The following quotation reflects one male student nurse's thoughts and feelings regarding his maternal-child clinical rotation:
...those assessments [postpartum], it's not the other part of the care.... I was uncomfortable in postpartum, therefore I avoided it... anxiety, I just didn't want to be there, I can't even describe it, it's anxiety, if s fear. I was afraid to be rejected.
This expression of anxiety was not isolated. Not only did students share these thoughts during the interviews, but male students also verbalized similar feelings aneedotally to one of the investigators regarding the maternalchild clinical rotation. The students expressed a desire to meet the clinical objectives and be successful in this setting, but their emotions related to this particular rotation often appeared to overshadow their ability to learn.
Both nursing faculty and students generally believe the clinical application of theoretical concepts is an integral part of the learning experience. Therefore, faculty make every effort to obtain optimal clinical learning situations for all students, regardless of gender, while meeting clients' needs. However, research supports the position that any clinical experience can be stressful, anxiety producing, and of concern to students (Kleehammer & Keck, 1990; Meisenhelder, 1987; Pagana, 1988, 1990).
Consequently, faculty efforts become even more crucial during the maternal-child rotation because anecdotal evidence indicates this rotation is stressful to students. Recognizing this stress, one approach is to gain insight into the student experience. Because the trend in enrollments of men in baccalaureate nursing programs has steadily increased from 2.4% in 1986 to 11.9% in 1996 (National League for Nursing, 1997), insights into the experience of male student nurses in the maternal-child clinical setting would enhance understanding of the male perspective and facilitate learning in this context.
This study is part of a larger program of research investigating the phenomenon of male student nurses in the maternal-child setting. A previously reported study (Morin, Patterson, Kurtz, & Brzowski, 1999) examined the perceptions of maternity clients and the hypothetical receipt of nursing care from a male student nurse. Tb date, the only published research report that addresses the experience of being a male student nurse in the maternalchild setting is that of Fogg (1961). Therefore, the purpose of this investigation was to describe male student nurses' experiences in that context. These findings add to the limited body of nursing knowledge related to the experience of being a male student nurse and clinical education.
Although men have been a significant part of the nursing profession for centuries, there is a paucity of research regarding male student nurses and their clinical experiences. In 1994, Okrainec recommended further research in the area of male students and obstetrical nursing based on the findings of his study of male students' perceptions of nursing education. In addition, role strain has been reported as being greater for male student nurses in the obstetrical setting (Sherrod, 1991). Most clinical education studies included only female student nurses or did not report the gender breakdown of the sample (Windsor, 1987; Yong, 1996). Although Streubert (1994) investigated perceptions of male student nurses' clinical experience, only Fogg (1961) specifically investigated male student nurses and the maternity experience.
In an early survey, Fogg (1961) explored the experience of male student nurses in the maternity setting. A summary of the responses on an opinionnaire completed by 30 male student nurses included reports of a valuable clinical learning experience, competency in the setting, feelings of self-consciousness and embarrassment, and an increased understanding of human life. The students expressed a "desire for competence and efficiency if they should be called upon to function in an emergency" (Fogg, 1961, p. 755). Most of the male students did not plan to practice maternity nursing after graduation.
In a descriptive study, Sherrod (1991) investigated the difference in role strain between 18 female and 18 male baccalaureate nursing students who had completed their maternal-child rotation. Sherrod hypothesized that obstetrical role strain would be greater for male students than for female students. Results indicated male students had statistically significantly higher role strain scores, higher Conflict, Incongruity, and Ambiguity subscale scores, and no difference on the Overload subscale. Sherrod suggested the results may be related to societal stereotypes about male student nurses in the obstetrical setting. In addition, contradictory role expectations may result in role conflict because male students must assume the different roles of nurse, student, and male.
