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Assigning a failing grade to a student in the final clinical semester Greathouse, Susan Elizabeth 1993

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ASSIGNING A F A I L I N G GRADE TO A STUDENT I N THE F I N A L C L I N I C A L SEMESTER by SUSAN ELIZABETH GREATHOUSE B.N.,  The U n i v e r s i t y o f C a l g a r y , 1981  A THESIS SUBMITTED I N PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE I N NURSING in THE FACULTY OF GRADUATE STUDIES The S c h o o l o f N u r s i n g  We a c c e p t t h i s t h e s i s a s c o n f o r m i n g to t h e r e q u i r e d stj^ndard  THE UNIVERSITY OF B R I T I S H COLUMBIA December, 1993 S u s a n E. G r e a t h o u s e  In  presenting  degree freely  at  the  available  copying  of  department publication  this  of  in  partial  fulfilment  University  of  British  Columbia, 1 agree that  for reference  this or  thesis  thesis by  this  for  his thesis  and study. scholarly  or  her  of  The University of British C o l u m b i a Vancouver, Canada Date  DE-6 (2/88)  the  requirements  I further agree that  purposes  may  representatives.  be  It  for financial gain shall not  permission.  Department  of  is  the  Library  an  advanced  shall make  permission for  granted  by  understood be  for  the that  allov^ed without  it  extensive  head  of  my  copying  or  my  written  Abstract The  purpose  p e r c e p t i o n s and  of t h i s  semester  to e x p l o r e the  f e e l i n g s of nurse educators  assigning a f a i l i n g final  s t u d y was  grade  to students enroled i n the  i n a diploma n u r s i n g program.  phenomenological  m e t h o d o l o g y , and L a z a r u s ' s  oriented theoretical  framework, n i n e  employed i n B r i t i s h Columbia  a n a l y s i s sought  audio-taped.  grade  i n the f i n a l  stressful  event  f o r nurse educators.  o v e r r i d i n g theme w h i c h  isolation,  the  of the experience.  f i n d i n g s of the study i l l u s t r a t e  Two  diploma  to i d e n t i f y the e x i s t e n c e of  a failing  stress.  process-  Lower M a i n l a n d  phenomena and d e s c r i b e t h e e s s e n c e The  Using  informants  n u r s i n g p r o g r a m s w e r e i n t e r v i e w e d and Data  on  clinical  that assigning  semester The  is a  prominent  emerged f r o m t h e d a t a  was  o t h e r i n t e r r e l a t e d themes, u n c e r t a i n t y and w e r e a l s o embedded i n t h e i n f o r m a n t s '  d e s c r i p t i o n s of t h e i r experiences.  T h e s e themes w e r e  s t r e s s o r s i n themselves. N u r s e e d u c a t o r s d e s c r i b e d i m m e d i a t e and e f f e c t s of l i v i n g  through t h e i r experiences.  e f f e c t s i n c l u d e d b e i n g more on g u a r d ,  as w e l l  long-term Immediate as  m o d i f y i n g and r e f i n i n g evaluation.  t h e i r approach t o c l i n i c a l  The l o n g - t e r m e f f e c t s  r e s u l t e d i n these  n u r s e e d u c a t o r s b e i n g q u i t e s i g n i f i c a n t l y a f f e c t e d by events.  They c o u l d v i v i d l y r e c a l l t h e d e t a i l s  experiences which l e f t  them w i t h l a s t i n g  of t h e i r  impressions.  These e x p e r i e n c e s s e r v e d as p o i n t s o f r e f e r e n c e f o r n u r s e e d u c a t o r s when f a c e d w i t h o t h e r s t u d e n t s similar  having  problems.  Three m a j o r c o n c l u s i o n s were i d e n t i f i e d . assigning a f a i l i n g Informants  First,  grade t o a student i s s t r e s s f u l .  d e s c r i b e d t h e e x p e r i e n c e a s more  when t h e s t u d e n t l a c k e d i n s i g h t .  Second,  stressful  nurse  e d u c a t o r s e x p r e s s e d a need f o r e m o t i o n a l support t h e i r peers.  They r e p o r t e d f e e l i n g  isolated  unsupported.  They w e r e a c u t e l y a w a r e o f t h e  r a m i f i c a t i o n s of a s s i g n i n g or not a s s i g n i n g a grade.  from  and potential failing  T h i s c r e a t e d an e l e m e n t o f u n c e r t a i n t y t h a t  affected their  decision-making a b i l i t y .  Third, the  nurse educators b e l i e v e d t h a t program a d m i n i s t r a t o r s c o u l d a n d s h o u l d h a v e b e e n more s u p p o r t i v e i n two m a j o r a r e a s : 1) a c k n o w l e d g e m e n t a n d r e a s s u r a n c e a n d 2 ) consistent administration of educational p o l i c i e s .  Table of Contents Page Abstract  i  Table of Contents List  of Figures  Acknowledgements  i i v  v i i viii  CHAPTER ONE INTRODUCTION  1  Background t o t h e Problem  1  Research Question  2  C o n c e p t u a l Framework  3  D e f i n i t i o n o f Terms  6  Assumptions  7  Limitations  8  S i g n i f i c a n c e o f t h e Study  8  Organization of theThesis  9  CHAPTER TWO REVIEW OF THE LITERATURE Feelings,  P e r c e p t i o n s , and Experiences  10 10  Impact on F a c u l t y  12  Summary  IV  CHAPTER 3 METHODOLOGY  20  Issues o f V a l i d i t y and R e l i a b i l i t y S e l e c t i o n o f Informants  23 24  Criteria  24  Procedures  25  Ethical Considerations  26  Data C o l l e c t i o n  27  Data A n a l y s i s  28  CHAPTER FOUR PRESENTATION AND DISCUSSION OF FINDINGS C h a r a c t e r i s t i c s o f Informants  30 30  Content A n a l y s i s  31  Stress  32  Uncertainty  36  Isolation  42  Lack o f A d m i n i s t r a t i v e Variables  that  Influence  Support  Appraisals  44 50  Nurse Educator  51  Student  61  Environment  67  Coping Problem-focused S t r a t e g i e s  74 76  Emotion-focused  Strategies  82  I m m e d i a t e a n d L o n g Term E f f e c t s  89  Summing Up  92  CHAPTER FIVE SUMMARY, CONCLUSIONS, AND IMPLICATIONS Summary  97 97  Conclusions  100  Implications  for Nursing  101  Nursing Education  101  Nursing Research  102  References  104  Appendices  108  A.  Explanatory Letter t o Agencies....  108  B.  A g e n c y C o n s e n t Form  I l l  C.  L e t t e r t o Informants  113  D.  S u b j e c t C o n s e n t Form  116  E.  Demographic Data Sheet  118  F.  Interview Questions  120  A d a p t a t i o n o f L a z a r u s ' s Framework to Depict Nurse Educators' Experiences W i t h A s s i g n i n g a F a i l i n g Grade  ACKNOWLEDGEMENTS  I w o u l d l i k e t o e x p r e s s my a p p r e c i a t i o n e d u c a t o r s who s h a r e d t h e i r making t h i s  study p o s s i b l e .  t o t h a n k my h u s b a n d Wayne, encouragement.  Finally,  Dr. M a r i l y n Willman, for  their  complete  feedback this  work.  t o the nurse  e x p e r i e n c e s w i t h me t h u s I n a d d i t i o n , I would l i k e f o r h i s unending  support and  I would l i k e t o acknowledge  Dr. Sonia Acorn,  a n d R a y Thompson  a n d e d i t o r i a l comments n e c e s s a r y t o  CHAPTER  ONE  Introduction Background t o the Problem Empirical observations of situations n u r s e e d u c a t o r s and f a i l i n g failing  involving  s t u d e n t s h a v e shown t h a t  a student i s a stress-producing part of the  f a c u l t y member's  role.  I t i s this researcher's  contention that the stress related to c l i n i c a l e v a l u a t i o n appears  t o be g r e a t e s t  f o r the nurse  e d u c a t o r who e n c o u n t e r s a s t u d e n t u n a b l e t o meet t h e program o b j e c t i v e s i n the f i n a l n u r s i n g program. unable to f u l f i l  term of a diploma  For students, the r e a l i t y of being their educational aspirations  i n i t i a t e s a h i g h l y emotional response. f a i l u r e t o complete seems t o r e s u l t  the f i n a l  often  In general,  semester of the program  i n student responses d i f f e r e n t  from,  a n d o f t e n more e x a g g e r a t e d t h a n , f a i l u r e i n e a r l i e r semesters.  These r e s p o n s e s t r i g g e r a v a r i e t y o f  t h o u g h t s a n d f e e l i n g s i n t h e n u r s e e d u c a t o r who i s responsible f o r issuing the f a i l i n g  grade.  These s i t u a t i o n s , w h i c h a r e o f t e n c o u p l e d w i t h h i g h l y e m o t i o n a l l y c h a r g e d s t u d e n t r e s p o n s e s , may a major and l a s t i n g  i m p a c t on t h e f a c u l t y member.  have  Recent r e s e a r c h f i n d i n g s l e n d support t o t h i s indicating that " f a i l i n g  clinically  view  unsatisfactory  s t u d e n t s " was one o f t h e i t e m s most f r e q u e n t l y r a t e d a s highly stressful students  by e d u c a t o r s o f b a c c a l a u r e a t e n u r s i n g  (Goldenberg  & Waddell,  1990, p. 5 3 7 ) .  There i s g e n e r a l consensus  among n u r s i n g a u t h o r s  that dealing with the c l i n i c a l l y  failing  student i s  often a negative, d e b i l i t a t i n g ,  and d e m o r a l i z i n g  experience f o rnurse educators  ( C a r p e n i t o , 1983;  Goldenberg 1991;  & Waddell,  T u r k e t t , 1987).  1990; S p i n k ,  Most o f t h e l i t e r a t u r e  makes r e f e r e n c e t o t h e i m p a c t failing  1983; Symanski,  a student i s based  which  on t h e n u r s e e d u c a t o r o f  on o p i n i o n o r s p e c u l a t i o n .  L i t t l e has been w r i t t e n about t h e nurse  educator's  p e r c e p t i o n s a n d what i s w r i t t e n may o r may n o t correspond w i t h r e a l i t y . Research The  question addressed  Question i n this  s t u d y was:  are t h e e x p e r i e n c e s and p e r c e p t i o n s o f nurse  What  educators  i n diploma n u r s i n g programs r e l a t e d t o a s s i g n i n g failing  grades  semester?  t o students i n t h e i r  final  clinical  C o n c e p t u a l Framework The p h e n o m e n o l o g i c a l t r a n s a c t i o n a l m o d e l o f L a z a r u s and F o l k m a n  (1984a)  i s a useful  framework  for  e n h a n c i n g one's u n d e r s t a n d i n g o f t h i s e x p e r i e n c e . U n l i k e e a r l y r e s e a r c h on s t r e s s by S e l y e , w h i c h f o c u s e d p r i m a r i l y on p h y s i o l o g i c a l  stress responses, Lazarus  a n d h i s c o l l e a g u e s a d d r e s s e d m e n t a l and  psychological  responses to s t r e s s .  f o c u s e d on  those c o g n i t i v e , arising  They p a r t i c u l a r l y  affective,  and a d a p t i v e r e s p o n s e s  from person-environment  In t h i s  individualistic,  transactions.  process-oriented  the n o t i o n of s t r e s s which a r i s e s between person-environment  from the  model,  interplay  t r a n s a c t i o n s i s mediated  by  two p r i m a r y p r o c e s s e s : c o g n i t i v e a p p r a i s a l and c o p i n g . An e v e n t i n t h e e n v i r o n m e n t  i s considered a  stressor  o n l y when an i n d i v i d u a l a p p r a i s e s i t as e x c e e d i n g h i s o r h e r r e s o u r c e s and d e t e r m i n e s t h a t i t i s t h r e a t e n i n g or d i s t u r b i n g The  (Lazarus & Folkman,  1984a).  teaching-learning process, p a r t i c u l a r l y i n  r e l a t i o n to d e a l i n g w i t h the c l i n i c a l l y  unsatisfactory  s t u d e n t , h a s b e e n i d e n t i f i e d as a s o u r c e o f s t r e s s and p o t e n t i a l cause o f b u r n o u t  significant  f o r nurse  educators 1984;  (Fong,  1990; G o l d e n b e r g & W a d d e l l ,  S y m a n s k i , 1 9 9 1 ; W e l b o r n & Thompson,  1990; Ray,  1982).  M u l t i p l e person-environment t r a n s a c t i o n s are i n v o l v e d in  issuing failing  final  grades t o n u r s i n g students  semester of a diploma  utilizing  Lazarus's  identification, how n u r s e  n u r s i n g program.  By  d e f i n i t i o n of stressor  t h e r e s e a r c h e r w i l l be a b l e t o i d e n t i f y  educators  Lazarus  i n the  appraise their  and Folkman  experiences.  (1991) b e l i e v e t h a t c o g n i t i v e  a p p r a i s a l s a r e i n f l u e n c e d by a v a r i e t y o f p e r s o n environmental  variables.  and  Personal c h a r a c t e r i s t i c s  may  i n c l u d e such v a r i a b l e s as one's v a l u e s and b e l i e f s , self-esteem, p r i o r  life  experiences,  and t h e a b i l i t y t o  r e c o g n i z e p e r s o n a l r e s o u r c e s w h i c h may e n h a n c e o r impede c o p i n g .  T h e s e may be t h i n g s s u c h a s  means, s o c i a l a n d p r o b l e m - s o l v i n g energy.  Environmental  the s t r e s s , situation, and  financial  s k i l l s , h e a l t h , and  v a r i a b l e s include the nature of  t h e t i m i n g , d u r a t i o n and a m b i g u i t y  of the  o t h e r s i t u a t i o n a l demands a n d c o n s t r a i n t s ,  t h e e x i s t e n c e and q u a l i t y o f s o c i a l  r e s o u r c e s w h i c h may f a c i l i t a t e Folkman, 1984a;  coping  support  (Lazarus  &  1991).  M u l t i p l e f a c t o r s have been i d e n t i f i e d  i n the  l i t e r a t u r e as s o u r c e s o f s t r e s s a s s o c i a t e d w i t h t h e assigning of f a i l i n g  grades  unsatisfactory students.  to c l i n i c a l l y  Many o f t h e s e f a c t o r s  from p r e s s u r e s and c o n f l i c t s  arise  inherent i nmaintaining  high standards of nursing p r a c t i c e while dealing w i t h pressures t o pass students.  Other v a r i a b l e s p e r c e i v e d  by n u r s e e d u c a t o r s a s s o u r c e s o f s t r e s s conflict, of  include  r o l e ambiguity, fear of l i t i g a t i o n ,  support  ( D i c k , 1986; F a i n , 1 9 8 7 ;  role  and l a c k  L e s s n e r , 1990;  O'Connor, 1978; P o l l o k & P o t e e t , 1 9 8 3 ) .  Fain  (1987)  p o s t u l a t e s t h a t r o l e a m b i g u i t y and r o l e c o n f l i c t  may  lead to job dissatisfaction. Coping,  a c c o r d i n g t o L a z a r u s and Folkman  (1991),  i s a m u l t i d i m e n s i o n a l p r o c e s s and c o n s i s t s o f c o g n i t i v e and b e h a v i o r a l a t t e m p t s  t o manage p e r c e i v e d s t r e s s o r s  t h a t a r e a p p r a i s e d as e x c e e d i n g t h e r e s o u r c e s o f t h e individual.  I n t h i s model, c o p i n g i s i d e n t i f i e d as  being e i t h e r problem-focused Problem-focused  o r emotion-focused.  coping processes are directed  a l t e r i n g the person-environment emotion-focused  relationship,  toward while  coping strategies are p r i m a r i l y  d i r e c t e d toward managing e m o t i o n a l d i s t r e s s r a t h e r changing the person-environment  relationship  than  (Lazarus &  Folkman, 1991). appraisal person  I n t h i s way, t h e i n d i v i d u a l ' s  o f t h e s t r e s s f u l s i t u a t i o n , i n f l u e n c e d by  and environmental  individual's  variables,  coping responses.  affects the  These c o p i n g  i n t u r n a l t e r the person-environment affect  responses  r e l a t i o n s h i p and  t h e q u a l i t y and i n t e n s i t y o f t h e i n d i v i d u a l ' s  emotional  response.  i n f l u e n c e nurse cognitive  By e x a m i n i n g  the variables  that  educators' a p p r a i s a l s of events,  both  a n d b e h a v i o r a l c o p i n g p r o c e s s e s may b e  i d e n t i f i e d a n d p a t t e r n s o f c o p i n g may be r e v e a l e d . T h i s h u m a n i s t - o r i e n t e d model d i r e c t e d  toward  e v a l u a t i n g an i n d i v i d u a l ' s p e r c e p t i o n o f , and to,  s i t u a t i o n s which  reaction  s/he a p p r a i s e s a s b e i n g  t h r e a t e n i n g o r s t r e s s f u l , i s congruent  with the  phénomènelogical m e t h o d o l o g y u s e d i n t h i s s t u d y . theoretical  The  framework and methodology d e s c r i b e t h e  i n d i v i d u a l ' s p e r c e p t i o n and e x p e r i e n c e a r i s i n g from t h e situation involving  clinically  failing  students.  D e f i n i t i o n o f Terms Words a n d p h r a s e s as  used i n t h i s study a r e d e f i n e d  follows:  Impact :  the effects, or the perception of the effects,  r e s u l t i n g from t h e e x p e r i e n c e o f f a i l i n g  s t u d e n t s on  the i n f o r m a n t s . Nurse educator:  an i n d i v i d u a l  who  is a  practicing  member o f t h e R e g i s t e r e d N u r s e s ' A s s o c i a t i o n o f B r i t i s h C o l u m b i a , who in  the f i n a l  synonymously  i s teaching i n a diploma nursing clinical  semester.  This term i s used  w i t h the term "nursing  F a i l i n g students:  s t u d e n t s who  e v a l u a t e d by a q u a l i f i e d  program,  faculty."  have been  clinically  n u r s e e d u c a t o r and h a v e b e e n  i d e n t i f i e d as n o t m e e t i n g t h e c o u r s e o b j e c t i v e s i n t h e final  clinical  semester of a diploma n u r s i n g  Diploma n u r s i n g programs: post-secondary i n s t i t u t i o n s  program.  n u r s i n g programs based i n that grant diplomas i n  n u r s i n g i n the p r o v i n c e of B r i t i s h Columbia. Final  clinical  semester: the f i n a l  clinical  prior  t o g r a d u a t i n g from a diploma n u r s i n g  semester program.  Assumptions The w r i t e r assumes t h a t any n u r s e e d u c a t o r who f a i l e d one o r more n u r s i n g s t u d e n t s i n t h e clinical qualified the  final  semester of a diploma n u r s i n g program i s t o speak about h i s / h e r e x p e r i e n c e s r e l a t e d  i m p a c t o f f a i l i n g a s t u d e n t and t h a t  the  experiences are v a l i d according to phenomenological theory.  has  to  Limitations Sample s e l e c t i o n was the province l e a s t one  o f B r i t i s h C o l u m b i a who  nursing student  n u r s i n g program. s a m p l e , was therefore, nurse  l i m i t e d to nurse educators  The  clinically,  f i n d i n g s c a n n o t be  diploma convenience and  generalized to a l l  educators.  Nurse educators' resulting  perceptions  Various  authors  educators  i n these  b u r n o u t , and may leaving c l i n i c a l  1984;  educators  failing  students  education.  s i t u a t i o n s may  Turkett,  difficult  lead  actually result teaching  1987).  1980;  Being  i n nurse  aware o f ,  to deal w i t h t h i s aspect  assist of  1983;  O'Connor,  f e e l i n g s t h a t may  s i t u a t i o n s may  e v a l u a t i o n more e f f e c t i v e l y .  to  (Carpenito,  Lenhart,  b e t t e r able to a n t i c i p a t e , the from these  feelings  i m p a c t on n u r s i n g  G o l d e n b e r g & W a d d e l l , 1990; Ray,  and  have p o s t u l a t e d t h a t the m u l t i p l e  stresses inherent s t r e s s and  Study  from working w i t h c l i n i c a l l y  have a s i g n i f i c a n t  1978;  in a  at  diploma programs  S i g n i f i c a n c e of the  may  failed  sample, a p u r p o s i v e ,  d r a w n f r o m o n l y two the  had  in  and result  nurse  clinical  Additional research  may  generate f i n d i n g s to i n c o r p o r a t e i n t o graduate programs  that prepare nurse educators. may  benefit  Novice nurse educators  from the f i n d i n g s of t h i s  s t u d y by  an i n c r e a s e d a w a r e n e s s o f t h e p e r c e p t i o n s and resulting  from i n t e r a c t i o n s w i t h f a i l i n g  students.  As a r e s u l t ,  t h e y may  feelings  clinical  f i n d themselves  a b l e t o cope w i t h t h e impact of t h e s i t u a t i o n s which they w i l l  gaining  better  challenging  i n e v i t a b l y have t o  face.  Organization of the Thesis This thesis i s organized into C h a p t e r One,  the context of the problem,  s t u d y , and t h e o r e t i c a l In  addition,  five chapters. purpose  of the  framework have been d e s c r i b e d .  key terms were d e f i n e d and  the  s i g n i f i c a n c e and l i m i t a t i o n s o f t h e s t u d y C h a p t e r Two  In  p r e s e n t s a review of the  delineated.  