Journal of Nursing Education

The Professional Self-Concepts of Nursing Undergraduates and Their Perceptions of Influential Forces

Brighid Kelly, PhD, RN, C

Abstract

ABSTRACT

This article explores the professional self-concepts of senior nursing undergraduates and their perceptions of the most significant forces that influenced the process. The method was qualitative; a grounded theory approach was used. The sample included 23 senior baccalaureate nursing students in their final clinical rotation prior to graduation. Audiotaped interviews were analyzed through the constant comparative method. Informants overwhelmingly perceived themselves as caring. They valued professional competence and many identified a lack of confidence in their skills. Caring qualities, caring role models, and qualities of the role models are listed.

Abstract

ABSTRACT

This article explores the professional self-concepts of senior nursing undergraduates and their perceptions of the most significant forces that influenced the process. The method was qualitative; a grounded theory approach was used. The sample included 23 senior baccalaureate nursing students in their final clinical rotation prior to graduation. Audiotaped interviews were analyzed through the constant comparative method. Informants overwhelmingly perceived themselves as caring. They valued professional competence and many identified a lack of confidence in their skills. Caring qualities, caring role models, and qualities of the role models are listed.

Introduction

Professional socialization culminates in the integration of professional role identity and self-concept (Cohen, 1981). What individuals believe about themselves and what they become is directly related to how they are treated by those around them and what is expected of them (Weistein, 1971). Studies have found that nursing students' image of nursing corresponds highly with that of their instructors (Dalme, 1983; Weller, Harrison, & Zahava, 1988).

Other factors linked consistently with successful professional role identity are opportunities to enact the professional role while still a student, amount of exposure to models of the professional role, and perceived success in professional tasks (Meleis, 1975; Pavalko & Holley, 1974). Integration of professional role identity and self-concept require that emerging professionals not only fully understand the tasks and responsibilities of that role but, in addition, have engaged in self-evaluation concerning how they meet professional standards. The purpose of this article is to explore the professional self-concept of senior nursing undergraduates and their perceptions of the most significant forces influential in the process.

Problem

Professional self-concept is constructed through selfevaluation about professional knowledge, values, and skills. Meléis (1975) says role modeling, role repetition, and interaction with professional reference group are necessary for professional role clarification. Historically, nursing educators and nursing service have not agreed on what constitutes the professional nursing role. The effect of such dissension on the professional self-concept of emerging graduate nurses is unknown. But, there is reason to believe that emerging graduate nurses are confused between what they learn in schools of nursing and what is expected of them in nursing practice (Kramer, 1985).

Professional socialization studies have found that nursing students receive conflicting messages from clinical nursing faculty (Buckenham & McGrath, 1983; Cohen, 1981; Melia, 1988; Olesen & Whittaker, 1968; Simpson, 1978). Incongruities noted were the classroom emphasis on an individualistic, holistic, caring approach in contrast to task-oriented, technically proficient messages of the clinical learning experience. Buckenham and McGrath (1983, p. 104) assert that "student nurses are groomed for subordination* They conclude that nursing students are socialized to obethence, respect for authority, and loyally to the team. Their acceptance and continued membership in the health team depends on their manifest recognition of their subordinate role. Cohen (1981, p. 140) says, "The requirement for a subservient, dependent demeanor must be reconciled with the demand for perfection and the fear of killing a patient."

New graduate nurses lack confidence in themselves (Kramer, 1985; Speedling, Ahmadi, & Kuhn-Weissman, 1981). Studies also reveal that nursing students lack self-esteem (Burgess, 1980; Ellis, 1980; Garrett, Manuel, & Vincent, 1976; Murray, 1983). Although the reasons are unclear, there is growing evidence that these problems may be related to punitive instructional styles (Ellis, 1980; Flagler, Loper-Powers, & Spitzer, 1988; Garrett et al., 1976; Pagana, 1988; Theis, 1988; Windsor, 1987). With such discrepancies between the professional nursing rhetoric, which views nursing as a caring profession, and what is apparently practiced, one wonders what students learn. Do contradictions such as these adversely affect the socialization process in nursing?

