Nursing Students Perception Of Faculty Role Models Nursing Essay

Abstract

Background: Professional role modelling is key component in educational arena, where teachers serve as best role models for the students. It serves as a primary way to impact students search for meaning, purpose, and value in their personal and professional life.. Therefore, to be able to assess what students perceived about their faculty approach as role modelling, we conducted a study to explore the students’ perceptions and experiences about the faculty role modelling at a private School of Nursing in Karachi, Pakistan.

Methodology: This study followed qualitative framework, considering group of diploma programme students as a ‘case,’ data was collected through semi structure interviews from fifteen representatives of all three years of diploma programme. All students of the diploma programme were approached for their voluntary participation. Subsequently, purposefully equal participation was considered from all three years of the diploma programme for their representation in the study. Tape record interviews were transcribed with major thematic analysis of the verbatim.

Findings: Participants in the study mentioned their disappointment with the ambiguity in their faculty as role models. While the faculty reinforced students to be equipped with the expected knowledge and demonstration of discipline, they themselves did not follow the same. The findings revealed that ‘Professional role modelling’ needs to be encouraged with the provision of appropriate mentoring and continued education of nurse educators. Participants strongly felt that though the nurse educators are well equipped with clinical skills, they lack in clinical and classroom teaching skills.

Conclusion: There is significant association between professional role modelling by nurse educators and students learning outcomes. Therefore, faculty members should demonstrate proper role modelling and practice what they preach while reinforcing professionalism.

Provision of appropriate mentoring and continued education can facilitate nurse educators to become the role models for nursing students to follow.

Key words: nurse educator, professional role modelling, students’ learning outcomes

Introduction:

The period of college/university education is accompanied by a significant transition of an individual from adolescence to a young adult; often requiring the students to meet several demands and challenges of education. Traditionally, the depth or accuracy of learning is usually expressed through assessment scores without major focus on cognitive, affective or behavioral learning (Lizzio et al, 2002); this reflects the basic educational system of Pakistan too. With transition to the university education, the students are often required to meet several demands and challenges; moving more towards cognitive, affective or behavioral learning than rote memorization. With this shifting paradigm, students’ perceptions influence their approach towards education and influences their overall learning outcomes (Lizzio et al, 2002), and their health and coping with the challenges of education. Learning environment, course structure and teaching methodology contribute overall towards the students’ coping and learning within these challenges of education. On the other hand, nature and structure of higher education have an implication on students’ well-being as they are often concerned with poverty, and become withdrawn and psychologically distressed (Dooris, 2001b).

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A similar change of educational environment is usually faced by the students when they enter their nursing education. Students in nursing education are required to meet academic demands which make them feel strained. This altered state of mind often impacts negatively on their academic function and health (Seyedfatemi et al, 2007). In this journey, teachers serve as a backbone of educational arena. Similarly, their teaching approach and mode of instruction plays crucial role in the development of conceptual learning in students. Considering nursing as an learning arena of specialized skills, nurse educators has to take prime position to ingrain the knowledge and skills in young future nurses, while motivating them to be self directed learner and sound decision makers.

Dooris (2001b) has identified the nature and structure of higher education as one of the factors affecting students‟ well-being. Nursing education require students to engage in several study hours. Struggle in meeting the requirements of various assignments and clinical (Seyedfatemi et al, 2007) often impacts on the mental health (Dunne and Somerset, 2004) of the nursing students. In the same line, faculty plays a vital role in creating positive learning environment and serve as a role model in the development of knowledge, skills and attitude in students (Glicken and Merenstein, 2007).

Students are required to meet the several demands of nursing education, markedly higher then what is expected in pre-nursing education level in Pakistan. Concerns of students’ poor coping with the academic demands and hostel stay are often reported at various forums and at different nursing programme faculty meetings, at selected School of Nursing, also highlighting students’ expression of uncertainty and helplessness. This alter state of mind, often make students’ prone for mal adaptive coping behaviours like excessive worrying, sleeplessness and feeling of loneliness; impacting negatively on their academic function and health (Seyedfatemi, Tafreshi and Hagani, 2007). This study is an identified factor of the Master’s study conducted to explore the Emotional well-being of Diploma Nursing students.