relevant  l i t e r a t u r e d e s c r i b i n g t h e f e e l i n g s , p e r c e p t i o n s and e x p e r i e n c e s o f n u r s e e d u c a t o r s , t h e i m p a c t on educators of i n t e r a c t i n g w i t h f a i l i n g conflicts  nurse  s t u d e n t s , and  inherent i n the nurse educator's r o l e .  Chapter Three,  the  select  informants presented.  Chapter Four  p r e s e n t a t i o n and d i s c u s s i o n o f t h e s t u d y ' s  findings.  C h a p t e r F i v e i n c l u d e s t h e summary,  c o n c l u s i o n s and  In  t h e p h e n o m e n o l o g i c a l method used i n t h i s  s t u d y i s d e s c r i b e d and an o u t l i n e o f t h e c r i t e r i a to  the  implications.  used  includes  CHAPTER  TWO  Review o f t h e L i t e r a t u r e The The  first  review of the l i t e r a t u r e i s r e l a t e d t o nurse  f o c u s e s on two a r e a s .  educators'  p e r c e p t i o n s , and e x p e r i e n c e s a r i s i n g  feelings,  from  interactions  w i t h n u r s i n g s t u d e n t s who h a v e b e e n i s s u e d a clinical nurse  grade.  The s e c o n d  educators  of t h i s  Feelings, O'Connor  r e l a t e s t o t h e impact  P e r c e p t i o n s and E x p e r i e n c e s  (1978) s p e c u l a t e d t h a t t h e  can s e t t h e scene f o r c o n f l i c t s  troublesome  on  event.  teaching-learning process, p a r t i c u l a r l y setting,  failing  f o r a l l nurse  educators.  i n the c l i n i c a l that  Various  prove authors  h a v e made r e f e r e n c e t o t h e e m o t i o n a l l y d r a i n i n g e x p e r i e n c e o f d e a l i n g w i t h s t u d e n t s who unsatisfactorily 1990; Wood,  Lenhart,  19 80;  setting  (Lankshear,  Symanski, 1991; T u r k e t t , 1987;  1971). The  clinical is  i n the c l i n i c a l  perform  l i t e r a t u r e that addresses  the process of  e v a l u a t i o n as i t r e l a t e s t o f a i l i n g a s t u d e n t  f i l l e d w i t h statements  out o f t h i s p r o c e s s .  describing feelings  Turkett  arising  (1987) s t a t e s t h a t "when  f a c e d w i t h t h e r e a l i t y o f f a i l u r e b o t h student and  n u r s e e d u c a t o r become u n c o m f o r t a b l e , depressed"  (p. 2 4 6 ) . F e e l i n g s o f i n s u f f i c i e n c y and  p o w e r l e s s n e s s may s u r f a c e .  F r u s t r a t i o n may b e  e x p e r i e n c e d by t h e n u r s e e d u c a t o r 1968;  t e n s e and  C a r p e n i t o , 1983; K e l l y ,  (Anderson  1973).  & Saxon,  Carpenito  (1983)  p o i n t s o u t t h a t n u r s e e d u c a t o r s may d i s t a n c e t h e m s e l v e s b o t h p h y s i c a l l y and e m o t i o n a l l y i n response anger and h o s t i l i t y . w i t h doubts process.  arising  t o student  Nurse educators a r e o f t e n from t h e c l i n i c a l  left  evaluation  They w o n d e r w h e t h e r t h e y h a v e "done t h e r i g h t  t h i n g , " knowing f u l l w e l l t h a t o p i n i o n s would among e q u a l l y c o m p e t e n t e d u c a t o r s  (Brozenec,  vary Marshall,  Thomas, & W a l s h , 1987, p. 4 2 ) . In Waddell  a r e c e n t e x p l o r a t o r y s t u d y , Goldenberg and (1990) e x a m i n e d s o u r c e s a n d l e v e l s o f p e r c e i v e d  s t r e s s among 7 0 f e m a l e b a c c a l a u r e a t e n u r s e e d u c a t o r s i n eight Ontario u n i v e r s i t i e s .  They f o u n d t h a t t h e m a j o r  s t r e s s e s were p r i m a r i l y c l i n i c a l l y - o r i e n t e d and included  "retaining failing  clinically  s t u d e n t s and  unsatisfactory students"  failing  (p.537).  Although  some l i m i t a t i o n s w e r e n o t e d i n t h e s t u d y , t h e f i n d i n g s supported the i n v e s t i g a t o r s ' with failing  contention that  students i s s t r e s s f u l .  dealing  In of  a study designed to i n v e s t i g a t e the  34 c l i n i c a l  different  attitudes  " a s s e s s o r s " and n u r s e t e a c h e r s f r o m  schools of n u r s i n g i n n o r t h e r n England,  p a r t i c i p a n t s were asked  to discuss issues r e l a t e d  clinical  failing  1990).  e v a l u a t i o n and Using  ...(p. 350),  students  ..."structured eavesdropping  about f a i l i n g  nursing students.  they experienced " o g r e s , " and  felt  to  methodology"  a t e r m n o t d e f i n e d by t h e a u t h o r ,  R e s p o n d e n t s d e s c r i b e d i n t h e i r own  the  (Lankshear,  p a r t i c i p a n t s took p a r t i n seven d i s c u s s i o n  outcome.  two  the  groups.  w o r d s how  they  felt  For example, they  felt  "flak,"  c o u l d be made t o f e e l  like  i t was  a h a s s l e h a r d l y worth  the  W h i l e t h e s e comments may  be o f some v a l u e ,  t h e f a c t t h a t t h e y a r e t a k e n o u t o f c o n t e x t makes i t difficult  to determine  their merit.  I m p a c t on F a c u l t y V a r i o u s a u t h o r s have d e s c r i b e d the p o s s i b l e on f a c u l t y o f h a v i n g t o w o r k w i t h f a i l i n g (Goldenberg The  & Waddell,  1990;  Lenhart,  students  1980;  l i t e r a t u r e c o n t a i n s numerous a r t i c l e s  impact  Ray,  1984).  that provide  a n e c d o t a l commentary on t h e s t r e s s - f i l l e d r o l e o f nurse educator 1984;  ( C a r p e n i t o , 1983;  T u r k e t t , 1987);  however,  Lenhart,  1980;  research-based  the  Ray,  l i t e r a t u r e o n s t r e s s a n d b u r n o u t among a c a d e m i c is  limited.  Typical of t h i s  Ray's a r t i c l e  (1984),  type of l i t e r a t u r e i s  on t h e p o t e n t i a l p r o b l e m o f  burnout f o r n u r s i n g f a c u l t y . pressures  faculty  and c o n f l i c t s  The a u t h o r  describes the  that are inherent i n  maintaining high standards  of nursing p r a c t i c e while  dealing with the pressures  t o pass students.  descriptive-correlational  study w h i c h examined burnout  i n c o l l e g i a t e n u r s i n g programs, Dick s i g n i f i c a n t negative  interpersonal relationships. spent approximately  with students.  (1986) d e s c r i b e s a  r e l a t i o n s h i p between burnout o f  n u r s i n g f a c u l t y and i n t e n s e student  study  a n d collégial  The s u b j e c t s i n t h i s  h a l f of t h e i r time  The a u t h o r  concluded  r e l a t i o n s h i p between c l i n i c a l  and  continuous  contact  i n contact  that while  was a s l i g h t burnout,  In a  there  supervision  i n intense  i n t e r p e r s o n a l r e l a t i o n s h i p s w i t h students and c o l l e a g u e s was a n i m p o r t a n t  f a c t o r i n burnout.  f a c t o r was c i t e d a s b e i n g more i m p o r t a n t worked o r c a s e l o a d of t h e f a c u l t y An a d d i t i o n a l fear arising 1990;  than  This the hours  member.  s t r e s s f o r the nurse educator  from t h e prospect  P o l l o k & Poteet,  1983).  of being  sued  i s the  (Lessner,  Many f a c u l t y a r e f e a r f u l  of  a grievance or lawsuit  f o r a v a r i e t y of  reasons.  Most n u r s i n g e d u c a t i o n programs today have a c a d e m i c and  clinical  standards  and a p p e a l m e c h a n i s m s t o a d d r e s s If  c a r e f u l l y designed,  stressful,  In  f o r student  these procedures,  students  (Orchard,  the p a s t t h r e e decades,  performance  student grievances. while  should safeguard the r i g h t s of  e d u c a t o r s and  developed  both  1992). i n the U n i t e d S t a t e s ,  there i s evidence suggesting a general increase i n litigation  i n v o l v i n g n u r s i n g e d u c a t i o n programs  & W e i l e r , 1991).  In the U n i t e d S t a t e s , s u i t s against  n u r s i n g e d u c a t i o n p r o g r a m s a r e more l i k e l y brought  (Helms  by s t u d e n t s and  (Helms & W e i l e r , 1 9 9 1 ) .  to  be  they are o f t e n s u c c e s s f u l I t i s r e a s o n a b l e t o assume  t h a t t h i s p a t t e r n l i k e l y m i r r o r s t h a t of Canada; h o w e v e r , no  l i t e r a t u r e c o u l d be  contention.  The  advent  found to support  o f s t u d e n t c o n s u m e r i s m demands  t h a t s t u d e n t s be t r e a t e d f a i r l y and  t h a t the  e d u c a t i o n a l program p r o v i d e the s k i l l s t h e new  graduate  professional.  this  necessary f o r  t o f u n c t i o n as a c o m p e t e n t  Goclowski  (1985) i d e n t i f i e s a " c a t c h 22"  s c e n a r i o where i t i s p o s s i b l e f o r n u r s e e d u c a t o r s t o sued  f o r both f a i l i n g  and n o t  failing  a student.  For  be  example, g r a d u a t e s  of n u r s i n g programs d i s m i s s e d  employment f o r i n c o m p e t e n c e  may  sue  f o r not  receiving  an e d u c a t i o n t h a t p r e p a r e d them t o f u n c t i o n competent p r o f e s s i o n a l s ; n u r s i n g p r o g r a m s may to  and  Goclowski  as  students dismissed  sue a f a c u l t y member f o r  t r e a t them i n a f a i r and  from  from  failing  r e a s o n a b l e manner  ( 1 9 8 5 ) , O'Connor  (1978) and  Symanski  (1991) p o s t u l a t e t h a t t h e m u l t i p l e s t r e s s e s i n h e r e n t i n dealing with f a i l i n g  s t u d e n t s may  l o s s of nurse educators  actually result  from c l i n i c a l t e a c h i n g .  F a c t o r s r e l a t e d t o t h e m u l t i f a c e t e d and a m b i g u o u s r o l e o f n u r s e e d u c a t o r s , and on  f a c u l t y energy  in a  somewhat the c o s t l y  e x a c t e d by t h e f a i l i n g  a l s o b e e n i d e n t i f i e d as p o t e n t i a l  drain  s t u d e n t have  causes  of s t r e s s  and  burnout. From t h i s p e r s p e c t i v e . F a i n (1987) and  O'Connor  (1978) f o u n d t h a t n u r s e e d u c a t o r s e x p e r i e n c e  role  conflict  hats;  and  r o l e ambiguity from wearing  two  t h o s e o f p r o f e s s i o n a l n u r s e and  educator.  conflict  lead to stress  and  r o l e a m b i g u i t y may  has been l i n k e d t o low j o b s a t i s f a c t i o n Schuler, Aldag & Brief,  Role which  (Schuler,  1975;  1977) .  Numerous n u r s i n g a u t h o r s h a v e c o n t r i b u t e d t o  an  understanding  o f t h e r e s p o n s i b i l i t i e s and c o n f l i c t s  inherent i n the nurse  educator's  role  (Batey,  K r a m e r , 1966; O'Connor, 1978; W i l l i a m s o n , O'Connor  (1978) i d e n t i f i e s a f u r t h e r  from the t e a c h i n g - l e a r n i n g process. o f t e n h a v e t o make d i f f i c u l t t o be done a n d what w i l l  1969;  1972).  conflict arising F a c u l t y members  c h o i c e s b e t w e e n what o u g h t  gain student  p r o v i d e them w i t h some i n t r i n s i c  a p p r o v a l and  reward f o r t h e work  they are doing.  Diminished  linked to stress  a r i s i n g from t h e r o l e c o n f l i c t and  r o l e ambiguity  experienced  (Marriner & Craigie,  j o b s a t i s f a c t i o n has been  b y many n u r s e  1977).  expressed  and  overload, junior  (1987),  Because of j o b  to role conflict,  ambiguity t o be  position.  educators'  and r o l e a m b i g u i t y  satisfaction,  first  i n a study t h a t examined  baccalaureate nurse conflict  into their  f a c u l t y w e r e more l i k e l y  planning to leave t h e i r Fain  junior  more j o b d i s s a t i s f a c t i o n  t h a n s e n i o r f a c u l t y members. dissatisfaction attributed  educators  In t h i s study,  f a c u l t y members i n p a r t i c u l a r , h i r e d teaching position,  thus  found  perceptions of role  as compared t o j o b  t h a t r o l e c o n f l i c t and r o l e  a m b i g u i t y were b o t h a s s o c i a t e d w i t h low l e v e l s o f j o b  satisfaction. 822  nurse  M a r r i n e r a n d C r a i g i e ' s (1977) s u r v e y o f  educators  i n b a c c a l a u r e a t e and h i g h e r  p r o g r a m s i n 13 A m e r i c a n w e s t e r n  degree  states reported that  t h e q u a l i t y o f s t u d e n t s was one o f t h e v a r i a b l e s w h i c h correlated with general job s a t i s f a c t i o n .  The h i g h e r  t h e q u a l i t y o f t h e s t u d e n t s , t h e more g e n e r a l l y satisfied to  educators  w e r e , a n d t h e more l i k e l y  remain t e a c h i n g a t that i n s t i t u t i o n .  Wood  they were (1971)  d e s c r i b e s how, i n n u r s i n g p r o g r a m s i n O n t a r i o a n d Quebec, c o m p e t e n t f a c u l t y w o r k i n g  with "borderline"  s t u d e n t s may l e a v e n u r s i n g p r o g r a m s w h i c h h a v e a h i g h a t t r i t i o n r a t e f o r o t h e r s w i t h more r e w a r d i n g environments. to  support  However, no s t a t i s t i c a l  the author's  teaching  data are given  contention. Summary  The  l i t e r a t u r e r e v i e w has i d e n t i f i e d t h a t t h e r e i s  a dearth of research-based topic.  Relevant  i n f o r m a t i o n on t h e t h e s i s  current American l i t e r a t u r e i s  limited,  a n d C a n a d i a n - b a s e d l i t e r a t u r e on t h e t o p i c i s  absent.  A review of the l i t e r a t u r e reveals there i s  l i t t l e more t h a n o p i n i o n a n d a n e c d o t a l commentary t o describe the experiences assign f a i l i n g  of nurse  educators  c l i n i c a l grades t o students  having t o i n general.  a n d no a r t i c l e s c o u l d be f o u n d t h a t d e s c r i b e d t h e experience of having t o assign f a i l i n g students i n the f i n a l highlights  clinical  grades t o  semester.  the complexities of c l i n i c a l  This review e v a l u a t i o n and  d e s c r i b e s t h e r o l e a m b i g u i t y and r o l e c o n f l i c t e x p e r i e n c e d by p r o f e s s i o n a l n u r s e e d u c a t o r s as t h e y c a r r y out t h e i r r e s p o n s i b i l i t i e s . r o l e c o n f l i c t a r e predominant from t h e s t u d i e s examined. are of  S t r e s s , burnout, and  concepts that  In addition,  emerged  some i s s u e s  i d e n t i f i e d r e l a t e d t o t h e impact on n u r s e e d u c a t o r s issuing  failing  c l i n i c a l g r a d e s . The l o n g a n d s h o r t  t e r m e f f e c t s on f a c u l t y members o f h a v i n g t o i n t e r a c t with failing  s t u d e n t s have n o t been s p e c i f i c a l l y  addressed i n t h e n u r s i n g l i t e r a t u r e (Symanski,  1991) .  In f a c t , a search of the r e l a t e d l i t e r a t u r e i n general education reveals that l i t t l e the  has been w r i t t e n  about  impact on f a c u l t y i n g e n e r a l o f f a i l i n g s t u d e n t s .  Whether t h e s e concerns a r e s p e c i f i c a l l y r e l a t e d t o nurse e d u c a t o r s i n diploma n u r s i n g programs i s n o t known s i n c e no a r t i c l e s c o u l d be f o u n d t h a t the  examined  experiences of diploma n u r s i n g f a c u l t y .  potential  The  s i g n i f i c a n c e o f t h e i m p a c t on n u r s e  e d u c a t o r s , and n u r s i n g e d u c a t i o n as a whole, o f h a v i n g  to a s s i g n a f a i l i n g clinical  semester,  i n t h i s a r e a , has  grade to a student  m  the  combined w i t h the l a c k of  final research  p r o v i d e d the impetus f o r t h i s  study.  CHAPTER THREE Methodology  In  this  chapter, t h e methodology used i n t h e study  is described.  Sample s e l e c t i o n c r i t e r i a ,  v a l i d i t y and r e l i a b i l i t y , data c o l l e c t i o n  ethical  issues of  c o n s i d e r a t i o n s , and  and a n a l y s i s a r e a l s o  addressed.  Methodology Spiegelberg's philosophical, phenomenological  introspective  m e t h o d was u s e d f o r t h i s  a i m o f p h e n o m e n o l o g y i s t o d e s c r i b e human through  the perception of the individual  experienced  (Munhall & O i l e r ,  With Spiegelberg's  study.  The  experience as l i f e i s  1986).  (1960) a p p r o a c h ,  the researcher  c a n s y s t e m a t i c a l l y e x p l o r e m e a n i n g i n t h e human experience.  From t h i s e x p l o r a t i o n ,  through the  informants' perceptions, consensually validated knowledge c a n be d e r i v e d , a t t e m p t i n g as f u l l y as p o s s i b l e t o d e p i c t t h e t o t a l i t y o f an e x p e r i e n c e as i t is  lived  (Munhall & O i l e r ,  1986).  S u b j e c t i v e phenomena a r e s t u d i e d t o u n c o v e r t h e o b j e c t i v e essences under examination  a b o u t t h e r e a l i t y o f t h e phenomena ( S p i e g e l b e r g , 1960).  The  s u b j e c t i v i t y o f t h e phenomenon r e l a t e s  only to  c o n t e n t o f t h e s i t u a t i o n and d e s c r i p t i o n p e r s o n a l e x p e r i e n c e s as r e l a t e d by t h e (Spiegelberg,  to phenomenological  relationships  of appearing; watching  They  among e s s e n c e s ;  phenomena; and  interpreting  modes  o f phenomena i n  b e l i e f s i n the e x i s t e n c e of t h e m e a n i n g o f phenomena.  three steps r e q u i r e the researcher to  i n t u i t i v e l y g r a s p t h e p a r t i c u l a r phenomenon analytically  apprehending  watching  the c o n s t i t u t i o n  suspending  include,  particular  general essences;  consciousness;  first  research.  order: investigating  phenomena; i n v e s t i g a t i n g  The  informants  (1960) i d e n t i f i e s s e v e n s t e p s i n h i s  i n the f o l l o w i n g  essential  the  1960).  Spiegelberg approach  of  the  e x a m i n e and d e s c r i b e i t .  done w i t h o u t p r e c o n c e p t i o n s .  The  and  T h i s must  be  investigator  "brackets" or c o n s c i o u s l y puts aside h i s / h e r opinions and u n d e r s t a n d i n g investigation. bracket thoughts nurse  of the experience  under  In t h i s study, the i n v e s t i g a t o r and  to  e x p e r i e n c e s a r i s i n g out of b e i n g  e d u c a t o r and h a v i n g i s s u e d f a i l i n g  students i n the c l i n i c a l researcher to view  had  setting.  the r e a l i t y  grades  This enabled  from the  to the  informants'  a  p e r s p e c t i v e and enabled  the informants  t h e i r v i e w s o f t h e phenomenon. "watching  modes o f a p p e a r i n g "  to fully  express  The f o u r t h s t e p , r e f e r s t o t h e need f o r  t h e i n v e s t i g a t o r t o e x p l o r e n o t o n l y what  essences  a p p e a r b u t t o e x a m i n e t h e way g e n e r a l e s s e n c e s  appear.  E x p l o r a t i o n o f t h e c o n s t i t u t i o n o f t h e phenomenon i n consciousness  c o n s i s t s o f d e t e r m i n i n g how t h e  i n v e s t i g a t o r p e r c e i v e s t h e phenomenon h a s t a k e n (Spiegelberg,  shape  1960).  The p u r p o s e o f t h e f i f t h s t e p i s t o " d e t e r m i n e typical  s t r u c t u r e of a c o n s t i t u t i o n i n consciousness  means o f a n a l y s i s o f t h e e s s e n t i a l steps"  (Spiegelberg,1960).  existence, bracketing, all  the by  sequence o f i t s  Suspending b e l i e f i n  the s i x t h step, maintains  the practice of  ensuring that the researcher w i l l  consider  t h e d a t a on an e q u a l b a s i s p r e s e r v i n g t h e c o n t e n t  as p u r e l y a s p o s s i b l e .  The a i m o f t h i s p h a s e i s t h e  f a c i l i t a t i o n of genuine i n t u i t i n g , d e s c r i b i n g of the given data final  step i n t h i s process,  a n a l y z i n g , and  ( S p i e g e l b e r g , 1960).  The  that i s , interpreting  c o n c e a l e d meanings, aims a t d i s c o v e r i n g meanings n o t immediately intuiting,  apparent  from the r e s e a r c h e r ' s  a n a l y z i n g and d e s c r i b i n g .  previous  Spiegelberg  (1960) s u g g e s t s for  t h a t t h e r e i s " s c o p e and  reason to look  deeper h i d d e n meanings whenever the  m e a n i n g s do n o t a d e q u a t e l y (p.  698).  