Over the course of nursing's history, there have been differences in societal views about which areas of nursing practice were appropriate for male and female nurses. As a result of the Victorian influence, during the 18th century more males than females entered formal midwife training programs. This trend did not prevail, however, and by the late 19th century, midwifery had been incorporated into medical training. The number of male midwives decreased and physicians became the only socially acceptable male health-care provider in the area of obstetrics (Neeson & May, 1986). Subsequently, only a female was socially acceptable as an obstetrical nurse.
Because nursing is perceived largely as a female profession, prejudicial attitudes and negative behavior toward male nurses have persisted. Snavely and Fairhurst (1984) suggested that because the male nursing student does not fit the stereotypical image of a nursing student, he will encounter negative attitudes from others in the health-care environment, particularly in the obstetrical area, that can affect his learning. Because the male is more visible as a minority, he will experience more stressful conditions. Additionally, the male nursing students perceptions of his educational experience will be affected by the prejudicial attitudes he will encounter because of his being numerically scarce in an occupation that is stereotypically female (Turnipseed, 1986).
Nurse educators can delineate specific sources of stress for male students and identify methods to minimize these Stressors, thus facilitating a more rewarding obstetrical educational experience for the male nursing student. These measures could include the use of the APPA System. The name is an acronym for the four components: avoid stereotyping; present an equitable perspective; provide comparable clinical experience; and anticipate guidance needed. The system serves as a guide only; each situation must be handled on an individual basis.
The system was developed by the author as a result of findings from a research study of role strain for the male nursing student in the obstetrical area. Data indicated that the male nursing student does experience more role strain, and thus more stressful conditions, than the female nursing student (Sherrod, 1988).
If the nurse educator is to facilitate the male nursing student's obstetrical educational experience, the nurse educator must use measures in the clinical area that do not increase the male nursing student's anxiety and stressful conditions caused by viewing himself as different. Nurse educators must first address their own feelings regarding males in nursing. A common reaction of some obstetrical nurse educators to a male student is one of frustration, resentment, and concern about how the student's clinical experiences can be arranged.
If there are problems of stereotyping, resentment, and frustration, instructors must deal with these before they can assist the male nursing student in contending with responses from other students, clients, and hospital staff. Since interactions between the nurse educator and the male nursing student can lead to certain student behaviors that bring about role success or failure in educational endeavors, nurse educators must be certain that they themselves are not treating the maie nursing student differently, thus adding to his anxiety.
Sex stereotyping by the nurse educator is detrimental and detracts from a positive self-image for the male nursing student in obstetrics. The nurse educator must make concerted efforts to free both male nursing students and themselves from the constrictions stereotyping will place on their abilities to interact effectively. Galvin and Read (1983) suggested several questions that could help nurse educators to examine their behaviors and attitudes in relation to sexism:
* "Do you use the same standards and the same punishment for students regardless of sex?
* Do you value and encourage independent and assertive behavior in both male and female students?
* Do you encourage male and female students to share jobs equally?
* Do you display tests, films, and pictures of girls and women as well as boys and men assuming a variety of androgenous behaviors?
* Do you distribute your time equally between male and female students in class?" (p. 13).
Presenting an Equitable Perspective
The nurse educator can assist the male nursing student in resolving possible anxieties and role strain by presenting an equitable perspective to the staff and others in the clinical setting. Regardless of the student's gender, it is the nurse educator's responsibility to see that each student receives the educational experiences that the course was designed to provide. The perspective and intent that male nursing students will be given the same educational opportunities as female nursing students must be perpetuated and made known to others in the health-care environment by the nurse educator (Turnipseed, 1986). Establishing lines of communication with the staff that clearly present this intent will reduce or prevent compromises in the male nursing student's education.
One mechanism for doing this is not asking the staff for special tasks or patients for the male nursing student when making assignments. His duties or patients should be no different from the female nursing student's. If this is suggested by other health-care workers, the nurse educator can discuss an equitable perspective viewpoint with these individuals. Students often receive a multitude of subtle and blatant negative stereotypical messages from nurse educators and other health-care personnel that influence them to limit their learning opportunities and restrict their aspirations for additional learning goals (Galvin & Read, 1983).
For example, the male nursing student may wish to gain experience in catheterizations. Because the stereotypical attitude would be that males should not do catheterizations on females, the student would be denied or discouraged from the opportunity to perform such a skill. In the future, when similar opportunities may be available, the male nursing student would not seek or plan for them because of his experience in the previous situation. When an equitable perspective is presented and such a message is perpetuated, the potential educational options of the male nursing student are not limited either by him or others in the clinical setting.
Presenting an equitable perspective can serve as a positive sanction for the male nursing student. Positive sanctions are behaviors that may be instituted by the nurse educator that build trust, motivate, and encourage role success by changing behavior in the student (Pace, 1983). Presenting an equitable perspective serves as a positive sanction that can assist the male nursing student in changing his behavior. The goals of learning he may have set may be expanded, the manner in which he presents himself to the client and other hospital staff may be less anxious, and his selfesteem may be increased.
