Nursing Education Research-Warming the Nursing Educaiton Climate for Traditional-Age Learners Who...

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12/6/11 8:vid: NURSING EDUCATION RESEARCH: WARMING the Nursing Education Climate for Traditional-Age Learners Who Are MALE.

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[Featured Articles]

Nursing Education Perspective

Issue: Volume 29(3), May/June 2008, pp 143-150

Copyright: Copyright 2008 by National League for Nursing, Inc.

Publication Type: [Featured Articles]

ISSN: 1536-5026

Accession: 00024776-200805000-00009

Keywords: Traditional-Age Male Learners, Education Climate, Nursing Student, Nurse Educators

NURSING EDUCATION RESEARCH: WARMING the Nursing Education Climate

for Traditional-Age Learners Who Are MALE

Bell-scriber, Marietta J.

Author InformationAbout the AuthorMarietta J. Bell-Scriber, PhD, FNP-BC, is professor of nursing and master's program

coordinator, Ferris State University, Big Rapids, Michigan.

ABSTRACT

For nurse educator to facilitate student learning and the achievement of desired

cognitive, affective, and psychomotor outcomes, they need to be competent in

recognizing the influence of gender, experience, and other factors on teaching and

learning. A study was conducted in one academic institution to describe how traditional-

age male learners' perceptions of the nursing education climate compare to perceptions

of female learners. Interviews were conducted with a sample of four male and four

female learners. Additional data from interviews with nurse educators, classroom

observations, and a review of textbooks provided breadth and depth to their

perceptions. Findings support a nursing education climate that is cooler to traditional-

age male learners and warmer to traditional-age female learners. The main cooling

factor for men was caused by nurse educators' characteristics and unsupportive

behaviors. Additional factors inside and outside the education environment contributed

to a cooler climate for the male learners. Based on these findings, strategies for nurse

educators to warm the education climate for traditional-age male learners are

presented.

MEN REPRESENT ONLY 5.8 PERCENT OF THE NURSING WORKFORCE(1). This is a

concern, not only with regard to the nursing shortage, but because nursing does not

reflect the gender characteristics of the population it serves (2). A further concern is

that attriti n and failure rates in nursin educati n are hi her f r men than f r w men


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(3). Although there have been attempts to understand the factors that contribute to

attrition and failure and offer strategies to retain male learners (2), only a small,

evolving body of research on these concerns has been published (4-7). Research

findings from 1991 to the present on male learners in nursing programs suggest that

men experience role strain, feelings of inadequacy, and a fear of gender stereotyping

(8-10).Additional findings suggest that male learners may have frustrating and

stressful experiences(9,10)that can make them feel isolated and excluded(5). Thereis also support in the literature for a lack of awareness by nurse educators of the

unique needs of male learners(11). Although men have reported experiencing

advantages consistent with male privilege in the classroom setting, they have also

reported feeling discriminated against in clinical settings (4), but the findings are

inconsistent. Some studies (9,10) have identified the obstetrical setting as stressful for

male learners, while others (12) have found that men perceived this setting as providing

an overall positive experience. THE CHALLENGES FOR MEN APPEAR TO BE ROLE

RELATED. BOUNDARIES OCCUR IN SETTINGS THAT TRADITIONALLY VALUE WOMEN AS

PRIMARY CAREGIVERS FOR INTIMATE BODILY FUNCTIONS (13). NURSES, RATHER THAN

CLIENTS, APPEAR TO INITIATE THESE PROBLEMS (14).

According to recent findings by O' Lynn (6) and Smith (7), the barriers and

challenges that men confront in schools of nursing have changed surprisingly little

during the past few decades. Some of these barriers and challenges include lack of

mentorship for male learners, failure to include the history of men in nursing in the

curriculum, the failure to create a welcoming environment in the clinical setting, and

lack of gender neutrality in textbooks (6). Like women, nontraditional male learners

also report the difficulty of balancing school, family, and work (7).

Research that compares how female and male learners perceive the nursing

education climate is needed to evaluate the context, or climate, in which males

describe their experiences (15). a study by Serex (16) examined the interaction of

gender and academic discipline and the perception of classroom climate. Serex's

findings, which examined students in accounting, education, engineering, and nursing,

indicate that regardless of gender, learners did not perceive the academic climate to be

chilly. Comparison studies are needed to either support or refute these findings.