In a phenomenological study, Streubert (1994) interviewed 9 male student nurses about their clinical experiences. Data analysis generated 11 themes, which included relationship of theory to clinical practice; skills development; women as primary caregivers; adjustment; team membership; opportunities; need to function like a real nurse"; past experience; challenge; feelings of excitement, confidence and success; and the student role. Based on these themes and her previous research with female student nurses in the clinical setting (Streubert, 1989), Streubert (1994) described the perceptions of these male student nurses as unique. She recommended this information be used as a starting point from which to understand male student nurses.
Research specifically examining male student nurses' experience in the maternal-child setting is limited. Therefore, the purpose of this study was to gain an understanding of the experiences of male student nurses who had completed the maternal-child clinical rotation.
The specific research question for this study was, "What is the experience of a male student nurse during the maternal-child rotation?" A phenomenological design was selected to describe the male student nurse experience as it is lived. This approach is an inductive, descriptive, qualitative method designed to uncover a phenomenon as it is experienced by an individual without considering any causal explanations or theories proposed by the researcher, thereby gaining an understanding of the phenomenon from the participant's perspective (Spiegelberg, 1975).
AU male baccalaureate nursing students (N = 12) who had completed their maternal-child course and clinical rotation at a private university in southeastern Pennsylvania were invited to participate. Eight male student nurses, ranging in age from 22 to 46, comprised the purposive sample. Seven students were White, and 1 was Black. Four students were married and had one to four children, and 4 students were single with no children. Experiential work backgrounds varied, ranging from construction worker to medical technician. The students' maternal-child experiences occurred in various settings. Data collection continued until saturation was reached.
Prior to initiating the study, University Institutional Review Committee approval for protection of human subjects was obtained. The study was described in full to the participants, and informed, written consent was obtained. Each participant was interviewed once in a mutually agreed on location. The interviews were audiotape recorded and lasted from 1 to 3 hours.
The same researcher conducted all the interviews. Prior to each interview, the researcher attempted to bracket her experiential and theoretical knowledge about male student nurses. This enabled the researcher to be as free as possible of previous beliefs and knowledge and enhanced her ability to remain completely open and receptive to the participants' experience.
Exhaustive Description of the Male Student Nurse Experience
Each student was asked to respond to the following statement, "Please describe your experience as a male student nurse in the maternal-child setting. Share all the thoughts, perceptions, and feelings you can recall until you have no more to say about your experience." To clarify and elaborate on the participants' descriptions, various probes were used (e.g., "Can you describe that more fully," "Give me an example," "Describe a typical day on the postpartum unit"). The participants' descriptions of their experiences unfolded spontaneously with little prompting. Several students stated that they welcomed this opportunity to share their thoughts and feelings.
AU interviews were transcribed verbatim, and the participants' identities were concealed using code numbers. Colaizzi's (1978) phenomenological method was used to analyze each of the male student nurse's descriptions of the experience of maternal-child nursing. The six procedural steps, as described by Colaizzi (1978), were followed for this study. They are:
* Reading the participants' descriptions to get a feeling for them.
* Extracting directly from each description phrases and sentences related to the phenomenon, which is known as extracting significant statements.
* Formulating meanings from the significant statements.
* Organizing the formulated meanings from all descriptions into clusters of themes.
* Developing an exhaustive description of the phenomenon.
* Validating with the participants the exhaustive description and incorporating any new relevant data into the final description.
Trustworthiness of the Data
To establish trustworthiness of the data, the criteria of credibility, auditability, and fittingness (Beck, 1993; Lincoln & Guba, 1985) were used. Credibility of the data was ensured through use of participant checks, investigator bracketing, and direct quotations. A copy of the themes and exhaustive description (Table) was shared with all participants to confirm that it accurately reflected their experience. Only 1 of the 8 participants added to the description. Prior to data collection, the researcher identified and bracketed her presuppositions regarding the phenomenon. An audit trail was established from transcription of the interviews to the writing of the exhaustive description. Many quotations from the participants formed a "thick description" (Geertz, 1973, p. 27). In addition, the audiotapes of the students' descriptions were transcribed verbatim and checked for accuracy. Fittingness of the study was supported when, on a formal public presentation of these findings, male RNs unknown to the investigators confirmed these descriptions were reflective of their experiences during the maternal-child experience as students.
