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

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.

Visible Tattoos on Nurses, Multi-grounded Theory, MGT

1. Adisa, T. A., Adekoya, O. D., & Sani, K. F. (2021a). Stigma hurts: Exploring employer and employee perceptions of tattoos and body piercings in Nigeria. Career Development International, 26(2), 217–237. https://doi.org/10.1108/CDI-09-2020-0239 [Google Scholar] [Crossref]

2. Adisa, T. A., Adekoya, O. D., & Sani, K. F. (2021b). Stigma hurts: Exploring employer and employee perceptions of tattoos and body piercings in Nigeria. Career Development International, 26(2), 217–237. https://doi.org/10.1108/CDI-09-2020-0239 [Google Scholar] [Crossref]

3. Macaskie, M. (2024). Tattoos and self-expression: Are people more likely to get tattoos now than ever before? Epigram. https://epigram.org.uk/tattoos-as-self-expression-are-people-more-likely-to-get-tattoos-now-then-ever-before/ [Google Scholar] [Crossref]

4. Aronson, E., Wilson, T. D., & Akert, R. M. (2010). Social Psychology. Prentice Hall. [Google Scholar] [Crossref]

5. Baclig, C. E. (2020). Tattoos: The art that exhibits Philippine culture and history. (2020, November 18). Lifestyle.INQ. https://lifestyle.inquirer.net/374686/tattoos-the-art-that-exhibits-philippine-culture-and-history/ [Google Scholar] [Crossref]

6. Bălăceanu-Gurău, B., Apostol, E., Caraivan, M., Ion, A., Tatar, R., Mihai, M. M., Popa, L. G., Gurău, C.-D., & Orzan, O. A. (2024). Cutaneous Adverse Reactions Associated with Tattoos and Permanent Makeup Pigments. Journal of Clinical Medicine, 13(2), 503. https://doi.org/10.3390/jcm13020503 [Google Scholar] [Crossref]

7. Baumgardner, M. (2023). 10 Reasons Why People Get Tattooed. Medium. https://medium.com/@poisonivycreations/10-reasons-why-people-get-tattooed-ffbf13d47ff4 [Google Scholar] [Crossref]

8. Bazen, A., Barg, F. K., & Takeshita, J. (2021). Research Techniques Made Simple: An Introduction to Qualitative Research. Journal of Investigative Dermatology, 141(2), 241-247.e1. https://doi.org/10.1016/j.jid.2020.11.029 [Google Scholar] [Crossref]

9. Bhandari, P. (2022). Triangulation in Research | Guide, Types, Examples. Scribbr. https://www.scribbr.com/methodology/triangulation/ [Google Scholar] [Crossref]

10. Bilham, S. (2024). Does the presence of visible tattoos on nurses affect the therapeutic relationship? [Google Scholar] [Crossref]

11. Bisht, D. R. (2024). What is Purposive Sampling? Methods, Techniques, and Examples | Researcher.Life. https://researcher.life/blog/article/what-is-purposive-sampling-methods-techniques-and-examples/ [Google Scholar] [Crossref]

12. Boultinghouse, D. M. (n.d.). Visible Tattoos and Professional Nursing Characteristics: A Study on How Appearance Affects the Perception of Essential Qualities of Nurses. [Google Scholar] [Crossref]

13. Cabalquinto, A., Dizon, C., Ramirez, C., & Santiago, M. (2022). Batok: The Exploration of Indigenous Filipino Tattooing as a Collective Occupation. Occupational Therapy | Graduate Capstone Projects. https://doi.org/10.33015/ tigmatiz.edu/2022.OT.02 [Google Scholar] [Crossref]

14. Can Having Tattoos and piercings Hurt Your Chances at securing a Job? An Expert Answers. (n.d.). People.Com. Retrieved May 13, 2025, from https://people.com/can-having-tattoos-piercings-hurt-your-chances-securing-job-expert-answers-8641086 [Google Scholar] [Crossref]

15. Carpio, A. (2023). This 106-Year-Old Woman Is Keeping an Ancient Filipino Tattooing Tradition Alive. Condé Nast Traveler. https://www.vogue.com/article/apo-whang-od-and-the-indelible-marks-of-filipino-identity [Google Scholar] [Crossref]

16. CDC. (2025). Creating Inclusive Communication. Healthcare Workers. https://www.cdc.gov/niosh/healthcare/communication-resources/inclusive-communication.html [Google Scholar] [Crossref]

17. Clark, R. (2022). Tattoos, Employment, and the Law. ProfSpeak | Business Ideas and Resources. https://profspeak.com/tattoos-employment-and-the-law/ [Google Scholar] [Crossref]

