The second complexity, also in relation to self-awareness, is that nursing
students have multiple roles in life that may impact negatively on their learning. Whilst the student is developing ability to accurately perceive
also need to keep on top of how they tend to respond to familiar and new, situations and people.
The following statements emphasise the educators assessment of the need for students to understand how their own emotional problems can lead to unhelpful communication, within their interaction with others:
…some of the most difficult people [students] that I have dealt with clinically [when supervising a student in clinical practice] have been older students who have been incredibly damaged in their life experiences (Group 3, p.12)
…students come from different backgrounds and are at different levels and do, or not do life well. They come into nursing with a need to engage with patients or staff and it’s almost as though they can’t put aside their own stuff [emotional problems] in order to work with the need (Group 2, p.9)
In recognition of this challenge, mindful regard was expressed by the educators, of the reality that many students face in life whilst engaging in tertiary study:
…a major contributor to responding to new things is not having too many other worries to weigh you down. Look at the issues of student loans, childcare, fitting employment around class and clinical experience, they’re running two lives some of them (Group 1, p.11)
Recognising students are individuals who have other commitments outside of their academic life is essential. Quin (2000) confirms that some students may lack confidence in their academic ability. The success of individualised learning often depends on the student being an
active rather than passive participant. Motivation to learn can be impaired by social circumstances within the students’ life. If the circumstances prevent the students developing personal competence a referral to, or suggestion of personal counselling, may benefit and enable the student to focus on learning. Regular praise, providing encouragement and positive reinforcement can help increase self- motivation in students. Motivation however, depends as much on the attitude of the educators as on those of the students (Rodgers, 1998). Encouragement is required for students who are learning to cope with and overcome a multiple of life roles, whilst they are developing self- awareness.
The educators frequently expressed that considering the students as individuals and acknowledging external demands outside of academic life was a commitment. This was in recognition that the majority of students make the most of their learning:
…they [the students] know when they finish here that they are going to do their jobs that they need to complete then they’ve got to go and look after their kids with this growing awareness of time lacking and they don’t always have a lot of tolerance for what they perceive might be a waste of time (Group 1, p.7)
Empathic communication from the educator is required to approach and understand the students’ situation. Working in partnership with the student to develop strategies in problem solving and the use of probing can help students clarify and focus on issues of concern. This then enables students to improve time management, develop appropriate study skills and assume responsibility for their own learning (Ashcroft & Foreman-Peck, 1994).
Student’s life roles may also affect their ability to understand and focus on the client’s story gained through assessment. With growing maturity and self-exploration of their reactions to emotional cues, students then need to ‘tune out’ of their own difficulties and ‘tune into’ the client’s needs. This tuning into the clients needs means engaging clients at a personal level. This engagement is a satisfying and rewarding experience for the student (McQueen, 1997). Yet, balance is required. The student aims to provide intimate attention to the client whilst learning to recognise their personal limitations. This balance is something many students come to understand as they develop personal competence as indicated in the following educators comment:
…one of the problems we have with students in maternal health is their extreme over-identification with the situation and their responses…for instance, their inability to recognise there are barriers in what to reveal to clients; and to not treat people like they are your kids or family, and I think it tends to be the older student that is at risk of that (Group 2, p.8)
Learning which takes place in relation to self-awareness may also promote the development of professional boundaries, essential within nursing relationships. Self-awareness was described by the educators as a pre-requisite to the students’ ability to set boundaries within professional relationships:
…they [the student] need to be able to step out of their role as mother, partner, friend, and develop responses in a nursing role (Group 1, p.8)
In doing so nursing students are then able to regulate their own emotional reactions internally and behave towards clients and peers in a purposeful manner. This internal regulation and understanding emotional reactions can enable the student to manage emotions when interacting with others, as these educators point out:
…to work out how they [the student] are going to relate to the patient there just seems to be this thing about how you can put aside where you are and what you are and what’s going on in your own immediate sort of history, to actually get on with the nursing stuff [role] (Group 3, p.14)
…I think it is a central part of nursing that we [all nurses] are able to separate out our own problems because it is not good for the patients to pour our own issues, or whatever, on top of them (Group 2, p.9)
Bolton (2001) argues that nursing has long been distinguished as an occupation requiring extensive amounts of emotional work. This highlights the importance of a student’s ability to manage emotion and present the desired demeanour in a number of clinical and relational settings throughout their learning. Whilst juggling the emotional demands of everyday life, students are required to present an acceptable nursing face. This was summed up by an educator in the third focus group:
…in nursing you are in a situation where you are looked on as a professional and therefore your behaviour has to reflect that no matter what or how you feel (Group 3, p.15)
Emotional reactions to current, perceived or pending workload may leave the student feeling exhausted or under pressure (Yong, 1996). Gaining awareness about personal coping mechanisms and developing new strategies that enable the student to tune into the other when interacting is essential to the student’s overall capacity to professionally care. Each of the focus group discussions highlighted that there is little separation of the personal and professional coping skills in relation to managing self-awareness, this is summarised in the following comment from an educator in the third group:
...the private and professional thing is interesting because in my opinion there aren’t huge differences between the two; it’s not as if a nurse goes to work and puts on a cloak – a nursing cloak, and that becomes the nurse. And when she takes the cloak off at the end of the day she becomes the private person again; we are both simultaneously private and public persons (Group 3, p.15)
However, it is doubtful that education programmes prepare students adequately to be self-aware and provide psychological support to the clients with whom they work. The literature suggests that student’s are given little preparation for providing psychosocial support in nursing education (Evans & Allen, 2002). Although, it was clear from the educators that their understanding of the public perception of a nurse means:
…making yourself available and relating to the patient is expected in nursing its expected by the clients I think because that is the one thing they imagine should be there is that the nurse will actually care about them, not for them but about them (Group 3, p.60 )
There is acknowledgment that nurses require the ability to manage their own emotional needs in order to understand the clients. However,
where and how this learning takes place within nursing curricula is unclear (MacCulloch, 1998; Henderson, 2001).