account  conscious  f o r a phenomenon"  Spiegelberg's phenomenological  approach  p r o v i d e s a s y s t e m a t i c methodology t o e x p l o r e meanings of  e x p e r i e n c e s and  i s an a p p r o p r i a t e m e t h o d o l o g y t o  in  t h i s type of r e s e a r c h problem  about the s u b j e c t under  where l i t t l e  qualitative  i s known  study.  I s s u e s o f V a l i d i t y and In  use  research,  Reliability the  determination  v a l i d i t y and r e l i a b i l i t y i s d i r e c t e d t o w a r d  of  understanding  t h e phenomenon u n d e r s t u d y i n n a t u r a l s e t t i n g s w i t h  few  controlling conditions. Internal validity i s ultimately b a s e d on w h e t h e r t h e d a t a and a n a l y s i s s t a n d t h e t e s t time data.  and  whether  the  If validity  findings  exists,  of  the  o t h e r s who  study have  "fit"  of the  experienced  t h e phenomenon w i l l r e c o g n i z e t h e f i n d i n g s as b e i n g t r u e (Munhall  &  Oiler,  1986) .  This  means  that  one  would  e x p e c t t h a t b o t h i n f o r m a n t s and o t h e r s f a m i l i a r w i t h t h e experience  would  comparable,  but  validation  from  interviews,  as  view not  was  the  experience  in a  c o n t r a d i c t o r y , manner.  informants done  through  in this  study,  a  similar  or  Obtaining  sequence i s one  way  of to  clarify  that the d e s c r i p t i o n i s accurate.  According research  to  Leininger  r e l i a b i l i t y should  documenting  recurrent,  (1985), focus  in  on  qualitative  "identifying  accurate  and  consistent  (homogeneous) o r i n c o n s i s t e n t ( h e t e r o g e n e o u s ) as and  p a t t e r n s , themes, v a l u e s , w o r l d other  phenomena  contexts"  (p.  69).  extracted  from  the  confirmed  data  views,  themes  reveal  to  features,  experiences,  in similar  Recurrent  and  or which  what  different can  be  extent  the  phenomenon u n d e r s t u d y c o n s i s t e n t l y r e f l e c t s m e a n i n g s and t r u t h s a b o u t t h a t p a r t i c u l a r phenomenon.  Reliability  can  a l s o be e s t a b l i s h e d by c l e a r l y d e s c r i b i n g t h e p r o g r e s s i o n of events  so t h a t o t h e r s c a n  researcher.  This  should  f o l l o w the t h i n k i n g of  allow  other  the  researchers  to  a r r i v e at s i m i l a r or comparable, but not c o n t r a d i c t o r y , conclusions. S e l e c t i o n of  Informants  Criteria The  informants  convenience  c o n s i s t e d of a  purposive,  sample of 9 q u a l i f i e d nurse  met  the f o l l o w i n g  1.  C u r r e n t l y e m p l o y e d as e d u c a t o r s  educators  criteria: in  diploma  n u r s i n g programs i n t h e B r i t i s h C o l u m b i a Lower  who  Mainland. 2.  Have a s s i g n e d f a i l i n g  clinical  grades  more n u r s i n g s t u d e n t s c l i n i c a l l y clinical 3.  t o one o r  i n the f i n a l  semester.  W i l l i n g t o be i n t e r v i e w e d a n d a u d i o - t a p e d on one o r more s e p a r a t e o c c a s i o n s . The  a d e q u a c y o f t h e s a m p l e s i z e was a s s e s s e d b y  a n a l y s i s o f t h e d a t a o b t a i n e d f r o m t h e i n f o r m a n t s . The i n t e r v i e w d a t a were a s s e s s e d a c c o r d i n g t o t h e relevance,  completeness,  a n d amount o f i n f o r m a t i o n  o b t a i n e d as t h e s t u d y p r o g r e s s e d .  Analyses  t h a t t h e s a t u r a t i o n p o i n t had been reached,  indicated and an  a d e q u a t e amount o f i n f o r m a t i o n f o r t h e s t u d y h a d b e e n o b t a i n e d when " n o t h i n g new" was c o m i n g o u t o f t h e interviews. Procedures Informants  f r o m two c o l l e g e d i p l o m a n u r s i n g  p r o g r a m s known t o t h e r e s e a r c h e r t o h a v e f i n a l semesters for  i n which  clinical  clinical  t h e f a c u l t y members w e r e r e s p o n s i b l e  s u p e r v i s i o n and e v a l u a t i o n o f s t u d e n t s  were approached.  A l e t t e r o f e x p l a n a t i o n (Appendix  was s e n t t o t h e p r o g r a m h e a d s o f t h e two c o l l e g e s seeking consent  t o d i s c u s s the study w i t h  interested  A)  f a c u l t y and  to request  an o p p o r t u n i t y t o meet w i t h  f a c u l t y to e x p l a i n the study. the agency consent form went t o t h i s  program head  ( A p p e n d i x B)  agency t o p r e s e n t  agency d i d not  One  and  Nurse Educators  the p r o p o s a l  d e s c r i b i n g t h e s t u d y and  the c r i t e r i a  Within  t o members o f  A letter  the informant's  and w e r e w i l l i n g  Behavioural  role  was  from  one  obtained.  Considerations  with a letter briefly expected  were s e l e c t e d .  T h i s i n f o r m a t i o n was  Other  A f t e r approval E a c h was  d e s c r i b i n g t h e s t u d y and  o f them  rights  Columbia  C o m m i t t e e f o r R e s e a r c h and  S t u d i e s I n v o l v i n g Human S u b j e c t s . informants  who  telephone.  the U n i v e r s i t y of B r i t i s h  Sciences  Nurses  briefly  procedures f o r p r o t e c t i o n of s u b j e c t s '  w e r e a p p r o v e d by  w o u l d be  five  f o u r from the o t h e r , were Ethical  obtained,  the  t o p a r t i c i p a t e were  f o u r weeks, n i n e i n f o r m a n t s ,  The  the  Individuals  t o c o n t a c t t h e r e s e a r c h e r by  a g e n c y and  other  Therefore  c i r c u l a t e d to i n t e r e s t e d i n d i v i d u a l s .  requested  The  I n t e r e s t Group of the R e g i s t e r e d  A s s o c i a t i o n of B r i t i s h Columbia.  met  researcher  the p r o p o s a l .  respond to the request.  researcher presented  the  signed  was  provided what  (Appendix C).  again reviewed  at the s t a r t of  the  first  interview.  c o m p l e t e d by (Appendix  A w r i t t e n c o n s e n t f o r m was  each informant  who  A q u e s t i o n n a i r e was on e a c h i n f o r m a n t  the sample  obtained:  The  t h e age  of t e a c h i n g  and  demographic  This questionnaire  was  p r i o r t o the s t a r t of  following information  of the  experience,  teaching position, failed,  used to o b t a i n  each informant  interview.  Procedures  f o r the purpose of d e s c r i b i n g  (Appendix E ) .  c o m p l e t e d by first  participate  D). Data C o l l e c t i o n  data  agreed to  then  individual,  the  was  number o f  years  l e n g t h of time i n c u r r e n t  number o f s t u d e n t s  informant  the e d u c a t i o n a l q u a l i f i c a t i o n s of  has the  informant. Data r e l e v a n t to the r e s e a r c h c o l l e c t e d through unstructured approximately taped.  Two  were  interviews  s i x t y m i n u t e s i n l e n g t h w h i c h were i n t e r v i e w s were needed t o  s u f f i c i e n t d a t a and  s e c o n d i n t e r v i e w was  first  meanings  interview.  more s t r u c t u r e d s i n c e  n e e d e d t o s e e k c l a r i f i c a t i o n and  f u r t h e r i n f o r m a t i o n from the  informant  audio-  collect  t o v a l i d a t e themes and  d e r i v e d from a n a l y s i s of the  researcher  question  The  the obtain  i n order  to  v a l i d a t e data obtained  i n the previous  interview.  The  researcher  e n c o u n t e r e d some d i f f i c u l t i e s  scheduling  o f t h r e e s e c o n d i n t e r v i e w s due t o w o r k l o a d ,  scheduling,  with  a n d v a c a t i o n commitments on t h e p a r t o f t h e  informants.  The t i m e r e q u i r e d t o c o m p l e t e t h e d a t a  c o l l e c t i o n was f o u r m o n t h s . As i n d i c a t e d i n A p p e n d i x F, t h e p r i m a r y q u e s t i o n was: D e s c r i b e educator's  what i t i s l i k e  perspective)  questions  clinical  semester.  u s e d when t h e s e  Describe failing  course  Secondary  objectives trigger  included:  how y o u f e l t when y o u h a d t o a s s i g n a grade t o a student  a diploma nursing 2.  student  components were a d d r e s s e d i n  the i n t e r v i e w by t h e i n f o r m a n t s 1.  (from a nurse  to inform a nursing  t h a t h e / s h e h a s n o t met t h e c l i n i c a l in the f i n a l  trigger  i n the f i n a l  semester of  program.  What h e l p s y o u d e a l w i t h t h e f e e l i n g s t h a t may arise i n this situations?  3.  What makes t h e s i t u a t i o n more Transcription occurred  completion  difficult?  as q u i c k l y as p o s s i b l e  after  of the interviews. Data A n a l y s i s  Data a n a l y s i s o c c u r r e d  simultaneously  with  data  collection.  Data from t h e i n t e r v i e w s were a n a l y z e d  using Spiegelberg's phenomenological  approach  p r e v i o u s l y d e s c r i b e d ( S p i e g e l b e r g , 1960). of  t h e a n a l y s i s was t o i d e n t i f y  phenomena a n d t o document t h e i r Morse,  The p u r p o s e  t h e forms and t y p e s o f existence (Field &  1985).  Written f i e l d  notes  u s e f u l i n data a n a l y s i s . accounts  as  k e p t by t h e r e s e a r c h e r were F i e l d notes  o f what t h e r e s e a r c h e r h e a r s ,  are descriptive sees,  e x p e r i e n c e s and t h i n k s about i n t h e c o u r s e o f collecting 1985).  and r e f l e c t i n g  on t h e d a t a  The d a t a w e r e t r a n s c r i b e d ,  and a n a l y z e d a l o n g w i t h t h e f i e l d describe the i n t e r v i e w context.  ( F i e l d & Morse,  coded, c a t e g o r i z e d , notes which helped t o  CHAPTER FOUR P r e s e n t a t i o n and D i s c u s s i o n o f F i n d i n g s In t h i s  c h a p t e r t h e d e m o g r a p h i c d a t a p r o v i d e d by  the informants are presented, a f t e r which f i n d i n g s a r e d e s c r i b e d and d i s c u s s e d . phenomenological  approach  the  Using  and L a z a r u s ' s  study's a  process-  o r i e n t e d framework, t h e r e s e a r c h e r examined t h e e d u c a t o r s ' a p p r a i s a l of each unique i n t e n t o f t h e e x a m i n a t i o n was themes and  experience.  the  i n f o r m a n t s as h a v i n g an i m p a c t  on t h e s i t u a t i o n .  addition,  i m m e d i a t e as w e l l  and  The  to i d e n t i f y recurrent  s i g n i f i c a n t v a r i a b l e s d e s c r i b e d by  coping responses  nurse  In as  long-term e f f e c t s of the experience are d i s c u s s e d .  C h a r a c t e r i s t i c s of the The  Informants  n i n e i n f o r m a n t s , a l l female, were  nurse  e d u c a t o r s employed i n diploma n u r s i n g programs i n the B r i t i s h Columbia  Lower M a i n l a n d .  The m a j o r i t y ( s i x )  w e r e 30 t o 39 y e a r s o l d .  Two  and  o v e r 50 y e a r s o f  one The  diverse.  i n d i c a t e d she was  w e r e 40-49 y e a r s o f  age  age.  i n f o r m a n t s ' e d u c a t i o n a l p r e p a r a t i o n was Two  h e l d master's  degrees,  one  i n n u r s i n g and  t h e o t h e r i n e d u c a t i o n , f o u r were c u r r e n t l y p u r s u i n g  s t u d i e s toward t h e MEd.  t h e MSN a n d one was c o m p l e t i n g w o r k f o r  One o f t h e i n f o r m a n t s h e l d a BScN a n d one a  BA d e g r e e .  A l l h a d one o r more y e a r s o f t e a c h i n g  experience w i t h three informants i n d i c a t i n g experience  teaching  i n t h e t h r e e t o s i x y e a r c a t e g o r y , and f i v e  r e p o r t i n g over t e n years of teaching experience. F i v e i n f o r m a n t s had been employed i n t h e i r c u r r e n t t e a c h i n g p o s i t i o n f o r one t o f i v e y e a r s a n d f o u r f o r over t e n years. one y e a r . semester ranged  No i n f o r m a n t h a d t a u g h t  f o r less  The number o f s t u d e n t s i n t h e f i n a l t o whom t h e y h a d a s s i g n e d f a i l i n g  f r o m one t o more t h a n s i x .  than  clinical  grades .  Three informants had  assigned f a i l i n g  grades  t o o n l y one s t u d e n t a n d two h a d  assigned f a i l i n g  grades  t o more t h a n s i x s t u d e n t s .  the time of a s s i g n i n g the f a i l i n g informants considered themselves  grades, novice  four of the clinical  i n s t r u c t o r s while the other f i v e considered experienced.  At  themselves  At the time of the i n t e r v i e w s , f i v e of  the i n f o r m a n t s were i n t h e p r o c e s s o f e v a l u a t i n g clinically  failing  students. Content  The  Analysis  content a n a l y s i s of the data revealed the  r e c u r r e n t themes o f s t r e s s ,  uncertainty, isolation,  and  l a c k of a d m i n i s t r a t i v e support. Stress The of having final The  p r e d o m i n a n t f e e l i n g e v o k e d by to assign a f a i l i n g  term of a diploma  the nurse educator  c a n be v i e w e d as a c i r c u l a r p r o c e s s  F o l k m a n , 1984) .  rational,  w h i c h may  S t r e s s f u l a p p r a i s a l s c a n be  & Folkman, 1984).  damage t h e p e r s o n has  Appraisal not  be  or d e l i b e r a t e (Lazarus  i n t o three c a t e g o r i e s : harm/loss, (Lazarus  t h r e a t , and  &  classified challenge  Harm/loss a p p r a i s a l s r e f e r  already sustained, threat  r e f e r s t o a n t i c i p a t e d harms o r l o s s e s , and  challenge  r e f e r s to events  of mastery  or  is  c o g n i t i v e a p p r a i s a l of  and what t h e y mean t o h e r w e l l - b e i n g .  e n t i r e l y conscious,  i n the  n u r s i n g program i s s t r e s s .  d e p e n d e n t upon t h e e d u c a t o r ' s  to  experience  grade to a student  d e g r e e o f s t r e s s p e r c e i v e d by  events  the  t h a t h o l d the p o s s i b i l i t y  gain. I t became e v i d e n t d u r i n g a n a l y s i s t h a t  informants  u s e d a v a r i e t y o f w o r d s and p h r a s e s t o d e s c r i b e Some o f them d e s c r i b e d t h e i r e x p e r i e n c e "difficult,"  "stressful,"  They e x p r e s s e d  their  "frustration,"  "distress,"  "scary," or  as  being  "worrisome."  f e e l i n g s i n terms of "shock,"  stress.  experiencing  "annoyance,"  "anger,"  o r "dread."  During the v a l i d a t i o n process,  i n f o r m a n t s c o n f i r m e d t h a t t h e s e t e r m s c o u l d be a c c u r a t e l y i n t e r p r e t e d as s t r e s s . p o r t i o n s of a t r a n s c r i p t was  The  following  i l l u s t r a t e how  this  concept  i d e n t i f i e d and d e p i c t s t h e p r o c e s s o f d a t a  used  i n this  study.  Throughout the t h e s i s ,  analysis  accounts  have undergone minor e d i t i n g t o d e l e t e d i s t r a c t o r s as  "um"  and  "eh"  i n o r d e r t o enhance  such  readability.  I n t h e f o l l o w i n g e x a m p l e , an i n f o r m a n t d e s c r i b e s b e i n g shocked R:  and  ... What was  assign this I:  anxious. the impact  failing  ...The i m p a c t  grade  on me  on y o u i n these  was  of having  to  circumstances?  t h a t I was  shocked  that  she w o u l d a c t u a l l y e v e n t h i n k a b o u t p u l l i n g i n somebody f r o m t h e o u t s i d e s u c h as a l a w y e r c o n t e s t my  decision.  s t a t e of shock One  and  So I t h i n k I was  to  really  in a  a f a i r amount o f a n x i e t y . . .  informant asserted that:  I : Out  o f e v e r y t h i n g I do  i n my  job I would  say  t h a t ' s p r o b a b l y t h e most s t r e s s f u l t h i n g I h a v e t o do. *R:  Researcher  * I:  Informant  She went on t o  say:  I: Well,  i f I t h i n k b a c k i n t e r m s o f t h e amount o f  t i m e and  energy  make s u r e t h i s  and a l l t h e c o n s c i o u s e f f o r t s t u d e n t has  a fair  chance I'd  t h a t i t ' s v e r y s t r e s s f u l . . . I t h i n k when going through  i t you  just  do  a u t o m a t i c a l l y because you I t ' s your  j o b t o do  i t .  the best p o s s i b l e t h i n g  i t .  You  to say  you're  just  do i t  know y o u h a v e t o do i t . And y o u ' r e  trying  f o r the student.  t h a t time i t i s s t r e s s f u l but you're  to So  do at  not  c o n s c i o u s l y aware of i t u n t i l  a f t e r w a r d s when i t ' s  all  say thank  o v e r and y o u  s i t down and  God...and  t h e n y o u move on. Some e x c e r p t s c o n t a i n e d a number o f t e r m s as t h e i n f o r m a n t s a t t e m p t e d feelings  generated  accounts,  were g e n e r a t e d The  informant  t o convey  by t h e e x p e r i e n c e ( s ) .  a number o f f e e l i n g s  "frustrated."  Informants  describe their  feelings  In  the their  were i d e n t i f i e d  i n the p e r s o n - s i t u a t i o n spoke of f e e l i n g  descriptive  "angry,"  that  interactions. "annoyed,"  used s i m i l a r words t o  although the sources  frustration  t h e y i d e n t i f i e d may  different.  While  of  h a v e b e e n somewhat  the m a j o r i t y of  informants  and  experienced  frustration,  annoyance.  The e x c e r p t b e l o w t a k e n  i n t e r v i e w attempts feelings.  not a l l experienced anger o r from a  second  to v a l i d a t e the informant's  This informant describes m u l t i p l e sources of  frustration. R: Some i n f o r m a n t s s a i d t h a t t h e y feelings of frustration, during t h i s process.  experienced  annoyance, and anger  D i d you experience  those  feelings? I : I was f r u s t r a t e d i n h e r l a c k o f r e s p o n s e t o what seemed t o me r e a l l y m a j o r d e f i c i t s a n d f r u s t r a t e d i n t e r m s o f what seemed t o me, a f t e r a couple of attempts  a t r e m e d i a t i o n , no e v i d e n c e o f  p r o g r e s s . . . m a y b e t h a t was b e y o n d h e r a b i l i t y , d o n ' t know.  B u t t h a t was f r u s t r a t i n g  w o u l d n ' t s a y I was e v e r a n g r y , t o h e r i n terms o f wanting and  f o r me.  I I  my h e a r t went o u t  h e r t o be s u c c e s s f u l ,  so I c e r t a i n l y wasn't angry w i t h t h a t ,  I was  f r u s t r a t e d t o some d e g r e e a s w e l l a s w i t h t h e s t a f f who seemed t o be v e r y s u p p o r t i v e o f h e r skill  ability  i n t h a t i t was a t a much l o w e r  t h a t what i t s h o u l d h a v e b e e n f o r a nurse.  graduate  level  R:  And  I : No, just R:  annoyance? I can't say I f e l t  a n n o y e d , I t h i n k i t was  an e l e m e n t o f f r u s t r a t i o n  Throughout the t r a n s c r i p t ,  r e c u r r i n g was stressful  t h a t t h i s was  experience.  from time t o time. t h e theme t h a t k e p t  a  particularly  Can y o u  i d e n t i f y what  the  p r i m a r y s o u r c e o f s t r e s s was? I: I t h i n k perhaps had not had particular certainly  the concern  that the  student  s u f f i c i e n t preparation to reach level,  because the behaviour  this  was  i n c o n g r u e n t w i t h what I w o u l d c o n s i d e r  w o u l d be e x p e c t e d I t h i n k t h a t was  for earlier levels the g r e a t e s t  as w e l l ,  and  frustration....  Uncertainty U n c e r t a i n t y c a n be c o n c e p t u a l i z e d as t h e  self-  d o u b t e x p e r i e n c e d by t h e n u r s e e d u c a t o r as t o w h e t h e r "she was  doing the r i g h t  thing."  an e l e m e n t o f s e l f - e v a l u a t i o n and p r o c e s s e s and The  literature  s t r a t e g i e s used  Uncertainty includes reflection  about  the  to evaluate the student.  supports the informants' perceptions  that the c l i n i c a l  e v a l u a t i o n process c r e a t e s doubts  t h e m i n d s o f n u r s e e d u c a t o r s as w e l l as an  in  awareness  t h a t o p i n i o n s as t o w h e t h e r t h e y h a v e "done t h e  right  thing"  may v a r y among c o l l e a g u e s a n d a g e n c y  (Brozenec, M a r s h a l l ,  staff  Thomas, & W a l s h , 1987; C a r p e n i t o ,  1983). The  following  quote  expresses a novice  nurse  educator's perception: I : To be c e r t a i n , certain you're  t o be c e r t a i n .  