Since, positive, motivational and unbiased learning environment has optimistic impact on students’ learning outcome in university setting (Lizzio et al, 2002); Papp, Markkanen and Bonsdorff (2003: 267) have rightly stressed that, “students should be treated equally and with consistency throughout their education.” In the same line, faculty plays a vital role in creating positive learning environment and serve as a role model in the development of knowledge, skills and attitude in students (Glicken and Merenstein, 2007). Therefore this study was conducted to explore the students’ perceptions and experiences about the faculty role modelling at a private School of Nursing in Karachi, Pakistan.

Methodology

Interpretative paradigm was opt to assess diploma nursing students’ perception their subjective meanings and definitions of the emotional well-being and its related factors (Clough and Nutbrown, 2007; Creswell, 2007; Laverty, 2003; Sandelowski, 2000; Merten, 1998). Qualitative approach was considered to obtain the interpretative in-depth analysis of the experience, perceptions and understanding of research participants (Neuman, 2003; Munhall, 1989).

Considering the ‘group’ of diploma programme students as prospective participants of this study, a Case Study approach was used as a guide to progress in this research project, as it provides chance to the researcher to have intimate knowledge of participants’ feelings (Polit and Beck, 2004; Yin 2003). Case study involves exploration of case/s within a bounded system (in a specific context) like in this study being in a diploma nursing programme (Creswell, 2007).

Study setting

Support Services for Students at selected School of nursing

Every student at selected school of nursing has a faculty advisor who guides them in their academic issues as and when required. Students are expected to visit their respective advisors at least three times a semester and also on the basis of their need (, 2006; , 2007a; , 2007c). Ambreen.Tharani2011-02-21T12:00:00

How can i refer to meeting minutes of AKU-SONIn addition, to support students emotionally, a student counsellor, who is a professional psychologist, is also available and provides support to students on need basis.

Sample:

Sampling was done in two stages. Initially, whole population of interest that is all the students of the diploma programme were contacted via their institutions’ student email identification, providing them with the study details and inviting for voluntarily participation in study.

As suggested by Polit and Beck (2004), to obtain the in-depth assessment, limited number of participants was selected in this case study. Considering that the participants’ perspective may vary with their years of experience in the programme and their status of accommodation (Neuman, 2003); in the second stage, equal participation was encouraged from all years of diploma programme (n= 15), representing both the day scholars (n1=7) and hostel resident students (n2=8).

Data collection and Analysis:

Systematic data collection was conducted via individual semi-structured interviews using the interview guide to explore participants’ experiences (Neuman, 2003) and perceptions (Robson, 2002). Interview was audio-taped and a journal was maintained to record participants’ impressions, reactions and other significant information during the interview (Rudestam and Newton, 2001; Speziale and Carpenter, 2003). Efforts were made to decrease the limitations of the study. Ethical consideration was taken into account throughout the research to maintain confidentiality, anonymity and providing a follow-up mechanism to the study participants to prevent any sort of harm.

Audio-recorded information was transcribed and thematic data analysis of data was done based on Laws (2003).

Trustworthiness:

Credibility, transferability, confirmability and dependability (Polit and Beck, 2004) were ensured in this study. Considering these criteria, credibility was ensured by cautiously interpreting and presenting the responses of the participants. For promoting transferability, detailed description of the context of the study is provided while disseminating the data for possible transfer of findings in other settings (Polit and Beck, 2004). For dependability, the process and the product of the research were carefully examined for its consistency. For confirmability, stepwise record of the raw data was constructed and maintained, followed by data reduction and reconstruction, synthesis of products and subsequent analysis (Polit and Beck, 2004).Ambreen.Tharani2011-02-22T08:28:00

Can we remove these details or as suggested by you we can purely move it to the discussion part

