Colleges and universities have been described as socializing organizations because they provide the contexts within which the adoption by students of normative values, attitudes, and behaviors is fostered (Feldman & Newcomb, 1969; Pascarella, 1985). The socializing function of colleges and universities assumes particular importance for nursing education because it is the vehicle through which the norms and values of the profession are transmitted and ultimately sustained. Despite the emphasis that has been given to caring as a normative value for the practice of nursing and the moral foundation for nursing education, there has been limited investigation of the socialization processes through which caring can be learned by those who will assume primary caregiver roles (Leininger, 1986; Tanner, 1990; Watson, 1988).
Although faculty are recognized as the traditional agents of student socialization, educators argue that the peer group that functions as both a comparative and a normative reference group may be instrumental in the socialization of college students (Chickering, 1969; Feldman & Newcomb, 1969; Pascarella, 1980; Weidman, 1979). Furthermore, there are data to suggest that faculty-student and peer group interactions tend to be associated with differing dimensions of college student socialization. Studies conducted within the discipline of education suggest that students' self-perceived intellectual or cognitive development is more strongly associated with the type and quality of the interactions that are experienced with faculty, while students' self-perceived interpersonal or affective development is more strongly associated with the quality of the interactions that are experienced with the peer group (Bean, 1985; Pascarella, Duby, Terenzini, & Iverson, 1983; Pascarella & Terenzini, 1980; Terenzini & Pascarella, 1980; Volkwein, King, & Terenzini, 1986).
Scholars argue that socialization of caring behaviors is bound to an environmental context that is shaped by the quality of the interactions that are experienced by students (Bevis, 1989; Pence, 1983; Sarason, 1985). Therefore, the linkage that has been documented between peer group interactions and the interpersonal socialization of students suggests that peer group interactions may constitute a central process within which the socialization of students to caring takes place. In her analysis of caring and a moral education, Noddings (1984), for example, suggests that interactions with the peer group provide valuable opportunities for students to practice caring behaviors and argues that such opportunities are central to the creation of a climate within which caring behaviors can be learned. The purpose of this study was to describe a climate for caring as it is experienced by junior nursing students within the context of peer group interactions, and to identify the peer group behaviors and interactional episodes through which junior nursing students experience a climate for caring.
* How is a climate for caring within the context of peer group interactions described by junior nursing students?
* What are the peer group behaviors and interactional episodes through which junior nursing students experience a climate for caring?
The methodologic approach used in this study was the descriptive mode of qualitative inquiry. Open-ended audiotaped interviews were conducted with 10 junior nursing students who served as key informants to obtain a detailed description of a climate for caring as it is experienced within the context of peer group interactions.
Subjects and setting
Both convenience and purposive sampling were used to select five National League for Nursing (NLN)-accredited baccalaureate schools of nursing as sites from which to recruit junior nursing students to participate in the study. Because students are not randomly distributed across post-secondary educational institutions (Pascarella, 1985), the schools of nursing were selected to provide variability in terms of organizational size (number of students enrolled in the junior class), types of programs offered (undergraduate/graduate nursing programs), and institutional control (public/private).
A convenience sample of 10 second-semester junior nursing students (two students enrolled at each school of nursing) who were willing to participate and met the following criteria were included in the study: female, white, first-time enrollees in junior nursing courses, those classified as full-time students, and those not possessing a license to practice as a licensed vocational nurse or as a registered nurse. The students who participated in the study ranged in age from 21 to 46 and three held a bachelor's degree in another discipline at the time of data collection.
Procedure for data collection
Individual audiotaped interviews were conducted by the investigator with each of the study participants in a private location at the school of nursing in which the students were enrolled. Interview sessions ranged in length from approximately 45 to 75 minutes. Informed written consent was obtained from each student prior to the interview. At the end of the interview session, the audiotape was assigned an organizational code number to ensure confidentiality of the identity of the school of nursing and the student.
Data were collected using an interview guide composed of 10 questions that were written to elicit the participants' description of a climate for caring as it is experienced within both faculty and peer group relationships because it is these individuals with whom students most frequently and consistently interact. In this article, the description of a chiniate for caring within the context of peer group interactions will be reported.
Data management and analysis
Because the purpose of this inquiry was descriptive, data collection, management, and analysis were conducted sequentially (Knafl & Webster, 1988). After all interviews had been conducted, a verbatim transcription of each audiotape was typed and coded to correspond with the audiotape. Each of the transcriptions was read as a whole to obtain a broad overview of a climate for caring as it was described by the students. The transcripts then were read again using a line-by-line approach to identify meaningful phrases or statements, which were extracted from a photocopy of the transcriptions and pasted on 5 X 8 file cards.