I don't  anyone c a n e v e r r e a l l y be.  know how  A n d when  r e s p o n s i b l e f o r someone's f u t u r e o r t h e  p a t i e n t ' s w h o e v e r t h e y may b e . . . p e r h a p s  their  l i v e s t h e n , i f y o u have t h i s k i n d o f responsibility  then i t ' s a l o t of weighing.  Am I b e i n g f a i r ?  Am I d o i n g t h e r i g h t  thing?  So  f o r me I h a d t o go t h r o u g h o t h e r p e o p l e t o t r y a n d validate.  T h i s i s what I s e e , t h i s  documented, t h i s  i s what I  R: A n d t h i s was y o u r a student at that  first  i s what I ' v e  feel. experience with  failing  level?  I: Yes. I:...I  don't  know i f i t ' s e x p e r i e n c e t h a t g e t s y o u  t o a p o i n t where y o u t r u s t  t h e t h i n g t h a t says t o  you, you've got d a t a , you've got e x p e r i e n c e , you've seen  this before.  Or do y o u go t h r o u g h t h e  p e r i o d where y o u say everybody  i s an  individual  and  I have t o l o o k a t t h i s  o f c o u r s e I'm anyway and  independently?  d o i n g anyway, w h i c h p e o p l e a r e  i s t h e r e more t o t h i s ,  have a l l the i n f o r m a t i o n ?  and do I  s o m e t i m e s when I'm  p e o p l e who appears doubts  are seasoned  I:  comparing  but  myself against  they absolutely i t ' s  T h i s p e r s o n c a n ' t do i t .  And  I get t o t h a t p o i n t ?  experienced nurse educator  disclosed  thoughts: . . . I t h i n k t h e r e i s always  d o u b t s . Am  the r i g h t d e c i s i o n ? I s t h e r e something missed?  Am  negatives? Am  i t wasn't  t e a c h e r s t h e n I am i t  i n t h e i r m i n d s and  I think, well, w i l l  similar  really  t h r o u g h c o n v e r s a t i o n t h a t t h e r e i s no  v e r y c u t and d r i e d .  An  doing  So I w i s h t h a t i t c o u l d  be j u s t as c u t and d r i e d as i t was, and  Which  I f o c u s i n g on more o f t h e Do  I have a b i a s towards  I making  t h a t I have student's  the  student?  I g i v i n g them t h e b e s t o p p o r t u n i t y t o  demonstrate  t h a t t h e y c a n meet t h e o b j e c t i v e s ?  * B o l d t y p e = E m p h a s i s by t h e  informant  Another informant v a l i d a t e d her thoughts w i t h the researcher  on a s e c o n d i n t e r v i e w when a s k e d  this  question: R: When y o u i s s u e d t h e f a i l i n g that  grade you mentioned  i t was h a r d b u t y o u w e r e p r e t t y c e r t a i n  that  i t was t h e r i g h t t h i n g t o d o . I:  That's true  ...it's  [pause] b e c a u s e a s I s a i d  a b a l a n c e t h i n g f o r me a n d a t one p o i n t  are  the scales tipped to the other  had  said earlier,  too, that  s m a l l measure o f doubt. there  earlier  side?  And I  I l i k e the notion of  I n any d e c i s i o n , I t h i n k  always i s a s m a l l measure o f doubt because  they're  difficult  decisions  g u e s s i n g y o u r s e l f ... t h e r e ' s You q u e s t i o n  yourself  R: So i t c r e a t e s  and y o u ' r e  second  a l w a y s some d o u b t .  constantly...  an e l e m e n t o f u n c e r t a i n t y ?  I: Yes. Some i n f o r m a n t s i n d i c a t e d t h e y r e - e v a l u a t e d findings again  and a g a i n .  Others dialogued  t h e m s e l v e s a b o u t how t h e y f e l t I:  A l o t of dialogue  I really the  their  with  toward the student.  w i t h m y s e l f a b o u t how do  f e e l about t h i s person.  i d e a t h a t am I b e i n g  fair  And always  t o her?  Am I  with  p i c k i n g on h e r more? F e e l i n g s of u n c e r t a i n t y a l s o arose from perceptions criteria  among a g e n c y s t a f f a n d c o l l e a g u e s  on w h i c h t h e y w e r e b a s i n g  During the v a l i d a t i o n process, that d i f f e r i n g perceptions  their  she  confirmed  related to c l i n i c a l and s t a f f  a g e n c y made h e r e x a m i n e t h e c r i t e r i a  based h e r judgements.  t h i s experience abilities  as t o t h e  judgements.  one i n f o r m a n t  e v a l u a t i o n , both from h e r c o l l e a g u e s clinical  differing  The i n f o r m a n t  i n the on w h i c h  indicated that  c a u s e d h e r a t t i m e s t o d o u b t h e r own  and added t o h e r f e e l i n g s o f u n c e r t a i n t y .  Some i n f o r m a n t s  termed t h i s apparent d i f f e r e n c e i n  standards  " i n c o n s i s t e n c y , " and a t t r i b u t e d t h e s e  perceived  d i f f e r e n c e s t o f a c u l t y having  philosophies  of teaching  differences also created  varying  and e v a l u a t i o n . self-doubt  These  and u n c e r t a i n t y .  I : . . . Y o u c a n j u s t p i n p o i n t p e o p l e who y o u know i f a student you  i s unsafe, o r i s not meeting o b j e c t i v e s  know t h e f a c u l t y w i l l  on...  not l e tthe student  a n d on t h e o t h e r h a n d y o u know t h a t  f a c u l t y who w i l l  do n o t h i n g  go  there's  about i t .  R: A n d how d o e s t h a t make y o u f e e l ? I: Well  that divides your c o l l e a g u e s .  Divides you  i n t o two  camps.  A n o t h e r i n f o r m a n t e x p r e s s e d c o n c e r n a b o u t how m i g h t be  v i e w e d by  describes  her  I : I'm  colleagues.  The  following  a l w a y s c o n c e r n e d a b o u t what my abilities.  And  philosophy  those kinds  of t h i n g s .  and  I n t e r e s t e d and  concerned t h a t  colleagues.  pass i n  And  o f what i s a t s t a k e , and  or should  aids be  my  I be v i e w e d w e l l  to nurse educators'  nurse educators i n t h i s  f a i l i n g grade.  This  lack? evaluations well-  what, i f a n y t h i n g ,  & Folkman, 1984b).  created  an  or not  element of  can  The  s t u d y were a c u t e l y aware o f  p o t e n t i a l r a m i f i c a t i o n s of a s s i g n i n g  by  don't  i t s significance for their  (Lazarus  my  I'm  s o m e t i m e s when s t u d e n t s  i n determining  done  colleagues  a p p r o a c h and  [ t h e f i n a l s e m e s t e r ] i s i t my  Appraisal contributes  being,  excerpt  uncertainty:  t h i n k a b o u t my  my  she  the  assigning  a  uncertainty  t h a t a f f e c t e d t h e i r a b i l i t y t o make a d e c i s i o n e v e n i n l i g h t of overwhelming evidence that a f a i l i n g grade.  The  j u s t i f i e d assigning  n a r r a t i v e below i l l u s t r a t e s t h i s  viewpoint. I:...upon r e f l e c t i o n , decision.  The  t h i s was  d e c i s i o n was  a  clear-cut  self-evident.  The  u n c e r t a i n t y o f how t h e d e c i s i o n w i l l the  impact of the d e c i s i o n f o r t h a t  i n c l u d i n g myself,  information  through with the d e c i s i o n . . .  s i t u a t i o n s a r e ambiguous  i s often missing,  may be u n c l e a r .  individual,  i s one t h a t m i g h t make one  h e s i t a t e about going Most s t r e s s f u l  be r e c e i v e d ,  or that which i s present  Ambiguity can i t s e l f  s t r e s s and u n c e r t a i n t y  since  (Lazarus  be a s o u r c e o f  & Folkman, 1984b). I n  an a m b i g u o u s e n v i r o n m e n t , a p p r a i s a l o f s i t u a t i o n s becomes more d i f f i c u l t .  The g r e a t e r  the ambiguity,  the  more i n f l u e n c e v a r i a b l e s s u c h a s t h e i n d i v i d u a l ' s personal  values,  determining (Lazarus  b e l i e f s and e x p e r i e n c e s  have i n  t h e meaning o f t h e s i t u a t i o n a l v a r i a b l e s  & Folkman,  1984b).  Isolation I s o l a t i o n describes the perceptions e x p r e s s e d about u l t i m a t e l y b e i n g  nurse educators  solely responsible f o r  t h e d e c i s i o n s t h e y f o u n d n e c e s s a r y t o make.  This  included  Informants  described setting,  an element o f p h y s i c a l i s o l a t i o n . at  times  distanced  feeling  from c o l l e a g u e s  the performance expectations as a s o u r c e o f  isolated  support.  i n the  who c o u l d  of the l e v e l ,  theme  clinical  understand  and thus a c t  •  -  43  Often  they  indicated  they  felt  unsupported  in  c a r r y i n g o u t t h e i r r o l e by c o l l e a g u e s and a d m i n i s t r a t o r s . Informants  identified  differing  philosophies  Because  of  they  their  of  c o l l e a g u e s o f t e n had  teaching  could  and  not always  evaluation. sure  that  c o l l e a g u e s would agree and support t h e i r d e c i s i o n .  And,  finally,  this  that  e v e n when s u p p o r t e d ,  be  some n u r s e e d u c a t o r s  a degree o f i s o l a t i o n because i n the f i n a l really  w e r e on t h e i r  describe these I:  own.  analysis  The n a r r a t i v e s  that  felt they  follow  feelings:  I t was my d e c i s i o n a n d m i n e a l o n e . T h a t a d d e d t o  my s t r e s s b e c a u s e a g a i n I was n o t c o m f o r t a b l e b e i n g solely responsible f o rthis  decision.  T h i s i n f o r m a n t i n d i c a t e d she " f e l t in  l i k e t h e o d d man o u t  the scenario." I:  . . . I would say that,  surrounded  by  people  even t h o u g h I c o u l d be who  had  been  previously  s u p p o r t i v e i n my r o l e a s an e d u c a t o r i n g e n e r a l , I f o u n d m y s e l f w i t h p e o p l e a r o u n d me, who h a d d e c i d e d to  take the p o s i t i o n  t o side w i t h the Student,  so  t h a t d i d add t o t h e f e e l i n g o f i s o l a t i o n . One i n f o r m a n t who was a n o v i c e r e p o r t e d f e e l i n g s u p p o r t e d b u t r e c o g n i z e d t h e r e w e r e t i m e s when, i n f a c t .  she d i d f e e l I:  alone.  And d i d I f e e l  felt  fairly  alone?  Surprisingly,  I guess I  w e l l - s u p p o r t e d by t h e people  here but  when i t g o t r i g h t down t o i t , i t was j u s t h e r a n d I ...so  i t i s you're  v e r y much o n y o u r  own t h e n .  An e x p e r i e n c e d n u r s e e d u c a t o r e x p r e s s e d s i m i l a r v i e w s i n t h i s way: I:  ...You d o n ' t h a v e a l o t o f c o n t a c t w i t h  c o l l e a g u e s . . .but  i tr e a l l y  does  your  come down t o y o u  c a u s e you're t h e one t h a t ' s t h e r e i n t h e c l i n i c a l area.  You're t h e one t h a t ' s s e e i n g  performance. semester  Even  i f y o u have  the student's  a partner  i n the  s h e ' s o n l y h e a r i n g your s i d e o f t h e  story.  Lack o f A d m i n i s t r a t i v e Support The  informants  indicated that administrative  s u p p o r t was l a c k i n g i n two m a j o r a r e a s : a) c o n s i s t e n t a d m i n i s t r a t i o n o f e d u c a t i o n a l p o l i c i e s , and b) a c k n o w l e d g e m e n t o f t h e s i t u a t i o n a n d r e a s s u r a n c e . Some i n f o r m a n t s c i t e d support. I: let  One i n f o r m a n t  "the system"  for lack of  reported:  . . . I g u e s s i t ' s y o u f e e l t h a t t h e system had you down o r l e t you and t h e student down. A n d  then the system  doesn't  o f f e r you thesupport.  Or  it's  so d i f f i c u l t  you  to f a i l  down up u n t i l  l e t t i n g you you  a student... they've l e t  t h a t p o i n t and now  they're  down y e t a g a i n b e c a u s e t h e y a r e m a k i n g  jump t h r o u g h h u r d l e s i n o r d e r t o f a i l  this  student. R:  When y o u  say the system  mean by t h a t ? I:  .  students  f r o m one  informant expressed  Our  semester  way  Nobody has  to the  ever s a i d that the appeals  is  s u p p o r t i v e to the i n s t r u c t o r s  exposure to them g a v e me t h e y had  of next.  similar ideas.  I:  thought  you  >  I guess our e v a l u a t i o n system.  promoting Another  ,  e x a c t l y what do  committee  [laugh]....My  the f e e l i n g that  they  e x p e r t i s e where t h e y r e a l l y d i d  not have i t . In  addition,  resulting  informants described  f r o m t h e i r m u l t i f a c e t e d and  a m b i g u o u s r o l e s as n u r s e were charged  educators.  conflicts somewhat  On  one  hand,  they  w i t h the r e s p o n s i b i l i t y of making a  p r o f e s s i o n a l judgement about t h e a b i l i t i e s s t u d e n t , and y e t , a t t h e same t i m e , many o f informants p e r c e i v e d a l a c k of support  of  the  the  from  a d m i n i s t r a t o r s r e g a r d i n g t h e i r judgements.  In  these  situations,  the nurse  educators'  v a l u e s and b e l i e f s  seemed t o c o n f l i c t w i t h a d m i n i s t r a t i v e d i r e c t i v e s , c r e a t i n g f e e l i n g s o f v u l n e r a b i l i t y and t h r e a t . f o l l o w i n g e x c e r p t s summarize t h e s e  The  findings:  I : And s o y o u w e r e d e a l i n g w i t h a l o t o f d i f f e r e n t issues w i t h her. an  But a g a i n i n t h a t s i t u a t i o n as  i n s t r u c t o r you didn't f e e l  what I was t o l d was t h a t t h i s  supported,  because  s t u d e n t had t o p a s s .  R: How d i d t h a t make y o u f e e l ? I:  [ l a u g h s ] W e l l , again from a p r o f e s s i o n a l  p e r s p e c t i v e y o u j u s t c o u l d n ' t do i t i n a l l conscience.  I c o u l d n ' t , t h i s woman c o u l d n ' t  p r a c t i c e as a s a f e nurse s o y o u h a d t o a g a i n a c c u m u l a t e t h i s d a t a a n d i t seemed l i k e no  matter  what how much d a t a y o u c o l l e c t e d t h e y w o u l d g i v e her another This informant  chance.  went on t o s a y :  I : I t was c l e a r l y  said.  I t was. I w o u l d l o s e my  job i f I d i d not pass h e r [ l a u g h s ] . R: A n d was t h i s a t t h e team l e v e l , a higher  o r was t h i s a t  level?  I : I t was a h i g h e r l e v e l . of t h e type o f program.  I t h i n k i t was b e c a u s e I t was d i f f e r e n t  from a  r e g u l a r c o l l e g e p r o g r a m i n t h a t i t was f u n d e d , t h e first  pilot project....  In c o n t r a s t , o t h e r i n f o r m a n t s had never been d i r e c t l y c o n f r o n t e d t o change t h e i r assessment o r threatened with losing t h e i r jobs. have thought  They may, h o w e v e r ,  about i t as i l l u s t r a t e d  i n this  next  quote. R: Some o f t h e i n f o r m a n t s  t h a t I have spoken t o  have s a i d t h a t t h e r e have been s u b t l e i n d i c a t o r s t o t h e f a c u l t y member t o p a s s t h e s t u d e n t a n d o t h e r i n f o r m a n t s have s a i d t h e r e have been d i r e c t i v e s t o them t o p a s s t h e s t u d e n t j o b was o n t h e l i n e . of those I:  or their  Have y o u e x p e r i e n c e d  either  situations?  ( S i g h ) No, I h a v e n o t .  I mean,  certainly  d i r e c t o r s h a v e a t t i m e s a s k e d me why I h a v e t o fail  them a n d (pause) b u t I n e v e r g o t t h e f e e l i n g  t h a t t h e y w o u l d s a y t h a t my j o b was i n j e o p a r d y . I t h i n k I m e n t a l l y thought These e x c e r p t s i l l u s t r a t e educators  felt  under s c r u t i n y .  that. that these  nurse  t h a t t h e i r p r o f e s s i o n a l j u d g e m e n t came They d e s c r i b e d f e e l i n g  t h r e a t e n e d and cross-examined.  pressured,  They d e s c r i b e d  having  '  48  t o jump t h r o u g h h u r d l e s . One i n f o r m a n t I  disclosed:  ...And y e t s h e came b a c k , a h a l f a y e a r o r a  year  l a t e r w i t h another  successful.  t e a c h e r a n d was v e r y  A n d t h a t was a n o t h e r v e r y  interesting  e x p e r i e n c e b e c a u s e I h a d no c o n t a c t w i t h h e r d u r i n g t h a t t i m e b u t I c e r t a i n l y made a note of h e r progress.  mental  And I wasn't s u r e a t t h a t  t i m e who was b e i n g e v a l u a t e d more.  W h e t h e r i t was  I i n f a c t who was b e i n g e v a l u a t e d i n t e r m s o f w h e t h e r I i n f a c t h a d made t h e b e s t j u d g e m e n t a t that time.  So a g a i n I r e l i v e t h e e x p e r i e n c e a n d  r e l i v e i t many t i m e s . those competencies  Going  b a c k t o what w e r e  t h a t were so i m p o r t a n t a t t h a t  t i m e a n d I w o u l d make t h e same d e c i s i o n One i n f o r m a n t  felt  today.  s o s u r e t h a t h e r a s s e s s m e n t was  a c c u r a t e t h a t she s t a t e d : I : I ' d be w i l l i n g for that.  t o p u t my l i c e n s e o n t h e l i n e  B u t a t t h e t i m e , when t h e p r o c e s s i s  o c c u r r i n g , you're  made t o f e e l  l i k e you're not  f u n c t i o n i n g a s a c o m p e t e n t number one n u r s e , number two e d u c a t o r . Finally,  responses  f r o m two i n f o r m a n t s d e s c r i b e d a  n e e d t o be a c k n o w l e d g e d f o r h a v i n g done a g o o d j o b i n difficult  circumstances.  r e c o g n i t i o n was one  Both informants  lacking.  informant attempted  A t one t o use  felt  p o i n t i n the i n t e r v i e w  rationalization  i n d i c a t e t h a t p r o f e s s i o n a l s s h o u l d n ' t need I:  ...So  t h e r e ' s no  support,  commendation t o say t h a t you t h e r e ' s no  internal  t h e r e w o u l d be any  this  there's  support. no  d i d a good j o b .  I:  ...So  support  f o r me  as an  individual was  [sounds a n g r y ] .  a g a i n i t ' s t h a t admin, support and  g u e s s t h a t ' s w h e r e one  And  t h a t t h e y ' r e on y o u r  as them a g a i n s t t h e s t u d e n t that they understand are going In  the second  and  side.  behind  Not  so much  s o r t of t h i n g .  e m p a t h i z e w i t h what  But you  through. interview, this  informant  on t h i s p e r c e i v e d n e e d f o r s u p p o r t . I : . . t h e s t u d e n t has realized,  I  of the f a c t o r s f o r s t r e s s  comes i n . . . y o u n e e d t o f e e l t h a t t h e y ' r e you.  So  s u p p o r t . . . I don't b e l i e v e t h a t  f a c u l t y member t o s a y t h a t I d i d what I s u p p o s e d t o do  to  hey,  then I thought,  the support.  where i s my  e l a b o r a t e d more  She I  said: quickly  support system!  But  no, y o u ' v e g o t t o k e e p a h a n d l e  on  things. R: Why  d i d you  need support  o r f e e l you  needed  support? I: W e l l , because i t ' s always  n i c e t o h a v e someone  t o l e a n on when y o u ' r e  being attacked...when  professional a b i l i t i e s  are questioned.  mean they were b e i n g q u e s t i o n e d  ...I  And  your they I  couldn't  believe i t . V a r i a b l e s That I n f l u e n c e A p p r a i s a l s Lazarus's  {1984b) d e f i n i t i o n o f s t r e s s  the r e l a t i o n s h i p between the p e r s o n and how  and  the  an i n d i v i d u a l c o g n i t i v e l y a p p r a i s e s  T h u s , i n f o r m a n t s s u c h as t h o s e  in this  environment events.  study,  e x p e r i e n c e s t r e s s t o some d e g r e e b u t d i f f e r t h e i r r e a c t i o n t o and  emphasizes  may  somewhat i n  i n t e r p r e t a t i o n of c e r t a i n  According to a l l informants, having to issue a grade to a student diploma  i n the f i n a l  n u r s i n g p r o g r a m was  clinical  a stressful,  events. failing  semester  of  a  individualized  experience. C o g n i t i v e a p p r a i s a l s are not  s t a t i c processes  and  c a n be a l t e r e d by c h a n g e s i n p e r s o n / s i t u a t i o n a l v a r i a b l e s which  are i n a c o n t i n u a l s t a t e of f l u x .  v a r i a b l e s i n t r o d u c e an e l e m e n t o f u n c e r t a i n t y i n t o  The the  nurse  educator's  a p p r a i s a l o f t h e s i t u a t i o n and can i n  and o f t h e m s e l v e s which  be a s o u r c e o f s t r e s s .  i n f l u e n c e t h e a p p r a i s a l o f t h e s i t u a t i o n c a n be  grouped under t h e c a t e g o r i e s of nurse s t u d e n t , and Nurse  Variables  educator,  environment.  