FINDINGS AND DISCUSSION
This study provides an initial view and understanding that specifically addresses male student nurses' experiences in the maternal-child setting. Several findings are consistent with previously reported research, while some appear exclusive to this experience.
From the analysis of the interview transcriptions, eight themes emerged related to male student nurses' experiences of maternal-child nursing. These themes clustered into three categories, reflective of the stages of the experience:
* Preconceptions about the maternal-child rotation.
* Enduring the clinical rotation.
* Surviving the clinical rotation.
An exhaustive description of the students' experiences was developed from these themes (Table).
Preconceptions About the Maternal-Child Rotation
All the students had preconceptions about this clinical experience. They shared that the anticipation of beginning this rotation was stressful. Several students acquired these conceptions, which they referred to as "baggage," from former male student nurses who had completed the rotation, whereas others knew male nurses who had shared their student experiences.
Theme 1: Feelings of Not Knowing What to Expect. The students anticipated rejection from patients because they were men. Despite this, they expressed a desire to learn, meet course requirements, and provide good nursing care. Students stated:
* ...it was sort of a force in the beginning that I was afraid, I had these fears.... I was afraid to be rejected... you know, one of them would say, "I don't want him seeing my breast," I don't want him seeing this...
* I basically thought it would be, you know, watch out, you may get thrown out of a room because, you know, it's a wife or a husband doesn't want you there...
The strong fear of rejection expressed by the students in this study preceding and during their clinical experience has been addressed only once in the literature (Peterson et al., 1996). In a phenomenological study of 28 male students at a Canadian university, Paterson et al. (1996) investigated the experience of the male student learning to care as a nurse. Rejection by patients was included under the theme of "experiencing the difference." They were différent because they were male student nurses. Although it occurred only infrequently, junior and senior students described distressing situations in which patients refused nursing care from them because of their gender.
Theme 2: Belief That Maternal-Child Nursing Has Been and Will Remain a Woman's Domain. For several students, this belief was based on gender stereotypes and societal values. They believed maternal-child nursing was primarily a setting for women and that, with the exception of physicians and husbands, other men were just visitors or "invaders." This is summed up by these student quotes:
* I believe that a woman's body is very personal and sacred to them... if s a women's world because women have babies, and men don't.
* When men first probably started getting into nursing that was always like, you know, a caring type role as a nurse and that always has been considered the domain of women. And so as I went into nursing, I didn't believe that stereotype, I thought, well, I could be as caring... but when I look at "motherhood" and babies, right or wrong, it's still to me the domain of and always has been the domain of women, and it just seems a more comfortable area for women to deal with.
In Streubert's study (1994) of male student nurses' perceptions of the clinical experience, she quoted one man who shared his feelings regarding his obstetrical rotation, which was consistent with those of the male student nurses in this study. Feelings of anticipation, dread, and concerns of examining a woman were expressed. This quotation appeared under the theme of "women as primary caregivers" (Streubert, 1994, p. 30) and supported research related to gender role stereotyping and the fact that the majority of nurses are women.
The issue of gender has been elucidated by Warren (1988) as being a reflection of "the ways in which biological sex roles are culturally elaborated: to the values, beliefs, technologies and general fates to which we assign women and men" (p. 13). In a study by Kelly, Shoemaker, and Steele (1996), the male participants shared that nurses tended to generalize nursing to women and only later included men. This feminine profile of nursing, particularly in the maternal-child setting, may create conflict for male student nurses as they attempt to fulfill societal expectations related to their gender (Sherrod, 1991).
