The Effect of the NURSIM-KID (NURSE IMAGE-KID) Program for Hospitalized Migrant Children on the Nursing Image of Children and Parents: A Randomized Controlled Trial

Migrant children often experience illness and hospitalization more traumatically than their peers due to socioeconomic difficulties, language barriers, cultural adaptation problems, and limited access to health services. Hospitalization can trigger loneliness, insecurity, and fear, while language barriers hinder self-expression and communication with healthcare staff. Cultural differences may make the hospital environment and medical procedures appear confusing or threatening, and parents' limited participation in care can deprive children of emotional support. Identified language barriers, cultural differences, hygiene practices, low health literacy, and poor post-discharge care continuity as major challenges in caring for hospitalized migrant children. These factors complicate both children's treatment and nursing care delivery. The first interaction between migrant children and nurses plays a key role in shaping their image of the nursing profession. Nursing image is a dynamic, multidimensional concept that changes over time depending on one's social environment, culture, and experiences. According to Boulding's (1956) image theory, people's perceptions of a profession are shaped by their experiences and the messages they receive about it. Children, therefore, form their perceptions of nursing through direct hospital experiences, serving as neutral reflectors of professional image. However, existing studies have mostly focused on children's hospital experiences or satisfaction with nursing care, with limited research exploring their lasting impressions of the profession. For migrant children, the image of nursing is particularly affected by communication difficulties, cultural differences, and healthcare providers' attitudes. In a study by Güney, Düzkaya, and Uysal (2025), nurses reported challenges such as miscommunication, culturally inappropriate practices, patient safety concerns, time loss, and emotional fatigue while caring for migrant children. These challenges can lead children to perceive nursing as a distant, procedure-oriented profession that lacks communication and empathy. Negative perceptions, in turn, may reduce children's willingness to cooperate and engage in care. Yet, the image of nursing formed in childhood can significantly influence individuals' later attitudes toward healthcare services, their health literacy, and even career choices. Based on the ecological systems theory, individuals' behaviors are shaped by their broader social and familial contexts. Similarly, control systems theory emphasizes the importance of parent-child interactions in shaping attitudes and behaviors. Therefore, parents' perceptions of nursing indirectly influence their children's image of the profession. A multicenter study conducted in Türkiye found that children generally held more positive images of nursing than their parents, but parental attitudes remained an important determinant of these perceptions. Given these dynamics, structured programs that provide positive and meaningful encounters with nursing during hospitalization are essential for migrant children. The NURSIM-KID (Nursing Image for Kids) program was designed to assess and improve the nursing image among hospitalized migrant children aged 8-11 years. By introducing nursing in an interactive, age-appropriate, and culturally sensitive manner, the program aims to portray nurses as caregivers who provide support, trust, and compassion-not merely as medical professionals. Ultimately, NURSIM-KID seeks to identify negative perceptions early and foster positive, lasting attitudes toward nursing and healthcare among migrant children.