Becoming a Nurse

A Hermeneutic Study of the Experiences of Student Nurses on a Project 2000 Course

Theresa Mitchell

• Publisher: Routledge
• Year: 2018
• Topic: Social Sciences
• eBook ISBN:
  9781351751940
• Subtopic: Social Work
• Index: Social Sciences

This title was first published in 2002: Presenting revealing insights into the structure and functioning of the Project 2000 courses, this book examines the original, creative and evolutionary research processes which led to the identification of student nurses' unique and common experiences, and portrays the learning milieu in which students developed a self-concept of being a nurse. Employing Heidegger's hermeneutic phenomenological approach, the book explores the concepts of intentionality, thrownness, being-in-the-world-with-others, temporality and active subject. It represents a substantial contribution to existing knowledge concerning student reflection and development, forms of teaching, leadership and supervision, and student exposure to a variety of experiences in clinical practice. It also contributes important new perspectives both to ongoing discussions related to socialization theory and to the qualitative methodology literature.

Part I
Modality and Motivation

1 Introduction

The introduction is usually written last, for only then will I be sure of what the account is about.

(Woods, 1999, p21)

It may seem strange to begin with this quotation, but for me, writing the introduction signifies a point of departure - the point where my work is handed over to the reader, and ownership of it ceases to be mine alone.

The journey encountered during the last six years has taken me through rough terrain, unknown territory and has exposed me to experiences associated with the intense pleasures and frustrations of being a part-time student in addition to full-time employee. The challenge has tested my stamina, stretched my capacity to learn and jousted with my character. My strengths have been illuminated and limitations exposed.

The aim in this introductory chapter is twofold; firstly to give reasons for my choice of topic and situate my research within the associated, existing literature and secondly to introduce the structure and style of the book to the reader and indicate the format of the study.

Background to the study

During the last decade nurse education has undergone significant transformation from the old ‘apprenticeship’ system to a diploma level education built upon a firm theoretical base. The desired outcome of these radical changes is an independent, assertive, autonomous nurse practitioner who is capable of responding to the health care needs of the population in the future (UKCC, 1986).

Within a diploma course [initially called ‘Project 2000’ because of its intention to prepare nurses for the year 2000 and beyond] students embarked upon a programme of study which, at the time this research was conducted, consisted of an initial 18 month common foundation period followed by a further 18 months in the chosen branch programme of either adult general, mental health, learning disabilities or sick children’s nursing. Project 2000 courses and subsequent courses derived from them contrast with the traditional nurse training model which I experienced as a student nurse, where we were part of the National Health Service (NHS) workforce and were therefore employed by the NHS, received a certificate level education, learned ‘on the job’ and were then registered as a nurse. By contrast, Project 2000 students receive a bursary, gain a diploma in higher education and registration for their chosen branch of nursing. The Diploma course demands greater academic involvement by the students where the emphasis has been on the application of theory to practice, rather than the acquisition of practical skills in order to ‘do the job’ as advocated on traditional courses.

Despite the demand for higher academic performance from students, minimum entry requirements remained the same, (5 GCSEs at A, B or C grade) although each college of nursing had their own stipulation with regard to entry qualifications.

The perceptions and experiences of student nurses have been of interest to educationalists for a long time. Professional socialisation of students into the role of the nurse has provided the focus for many research studies (Bradby, 1989; Buckenham, 1998; Conway, 1993; Davis-Martin, 1990; Day, Field, Campbell and Reutter, 1995; Macleod Clark, Maben and Jones, 1996; Melia, 1981; Oleson and Whitaker, 1968; Simpson, 1979; Wilson and Startup, 1991; Wyatt, 1978). All these studies, except Macleod Clark et al. (1996) and Buckenham (1998) were concerned with the occupational socialisation of students into nursing through traditional nurse training prior to the introduction of Project 2000 curricula. Without exception, they viewed socialisation as a process whereby those being socialised acquire the attitudes and values, with the skills and behaviour patterns, that constitute the ‘professional role’.

Professional socialisation is regarded as a specific aspect of adult socialisation (Goldenberg and Iwasiw, 1993) and is thought to occur through complex interactive processes which enable the professional role to be learned and the values, attitudes and goals, integral to the profession, to be internalised. For a full explanation of the complexities of adult socialisation theory, see Feldman (1976), Grbich (1990) and Mortimer and Simmons (1978).

My reading of the socialisation literature was motivated by high attrition and wastage rates for the first two Project 2000 courses in the area where this study was conducted. Only one third of all those who started the Course completed three years later and registered as nurses. As a nurse tutor I was concerned by students’ stories of thwarted expectations, disillusionment and dissatisfaction with the Project 2000 course [also noted by Parker and Carlisle, 1996] and subsequently by their lack of enthusiasm to continue. It seemed to me that this new, demanding and somewhat challenging phenomenon needed investigating for its impact upon individuals who wanted to be nurses.

