Journal of Nursing Education

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Hopes and Fears: The Attitudes of Freshman Nursing Students

Norma Grassi-Russo, RN, MA; Peter B Morris, MA, MSEd

Abstract

Table 4 shows the unpleasant and/or negative experiences felt by students over the first eight months of the freshman year. Here the leading category is by far "Overall pressure and stress" representing nearly a third of the responses. Often students' responses consisted of only one word, "Pressure" or "Stress" or "Tension." Sometimes students responded with "Pressure of school work," "Not enough time to get everything done," "Have to work too hard." The specific fear of failing in school which headed the initial list of fears is now ranked second but could easily be present as a cause of the "Overall pressure and stress." It is somewhat surprising in the light of counseling experience with students that only six responses are concerned with negative reaction to clinical experiences. Perhaps this difficulty also constitutes a part of "Overall pressure and stress."

Discussion

TAf Theme of Competence: In both lists of positive attitudes "Becoming competent"is a specific category accounting for a sizeable portion of the responses. When one recognizes the respect and desire for competence which is implicit in other positive responses such as "Helping people," "Getting a good education," "Proud, positive self-image" and the like, this theme comes across very strongly. In addition, many of the negative responses reflect a concern about being competent as well. Fear of making a mistake, uneasiness about assuming responsibility, fear of failure, and other attitudes also indicate a student's preoccupation with her level of competence.

Probably there is some degree of social desirability in these responses. Freshman students would scarcely wish to present themselves as tolerant of incompetence or as lazy or uncaring. Nevertheless, the concern about competence does appear to be a prevalent attitude of student nurses. There are obvious benefits of a desire for competence, but this attitude can also lead to difficulty. Neophyte nursing students encounter a bewildering array of strange, complicated, and even forbidding things which must be mastered. They often feel overwhelmed by their initial lack of knowledge and skill both academic and clinical. They compare themselves to their instructors and find themselves lacking.

When this situation is coupled with an intense, almost urgent desire to be competent, it spells trouble for some students. Most faculty members are familiar with the student who reasons this way: "Competence is essential in nursing. The margin For error is small, and a large premium is put on efficiency and organization. When I try to do the things my instructors demonstrate, 1 am clumsy and slow which makes me nervous and upset. If I become nervous and upset in this situation, perhaps I lack the qualities necessary to become a nurse." This in turn sometimes leads the student to feel anxious and depressed about feeling nervous and upset. While this constellation of attitudes is not extremely common, experience in listening to students suggests that it, or something like it, produces much emotional stress and some actual failure and withdrawal.

Fortunately, there are ways to deal with this attitudinal set to reduce its negative impact. First, sharing attitudes with peers and faculty in some fairly structured way is always beneficial. Communication leads the student to realize, "I'm not the only one with these feelings. Since my hopes and fears are shared by many of my classmates, I guess they're really not so unusual or inappropriate." This type of experience is best carried out in a structured way with skilled group facilitation by faculty members, and if possible, upperclass students.

Secondly, in group or indi vidual counseling sessions, students can learn to sort out effective and ineffective attitudes. The hope of being as competent as an instructor…

Most nursing students experience a variety of strong hopes and fears as they begin their education. Even at the outset they sense that their careers as students will be exhilarating, challenging, absorbing, exhausting, frightening, and much more, which they anticipate only vaguely. A better understanding of students'attitudes might well be useful to faculty members in their efforts to provide support for students during the initial phase of their nursing education. Students could also benefit directly from a keener awareness of their own feelings and of those which they share with their peers.

This is an account of an effort by the authors to identify and examine attitudes of students at the beginning of their educational career. The data were gathered and analyzed as a part of a practical attempt to enhance students' learning experiences and to prevent failure and withdrawal.

