The implementation of the Patient Protection and Affordable Care Act (2010) and the recommendations of the Institute of Medicine (2010) on the future of nursing are creating opportunities for leadership by nurses. Preparation for these leadership roles can begin at the baccalaureate educational level by helping nurses to develop a strong nurse self-concept.
The psychological construct of self-concept has been defined as one’s personal perceptions of the self, which are “formed through experience with and interpretations of one’s environment” (Marsh & Perry, 2005, p. 72). These experiences occur in both social and academic settings. Much of the research on self-concept has been conducted in education, athletics, and psychology (Cowin, Johnson, Craven, & Marsh, 2008; Jahanbin, Badiyepeyma, Sharif, Ghodsbin, & Keshavarzi, 2012). Investigations of self-concept in nurses have focused primarily on practicing nurses. This article reports the effects of a peer-mentoring experience on the nurse self-concept of senior-level baccalaureate nursing students.
Shavelson and Bolus (1982) described self-concept as multifaceted and hierarchical. Self-concept has academic, social, and physical aspects, and is hierarchical in the sense that as individuals achieve and develop perceived competency in more specific areas, their general self-concept becomes more positive. Academic achievement is only one aspect of overall self-concept and is built on success in individual academic areas (e.g., math, science, and language). Interactions with peers and significant others are components of social self-concept. Particular emotional states contribute to emotional self-concept, whereas physical ability and physical appearance comprise physical self-concept. Age affects self-concept indirectly in that self-concept becomes increasingly more multifaceted as one grows and develops. There is no direct connection to gender or ethnicity in this model.
Building on the work of Shavelson and Bolus (1982), Cowin (2001) developed a multidimensional model of nurse self-concept. Based on interviews with practicing nurses, six dimensions of nurse self-concept were identified (Cowin, n.d., as cited by Hensel, 2011):
- Nurse general self-concept—the overall sense of self-esteem that arises from a sense that one belongs in the nursing profession.
- Caring—the support given to one another.
- Communications—sharing information and ideas with patients, families, communities, and other health care workers.
- Knowledge—the possession and confident use of nursing skills and theories.
- Staff relations—collegial relationships.
- Leadership—the ability to confidently direct activities of the health care team.
Nurse self-concept has been linked to a number of challenges that the nursing profession currently faces, including retention (Cowin, 2001; Cowin et al., 2008), job satisfaction (Cowin et al., 2008), healthy lifestyle behaviors (Hensel, 2011), and perceived quality of care (Andrews, Burr, & Bushy, 2011). Cowin (2001) and Cowin et al. (2008) demonstrated a relationship between nurse self-concept and intention to remain in the profession after 1 year. In both of these studies, respondents with lower self-concept scores reported that they were less likely to remain in nursing. The relationship between self-concept and retention was stronger than the relationship between job satisfaction (including satisfaction with pay) and retention. Relationships between nurses’ perceptions of the quality of care they are able to provide and self-concept also have been demonstrated, although these relationships have not been shown to be causal (Andrews et al., 2011)
The development of a strong nurse self-concept begins in nursing educational settings. Jahanbin et al. (2012) demonstrated a significant improvement in overall nurse self-concept, as well as in the caring, knowledge, and communication components of Cowin’s nurse self-concept model after students participated in a 2-day intensive workshop on nurse self-concept. The aim of the current study was to measure the effectiveness of a peer-mentoring experience on nurse self-concept; the peer-mentoring experience is part of the curriculum and takes place during students’ clinical experience.
Beginning nursing students often struggle to understand their roles as nurses and lack confidence in presenting themselves to patients as nurses (Harmer, Huffman, & Johnson, 2011). Programs that use mentoring of lower-level students by upper-level students have been developed within schools of nursing to support the lower-level students. Such programs vary widely. Some programs are social (Gilmour, Kopeikin, & Douche, 2007), some occur in skills laboratory settings (Hunt & Ellison, 2010), and others occur in patient care settings (Giordana & Wedin, 2010; Harmer et al., 2011).
Peer mentoring has been defined as a relationship in which the mentor and mentee are of similar age and status (Hunt & Ellison, 2010). Benefits of a peer-mentoring program are that less experienced students may find peer mentors more accessible than instructors or faculty members. In addition, a student may be more comfortable approaching a peer than a faculty member or instructor (Bulut, Hisar & Demir, 2010).
Peer mentoring in the patient care setting has been shown to have benefits for both the mentored and the mentoring students. Mentored students reported that they felt supported and encouraged by their mentors, and that their anxiety decreased. Upper-level students who acted as mentors reported feelings of competence and self-confidence, as well as an increased understanding of the role of the nurse leader. Students who participated in peer mentoring in clinical settings reported that they gained an appreciation of collaboration, teamwork, time management and prioritization (Giordana & Wedin, 2010; Harmer et al., 2011; Hunt & Ellison, 2010; Sprengel & Job, 2004).
