{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:00:36Z","timestamp":1790373636975,"version":"4.1.0"},"reference-count":80,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Nursing Review"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To synthesize existing evidence to inform targeted recruitment strategies and interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The ongoing global shortage of nurses presents a significant threat to healthcare delivery. Addressing this requires an understanding of why pre\u2010nursing students choose to or avoid nursing as a career. A key deterrent is the profession's negative image, often associated with \u201cdirty work.\u201d However, current literature lacks a comprehensive view of the factors shaping these perceptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nine databases were searched from inception to October 2024. Eligible studies included quantitative, qualitative, and mixed\u2010methods designs focusing on pre\u2010nursing students\u2019 perceptions of nursing image. A five\u2010stage framework analysis structured the findings, and Bronfenbrenner's social\u2013ecological model categorized factors at individual, interpersonal, and societal levels. The JBI Convergent Integrated Method integrated qualitative findings and qualitized quantitative evidence according to these levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010two studies (9034 participants) from 14 countries were included. Individual\u2010level factors included gender stereotypes, knowledge of the profession, perceived work attributes, and intrinsic motivation. Interpersonal\u2010level factors included the role of family, peers, and exposure to nursing professionals. Societal\u2010level factors included media portrayals, sociocultural norms, and targeted recruitment interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Factors converge across levels, and passive visibility alone is insufficient to shift entrenched views. Post\u2010COVID \u201chero\u201d narratives may increase visibility but also reinforce associations with fatigue and difficult working conditions. Improving pre\u2010nursing students\u2019 perceptions of nursing image requires sustained, coordinated, multilevel recruitment strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for nursing<\/jats:title>\n                    <jats:p>Educators and healthcare institutions may consider strategies that challenge gender stereotypes, engage parents and peers, provide structured exposure to nursing roles, and strengthen leadership\u2010focused media portrayals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for health policy<\/jats:title>\n                    <jats:p>Recruitment strategies should be supported by policy and aligned with efforts to address structural conditions that shape nursing image, with the ultimate goal of strengthening the future nursing workforce and as part of workforce planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/inr.70234","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:02:22Z","timestamp":1790337742000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nursing Image Among Pre\u2010Nursing Students: A Mixed\u2010Methods Systematic Review with Future Directions on Recruitment Strategies"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4221-9871","authenticated-orcid":false,"given":"Shin Syuen","family":"Lee","sequence":"first","affiliation":[{"name":"Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6694-8679","authenticated-orcid":false,"given":"Joko","family":"Gunawan","sequence":"additional","affiliation":[{"name":"Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0138-5881","authenticated-orcid":false,"given":"Siriwan","family":"Lim","sequence":"additional","affiliation":[{"name":"Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6067-9578","authenticated-orcid":false,"given":"Ivan","family":"Rubbi","sequence":"additional","affiliation":[{"name":"School of Nursing Ravenna Campus University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7406-5160","authenticated-orcid":false,"given":"Vivien K. G.","family":"Lim","sequence":"additional","affiliation":[{"name":"Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine Department of Management &amp; Organization NUS Business School National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8326-4049","authenticated-orcid":false,"given":"Sok Ying","family":"Liaw","sequence":"additional","affiliation":[{"name":"Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3928\/01484834\u201020051201\u201002"},{"key":"e_1_2_13_3_1","unstructured":"Andrews K. E.2005. \u201cPerceptions of High School Boys Toward Nursing as a Career Choice\u201d (Order No. 3167305). 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