind penis well enough to bandage. It didn’t take much time for the their choice of a preferred nurse was due to the condition on bandage to loosen and remove. But the male nurse took his time admission. Participants confirmed that when you are seri- to clean around the scrotum and the penis and bandaged them ously ill, unconscious or in a critical condition, you cannot properly the previous day (P09, 51 years, M, surgical B1). indicate your preference because you may not be aware of yourself, not having the energy to talk and the gender of a Moreover, a female participant shared her experience that nurse might not concern you in that state. Moreover, your relating to the opposite gender was not easy due to opposite concern will be on your health and whoever will help you gender attraction because she could not conclude on the psy- recover, not necessarily on a male or a female nurse. This chological impact of her interaction with the male nurse. She participant had this to say: noted: If you are unconscious, what can you do? Look at this man (he A male will misunderstand you and wouldn’t want to get too pointed to the ward). He has been soiling himself. The nurses attached to you perhaps he might have a different feeling for bath him every morning and change his diaper, do you think he you. The female is all general about female emotions (PO12, F, will be able to tell them that he wants a male or a female nurse? 31 years, medical D5). (P05, 46 years, M, Surgical B2). However, some participant confidently said that, there Similarly, some participants shared their stories below: should be no problem when nurses are providing intimate care for the opposite gender because nurses have the duty to When the male nurses are coming, I don’t even see them as provide all manner of care for patients of all genders. So far males. I only see them as human beings. My mind is always on as they are carrying out their responsibility appropriately, it my pains. So, it depends on the situation. . .I have been naked should be accepted. One participant had this to say: severally before the male nurses and the female nurses when they are dressing my wound and I have never been shy, my I feel so long as there are no inappropriate things done, it’s ok. focus is on how I will get my healing without complications To bath you, he needs to touch you. If he is not doing it under (PO14, 70 years, F, surgical BICU). 8 SAGE Open Medicine I remember at my initial stay at the ward I was always naked and their fears, anxieties and emotions. It must also be noted that it got to a time that the female nurses told me to cover my job at the Komfo Anokye Teaching Hospital does not have a nakedness and stop scaring them but I never mind them because clear policy on providing for the gender preferences of that time the pains were unbearable and I did not notice anybody patients who come to the facility. Consequently, most as a female or a male, my main concern was with my injury and patients have not developed the need to consider gender in the pains and how to recover (PO11, 24 years, M, surgical BICU). the criteria for choosing their nurses. It may be true that preference for nurses’ gender is mainly for patients who are fairly ill and not seriously ill. Moreover, Discussion of findings patients’ condition matters to them and not the choice of Findings from this study points to varied reactions of patients nurses’ gender in nursing care. to their gender preferences for nurses. The result of several studies conducted in different geographical location world- Qualities of a nurse not gender as a determinant for patients’ wide with different methodology reviewed that, participants preference of a nurse in nursing care. Most participants who had varying preference for the gender of their nurses as a declared of not having a preference for nurses’ gender result of their individual demographic characteristics.19,20 explained that their preference was not based on the gender While the earlier studies cited above present some related of a nurse but rather on the good morals and professional knowledge on patients’ gender preferences of nurses who qualities of a nurse because that indicates a competent and a provide them health care, the current study extends the dis- good nurse and not the gender. course with deeper qualitative engagements to unpack the varied factors influencing these choices, in a facility where My preference is not about the gender of a nurse but about the there were limited options. good qualities in a nurse such as expertise, caring, efficient, The current study appears to have the choice of female empathetic, neat and attentive, because that shows the difference nurses embedded in the preferences of most of the patients (PO12, F, 31 years, medical D5). studied. This seems to have a link with the inherent socio- The participants also noted that, a nurse with good quali- cultural belief that nursing and health care provision is a ties exhibits characteristics such as caring, attentiveness, female-dominated work. patience, encouraging patients, having a cheerful face and Consequently, only few participants preferred male nurses showing concern for patients. to provide care for selected conditions (See Table 1). This study findings are similar to the findings of other studies The things that I will look out for in a good nurse are not gender with different health workers which noted