At the study site, a peer-mentoring experience has been part of the curriculum since 2008. As part of their Nursing Leadership and Management course, all senior-level students provide peer mentoring to sophomore students during the sophomores’ first clinical experience in a long-term care facility. The previously conducted research in this area suggests that the peer-mentoring experiences of the senior students could impact their nurse self-concept by allowing them to experience collaboration and team-work, feel competent, and act as a role model for less experienced students (Cowin, 2001; Giordana & Wedin, 2010; Harmer et al., 2011; Hunt & Ellison, 2010; Sprengel & Job, 2004).
The purpose of this study was to evaluate the effects of the peer-mentoring experience on senior-level nursing students’ nurse self-concept as measured by Cowin’s (2001) Nurse Self-Concept Questionnaire (NSCQ).
This quasi-experimental study used a pretest–posttest design to measure the effect of the peer-mentoring experience on nurse self-concept of senior students. The study was reviewed and approved by the university’s human subjects institutional review board.
Participants were asked to complete a short demographic survey that included age, gender, and race/ethnicity. Cowin’s (2001) NSCQ was used to measure nurse self-concept in the students. The NSCQ consists of 36 items. Participants are asked to read a set of statements and indicate the level to which each statement is true using a Likert-type scale ranging from 1 (definitely false) to 8 (definitely true). Total scores for nurse self-concept are reported in a range from 36 to 288, with higher numbers representing a higher overall self-concept. The instrument consists of six subscales, each of which measures one of the dimensions of nurse self-concept described by Cowin. Scores for each of the subscales range from 1 to 48; again, higher scores indicate a higher level for the subscale. Internal reliability values for the instrument ranged from 0.83 to 0.93 (Cronbach’s alpha) (Cowin, 2001).
All 43 senior-level students consented to participate. They were asked to complete the NSCQ 1 week prior to beginning the peer-mentoring experience and again at the end of the experience. To provide students with confidentiality, random numbers were assigned and recorded on the blank surveys. A sticky note with the student’s name was adhered to the survey, and when the survey was handed to the student, the note was removed. This same procedure was followed for the postexperience survey.
The peer-mentoring experience for the senior students consisted of 3 clinical days of 5 hours each. The experience occurred at an extended care facility where second-semester sophomore level students underwent their first clinical experience caring for patients. Each senior-level student was assigned to be a mentor for three to four sophomore students. The sophomores remained in the setting for a total of 6 weeks; at the 3-week point, the sophomores were assigned a new mentor.
The senior students were provided with an overview of the experience by the faculty for both the senior and sophomore courses. In addition, the senior students had been mentored students during their sophomore year. The objectives for the senior students were twofold—(a) to practice supervision, delegation, and subordinate evaluation skills, and (b) coach, teach, and support sophomore students during their first clinical experience.
Prior to the experience, senior students were required to review basic skills, teaching–learning principles, and therapeutic communication. The expectations for senior students included:
- Socializing the sophomore students to the institutional setting.
- Helping the sophomore students gain confidence in therapeutic communication and basic nursing skills (e.g., assessment, treatments, bathing, and feeding).
- Initiating communication with the sophomore students.
- Identifying potential practice and safety issues.
- Treating the sophomore students with respect.
- Consulting the clinical faculty for problems.
The mentor students also were expected to provide the sophomore students with feedback on clinical performance and written work prior to its submission to the faculty. Senior students were specifically prohibited from administering medications or supervising sophomore students in giving medications.
Data were analyzed using SPSS®, version 20, software. Descriptive procedures were used to analyze the demographic characteristics of the sample. Cowin (2001) did not report results using these characteristics. However, given that Shavelson and Bolus (1982) noted the effects of growth and development on self-concept, Pearson’s correlation was used to determine whether there was a relationship for age, gender, or ethnicity with each of the subscales both prior to and after the peer-mentoring experience. Paired t tests were conducted to evaluate the degree of change in the means for the entire instrument as well as for each of the subscales.
The majority of participants were Caucasian (87.5%) and women (87.5%). The finding that 12.5% of the students were men was higher than the percentage of male nurses in the United States, which is approximately 9.6% (Landivar, 2013). The mean age of respondents was 23.15 years (range = 21 to 42, SD = 4.029).
No significant correlations were noted between the entire scale and any of the subscales with regard to age or ethnicity, either before or after the peer-mentoring experience. However, significant correlations were identified between gender and the Staff Relations (r = 0.321, p = 0.043) and Knowledge (r = 0.383, p = 0.015) subscales prior to the peer-mentoring experience. No significant correlations were noted with gender after the experience. This finding prompted comparison of the mean scores on those two subscales before and after the peer-mentoring experience for male and female students.