Research questions guiding this study were:

* How do senior nursing undergraduates describe their professional self-concept?

* What do senior nursing undergraduates describe as the influential forces that molded their present professional self-concept?

Method

The method was qualitative; specifically, a grounded theory approach was used (Glaser & Strauss, 1967). The setting was a large midwestern university. The population consisted of fourth-year undergraduate nursing students. A sample of 23 nursing students, from a total population of 120, were in their final clinical rotation before graduation. Informants were volunteers who gave informed consent after being given details of the purposes of the study, and how their confidentiality would be protected. Data were collected through audiotaped in-depth interviews.

Methodological issues

Glaser and Strauss (1967) defined grounded theory as discovery of theory from data. Grounded theory directs that a strategy of constant comparison be done throughout data collection and analysis. Emerging data provide direction for further questioning, which is called theoretical sampling. Whether theoretical sampling requires one to sample outside the group under study depends on the focus of the study (Glaser & Strauss). This study focused on the perceptions of undergraduate nurses.

Informants. All informants were products of a generic baccalaureate nursing program. The investigator had issued a general invitation to the senior class of 120, resulting in 23 volunteers. The majority were between the ages of 22 and 25; three were in their late 20s; one was in her early 30s; two were in their 40s. Two informants were men and two were African-American.

The sample, albeit voluntary, was an excellent demographic representation of the senior class. All had a required course in nursing ethics, the focus of which was guided analysis of frequently encountered ethical and moral dilemmas in practice settings. Their final clinical course was designed to minimize the effects of "reality shock." All informants selected hospital settings where they worked under the supervision of a hospital staff nurse.

Data Collection. Collection of data occurred through audiotaped in-depth interviews. A semistructured interview began with questions relating to nursing's professional values and theirs in particular. The bulk of data presented in this article, however, was in response to the following statements:

* What kind of nurse are you? To answer that question, I want you to reflect on the kind of nurse you believe yourself to be, but also tell me what you think your patients and your colleagues would say about you.

* What are some of the influential forces that have resulted in your present view of yourself as a nurse?

Every effort was made not to influence the informants. Lincoln and Guba (1985) provide important guidelines in this area and these were followed. Each informant was given the opportunity to validate data throughout the interview, and finally, to discuss anything he or she had thought of during the interview. Lincoln and Guba also warn about distorting data; in particular, they caution the researcher not to allow a particular relationship between informant and investigator to bias data.

It is important to note that the researcher is a faculty member in the college from which the sample was selected. All informants had been the investigator's students in a classroom setting before data collection. The concern that informants might be intimidated by the investigator is valid. However, data collection took place in the last quarter of informants' senior year when most students are less likely to be reactive about instructors' prior evaluations of their clinical and classroom performance. The investigator's own professional values are a potential threat to validity, and thus the investigator made an effort to be conscious of possible biases and to be noncommittal.

Initial classification of data was accomplished by collating the verbatim, transcribed answers to each pertinent question. Data were then reviewed critically for patterns. Examples of coding categories emerging early in this study were caring, competence, and role models. Atwood and Hinos (1986) suggest a validity check to test how well data bits, i.e., informant's words, fit the categories. Two experts reviewed and compared raw data and findings for category "fit" and were also in agreement with the investigator on core variables. In addition, informants reviewed findings and found them credible. Lincoln and Guba (1985) refer to this strategy as "member checks."

Findings

Caring was identified as the core variable. Informants overwhelmingly perceived themselves as caring. In addition, they valued professional competence and many identified lack of confidence in their skills. Concerning the influential forces, there was no doubt that caring role models were the major influences. Most specified nursing role models but a few spoke of family role models.