Educator Influencing variables include the l i f e  commitment, v a l u e s , b e l i e f s , i n d i v i d u a l nurse These v a r i a b l e s  h e a l t h , and energy  t h a t an  educator brings i n t o the s i t u a t i o n . i n f l u e n c e t h e way a n u r s e  i n t e r p r e t s events and  experience,  a n d h a v e an i m p a c t  coping s t r a t e g i e s nurse  educator  on t h e r e s o u r c e s  e d u c a t o r s may h a v e  a v a i l a b l e t o them. L i f e experience.  Four  study considered themselves  of the informants i n t h i s t o be n o v i c e  i n s t r u c t o r s w h i l e the other f i v e viewed experienced.  clinical themselves  Some i n f o r m a n t s , w h i l e n o t n o v i c e  e d u c a t o r s , w e r e new t o t e a c h i n g i n t h e f i n a l term.  clinical  These i n f o r m a n t s i d e n t i f i e d a s p e c t s o f t h e i r  performance which refinement.  as  they f e l t  required further  I t became a p p a r e n t  during the analyses  that the informants perceived the experience of assigning a f a i l i n g  g r a d e d i f f e r e n t l y when t h e y h a d  p r e v i o u s e x p e r i e n c e i n d o i n g so.  Although  a p p r a i s e d the event  i t seemed t o be  as s t r e s s f u l ,  they  so b e c a u s e o f t h e c o p i n g s t r a t e g i e s d e v e l o p e d previous experience. s u p p o r t . One  Novice  informant  her being a novice educator clinical I:  t e r m o f a new I was  less  from  informants tended  r e c a l l e d what i t was  still  t o seek  like  t e a c h i n g i n the  the  for  final  program.  a r o o k i e t e a c h e r and my  e x p e r t i s e was  measured y e t . . . . I wasn't sure w i t h the  not  students.  B e i n g a r o o k i e i n s t r u c t o r made i t very, v e r y difficult. Novice  i n f o r m a n t s d i s c l o s e d t h a t they sought  out  others : I:  . . . . I d i d a l o t of t a l k i n g .  I t h i n k the  t i m e a r o u n d I d i d n ' t want t o a p p e a r l i k e  I wasn't  s u r e what I was  g o i n g t o do.  to  This time around I t a l k e d to  one  person.  And  first  so I o n l y  talked the  w h o l e team. One  i n f o r m a n t , a l t h o u g h not a n o v i c e educator,  t e a c h i n g i n the f i n a l t i m e and  clinical  semester  r e p o r t e d r e c e i v i n g feedback  f o r the  about  first  her  documentation. I:  . . . I r e a l l y d i d n ' t have a l o t of  was  * clinical  documentation. to the  And  fact that  I think again  I was  new  t h a t goes back  to teaching  this  level.... The  informants emphasized the  experience.  importance  of  They s p o k e o f h o n i n g t h e i r s k i l l s  and  b u i l d i n g r e p e r t o i r e s of s k i l l s t o enhance t h e i r to teach  and  illustrate R:  evaluate.  The  t h i s coping  ...what h e l p s  cope w i t h  the  f o l l o w i n g two  ability  excerpts  strategy. you  deal w i t h the  feelings  or  f e e l i n g s that a r i s e i n these  s i t u a t i o n s that you've t a l k e d about?  Being  shocked? I:  . . . b a s i c a l l y j u s t t a l k i n g with other  what w o u l d y o u and  that  s o r t of t h i n g .  And  I guess j u s t l e a r n i n g  [helped].  And  I  c e r t a i n l y repeated experiences w i t h i n  semester  I did  clinical  s e m e s t e r ] and  f o c u s i n on  and  h a v e done i n a s i m i l a r s i t u a t i o n  that b e t t e r documentation that  people  think the  [numerous] y e a r s i n [ t h e I t h i n k t h a t my  final  ability  the problem student c e r t a i n l y  to  was  honed t o a f i n e p o i n t . I: Well,  I constantly  when I'm  confronted  t h i n k of t h o s e s i t u a t i o n s  with another student that  has  a s i m i l a r problem...if patterns I'll  they have s i m i l a r l i t t l e  t h e n . . . I ' 1 1 t r y them w i t h t h i s one a n d  t r y some o t h e r s . . . b u i l d i n g up y o u r r e p e r t o i r e  of s k i l l s  t h a t y o u p u l l o u t t o t r y and h e l p  this  student.... Commitment. commitment  L a z a r u s a n d F o l k m a n (1984b)  describe  as t h a t w h i c h i s i m p o r t a n t and has meaning  t o an i n d i v i d u a l .  Commitments  i n f l u e n c e an  i n d i v i d u a l ' s a p p r a i s a l of a s i t u a t i o n .  Individuals'  commitments r e f l e c t  t h e i r goals  choices  L a z a r u s and Folkman p o s t u l a t e  t h e y make.  and i n f l u e n c e t h e that  commitments i n f l u e n c e a p p r a i s a l s i n two m a j o r w a y s . First,  the greater  potential  or challenging.  vulnerability,  the  as  S e c o n d , commitment  and v u l n e r a b i l i t y  creates  can a c t as a  force that d i r e c t s a person toward a course  of a c t i o n that coping  the greater  f o r a n e n c o u n t e r t o be a p p r a i s e d  threatening  motivating  t h e commitment  can reduce t h r e a t and h e l p  to sustain  e f f o r t s i n the face of s t r e s s o r s .  The i n f o r m a n t s i n t h i s t h e i r commitment  to passing  s t u d y were unanimous i n only  those students  c o u l d meet t h e s e m e s t e r o b j e c t i v e s . expressed t h e i r  The  who  informants  f e e l i n g s o f c o n c e r n and c a r i n g f o r t h e  s t u d e n t who  was  unable  l e v e l of performance.  t o d e m o n s t r a t e an  acceptable  They s p o k e o f f e e l i n g g u i l t y  and  s a d f o r t h e s t u d e n t w h i l e a t t h e same t i m e r e c o g n i z i n g t h e r e was at  no d o u b t t h a t t h e s t u d e n t was  the expected  level.  not f u n c t i o n i n g  However, r e g a r d l e s s o f  f e e l i n g s , n o v i c e and  experienced nurse  r e s p o n s i b l e f o r , and  committed t o , g r a d u a t i n g  who  had  the necessary  and  safely.  skills  their  educators  students  to f u n c t i o n competently  Faced w i t h a v a r i e t y of s t r e s s o r s ,  informants u t i l i z e d  felt  the  a number o f c o p i n g s t r a t e g i e s  to  achieve t h e i r goal. One  novice informant  expressed her thoughts  in  t h i s way : I:  . . . i n i t i a l l y t o be a b l e t o t e l l a s t u d e n t  t h e y ' r e not meeting makes me  feel  the o b j e c t i v e s .  somewhat g u i l t y .  G u i l t y because I f e e l  sooner.  a l t e r n a t i v e way  The  Somewhat  sad.  I s h o u l d have p i c k e d  I s h o u l d have found  up  some c r e a t i v e  t o h e l p them g e t t o t h e p l a c e  where t h e y needed t o be. I  Initially i t  responsible that I should  h a v e done more f o r them. on t h i s  that  feel very relieved  i n f o r m a n t went on t o  And,  [laughs]. say:  t h e n a t some p o i n t  I:  . . . So I f e l t  breaks  a little  as I f e l t  s a d b e c a u s e a s many-  I had given t h i s person,  c o u l d n ' t g i v e them a break f o r t h i s . . . i t really absolutely clear  I just was  t h a t she c o u l d not  c o n c e n t r a t e on the s i m p l e s t o f procedures... a b s o l u t e l y . . . i f I was t o l e t h e r go through  thinking that s h e ' l l get i t together I  couldn't I couldn't sleep with the idea.  I  couldn't l i v e with the idea.... Similarly,  an e x p e r i e n c e d  i n f o r m a n t d e s c r i b e d how s h e  felt: I :...she c e r t a i n l y couldn't  fault  this  had t h e theory background.  You  student theory-wise ata l l .  I t ' s j u s t t h a t she c o u l d n ' t s h e was a l l thiombs i n the c l i n i c a l  area..and  I really  felt  sorryf o r  t h i s wonderful p e r s o n was g o i n g t o h a v e t o f a i l . But  t h e b o t t o m l i n e was t h a t t h e r e ' s no way t h a t I  could pass t h i s  student and put h e r f o r t h  as a  r e p r e s e n t a t i v e o f o u r program out onto t h e u n s u s p e c t i n g p u b l i c as a nurse o r even t o t h e unsuspecting nursing people  t h a t s h e was g o i n g t o  have t o work w i t h . Values  and b e l i e f s .  A p p r a i s a l s a r e always  made  w i t h i n the context of the encounter  a n d d e p e n d upon t h e  informant making a s e r i e s of r e a l i s t i c the s i t u a t i o n and i t s impact  judgements about  on t h e i r w e l l - b e i n g .  V u l n e r a b i l i t y a n d o n e ' s commitments a n d v a l u e s go h a n d i n hand.  The more a p e r s o n  c a r e s , t h e more s t r o n g l y  one h o l d s t o h i s / h e r v a l u e s , a n d t h e more v u l n e r a b l e he or  she i s t o a p a r t i c u l a r t h r e a t ( L a z a r u s & Folkman,  1984b).  T h u s , an i n d i v i d u a l ' s v a l u e s a n d  commitments  can c r e a t e a m b i g u i t y and f e e l i n g s o f v u l n e r a b i l i t y result  that  i n s i t u a t i o n s b e i n g p e r c e i v e d as t h r e a t e n i n g .  Descriptions i n the l i t e r a t u r e depict the r e s p o n s i b i l i t i e s and r o l e c o n f l i c t s nurse  educator's  O'Connor,  role  and  ( B a t e y , 1969; K r a m e r ,  1978; W i l l i a m s o n , 1 9 7 2 ) .  have p o s t u l a t e d t h a t ,  experience s t r e s s , burnout  Craigie,  1970;  Numerous  authors  as a r e s u l t o f t h e i r m u l t i f a c e t e d  somewhat a m b i g u o u s r o l e s ,  satisfaction  inherent i n the  (Fain,1987;  nurse  educators  may  and d i m i n i s h e d j o b  O'Connor,1978 ; M a r r i n e r &  1977; S c h u l e r , 1975; S c h u l e r , A l d a g & B r i e f ,  1977; Wood, 1971) . The e x c e r p t s b e l o w i l l u s t r a t e the nurse  educator  role,  informants experienced.  the complexity of  and t h e c o n f l i c t s These c o n f l i c t s  some o f t h e  primarily  r e l a t e d to the educators' perceptions of a lack of a d m i n i s t r a t i v e support and  the nurse  graduate  f o rtheir professional  judgement  e d u c a t o r s ' v a l u e s a n d commitments t o  o n l y competent n u r s e s .  R: A n d how d o e s t h a t make y o u f e e l ? be p a r t i c u l a r l y what y o u d o ? "  ["to h a v e t o  c a u t i o u s and v e r y , s t r i n g e n t i n To make s u r e y o u g i v e them  every  o p p o r t u n i t y t o d e m o n s t r a t e t h e y c a n make t h e objectives"]? I:  Personally i t calls  i n t o q u e s t i o n my  p r o f e s s i o n a l judgement.  I have been h i r e d as t h e  e d u c a t o r a n d i f I h a v e t o go i n t o s u c h l o n g out d i s c u s s i o n s and r a t i o n a l i z e t o j u s t i f y  drawn my  p r o f e s s i o n a l d e c i s i o n then t h a t has an impact me i n t e r m s o f my a b i l i t y  t o make t h i s  Another informant described being l a b e l l e d t e a c h e r who f a i l s  on  decision. "as a  students:"  R: A n d how d o e s t h a t make y o u f e e l ?  You s a i d  e a r l i e r a b o u t b e i n g l a b e l l e d a s a t e a c h e r who fails  s t u d e n t s o r who w o r k s w i t h s t u d e n t s a n d t h e n  makes t h e d e c i s i o n t h a t t h e s t u d e n t c a n ' t I:  W e l l , my p r o f e s s i o n a l c o n s c i e n c e  t h i n k I w o u l d be more u p s e t  pass.  i s clear.  I  i f I had l e t a student  . continue was  not  on o r g r a d u a t e who  energy.  The  way  the s i t u a t i o n . these  events  It  they assessed  this  One  resource.  informant  coping  h e a l t h y , one stressful All  efforts.  to deal  just with  informants'  energy. t h a t h e a l t h and  I f one  i s energized  t a l k e d about e x p e r i e n c i n g a while working  energy and  One  informant  i n h e r v i e w as t o w h e t h e r she e x c e s s i v e l y more b u t  significant  w i t h the student  d i f f i c u l t i e s p r o g r e s s i n g to the  l e v e l of performance.  T h o s e who  of which  events.  informants  having  This, i n  i s b e t t e r a b l e t o c o p e w i t h t h e demands o f  increase i n workload was  her  This s e c t i o n d e s c r i b e s the o f t h e i r h e a l t h and  during  indicated that  helped  i s generally recognized  facilitate  i n c l u d i n g the  acknowledged t h a t  b e i n g aware o f h e r r e s o u r c e s  perceptions  or  a p e r s o n copes i s a l s o  t u r n , a s s i s t e d them i n t h e d e t e r m i n a t i o n  the s t r e s s .  safe  energy i n d i v i d u a l s have t o b r i n g t o  Informants  s t r a t e g i e s t o use.  not  role.  d e t e r m i n e d p a r t l y by h i s / h e r r e s o u r c e s , l e v e l o f h e a l t h and  9  I knew was  r e a d y t o assume t h a t  H e a l t h and  5  was  who  expected  inconsistent  thought her workload  indicated " i t feels like  p e r c e i v e d an i n c r e a s e i n w o r k l o a d  was  more."  attributed  it  t o l o n g e r h o u r s , more d o c u m e n t a t i o n ,  more m e e t i n g s  and p l a n n i n g s e s s i o n s a n d a d d i t i o n a l • p r e p a r a t i o n the student g r i e v e the nurse  educator's  should  decision.  i n f o r m a n t d e s c r i b e d t h e e f f e c t on h e r o f w o r k i n g  One longer  than u s u a l hours : I:  . . . a t t h e v e r y end t h e r e I f e l t  b e c a u s e I was e x h a u s t e d put  relief  from t h e hours  actually  that I had  i n there.  This informant  commented o n t h e e n e r g y  working with t h i s  she p u t i n t o  student:  I : . . . I r e a l l y d i d n ' t t h i n k t h a t i t was f a i r t o have t h i s  student  come b a c k a t h i r d t i m e i n t o t h e  program r e g i s t e r e d i n t o semester]  [thef i n a l  clinical  and abuse t h e r e s o u r c e s o f an  instructor.  The t i m e a n d e n e r g y  t h a t i ttook f o r  me t o p u t i n t o t h i s one s t u d e n t was phenomenal! Another I:  informant  that:  I was r e a l l y t i r e d a n d I don't t h i n k I  physically lot  indicated  was u n h e a l t h y but I c e r t a i n l y  more t i r e d .  More t i r e d p h y s i c a l l y .  c o n s i d e r a b l y l e s s energy t o o , I t h i n k ,  I had to give to  t h e o t h e r s t u d e n t s a n d t o my own p e r s o n a l And  probably  I was somewhat e d g i e r t o o .  felt a  life.  In and  addition,  one i n f o r m a n t d e s c r i b e d l o s i n g  experiencing sleep I:  weight  difficulties.  . . . I l o s t weight,  [and had] s l e e p l e s s  nights.  R: S l e e p l e s s n i g h t ? I:  ...You t u r n o v e r t h e same t h i n g s a g a i n a n d i s  t h e r e a n y o t h e r way o f d o i n g i t ?  I thinlc i t has  an i m p a c t when y o u s p e n d t h a t many hours. These f i n d i n g s s u g g e s t , upon n u r s e e d u c a t o r s adversely affect  t h a t t h e demands p l a c e d  i n t h e s e c i r c u m s t a n c e s may  their  health.  Student The  second  group o f v a r i a b l e s which  a p p r a i s a l of t h e s i t u a t i o n a r e termed variables.  influence the  student  Student v a r i a b l e s i n c l u d e the students'  i n s i g h t s r e l a t e d t o c l i n i c a l performance,  their  general  expectation that they are e n t i t l e d t o r e c e i v e a passing grade  once t h e y r e a c h t h e f i n a l  clinical  semester,  and  other extenuating circumstances. Insight. grade  The e x p e r i e n c e o f a s s i g n i n g a  t o a student i n the f i n a l  clinical  failing  semester  c a r r i e d w i t h i t some d e g r e e o f s t r e s s , b u t a s s i g n i n g a failing  grade  t o a s t u d e n t who lacl^ied t h e i n s i g h t t o  recognize the d e f i c i t s  i n h i s / h e r performance  was e v e n  more s t r e s s f u l . views  that  I n f o r m a n t s were unanimous i n t h e i r  s i t u a t i o n s where s t u d e n t s l a c k e d  i n t o t h e i r performance On o c c a s i o n ,  insight  w o u l d be a p p r a i s e d a s s t r e s s f u l .  i n f o r m a n t s c i t e d e x p e r i e n c e s where  they  h a d more t h a n one s t u d e n t i n j e o p a r d y o f n o t m e e t i n g t h e c o u r s e o b j e c t i v e s a t t h e same t i m e . s i t u a t i o n s compounded I:  ...it  These  t h e f a c u l t y members' s t r e s s .  d e p e n d s s o much on t h e s t u d e n t a n d t h e i r  a w a r e n e s s o f t h e i r p r o g r e s s o r l a c k o f a n d how w e l l they receive not.  i t .  I f they have i n s i g h t o r  A n d f r o m my e x p e r i e n c e I w o u l d s a y I h a d one  s t u d e n t t h a t h a d no i n s i g h t o r v e r y v e r y  little.  And i t was q u i t e f r u s t r a t i n g when y o u ' r e w i t h t h a t t y p e o f s t u d e n t and y o u ' r e h o p e f u l l y h a v e them r e c o g n i z e I:  dealing  trying to  it....  . . . t h a t ' s w h e r e t h e s t r e s s f o r me comes.  when when t h e y d o n ' t  have t h e i n s i g h t . . . .  The same i n f o r m a n t d i s c l o s e d  that:  I : I had enough d a t a t h a t  I knew t h e s t u d e n t was  not  safe.  So I d i d n ' t h a v e s t r e s s w i t h  had  s t r e s s w i t h t h e way s h e r e a c t e d  General expectations. generally believed  Is  In addition,  that assigning  that.  to i t . informants  a failing  grade i n  I  the  final  clinical  semester r a t h e r  than e a r l i e r  i n the  p r o g r a m u s u a l l y met w i t h more r e s i s t a n c e on t h e student's part  a n d was more d i f f i c u l t  T h i s was p a r t i c u l a r l y t r u e had  difficulty  I...at  i f s i g n i f i c a n t others  coming t o terms w i t h  i n f o r m a n t summed i t up t h i s  okay,  back a t another time. time t o repeat. clinical  term]  five[pause]  also  the decision.  One  way:  l e a s t i f they f a i l  semester you t h i n k ,  for faculty.  earlier  i n .. a p r e v i o u s  ( S i g h ) . They c a n come  They h a v e a l i t t l e  B u t when t h e y f a i l  extra  i n the f i n a l  [pause] i f t h e y go b a c k t o  i t ' s j u s t n o t t h e same...I  because i t ' s the f i n a l graduating with  semester.  think  They're not  t h e i r friends...t h e i r family are  a n t i c i p a t i n g them t o g r a d u a t e .  So I t h i n k  more d i f f i c u l t  f o r the student.  more d i f f i c u l t  f o r the i n s t r u c t o r .  that's  T h a t makes i t Because even  though y o u c a n ' t t h i n k about t h a t , y o u have t o f o c u s on t h e o b j e c t i v e s .  It still  has an i m p a c t .  R: I know t h a t y o u h a v e e x p e r i e n c e i n some o f t h e lower semesters.  Do y o u t h i n k t h e r e  d i f f e r e n c e between f a i l i n g and  failing  is a  a student at t h i s  a student at a lower l e v e l ?  level  I:  Yes,  because a t a lower l e v e l t h e r e ' s not  much i n v e s t m e n t  on t h e s t u d e n t ' s p a r t o r on  faculty's part.  As an i n s t r u c t o r you  l i k e t h e r e ' s so much e n e r g y  and  gone i n t o t h e w h o l e s c e n a r i o . I  t i m e and And  effort  so i t i s e a s i e r  t h e s t u d e n t s t e n d t o h a v e , I won't s a y , i n s i g h t b u t t h e y a r e more a c c e p t i n g . t h a t t h e y see y o u  I:  s a y as s o m e t h i n g  more  I t may  be  b u t t h e y seem t o t a k e what c o n s t r u c t i v e and  not  that i s a personal attack.  W e l l , i n my  difficult in  reason  i n a more a u t h o r i t a r i a n r o l e i n  those lower semesters  something  the  don't f e e l  t h i n k t o s a y t o a s t u d e n t t h e n . F o r some  you  so  experience  I t h i n k i t i s more  [to a s s i g n a f a i l i n g  the f i n a l  clinical  semester]  grade to  students  than i t i s w i t h  s t u d e n t s i n l o w e r s e m e s t e r s . . . i t i s much more difficult.  