For the Staff Relations subscale, the mean scores before the experience were 43.94 (SD = 2.99) for female students and 42.40 (SD = 5.32) for male students; this difference was significant (t = −2.089, df = 38, p = 0.043). After the peer-mentoring experience, no significant difference was noted in the mean scores for male and female students.
For the Knowledge subscale, the mean scores before the experience were 38.60 (SD = 3.435) for male students and 42.51 (SD = 3.175) for female students; this difference was significant (t = −2.556, df = 38, p = 0.015). After the peer-mentoring experience, no significant difference was noted in the mean scores for male and female students.
The mean changes as evaluated by paired t tests for each of the subscales as well as for the entire instrument were significant. The change in subscale means ranged from 1.02 to 4.05, with the greatest change in the Leadership subscale. The mean change for the entire scale was 10.9. Complete results are shown in the Table. Cronbach’s alpha for the subscales ranged from 0.74 to 0.92; for the entire scale, Cronbach’s alpha was 0.94.
NSCQ Scores Before and After Peer-Mentoring Experience
The results of this study indicate that the peer-mentoring experience for senior nursing students improved their nurse self-concept scores, both overall and on each of the six subscales identified by Cowin (2001). The improvement in the Leadership subscale indicated that the mentoring experience may contribute to students’ perceptions of themselves as nurse leaders.
Earlier qualitative studies reported that students felt more confident and competent, and had increased understanding of team members’ roles as a result of acting as a peer mentor. The findings from this study reflect the findings of earlier investigations into peer mentoring for upper-level students. For example, increases in the Staff Relations subscale may be due to an appreciation of collaboration and teamwork, as described by Harmer et al. (2011) and Hunt and Ellison (2010). Increased scores on the Knowledge subscale may be a result of increases in self-confidence reported in previous studies (Giordana & Wedin, 2010; Harmer et al., 2011; Hunt & Ellison, 2010; Sprengel & Job, 2004). In the current study, the significant changes observed in all six NSCQ subscale scores after the peer-mentoring experience reflect areas of growth for the students.
The finding that male students scored significantly lower than females on the Knowledge and Staff Relations subscales was unexpected. Previous studies have identified that male students perceive that they are called on for answers more frequently than female students and that clinical environments may be more discriminatory than classroom settings (Meadus & Twomey, 2011). There have been reports of male nursing students being told that they do not belong in clinical settings and being more closely monitored and judged than female students. Male students have reported feelings of exclusion and isolation during clinical placements (Kouta & Kaite, 2011; LaRocco, 2008). Although there were no documented complaints of these experiences during this cohort’s time in the program, if male students experienced these types of behaviors during the course of their educational experience, they may have felt less confident in their knowledge and in their roles as members of the health care team.
These differences were no longer evident after the peer-mentoring experience. It is possible that the opportunity to act as a mentor may have served to bolster the male students’ perceptions of themselves as knowledgeable and as contributing to the health care team.
This investigation included a single group of students. Findings would have been strengthened by the use of a control group of students who did not participate in the peer-mentoring experience. However, the peer-mentoring experience has been a part of the normal educational practice in this program since 2008, thus no such control group was available.
Implications for Future Research
Cowin et al. (2008) have identified that NSCQ scores vary over time. A future investigation is planned to monitor a group of students throughout the educational program (six semesters) to determine whether nurse self-concept fluctuates over time. An additional question is prompted by the finding that male students had lower scores than female students prior to the mentoring experience. It may be worthwhile to investigate this issue further.
Cowin et al. (2008) have shown that the Nurse General Self-Concept subscale can be used as a predictor for retention in nursing. Although those connections have not been identified in student populations, it would be of interest to determine whether a relationship exists between Nurse General Self-Concept and student attrition.
Nursing education programs have an opportunity and an obligation to help students develop a strong concept of themselves as nurses. The results of this study reinforce the value of providing opportunities to practice leadership and develop nurse self-concept in nursing students.
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NSCQ Scores Before and After Peer-Mentoring Experience
|Subscale||Mean (SD) Score||Paired t Test a||p Value|
|Before Peer Mentoring||After Peer Mentoring|
|Overall NSCQ scale||249.73 (17.781)||260.63 (15.956)||5.015||<0.001|
|Caring||42.58 (3.054)||43.93 (3.125)||3.18||0.003|
|Staff Relations||42.73 (3.250)||43.75 (3.311)||2.415||0.021|
|Knowledge||42.03 (3.423)||43.55 (3.146)||3.574||0.001|
|Leadership||35.83 (5.286)||39.88 (4.351)||5.865||<0.001|
|Communication||42.08 (3.116)||43.73 (2.882)||3.295||0.002|
|Nurse General Self-Concept||44.5 (3.922)||45.8 (3.123)||3.397||0.002|