The experience of the student nurse is an intense combination of academic effort, clinical demands, and emotional pressures. How successful a person will be as a student is undoubtedly related to the attitudes she brings to nursing school and to the changes in attitudes which take place over the course of her education. Attitudinal factors probably play an even more significant role in nursing school than in other educational settings because of the extensive affective component in nursing education. Mastering rigorous and exacting procedures, developing the empathie quality of the helping person, and coping with crises, suffering, and death are experiences which reflect and influence students' attitudes. Clearly, if a student holds attitudes which are negative with respect to her experience, difficulty and even failure may result. Fortunately, attitudes change, and the development and maintenance of appropriate, effective, and even selfenhancing attitudes can be a vital part of nursing education. Too often, however, the process of dealing with students' attitudes is unplanned, inconsistent, or neglected.

Research on the relationship of nursing students' attitudes to their educational experience has not been abundant. This is especially true with respect to attitudes of beginning students, to how students' attitudes change, and to how attitudes are related to success and failure. Brunclik and Thurston have pointed to the need for research in such areas as motivation, personality, and social factors of nursing students, but the findings have been sparse.1 Redman reported that nursing instructors vary greatly in their ability to predict student attitudes toward clinical experiences, although instructors are fairly well able to recognize their own degree of effectiveness in predicting student attitudes.2 Stein found that the general direction of attitudinal change during nursing school was toward increased self-assertion.3 Gunter has pointed to the deep and intense commitment of nursing students to the profession. A recent study by the present authors found that students tend most often to be motivated by a desire to help others and by an interest in science and medicine.5 Nursing students also appear to be more interested in seeking responsibility and leadership than nonnursing college students.6 Finally, a fair amount of work has been done in the related area of assessing personality structure of student nurses using standardized measures. Also, instruments have been developed specifically for that purpose.10 These studies, however, tend to be concerned primarily with selection and usually are more descriptive than prescriptive.

Procedure

The present study originated in an attempt to provide an. opportunity for students to gain increased awareness of their basic attitudes toward beginning nursing school and to share these feelings with their classmates. We believe this to be important because, "The attitude concept seems to reflect quite faithfully the primary form in which past experience is summed, stored, and organized in the individual as he approaches any new situation."" Our use of the concepts hopes and/cars was based on the recognition by most authorities that the essential quality of an attitude is the tendency of an individual to evaluate something as favorable or unfavorable to him or herself.12'13 Also, we wanted to distinguish between a student's altiiuâe which has the preferential quality and a belief which does not.14 For example, a student's statement that she views her forthcoming nursing school experiences as requiring a great deal of study cons ti tu tes a belief. Only if she evaluates "a great deal of study" as favorable or unfavorable for her, can we perceive an attitude. Likewise, descriptions of the experience as challenging, exciting, demanding, time consuming, etc. do not in themselves reveal attitudes. We used the terms hopes, fears, pleasant, unpleasant, positive, and negative in an attempt to elicit attitudinal data.

The 102 members of the freshman class of a diploma school of nursing were asked at the beginning of their first class to write down in one word or a short phrase two hopes and two fears about their forthcoming experience as students of nursing. We defined hope as the anticipation of something pleasant and positive, and fear as the anticipation of some t hing unpleasant and negative. Students were asked to make their decisions privately without discussion, but were informed that they would be asked to share what they had written with their classmates. They were requested to be specific and to list those things about which they felt most strongly. The students printed their responses on cards, and circulated around the room reading the cards of their classmates. The students then reassembled and discussed their own attitudes and their reactions to those of their classmates.

Eight months later, 83 of the same students remained in the program. They were asked to write down the two experiences in school up to that time which were most pleasant and/or positive and the two which were most unpleasant and/or negative. The students were again urged to be specific and to reflect accurately their strongest feelings.

All the responses were sorted into categories judged by the authors to be inclusive and mutually exclusive. The res ponses were tabu Iated by rank, frequency, and percentage, but they did not consist of two hopes and two fears from each student because some students did not give a total of four responses. Also, some pairs of responses were judged to represent the same attitude, for example, "Working with patients" and "Giving good nursing care" were interpreted as reflecting the single attitude, "Helping people," and counted only once. The same procedure was employed with both questionnaires.