18. Covell, Y. (2023). Do tattoos, piercings, or dyed hair make nurses less professional? Rcni.com. https://rcni.com/nursing-standard/features/do-tattoos-piercings-or-dyed-hair-make-nurses-less-professional-195196 [Google Scholar] [Crossref]

19. Credibility In Qualitative Research. (2024). https://www.simplypsychology.org/credibility-in-qualitative-research.html [Google Scholar] [Crossref]

20. Cronholm, S., & Remenyi, D. (2002). Grounded Theory in Use: A Review of Experiences. First European Conference on Research Methodology for Business and Management Studies (ECRM 2002) (Remenyi D, ed), Reading, UK, Apr 29-30, 2002. https://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-8266 [Google Scholar] [Crossref]

21. Cruz, M. D. (2023). Navigating Appearance-Based Challenges in the Workplace: Insights from Filipino Employees. LocalTalent.PH. https://localtalent.ph/navigating-appearance-based-challenges-in-the-workplace-insights-from-filipino-employees/ [Google Scholar] [Crossref]

22. Definition of MANAGE. (2025). https://www.merriam-webster.com/dictionary/manage [Google Scholar] [Crossref]

23. DeMarco, C. (n.d.-a). LibGuides: Section 3: Trustworthiness of Qualitative Data. https://resources.nu.edu/c.php?g=1013606&p=8394398 [Google Scholar] [Crossref]

24. EERA. (2020). Multi-Grounded Theory as a research methodology for theory development in education | Retrieved October 28, 2024, from https://eera-ecer.de/ecer-programmes/ conference/ 1/ contribution/857 [Google Scholar] [Crossref]

25. Rholetter, W. (2025). First impression (psychology) | EBSCO Research Starters. (n.d.). Retrieved May 14, 2025, from https://www.ebsco.com/research-starters/psychology/first-impression-psychology [Google Scholar] [Crossref]

26. Garcia, A., & Reyes, M. (2021). The evolution of tattoo acceptance in Filipino society. Philippine Journal of Cultural Studies, 15(2), 120-135. [Google Scholar] [Crossref]

27. Gilbert, N. (2008). Researching Social Life. The Centre for Research in Social Simulation. [Google Scholar] [Crossref]

28. Glaser, B. G. (1998). Doing Grounded Theory: Issues and Discussions. Sociology Press. [Google Scholar] [Crossref]

29. Goldkuhl, G., & Cronholm, S. (2010). Adding Theoretical Grounding to Grounded Theory: Toward Multi-Grounded Theory. International Journal of Qualitative Methods, 9(2), 187–205. https://doi.org/10.1177/160940691000900205 [Google Scholar] [Crossref]

30. Goldkuhl, G., & Cronholm, S. (2010a). Adding Theoretical Grounding to Grounded Theory: Toward Multi-Grounded Theory. International Journal of Qualitative Methods, 9, 187–205. https://doi.org/10.1177/160940691000900205 [Google Scholar] [Crossref]

31. Goldkuhl, G., & Cronholm, S. (2010b). Adding Theoretical Grounding to Grounded Theory: Toward Multi-Grounded Theory. International Journal of Qualitative Methods, 9(2), 187–205. https://doi.org/10.1177/160940691000900205 [Google Scholar] [Crossref]

32. Ichikawa, N., Yamamoto-Mitani, N., Takai, Y., Tanaka, M., & Takemura, Y. (2020). Understanding and measuring nurses’ professionalism: Development and validation of the Nurses’ Professionalism Inventory. Journal of Nursing Management, 28(7), 1607–1618. [Google Scholar] [Crossref]

33. Identity. (2025, May 7). https://dictionary.cambridge.org/us/dictionary/english/identity [Google Scholar] [Crossref]

34. Im, D., Pyo, J., Lee, H., Jung, H., & Ock, M. (2023). Qualitative Research in Healthcare: Data Analysis. Journal of Preventive Medicine and Public Health, 56(2), 100–110. https://doi.org/10.3961/jpmph.22.471 [Google Scholar] [Crossref]

35. Isaacs, D. (2012). Tattoos. Journal of Paediatrics and Child Health, 48(12), 1051–1052. https://doi.org/10.1111/jpc.12007 [Google Scholar] [Crossref]

36. Jansen, D. (2020, December 24). Qualitative Data Coding 101 (With Examples). Grad Coach. https://gradcoach.com/qualitative-data-coding-101/ [Google Scholar] [Crossref]

37. Kaufmann, L., & Armstrong, M. L. (2022). The Influence of Tattoos on Health Care Experiences. Journal of Continuing Education in Nursing, 53(4), 178–184. https://doi.org/10.3928/00220124-20220311-08 [Google Scholar] [Crossref]