Climate, the social and psychological context within which educators and learners

interact and form their relationships, is reported to be highly predictive of effective

teaching and learning (17). Over the past few decades, the higher education literature

has reflected increasing concerns about a differential impact that educational climates

may have on some learners, particularly women (18). The contention is that a woman

and a man, with equal skills, who are seated next to each other in the same classroom,


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.

classroom climate(19) has been used to describe educational settings that are not as

supportive and facilitative to learners who are female.

More recently, the term has also been used to describe ways in which an

educational environment may disadvantage any student because of sex, race, social

class, disability, or sexual orientation (20). Posited in this concept is the notion that

although educator behaviors, learner behaviors, and additional factors inside and

outside the classroom can all contribute to creating the education climate, there can be

different perceptions by learners about the warmth or chilliness of this climate. The

premise is that if a learner is in an education climate that is perceived as chilly and

unsupportive, he or she may fail or choose not to stay.

The academic imperative of creating a warm education climate for all learners is

included in the National League for Nursing's core competencies for academic nurseeducators. One of the competencies states that the nurse educator is responsible for

creating an environment in classroom, laboratory, and clinical settings that facilitates.

student learning and the achievement of desired cognitive, affective, and psychomotor

outcomes" (21, p. 15). The NLN contends that in order for nurse educators to do this

effectively, they need to be competent in recognizing the influence of gender,

experience, and other factors on teaching and learning.

According to Maher and Tetreault (22), creating a warm education climate can be a

challenge because of the variables brought into the environment. For example, whethera learner is male or female, older or younger, or a high or low achiever may reveal

complex and shifting positions and relationships that can be masked by anyone

ideological position. The goal is to reveal and challenge any positions or relationships

that interfere with the creation of a warm, supportive education climate for all

learners.

Although it is important to study all variables that interfere with a warm and

supportive education climate for all learners who may be disadvantaged because of sex,

race, social class, disability, or sexual orientation, the current study was designed to

reveal factors specifically affecting male learners. What is not clear from previous

research findings is how male learners' perceptions of the nursing education climate

compare to the perceptions of females whose background and other characteristics are

similar. The central goal of this research was to identify important differences between

male and female learners' perceptions of the nursing education climate and then offer

recommendations for the reform of nursing education to address these differences.


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Methodology A constructive, qualitative approach was used with a case study

strategy at a four-year, public, midwestern university. A case study approach allows in-

depth exploration (23) of the nursing education climate and the ability to deal with a

full variety of evidence, such as artifacts, interviews, and observations (24). A nursing

course containing a majority of medical-surgical nursing content was selected; such

content provides the basic knowledge and skills for entry-level nurses and serves as an

introduction into the nursing profession (25). The course selected, which had 53

learners and included eight men (15 percent), occurred during the seventh semester of

the BSN program (two semesters followed, for a total of nine semesters in the program).

Selecting a classroom beyond the first semester is appropriate because logically,

detrimental effects may accrue over time.

Seven nurse educators taught in this classroom; four were doctorally prepared and

three were prepared at the master's degree level. After receiving approval from two

human subjects' committees, three methods were used to collect data: classroom

observations, semistructured interviews, and a review of textbooks.

CLASSROOM OBSERVATIONS This medical-surgical nursing classroom, consisting of

two-hour sessions with a 10-minute break, was observed 22 times or the course of the

term for a total of 42 hours of observation. A meeting was held with the course

coordinator to discuss the purpose and provide general background information related

to the study. There was also an attempt to meet briefly with as many nurse educators

as possible before observing their classrooms. Proceeding to observe without informing

participants presents an ethical dilemma (26); therefore, the seven educators teaching

the course were asked permission to observe their classrooms. Six provided consent and

one declined.

At the first class meeting, the researcher was introduced and learners were asked

for permission to observe and record the classroom environment. All of the learners

returned signed consent forms providing permission to observe the classroom. Because

one student declined to have the classroom audiotaped, ethnographic notes about the

classroom environment were taken manually.

SEMISTRUCTURED INTERVIEWS At approximately mid-semester, the learners were

provided with student information questionnaires to collect demographic data. At this

time, they were told to communicate on their return forms if they did not want to be

interviewed. One female student asked not to be interviewed.


