|Teaching and Learning Forum 2010 [ Refereed papers ]|
University of Notre Dame Australia
As educators it is our responsibility that we not only teach our students sustainability strategies but also practices to sustain them in a world that is ever changing. This study addresses the theme of this conference because it deals with teaching students strategies to equip themselves with practices that will impact on their role as professionals. This pilot study aimed to assess effectiveness of a 3 week self-care intervention program from the perspective of 3rd year nursing students at the University of Notre Dame Australia. The methodological approach underpinning the study was descriptive and the students were engaged as active participants in the study with the aim of having a positive impact on the lives of the participants. The study sought student nurse participants who would be involved in 3, 1 hour instructional sessions. All students were given the opportunity to participate in the research. Students who consented to participate were given a pre-questionnaire followed by three 1 hour instruction on self-care. On completion of the third session, students were asked to complete the post-questionnaire and were invited to participate in a focus group interview. This paper will present the findings from this innovative pilot project. Recommendations from this study were included as part of the University's strategy to promote and facilitate students' self-care abilities.
Discussions with Nurses-Academics indicate that one reason for the lack of self-care programs in nursing education is that the curriculum is more than full. Another factor is that students, as a rule, feel concerned about their academic and clinical requirements and so do not want to take time away from these. Therefore, any self-care intervention needs to work within the constraints of the curriculum and students perceptions of their priorities.
A review of the literature indicates that there is ample evidence of stress and its consequences in the nursing profession. It is known that stress can influence job-satisfaction, psychological well-being and physical health. In a study exploring the relationship between stressors, coping methods, demographic characteristics and health in Australian nurses, significant correlations between stressors and both physical and mental health were found (Chang, Daly, Hancock, Bidewell, Johnson, Lambert, Lambert, 2006).
Jones and Johnson (1997) reiterate this finding when they state that nursing students face not only the demands of their profession but also the range of stressors that a Bachelor program entails. These stressors include fear of failure, long hours of study and lack of free time. The study also found that the level of stress among nursing students exceeded the stress level in senior medical students and in the general population (Jones, Johnson, 1997). Beck and Srivastava (cited in Kanji, 2006, p.730) delineated these stressors further citing the intense emotional challenges associated with nursing work and also the challenge of assimilating difficult and tentative information caused stress in nursing students. Additionally, there is evidence to suggest that the perceived level of stress by student nurses does not vary significantly across the branches of child, adult and mental health nursing (Por, 2005).
There exists a range of modalities, which can be drawn from to prevent stress and so to develop 'resilience' in nursing students and nurses. Likewise, the literature highlights several interventions offered to nurses and nursing students. One intervention focused on the effects of Mindfulness Meditation on student nurses' stress levels. Following the 8-week intervention, which included use of guided meditations at home, participating nurses reported significantly reduced anxiety. Favourable trends were observed in a number of stress dimensions, including attitude, time pressure and total stress levels (Beddoe & Murphy, 2004).
Another intervention using a controlled group design was a creative arts exercise for nursing students. Significant differences existed between the two groups with the experimental group reporting less stress, decreased anxiety and more positive emotions (Walsh, Chang, Schmidt & Yoepp, 2004). A third controlled prospective crossover study examined the impact of a 6-session Recreational Music-Making protocol on burnout and mood dimensions in first year associate nursing students. Statistically significant reductions in multiple burnout and mood dimensions were noted (Bittman, Snyder, Bruhn, Liebfreid, Stevens, Westengard & Umbach, 2004).
At the Griffith University Research Centre for Clinical Practice Innovation in Queensland, a study was conducted to determine the benefits of a 15 minute weekly massage in reducing physical and psychological stress in nurses. Sixty nurses participated in the study, and though the intervention may appear modest, the results were definitive. Differences in State and Trait Anxiety levels, measured over the five weeks, were statistically significant (Bost & Wallis, 2006).
A randomized controlled trial, focused on the intervention of Autogenic Training to reduce anxiety in nursing students. The intervention consisted of eight weekly sessions of Autogenic Training, a form of guided relaxation/imagery. Results demonstrated a significantly greater reduction of anxiety in the experimental group (Kanji, White and Ernst, 2006).
In the literature, the term hardiness and resilience appears to have been used interchangeably. However, "hardiness" is defined by Maddi and Khoshaba (2004, p 265) as "psychological vitality and enhanced performance" whilst "resilience" is defined by Vaishnavi, Connor and Davidson (2007, p293) as "personal qualities that enable one to thrive in the face of adversity". The relationship between hardiness, or resilience, stress and health-promoting behaviours was explored in a study of 250 female nursing students from 39 nursing schools in the USA. The findings indicate a significant positive relationship between hardiness and health-promoting behaviours and a significant negative relationship between stress and health-promoting behaviours. Interestingly, the participants in this study indicated that their nursing faculty members were good exemplars of health-promoting behaviours (Nikou, 1998, Ph.D. thesis).