38. Kirkegaard, A., Mitchell, L., Ball, L., & Williams, L. T. (2023). Developing the EQUIPED approach to quality management using multi-grounded theory. Nutrition & Dietetics, 80(3), 273–283. https://doi.org/10.1111/1747-0080.12780 [Google Scholar] [Crossref]

39. Lee, M. L., Kate Newby, Amanda. (2023). Nurses with visible tattoos and the issue of stigmatization by the public. British Journal of Nursing. https://www.britishjournalofnursing.com/ content/regulars/nurses-with-visible-tattoos-and-the-issue-of-stigmatisation-by-the-public/ [Google Scholar] [Crossref]

40. Lee, M. L., Kate Newby, Amanda. (2023, November 9). Nurses with visible tattoos and the issue of stigmatisation by the public. British Journal of Nursing. https://www.britishjournalofnursing.com/ content/regulars/nurses-with-visible-tattoos-and-the-issue-of-stigmatisation-by-the-public/ [Google Scholar] [Crossref]

41. Lidija Galović, Nikolina Farčić, Lasić, I., Barać, I., & Zvjezdana Gvozdanović. (2023). The Opinion of Patients and Nurses About the Professional Appearance in Nursing. Croatian Nursing Journal, 7(2), 107–115. https://doi.org/10.24141/2/7/2/1 [Google Scholar] [Crossref]

42. Lim, W. M. (2025). What Is Qualitative Research? An Overview and Guidelines. Australasian Marketing Journal, 33(2), 199–229. https://doi.org/10.1177/14413582241264619 [Google Scholar] [Crossref]

43. Madayag, R. A., Mallari, M. F. M., Dizon, D. S., Mangibin, R. A. P., Yumang, J. S., Mallari, J. D., Tanhueco, Ma. C. M., Lozano, D. A. A., & Fernandez, Z. S. (n.d.). A Mixed Methods Study on Character Traits of Nursing Students and Faculty Influencing a 100% Passing Rate in the Nursing Licensure Exam in the Philippines. Cureus, 16(9), e69911. https://doi.org/10.7759/cureus.69911 [Google Scholar] [Crossref]

44. Marketing of self: Using tattoos to symbolize ownership and control of one’s body. Narratives from Middle Eastern women—Khair—2022—Sociology Compass—Wiley Online Library. (n.d.). Retrieved May 13, 2025, from https://compass.onlinelibrary.wiley.com/doi/full/10.1111/soc4.13002 [Google Scholar] [Crossref]

45. Mashuri, S., Sarib, M., Alhabsyi, F., Syam, H., & Ruslin, R. (2022). Semi-structured Interview: A Methodological Reflection on the Development of a Qualitative Research Instrument in Educational Studies. [Google Scholar] [Crossref]

46. McLeod, S. (2023). Components of Attitude: ABC Model. (2023, June 13). https://www.simplypsychology.org/attitudes.html [Google Scholar] [Crossref]

47. Meeker, Z. (2024). Can Nurses Have Tattoos? Exploring Attitudes and Policies. (2024, June). Nurse.Com. https://www.nurse.com/blog/can-nurses-have-tattoos-nsp/ [Google Scholar] [Crossref]

48. Messineo, L., Seta, L., & Allegra, M. (2021). The relationship between empathy and altruistic motivations in nursing studies: A multi-method study. BMC Nursing, 20(1), 124. https://doi.org/10.1186/s12912-021-00620-4 [Google Scholar] [Crossref]

49. Morlock, R., & Morlock, A. (2023). Think Before You Ink: Perception, Prevalence, and Correlates of Tattooing and Tattoo Regret in US Adults. Cureus. https://doi.org/10.7759/cureus.48167 [Google Scholar] [Crossref]

50. Nease, B., Hester, S. W., Cassada, A. M., Stowers, C., & Fisher, G. (2021). Patients’ perceptions of care provided by nurses with visible tattoos. Nursing Management, 52(3), 44. https://doi.org/10.1097/01.NUMA.0000731940.09795.a6 [Google Scholar] [Crossref]

51. Nikolopoulou, K. (2022, July 20). What Is Non-Probability Sampling? | Types & Examples. Scribbr. https://www.scribbr.com/methodology/non-probability-sampling/ [Google Scholar] [Crossref]

52. Nursing Uniforms Through the Ages: A Historical Perspective – Style for the Seasons. (n.d.). Retrieved May 13, 2025, from https://stylefortheseasons.com/nursing-uniforms-through-the-ages-a-historical-perspective/ [Google Scholar] [Crossref]