Sherrod's research (1991) on obstetrical role strain for male student nurses suggests men experience more role strain in this context than women. Sherrod speculated that the feminine behaviors of the obstetrical nurse (e.g., patience, nurturance, compassion) are not viewed as socially acceptable for men. It also has been argued that nurse educators, administrators, and female nurses continue to encourage male nurses into prestigious positions perceived as congruent with the masculine gender role (Evans, 1997; Williams, 1995). However, obstetrics is not such a setting.
Enduring the Clinical Rotation
The male student nurses sought different ways to complete the rotation successfully. Although most of their discomfort, anxiety, and fear lessened over time, several students avoided the postpartum unit by "volunteering" to rotate to the nursery or labor and delivery many times. They were more comfortable in those settings. They felt less "threatened" and more accepted by staff. Similarly, labor and delivery felt like "med-surg," a rotation with which they had a degree of comfort. In addition, concerns about meeting maternal-child clinical objectives and personal goals surfaced for the students because they felt that because of their gender they may not be able to complete a postpartum assessment successfully.
Theme 3: Concerns of a Possible Misinterpretation by Mothers of Their Nursing Care. How the male student nurses touched the patients was perceived as a potential issue. Although they knew this was part of their learning experience, they worried these activities would be viewed differently by patients. The students shared:
* The only, well it wasn't really a restriction, but it was for my own well, you know, my own personal, urn, basic vulnerable safety,... because I was a male and when I did assessments that, you know, I had a female present...
* ...you know I didn't want to approach somebody wrong, touch somebody wrong, being a male.
Students' concern that their nursing care would be perceived by patients as something other than professional behavior is a finding that has not been addressed extensively in the literature. Paterson et al. (1996) noted that their participants "wrestled with appropriate ways to touch a patient" (p. 33) to provide care, while avoiding a misunderstanding of their touch.
While the male student nurses in this study felt competent performing postpartum assessments when supervised by faculty, they consistently expressed the need to have a female colleague (e.g., staff nurse, faculty member, student) present or within immediate reach during any postpartum assessment. They felt they could be at risk of being accused of improper sexual behaviors. Therefore, the students tried to be "extra" professional to avoid any misinterpretation. One explanation of this theme could be that it is a social convention that members of the opposite gender not be alone together, particularly with the examination of certain parts of the physical anatomy. The presupposition of this social convention is sexual in nature. Consequently, female nurses often are present when male gynecologists and obstetricians examine patients.
Theme 4: Feelings of Being Alone, as well as an Outsider. These feelings emerged as male students realized they were the only men providing nursing care on the postpartum units. None of these students had the experience of working with a male nurse in this context. Subsequently, they felt "out of place." In labor and delivery, in general, there often were more men present, and the male student nurses' degree of comfort increased. This theme was captured by these student quotes:
* [Y]ou are aware that you're the only male in the environment.... I felt a little bit like an outsider... no one ever treated me that way.. .because I was the only male there.
* I found on the postpartum floor being a male, I felt extremely out of place, the nurses that were on the floor kind of led the whole feeling too, in fact one of the nurses said that "I would never have a male nurse, I would never have a male look at me," which I found kind of [sic] unusual coming from another nurse, but I accepted it.
The findings of this study are consistent with some of the research related to feelings of being alone (Kelly et al., 1996) or being the only male nurse in the setting and not being inclined to select maternal-child nursing as a career option (Okrainec, 1994). Kelly et al. (1996) found that male students indicated they felt isolated and lonely when asked about their clinical experiences. The authors noted the students related these feelings to a lack of male role models.
Theme 5: Female Colleagues Sought for Reassurance and Comfort. Although the male student nurses did not perceive special restrictions or barriers because of their gender, they sought female colleagues during postpartum assessments for reassurance and comfort. It provided them with a sense of security when they assessed the fundus or performed a breast check. Two students captured this theme with their statements:
* ...sweating, a lot of sweating... you have to go in there and poke and prod at them, at their breast, check their fundus, make sure they're not bleeding. These are all private things... these women are like [sic] almost naked, and you're fumbling around.... I usually had a female student with me. ..it was for my own protection... it's not that I'm a prude...