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Educators and learners were interviewed privately with the researcher in the last

third of the semester in a private office or conference room in the same building where

the learners attended classes. These interviews were scheduled when the learners were

not in this class. The typical interview lasted 60 minutes; times ranged from 45 to 75

minutes. Different open-ended questions were asked of learners and educators,

followed by open-ended probes that allowed participants to describe the essence oftheir experiences from their different perspectives. Some examples from the interview

schedule for the learners were:

Tell me about your personal experiences as a student in this class.

How would you describe the teachers in this class?

Tell me about anything said in this class that was disturbing to you.

Some examples for the educators were:

How would you describe the environment of this class?

How would you describe yourself as a teacher in this class?

Are you aware of an incident where you treated a student more harshly or

unfairly than the other students?

After the interviews were completed, the tapes were transcribed by a secretary at

a research university who had previous experience with qualitative research. Of the 44learners who consented to be interviewed, 21 learners, 6 men and 15 women, were

interviewed as part of a larger collection of data looking at ethnicity and age as

additional factors affecting the education climate. For this research study, the four men

who were traditional-age college learners, 20 to 22 years of age, were selected; those

excluded were 32 and 33 years of age.


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oug e samp e o our men may appear sma , s represen a ve o e

percentage of men in nursing. Four men in a class of 53 learners represented

approximately 8 percent of this sample of nursing students, which correlates closely

with the 6 percent of men in the nursing profession population. Thus, this correlative

percentage was reflective of the typical nursing education environment for men.

Traditional-age learneris a term used to describe students in a university

environment during the four to five years immediately following secondary school. For

this study, traditional-age learners are between 18 and 23 years of age. This group is

important to assess because adult, nontraditional learners can have greater variance as

learners due to life experience (27). Research supports (7) that traditional-age learners

may be able to cope better with the challenges they face in schools of nursing.

It is important to select learner samples beyond their biological sex characteristics.

Previous research findings on the nursing education environment (28,29) reveal that age

and academic achievement may affect learners' perceptions. There is also research to

support that ethnic background may affect learners' perceptions due to cultural nuances

that can influence understanding and meaning (30). This study included these factors as

critical demographic characteristics and paired four female learners as closely as

possible to the four male learners according to age, ethnicity, and grade point average

(GPA). Although all learners were Caucasian, sometimes only age or GPA could be

directly matched due to the variance of the learners' characteristics. Self-reported

learner characteristics and self-selected pseudonyms are displayed in Table 1.

Table 1. Learners' characteristics

All seven nurse educators were women. The one educator who not did no agree to

participate is referred to as Educators X. It is important to note that learners were not

advised to omit Educator X from their discussions. Characteristics of the educators are

displayed in Table 2.


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Table 2 Nurse educators' teaching experience

REVIEW OF THE TEXTBOOKS Three textbooks related to this course were reviewed

to determine how nurses were depicted in pictures, examples, and text, with a focus on

whether there was an equal representation of men and women. These textbooks, from

2003, 2004, and 2005, focused on nursing care of infants and children, medical-surgical

nursing, and psychiatric nursing, respectively. The review occurred after the classroom

observations and interviews were completed but prior to data analysis.

Findings Because the purpose of this study was to describe the nursing education

climate from traditional-age learners' perceptions, the interviews with nurse educators,

classroom observations, and an analysis of the textbooks were used to support or refute

the learners' perceptions and offer a broader view of the education climate. This

triangulation of data sources and methods offered additional ways to compare the data.

The author, the nurse researcher, had a close relationship to the topic; she had

been a nursing student and was currently nurse educator at another university.

Therefore, the researcher participated in bracketing (26) before the investigation began

that allowed an opportunity to set aside and personal perspectives about the research

topic. She kept a diary to record personal thoughts and feelings about the topic. These

ideas were disclosed and then set aside; they were reviewed during data collection and

analysis to determine whether findings reflected personal beliefs rather than

observations or reflections by participants.

To increase the accuracy of the findings, peer debriefing (23) was used. The study

was reviewed by three additional researchers from nursing and higher education to

ensure that the account would resonate with people other than the researcher.