Ethical Consideration

Ethical consideration was ensured following the British Educational Research Association-Code of Ethics. Along with that, Institutional Ethical Review Committee (of data collection site) was accessed and written approval was obtained for research. Director of Diploma Programme and the Dean of selected school of nursing were approached in person to state the purpose and process of the research, along with obtaining Dean’s permission for data collection

To consent for voluntary participation, adequate information was provided in the consent form regarding the purpose of research, their participation requirement, possible risk and benefits, financial consideration and their wish to decline the participation (Speziale and Carpenter, 2003). Permission was also sought for the participants before tape-recording the interviews. To ensure anonymity and confidentiality during data collection, tape-recording, data transcribing and data analysis, the participants were addressed and referred to with respondent numbers.

As this study focuses on the perceptions and feelings of the participants, the possible harm to the respondents would be emotional. My experience as a mental health nurse has helped me to utilize the therapeutic communication, including broad opening, being non-judgmental, paraphrasing and clarifying (Videbeck, 2005) during the interviews. Ambreen.Tharani2011-02-22T08:26:00

How to rephrase this- i m confused

Findings:

Learning Environment

The participants felt that the major focus of the faculty at SELECTED SCHOOL OF NURSING was on professionalism. While reinforcing professionalism, they often put undue restrictions on the students, which in turn lead to limited learning opportunities and they felt that they were being discriminated against other students.

Yes, another important thing is environment; environment in terms of professionalism. Again the teachers are around you, students are around you, so there behaviour has an impact on us and you will adopt those things … People in other programme are more professional. They [teachers] restrict in dressing which is not on other programmes. (Respondent 6)

In this study, the participants identified various factors in the environment that impacted their learning and emotional health likes: high expectations, ambiguity in role modelling, and teaching approach of faculty members. In addition, large classrooms played a crucial role in students’ learning and eventually on their emotional health.

4.2.2.1 High Expectations

Participants in this study reported too many expectations by the faculty members and academia at SELECTED SCHOOL OF NURSING . Three participants strongly mentioned that they should not be considered as ‘born nurses’ by the faculty members.

When faculty are hired they should be taught several things before giving them teaching responsibility. Students are students not born learners. (Respondent 6)

They felt that the high expectations in clinical and theory made them stressful. Furthermore, stress of going on clinical made them anxious. To make learning environment positive, they emphasized that faculty should be more supportive and flexible to understand the students’ problems.

Clinical take too much stressor, during performance and skills. We need time to adjust and faculty expect to do each and every thing like skills lab, in front of patient and in front of staff there. It gives stress. (Respondent 12)

Teachers expect that on clinical we should know every thing and when we don’t know, she doesn’t teach us, and say why you don’t know this? We are students and in learning process. This thing disturbs students a lot. (Respondent 5)

To support students at clinical, one of the participants stressed on the need for more faculty ‘coordination’ with and ’emotional support’ of the students.

You [faculty] should keep yourself in students’ shoe and see how much stress you are giving to students…You should coordinate with students more to understand what problems they have? With some personal problem sometimes students does some mistake on clinical and then they are put on learning contract, without thinking what they are going through. Coordination should be done with students. Though we have advisors who guide us but teachers should emotionally support students. (Respondent 2)

One of the participants found challenges related to the transition from life at home to life in the hostel and university:

…In hostel, we have to do many things by ourselves which our parents use to do for us. Like we have to wash our clothes we have to make breakfast and no one to wake-up us. Besides that clinical! When I have to go clinical I even don’t sleep previous night. I have disturbed sleep and I become very upset when I go on clinical. (Respondent 14)

To study participants, the high expectations set by faculty members at clinical also resulted in poor image of the students. They were highly concerned about their image in front of the faculty members. To participants, a similar image is communicated to the other faculty members with their shift in clinical placement and with their progression to next academic semester and/or year.