My intention in the next section is to review pertinent socialisation studies which informed me of the overall picture in the nursing literature. It is not a review to provide background to the whole study, as I shall be introducing literature from a range of sources at appropriate points in the book.

An overview of pertinent nurse socialisation studies

Wyatt’s (1978) study focused upon the theory-practice gap and student experiences in hospital settings and was reviewed because of its similarity to Melia’s (1981) study conducted in 1979. Twenty-seven student nurses were interviewed in Wyatt’s study either in their second or third year of training. The data were analysed using a framework suggested by Becker, Geer and Hughes (1968), which proposes three components in the acquisition of a perspective; the definition of the situation, the activities one may engage in and the criteria of judgement used in the situation. All the participants in Wyatt’s study were female and comments relating to the ‘remoteness’ between tutors and students because of age differences imply that the students may well have been direct entrants from school. The aim was to elicit the perceptions of student nurses of their role and learning experiences on the wards, but all the student data were aggregated and analysed using descriptive statistics to determine ‘good’ and ‘bad’ features of training and the General Nursing Council syllabus. Within the analysis, there was no acknowledgement of individual development during training and no male or mature entrant perspective.

As a result of critiquing the socialisation studies of her time, Simpson (1979) is adamant that socialisation must be seen as individual change, perceived as a process or outcome or both. She supports the view that, in order to capture the essence of socialisation, examination of responses from the same individual at different points in time is essential. This enables the identification of persistent or changing dispositions or actions in response to exposure to nursing education and practice. Simpson cautions researchers against using data from different subjects at different times in a longitudinal study of socialisation and comments that snapshots are static and, even if chronologically arranged, may obscure connections which create diachronic patterns for an individual.

One of the findings from Simpson’s study, which was completed in 1965, was that students went into nursing to help others. They were less concerned with self expression, competitive achievement or other values that would individuate them. Students were not attracted to academic courses or experiences such as contact with non-nursing students which would de-emphasise or void their status as student nurses. Insulation of student nurses from other university students is an interesting issue which has been raised by the participants in my study (Chapters 8 and 9). Simpson’s large study revealed that occupational orientations are acquired; they do not simply mature.

The core contribution of Melia’s (1981) classic work is an analysis of student interviews at various stages during the three year traditional training period. Her study examined the issues discussed between herself and the students and provides a snapshot of experiences from students at different stages of their course. Data for Melia’s study were collected over a period of 18 months, comprising 40 hours of interviews at 8, 18 or 30 months into their training for the General Register. This means that she did not access any students undertaking mental health, learning disability or sick children’s nursing. The emphasis of her study is upon ward work and hands-on care and themes emerged concerning learning and working concurrently.

Six themes emerged from Melia’s data: “Learning and working” referred to those experiences associated with the theory-practice gap; “Getting the work done” included descriptions of nursing work and the management styles employed on hospital wards; “Learning the rules” evolved through students’ experiences of on-the-job training and expectations of them on the wards; “Nursing in the dark” emerged after a number of students described the difficulties concerning what they were and were not allowed to say to patients; “Just passing through” emerged as a category through students’ description of the constant movement from ward to ward and “Doing the work and being professional” included a discussion of disparate data where students were not always prepared to call the work they were doing ‘nursing’. These six categories are all concerned with on-the-job style training, in a hospital environment, within a hierarchical structure, with emphasis upon the role of the student nurse as a pair of hands and not as a supernumerary learner of nursing.

In 1983, Bradby (1989) followed four complete cohorts of female student nurses, in two schools of nursing, during their first year of general training with the aim of identifying any change in the attitudes of students as part of the socialisation process. Bradby uses the term “status passage” to describe the experiences of her subjects in their transition from lay people to first year student nurses. Although the researcher used triangulation of method, the study is restricted in its depth of examination of the issues identified in students’ experiences and the length of time during which these experiences occurred.

A comparative study by Wilson and Startup (1991), concerned with the professional socialisation of student nurses, was conducted in three education centres in South Wales during traditional nurse training. The core aim was to discover the roles of teachers and practitioners in establishing the relationship between theory and practice for student nurses and therefore the project draws upon role theory as a theoretical framework. Fundamentally, this research focuses upon the experience of learning nursing skills without consideration of any other contextual data. The term used throughout the report is “socialisation process”, which implies that there are recognised stages of development in the process of becoming a nurse. Wilson and Startup adhere to the premiss that there exists a predetermined pattern of events through which students are expected to pass, despite their own evidence which suggests otherwise. Their sample did not undergo an integrated professional socialisation process because they were submitted to conflicting and divergent values between the school of nursing and the wards, an issue which should have been explored more thoroughly because of its potential to influence the development of student nurses. Unfortunately, the emphasis remained upon the expectation of a single predictable process and therefore the data were not fully exploited.

