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Table of Contents
CONCEPTS AND ISSUES
Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 3-6

Teaching angels to fly


Department of Pediatric Nursing, College of Nursing, MOSC Medical College Hospital, Kochi, Kerala, India

Date of Web Publication09-Oct-2019

Correspondence Address:
Mr. Prashanth Padmini Venugopal
Department of Pediatric Nursing, College of Nursing, MOSC Medical College Hospital, Kolenchery, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCN.IJCN_8_19

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  Abstract 

This article is concerned with the influence teachers of nursing have on the students. In particular, it talks about the concept of conventional discipline and the perception of nursing students regarding the type of disciplining. The article also focuses on identifying what causes misbehaviour in students and how to tackle various levels of indiscipline among nursing students. The aim of this article is to bring together and summarise the current student–teacher paradigm and how it needs to be changed using a selection of techniques that have been highly successful globally in improving student performance and resulting in a better outcome.

Keywords: Bullying, discipline, faculty–student relationship, misbehaviour, nursing student


How to cite this article:
Venugopal PP. Teaching angels to fly. Indian J Cont Nsg Edn 2019;20:3-6

How to cite this URL:
Venugopal PP. Teaching angels to fly. Indian J Cont Nsg Edn [serial online] 2019 [cited 2019 Oct 18];20:3-6. Available from: http://www.ijcne.org/text.asp?2019/20/1/3/268700


  Introduction Top


Institutions of higher education should have a learning environment that is caring, flexible, and engaging, which will promote favourable academic outcomes for both the teachers and the students. Nurse educators who stress on caring for the patient and emphasise the theme of compassion in teaching the nursing students often fail to apply the same concepts in their relationship with their students. The emphasis on behaviourism, importance to hierarchy and rigid discipline that has been historically followed in nursing may attribute to the often authoritarian, reformative attitude that is taken by nurse faculty. This attitude and behaviour within a hierarchical power structure can lead to something students call as bullying.[1]

As Cooper et al.[2] suggest, there is a typical hierarchical structure that exists within the nursing classroom and the clinical area. The faculty assumes the role of a supervisor, and the student is a subservient worker. The student is expected to produce the expected results as assignments, grades or papers within the expected frame of time, place and space, bringing power differences to the forefront. In addition, these expectations and responses may not happen within the context of respect and support causing reduced self-esteem, disempowerment and sometimes disillusion in students. Faculty, on the other hand, may become frustrated with the lack of response from students and the unmet expectations which further contribute to the power struggles. These power struggles are the basic trigger factors for misbehaviour as well as misplaced disciplining.

Faculty often are unaware of the influences that their corrective or reformative attitude has on students. The actions that are actually meant to assist in helping students to do well may have negative consequences. On the other hand, faculty also can deliberately be harsh, rude, hostile and in extreme conditions violent towards students which is termed as bullying or abuse.[2] Many studies have suggested bullying in nursing as a common phenomenon.[3],[4],[5] In one study, 41.3% of nursing students reported verbal abuse from faculty.[4] Majority of nursing students (88.72%) experienced negative behaviours in the clinical setting, and the clinical instructors in the clinical area were identified as the source of bullying by 30.22% of nursing students in another study.[6] Undervaluing students' efforts, placing undue pressure to produce work, setting impossible expectations, intimidation with disciplinary measures, unjustly criticising, changing work expectations without notice, threatening with a poor evaluation, removing areas of responsibility without warning and withholding necessary information purposefully were some negative behaviours that were reported by nursing students in this study.[6] Low grades used as a form of punishment, work, homework, and job rotation used as punishment, impossible workloads and the spreading of rumors and gossip were also reported by nursing students as negative or bullying behaviour.[7]

Whether intentional or unintentional, faculty attitude and behaviour that are perceived as negative by students can have dire effects such as anger, frustration, shame, guilt, panic attacks, loss of confidence, self-esteem and even self-harm.[5],[8] The negative effects can lead to poor clinical performance and even leaving the nursing profession. This effect is illustrated in the following case scenario given by the author.

'I recollect the incident with one of my classmates – One day, during our clinical rotation, the faculty member (who was clearly having a nasty day) continuously kept on criticising a student and embarrassing her. The student looked the faculty member in the eye and said 'you have always needed me to fail and regardless of what I do, I will never be able to be a good student in your eyes and for that, I quit'. The student walked out of the hospital that day which was the end of her goals and dreams as a nurse. She never came back to the school of nursing and selected a unique career path. I think to myself, did that make the faculty member one bit a better teacher?'