that only few par- 21,22 based. . . .Someone who is tolerant, compassionate and pays ticipants prefer male practitioners. In contrast, the find- 23 attention to patients. Yes, that is what I look out for. It is just the ings of showed that majority of patients prefer male doctors person’s behavior that makes the difference and not the gender to attend to them. Though this study did not explore patients’ (PO3, 36 years, F, medical special ward). preferences for the gender of doctors, it connects with another socio-cultural belief that most doctors are males. Additionally, other participants indicated that when a The choice of female nurses and male doctors by a typical nurse is assigned to take care of patients, it is an indication patient could be linked to socio-cultural connotations. Thus, that the nurse is a professional with the capabilities and have in the current study, male participants chose male nurses the license to practice and render proper nursing care to only when they were hard-pressed to make a choice. patients. Therefore, there would be no need to worry about Again, the present study found that the preference for a the gender of the nurse. male nurse was due to their unique characteristics of being smarter, healthier, energetic, hardworking and skillful in the When the nurse is a professional and licensed, the gender will management of conditions which requires the use of medical not be considered. She will be able to render proper care (PO14, equipment as compared to the female nurse. The preferred 70 years, F, surgical BICU) characteristics of male nurses in this study’s findings cor- roborate with the findings of a number of literatures24,25 A synthesis of the patients’ views quoted above shows which stated that male nurses are suitable for tasks involving that the gender of nurses is not as important as their quality physical labour and dealing with violent and irritable of service, performance, professionalism and ability to effec- patients. Additionally, male nurses are believed to be perfect tively carry out the procedure involved. Even in the instances in performing job requiring technical skills because men are where patients suggested their preferences for specific gen- good at handling machines.26 der of a nurse, it was related to the kind of activity they A female participant in this study added that for female expect the care provider to perform. Thus, patients connected nurses, age and stress of the work often show on their appear- their gender preferences more to the procedures and activi- ance, they easily get fatigued and emotionally down unlike ties involved in providing care than other reasons related to the male nurses and are less likely to perform the expected Asante et al. 9 task at the workplace. The above findings reflect the findings However, some participants in this study expressed that it of27 and.28 In addition,29 reported about the differences in feels more comfortable and there is little or no shyness to be health, productivity and quality of care in younger and older nursed by same gender. Similarly, most patients preferred a nurses and concluded that almost all the older nurses had same-gender urologist and nurse because they feel less higher pain scores, and a higher prevalence of having health embarrassed with them during treatment.44 The participants problems, and reported a higher health-related productivity in the current study went further to explain that it is also loss than younger nurses. They added that, nurses who are easier to communicate with the same gender about several 50 years and above are less likely to accomplish the expected things including sensitive issues and also ask questions task at work. This also challenges with the findings reported because they understand them better than the opposite gen- in earlier studies which stated that older student nurses had der. These findings identify with related studies in Iran and more positive attitudes leading to more productivity and this Saudi Arabia which indicated that practitioners and nurse– was attributed to more mature views about the reality of age- patient gender differences are one of the hindrances to proper ing.30 Another study by31 contrasted that, elderly nurses are communication between nurses and patients, which affects highly skilled and productive and reported less aches and nursing care. The research further stated that adequate nurse– pains; moreover, their accumulated experience, communica- patient communication creates hope, increases compliance tion skills, dedication and loyalty often exceed that of their with a care plan and treatment regimen and improves treat- younger colleagues but were not specific to female or male ment outcome.45,46 The views of the participants in this study nurses. Another contradictory finding of32 revealed that age, seem to suggest that it would be difficult to relate to the gender and clinical practice experience do not impact on car- opposite gender and there may be tension on the part of both ing behaviour. Moreover, some studies revealed that, male the nurse and the patient when care that requires exposure of nurses are respectful, considerate, good listeners, and have the genitalia of patients of the opposite gender is required. good interpersonal relationship with patients than female Other studies found that physician gender had a variable nurses. In the same vein, they were observed