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, .

and sentences as the learners' interviews were reviewed. A "start list" (31) was created

from the conceptual research questions and key variables. Using this list as a guideline,

four interviews (two each from learners and educators) were coded and recoded to

check reliability. The start list was then redefined and codes were discarded. after

code-recode reliability was declared to be greater than 90 percent for the four

interviews and codes were identified that were representative of the data, a nurse

educator and a traditional-age female learner who were not participants in the studycoded the same data sets. Codes were then expanded or amended to achieve intercoder

agreement of 94 percent. Participants were grouped as their interview data were

coded, matching similar coded data together. Broad categories, or themes, were then

developed as conceptualized by the researcher.

Five themes emerged from analysis of the data:

* Nurse educators' characteristics and behaviors

* Meaningful experiences

* Peer learners' characteristics and behaviors

* Additional education environment factors

* Factors outside of the education environment.

Generally, it was revealed that this nursing education climate was warmer to

traditional-age learners who were female and cooler to traditional-age learners who

were male. Detailed perceptions and comparisons are presented for the five themes

that emerged.

NURSE EDUCATORS' CHARACTERISTICS AND BEHAVIORS For the men, the most

important unsupportive (cooling) factor was nurse educators' characteristics and

behaviors. One man described some of these behaviors: "You'll ask questions, and they'll

be...a little harsh with you." Another said, "[There is] a terseness. Sometimes in voice

tone. Sometimes in body language. It's usually not in the words they speak. It's the way

they say it. You just don't know what you're talking about and your feelings on a specific

subject don't matter."

The men also described some discriminatory behaviors. One man noticed that in the

clinical setting, instead of getting attention from the nurse educator, he spent most of

"


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.

trusts us [men] more or maybe it's just that she doesn't want to give us the time of day."

This man had the feeling that nurse educators do not approve of men in nursing and do

not want men to become nurses.

One of the female learners supported that discrimination was taking place: "I think

the teachers sorta pick on [men] more and think they're really not doing the work,which I think is unfair to them [men]. If they talk in class, they're more likely to be

zeroed in on."

A sense of prejudice was also supported in an interview with one of the nurse

educators. She described her feelings: "It seems to me...it's always the males who are

whispering or condescending. I think a lot of the males that I experience that go into

nursing, they're going into it for the wrong reasons. Whatever they wanted to do didn't

work out. And they have more of a chip on their shoulder, a confrontational attitude.

Like we have to prove ourselves or something." When this nurse educator was asked if

she would like to bring more men into the program, she stated, "No, I'd like to get rid of

the men. They all wanta be...anesthesiologists. The majority of males that I have

taught clinically are not in nursing for the reasons I think they should be in nursing. They

wanta be PAs or they want to be nurse anesthetists." The researcher observed this same

nurse educator using a generalization based on gender in the classroom when she

attempted to provide an example during a mental health lecture: "Say you're angry at

your husband..."

Another educator said, "We have faculty who don't know what to do with male

students." She reported that some of her colleagues have said that men are lazy. She

described becoming aware of a situation, close to graduation, where a male learner was

assigned to care for a female client for the very first time.

Some cooling factors (19) were also noted for female learners. Women offered a

few descriptions of condescending and unsupportive behaviors by nurse educators. They

told of some educators being more difficult to approach than others, a female learner

being singled out by an educator, and some educators getting annoyed with questions.However, there were more warming factors for the women in this course. Unlike the

men, the women perceived more caring, connecting, and supporting behaviors by nurse

educators; they described them as providing a "comfort zone" and sending a message

that they were, always there for the learner. One woman warmly described the nurse

educators' availability: "I definitely feel comfortable just going to talk to them about

anything...not even nursing. Just going to see how their weekend was or anything like

that." Another declared, "They want you to do well and kind of calm you down. [They


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would say to her]: 'You're doing fine. Don't worry about it. You'll get through this.'"

Although the nurse educators were observed praising men and women equally for

asking excellent questions and generally challenging and encouraging both men and

women to continue class participation, some of the classroom observations supported

female gender dominance. One nurse educator in particular habitually referred to nurse

as "she."

MEANINGFUL EXPERIENCES The learners were asked, "Describe an experience that

was personally meaningful to you as a student." All of the men described experiences

that happened with clients, away from nurse educators and other learners. One man

described a particularly meaningful encounter: "I was taking care of an older lady and

she had multiple cancer...throughout her body. I...listened to her talk and she told me

about...the troubles in her life. Just to listen to that was a powerful moment...for

me..."