In the absence of literature on misbehaviours of nursing students in the classroom and clinical areas, it is hard to have objective explanations on why faculty take an attitude of regimentation which of course is often perceived as bullying by students. It does not mean intentional bullying is eliminated in nursing, which is otherwise evident from many of the above studies. However, from experiential knowledge, it can be said that a nursing faculty often comes across students who misbehave in terms of not respecting faculty's expectations, not completing clinical requirements on time, indulging in dishonest behaviours with regard to both academic requirements and clinical documentation and reporting. Academic dishonesty is a phenomenon evident in nursing students.[9] With an intense curriculum that expects nursing students to achieve many nursing care competencies, the pressure of completing clinical requirements within the allotted number of hours falls both on the faculty/clinical instructors and the students. The pressure may contribute to misbehaviour in students and negative behaviours in faculty and instructors. From experience, one might say that negative behaviours may be more among novice teachers, especially in the first 3 years of their career. It might be because of the extremely unprofessional attitude of 'what I received I pass on' or because of the incompetency felt by novice teachers that if they do not display their power, students may not respect them. Senior faculty by no means are an exception, but the incidences are comparatively less if they are properly mentored in their early years and also influenced by peer.

In countries like India, the sociodemographic and financial context of each student also determines how student responds to the pressure from the curriculum and the pressure from faculty. Faculty in Indian institutions encounter some students with loaded emotions who dissolve in tears if disciplined, leaving the teacher to wonder on ways to process the situation. If looked at from the student's perspective, the background pressure the student already may have as a child from a poor, abusive family who is dealing with strained family relationships everyday may be understood better. Such perceptions on the part of faculty may help in lessening the power issues and negative teacher behaviours. If nursing is a calling, so is teaching nursing. Therefore, there is a need for change in the paradigm of faculty–student or instructor–student relationship and the change may well start from the teacher or clinical instructor.


  Cooperative Discipline Top


Nursing students when stepping into nursing have a limited notion of the intenseness of the training. Nurse teachers need to be aware of this vulnerability and should treat students like rudderless ships in a storm. The obligation of giving wings to these angels to soar rests with the faculty instructors. The approach and attitude to discipline need to be altered. Cooperative discipline explicated by Albert and Desisto can be an answer to the dilemma of correcting students.[10],[11] Albert in her path-breaking approach to discipline among students had said 'One important tip to remember is that students choose their behaviour, and we have power to influence –not control –their choices'. The change starts with the teacher, 'we need to learn how to interact with students so they will want to choose appropriate behaviour and comply with the rules'. Albert's cooperative discipline, which works well in lower educational levels, may work in higher education also if the principles are applied effectively. Alberts' principles of discipline are discussed below:[12]

Step one: Identify student's behaviour

Student misbehaviour can be attributed to four identified categories: attention-seeking, relinquishing power, taking revenge and avoidance of failure.

Attention seeking

The student may display unacceptable behaviours such as absenting themselves, calling in sick more often and deliberately leaving work undone to seek attention to their weaknesses and needs.

Power

From the student point of view what she/he thinks or does is right, and the student often believes that it is not understood by anyone. There is also a sense of powerlessness in nursing because it is difficult to share one's views or problems.

Revenge

Students may misbehave as a way of manifesting physical or emotional revenge targeted against usually parents or friends and clinical instructors.

Avoidance of failure

To mask their fear of failure, students may indulge in activities like not submitting assignments on time, not completing clinical requirements or act as if they have some kind of disability.

Step two: Handle the misbehaviour immediately

Attention

  • Pay attention to behaviour deficits
  • Talk to students, spend time in identifying needs
  • Recognise potentials, appreciate efforts whether minor or major, significant or insignificant.


Power

  • Do not engage in direct confrontation with the student
  • Adopt a relational attitude rather than a corrective attitude
  • Give the student a chance to set a deadline for himself/herself to submit requirements
  • Give flexible time frames but set limits.


Revenge

  • Create a caring relation by making the student feel that you accept him/her but not their behaviour
  • Involve college authority or parents if necessary.


Avoidance of failure

  • Acknowledge the difficulty of the work but remind them of their previous success
  • Modify teaching methods and lessons
  • Motivate the student to say 'I can' instead of 'I cannot'
  • Practice a student mentor policy, where the student can have a peer as mentor and give the opportunity for the student to mentor younger students.


Step three: Provide encouragement

Capable

  • Make your students feel capable
  • Tell them that to make mistakes is acceptable but correction is needed
  • Build confidence
  • Plan objectives keeping in mind all types of learners.


Connect

  • Help build a positive relationship between the student and teacher
  • Accept all students irrespective of past mistakes
  • Be attentive to what the students have to say and try to be a part of their activities outside the classroom
  • Appreciate their efforts both verbally and in writing
  • Be kind and gentle.


Contribute

  • Make them feel responsible for the welfare of their class
  • Give them class responsibilities
  • Ask them to contribute ideas during common discussions.


Step four: Making partners

  • A good partnership between teacher, student and parent has to be nurtured. Meeting parents or family members although not conventional in higher education contexts is vital to involve family when students' family background and issues influence their education. Understanding family's part in student's education may help teachers to identify and understand issues and plan learning activities according to the needs of the students
  • It is also important to inform parents of the student's achievements and not only their misbehaviour.