…then these impression goes to other faculty, my image was disturbed in front of all. (Respondent 6)

Most of the participants suggested that the students should be provided with ample time to practice their learnt skills and concepts in a non threatening environment under faculty guidance.

During clinical, students should be keep relax because these are all practical work and with practical work; more practice makes you perfect. When we are more anxious we even forgot small skills. Teacher should remind us but in relax manner because we are dealing with lives of patients. (Respondent 14)

One of the participants also talked about the difference in academic and summer clinical as:

I don’t know but I feel so because when we go on clinical we are in so much tension that if are going to be put on learning plan. That’s make us more fearful …I find summer clinical are different because fear of learning plan was not there. (Respondent 14)

Therefore, for policy implementation, participant suggested that:

People who are running institution should not take students as sometimes machines. They are here for studies, should get particular stuff and should go back. Yes, there are requirement of institution that should be fulfilled. But still they should consider and policy should be flexible … At time it can be changed, it is not so as it is done by somebody from another planet that we can’t change. There should be ways. (Respondent 10)

4.2.2.2 Assessment Criteria

Students, in each semester at SELECTED SCHOOL OF NURSING , are required to take multiple subjects and face various assessment criteria. In addition, they are required to meet the clinical component of all the courses. As a result, they complained of being overwhelmed and felt that their ‘productivity’ got impacted when they had to meet all the requirements.

Don’t give to much stress to students so there others things are not being suffered. Gap should be given after clinical, before the assignments are expected, so we can work in more productive way. (Respondent 2)

Another participant suggested that they should be given ample time after clinical to refresh themselves.

Students go on clinical from too long hours so they should get time for refreshing themselves. (Respondent 3)

Students, with their transition to university education, also faced difficulty with time management. They always seemed to be struggling to meet the academic deadlines. Similar concern of time management was raised by the participants with the examination schedule, which often gave them ‘stress.’

Another thing is that, all paper comes together. In a week we have 3-4 paper together and we cannot utilize time effectively [translated]. It gives stress. (Respondent 9)

The mostly impacting factors are exams. In which me often feel a lot of burden because there are too many things scheduled together. Then our clinical comes simultaneously and then assignment comes… Then you can imagine how much stress it can cause. (Respondent 2)

Highlighting similar concerns of time management and university academic schedule, one of the study participants suggested provision of ample time to the students to prepare for the examination and the clinical.

Students should be given enough time so they can easily do preparation for themselves. (Respondent 1)

4.2.2.3 Ambiguity in Role Modelling

Participants in the study mentioned their disappointment with the ambiguity in their faculty as role models. While the faculty reinforced students to be equipped with the expected knowledge and demonstration of discipline, they themselves did not follow the same. One of the participants reinforced that the faculty should also demonstrate respect for their uniforms when they emphasized that the students should observe a proper dress code.

… Faculty says that our uniform should be perfect but there are faculty whose buttons of Koti are open, there dupattas are inside their koti and they are very senior faculty. (Respondent 8)

The participants verbalized feelings of uncertainty when the verbal emphasis and role demonstration of the faculty were not congruent. These ambiguities made them feel ‘lost’ and being ‘targeted.’ One participant shared her feelings when she received vague instructions from the faculty as:

Every time we (student) have to listen. On clinical… teachers are saying stay with your patient though we are alone with our work patient says go away because we can’t stay on their heads. We are lost. (Respondent 8)

To participants, the faculty role model also counted in keeping up the image of nursing profession.

We are taught professionalism, I have seen teachers un professional in class, using language as they are at home … what impression we are giving to outsiders. (Respondent 6)

Students in nursing profession are expected to take responsibility of the action they take. While sharing an incident that took place at clinical setting, one of the participants emphasized that the faculty members should be honest and take responsibility for their action. She mentioned that as a result, she herself was emotionally disturbed and was unable to take care of the patient as expected.