I t h i n k a l s o we  have t o f a c e  certain  q u e s t i o n s from o t h e r i n s t r u c t o r s because I t h i n k some o f them h a v e a v e s t e d i n t e r e s t . known t h e s t u d e n t s . semester  but  clinical  semester]  different.  They h a v e  Maybe t h e y d i d f i n e i n t h e i r  they a r e not now  f i n e i n [the  final  because i t i s v e r y  They a r e now  having to p u l l  a l l their  knowledge t o g e t h e r . i d e n t i f y other I:  This informant  "pressures"  she  went on t o  experienced.  . . . i f they have done w e l l o r a t l e a s t met t h e  objectives  from past  semesters,...[pause]  I t h i n k there i s also...the pins,  t h e bake s a l e s ,  why  now?  pressure,  the grad  t h e [laugh] and  students  g i v e y o u t h a t . . . l i k e I h a v e b o u g h t my p i n . I , have p a r t i c i p a t e d  i n r a i s i n g money f o r g r a d u a t i o n  and what a r e y o u s a y i n g ?  I t h i n k sometimes,  b e c a u s e t h e y h a v e more i n v e s t e d t h e i r i n s i g h t i s not v e r y good.  Many o f them h a v e a l r e a d y made  p l a n s w h e r e t h e y a r e g o i n g t o go w o r k . . . . Extenuating circumstances. the nurse  educators'  of extraneous  Further  compounding  a p p r a i s a l s o f e v e n t s w e r e a number  v a r i a b l e s w h i c h added t o t h e u n i q u e n e s s  of the s i t u a t i o n .  These i n c l u d e d s t u d e n t  f i n a n c i a l problems, and f a m i l y s t r e s s e s . o f t h e s e v a r i a b l e s may be p r e s e n t  illness, One o r more  i n a given  situation.  The e x c e r p t s b e l o w i d e n t i f y some o f t h e s e v a r i a b l e s a n d d e s c r i b e t h e i n f o r m a n t s ' v i e w s on t h e i m p a c t  of the  v a r i a b l e s on t h e e v a l u a t i o n p r o c e s s . I:  ... y o u s e e how  they r e a l l y . . . students are  under a l o t of duress.  Financial,  family  stresses.  They r e a l l y p u t t h e m s e l v e s  end o f t h e r o p e .  o u t on t h e  And so t h e y l o s e s i g h t .  And a l l  t h e y want t o do i s r e a c h t h a t g o a l a t no m a t t e r what  cost.  Often i n t a l k i n g w i t h nurse educators semesters  instructors could identify  i n previous  extenuating  c i r c u m s t a n c e s which p r e v e n t e d t h e student from in  a n e a r l i e r . s e m e s t e r . The f o l l o w i n g  identifies I:  some o f t h o s e e x t e n u a t i n g  [In t a l k i n g w i t h another  ...and t h e n t h e y ' l l  excerpt factors.  faculty  member}  s a y s h e was d o i n g t h i s a n d  a c t u a l l y t h a t sometimes i s q u i t e h e l p f u l you  c a n s a y why t h e h e l l  about i t i n semester you  that f o r this,  d i d n ' t y o u do  because something  four...then they w i l l  this,  or this,  the student had a l o t of i l l n e s s used absentee  failing  reason  tell  either  or the student  t i m e o r a change o f i n s t r u c t o r or  something t o p a c i f y o r t o make i t n o t seem t o shift  t h e blame from t h e s t u d e n t ' s b e h a v i o u r t o  whatever..... R: So, f o r w h a t e v e r r e a s o n t h e r e was some extenuating circumstances the student didn't at  that p a r t i c u l a r point?  fail  I:  Yes.  R:  And  continued  I:  ...that you  instructors] can  on?  think previous  semester  should have f a i l e d  u n d e r s t a n d why  them b u t  t h e y were u n a b l e  then  you  to.  Environment During the  interviews,  informants i d e n t i f i e d  v a r i e t y of environmental v a r i a b l e s which t h e i r a p p r a i s a l of the introduce  an  element of u n c e r t a i n t y  making process. contributed be  These e x t e r n a l  the  educational  Clinical  to provide  experiences,  the  tended i n t o the  decision-  s t r e s s o r s which  the  clinical  students'  clinical  the a b i l i t y the  learning  ...Can y o u  agency  I n f o r m a n t s spoke about  and  agency i n terms of types of  w i l l i n g n e s s of  s t u d e n t and  the being  clinical agency  i n s t r u c t o r , as  i n t e r n a l a g e n c y p r o b l e m s w h i c h may  R:  to  institution.  appropriate  s t a f f t o work w i t h as  categories:  agency.  s u i t a b i l i t y of the able  influenced  to the uniqueness of each s i t u a t i o n c o u l d  g r o u p e d i n t o two  and  s i t u a t i o n and  a  adversely  well  affect  environment.  t h i n k a b o u t what e l s e makes  situation particularly  difficult?  this  . I:  8  W e l l , y o u can t h i n k i n terms o f t h e agency  itself.  I f you look at the p a r t i c u l a r u n i t .  type of u n i t  is it?  student or a f a i l i n g  patients....  That  s t u d e n t who's on a n u n s t a b l e  safe....  changing  poses p a r t i c u l a r  b e c a u s e y o u h a v e t o be on y o u r sure that you're  What  A n d i f y o u h a v e a weak  f l o o r t h a t ' s v e r y busy and has  is  6  toes.  t h e r e t o ensure  The s t a f f .  problems A n d make  that the student  What q u a l i f i c a t i o n s do  the s t a f f have i n terms o f t h e l e n g t h o f experience?  A r e t h e y new t o t h a t h o s p i t a l ? A r e  t h e y new t o b e i n g a s t u d e n t g u i d e ? to  Are they  [ e d u c a t i o n a l a g e n c y ' s name] p r o g r a m ?  been a p r e c e p t o r f o r another program?  new  Have t h e y You d o n ' t  r e a l l y g e t an o p p o r t u n i t y t o look a t t h e particular  student guides. I n t h i s  t h e y were j u s t a s s i g n e d . hospital, cold. I've  last  situation  I d o n ' t know t h e  I d o n ' t know t h e s t a f f ,  s o I'm c o m i n g i n  I d o n ' t know my s t u d e n t s o t h e r t h a n what read i n t h e i r  files.  So I'm c o m i n g i n c o l d .  I : So I h a v e t o f i n d o u t a s we go a l o n g i n t h e r o t a t i o n what t h e e x p e r i e n c e i s o f t h e g u i d e s . t h a t i s a problem.  I f t h e r e ' s any i n t e r n a l  So  p r o b l e m s on t h e u n i t .  L i k e one o f t h e f l o o r s  t h e r e i s some p r o b l e m s r e l a t e d t o u s i n g t h e s t u d e n t s as w o r k l o a d . Another I:  informant  commented:  . . . I f I've got f a i t h i n the student guide I  sleep  better.  Educational i n s t i t u t i o n . institution,  Within the educational  particular policies,  p r i o r i t i e s , and  i n i t i a t i v e s were p i n p o i n t e d as v a r i a b l e s w h i c h influence the informant's appraisal.  Also  might  identified  were t h e adequacy o f t h e r e s o u r c e s a v a i l a b l e t o t h e nurse  educator which might r e s t r i c t  the informant's  o p t i o n s and/or s t r a t e g i e s . Furthermore, r e g a r d i n g j o b s e c u r i t y were a l s o In t h i s next n a r r a t i v e , informant  concerns  expressed.  t h e r e s e a r c h e r asked t h e  a b o u t how s h e f e l t when s h e h a d l a i d o u t h e r  p l a n and r e a l l y t r i e d h a r d t o work w i t h t h e s t u d e n t and n o t h i n g was h a p p e n i n g .  Her response  about t h e program's a d m i s s i o n  reflected  concerns  criteria.  I: W e l l t h e y ' r e not ready  or they're out of t h e i r  league.  s h o u l d n ' t be h e r e , she  Like the student  s h o u l d n ' t h a v e b e e n a l l o w e d t o come i n t o t h e program.  Two o t h e r i n f o r m a n t s r e c a l l e d circumstances new.  being sensitized  to  t h a t a r o s e because t h e i r programs were  The i n f o r m a n t s i m p l i e d t h e y f e l t p r e s s u r e  under  t h e s c r u t i n y t h a t came w i t h t h e new p r o g r a m s . I : T h i s was  [ t h e p r o g r a m ] v e r y v e r y new t o t h e  c o l l e g e and c e r t a i n l y  a t t h a t t i m e , my c o l l e a g u e s ,  I mean t h i s was t h e i r f a v o r i t e program...we h a d all  w o r k e d o n t h e c u r r i c u l u m a n d why w e r e t h e y n o t  passing? I:  ...and I t h i n k i t was because o f the type o f  program.  I t was d i f f e r e n t  from a r e g u l a r c o l l e g e  p r o g r a m i n t h a t i t was f u n d e d , p r o j e c t t h a t was f u n d e d Other  the f i r s t p i l o t .  by....  i n f o r m a n t s r e s p o n d e d i n t h i s way: R: So what i f a n y t h i n g i s t h e i m p a c t assigning a f a i l i n g final  clinical  grade t o a student  problem  how f a r we l e t a s t u d e n t go b e f o r e failed.  i n the  semester?  I : I t h i n k we h a v e a n i n t e r n a l  actually  of you  i n terms o f  they're  And I t h i n k t h i s goes back t o  the i s s u e o f r e t e n t i o n and r e m e d i a t i o n . Particularly chance.  f o r a s t u d e n t who i t ' s t h e i r  They d o n ' t h a v e a n o t h e r  last  opportunity to  corne b a c k i n t o t h e p r o g r a m s o y o u ' r e cautious and v e r y  particularly  s t r i n g e n t i n what y o u do t o make  s u r e y o u g i v e them every o p p o r t u n i t y t o demonstrate t h e y c a n make t h e o b j e c t i v e s . This  i n f o r m a n t went o n t o s a y : I:  ...no p r a c t i c u m  being  eligible  s t u d e n t s were d e s i g n a t e d  as  •  f o r r e m e d i a t i o n . . . so t h a t c e r t a i n l y  i m p a c t s on y o u r d e c i s i o n .  Then, when y o u ' r e  m a k i n g up y o u r l e a r n i n g p l a n  and y o u have t o  r e a l i z e t h a t y o u h a v e t o make sure t h a t that  failing  the time  you  spend w i t h  student i s adequate  and  a l s o t h e t i m e y o u spend w i t h y o u r good  s t u d e n t s i s a d e q u a t e . . . b e c a u s e you're not going t o be r e c e i v i n g any help, a n y c l i n i c a l  help,  therefore  that puts i n t o context  achieve.  What k i n d o f l e a r n i n g s t r a t e g i e s c a n I  use I:  what y o u c a n  t h e n i f I'm o n my own? ...however I h a v e t o s a y t h a t one o f t h e  f a c t o r s that probably impinged a great t h a t d e c i s i o n was a b u d g e t a r y o n e .  d e a l on  And t h a t i s  a n o t h e r i n t e r e s t i n g a s p e c t i n terms o f once y o u i d e n t i f y p r o b l e m s how much r e m e d i a t i o n o f f e r w i t h i n the resources  can you  that you personally  R: And how d o e s t h a t make y o u f e e l resources  l i m i t your a b i l i t y  appropriate I: Well,  to  i f the  provide  remediation?  one o f t h e t h i n g s  i t ' s done f o r me i s  t h a t I know t h a t many t i m e s I h a v e e x t e n d e d m y s e l f by f a r a b o v e a n d b e y o n d t h e e x p e c t a t i o n s r o l e a n d a s w e l l a b o v e a n d b e y o n d what colleagues  a r e p r e p a r e d t o do.  w r o n g l y , I h a v e done t h a t .  my  Rightly or  B u t I h a v e done  f o r the b e n e f i t of the student instances  o f my  a n d i n many  I have t o say i t has been b e n e f i c i a l f o r  the  student.  for  me.  Don't know t h a t i t ' s b e e n  beneficial  In a d d i t i o n , problems r e l a t e d t o l i m i t e d w e r e compounded had  that  by t i m e l i m i t s  resources  i n which the d e c i s i o n  t o be made. I:  ...at the time I f e l t very  of resources quickly]  I had.  l i m i t e d i n the k i n d  And i t seemed a l s o  [speaking  t h a t t h i n g s were moving q u i c k l y .  More t h a n one i n f o r m a n t  commented a b o u t t h e r e -  entry opportunities a v a i l a b l e to  students.  I : I f e l t p a r t i c u l a r l y b a d b e c a u s e I knew t h a t  t h i s w o u l d be t h e l a s t . chance t o r e - e n t e r . more d i f f i c u l t . and  She w o u l d n ' t  have  A n d s o i t made i t a l l t h e  I t wasn't l i k e  I could offer her  s a y w e l l now come b a c k a n d r e p e a t  In contrast,  another  it...  i n f o r m a n t saw t h e r e e n t r y  p o l i c y as b e i n g t o o l a x thus c r e a t i n g another frustration  f o r the nurse  I: Well, it's  another  source of  educator.  i t ' sa very l a xre-entry policy.  The way  supposed t o work i s t h e y a r e supposed t o have  32 months t o c o m p l e t e them one s e m e s t e r  t h e program. That's  off, allowing  f o rsickness or  w h a t n o t a n d they w i l l extend i t . semester,  giving  They say one  s o a n e x t r a f o u r months i n v e r y _  e x t e n u a t i n g circumstances.  Y e t t h e y I've seen  them extend i t and extend i t b e y o n d I t h i n k a n y point  that  they're doing the  R: So y o u d o n ' t  s t u d e n t any good.  h a v e one o r two c l i n i c a l  failures  or academic f a i l u r e s and then they can't r e - e n t e r ? I: Well, adhered  I t h i n k we do h a v e t h a t b u t i t ' s n o t to.  A n d t h a t ' s the f r u s t r a t i n g  part.  B e c a u s e I t h i n k i f you put a student through a semester t h r e e times t h e n t h e y w i l l it.  That doesn't  eventually get  mean t h e y ' r e a c o m p e t e n t  nurse  but  i t ' s j u s t t h a t you wouldn't  to f a i l  them t h e t h i r d t i m e  In t h i s next excerpt another  h a v e enough data  through.  i n f o r m a n t d e s c r i b e d how  the p o l i c y i n f l u e n c e d h e r approach. I : Because o f t h e unique  situation of this  student  [the i n f o r m a n t i n d i c a t e d she spent a l o t o f time t a l k i n g w i t h other people, planning her approach]. I t h i n k t h e f a c t t h a t she had spent  s o much t i m e  i n o u r p r o g r a m a n d s h e was r e p e a t i n g t h e s e m e s t e r and  s h e was a t t h e l i m i t s o f h e r 32 months b e c a u s e  she h a d b e e n e x t e n d e d clinical  to finish  [the f i n a l  semester].  These e x c e r p t s i n d i c a t e t h a t a d m i n i s t r a t o r s need t o be c o n s i s t e n t i n t h e i m p l e m e n t a t i o n o f e d u c a t i o n a l policies.  P o l i c i e s n e e d t o be d e s i g n e d t o u t i l i z e  i n s t r u c t o r resources optimally.  I n t h i s way, n u r s e  e d u c a t o r s c a n be a s s u r e d t h a t t h e y a r e w o r k i n g t o a c h i e v e a common g o a l ; t h a t o f g r a d u a t i n g c o m p e t e n t a n d safe  nurses. Coping Two f i e l d s o f s c i e n t i f i c  examined t h e concept  i n q u i r y have  extensively  o f c o p i n g : animal p h y s i o l o g y and  psychoanalytic psychology  (Lazarus & Folkman,  1984b).  The  a n i m a l m o d e l f o c u s e d on t h e c o n c e p t  t h e e m p h a s i s p r i m a r i l y on a v o i d a n c e behaviours.  The  s i g n i f i c a n c e of c o g n i t i o n but of behaviour.  c o p i n g were i d e n t i f i e d . d e s c r i b e s t y l e s and t o s i t u a t i o n s and  simplistic  t r a i t s u s e d by  d e f i n i t i o n of coping.  t o downplay  the  to  i n d i v i d u a l s t o adapt  stress.  Coping  was  not  process.  and F o l k m a n ' s  (1984b)  These r e s e a r c h e r s v i e w  coping  as  d y n a m i c , c o g n i t i v e and b e h a v i o r a l  They d e f i n e c o p i n g as an  " c o n s t a n t l y changing  the  These systems tended  This study used Lazarus  individual's  c o g n i t i v e and b e h a v i o r a l e f f o r t s  t o manage s p e c i f i c e x t e r n a l a n d / o r i n t e r n a l t h a t a r e a p p r a i s e d as t a x i n g o r e x c e e d i n g of the person"  and  H i e r a r c h i c a l p a t t e r n s of  thus reduce  a context-specific,  recognized  tended  c o n c e i v e d as a d y n a m i c , c h a n g i n g  process.  escape  component.  p s y c h o a n a l y t i c approach  importance  and  T h i s m o d e l o f c o p i n g was  lacked a cognitive  of d r i v e w i t h  demands  the  resources  ( L a z a r u s & F o l k m a n , 1984b, p . 1 4 1 ) .  b e l i e v e t h a t e f f e c t i v e c o p i n g d e p e n d s on  the  r e l a t i o n s h i p b e t w e e n t h e demands o f t h e s i t u a t i o n the person's  resources.  effectively,  c o p i n g e f f o r t s must n o t be  They  I n o r d e r f o r one  and  t o cope  in conflict  w i t h an i n d i v i d u a l ' s v a l u e s , c o m m i t m e n t s , a n d (Lazarus & Folkman,  1984b).  U n l i k e o t h e r models,  t h i s one  takes into  t h a t many s o u r c e s o f s t r e s s c a n n o t be managed.  account  effectively  R e g a r d l e s s o f outcome, e f f e c t i v e c o p i n g i n  t h e s e i n s t a n c e s t h e n i s d e f i n e d as does o r t h i n k s , works"  beliefs  r e g a r d l e s s o f how  ( L a z a r u s & Folkman,  "anything a person w e l l or badly i t  1984b, p . 1 4 2 ) , w h i c h " a l l o w s  the person to t o l e r a t e , minimize, accept, or ignore what c a n n o t be m a s t e r e d "  ( L a z a r u s & Folkman,  1984b,  p. 140) . C o p i n g i s d e t e r m i n e d by c o g n i t i v e I n d i v i d u a l s use p r o b l e m - f o c u s e d and strategies.  emotion-focused  Often these s t r a t e g i e s are  concurrently.  utilized  The p r o b l e m - f o c u s e d p r o c e s s e s u s e d  informants i n t h i s categories:  appraisal.  s t u d y c a n be c l a s s e d i n t o two  1) i n f o r m a t i o n s e e k i n g ; a n d  a c t i o n t o a l t e r one's Problem-focused  2)  by broad  direct  approach.  Strategies  Information seeking.  A l l informants  the importance of t a l k i n g w i t h o t h e r s .  emphasized  T h i s was  as an easy and e f f e c t i v e c o p i n g s t r a t e g y .  By  they sought out i n f o r m a t i o n , v a l i d a t e d t h e i r  viewed  talking, actions.  vented  their  f r u s t r a t i o n s a n d , a t t h e same t i m e ,  r e c e i v e d some e m o t i o n a l  support.  summarize t h e i n f o r m a n t s I:  The n a r r a t i v e s b e l o w  experiences:  [I] discussed i t w i t h the other  instructor.  often  We s p e n t  semester  l o t s of hours o n t h e phone  b e c a u s e s h e was t e a c h i n g a t [ n a m e o f a g e n c y ] a t t h e time.  I spent  a l o t of time t a l k i n g  the department chairman affairs  i t over w i t h  and w i t h t h e s t u d e n t  c o o r d i n a t o r . . . . A n d f i n a l l y we  decided  t h a t we n e e d e d t o go a c o n t r a c t r o u t e w i t h s t u d e n t a n d I s e t up a v e r y s p e c i f i c In the previous t r a n s c r i p t , direction, because  this  contract.  the informant  sought  took d i r e c t a c t i o n and a l t e r e d h e r approach  "of t h e unique  Another I:...But  informant  s i t u a t i o n of the student." disclosed:  i t was very, very, f r u s t r a t i n g .  I  remember g o i n g home e v e r y n i g h t n o t k n o w i n g what t o do. R: A n d how d i d y o u d e a l w i t h t h a t when y o u d i d n ' t know what t o do? I:  . . . I h a d l o t s o f f r i e n d s b u t one i n p a r t i c u l a r  t h a t who h a d a c t u a l l y b e e n my i n s t r u c t o r a s w e l l i n t h e d i p l o m a p r o g r a m a n d h e r b i g t h i n g was  • documenting.  ,.  78  And j u s t d o c u m e n t i n g r e a l l y  --  a c c u r a t e l y what went o n a n d what t h e s c e n a r i o s were.  And making sure t h a t I h a d a r u n n i n g  tab...  so i n s t e a d o f j u s t d o c u m e n t i n g a n d n o t s a y i n g anything  to her, saying  i t t o h e r and a s k i n g h e r  t o s i g n t h a t s h e h a d r e a d what I h a d w r i t t e n s o t h a t she c o u l d n ' t  come b a c k l a t e r a n d s a y t h a t s h e  d i d n ' t h a v e a c l u e what was g o i n g o n . Another informant I:  indicated that:  I t was v e r y  people..I  h e l p f u l j u s t t o t a l k t o the other  d i d n o t o n l y j u s t go t o t h e p e o p l e  I respected  that  b e c a u s e t h a t ' s who I went t o f i r s t .  So t h a t I m y s e l f c o u l d g e t some f e e d b a c k f r o m them first  so t h a t I wouldn't f e e l  instructor i n the last  so i n e f f e c t i v e as an  clinical  semester.  