Attitudes and Opinions of Health Care Students of Medical Faculty in Banja Luka about Study Program and Nursing as a Profession

Introduction: The level of education quality of medical health care graduates (Bachelors of Health care and Nursing) depends on curriculum quality. Knowing what motivates students to enroll medical health care studies and development of professional and academic career are of great importance for education as well as the practice. Aim of the study: To see if there is a difference in attitudes and opinions between 1st year students and 4th year students about health care study program and nursing as a profession, students motivations for enrolling the program and their expectations about possibilities to develop personally, professionally and scientifically after graduating. Patients and Methods: 55 Health care students of Medical Faculty University of Banja Luka (1st year 37 and 2nd year 18 students) were a sample. Research was conducted by using anonymous, original questionnaire which was written for the needs of this research. SPSS (Statistical Product and Service Solutions) version 20. was used for data processing, and Windows, operating system, for data analysis. Results: Conducted research shows that material component, with possibility of finding better job and willingness to care for other people are major criteria which motivate students to choose nursing study. Health care students of both generations graded study program with 3,22 ± 0,76, and there was statistically significant difference (p<0.001) concerning access to literature and companion paper. Both generations of students have positive attitudes about nursing as a profession. Majority of the students (1st year = 77,8%; 4th year = 75,7%) showed interest for further academic development after graduating the study of Health care. A large number of students chose going abroad (1st year 67,6% ; 4th year 77,8%), whereas minority of the students have desire to stay in their own country after graduating. Conclusion: Motives for enrolling the study of Health care in this country and in other countries have no significant differences, and the most frequently cited reasons are possibility of finding better job, and desire to help other people. Academic study program of Health care should be extremely high-quality and alluring enough to draw attention of young students as well as the older students.


Introduction
Medical Faculty University of Banja Luka founded Health care study program in school year 2007/08.Title which is gained after finishing this study program is Bachelor of Health care and Nursing.
[3][4] Level of education quality of medical health care graduates depends on curriculum quality.Integrative study conducted by literature review shows quality of nursing curricula which were published during a period of forty years.This study shows that only eight out of 27 studies include students' opinions about curriculum.The results point that there are significant limitations which are related to quality level improvements of curricula. 5Education programs for nurses must be based on constant monitoring and self-evaluation of work and cognitive research. 2Health care students should be theoretically and practically qualified for performing health care procedures within their competence. 6[9] In our country there is not knowledge about students motives for enrolling health care studies as well as their expectations for their personal, professional and scientific development of nurses after graduating.

Aim of the study
To see if there is a difference in attitudes and opinions between 1st year students and 4th year students about health care study program and nursing as a profession, students motivations for enrolling the program and their expectations about possibilities to develop personally, professionally and scientifically after graduating.

Patients and Methods
All respondents were 1st year and 4th year students of Health care students of Medical Faculty University of Banja Luka.55 students were involved in the research (1st year 37 (67%) and 4th year 18 (33%) students).Research was conducted in December 2014, during regular classes.
For the needs of this research, original questionnarie was constructed on the basis of important literature review, and research was conducted by anonimus questionnarie which was given to students.
Questionnaire was made of 25 questions, divided into three parts:   There was not statistically significant difference between 1st year and 4th year students p˃0.05 in their opinions and attitudes about professional and scientific advancement of nurses.
Majority of health care students (1st year = 77,8%; 4th year = 75,7%) showed interest for further academic progress in field of nursing after graduating health care study program.
Students had their opinion about nursing profession (Table 3).There was not statistically significant difference between 1st year and 4th year students in their opinions and attitudes about nursing as a profession ( p<0,05).
92.7% of respondents consider that nurses or medical technicians are not adequately paid for the work they do.
In relation to the degree of interest for performing tasks most of the students chose to work in their profession as Bachelors of Health care and Nursing (1st year 40.4%; 4th year 55.6%), and for managerial job as head nurse (1st year 43,2%; 4th year 27.8%).There is great interest among students for teaching (1st year 18.9%; 4th year 27.8%).There is not statistically significant difference between 1st year and 4th year students concerning abandonment of nursing profession (t = 1.28, p = 0.21).
Most of the students chose to work abroad after graduating (1st year 76.6%; 4th year 77.8%).