All data file cards were read repeatedly and the meaning suggested by the extracted data was written on the back of each data file card. The interview transcriptions also were read repeatedly to ensure that the meaning assigned to the extracted data was appropriate within the context of the transcript text. As categories and subcategories emerged, they were named and a written statement of their meaning was formulated. The data file cards and the interview transcripts were read repeatedly until all data file cards had been categorized and no new meanings became evident from reading the transcriptions.
Reliability and validity
Estimates of both intracoder and intercoder reliability were used to assess for stability or consistency of the coding decisions used to categorize the data file cards. Receding of a 20% random sample of data file cards drawn from each category and subcategory by the investigator after a two- week time lapse resulted in 100% agreement in the coding of the peer group data file cards.
Because of its appropriateness for use in estimating decision-making stability or consistency in criterion referenced situations, Cohen's Kappa was used to estimate intercoder reliability. Using the meaning statements written for each category and subcategory, two nurse educators independently coded the same 20% random sample of data file cards. The intercoder reliability calculated for the peer group data file cards was K = . 9 1 .
Figure. Descriptive model of student-perceived climate for caring (peer group interaction).
Credibility or truth value of qualitative data interpretations can be inferred if they provide a faithful description of the phenomenon as it is experienced by the study participants (Sandelowski, 1986). Eight of the 10 study participants responded to a mailed request to review a written summary of the study findings and indicated that the summary provided a faithful description of their experience. At least one participant from each of the five schools of nursing participated in the validation of the study findings.
The climate for caring within the context of peer group interactions was described by these participants as one in which they experience their peers as a cohesive network of close relationships and personal friendships sustained by trust, mutual concern, and a high degree of interactional reciprocity. Based on the data focused on peer group interactions, the climate for caring was experienced through the enactment of behaviors that were perceived to be caring and during interactional episodes through which the meaning of giving assistance was conveyed. The model depicting a climate for caring within peer group interactions as described by these study participants is presented in the Figure. A pyramid was used to diagram the category of giving assistance because the meaning conveyed by the subcategories labeled sharing of information, sharing of ideas, and sharing of the self suggested a hierarchical progression in the intensity with which the involvement of a peer was required to be of assistance.
Peer group behaviors
Four subcategories of peer group behaviors described as caring by these participants were identified: willingness to help, sensitivity, presence, and supportiveness. Nine of the 10 participants in this study were unable to recall experiencing peer group behaviors that were perceived as uncaring and, therefore, used only positive examples to describe the meanings conveyed by these subcategories of peer group behaviors.
One of the participants, however, identified both positive and negative examples of peer group behaviors through which the meanings of willingness to help and supportiveness were conveyed. Because the negative examples conveyed the opposite meaning of caring, they were labeled unwillingness to help and unsupportiveness. Examples of peer group behaviors through which the meaning of willingness to help was conveyed were described with two to three times greater frequency than were those behaviors that were grouped under the remaining three subcategories. The meaning statements and data examples for the subcategories of peer group behaviors are presented in Table 1.
The common underlying theme to the description of the peer group interactional episodes categorized as giving assistance was the contribution of a peer to the resolution of a need being experienced by these participants. These participants identified three needs they experience as a junior nursing student: the need for information, the need to satisfactorily complete nursing course requirements, and the need to ventilate feelings or resolve a personal problem. Based on the intensity of peer involvement required to respond to these needs, three subcategories of peer group interactional episodes through which the meaning of giving assistance was conveyed were identified: sharing of information, sharing of ideas, and sharing of self. The meaning statements and data examples for the subcategories of giving assistance are presented in Table 2.
Caring Interactional Episodes: Giving Assistance
Six of the 10 participants identified as caring an interactional episode during which their need for information was resolved by a peer who shared books, notes, or other course-related information with them. Because such episodes required a limited investment by the peer of time and personal energy, the subcategory labeled sharing of information was thought to convey the meaning of giving assistance at its most superficial level.
Beyond sharing information, four of these participants described episodes during which their need to complete nursing course requirements was resolved during peer group interactions that were characterized by sharing of ideas. These participants collaborated with their peers about written assignments, participated in study sessions where peer group members helped one another to learn nursing content, and sought consultation with their peers to identify interventions that might be appropriate for specific patient care situations or to understand clinical events they had experienced. Because these interactional episodes suggested a more intense investment of peer time and personal energy than that required to share information, the subcategory labeled sharing of ideas was thought to convey the meaning of giving assistance at a more substantial level than sharing of information.