A final consideration is raised by a nursing student herself. In her student paper, Caring for Self: A Pre-requisite of Caring For Others, Canadian nursing student, Jaime Mantesso, considers nursing theorist Dr. Gwen Sherwood's Theory of Caring. She draws the conclusion, based in part on her own life experience that it is only by "being in tune to self-care that a nurse can more fully address the needs of others through a caring mode of being." (Mantesso, 2005, p.75)
This pilot project was undertaken to evaluate the benefits of a self-care intervention within a sample group of 3rd year nursing students at University of Notre Dame Australia. Nursing students, it is recognized, carry the stressors associated with their profession but also the full range of stresses faced by mainstream academic students, including long hours of study, fear of failure and lack of free time (Kanji, 2006). In a literature review of workplace stress in nursing (cited in Kanji, 2006, p. 730), McVicar concluded that stress intervention measures should be introduced that focus on stress prevention for individuals. This pilot project is a response to this call for prevention. Third year nursing students were offered the opportunity to learn and practice Guided Imagery, within a 3-week pilot program.
It is well recognised that demands on students nurses and nurses in practice are not lessening; that nurses need to be able to cope with the demands, or even better to have developed a certain resilience in the face of these demands. These issues have provided an impetus for this project. This study has a number of implications that translate to a national as well as a local (Western Australian) level. This pilot project was considered to be an early intervention and therefore has the promise of fostering an individual's commitment to self-care early in professional life. This pilot project carries with it the possibility of becoming a template for self-care interventions in nursing schools around Australia.
Triangulation was also used in this research because according to Halcomb and Andrew (2005), the use of multiple data sources and methods to validate findings increase the depth and quality of the results. Morse (1989) cited in Minichiello, et al. (1999) believes that triangulation is a means by which the researcher is able to capture a comprehensive picture of the phenomenon. In this study triangulation was used to collect data from focus group interviews about the perception of students in relation to the effectiveness of the intervention on their personal lives.
The methods employed were the interventional sessions and techniques used to support positive self-care activity throughout the 3, 1 hour sessions and an evaluation of these sessions. A pre and post intervention survey (questionnaire) and a focus group interview, were conducted after the conclusion of the interventional sessions with those participants who undertook the interventional program.
The research process is as explained below:
|I feel relaxed||4.17%||8.33%||25%||8.33%||45.8%||4.17%||4.17%|
|I feel confident||0||0||25%||16.7%||50%||8.3%||0|
|Learning to relax is important to me||0||0||0||0||16.7%||25%||58.33%|
|Self Care is important to me||0||4.17%||0||4.17%||16.7%||20.83%||54.17%|
|Self care is important to my performance as a nurse||0||0||0||8.33%||12.5%||29.17%||12%|
|Guided imagery can improve my effectiveness as a nurse||0||0||0||54.1%||20.8%||16.7%||8.33%|
|Guided imagery can improve my effectiveness in other areas of my life||0||0||0||54 1%||16.7%||12.5%||16.7%|
Students were requested to write comments on the survey if they chose. Some of the comments, highlighted below, indicated a degree of anticipation and the willingness of students to apply new strategies to dealing with their personal issues. These were:
I am looking forward to discovering more about myself and hoping these skills will give me the opportunity to expand and grow as an individual.The post-test results are presented in Table 2 below.
A lot happened to me in the past couple of years from family issues to being diagnosed with Coeliac's disease. I am interested in learning about self-care because my lack of self-care ended up leaving me in ________ emergency department... despite many attempts I have not learnt to put me first.
|I feel relaxed||0||0||0||0||21.05%||36.84%||42.10%|
|I feel confident||0||0||0||0||36.8%||31.57%||31.6%|
|Learning to relax is important to me||0||0||0||0||0||10.52%||89.47%|
|Self Care is important to me||0||0||0||0||4.17%||4.17%||89.5%|
|Self care is important to my performance as a nurse||0||0||0||0||0||4.17%||94.73%|
|Guided imagery can improve my effectiveness as a nurse||0||0||0||0||10.5%||15.78%||73.68%|
|Guided imagery can improve my effectiveness in other areas of my life||0||0||0||0||10.5%||10.5%||78.945|
The important thing of note between the pre and post-test was that no students answered below an "agree" and a significant number very strongly agreed with the survey questions.