The themes of caring and competence were pervasive in self-descriptions. Some students saw themselves only in terms of caring. Others combined caring and competence, and a few described themselves only in terms of competence. The majority used caring qualifiers such as cheerful, friendly, good listener, happy, good-humored, empathie, compassionate, patient, and thorough and safe. Some of these are exemplified in the following self-descriptions.

I am a happy nurse . . . cheerful and friendly. I am a very caring person. Patients tell me they know I care about them. It makes a difference when you walk into a person's room and say "good morning!" You might be checking an IV but you are starting his day.

I am warm with patients ... I feel comfortable giving someone a hug or comforting them. I encourage self-care. I try to treat them as persons, not as patients. I enjoy talking to them and interacting with them.

I am a good nurse ... a caring nurse. I take the time to explain things to patients. I go hack and ask, "Is there anything you need?*

There were those who saw themselves as caring and competent but not confident.

I am a caring kind of person ... I am very friendly, very people-oriented ... I am skilled but lack confidence, but I am a very thorough nurse.

I am a very caring nurse who is a kind of affiliator. I care about establishing good rapport with patients and making them feel comfortable. I am not a very skillful nurse as far as technical skills are concerned.

Warm and compassionate and doing the right thing . . . competent. I have the knowledge in my head but it doesn't always come out. I lack confidence in some areas. But my preceptor says that with confidence, I will make a great nurse.

Self-descriptions of competence only are exemplified by the following:

Competent. I try to treat everyone the same and not discriminate.

Efficient, pleasant, dependable ... on top of things, good skills.

Since caring qualities were so important to these students, it will come as no surprise that the most distinguishing quality of those identified as influencing their view of themselves was caring.

Caring role models

Students' perceptions of their most influential forces were, in descending order, nursing faculty, nursing clinical preceptors, and family or friends. The qualities of those considered to be a major influence were: being supportive, taking pride in the work, taking the time to do a good job, listening, having a good sense of humor, and being involved with patients. Some of these qualities are exemplified in the following excerpts from data:

I think the instructors here are very supportive and think it increases your progress through the program by making you feel more like a cohort than a student even though their education is far superior.

I had a very good medical-surgical professor who believed in me . . . she really believes in her students and she also teaches you how to correct your mistakes . . . Nobody makes mistakes! Maybe nobody talks about their mistakes, but people make mistakes all the time and . . . learning is how not to be part of the problem . . . She was real cool about mistakes and she taught you how to make out an incident report and wasn't punitive. She was a good influence on me. She also has a good sense of humor.

The faculty here have really changed me. I am more assertive now. I kind of felt negative at first but I could see what they were trying to do and now I am really glad about that.

The positive feedback I got from my instructors ... in not just telling me I am doing it wrong but showing me a better way to do it. One thing positive that I have gotten from my instructors is that I take the time to do it correctly. What I have learned from my peers that influenced me is they have all been positive also.

The influence of clinical role models was very often cited:

What comes to mind is ... my preceptor. She has been a good role model . . . just the way abe would talk to the patients. She would treat them like human beings . . . and encourage them, especially in labor and delivery where they need a lot of encouragement. It was not just what she said, it was the way she said it.

. . . one particular nurse - she is also a faculty member - this was a nurse that sang to her patient when I went to dry dress him . . . Not only was this therapeutic for the patient, it was very therapeutic for me. She gets to know the patient . . . They ask, "When are you coming back?"

My preceptor . . . you could see the pride she takes in her work . . . she showed how to do trach care, checking the children's necks where the rubber goes into the neck, she noticed . . . the nurses . . . leaving cotton sticking around there or they were dirty or just wasn't done right . . . She is willing to stay. If it takes a half hour longer ... to get the job done right.

The influence of family, friends and teachers was identified by a few:

One of my main forces is my family, my parents in particular. I think I get the caring part of me from them, the willingness to go the extra mile, the willingness to sit down and listen, because they have always done that for me and they have done that with multitudes of people . . .