Finally, four of the participants described an interactional episode in which the need to ventilate their feelings or resolve a personal problem was met through dialogue with a member of their peer group. These episodes were grouped under the subcategory labeled sharing of the self because they involved self-disclosure by the participant along with a considerable investment of both time and personal energy by a peer. Conversely, three of these participants described as uncaring an interactional episode in which a member of their peer group refused to respond to a need they were experiencing. Because the resolution of their need would have necessitated a substantial investment of time and energy by the peer, these episodes were thought to convey the opposite meaning of sharing of the self and were labeled withholding of the self Sharing of the self was thought to convey the meaning of giving assistance at its most substantial level.
Discussion of Findings
Nine of the 10 participants in this study identified as caring the climate they experienced during interactions with their peers. According to these participants, this climate emerged in conjunction with the evolution of their peer group as a cohesive network of interdependent relationships. Describing themselves as bonding with their peers during the first semester of their enrollment in junior nursing courses, these participants communicated a sense of belonging, commitment, and shared identity with their peer group that was thought to convey the meaning of peer group connectedness. This meaning was expressed through such statements as: "It's like a sorority"; "I feel like we're part of a family here"; and "We seem to bind together. We all feel like we're in the game together so we help each other make it through. The name of the game is survival, but not survival of the fittest. So we help each other . . . like a brotherhood."
Two factors were identified as catalysts for the peer group bonding described by these participants. With their entry into upper-division nursing courses, these participants were exposed to structured learning situations in which they experienced a level of interactional intensity with their peers unlike that which they had encountered previously as students. These participants engaged in prolonged, consistent, and almost exclusive interaction with other members of their nursing class. Alluding to the vulnerability they experience as a junior nursing student, several of these participants acknowledged that their desire to establish harmonious peer relationships was motivated by the recognition that their access to other sources of support was limited. As one of the participants said, "We all feel like we're in it together, so we don't want to step on each other's toes because there goes our support. If I have a bad time with one of my fellow students, then that's one less person I can count on if I need some help."
Additionally, the intensity that was characteristic of their peer group interactions was described by several of these participants as a vehicle through which they could know their peers on a personal level. The ability to enact caring behaviors with their peers was attributed to such personal knowledge by these participants. As one of them described it, "We are all friends and know something about each other's personal lives. When you know somebody has two kids and misses a test or a lecture, you might say "You're welcome to my notes.' Whereas with someone you didn't know that well, you wouldn't be likely to offer your notes."
One participant in this study provided data that were suggestive of a contrasting exemplar of a climate for caring within the context of peer group interactions. Referring to the clinical group to which she had been assigned, this participant described her peer group in the following way: "Our group is diminishing. Everybody wants to go their own separate way. I think some of the groups are doing alright, sticking together. But our group is kind of dying off."
Unlike the remaining nine participants who had difficulty recalling an episode in which a peer was perceived as uncaring, this participant had difficulty recalling an episode during which a member of her peer group had been perceived as caring. She described the members of her clinical group as distrustful of one another and, beyond sharing notes or other course-related information, unwilling to be of assistance to each other. Blaming competition for the disunity that she perceived to be characteristic of her peer group, this participant said, "Everybody knows the A student, the B student, and the C student, and toward the end of the semester it gets real competitive and it breaks friendships."
Although the data obtained from this participant can be interpreted only as suggestive of working hypotheses for further investigation, several other participants in this study attributed their ability to experience a climate for caring within peer group interactions to an absence of competition. One of the participants described her experience as a student in another discipline for comparison: "It was competitive . . . your classmates would give you notes if you missed a class, but they weren't real helpful about it . . . We would study together a bit but not so much to help each other. It was more to help yourself see what they got."
The same student said of her peer group in the school of nursing, "We study together so we can all learn. People just want to help you get through. You don't feel like you're in competition with all these people."
Although the gen eraliz ability of the data from this study is limited due to the small sample size, the findings suggest that interactions with the peer group constitute a vehicle through which junior nursing students can experience a climate for caring.
Although no studies could be found in which caring within the context of peer group interactions was specifically studied, several investigators have documented data that suggest that the peer group is actively involved in the normative socialization of nursing students. In a phenomenological study conducted by Nelms (1990) with 17 students attending a single baccalaureate school of nursing, the formation of close peer group relationships was identified by these students as one of the most meaningful aspects of their educational experience.
Similarly, in a qualitative study conducted to investigate student perceptions about clinical experiences, Windsor (1987) interviewed nine senior students attending one baccalaureate school of nursing and reported that the peer group was identified by these students as important to their ability to learn during clinical experiences. These students said they frequently consulted with their peers during clinical experiences and identified their peer group as a primary source of essential emotional support.