Step five: Spend time that is out of class hours with the students

  • Spend time talking with students in the classroom after the lecture
  • Ask them about their out of class/college life
  • Have lunch with the students in the canteen or coffee shop once in a while
  • Invite students to share a snack with you in your classroom
  • Attend student events such as culturals and sports and cheer them
  • Get involved in a community project with your students
  • Meet up individually with every student at least once a month
  • Set bulletin boards for students to showcase their talents
  • Send cards, messages and class notes to absent students
  • Show genuine interest in students' hobbies (Adapted from Cooperative Discipline by Linda Albert).



  Passion To Teach Heart To Love – The Author's Voice Top


'Discipline cannot be compromised as it is inevitable for the welfare of the patient under the nurse's care, but where should one draw the line? My favourite teacher was the one who told me directly when I was doing things wrong who would take me back into the room and reprimand when necessary, but she was also the one to ensure I completed my clinical requirements and supported me when the patient I was caring for passed away'. Where is that line drawn?

For my students, I combine discipline with the welfare of the student. I share my experiences with them, I make them memorise formulae and procedures, write good nursing care plans and find time to take their patient for a walk down the hall. I gently remind them that being a bit afraid is always good – it as it will save lives. However, I take extra time to let them know they did their best, that mistakes are part of learning and that nobody is perfect. I allow them to grasp that I appreciate their effort even in failure. I make them realise that hours and hours of lost sleep and worrying are taking them nowhere. To accept that they will text me, E-mail me and discuss their questions openly, although I may note provide them all the answers. I am providing them the means to find those answers. I think the most effective teachers are those who believe that 'To push is nice, to shove is wrong'.


  Conclusion Top


Nurse educators, practicing nurses and nursing administrators jointly hold the excellence of nursing education in their hands. No longer can we place all the responsibility for education in higher education or practice environments in isolation of one another.[13] A sensitive approach to teaching and learning with in a collaborative and relational clinical-classroom setting will enable students to become caring professionals. Misbehaviours in students have to be understood within a broader context, and concepts such as attention, power and discipline have to be moderated to promote a culture of collegiality between faculty instructors and nursing students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lewis MA. Nurse bullying: Organizational considerations in the maintenance and perpetration of health care bullying cultures. J Nurs Manag 2006;14:52-8.  Back to cited text no. 1
    
2.
Cooper JR, Walker JT, Winters K, Williams PR, Askew R, Robinson JC. Nursing students' perceptions of bullying behaviours by classmates. Issues Educ Res 2009;19:212-26.  Back to cited text no. 2
    
3.
Meires J. The essentials: Nursing faculty who bully students and Colleagues. Urol Nurs 2018;38:303.  Back to cited text no. 3
    
4.
Celik SS, Bayraktar N. A study of nursing student abuse in Turkey. J Nurs Educ 2004;43:330-6.  Back to cited text no. 4
    
5.
Kolanko KM, Clark C, Heinrich KT, Olive D, Serembus JF, Sifford KS. Academic dishonesty, bullying, incivility, and violence: Difficult challenges facing nurse educators. Nurs Educ Perspect 2006;27:34-43.  Back to cited text no. 5
    
6.
Clarke CM, Kane DJ, Rajacich DL, Lafreniere KD. Bullying in undergraduate clinical nursing education. J Nurs Educ 2012;51:269-76.  Back to cited text no. 6
    
7.
Karatas H, Ozturk C, Bektas M. A study of bullying against nursing students. J Nurs Res 2017;25:198-202.  Back to cited text no. 7
    
8.
Birks M, Budden LM, Biedermann N, Park T, Chapman Y. A 'rite of passage?' Bullying experiences of nursing students in Australia. Collegian 2018;25:45-50.  Back to cited text no. 8
    
9.
Bultas MW, Schmuke AD, Davis RL, Palmer JL. Crossing the “line”: College students and academic integrity in nursing. Nurse Educ Today 2017;56:57-62.  Back to cited text no. 9
    
10.
Charles CM, Senter GW, Barr KB. Building Classroom Discipline. New York: Longman; 1999.  Back to cited text no. 10
    
11.
Albert L, Desisto P. Cooperative Discipline. Circle Pines, MN: American Guidance Service; 1996.  Back to cited text no. 11
    
12.
Baker K, Mccallum K, Mc Gibbon M. Cooperative Discipline Model by Linda Albert. Available from: https://vrogersmanagementprofile. weebly.com/uploads/1/3/8/3/13836263/linda_albert_summary_3_pages.pdf. [Last accessed on 2019 Jan 06].  Back to cited text no. 12
    
13.
Benner PE, Sutphen M, Leonard V, Day L, Shulman LS. Educating Nurses: A Call for Radical Transformation. Somerset, NJ: Jossey-Bass John Wiley Sons; 2009.  Back to cited text no. 13
    




 

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