Teachers have done the same thing. Being here, the caring was mixed into the ideas of being responsible, being honest, being accountable.

A good friend of the family is a nursing professor . . . She has a wonderful sense of humor . . . Also a member of my family is a nurse . . . She is my image of a nurse ... so involved with each and every patient . . . subscribes to several nursing journals . . .

Discussion

The purpose of this study is to examine the professional self-concept of senior nursing undergraduates and their perceived influences. Interviews revealed that they perceived themselves as caring and competent but were lacking in confidence. They were highly influenced by caring role models. The qualities they used to describe themselves were reflections of what they admired most in their role models. Regardless of how accurate these perceptions are, they require serious consideration because persons act according to their perceptions.

The findings speak for themselves. The most intriguing finding is the corollary between the self-proclaimed qualities of informants and the qualities most admired in those whom they considered influential. While this finding may appear consequential, its meaning may be more obscure. For example, one could speculate that informants' values about caring were already deeply entrenched prior to nursing education and were merely reinforced by the qualities they self-selected in certain role models. Another possibility is that students' self-proclaimed qualities were of an ideal self who resembled those they most admired. Finally, it is highly possible that students do indeed emulate their role models and, with sufficient practice, come to own the qualities they most admire in others.

If we were to take these findings at face value, we would have to agree that nursing educators have a powerful potential for molding the professional self-concepts of their students. Unfortunately, the negative implications of this are only too real. If nursing instructors have such a powerful influence for good, they can have an equally negative impact. Lest it is believed that these students had only positive things to say about their instructors, it must be kept in mind that the question to be answered here was not what they thought of their instructors but what was most influential. The following excerpts will provide a more balanced view.

I had a clinical instructor . . . everyone was absolutely fearful of her . . . We hid in the rooms . . . She gave everyone the third degree ... I did receive a high grade from her . . . Why she gave it to me after what she said to me, I don't know ... I felt like I didn't deserve it ... I didn't receive enough positive feedback from her to believe I deserved it.

I was always intimidated in school ... I always felt I was on trial when I went to clinical . . . If you do this, you will rail If you do that, you will fail.

These accounts imply feelings of inadequacy. If students perceive an inconsistency in what is said and what is done, they may become confused. Students depend on experts to model the professional role. If students are only made aware of their mistakes, they internalize an inferiority complex. Students who are consistently faced with the prospect of failure cannot be creative or risk-takers. Why do these students lack self-confidence? Is lack of selfconfidence at this stage of professional socialization normal?

Self-confidence is an important dimension of the professional role. It means that a person has engaged in self-evaluation and been given a good grade. But, on what criteria do emerging graduates judge their own readiness for independence? Do they perhaps examine their grade point averages and reassure themselves or do they recall their clinical experiences and dwell on the positive? Self-confidence comes from perceived success in problemsolving, hence, the importance of honest constructive feedback and transition to greater reliance on selfevaluation. Self-evaluation is a vital component of professional socialization. However, it does not come naturally; it has to be learned. Excellent instructors know the value of self-evaluation as a strategy of empowerment and professional growth. Yet, it is entirely possible that confidence in the professional role cannot be attained while still a student.

The importance of this study is its effort to explain rarely studied phenomena. In addition, the phenomena were examined and described from the informant's perspective. However, research is required to test the transferability of these concepts under similar conditions. That all informants were voluntary could suggest that they possessed qualities not representative of the total population. For example, these volunteers may have possessed greater caring qualities than the population in general, or even a greater need to please others. Yet, the issue of representation is not central in this study because we are interested in perceptions. It is not generalizability that the qualitative investigator seeks but trans ferability, i.e., the degree of similarity among contexts (Lincoln & Guba, 1985). Thus, richness of the data in illuminating areas of concern in this population is of particular importance.

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10.3928/0148-4834-19920301-08

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