The mistake was done by faculty but on asking by staff she said it is students mistake … I feel I can’t say anything at that time … Yes it has an impact as I couldn’t explain medication to patient properly … Teacher should be honest with their student and should take responsibility of their action. (Respondent 12)

Referring to the responsible attribute of faculty, one of the participants mentioned:

If the faculty is fully prepared for their classes then they have right to scold us and expect from us but there are other teachers who are not prepare themselves and have too much expectation from us… If they are not prepare they should clearly mention; she can have problem as a human. (Respondent 6)

Another participant mentioned that this ambiguity on the part of the faculty as role model had ruined her expectation with the institution.

I came with very high expectation that I will learn their culture, their languages and I will learn the art of this culture. Then I came I found to some extend teachers abusive. I found that even they themselves are not professionals and asking me … they [faculty members] scold for what I don’t know. (Respondent 10)

One participant emphasized on appropriate role modelling as:

There are teachers who are prepared and excellent in teaching and if they expect/scold. I don’t mind at all. They should be proper role model. (Respondent 6)

For instance, few participants were open to accept flaws in the faculty role model. Along with that they suggested faculty to be open and transparent with the students.

Yeh, student should respect their faculty, but faculty should respect her students also. (Respondent 13)

4.2.2.4 Teaching Approach of Faculty

In this study, the participants have identified various factors related to teaching approaches that impacts their learning and emotional health, including faculty preparedness, lack of positive reinforcement, and self directed learning.

4.2.2.4.1 Faculty Preparedness

One of the participants in this study, highlighting the concern of faculty knowledge and experience, shared that:

Then again I identified that they are prefect nurses but they are not perfect teacher. For being a teacher they need to go through all the strategies and methodologies. They (faculty) are the beginners as I am. They are trying to find their own way in the ocean of institution. So the difference is of 3-4 years of nursing knowledge otherwise its same. (Respondent 10)

The participants also discussed about the teaching methodology used by teachers in classroom setting at SELECTED SCHOOL OF NURSING . They expressed feelings of their ‘time being wasted’ when faculty did not discuss but regurgitated information in class.

In some classes teacher’s just read from transparency. If they want to teach like this they just forward us the soft copy and we will read on our own. This will save your time and our time, and their expectations are too high. (Respondent 6)

One participant commented on faculty preparation in clinical area as:

They [faculty] should come prepare with their theory in class and in clinical. (Respondent 6)

To ensure students’ learning, the participants suggested that proper training need to be given to faculty members to develop their teaching skills.

Teachers should be nicely guided by the institution so they can guide students properly. (Respondent 10)

4.2.2.4.2 Lack of Positive Reinforcement

The participants emphasized on the importance of positive reinforcement provided by faculty and verbalized their feelings of hopelessness when they did not receive encouragement from the faculty.

I feel there is no use of doing hard work. If I have any weakness teacher should told me how I can make it better. (Respondent 6)

They reported that they get motivated and their self-confidence increases when they receive timely feedback from faculty on their (the students’) areas of improvement in a non-threatening manner. According to one participant:

If a student does something nice they should get encouragement for it … Students thinking gets limited when they are not provided encouragement. (Respondent 3)

Another participant suggested:

Faculty should give constructive feedback on ongoing basis so student improve… because it is wrong to give negative feedback at the end if ongoing feedback for improvement was not given. (Respondent 11)

4.2.2.4.3 Lack of Self Directed Learning

Participants in this study emphasized on need for self directed learning instead of long direct contact teaching hours at SELECTED SCHOOL OF NURSING .

Curriculum should be like that the teacher should give the overview and there should be some how less hours class, credit should be low, so we will use more library and LRC [learning resource centre], so we are more clear … (Respondent 14)

Students become submissive and dependent on the educators when they do not receive enough opportunity to be self-directed learners. They highlighted that the passive role developed in the nurses during academia continues in their professional life as well.

They [faculty] are not professional when they behave with students … that’s why the girls [student] are afraid and they break them [students], they break them all nicely, badly damaged showing you are a nurse, nobody else. You can’t take decisions, not for the patient and for your self. Then they are send in ward and very nicely they go under doctors, why? Because they are taught here like this. (Respondent 10)

One of the participants proposed that faculty should respect individual learning capacity of students and provide opportunities for self directed learning.

