Exploring Diverse Perspectives on Nurses with Visible Tattoos: A Multi-Grounded Theory Approach

Abstract

Nurses are often represented by white scrubs, a testament to their purity and commitment to patient care. Tattoos, however, remain stigmatized in many societies. This study developed a contextually relevant conceptual framework explaining how visible tattoos on nurses are perceived in the CALABARZON region of the Philippines. Using the Multi-Grounded Theory (MGT) approach, semi-structured interviews were conducted with 30 participants purposively sampled to represent multiple perspectives: a) Stakeholders; b) Academia; and c) Multi-disciplinary Team. Interview data were manually transcribed, coded, and theoretically condensed to produce an empirically-anchored conceptual framework that explains the relationships among perspectives. The analysis produced three core, interrelated categories: (1) Identity—nurses use tattoos as markers of personal expression, (2) Perception—responses to visible tattoos are shaped by those who view them, and people value tattoos differently as the nature of their diversity, prompting nurses to employ management strategies to negotiate professional expectations, (3) Management. On the other hand, the study discovered that no management often occurs when they are viewed positively. Key findings include consistent generational differences, a general lack of effect on perceived clinical competence, but persistent bias influencing interpersonal interactions and trust in some contexts. Further grounding in theoretical congruence and coherence testing validated the intrinsic meaning of the emergent model. The conceptual framework may be used to inform institutional dress code and human resources policy, direct diversity and sensitivity training, and inform curriculum planning in nursing education to address professional image and inclusive practice. It adds to qualitative literature on nursing diversity in local health-care settings. It lays a foundation for cross-cultural comparison and future empirical study of appearance, trust, and workforce policy in the nursing arena. Definitely, this study should serve as a basis for inclusivity among tattooed nurses, who aim to deliver the care their duty requires.