c o u l d g i v e me some f e e d b a c k a n d I c o u l d maybe I'm o n t h e r i g h t doing  my j o b . . . .  respect  the  say.  Okay  M a y b e . . . I am  And t h e n I went t o p e o p l e t h a t I  b u t I d o n ' t know s o w e l l who h a v e a  d i f f e r e n t philosophy students  track here.  So t h e y  .  o r d i f f e r e n t approach t o  and have a d i f f e r e n t r e p u t a t i o n . . . w i t h  students...but  t h e message k e p t c o m i n g  d e s p i t e who I t a l k e d t o t h a t t h e r e ' s  really  through just  no way  that t h i s person  Inherent  c a n go  through.  i n t h i s q u o t a t i o n i s an e l e m e n t  seeking emotional  support.  By r e c e i v i n g  of  validation  h e r d e c i s i o n f r o m m u l t i p l e f a c u l t y members, t h i s e d u c a t o r o b t a i n e d c o n f i r m a t i o n t h a t she was " d o i n g h e r j o b " and was  "on t h e r i g h t  I n c o n t r a s t , an e x p e r i e n c e d e d u c a t o r s p e c i f i c c o l l e a g u e s who  track." sought  were f a m i l i a r w i t h  out the similar  experiences:  R: What h e l p s y o u arise I:  novice  indeed  e d u c a t i o n a l l e v e l o f t h e s t u d e n t and h a d h a d types of  for  i n these  support  W e l l , I guess the support  But  c o l l e a g u e s who  you  will  I would go  the s i t u a t i o n . T h i s i s what I'm suggestions?  have to seek out g i v e you  support.  to i n d i v i d u a l s  from  specific I f I wanted  and  say t h i s i s  This i s the student's  behaviours.  doing.  Can y o u  g i v e me  some  So v e r y s p e c i f i c people w o u l d  i d e n t i f i e d to offer  support.  want t h e w h o l e f a c u l t y w o u l d be  that  situations?  [Long p a u s e ]  colleagues.  cope w i t h t h e f e e l i n g s  be  I wouldn't expect  t o g i v e me  support.  s p e c i f i c p e o p l e whom I r e s p e c t and  t h a t they've been i n a s i m i l a r s i t u a t i o n  It know  and  or  t h e r e f o r e c a n h e l p me o u t .  They c a n comment on  it. Clearly,  this quotation indicates that the  experienced nurse resources.  educator  I n t h i s case,  experience at the f i n a l  sought out s p e c i f i c  t h e y w e r e i n d i v i d u a l s who h a d • clinical  semester  and thus  m i g h t be a b l e t o p r o v i d e h e r w i t h s p e c i f i c i n f o r m a t i o n . This informant used the term support  i n referring to  a c q u i r i n g s u g g e s t i o n s and feedback.  This  experienced  informant d i d not appear t o r e q u i r e v a l i d a t i o n o r reassurance  t h a t s h e was d o i n g a g o o d j o b .  D i r e c t a c t i o n t o a l t e r one's Informants  approach.  o f t e n a l t e r e d t h e i r approach  to  clinical  e v a l u a t i o n on r e c e i v i n g s u g g e s t i o n s a n d  feedback  from o t h e r s .  P r i o r experience with having t o  i s s u e a f a i l i n g g r a d e may i n i t s e l f be a m o t i v a t o r t o a l t e r one's approach. I: had of  One i n f o r m a n t  reported that:  The i n s t r u c t o r t h a t I was w o r k i n g w i t h t h e r e taught  [the f i n a l  clinical  semester]  t i m e s a n d h e l p e d me a l o t a c t u a l l y  a number i n how I  c o u l d b e t t e r f o c u s my t i m e when I went t o t h e clinical In  area.  a second  interview, the researcher validated  •  t h a t an  i n f o r m a n t had,  p r a c t i c e had  i n fact,  indicated that  c h a n g e d b e c a u s e she  perceived  her  increased  risk. R:...  [you  increased  also said that]  concerns about  risk resulted in  p r a c t i c e ways t o be  very  [you]  putting  t h r o u g h and  a b o u t s t u d e n t / i n s t r u c t o r and  into  conscientious  ward  responsibilities. I:  Right.  R:  So y o u  a c t u a l l y increased  t h i n k t h a t was I: R:  your s u r v e i l l a n c e , I  one  of the  t h i n g s you  said?  Your m o n i t o r i n g  of the  student because you  Yes.  worried  about the  l e g a l i t i e s with  the  care  were  that  surrounded t h i s ? I : Yes. Another informant d i s c l o s e d that: I : So  t h o s e two  chair].  You  l e f t me  l i k e wow,  r e a l l y have t o get  [ s i t t i n g back i n a s y s t e m down  t h a t ' s a c t u a l l y what h a p p e n e d . I g o t quick  a l o t more  o f f t h e mark a b o u t l e a r n i n g p l a n s  I t h o u g h t t h e r e was t h e way  i n w h i c h you  some u n e a s i n e s s . use  the  tool.  and  as  soon  as  I guess i t ' s I use  i t as  you're  doing you're  t r y i n g r e a l l y hard.  p l a n s o t h a t y o u c a n be s u c c e s s f u l . put  i t i n that l i g h t .  my b u t t  Here's a  And I t r y t o  B u t I a l s o do i t t o c o v e r  [ v o i c e low, as i f n o t w a n t i n g  t o be  heard]. This narrative describes a s i m i l a r I:  ...So y o u ' r e  boolckeeping.  viewpoint:  a l i t t l e more s t r i n g e n t w i t h  your  Y o u c a n s o m e t i m e s s e n s e when y o u a r e  g o i n g t o have a d i f f i c u l t s t u d e n t .  Someone who's  g o i n g t o a p p e a l o r someone who's g o i n g t o f i g h t . Someone who d o e s n ' t  have any i n s i g h t and c a n ' t ^  r e c o g n i z e t h a t t h e y ' r e not ready  t o graduate.  They c o u l d not work as a graduate nurse w i t h current  abilities.  Emotion-focused Informants  Strategies u s e d a number o f  s t r a t e g i e s d i r e c t e d toward emotional d i s t r e s s . emotional  their  emotion-focused  lessening their perceived  These i n c l u d e d :  a) s e e k i n g  s u p p o r t ; b) v e n t i n g o f a n g e r ;  physical activities;  d) r a t i o n a l i z a t i o n ;  c) e n g a g i n g i n a n d e)  distancing. Seeking one  emotional  support.  I n the next  narrative,  i n f o r m a n t d i s c l o s e d how t a l k i n g h e l p e d h e r t o c o p e  through  the decision-making process  and a  subsequent  appeal. I : I was  c o p i n g through t h e d e c i s i o n and  a p p e a l and  those kinds of t h i n g s .  d o i n g t o cope?  T a l k , and  talk,  o t h e r s : t h e i r husbands, f a m i l i e s , colleagues. informant's  The  Any  I  talk.  from  significant  friends,  and  following narrative depicts  nursing one  experience:  I : So I d i d t a l k t o a l o t o f R:  And what was  and  Some i n f o r m a n t s s o u g h t s u p p o r t  the  people  people.  t h a t were not n u r s i n g - r e l a t e d p e o p l e  necessarily? I: T r u t h f u l l y ?  My  babysitter  [ l a u g h s ] . My  b a b y s i t t e r i s my c o n f i d a n t . . . R:  So a s i g n i f i c a n t  I: A s i g n i f i c a n t  other  then?  o t h e r . Yes,  v e r y much s o . And  s p e a k t o h e r a b o u t i t n o t b e c a u s e I'm s e n s a t i o n a l i z e the s i t u a t i o n s e e how  s t a b l e I am.  She  trying  see j u s t and  how  s t a b l e I am  c a n g i v e me  irrational  feedback  about t h i s  to  b u t b e c a u s e she  can  c a n s e e a p a r t o f me  t h e y don't e v e r get t o see a t s c h o o l . i n my  own  So  on w h e t h e r I seem  situation  or  not.  that  she  personal  I  can  life  However, n o t a l l i n f o r m a n t s s o u g h t s u p p o r t o r feedback  from s i g n i f i c a n t o t h e r s .  A number o f  i n f o r m a n t s r e a l i z e d t h a t f a m i l y members w e r e o f t e n t o o removed from t h e c o n t e x t o f c l i n i c a l  p r a c t i c e and t h e  p r o f e s s i o n a l a s p e c t s o f p r a c t i c e t o be a b l e t o p r o v i d e effective  support.  In these cases, the informants  looked t o other colleagues f o r support  and a d v i c e .  For  example : I:  . . . W e l l , I am m a r r i e d a n d I h a v e a f a m i l y .  P r o b a b l y my h u s b a n d does know when I'm i n t h e throes of a n x i e t y over a student, o r having a p r o b l e m w i t h a s t u d e n t , o r i f I'm h a v i n g a semester t h a t ' s not going w e l l .  But he's t o t a l l y  removed f r o m t h e m e d i c a l o r p a r a m e d i c a l p r o f e s s i o n period...  I t h i n k a s f a r a s h e ' s t h e r e f o r me a n d  r e c o g n i z e s t h a t maybe I'm h a v i n g a d i f f i c u l t in  the c l i n i c a l  he  c e r t a i n l y has stepped  time  a r e a , a n d i f I'm p a r t i c u l a r l y busy i n and has taken  over  some o f t h e f a m i l y r e s p o n s i b i l i t i e s , a n d . . . . ; R: So s u p p o r t i v e i n a d i f f e r e n t I:  way?  Y e s . Y e s , s u p p o r t i v e , n o t s u p p o r t i v e o f me  making the d e c i s i o n b e c a u s e he c e r t a i n l y h e l p me make t h e d e c i s i o n .  can't  T h a t h a s t o come f r o m  me  and  i f I'm  g o i n g t o get  help making t h a t  o f d e c i s i o n I t h i n k i t has colleagues  program.  Venting  of anger.  stress  with  my  some o f t h e  by  one's f r u s t r a t i o n s can  (Levy, Dignan & S h i r r e f f s , she  the  Some a n g e r i s c a u s e d  Expressing  disclosed that  from  more t h a n p e o p l e e x t e r n a l t o  nursing  frustration.  t o be  kind  used her  1987).  One  family to help  f e e l i n g s t h a t a r o s e out  of  reduce  informant  her  cope  the  situation. I:  . . . I must s a y  I do  use  [laughs]  h u s b a n d q u i t e a b i t f o r t h a t and b e c a u s e he's  t h a t one  step  p r e s e n t I t h i n k more o f t h e story.  B e c a u s e he's  not  y e t when I'm  this this?  being  s t u d e n t s a y i n g why I felt  i n the  evaluator  emotional or being won't t h i s  l i k e w r i n g i n g her  o r I d o n ' t f e e l as  my  can the  role  and  p e e r s have been. angry  student  at  do  neck or whatever. say  y o u r emotions i n t h o s e terms t o him  colleague.  he  s t u d e n t ' s s i d e of  I t ' s o k a y t o v e n t i l a t e t h a t and  couldn't  family or  I t h i n k i t ' s good  removed and  h a s n ' t b e e n i n t h a t r o l e as my And  my  that,  express  whereas  you  comfortable doing to  a  Similarly, I:  another  ...So  informant  expressed  I h a v e t o s a y t h a t my  this  view:  f a m i l y members w e r e  p r o b a b l y t h e y p r o v i d e d t h e most s u p p o r t t i m e f o r me [pause] to  and  at that  I w o u l d come home and a i r my  perhaps f r u s t r a t i o n about not b e i n g  ma]<;e e n o u g h p r o g r e s s w i t h i n t h e t i m e  Physical activity. activities  t h e t e n s i o n s we  stress.  ( C o r b i n & L i n d s a y , 1985).  In t h i s  are under  the  Thus, p h y s i c a l a c t i v i t i e s  can  strategies.  Exercise. Exercise.  R:  Exercise?  I:  Oh.  critical.  an e x e r c i s e f i e n d .  I thinly; t h a t ' s so  When s t r e s s e d r e g a r d l e s s o f what i t i s .  E s p e c i a l l y worJcing w i t h s t u d e n t s . away and  You  need t o  so t o spealc b l o w o u t t h e c a r b o n .  t h e r e and wor]<: i t o u t . r e f r e s h e d and angle.  stress  to reduce  I:  I'm  -  s t u d y , a number o f  i n f o r m a n t s engaged i n p h y s i c a l a c t i v i t i e s s t r e s s they experienced.  can  E x e r c i s e seems t o d i s c h a r g e  e x p e r i e n c e when we  be d e s c r i b e d as c o p i n g  left.  Engaging i n p h y s i c a l  t o get one's mind o f f a p r o b l e m  e f f e c t i v e l y reduce  able  Not  So t h a t y o u  Get  get out  c a n come b a c k  l o o k a t i t f r o m maybe a  different  t h a t e x e r c i s e i s going t o h e l p you  do  that.  But I f i n d i t r e a l l y h e l p f u l d e a l i n g  s t r e s s . And i f y o u c a n b r i n g y o u r s t r e s s  with  level  down t h e n , y o u c a n l o o k a t t h i n g s maybe f r o m a different  angle.  Rationalization.  Emotion-focused coping processes  c a n be u s e d t o m a i n t a i n hope a n d o p t i m i s m .  In this  s t u d y , r a t i o n a l i z a t i o n was s o m e t i m e s u s e d i n t h i s manner.  When some i n f o r m a n t s r a t i o n a l i z e d ,  they  r e f l e c t e d back on t h e e n c o u n t e r s and i d e n t i f i e d p o s i t i v e outcomes. I:  some  One i n f o r m a n t d i s c l o s e d :  . . . I ' d never r e a l l y e n c o u n t e r e d t o t h i s  [the magnitude  of problems]  degree  with other  s t u d e n t s . . . s o i t was g o o d f o r me. Distancing.  D i s t a n c i n g r e f e r s t o mechanisms by  which the informants attempted t o s h i e l d from p e r c e i v e d t h r e a t . "Is i t worth i t ? " semester?"  themselves  I n f o r m a n t s made s t a t e m e n t s  like  and " W e l l , c a n I n o t work f o r a whole  One i n f o r m a n t d i s c l o s e d t h a t s h e u s e d  p r a y e r e f f e c t i v e l y t o keep h e r emotions  i n check w h i l e  a student vented h e r anger. I:  . . I u s e p r a y e r a n d t h a t ' s one t h i n g t h a t  h e l p e d me g e t h o l d b e c a u s e praying whilst  I l i t e r a l l y was  really  just  t h i s woman, I had t o g i v e h e r t h e  o p p o r t u n i t y t o b l o w o f f s t e a m . . . I was saying l i t t l e crescendo  p r a y e r s as she was  w i t h some o f t h e s e  Another informant I : ... I was  literally  b u i l d i n g to a  comments...  disclosed that: t h i n k i n g I am  never going to t e a c h i n  t h i s semester a g a i n . R:  Because of your w i s h o r because you wouldn't  be  placed? I : No! So,  My  wish..  I was  a sessional  I mean t o s a y h e r e I was  instructor..  thinking.  Well,  can  I n o t w o r k f o r a w h o l e s e m e s t e r and h a v e no money? Yes  I could but,  I mean on t h e o t h e r h a n d I d i d  l i k e teaching...and p o s i t i o n there t o do t h a t  I was  t h i n k i n g I want t o g e t  [deep b r e a t h ]  and  t o get  i t I have  [work.]  I : W e l l I guess you  t h i n k i s i t worth i t ?  [laughs]. There's a l o t of other jobs I c o u l d  be  d o i n g t h a t d o n ' t h a v e t h i s amount o f s t r e s s involved i n i t . right  [laughs]  you're you  And  you  t h i n k w e l l am  i t makes y o u  s h o u l d be  in this  second guess whether l i n e of work.  These q u o t a t i o n s p r o v i d e support observations  (1983) t h a t n u r s e  I i n the  for Carpenito's  educators  may  distance  a  t h e m s e l v e s b o t h p h y s i c a l l y and to  student  a n g e r and  emotionally  hostility.  Likewise,  n a r r a t i v e s g i v e a d d i t i o n a l support O'Connor  (1978) and  Symanski  students  educators  may  (1991) .  to  i n the  final  to assign a f a i l i n g  clinical  semester of  d i p l o m a n u r s i n g program were v a r i e d . was  individualized,  i n f l u e n c e d by  Informants used a v a r i e t y of coping  informants  experience  left  educator.  Nurse educators  circumstances p e r i o d of The  a lasting  and  felt  a  situation  situation. s t r a t e g i e s to  F e e l i n g s of s t r e s s  u n c e r t a i n t y were always p r e s e n t circumstances,  Each  grade  the v a r i a b l e s  w h i c h were u n i q u e t o t h a t p a r t i c u l a r  i n f l u e n c e the outcome.  nurse  Long-term E f f e c t s  outcomes of h a v i n g  a student  i n a l o s s of  teaching.  I m m e d i a t e and The  They p o s t u l a t e i n dealing with .  actually result  from c l i n i c a l  these  f o r the p o s i t i o n s of  that the m u l t i p l e s t r e s s e s inherent failing  i n response  and,  in certain  isolated.  impression  and  The  w i t h the  could v i v i d l y  events which occurred  nurse  recall during  this  time. f o l l o w i n g n a r r a t i v e s d e s c r i b e the  perceptions  o f how  t h e y had  been a f f e c t e d .  informants'  Immediate The  Effects  majority of informants described f e e l i n g I:  ...I actually  felt  relief.  relief.  W i t h a l l o f them I  f e l t r e l i e f because o f p a t i e n t s a f e t y . . . i t ' s like  i t a l l t h r e e were, e s p e c i a l l y t h e f i r s t and  t h i r d were p a t i e n t s a f e t y c o n c e r n s , thought,  t h a n k God.  R: A n d when i t ' s o v e r ? failing  ... [ I ] j u s t  grade,  When y o u ' v e a s s i g n e d t h e  gone t h r o u g h g r i e v a n c e i f t h a t ' s  what's r e q u i r e d and i t ' s over? I:  It's like  a weight  has been l i f t e d o f f y o u r  shoulders. I: for  ...So i n t h e w h o l e s c e n a r i o i t made i t e a s i e r me t o d e a l w i t h t h e o t h e r two s t u d e n t s who •  w e r e weak c l i n i c a l l y  and had a l o t o f d i f f i c u l t i e s  making d e c i s i o n s under p r e s s u r e .  So i t made i t a  lot  easier.  One was s o c l o s e t o f a i l i n g  and  I h a d t o spend a l o t o f time w i t h him.  was  r e l i e v e d because I f e l t  Some s u c c e s s . I:  ...those  like  as w e l l So I  I h a d some t o o l s .  Some e x p e r i e n c e t o draw  two e x p e r i e n c e s , t h o s e  from.  initial  e x p e r i e n c e s h a v e r e a l l y p u t me o n g u a r d . In  t h e second  i n t e r v i e w , when t h i s  i n f o r m a n t was  a s k e d t o d e s c r i b e what she meant by b e i n g on g u a r d  she  replied: I : Okay. On  guard.  I t h i n k i t ' s as s o o n as  emotions  start  initiate  a l e a r n i n g p l a n or something  t o come o u t and y o u h a v e t o like  be r e a l l y a w a r e o f w h a t ' s g o i n g on and other people.  the  to  that to involve  Whereas n o r m a l l y i n t h e p a s t  wouldn't  have.  Now,  I:...you  r e a l l y had  I ' l l be much more t o get a system  t h a t ' s a c t u a l l y what h a p p e n e d .  I  ready.  down  and  I g o t a l o t more  q u i c k o f f t h e mark a b o u t g e t t i n g l e a r n i n g p l a n s s o o n as I t h o u g h t I:  t h e r e was  some u n e a s i n e s s . . . .  . . . I d e f i n i t e l y m o d i f i e d my  second  as  approach  w i t h the  one....  L o n g Term E f f e c t s In  the long term  significantly  , nurse  e d u c a t o r s were q u i t e  a f f e c t e d by t h e e x p e r i e n c e o f f a i l i n g  a  student. I:(the experience) how  clearly  ...  I g u e s s when I t h i n k  I can r e c a l l g i v e n t h e span of y e a r s  t h a t have t r a n s p i r e d from t h a t t i m e . a f f e c t e d me it  anytime  about  quite significantly.  I t must h a v e  I do r e f l e c t  anyone e l s e s h a r e s t h e i r  experience  on  about d o i n g a s i m i l a r t h i n g . • I:  ...Well, I c o n s t a n t l y t h i n k of those  when I'm c o n f r o n t e d w i t h a n o t h e r a similar I:  student  situations t h a t has  problem.  ...when s h e d i d come b a c k i n t o t h e p r o g r a m a n d  do s o w e l l .  That r e a l l y ,  more c o n f i d e n t i n f a i l i n g  I t h i n k , made me  feel  students.  R: T h a t t h e r e w e r e some p o s i t i v e s  there?  I : T h a t t h e r e was p o s i t i v e a s p e c t s , t h a t maybe my judgements weren't a l l bad.  Because I t h i n k o f t e n  when y o u a r e f a i l i n g  this  s e m e s t e r y o u do f e e l  that here's  she  can see t h e f i n i s h  line,  that you're going to t r i p yards  student  i n the f i n a l this  student..  a n d y o u ' r e s a y i n g no,  them up one h u n d r e d  short of t h e i r goal. Summing Up  The p r e d o m i n a n t o v e r r i d i n g theme w h i c h emerged f r o m t h e d a t a was s t r e s s . themes embedded  Two o t h e r  interrelated  i n the informants' d e s c r i p t i o n s of  t h e i r e x p e r i e n c e s were u n c e r t a i n t y and  isolation.  Nurse educators  i n their  often felt  unsupported  T h e s e themes a r e i n t e r r e l a t e d a n d i n t h e m s e l v e s i d e n t i f i e d as  stressors.  