53. Pablo, D. (2020, December 12). TATTOO HISTORY (PART I). No Land Tattoo Parlour. https://www.nolandtattooparlour.com/en/tattoo-history-part-i/ [Google Scholar] [Crossref]

54. Perception. (2025, May 7). https://dictionary.cambridge.org/us/dictionary/english/perception [Google Scholar] [Crossref]

55. Pittman, A., Gary, J., & Pepper, C. (2022a). An Integrative Review of Body Art in Nursing. Nurse Educator, 47(4), 197–201. https://doi.org/10.1097/NNE.0000000000001168 [Google Scholar] [Crossref]

56. Pittman, A., Gary, J., & Pepper, C. (2022b). An Integrative Review of Body Art in Nursing. Nurse Educator, 47(4), 197–201. https://doi.org/10.1097/NNE.0000000000001168 [Google Scholar] [Crossref]

57. Pullam, T. (2024). Nursing dress code: Explaining varying policies. Nursing Management, 55(5), 48. https://doi.org/10.1097/nmg.0000000000000116 [Google Scholar] [Crossref]

58. Pyo, J., Lee, W., Choi, E. Y., Jang, S. G., & Ock, M. (2023). Qualitative Research in Healthcare: Necessity and Characteristics. Journal of Preventive Medicine and Public Health, 56(1), 12–20. https://doi.org/10.3961/jpmph.22.451 [Google Scholar] [Crossref]

59. Read, 7 Minute. (2024, June). Can Nurses Have Tattoos? Exploring Attitudes and Policies. Nurse.Com. https://www.nurse.com/blog/can-nurses-have-tattoos-nsp/ [Google Scholar] [Crossref]

60. Richardson, K., Tortoriello, G. K., & Hart, W. (2020). Attitudes. In V. Zeigler-Hill & T. K. Shackelford (Eds.), Encyclopedia of Personality and Individual Differences (pp. 310–312). Springer International Publishing. https://doi.org/10.1007/978-3-319-24612-3_1777 [Google Scholar] [Crossref]

61. Sam, A. H., Reid, M. D., Thakerar, V., Gurnell, M., Westacott, R., Yeates, P., Reed, M. W. R., & Brown, C. A. (2021). The influence of candidates’ physical attributes on assessors’ ratings in clinical practice. Medical Teacher, 43(5), 554–559. https://doi.org/10.1080/0142159X.2021.1877268 [Google Scholar] [Crossref]

62. Sanchez, R. (2018). The Forgotten Filipino Tattoo Tradition. (2018a, April 29). The Forgotten Filipino Tattoo Tradition. https://filipinotattooculture.wordpress.com/ [Google Scholar] [Crossref]

63. Santos, M. L. L. C., & Villafranca, M. C. (2019). The Art in Pain on Becoming A Tattooed Person: A Grounded Theory. Asia-Pacific Social Science Review, 19(2). https://doi.org/10.59588/2350-8329.1223 [Google Scholar] [Crossref]

64. Selekman J. (2024). A new era of body decoration: what are kids doing to their bodies? Pediatric Nursing, 29(1). https://pubmed.ncbi.nlm.nih.gov/12630514/ [Google Scholar] [Crossref]

65. Stahl, N. A., & King, J. R. (n.d.). Understanding and Using Trustworthiness in Qualitative Research. [Google Scholar] [Crossref]

66. Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory, 2nd ed (pp. xiii, 312). Sage Publications, Inc. [Google Scholar] [Crossref]

67. Strauss, A., & Corbin, J. M. (1990). Basics of Qualitative Research: Grounded Theory Procedures and Techniques. SAGE Publications. [Google Scholar] [Crossref]

68. Tenny, S., Brannan, J. M., & Brannan, G. D. (2022, September 18). Qualitative Study. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470395/ [Google Scholar] [Crossref]

69. Tenny, S., Brannan, J. M., & Brannan, G. D. (2024). Qualitative Study. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470395/ [Google Scholar] [Crossref]

70. Tenny, S., Brannan, J. M., & Brannan, G. D. (2025). Qualitative Study. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470395/ [Google Scholar] [Crossref]

71. Teramae, L. (2021, October 18). Tattoos in the Workplace Are an Evolving Issue in Hawai‘i. Hawaii Business Magazine. https://www.hawaiibusiness.com/tattoos-workplace-evolving-policies-human-resources-hawaii/ [Google Scholar] [Crossref]

72. The Logic and Language of Classic Grounded Theory: Induction, Abduction, and Deduction | Grounded Theory Review. (n.d.). Retrieved May 14, 2025, from https://groundedtheoryreview.com/2023/06/22/the-logic-and-language-of-classic-grounded-theory-induction-abduction-and-deduction/ [Google Scholar] [Crossref]

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