to show con- impact on female patient’s preference for a chaperone. cern for their patients.33,34 Furthermore, a number of partici- Almost all the participants47 considered the presence of a pants in the present study preferred elderly female nurses chaperone appropriate during intimate physical examination. because they are perceived to be mothers and have respect The most commonly cited reasons included the protection and time for patients. This corroborate with the findings of35 against sexual harassment, and to provide psychological who stated that participants who preferred female obstetri- support.48 cians believed that they are more understanding because of It was identified by participants of the present study that, going through childbirth themselves, they have sympathy for if you are seriously ill or unconscious you would not be able patients. But contrary to other studies, elderly female mid- to make your preference known; as a result, you accept any wifes are found to be rude to women during delivery, ignor- gender of a nurse for nursing care.49 This showed that the ing and neglecting them during suffering despite their yelling severity and types of illnesses determine the level of partici- for help.36,37 Moreover, young beautiful nurses were pre- pation of a patient in his care and this is consistent with the ferred by some participants of this current study because of findings of the present research. Similarly, patients’ partici- their attraction and beauty. Closest findings from the litera- pation in medical encounters depends on the degree to which ture were not found, however according to,38 younger patients asked questions, were assertive, and expressed con- Chinese student nurses have more positive attitudes towards cerns. Therefore, an unconscious patient cannot indicate patients. preferences.50 Contrary to the discovery of most previous published The participants in the current study went further to studies that nurse’s gender is an important factor in deter- emphasize that they mostly prefer nurses with characteristics mining the majority of patient’s choice of a nurse in nursing such as good, nice, expertise, caring, efficient, empathetic, care39,40 in this current study, participants both men and neat, attentive and hardworking to determine a preferred women had no specific preference regarding the gender of nurse and both genders of nurses can possess these qualities. their nurses. This study observed that, gender does not deter- This agrees with a study by11 that most Israel women reported mine the quality of a nurse’s performance, human character that the gender of their gynaecologist or obstetrician was not is not static, it depends on the sentiment of the person at the an important determinant when choosing a gynaecologist or time of interaction. These support the findings of 41 that both an obstetrician. Their major consideration in their choice of male and female nurses are good no matter the environment a gynaecologist or an obstetrician included professionalism, in which they are working, they are able to make a difference good manners and board certification. Secondly, this study’s in the lives of many. The study of 42 also confirmed that per- findings are in agreement with the findings of.51,52 In their sonality traits showed consistency, however, can change sys- research, respondents consistently reported that they consid- tematically. This was also agreed by43 that human behaviour ered the qualifications, experience and technical skills is unpredictable. important when choosing a urogynaecologist, obstetrician 10 SAGE Open Medicine and gynaecologist while the gender of a practitioner was less of patients from the rural settings might be different. Again, all important to them.51,52 By comparison it was found that the the participants were from the medical and surgical wards; current study and the study of 51 had similar result but uses therefore, preferences of patients from other wards might be different words in describing the characteristics of a pre- different. As a result, a replication of the study is recommended ferred nurse, for example, experience and expertise, good with patients from other departments of the Komfo Anokye manners and hardworking. Teaching Hospital. Moreover, a subsequent quantitative ver- The present study additionally revealed that being nursed sion of this study in public, mission and private hospitals is by a professional nurse who has the license to practice gives recommended in Ghana to justify statistical connection. much confidence and does not make one worry about the gender of a nurse. A study by53 confirmed to the findings of Conclusion this study that professional nurses are capable of providing effective and efficient care and the gender does not make a Patients have preference for their nurses. They prefer a nurse difference. Additionally,54 found in their study that although with professional expertise and good qualities such as car- patients with incontinence had a statistically significant pref- ing, efficient, empathy, neatness, attentive, respectful and erence for the gender of their provider, patients with different hardworking yet others are interested in being nursed by a diagnoses did not place importance on their gender prefer- gender of a nurse as that enhances their wellbeing. It would ence. Interestingly, participants with erectile dysfunction be ideal to match