Table

TABLE 1HOPES OF NURSING STUDENTS DURING THEIR FIRST WEEK OF SCHOOL N = 102

TABLE 1

HOPES OF NURSING STUDENTS DURING THEIR FIRST WEEK OF SCHOOL N = 102

Results

Table 1 presents the rank order, frequency, and percentage of hopes of freshmen during their first class. It is not surprising that the first three hopes are "Helping people," "Becoming a professional," and "Becoming competent." They represent about 55 percent of all the responses. These results are consistent with those of other studies. In a study of a different group of diploma school freshmen, the authors found that the students ranked "Helping people" and "Interest in science and medicine" as the two most important reasons for choosing nursing school.5 According to DeLora and Moses, the three most important qualities baccalaureate students seek in their occupation are: "A chance to be helpful to others, ""An opportunity to use my special abilities,"and "Advancement to a position of increasing responsibility."6 Other researchers have reported similar findings.15'16 Students clearly appear to be seeking two types of experiences, the helping relationship and professional, scientific competence. These attitudes seem to reflect an image of the nurse as a helping person who is also a welleducated and highly skilled professional.

By way of explanation, the category labeled "Being enthusiastic" contains all the generalized responses of enthusiasm, such as "Looking forward to getting started/' "Happy to be here," and so forth. The category "Working with people" contains responses not specifically associated with patients or helping. It refers to relationships with peers, instructors, staff, and the like. "Clinical work" contains responses not related directly to helping, such as "Working in the hospital" or "Watching an operation."

Table

TABLE 2FEARS OF NURSING STUDENTS DURING THEIR FIRST WEEK OF SCHOOL N = 102

TABLE 2

FEARS OF NURSING STUDENTS DURING THEIR FIRST WEEK OF SCHOOL N = 102

When we come to the fears expressed by the new freshmen, which are presented in Table 2, "Failure in school" tops the list by a wide margin. Forty-six percent of the responses undoubtedly represents well over half of the students, since most students listed two fears. The second- and third-ranked fears appear to reflect anxiety about experiences in the clinical settings. These first three categories constitute 78.3 percent of the responses, which is probably very close to 100 percent of the students.

Table 3 presents the experiences with students rated most positively after eight months in the school. In this list the responses are fairly well distributed over the first five ranked categories. It is interesting to note that "The instructors" did not appear before and now heads the list. Other categories such as "Being competent" and "Helping patients" are repeated from the initial list of hopes.

Table

TABLE 3POSITIVE EXPERIENCES OF NURSING STUDENTS AFTER EIGHT MONTHS IN SCHOOL N = 83

TABLE 3

POSITIVE EXPERIENCES OF NURSING STUDENTS AFTER EIGHT MONTHS IN SCHOOL N = 83

Table

TABLE 4NEGATIVE EXPERIENCES OF NURSING STUDENTS AFTER EIGHT MONTHS IN SCHOOL N = 83

TABLE 4

NEGATIVE EXPERIENCES OF NURSING STUDENTS AFTER EIGHT MONTHS IN SCHOOL N = 83

Table 4 shows the unpleasant and/or negative experiences felt by students over the first eight months of the freshman year. Here the leading category is by far "Overall pressure and stress" representing nearly a third of the responses. Often students' responses consisted of only one word, "Pressure" or "Stress" or "Tension." Sometimes students responded with "Pressure of school work," "Not enough time to get everything done," "Have to work too hard." The specific fear of failing in school which headed the initial list of fears is now ranked second but could easily be present as a cause of the "Overall pressure and stress." It is somewhat surprising in the light of counseling experience with students that only six responses are concerned with negative reaction to clinical experiences. Perhaps this difficulty also constitutes a part of "Overall pressure and stress."