* I would take the faculty member, one of the staff nurses, or another nursing student... if I was going to be doing anything sensitive as far as looking at the perineum...
Theme 6: Needing to Be "Extra" Professional in the Maternal-Child Setting. The male student nurses were particularly sensitive to the personal and private nature of postpartum assessments and felt the need to be "extra" professional when performing these assessments. They reviewed how to put patients at ease through thenapproach and attitude toward the patients. Professional demeanor appeared to be more significant in the maternal-child setting than in previous rotations. This theme was expressed in the following quotations:
* ...on the level that we are professional, that is what we need to do, and it's for their benefit and for our benefit too, and that's when I realized that I was able to address this issue, I felt better about myself, stronger going in.... I just tried to be more professional, more aggressive in my tone of voice, not passive like, you know, the student kind of thing...
* [ T ]he way I think I overcame the barrier of going in and invading the females' most private space is being as professional as I can, I think even adding a little extra manners... to make her see that this is something serious, I know this is your body and I respect your privacy...
None of the male student nurses in this study expressed feelings of embarrassment about the nursing care they provided, although they did find that their professional demeanor helped put themselves and the patients at ease during postpartum assessments. Mixed feelings and thoughts have been voiced by other students on entry into the clinical experience as well (Yong, 1996). Although participants' gender and clinical specialty areas ("with at least 13 weeks of clinical experience," Yong, 1996, p. 73) were not indicated, Yong (1996) reported the students shared that the clinical experience can be a time filled with uncertainty and unclear expectations. Conversely, the male student nurses in Streubert' s study (1994) most often stated feelings of excitement, confidence, and success. Infrequent feelings of fear related to doing harm to patients were voiced. Fogg (1961), in the opinionnaire of 30 male nurses, noted that participants expressed some self-consciousness and embarrassment with their maternity experience, although it increased their level of maturity.
Theme 7: Role of Nursing Faculty in the Creation of the Learning Environment. The influence of individual faculty members in minimizing apprehensions was crucial. Students recognized the faculty could provide either a supportive or nonsupportive context. Faculty bridged the gaps among students, patients, and staff. The faculty were perceived as "setting the tone" by creating a learning environment and offering students the confidence they lacked in this setting. One student stated succinctly:
[TJhe thing that stands out in my mind more than anything else was the faculty member's perceptions of the male's role in nursing.... I found that if the professor were to treat me like a nurse, as opposed to a male nurse, and introduced me as this is so-and-so, he's your nurse today and treats it as a normal occurrence. ..then my acceptance was higher.
Surviving the Clinical Rotation
The male student nurses expressed relief at the completion of this rotation. Surprisingly, the maternal-child rotation was perceived as a "great experience." Because of the nature of the setting, the male student nurses had more opportunities to teach and interact with patients. One student stated, "there wasn't a lot of pressure... you didn't have 100 drugs to look up." The students enjoyed observing births and learning to care for newborns. They were delighted when they successfully passed course objectives and "were done."
Theme 8: Disinclination to Seek Future Employment in Maternal-Child Nursing. Despite having a pleasurable experience in the maternal-child setting, the male student nurses indicated their disinclination to seek future employment in this setting. The feeling that it was a "women's world" remained. This theme is demonstrated by the following quotations:
* Would I want to work on a postpartum floor, NO, I liked it, or L & D [labor and delivery], NO, it was interesting.... You know, I don't know, I just feel that it's a primarily a female ward, and I think that's maybe where [sic] it should be.
* I would probably take a job in OB [obstretics] if I could work in the nursery. If I got hired in OB, I think I would encounter more problems, see, I still worry about that rejection.
Okrainec (1994) noted in his study of 117 Canadian male student nurses that essentially no one selected obstetrics for future employment and few expressed a preference for the obstetrical course, in sharp contrast to the 121 female respondents. In 1961, Fogg noted the men seldom selected this area of nursing for future practice.