Allow us study in a way we want, every student strategy is different. If you accept that every teachers teaching strategy is different, why can’t you accept that every students learning capacity is different. (Respondent 8)

Likewise, participants emphasized that faculty openness and flexibility helped the students in learning and provided them comfort in clarifying their concepts with faculty.

If the teacher is very co-operative and if she understands your psychology … if she knows your way of learning … you will be more close and free to ask when you have difficulty understanding some concepts. If teacher is very dominating … like she is very stern and she is not flexible, so you will never ask anything. (Respondent 6)

Discussion:

Papp, Markkanen and Bonsdorff (2003: 267) have stressed that ‘students should be treated equally and with consistency throughout their education.’ Equal treatment of students is also highlighted in the principles and perspective of setting-based approach for health promoting university. Participants in this study highlighted that though the institution / university’s rules and regulations, and academic policies are uniform for all of its students, in practice, discrimination appears widespread. They felt that they were discriminated with students of other nursing and undergraduate programmes in the university.

An optimistic, motivating, and unbiased environment of learning has a positive impact on students’ learning outcome in the University setting (Lizzio, Wilson and Simons, 2002). In the same line, participants also highlighted various factors, like positive reinforcement, promotion of self directed learning and positive teaching approach of faculty, contributing towards their positive learning outcome and enhancing their emotional well-being.

Professional nurse educators are responsible for students’ learning in clinical practice (Papp, Markkanen and Bonsdorff, 2003). Simultaneously, the teaching approach of faculty creates the environment of either rote memorization or conceptual learning in education. Rothstein, Wilder and Jacobsen (2007:10) have emphasized that ‘a balanced curriculum should be concerned not only with what subjects schools teach but also with how schools teach them.’ The participants in this study felt that the appropriate implementation of the nursing curriculum can soothe their emotional distress and could also provide them positive learning outcome. Teaching is a special skill and medical university often come with little or no training or preparation on how to communicate knowledge and experience to the students (Glicken and Merenstein, 2007); a similar situation prevails in nursing education. The participants felt that the teaching skills of faculty members need to be strengthened as they have difficulty in communicating their concepts and experiences to the students. Agitation was found among participants as, to them, it wastes their time.

Curriculum implementation and faculty teaching approach promote self directed learning in students. Along with that, positive reinforcement in nursing education strengthens and supports students’ positive academic outcome. Hagbaghery, Salsali and Ahmadi (2004) found negative impact on students’ self-esteem and self confidence when they were not facilitated by their faculty for their problem solving and decision making skills. Ruth (2002: 120) has described self-esteem as ‘a positive regard to oneself’ and has found it as ‘a key component in restoring and maintaining mental and physical health.’ Consequently, participants found positive reinforcement as a motivational factor for students.

In the same line, clinical practice is considered an important part of nursing education (Papp, Markkanen and Bonsdorff, 2003). Participants reported that they got motivated and their self-confidence increased when they received feedback from faculty from time to time on their areas of improvement in a non-threatening manner. Glicken and Merenstein (2007) have reported that correcting students in front of patients was found to be unacceptable in some cultures; therefore, cultural acceptance and environmental feasibility need to be considered while providing timely feedback to students. Seyedfatemi, Tafreshi and Hagani (2007) found that a large amount of preparatory work for clinical as stressful for students. Participants also felt that high expectation in clinical and theory made them stressful. Participants’ responses were consistent with the findings of the External Review Report of SELECTED SCHOOL OF NURSING ( 2008) that highlights no promotion of self-directed learning in the diploma programme. Students become submissive and dependent on the educators when they do not receive enough opportunity to be self-directed learners. Seyedfatemi, Tafreshi and Hagani (2007: 2 of 10) found that, ‘Nursing students had to devote long hours to study, were given multiple assignments, and lacked free time ….’ Participant felt