Discussion

TAf Theme of Competence: In both lists of positive attitudes "Becoming competent"is a specific category accounting for a sizeable portion of the responses. When one recognizes the respect and desire for competence which is implicit in other positive responses such as "Helping people," "Getting a good education," "Proud, positive self-image" and the like, this theme comes across very strongly. In addition, many of the negative responses reflect a concern about being competent as well. Fear of making a mistake, uneasiness about assuming responsibility, fear of failure, and other attitudes also indicate a student's preoccupation with her level of competence.

Probably there is some degree of social desirability in these responses. Freshman students would scarcely wish to present themselves as tolerant of incompetence or as lazy or uncaring. Nevertheless, the concern about competence does appear to be a prevalent attitude of student nurses. There are obvious benefits of a desire for competence, but this attitude can also lead to difficulty. Neophyte nursing students encounter a bewildering array of strange, complicated, and even forbidding things which must be mastered. They often feel overwhelmed by their initial lack of knowledge and skill both academic and clinical. They compare themselves to their instructors and find themselves lacking.

When this situation is coupled with an intense, almost urgent desire to be competent, it spells trouble for some students. Most faculty members are familiar with the student who reasons this way: "Competence is essential in nursing. The margin For error is small, and a large premium is put on efficiency and organization. When I try to do the things my instructors demonstrate, 1 am clumsy and slow which makes me nervous and upset. If I become nervous and upset in this situation, perhaps I lack the qualities necessary to become a nurse." This in turn sometimes leads the student to feel anxious and depressed about feeling nervous and upset. While this constellation of attitudes is not extremely common, experience in listening to students suggests that it, or something like it, produces much emotional stress and some actual failure and withdrawal.

Fortunately, there are ways to deal with this attitudinal set to reduce its negative impact. First, sharing attitudes with peers and faculty in some fairly structured way is always beneficial. Communication leads the student to realize, "I'm not the only one with these feelings. Since my hopes and fears are shared by many of my classmates, I guess they're really not so unusual or inappropriate." This type of experience is best carried out in a structured way with skilled group facilitation by faculty members, and if possible, upperclass students.

Secondly, in group or indi vidual counseling sessions, students can learn to sort out effective and ineffective attitudes. The hope of being as competent as an instructor is a valid aspiration. The fear of not being to tally competent immediately is irrational. Hoping to achieve a greater level of competence is motivating and beneficial. Fearing one's initial lack of competence as evidence of no potential and imminent failure is self-defeating. While the desire to be competent is certainly inherent in nursing, it is probably better expressed as a hope than as a fear.

The Theme of Pressure and Stress: There seems to be no way to avoid pressure and stress if you are a nursing student, and the attitudes of the students studied here certainly appear to support that belief. The initial fears of failure in school, taking responsibility, and making a dangerous mistake become generalized over the first eight months to "Overall pressure and stress." It seems extremely unlikely that all pressure and stress will ever be removed from nursing education. Nor may we assume that doing so would be wholly beneficial. However, this study indicates that pressure and stress are a serious concern for students and may take a toll in the form of attrition.

If we cannot or will not eliminate pressure and stress in nursing education, or for that matter in nursing practice, what we might do is eliminate its self-defeating aspects and perhaps, as has been suggested, even learn to make stress work positively.17 As with the desire for competence, the experience of pressure and stress is common to many students. Sharing can be beneficial to a student if it leads to a realization such as, "Stress is not my own unique affliction. Other students and even faculty members experience it. If I feel pressure and stress, it does not clearly indicate my unsuitability for the nursing profession." Again, it is probably better if this sharing occurs in some kind of structured situation to avoid the gripe session, or "Misery loves company" phenomenon.

Furthermore, students can be helped to the awareness that pressure and stress, while inevitable to some extent, may not be entirely negative experiences. If a student feels nervous about new clinical responsibilities, she is not necessarily experiencing a destructive emotion. She may simply be reflecting an attitude of concern and caring. If, however, she interprets her nervousness as evidence of inadequacy, she is likely to feel nervous about feeling nervous, and that is dysfunctional. It is also necessary, since her nervousness is probably coming from those very attitudes, concern and caring, which are at the heart of nursing practice. All this can be communicated to students in conferences with faculty members, structured group discussions, and counseling sessions.