Certainly, the question of why this is the case is raised. Okrainec (1994) suggested these preferences may be because of the nature of obstetrical nursing tasks or the postpartum care of patients. Interestingly, concern about having a male student nurse perform certain nursing activities during the postpartum period has been expressed by patients as well (Cooper, 1987; Morin et al., 1999; Mynaugh, 1984; Newbold, 1984). On the other hand, noninvasive care activities were identified consistently as more acceptable (Morin et al., 1999).
IMPLICATIONS FOR NURSING EDUCATION
Although these findings only reflect the experience of these participants, the description of their experience is powerful. The findings provide information about potential issues related to the clinical experience of male student nurses during their maternal-child rotation that have implications for nurse educators. These implications are discussed by organizing categories.
Preconceptions About the Maternal-Child Rotation
Given the themes in this category (i.e., "feelings of not knowing what to expect," "believing that maternal-child nursing is and will remain a woman's domain"), planning preclinical or class time to discuss students', faculty's, and patients' expectations may decrease students' fears of rejection. In addition, exercises to help students clarify their personal perceptions of the clinical setting (i.e., a woman's world) and then place these perceptions within a professional context also may be beneficial. Role playing, case studies, and small group discussions are strategies that may be implemented to help clarify expectations and beliefs.
To facilitate learning for all students, faculty is encouraged to continue to challenge societal stereotypes of male student nurses in the maternal-child context. As Turnipseed (1986) noted, "The stereotyping of occupations results in a compromise of male nursing students' education" (p. 346). Therefore, current findings may help sensitize faculty to underlying societal issues that influence student experiences.
Enduring the Clinical Rotation
The male student nurses' comments in this category support the need to undertake nursing assessments and interventions from a perspective unbiased by gender. In fact, students addressed this issue from two perspectives-from possible misinterpretation and from the need to be "extra" professional. Therefore, helping students explain and perform assessments in a competent, nonsexual manner is critical. As male student nurses in this study indicated, a female presence was helpful. Accordingly, faculty may wish to encourage the continuation of this practice. In addition, faculty's approach to patients in the presence of male student nurses may help create a better environment for student-patient interactions. The benefits of supportive faculty and a positive learning environment during the clinical experience are supported in the literature (Windsor, 1987).
Context appears to play a significant role, considering students expressed feeling more out of place in the postpartum setting than in labor and delivery. Given this, faculty may wish to have male student nurses begin their experience in labor and delivery and follow clients to the postpartum setting. Such an arrangement would provide students and patients with some history and continuity, a point found to be important to patients in an earlier study (Morin et al., 1999).
Surviving the Clinical Rotation
Findings from this study, with the identified implications, may have a role in students' choice of future employment. Faculty can recognize this in interactions with students, and such acknowledgment could convey faculty sensitivity to students' perspectives. Certainly the presence of male nurse role models in maternal-child settings can contribute to students' consideration of this specialty for practice. Unfortunately, none of the clinical facilities in which students in this study had clinical experiences had any male nurses in their maternal-child units.
Although the focus of this study was the experiences of male student nurses, female student nurses may experience similar feelings during the maternal-child rotation. Therefore, future research could explore female student nurses' experiences during this particular rotation. In addition, gaining an understanding of nursing faculty's and maternal-child nursing staffs perspectives would add dimension to the phenomenon of student experiences in the maternal-child clinical setting.
In reflecting and sharing their experiences in the maternal-child setting, the male student nurses in this study voiced the perception that it was an overall positive experience. This seems contradictory because the students stated they began the rotation with feelings of anxiety, fear, and possible rejection. Nevertheless, they also highlighted the positive elements, such as the birth of a child and the opportunity to teach. Findings from this study should sensitize faculty to the needs of the male student nurse population in the maternal-child setting. Such an outcome would provide a supportive context for both students and patients. The end result is a win- win situation for all involved.
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Exhaustive Description of the Male Student Nurse Experience