The student who does not receive the positive sanction of presenting an equitable perspective may feel ineffective or inadequate and may punish himself with negative internal sanctions that may be detrimental to role success. The nurse educator must be aware of the potential effects of all these aspects of presenting an equitable perspective as a sanction to assure successful behavior (Pace, 1983).
When presenting an equitable perspective, professionalism as well as respect for the clients rights and dignity by the male nursing student must be conveyed. One mechanism for doing this is through conversations with staff, the client, and other health-care personnel. The nurse educator must stress that male nursing students are just as capable of maintaining professionalism, observing common courtesies, and remaining sensitive to the rights and feelings of the patient in the obstetrical areas as the female nursing student Brown (1986) noted that it is unfair to think that males cannot function appropriately in obstetrics. Males have to fulfill the same requirements as females to obtain licensure.
Providing Comparable Clinical Experiences
To prevent his educational experience from being compromised, the male nursing student must be exposed to the same learning experience as the female nursing student. In obstetrics, male students need experiences in the labor, delivery, nursery, and postpartum areas. Clinical faculty should not seek permission to assign a male student to an obstetrical client if permission is not obtained prior to assigning female students to obstetrical clients. One method to accomplish this would be to allow the male nursing student to meet the client without prior permission by the client, just as the female nursing student would. The author has found it helpful to make rounds immediately after the student has met the client and left the room to ascertain if the client has any objections to the student. Rather than asking direct questions such as "do you object to your male nursing student?" the educator should ask general questions such as "how are things going?" Such general questions provide an opening for comments. If the client raises objections or requests limits on the care the male nursing student may give, another assignment can be made. At this point, however, it is crucial to provide some reassurance to the male nursing student so that his self-concept is not compromised. A subsequent assignment where he can be successful will lead to a sense of accomplishment and foster a positive selfconcept.
Benda (1981) suggested that the nurse educator should have the male nursing student begin his clinical rotation in the nursery to allow him to become more comfortable with being in the area. Caring for babies initially is thought to be less anxiety-producing than caring for the mother. Benda (1981) also suggested that assigning a male nursing student to a bottle-feeding, older, married mother initially can be less anxiety-producing. This idea is practical and can be helpful as long as the male student is not limited to these clients and his experiences are comparable to those of the female student.
The nurse educator serves as a facilitator to a successful obstetrical clinical experience for the male nursing student. If limitations are necessary, it should be only in those situations in which the limitation will enhance rather than deter from the educational experience. One example of such a limitation may be the patient's refusal to have the student. The students pool of potential clients would be limited to those who presented no objections to care by a student. If the student were placed in a situation with a hostile patient, it would not be the most conducive learning environment for the student. It is a limitation instituted by the nurse educator because of the patient's preference, not because the student is male.
Anticipating Guidance Needed
Anticipating guidance needed can help diminish unrealistic expectations of male students and enable them to handle clinical situations that may be anxiety-producing. Also, anticipating guidance needed can prepare the student for rote bargains that might be necessary in the clinical area. For example, at times male students may have to rely on assistance from a female because of the client's wishes. Anticipating guidance needed also entails validating the male nursing student's perception of his role and functioning in the obstetrical area. Validating his perceptions includes verification of his emotions, thoughts, and understanding of what is or ought to be happening in a particular situation.
For example, a student may inform the nurse educator that he cannot help a labor patient on the bedpan. He may believe that it is socially unacceptable to perform this or other aspects of care. At the same time, he may be anxious about how the assistance will be given. Preparing the student in advance provides the nurse educator with the opportunity to alleviate or counteract the anxiety because the student has prior information, either confirmation or denial of his perceptions, about what to expect and what he can or cannot do (Pace, 1983).
The role of the nurse educator regarding male obstetrical nursing students is to facilitate a more rewarding and successful educational experience for them. The nurse educator can use specific measures to enhance role success and the student's selfconcept. The APPA system may be used to accomplish this. The system is a set of strategies that includes avoiding stereotyping, presenting an equitable perspective, providing comparable clinical experiences, and anticipating guidance needed. This will assist the nurse educator in fulfilling role obligations when the obstetrical nursing student is male.
- Benda, E. (1981). When the postpartum nursing student is male: A challenge to maternity instructors. J Nura Educ, 20(4), 5-8.
- Brown, W.D. (1986). Why won't they let us help deliver babies? RN. 49(1), 61-62.
- Galvin, M.. & Read, D.A. (1983). Combating racism and sexism in health education: Some issues, responsibilities, and possibilities. Health Education, 14(2}, 10-14.
- Neeson, J.D., & May, K.A. (1986). Comprehensive maternity nursing: Process and the childbearing families. Philadelphia: J.B. Lippincott Company.
- Pace, J.A. (1983). A model to resolve role strain encountered by male nursing students. Unpublished paper, University of Alabama School of Nursing, University of Alabama at Birmingham, Birmingham.
- Sherrod, R.A. (1988). Role strain for the male nursing student in the obstetrical area. Unpublished doctoral dissertation. University of Alabama at Birmingham, Birmingham.
- Snavely, B.K.. & Fairhurst, G.T. (1984). The male nursing student as a token. Res Nurs Health, 7, 287-294.
- Turnipseed, L.A. (1986). Female patients and male nursing students. J Obstet Gynecol Neonatal Nurs, 15(4], 345-348.