The Instructor as Role Model: Few would debate the significance of the instructor as role model in nursing education. Because of the clinical experience, this relationship is undoubtedly much stronger than in most learning situations. This belief certainly finds support in the positive attitudes of students toward their instructors after eight months in the school. The positive experience with faculty is ranked first by more than five percentage points, and it is even ranked ahead of "Being competent" and "Helping patients," the two experiences most often sought by students. This positive attitude toward faculty members cannot be seen in isolation from the negative attitudes students hold. If students feel pressure and stress and fear failure, the role of the faculty assumes even more importance.

It is likely that faculty members are seen as models of professional competence, but perhaps even more importantly, they appear to serve as examples of emotional strength and stability. This interpretation is reinforced by experience in counseling students. It seems that instructors are viewed not only as exemplars of "grace under pressure" but also as empathie helping persons to whom students themselves can go for support. Not all faculty members serve this helping role for students. Some prefer to preserve the image of the pedagogue, even believing that too interactive a relationship with students limits their effectiveness. There seems to be little evidence to bear out the latter contention. After eight months of pressure, stress, and fear of failure, students see members of the faculty as the most pleasant and positive aspect of their educational experience. Hopefully, instructors will perceive this attitude as an opportunity for helping students.

The Fear of Failure and The Expectation of Success: Attrition is a perennial problem in nursing education, and the causes of failure which seem to be most difficult to predict and control are those involving attitudes and other personality factors. At the very beginning of their education the students studied identified "Fear of failure" as their most prevalent negative attitude by a wide margin. After eight months, 19 students had in fact left the program, and for those who remained, nearly 13 percent of the responses still make this fear the second most prevalent negative attitude. In addition, we can probably assume that this same fear contributes to the feeling of "Overall pressure and stress."

There is considerable evidence that anxiety is linked to lower achievement and greater learning difficulty.18 In addition, it is clearly recognized that expectations of teachers have a profound effect on achievement.19 There is little opportunity to influence the attitudes of students prior to their entrance into the school. Perhaps one way of counteracting the fear of failure after students begin their studies is for faculty to project consistently and forcefully the expectation of success. Since the way people are treated undoubtedly influences their behaviors, the expectations of students by instructors should be very powerful because of their positive role model status. Developing a predominant success orientation on the part of the faculty and the school involves effective communication, planning, commitment, and some expenditure of time. What is really crucial is faculty altitudes. After all, the students have met the admissions requirements of the school, and hopefully, there is a counseling capability available to deal with non-academic difficulties. Why then shouldn't the expectation, "We'll probably lose 30 percent of our students before graduation" be changed to, "There seems to be no reason why any of the students we have admitted should fail to complete the program"? And why shouldn't this positive expectation be projected vigorously and unambiguously to students? Implementing such a strategy is quite possible, and the probability seems high that some positive changes in students'attitudes would result.

Conclusion

This study has identified and examined some attitudes of freshmen nursing students. The data were gathered as a part of a practical attempt to provide support to students as quickly and effectively as possible. Certainly, we would benefit from further research in this area. In addition, we hope that schools of nursing will develop specific programs for influencing student attitudes as a deterrent to failure and withdrawal. If such efforts were successful, not only would more qualified people complete nursing school, but the experience of nursing education would be characterized much more by hopes than by fears.

References

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TABLE 1

HOPES OF NURSING STUDENTS DURING THEIR FIRST WEEK OF SCHOOL N = 102

TABLE 2

FEARS OF NURSING STUDENTS DURING THEIR FIRST WEEK OF SCHOOL N = 102

TABLE 3

POSITIVE EXPERIENCES OF NURSING STUDENTS AFTER EIGHT MONTHS IN SCHOOL N = 83

TABLE 4

NEGATIVE EXPERIENCES OF NURSING STUDENTS AFTER EIGHT MONTHS IN SCHOOL N = 83

10.3928/0148-4834-19810601-04

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