Some students chose to respond to the comments section in the post intervention survey. The overwhelming response was positive as indicated below.
In a short space of time, I have learnt valuable tools that I can take into my professional and personal life.It is important to point to another finding from this pilot study in relation to the statement "Self care is important to my performance as a nurse". The blue column in Figure 1 below indicates the pre-test and the pink the post. In the post-intervention survey 18 out of 19 students very strongly agreed with this statement.
Brilliant life-long skill to master and use often
This relaxation is fantastic. I have been using it during the past couple of weeks during particular times in my life. It is great thanks.
Figure 1: Self-care is important to my performance as a nurse
Power of guided imagery
Those who spoke at the meeting confirmed what they had written in the comments section of the post-test - that they found Guided Imagery a powerful tool, one in which they would like to develop more proficiency.
Processing emotions through guided imagery
A common question that arose was about how to process fear, sorrow or anger during a Guided Imagery exercise. Some students talked about a specific emotion that they had trouble releasing. Given that the question had a real relevance and applicability, the expert focused on demonstrating to students how to release the emotion. They participated fully and one of them commented at the end of the exercise that she had "never felt so open."
Future of GI in nursing practice
Several students talked about their wanting to work at hospitals that subscribe to a holistic vision of nursing. They pointed out that their education at Notre Dame had always ("from day one," in one student's words) subscribed to this vision. Two specifically asked about working at a particular hospital that included GI in the care of their employees as they would like to be involved in the Relaxation and Guided Imagery project.
As is indicated the majority of students could see the benefit of implementing this strategy in their future professional lives. Some of them sought employment where the opportunity to undertake self-care activities were promoted by the employers.
During the focus group sessions, students identified areas within the curriculum where this education could be incorporated and made suggestions for further development of this intervention.
Anecdotal information from the practitioner indicated that many of the students who participated in the pilot project continued their sessions with her individually.
The self-care intervention offered in this pilot project contained identified limitations. The program was voluntary and consisted simply of three one hour sessions. The intention was to help students discover that self-care practice can be manageable time-wise and can yield significant benefits that justify the time spent.
One challenge clearly emerged from the depiction of a profession characterized by intensely stressful demands. The challenge, described by Hodges, is that nursing educators must consider how to more adequately prepare nursing students for sustained pressure, given the many indeterminable forces inherent in contemporary nursing (Hodges, Keeley & Grier, 2004, p.548). How can they face their demons head on? In the words of one of my students, "Since taking part in these sessions I've started gaining more confidence and have learnt how important self-care is. If I can't look after myself and my own problems I cannot look after others. As a nurse you need to be very well centred, grounded, focused and self-caring. I've found these sessions incredibly helpful and hope the University incorporates more of this in the nursing course".
Clarke J. E. (2000). Cited in D. Cormack, The Research Process in Nursing. (4th Ed) Blackwell Publishing. London.
De Vaus D. A. (2001). Research design in social research. Sage Publications, London.
Grbich C. (1999). Qualitative research in health: An introduction. Sage Publications. London.
Tarling M. & Crofts L. (2002). The essential researcher's handbook: For nurses and health care professionals. Bailliere Tindall. Edinburgh.
Beck, D.L. & Srivastava, R. (1991). Perceived level and sources of stress in baccalaureate nursing students. Journal of Nursing Education, 30, 127-133.
Beddoe, A. E., & Murphy, S.O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43, 305-312.
Bittman, B.B., Snyder, C., Bruhn, K.T., Liebfried, F., Stevens, C. K., Westengard, J. & Umbach, P. O. (2004). Recreational music-making: An integrative group intervention for reducing burnout and improving mood states in first year associate degree nursing students; insights and economic impact. International Journal of Nursing Education Scholarship, 29 p.
Bost, N., & Wallis, M. (2006). The effectiveness of a 15 minute weekly massage in reducing physical and psychological stress in nurses. The Australian Journal of Advanced Nursing, 23, 28-33.
Chang, E., Daly, J., Hancock, K., Bidewell, J., Johnson, A., Lambert, V.A. & Lambert, C. E. (2006). The relationships among workplace stressors, coping methods, demographic characteristics and health in Australian nurses. Journal of Professional Nursing, 22, 30-38.
Crooks, P. & Knight, S. (2001). Processes of change in bureaucratic environments. In E. Chang & J. Daly (Eds.), Transitions in nursing (pp.91-119). Sydney: MacLennan & Petty.
Crout, L., Chang, E. & Cioffi, J. (2005). Why do registered nurses work when ill? Journal of Nursing Administration, 35, 23-28.