Finally, in a phenomenological study conducted to ascertain the caring content and experiences in baccalaureate nursing curricula, Bauer (1990) interviewed 26 faculty members and 32 senior students representing five baccalaureate schools of nursing and identified peer group modeling of caring behaviors as one of the ways in which students learn caring during their nursing education.
The findings from this study suggest several areas for further investigation. In particular, there is a need to identify methods by which faculty can nurture and sustain the ability of students to experience a climate for caring within the context of peer group interactions. Based on the data from these participants, studies conducted to investigate the effectiveness of teaching strategies that minimize student competition, for example, are warranted.
Additionally, schools of nursing differ in the size of their clinical groups, the decision-making strategy used to determine student assignment to clinical groups, and the length of time with which such assignments remain stable. Studies are needed to determine whether such factors as size of the clinical group, self-selection or faculty assignment of students to clinical groups, and periodic reconstitution of the membership of clinical groups facilitate or hinder the emergence of a climate for caring within the context of peer group interactions. Finally, research is needed to describe the relationship between a climate for caring as it is experienced during peer group interactions and such educational outcomes as the adoption by students of caring as a normative value for the practice of nursing.
- Bauer, J.A. (1990). Caring as the central focus in nursing curriculum development. In M. Leininger & J. Watson (Eds.), The caring imperative in education (NLN Publication No. 41-2308, pp. 255-266). New York: NLN.
- Bean, J.P. (1985). Interaction effects based on class level in an explanatory model of college student dropout syndrome. American Educational Research Journal, 22, 35-64.
- Bevis, E.O. (1989). Illuminating the issues: Probing the past, a history of nursing curriculum development - the past shapes the present. In E.O. Bevis & J. Watson (Eds.), Toward a caring curriculum: A new pedagogy for nursing (NLN Publication 15-2278, pp. 13-25). New York: NLN.
- Chickering, A. (1969). Education and identity. San Francisco: Jossey Bass.
- Feldman, K.A., & Newcomb, T.M. ( 1969). The impact of college on students (Vol. 1). San Francisco: Jossey Bass.
- Knafl, K., & Webster, D. (1988). Managing and analyzing qualitative data: A description of tasks, techniques, and materials. Western Journal of Nursing Research, 10, 195-218.
- Leininger, M. (1986). Care facilitation and resistance factors in the culture of nursing. Topics in Clinical Nursing, 8, 1-12.
- Nelms, T.P. (1990). The lived experience of nursing education: A phenomenological study. In M. Leininger & J. Watson (Eds.), The caring imperative in education (NLN Publication No. 41-2308, pp. 285-297). New York: NLN.
- Noddings, N. (1984). Caring: A feminine approach to ethics and moral education. Berkeley: University of California Press.
- Pascarella, E.T. (1980). Student-faculty informal contact and college outcomes. Review of Educational Research, 50, 545-575.
- Pascarella, E.T. (1985). College environmental influences on learning and cognitive development: A critical review and synthesis. In J.C. Smart (Ed.), Higher education: Handbook of theory and research (pp. 1-61). New York: Agathon.
- Pascarella, E.T, Duby, P.B., Terenzini, P.T., & Iverson, B.K. (1983). Student-faculty relationships and freshman year intellectual and personal growth in a nonresidential setting. Journal of College Student Personnel, 24, 395-402.
- Pascarella, E.T, & Terenzini, RT. (1980). Student-faculty and student-peer relationships as mediators of the structural effects of undergraduate residence arrangement. The Journal of Educational Research, 73, 344-353.
- Pence, G.E. (1983). Can compassion be taught? Journal of Medical Ethics, 9, 189-191.
- Sandelowski, M. (1986). The problem of rigor in qualitative research. Advances in Nursing Science, 8, 27-37.
- Sarason, S.B. (1985). Caring and compassion in clinical practice. San Francisco: Jossey Bass.
- Tanner, C. A. (1990). Caring as a value in nursing education. Nursing Outlook, 38, 70-72.
- Terenzini, P.T., & Pascarella, E.T. (1980). Student/faculty relationships and freshman year educational outcomes: A further investigation. Journal of College Student Personnel, 21, 521-528.
- Volkwein, J.F., King, M.C., & Terenzini, RT. (1986). Studentfaculty relationships and intellectual growth among transfer students. Journal of Higher Education, 57, 413-430.
- Watson, J. (1988). Human caring as moral context for nursing education. Nursing & Health Care, 9, 423-425.
- Weidman, J.C. (1979). Nonintellective undergraduate socialization in academic departments. Journal of Higher Education, 50, 48-62.
- Windsor, A. (1987). Nursing students' perceptions of clinical experience. Journal of Nursing Education, 26, 150-154.
Caring Interactional Episodes: Giving Assistance