In contrast, three of the four women described meaningful experiences that

occurred with nurse educators. One learner referred to her current mental health

setting: "Instead of doing one of our verbatim assignments, she [nurse educator] had us

partner up...and we'd counsel each other in front of her. And I was really nervous about

it but she made me feel comfortable. My partner and I spent probably an hour with her

and we got really close and emotional."

PEER LEARNERS' CHARACTERISTICS AND BEHAVIORS Both the men and women

learners spoke of complaining, interrupting, challenging, and cheating behaviors by

their peers. However, no man or woman reported unsupportive, discriminatory, or

biased behaviors. The men reflected that their motives for becoming nurses were never

questioned by their classmates.

ADDITIONAL EDUCATION ENVIRONMENT FACTORS One described the size of the

classroom as too big for asking questions. He asked questions of other learners or theeducator during breaks.

In addition, the textbooks did not represent male and female nurses equally,

especially the pediatric and mental health nursing textbooks. All of the pictures and

stories about nurses in one book used female examples. In another, examples of

therapeutic dialogue were always between female nurses and their clients. Two men


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noted this unequal representation of men in textbooks. One said, "They still talk about

the nurse as a her, not a him or her." The other said the pictures in textbooks of women

giving care reinforced his role as a minority male and he found this realization "kind of

alarming."

The men also reported a diminishing male population. One man reported, "If you

notice in our class, we don't have very many male students anymore. And there were

more, a lot more the previous semesters. They're gone." The women were aware of

being the majority. This awareness contributed to their feelings of blending in, not

being intimidated, and being in a very comfortable environment.

FACTORS OUTSIDE THE EDUCATION ENVIRONMENT The education environment does

not exist in isolation and reflects the culture, values, and beliefs of the greater society

in which education is positioned. Outside factors affect behaviors, perceptions, and

experiences and may have an indirect effect on the education climate. Unlike the

women, the men spoke of factors outside the nursing education environment thatcontributed to uncomfortable experiences and may have been cooling factors (19). For

example, the men reported a lack of social support outside their immediate families;

they were often teased or questioned about why they wanted to become nurses. One

man said he finds that it is usually younger people who will question him and say, "Oh

really? You're gonna be a nurse? What's up with that kinda thing?"

One man's perspective was more positive about his overall experience in the nursing

education environment. Negative comments by other men outside the education

environment did not other him, and he perceived that he had been treated fairly by thenurse educators. The factor that may have contributed to his overall positive perception

was his socialization with female learners. He appeared to have particularly close

female relationships; he described some of the women as his best friends.

Limitations and Implications for Future Research Although the researcher

attempted to match the male and female learners as closely as possible based on

ethnicity, grade point average, and age, it is important to recognize that only one pair

was exactly matched. While it would be best to have all exact matches for all

characteristics, that would be impossible to bring about in a single learning

environment. Future studies should be based on more than one environment.

Another limitation in this study is that all nurse educators were female. Findings in

the higher education literature support that the gender of the teacher may affect the

climate of the classroom (32,33). Therefore, although there are few male nurse

'


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,

include a sampling of men.

Finally, the findings of this research are limited to the nursing education climate.

Additional research should be conducted to explore the adaptability of men and women

beyond nursing education. Comparisons of men's and women's perceptions of the nursing

practice climate and how these perceptions relate to retention in the nursing workforcewould also be important to explore.

Discussion and Implications for Nurse Educators One logical conclusion from this

study is that male and female learners, who are similar in age, ethnicity, and grade

point average, can have different perceptions of the nursing education climate. The

findings also support that nurse educators may inadvertently project sex-biased

behaviors, causing a cooler climate (19) for male learners. According to a leading

consulting firm that specializes in diversity leadership (34), "microInequities" are

negative micromessages that, although frequently unconscious, can devalue,

discourage, and ultimately impair performance. Called the power of small, these

messages can include looks, gestures, tones, nuance, inflection, and inference and are

often driven by race and gender. It is proposed that even the absence of a message can

be a message in itself. Repetitively sending or receiving inadvertent, subtle, negative

micromessages (34) results in an erosion of an effective education climate and may

cause learners who receive them to question their value, and ultimately their

commitment, to the nursing profession.