Discussion
Results of our research show that there is statistically significant difference between the ages of respondents (p<0.001).Majority of the tested 1st year students was at the age of 18 to 22, and majority of the 4th year students was at the age of 23 to 27.Distribution by gender of both generation points that there is significantly larger number of females.According to the data from the literature, females, in their middle ages, are more likely to choose nursing as a profession compared to men.Age difference significantly affects the motives and expectations of the students.Students, who are a bit older than the average, accepts new knowledge, and younger students contribute significantly to constant scientifically and professional progress in nursing. 7In conducted research (96,4%) of the students are unemployed.Others researches show that employment among students is significantly higher, and that their employment has little affect on their academic achievements. 7,9,12 our study half of the studets finished medical high school, whereas the study coducted in Bahrian (2012)  shows that all students who enroll the studies have degree from medical high school. 8 for the criteria that motivate studets to choose nusring study, the dominant factor is said to be material component with possibility of fiding better job.There is also great willingness to help others.][9][10] In coutries around the world there is obvious deficit of nurses which enables people in this profession to find jobs fast and more easiely and also to have long time position . 11ngitudinal research on the evaluation of nursing curriculum at Southern Cross University in Australia points that average grade was from 3.89, in 2006, to 4.00, in 2008. 12Health care students evaluated curriculum and the quality of the practical work of teaching with 3,22 ± 0,76.For students to give higher evaluation of curriculum, it is neccessary to work to improve curriculum which would ultimately mean better education.
Both generations of students showed great interest for further academic progress in graduate health care studies.Data from the literature point similar results. 7,8,13urther academic progress contributes to professional and scientific improvement of nurses, and it also justifies the introduction of doctoral studies for nurses in our country.Majority of the students is ready to work as nurses after graduating without thinking of leaving nursing profession.[15] The importance and role of Bachelors of Health care and Nursing are still not enough recognized.
In order to promote health care as better as possible, it is necessary to make development health care strategy and involve nurses who have positive attitudes.Health care students have positive attitude about nursing, but at the same time they think that nursing is not appreciated profession in Republic of Srpska.[16] Health care students mostely dissagree that nursing is female profession, although there is dominance of females.Similar results are obtained in other researches where students defended the idea that gender should not be the key factor in the choice of profession. 18,19wever, the study of Karabacak and associates (2012)  found that male health care students are differently perceived by the public in relation to female students, because it had long been believed that nursing was exclusively female profession. 20 a survey conducted among doctors and nurses both groups of respondents estimated to have a low level of personal involvement in their organizations and insufficient participation in work teams, and nurses considered themselves to be inferior to physicians. 21Research conducted in Italy suggests that nurses throughout history did not have rights similar to other health care professionals. 22The results of our study show that nursing in health care institutions does not operate within the framework of autonomy and that nurses should be more involved in policymaking.This result could explain the numerous problems in nursing: the low status of health care, poor financial status of nurses, unregulated issue of education and vocation of nurses, as well as poor motivation for improving the quality of health care.
When we asked:"Where would you like to work after graduating?", majority of students chose to go and work abroad (1st year 67,6% ; 4th year 77,8%), while a smaller number of students expressed a desire to remain in their country.4][15][16] So far, establishing a European labor market for occupations in the health sector has not led to extensive migration among the EU member states.However, in the coming years the mobility of health professionals is expected to increase.The motives of health professionals to leave their country can be attributed to low wages, poor working conditions, undefined competence, lack of health resources and limited opportunities for career advancement. 23

Conclusions
The results of this research showed that the motivations of enrollment of health care in our country and other countries do not differ significantly.The dominant factor is said to be material component with possibility of fiding better job.There is also great willingness to help others.
Students generally expressed a positive attitude about nursing as a profession and evaluated study program with a relatively high grade, while 1st year and 4th year students' opinions were divided in terms of available nursing literature.
The results show that it is necessary to try to improve curriculum in accordance with the needs of the labor market and European guidelines for study program to have better quality and to draw attention of younger and older students.
This research shows that the implementation of longitudinal studies with 1st year students at the end of their schooling, with the same measuring instrument, would give a more complete picture of the health care study.

and the
smallest number of respondents who are within the age group of 33 to 37 (6%), and generation of 2014/15 school year has the biggest number of respondents who are within the age group 18 to 22 (97%), only 3% those who are within the age group of 23 to 27, t(53) = 6.23, p=0.000.The largest number of respondents finished medical high school -50, 9%, and than those who finished high-school (gymnasium) 25, 5 %, and 23, 6% of students who finished other high schools.Of total number of respondents 56, 4% finished high school in 2014 (2011,9 ± 3,3).Among the respondents there is a majority of those who are unemployed (96, 4%).Respondents of Health care study program of MedicalFaculty University of Banja Luka agree the most with the claim that they will find a better job after graduating Health care studies (I year 81,1%; IV year, 66,6%) and with the willingness to help other (1st year, 78,4%; 4th year, 72,2%).Students do not agree with the claim of inability to enroll what they wanted at first (1st year, 18,9% ; 4th year, 16,7%).

Table 1 .
Students' attitudes and opinions about health care study program Results of the attitudes and opinions of health care students' research are compared by the T-test of the independent samples (Table1.).There was not statistically significant difference in evaluating health care study program and top quality practical training between 1st year students and 4th year students.There is statistically signicicant difference regarding availability of professional literature among 1st year students (3.43 ± 0.87) and 4th year students (2.5 ± 1.19); t (55) = 3.42, p = 0.001 (mutual).Students had professional and scientific advancement in their expertise (Table2.).

Table 2 .
Students' attitudes and opinions about professional and scientific improvement of nurses a d.f.= 55 p <0.05 is considered statistically significant

Table 3 .
Students' attitudes and opinions about nursing as a profession