Ellis, L. (2000). Have you and your staff signed self-care contracts? Nursing Management, 31, 47-48.
Farrington, A. (1995). Stress and nursing. British Journal of Nursing, 5, 574-578.
Gilbert, M. (2004). Mind Body Medicine Program Skills Group Program, University of Arizona. http://www.psychiatry.arizona.edu/html/people/faculty/gilbert.htm
Halcomb, E & Andrew, S. (2005). Triangulation as a method for contemporary nursing research. Nurse Researcher, 13, 71-82.
Harazduk, N. (2003). Mind Body Medicine Program, Georgetown University. http://camprogram.georgetown.edu/MB_web/MB_home.html
Hassed, C. (2002). Know thyself: The stress management programme. Melbourne: Michelle Anderson Publishing. http://books.google.com.au/books?id=aSzujQXOS3MC
Healy, C. & McKay, M. (2000). Nursing stress: The effects of coping strategies and job satisfaction in a sample of Australian nurses. Journal of Advanced Nursing, 31, 681-688.
Hodges, H., Keeley, A., & Grier, E. (2005). Professional resilience, practice longevity: Parse's theory for baccalaureate education. Journal of Nursing Education, 44, 548 -554.
Jones, M. C. & Johnston, D. W. (1997). Distress, stress and coping in first year student nurses. Journal of Advanced Nursing, 26, 475-482.
Kanji, N., White, A. & Ernst, E. (2006). Autogenic training to reduce anxiety in nursing students: Randomized controlled trial. Journal of Advanced Nursing, 53, 729-735.
McInnes, B. (1999). Stamp out stress. Nursing Standard, 13, 53-55.
McVicar, A. (2003). Workplace stress in nursing: A literature review. Journal of Advanced Nursing, 44, 633-642.
Maddi, S. & Khoshaba, D. (1994). Hardiness and mental health. Journal of Personal Assessment, 63(2), 265-74.
Mantesso, J., (2005). Caring for self: A pre-requisite of caring for others. International Journal of Human Caring, 9, 73-75.
Marriner-Tomey, A. (2000). Guide to nursing management and leadership (6th ed.). Sydney: Mosby.
Minichiello, V., Sullivan, G., Greenwood, K. & Axford, R. (Eds.) (1999). Handbook for research methods in health sciences. Sydney: Pearson Education Australia.
Nikou, V. R. (1998). The relationships among hardiness, stress and health-promoting behaviours in undergraduate nursing students. Unpublished doctoral dissertation, New York University, New York, USA.
Piko, B. F. (2006). Burnout, role conflict, job satisfaction and psychosocial health among health care staff: A questionnaire survey. International Journal of Nursing Studies, 43, 311-318.
Polit, D., Beck, C. & Hungler, B. (2001). Essentials of nursing research: Methods, appraisal and utilization (5th ed.). Philadelphia: Lippincott.
Por, J. (2005). A pilot data collecting exercise on stress and nursing students. British Journal of Nursing, 14, 1180-1184.
Simoni P. & Patterson, J (1997). Hardiness, coping and burnout in the nursing workplace. Journal of Professional Nursing, 13, 178-185.
Taylor, B., Kermode, S. & Roberts, K. (2007). Research in nursing and health care: Evidence for practice (3rd ed.) Sydney: Thomson.
Vaishnavi, S., Connor, K. & Davidson, J. (2007). An abbreviated version of Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: Psychometric properties and applications in psychopharmacological trials. Psychiatry Research, 152(2-3), 293-297
Walsh, S. M., Chang, C. Y., Schmidt, L. A. & Yoepp, J. H. (2005). Lowering stress while teaching research: A creative arts intervention in the classroom. Journal of Nursing Education, 44, 330-333.
Williams, G. F., Chaboyer, W. & Patterson, E. (2000). Australia's workforce in perspective. Journal of Nursing Administration, 30, 304-308.
|Author: Professor Selma Alliex, University of Notre Dame Australia. Email: email@example.com
Please cite as: Alliex, S. (2010). Sustainability of future professionals. In Educating for sustainability. Proceedings of the 19th Annual Teaching Learning Forum, 28-29 January 2010. Perth: Edith Cowan University. http://otl.curtin.edu.au/tlf/tlf2010/refereed/alliex.html
Copyright 2010 Selma Alliex. The author assigns to the TL Forum and not for profit educational institutions a non-exclusive licence to reproduce this article for personal use or for institutional teaching and learning purposes, in any format, provided that the article is used and cited in accordance with the usual academic conventions.