The discriminatory findings in this study can be correlated with findings in non-

nursing classrooms where discriminatory treatment toward women has been previously

described in male-dominated career paths (35-37). These findings support the

challenges for either sex when they are situated as minorities an education

environment.

This study's finding of differential treatment for male learners is consistent with

Kelly et al. (5), who reported that perceived differential treatment for male learners

was frustrating and contributed to feelings of isolation. This study's observations ofnurse educators using sex-biased language correlate with findings by O'Lynn (6), who

reported this factor to be among the top barriers for male learners in nursing education.

One strategy to increase awareness of discriminatory treatment and negative

micromessaging (34) is for nurse educators to invite outsiders into their teaching areas

and allow videotaping, audiotaping, or observation by colleagues (38). Nurse educators


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may be unaware of unsupportive behaviors and would benefit from being able to see

themselves in the classroom and having feedback from others. Another strategy is to

encourage learners, either verbally in person or by statements in the syllabi, to tell

nurse educators if there are behaviors that are perceived as sexist or offensive.

Because nurse educators may be unprepared to see subtle, unintentional bias,

schools of nursing should consider formulating an ongoing plan for assessing bias related

to gender, culture, and other factors. The plan could include faculty development

programs focused on education climate issues for all full-time, part-time, and adjunct

faculty. It might be helpful to develop and distribute a handbook or checklist (38) of

items that should be assessed to determine if there is an equitable learning environment

for all learners. Items should include verbal and nonverbal communication as well as

written materials. These instruments could be used to evaluate nurse educators for

promotion, tenure, and continued employment.

Due to the current nurse educator shortage, nursing programs are actively seeking

and interviewing prospective faculty. During the interview process, it is important to ask

questions that explore the potential new educator's awareness of climate issues (19). A

rubric could be developed to assist with the assessment the nurse educator's knowledge

of an equitable learning climate.

The finding that some of these male learners were bothered by unsupportive

incidents in the nursing education climate is in stark contrast to Smith's (7) findings on

older, nontraditional male learners. Smith found that men in nursing education were notbothered by incidents that reminded them that they were minorities in the nursing

profession. These older learners reasoned that these incidents reflected a fact of life in

nursing, and their previous life experiences helped them cope and not let these issues

affect their success. Smith's findings correlate directly with Whittock and Leonard's (14)

pilot study findings from the United Kingdom, which support that age appears to affect

pre-and postregistration male nurses' attitudes and level of confidence. This has an

important implication for nurse educators who may want to consider that younger male

learners may lack the maturity from life experience to cope as well as nontraditional

male learners and there-fore may need more support.

The finding that some of the textbooks were biased toward women is congruent

with other research findings (5-7). It is interesting that in 10 years, there is still a lack

of progress in creating a more diverse representation of nurses in textbooks. Therefore,

it is important for l1urse educators to select resources based not only on content, but

on an equal representation of all learners (38).


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The unique finding related to an overall positive experience for one of the male

learners is an important consideration. This description is in stark contrast to previous

studies' findings related to male socialization in higher education. There have been

previous reports of men being less likely to have close friends and more likely to endure

alienation and loneliness (18), and there have been reports of isolation for learners in

programs with inequitable representation (39). This study's findings suggest that

socialization with female learners may help override a difficult and sometimes stressful

experience for men. Therefore, it is important for nurse educators to consider ways to

support male-female friendships and strong affiliation and socialization with female

learners.

One man reported that the classroom size was an inhibiting factor. Learners often

report that their own participation in discussion is inhibited when the class is large (40),

and it is possible that this man was reluctant to participate because of his visibility asone of only a few men and fear that he might be subject greater scrutiny (19). It is

important for nurse educators to cognizant of potential inhibitive factors in the

classroom for men and other minorities. Minority learners may have a special need for a

nursing education climate that specifically acknowledges and recognizes them and their

contributions.

Contributing to male and female learners' perceptions of the nursing education

climate is how educators create the climate and its contextual reality (41). It is often

the nurse educator who determines whether a learner feels welcome or unwelcome. Ascreators of the education climate, nurse educators must use strategies and tactics to

warm this climate for male learners, to make them feel not only that they are

accepted, but, more importantly, that they are pursued because of the unique talents

and traits they bring to the profession.

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Key words: Traditional-Age Male Learners; Education Climate; Nursing Student;

Nurse Educators

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