O’Neill, Morrison and McEwen (1993) aimed to compare student socialisation through two different models of nurse education - ‘traditional’ and ‘Project 2000’. Two-hundred and seventy-five students were accessed at various times during the Common Foundation Programme of the Project 2000 course or the first eighteen months of traditional training. The researchers used qualitative methods to compare attitude profiles, perceptions of nursing and experiences in nursing practice. A proportion of students completed each data set consisting of diaries, interviews and questionnaires. Interviews were conducted with a random sample of students from both models of traditional and Project 2000 education. Again qualitative student data were aggregated and a thematic analysis and discussion of the most pertinent issues ensued. There appears to be dependence upon the data to represent the total student population which does not report beyond the Common Foundation Programme. However, the intentions of the study are satisfied in that there is a general evaluation of opinions related to traditional and Project 2000 education by recipients. This complements studies commissioned by the English National Board (Jowett, Walton and Payne, 1994; Robinson, 1991) which aimed to evaluate the quality of the student experience on Project 2000 courses.

Fifty student nurses were the primary informants in a Canadian study conducted by Day, Field, Campbell and Reutter (1995) during a four year baccalaureate programme. In addition, 81 students completed questionnaires making a total of 131 informants. First, second and third year students were interviewed and re-interviewed in a subsequent year. Content analysis was employed to identify group items and themes using a framework developed by Davis (1975). The student data appear to have been assigned to predetermined themes within this framework; initial innocence, labelled recognition of incongruity, psyching out, role simulation, provisional internalisation and stable internalisation. Whilst this framework is useful for comparing data collected in different studies, in my view, it could prevent the natural emergence of themes. In addition, Davis’ theory of “doctrinal conversion” may disregard important current political and social issues relevant to the 1990s. There appears to be a weak rationale for using this framework, resulting in a misfit of theoretical framework to the data generated. However, Day et al. (1995) acknowledge that although students exhibited behaviours are congruent with the stages of Davis’ theory of doctrinal conversion, they did not necessarily occur in the sequence that Davis describes. This is an important observation which contributes to the discussion regarding socialisation as a staged process. The idea that students work through a similar process was contested as far back as 1968 by Oleson and Whitaker who claimed that their study revealed that students were active, choice-making individuals who influenced their own socialisation. This supposition is demonstrated throughout written and verbal communications with the participants in my study.

More recently, Macleod Clark, Maben and Jones, (1996) conducted research into perceptions of the philosophy and practice of nursing within the realms of Project 2000. The aims of this research included exploring students’, teachers’ and practitioners’ perceptions in relation to nursing and Project 2000 and identifying the contribution that the Course makes towards the process of professional socialisation. The intention was to generate themes and categories representing 498 students’ views which were obtained through questionnaires distributed on three occasions in two case study centres. Macleod Clark et al.’s (1996) study is concerned with professional socialisation and how it is defined and categorised by a large number of students. Using questionnaires, the researchers have determined the direction of questioning, a weakness of previous socialisation studies, in which respondents have been restricted in telling their stories.

Gray and Smith (1999) and Philpin (1999) conducted studies during the late 1990s to identify the impact of Project 2000 on the socialisation of Diploma of Higher Education in Nursing Studies students. Philpin, with her interest in aspects of change in the occupational socialisation of nurses, focused upon newly qualified nurses who had undertaken a Project 2000 course and compared their perceptions with those who had been traditionally trained. The intention of this retrospective study was to discover ways that the major change in nurse education had influenced the acquisition of nursing culture. Her findings emphasise the disparity which appears to have existed between nursing education and practice for many years [referred to as the “theory-practice gap” by Bendall, 1974; Holloway and Penson, 1987; Kramer, 1974], Philpin conducted one set of retrospective interviews [as all participants had been qualified for at least one year and therefore reflected upon their experiences] with her 18 participants. Her main finding was that the nature of the socialisation process related to the work contexts in which it was experienced. In particular, her respondents offered sharply contrasting accounts of their experiences as newly qualified nurses in ‘acute’ and ‘chronic’ areas of nursing work. She suggests that her findings “closely parallel” the model of occupational socialisation identified by previous writers such as Melia (1981) and therefore has no reason to contest existing socialisation theory.

Gray and Smith (1999) on the other hand, used a three year ...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• List of Figures and Tables
• List of Appendices
• Abstract
• Preface
• Acknowledgements
• Part I Modality and Motivation
• Part II Philosophical and Methodological Foundations
• Part III Contexts and Significant Others
• Part IV Being and Becoming a Nurse
• Part V Discussion and Emergent Issues
• Appendices
• References
• Bibliography