patients with the nurses of their choice in were also not worried about the gender of their urologist order to ensure patient satisfaction. This, however, may not because participants’ concern were on the professionalism be possible in most hospitals as health facilities do not have and the expertise of the care provider. adequate capacity to satisfy patients’ needs and preference In other studies, there is evidence suggesting that stereo- and do not factor patients’ preferences into health policies. types of the male identity being strong, independent and self- Other factors need to be taken into accounts such as nurses’ reliant make them reluctant in disclosing their preference expertise, availability and attitude towards patients. These due to fear of being embarrassed and victimized.55 This may challenges prevent patients from becoming comfortable and be the reason for majority of male participants not having satisfied with health care. It is essential that health care pol- preference for a particular gender of a nurse in this present icy makers factor patients’ needs and preferences into health study. In addition, some studies indicated that, majority of policy to satisfy the preferences of patients. It is also impor- females have been identified to have preference for the gen- tant that nurses demonstrate good attitude towards patients to der of their care giver more than males because women have improve the recovery process of patients. Health training much concern with issues of modesty.56,57 Interestingly, the institutions should increase the number of male intakes in the results disagree with this current study’s findings. In the pre- nursing training schools to cater to patients who prefer male sent study, few female participants were gender-biased and nurses. this finding is in line with the findings of.44 In their study, they found that the female participants did not care about the Acknowledgements gender of the health care provider because of being familiar We would like to extend our sincere appreciation to the patients at with both male and female nurses as well as the good atti- the Adult Medical and Surgical Wards of the Komfo Anokye tudes of male nurses. Teaching Hospital, Kumasi-Ghana who participated in the study. Therefore, it appears that the current study’s finding of absent preference for nurse’s gender was as a result of diverse Authors’ Contributions demographic characteristics of the sample such as age, tribe, AOA, KAK and CA were responsible for the conception and study religion and educational level. Interestingly, it showed that design. AAO performed the data collection. AAO, KAK and AC because patients in Ghana have not had the chance to be contributed to the analysis of the data. AAO and AC were involved choosing a preferred nurse’s gender most patients were toler- in drafting the manuscript and revising it critically for important ant and familiar with both male and female nurses. intellectual content. All authors have read and approved the final Additionally, the setting of the study being medical and sur- manuscript. gical ward may not require much exposure and technical skills for patients to care about the gender of a caregiver. Availability of data and materials Future research on determinant of women preference for All datasets generated during the current study are included in the their midwives in Ghana is recommended. published article and its supplementary files. Limitations Declaration of conflicting interests The author(s) declared no potential conflicts of interest with The sample for the study was only limited to patients in a single respect to the research, authorship, and/or publication of this Teaching Hospital in the urban setting, therefore, preferences article. Asante et al. 11 Funding 6. Shakwane S and Mokoboto-Zwane S. Demystifying sexual The author(s) received no financial support for the research, author- connotations: a model for facilitating the teaching of intimate ship, and/or publication of this article. care to nursing students in South Africa. Afr J Health Prof Educ 2020; 12(3): 103–108. 7. Juliff D, Russell K and Bulsara C. Male or nurse what comes Ethics approval and consent to participate first? Challengemen face on their journey to nurse registration. The study was approved by the ethics committees of the Komfo Austr J Adv Nurs 2016; 34(2): 45–52. Anokye Teaching Hospital, Kumasi-Ghana with the registration 8. Anglade P, Ibrahim H and Abdel-Razig S. Does provider number RD/CR17/021 and receipt number K/16/0163177. The par- gender matter iendoscopy? An international perspective. ticipants signed consent form after indicating their willingness to Gastrointestinal Endosc 2021; 93(5): 1160–1168. participate in the study. All methods were performed in accordance 9. Adeyemi-Adelanwa O, Barton-Gooden A, Dawkins P, et al. with the relevant guidelines and regulations. Written informed con- Attitudes of patients towards being cared for by male nurses in sent was obtained from all participants. a Jamaican hospital. Appl Nurs Res 2016; 29: 140–143. 10. Turan Z, Özge ÖNER and Atasoy I. Male and female nursing Ethics approval students’ opinions about gender and nursing as a career in tur- key: a qualitative study. Nurs Educ Pract 2021; 53: 103078. Ethical approval for this study was obtained from the ethics com- 1 1. Amir H, Abokaf H, Levy YA, et al. 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