role. c a n be  The n u r s e e d u c a t o r s ' p e r c e p t i o n s o f t h e i r e x p e r i e n c e s were i n f l u e n c e d by t h e i r  subjective  a p p r a i s a l o f t h e v a r i a b l e s p r e s e n t i n each and  t h e d e g r e e o f harm, t h r e a t ,  perceived. the l i f e  situation  o r challenge they  V a r i a b l e s i n c l u d e d such c h a r a c t e r i s t i c s as  e x p e r i e n c e , commitment, v a l u e s , b e l i e f s , a n d  h e a l t h and energy  of the nurse educator.  Additional  f a c t o r s o f t e n i d e n t i f i e d as e x t e r n a l s t r e s s o r s c a n be broadly c l a s s i f i e d environmental  i n t o student v a r i a b l e s and  variables.  By a s s e s s i n g s t u d e n t a n d e n v i r o n m e n t a l the nurse educators determined and  whether t h e experiences  t h e i r consequences were i r r e l e v a n t ,  stressful.  variables,  positive, or  Once a c o g n i t i v e a p p r a i s a l was made a n d t h e  degree o f t h r e a t determined,  t h e e d u c a t o r s made  j u d g e m e n t s a s t o what m i g h t o r c o u l d be d o n e . this,  t h e i n f o r m a n t s examined t h e i r c o p i n g  a n d t h e s t r a t e g i e s a v a i l a b l e t o them. assessment o f t h e s i t u a t i o n a l  In doing  resources  T h i s i n c l u d e d an  s u p p o r t a v a i l a b l e t o them  from peers and a d m i n i s t r a t o r s . In order t o deal w i t h t h e i r s t r e s s f u l  experiences,  the nurse educators used a v a r i e t y o f coping strategies.  These c o n s i s t e d o f p r o b l e m - f o c u s e d and  emotion-focused solving,  a c t i o n s d i r e c t e d toward  problem-  along with e f f o r t s t o control the emotional  reactions arising  from t h e s i t u a t i o n .  Problem-focused  c o p i n g s t r a t e g i e s i n c l u d e d i n f o r m a t i o n s e e k i n g and t h e t a k i n g o f d i r e c t a c t i o n t o a l t e r one's Emotion-focused  responses  included seeking  support, v e n t i n g of anger, rationalization, In a d d i t i o n ,  approach.  physical  emotional  activity,  and d i s t a n c i n g . informants i d e n t i f i e d  long-term e f f e c t s of l i v i n g  through  immediate and  their  experiences.  Many o f t h e e f f e c t s t h e y i d e n t i f i e d h a d p o s i t i v e a s p e c t s such as f e e l i n g a sense o f r e l i e f confidence i n t h e i r a b i l i t y situations by  i n the future.  t o handle  as w e l l as  similar  Immediate e f f e c t s d e s c r i b e d -  i n f o r m a n t s i n c l u d e d b e i n g more on g u a r d i n  s i t u a t i o n s which might r e q u i r e e a r l y i n t e r v e n t i o n ,  as  w e l l as m o d i f y i n g and r e f i n i n g t h e i r approaches t o clinical  evaluation.  I n t h e l o n g term,  faculty  were q u i t e s i g n i f i c a n t l y a f f e c t e d by t h e i r  members  experiences.  These s i t u a t i o n s p r o v i d e d an e x p e r i e n t i a l base f o r t h e nurse  educator  o r f o r h e r c o l l e a g u e s who w e r e  w i t h o t h e r students having s i m i l a r problems.  working A number  of i n f o r m a n t s d e s c r i b e d t h e e x p e r i e n c e as c o n f i d e n c e -  building.  The  experience  served  to r e i n f o r c e that  " t h e i r j u d g e m e n t s w e r e n ' t a l l bad." described  f e e l i n g more c o n f i d e n t  work w i t h s t u d e n t s  who  were not  semester o b j e c t i v e s w h i l e others  Some  informants  in their abilities a b l e t o meet expressed  d i s t a n c e t h e m s e l v e s f r o m t h e s i t u a t i o n by  to  the  a desire  to  never  teaching  i n that p a r t i c u l a r semester again or l e a v i n g  teaching  altogether.  The  f o l l o w i n g framework  represents a failing  nurse educators' grade.  ( F i g u r e 1) g r a p h i c a l l y experiences  with  assigning  VARIABLES INFLUENCING APPRAISAL SUPPORT  Nurse Educator 1. 2. 3. 4.  / /  Life Expartenco Commitment Values and Beliefs Health A Energy  \  7 /  \ \ \ A  /  Throat  \  /  \  <  ^  Cognitive A Appraisal  ^  OR^  "Challenge  ^  COPING  Coping Strategies student  Environment  1. Insight 2. Expectations 3. Extenuating Circumstances  1. Clinical Agency 2. Educational Institution  Problem-focused 1. Information Seeking 2. Direct Action to Alter One's Approach Emotion-focused  STRESS F i g u r e 1.  Adaptation of Lazarus's Framework to Depict  Nurse Educators' Experiences with Assigning Grade.  a Failing  1. Seeking Emotional Support 2. Venting of Anger 3. Engaging In Physical Activities 4. Rationalization 5. Distancing  /  IMMEDIATE EFFECTS  \ LONG-TERM EFFECTS  CHAPTER F I V E Sliinmary, C o n c l u s i o n s ,  and  Implications  Summary The  purpose of t h i s  s t u d y was  i m p a c t on n u r s e e d u c a t o r s to  students  diploma  e n r o l e d i n the  n u r s i n g program.  m e t h o d o l o g y , and  Lazarus's  framework, n i n e i n f o r m a n t s  final Using  t h e f o r m s and  types  and  had  one  to over  Three informants student than  w h i l e two  nursing  audio-taped.  From  The  diverse.  assigned  the  identify  to describe  the  educational preparation They w e r e a l l f e m a l e  of teaching  experience.  grades to only  failing  one  g r a d e s t o more  s i x students. The  f i n d i n g s of the study  assigning a f a i l i n g final was  diploma  issued f a i l i n g  had  theoretical  c u r r e n t l y employed i n  ten years  had  clinical  a stressful  a  phenomenological  o f phenomena and  was  grade  semester of  data a n a l y s i s sought t o  essence of the experience. of the informants  clinical  process-oriented  p r o g r a m s w e r e i n t e r v i e w e d and accounts  the  of a s s i g n i n g a f a i l i n g  B r i t i s h C o l u m b i a Lower M a i n l a n d  informants'  to explore  illustrate  that  grade to a n u r s i n g student  semester of a diploma  i n the  n u r s i n g program  event f o r nurse educators.  The  prominent  o v e r r i d i n g concept which  d a t a was  stress.  S t r e s s was  emerged f r o m  d e f i n e d as  " r e l a t i o n s h i p b e t w e e n t h e p e r s o n and  the  the  environment  t h a t i s a p p r a i s e d by t h e p e r s o n as t a x i n g o r his  o r h e r r e s o u r c e s and  being"  endangering  ( L a z a r u s & F o l k m a n , 1984b, p.  Two  exceeding  h i s or her 19).  experienced  some d e g r e e o f  stress.  w e r e a l s o embedded i n t h e i n f o r m a n t s '  d e s c r i p t i o n s of t h e i r experience.  U n c e r t a i n t y was  c o n c e p t u a l i z e d as t h e s e l f - d o u b t e x p e r i e n c e d by e d u c a t o r s as t o w h e t h e r t h e y w e r e d o i n g t h e  responsible for their decisions. they f e l t  a l a c k of support  administrators.  interrelated themselves,  indicated  informants described at  i s o l a t e d i n the  T h e s e two  clinical could act  themes w e r e  i n the informants' accounts stressors.  solely  Often they  and d i s t a n c e d f r o m c o l l e a g u e s who  a source of support.  nurse  f r o m c o l l e a g u e s and  In addition,  times f e e l i n g p h y s i c a l l y  nurse  right  I s o l a t i o n d e s c r i b e d the perceptions the  e d u c a t o r s e x p r e s s e d about u l t i m a t e l y b e i n g  setting,  the  o t h e r i n t e r r e l a t e d t h e m e s , u n c e r t a i n t y and  isolation,  thing.  well-  While  s o u r c e s o f s t r e s s v a r i e d , b o t h n o v i c e and educators described f e e l i n g  the  and w e r e , i n  as  The was  u n i q u e n e s s and  influenced  c o m p l e x i t y of  by m u l t i p l e  variables  i n t e r r e l a t i o n s h i p among them. t h e way  the  Uncertainty could  be  as  interpreted  l e d t o a m b i g u i t y and  or s t r e s s f u l .  r e s o u r c e s and  the  influenced  events.  to nurse educators appraising  threatening  the  variables  t o t h e m u l t i p l e ways t h a t  of the v a r i a b l e s ,  be  and  nurse educator appraised as  contributed  The  each s i t u a t i o n  B a s e d on  variables thus the  their  situation appraisal  i n f o r m a n t s examined t h e i r  made j u d g e m e n t s as  t o what m i g h t o r  could  done. The  e d u c a t o r s used a v a r i e t y of  c o n s i s t i n g of a c t i o n s along with arising  information  situation.  These  emotional  s e e k i n g , d i r e c t a c t i o n t o a l t e r one's  activity,  In a d d i t i o n ,  r a t i o n a l i z a t i o n , and  aspects. included  the  of  anger,  distancing.  educators i d e n t i f i e d immediate  l o n g - t e r m e f f e c t s of Many o f  reactions  included  approach, seeking emotional support, venting physical  strategies  d i r e c t e d toward problem-solving  e f f o r t s to c o n t r o l the  from the  coping  living  through t h e i r experience.  e f f e c t s t h e y i d e n t i f i e d had  Immediate e f f e c t s d e s c r i b e d b e i n g more on  and  by  positive informants  g u a r d , as w e l l as m o d i f y i n g  and  refining  t h e i r approach  to c l i n i c a l  evaluation.  l o n g - t e r m outcomes i n d i c a t e d t h a t f a c u l t y q u i t e s i g n i f i c a n t l y a f f e c t e d by t h e i r These s i t u a t i o n s nurse  The  members w e r e '  experiences.  s e r v e d as a p o i n t o f r e f e r e n c e f o r  e d u c a t o r s when f a c e d w i t h o t h e r s t u d e n t s  s i m i l a r problems.  having  A number o f i n f o r m a n t s d e s c r i b e d t h e  e x p e r i e n c e as c o n f i d e n c e - b u i l d i n g , s e r v i n g t o r e i n f o r c e that  " t h e i r judgements weren't a l l bad."  Some  i n f o r m a n t s d e s c r i b e d f e e l i n g more c o n f i d e n t i n t h e i r abilities  t o w o r k w i t h s t u d e n t s who w e r e h a v i n g  difficulties  meeting  the semester  o b j e c t i v e s and i n  u l t i m a t e l y having to assign a f a i l i n g not a l l informants  felt  t h i s way.  grade.  One  However,  informant  recalled  not ever wanting  to teach i n the f i n a l  semester  again, w h i l e another  thoughts  of l o o k i n g f o r other job prospects w i t h  informant  disclosed less  s t r e s s a n d more j o b s a t i s f a c t i o n . Conclusions T h r e e m a j o r c o n c l u s i o n s c a n be i d e n t i f i e d f r o m t h e findings. student  assigning a failing  i s a s t r e s s f u l event.  expressed peers.  First,  a need f o r e m o t i o n a l  grade t o a  Second, nurse support  from  educators their  T h i r d , program a d m i n i s t r a t o r s c o u l d and s h o u l d  be  supportive to nurse educators  i n two  a c k n o w l e d g e m e n t o f t h e s i t u a t i o n and  areas:  reassurance  and  c o n s i s t e n t a d m i n i s t r a t i o n of e d u c a t i o n a l p o l i c i e s . Implications for Nursing Nursing  Education  Graduate programs p r e p a r i n g nurse educators benefit  from the f i n d i n g s of t h i s  t h e u n d e r s t a n d i n g o f s t r e s s and  study which  i t s impact  enhance  on t h e  e d u c a t o r and n u r s i n g e d u c a t i o n as a w h o l e . t u r n may  may  nurse  This i n  p r o v i d e the b a s i s f o r the development of  c u r r i c u l u m content r e l a t e d to the t e a c h i n g / e v a l u a t i o n process.  T h u s , a c t i o n s c a n be d i r e c t e d  toward  m i n i m i z i n g the s t r e s s nurse educators experience  and  decreasing the p o t e n t i a l of t h e i r l e a v i n g  clinical  t e a c h i n g f o r l e s s s t r e s s f u l and  more  rewarding  seemingly  positions.  Furthermore,  a d m i n i s t r a t o r s of n u r s i n g e d u c a t i o n  programs need t o examine t h e e f f e c t s of p o l i c i e s program i n i t i a t i v e s faculty,  and how  and  t h e i r implementation  t h e s e may  and  on  u l t i m a t e l y h a v e an i m p a c t  the q u a l i t y of the graduate.  Resources  on  s h o u l d be made  a v a i l a b l e t o p r o v i d e nurse educators w i t h adequate s u p p o r t and a s s i s t a n c e t o d e a l w i t h t h e i n c r e a s e d  workload  experienced  students.  when w o r k i n g  with  failing  D e b r i e f i n g o p p o r t u n i t i e s s h o u l d be p r o v i d e d .  E d u c a t i o n a l a d m i n i s t r a t o r s need t o acknowledge t h a t they and  recognize  the stresses inherent i n the s i t u a t i o n  appreciate the considerable effort  members e x p e n d d u r i n g t h e p r o c e s s .  that  faculty  •  E d u c a t i o n a l a d m i n i s t r a t o r s o f n u r s i n g p r o g r a m s may wish  to explore the potential benefit faculty  may p r o v i d e , p a r t i c u l a r l y  to novice  mentors  f a c u l t y members.  T h e s e m e n t o r s may be a b l e t o p r o v i d e t h e much n e e d e d support,  validation,  a n d f e e d b a c k many n u r s i n g  seem t o l a c k when w o r k i n g  with failing  faculty  students.  Nursing Research , There i s a need f o r f u r t h e r r e s e a r c h i n t h i s Using to  a p h e n o m e n o l o g i c a l p e r s p e c t i v e , i t may be u s e f u l  examine whether n u r s e e d u c a t o r s  programs share  i n baccalaureate  s i m i l a r or c o n t r a s t i n g perceptions of  t h e i r experience. by  area.  A d d i t i o n a l i n s i g h t s m i g h t be  gained  examining t h e r e l a t i o n s h i p o f t h e v a r i a b l e s and t h e  effectiveness of coping educator's  experience  responses,  level.  and t h e n u r s e  I n a d d i t i o n , the concept  of s t r e s s and t h e i n t e r r e l a t i o n s h i p s o f u n c e r t a i n t y and i s o l a t i o n warrant  further in-depth a n a l y s i s .  Lastly,  r e s e a r c h i s needed t o c o n f i r m whether o r not educators of these nursing  do,  i n fact,  experiences  leave c l i n i c a l  and,  by n u r s e e d u c a t o r s  to  on  provided a phenomenological  who  and  feelings  assign f a i l i n g  enroled i n the f i n a l n u r s i n g program.  encapsulate  through  because  i f s o , what i s t h e i m p a c t  d e s c r i p t i o n of the p e r c e p t i o n s  diploma  teaching  education.  T h i s t h e s i s has  students  nurse  The  clinical  grades to  :  semester of  a  f i n d i n g s have attempted  the essence of the experience  the eyes of the  experienced  informants.  as  viewed  References A n d e r s o n , D. M., & S a x o n , J . (1968) . P e r f o r m a n c e evaluation of nursing students. Nursing Outlook, ( 5 ) , 56-58.  16  B a t e y , M. V. (1969). The two n o r m a t i v e w o r l d s o f t h e university nursing faculty. N u r s i n g Forum, 8, ( 1 ) , . 5-17. 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( 1 9 7 3 ) . E v a l u a t i o n i s more t h a n m e a s u r e m e n t . A m e r i c a n J o u r n a l o f N u r s i n g , 73, 114-116.  (1),  K r a m e r , M. (1966) . Some e f f e c t s o f e x p o s u r e t o employing success i n h o s p i t a l nursing. Nursing R e s e a r c h , 19, ( 5 ) , 428-434. L a n k s h e a r , A. ( 1 9 9 0 ) . F a i l u r e t o f a i l : The t e a c h e r ' s d i l e m m a . N u r s i n g S t a n d a r d , 4, ( 2 0 ) , 3 5 - 3 7 . L a z a r u s , R. S. (1966). P h y s i o l o g i c a l s t r e s s and c o p i n g p r o c e s s . New Y o r k : McGraw-Hill.  the  L a z a r u s , R. S., & F o l k m a n , S. (1984a). C o p i n g and adaptation. I n W.D. G e n t r y ( E d . ) , The h a n d b o o k o f b e h a v i o r a l m e d i c i n e (pp.282-325). New Y o r k : Guilford. L a z a r u s , R. S., & F o l k m a n , a p p r a i s a l , and c o p i n g . Publishing. L a z a r u s R. coping. coping: Columbia  S. New  (1984b). Stress, York: Springer  S., & F o l k m a n , S. ( 1 9 9 1 ) . The c o n c e p t o f I n A. Monat & R. L a z a r u s ( E d s . ) , S t r e s s a n d An a n t h o l o g y (pp. 1 8 9 - 2 2 7 ) . New Y o r k : University Press.  L a z a r u s , R., & L a u n i e r , F. (1978). Stress-related t r a n s a c t i o n s between p e r s o n and e n v i r o n m e n t . I n L. P e r v i n & M. L e w i s ( E d s . ) , Perspectives i n i n t e r n a t i o n a l p s y c h o l o g y (pp. 2 8 7 - 3 2 7 ) . New Y o r k : Plenum P u b l i s h i n g . L e i n i n g e r , M. M. ( 1 9 8 5 ) . E t h n o g r a p h y and e t h n o n u r s i n g : M o d e l s a n d modes o f q u a l i t a t i v e d a t a a n a l y s i s . I n M. M. L e i n i n g e r ( E d . ) , Qualitative research methods i n n u r s i n g , (pp.33-69). New Y o r k : Grune & S t r a t t o n I n c .  L e n h a r t , R. C. (1980). F a c u l t y b u r n o u t - - a n d some reasons why. (EDITORIAL) N u r s i n g O u t l o o k , 28 ( 7 ) , 424-425. L e s s n e r , M. W. (1990). Avoiding student-faculty l i t i g a t i o n . N u r s e E d u c a t o r , 15 ( 6 ) , 2 9 - 3 2 . L e v y , M. R., D i g n a n , M., & S h i r r e f f s , J . H. ( 1 9 8 7 ) . and h e a l t h . New Y o r k : Random House. M a r r i n e r , A., & C r a i g i e , D. (1977). and m o b i l i t y o f n u r s i n g e d u c a t o r s . 26, ( 5 ) , 3 4 9 - 3 6 0 .  Life  Job s a t i s f a c t i o n Nursing Research,  M u n h a l l , P. L., & O i l e r , C. J . ( 1 9 8 6 ) . Nursing research: A qualitative perspective. Connecticut: Appleton-Century-Crofts. O'Connor, A. B. ( 1 9 7 8 ) . S o u r c e s o f c o n f l i c t f o r f a c u l t y members. J o u r n a l o f N u r s i n g E d u c a t i o n , 17, (5), 35-38. O r c h a r d , C. ( 1 9 9 2 ) . F a c t o r s t h a t i n t e r f e r e w i t h c l i n i c a l judgement o f s t u d e n t s ' performance. Journal of Nursing Education, 31, ( 7 ) , 309-313. P o l l o k , C. S., P o t e e t , G. W. (1983). Diminishing . faculty l i a b i l i t y . N u r s e E d u c a t o r , 8. ( 1 ) , 31-34 Ray, G. J . ( 1 9 8 4 ) . nursing faculty. 218-221.  Burnout; p o t e n t i a l problem f o r N u r s i n g a n d H e a l t h C a r e , 5, ( 4 ) ,  S c h u l e r , R. S. ( 1 9 7 5 ) . R o l e p e r c e p t i o n s , s a t i s f a c t i o n , and p e r f o r m a n c e ; a partial reconciliation. Journal o f A p p l i e d P s y c h o l o g y , 60, ( 6 ) , 683-687. S c h u l e r , R. S., A l d a g , R. J . , & B r i e f , A. B. (1977). R o l e c o n f l i c t and a m b i g u i t y ; a scale analysis. O r g a n i z a t i o n a l B e h a v i o r a n d Human P e r f o r m a n c e , 20, 111-128. S p i e g e l b e r g , H. ( 1 9 6 0 ) . The p h e n o m e n o l o g i c a l movement: A historical introduction: V o l . 2. The Hague: Martinus Nijhoff.  S p i n k , L. M. (1983). Due p r o c e s s i n a c a d e m i c dismissals. J o u r n a l o f N u r s i n g E d u c a t i o n , 22, ( 7 ) , 305-306. S y m a n s k i , M. E. ( 1 9 9 1 ) . Reducing the e f f e c t of f a c u l t y d e m o r a l i z a t i o n when f a i l i n g s t u d e n t s . N u r s e E d u c a t o r , 16, ( 3 ) , 18-22. T u r k e t t , S. (1987). L e t ' s take the " i " out o f f a i l u r e . J o u r n a l o f N u r s i n g E d u c a t i o n , 26, ( 6 ) , 2 4 6 - 2 4 7 . W e l b o r n , P., & Thompson, D. ( 1 9 8 2 ) . Strategies for d e a l i n g w i t h s t u d e n t s whose c l i n i c a l p e r f o m a n c e i s unsatisfactory. Journal of Nursing Education, 21, (5), 26-30. W i l l i a m s o n , J . A. (1972). The c o n f l i c t - p r o d u c i n g r o l e o f t h e p r o f e s s i o n a l s o c i a l i z e d n u r s e - f a c u l t y member. N u r s i n g Forum, 11, ( 4 ) , 357-366. Wood, V. ( 1 9 7 1 ) . The b o r d e r l i n e s t u d e n t n u r s e . Papers, 15, ( 2 6 ) , 15-26.  Nursing  Appendix A E x p l a n a t o r y L e t t e r f o r Agency Consent  THE  UNIVERSITY  OF B R I T I S H  COLUMBIA  School of Nursing T. 206-2211 Wesbrook Mall Vancouver, B.C. Canada V6T 2B5 Fax: (604) 822-7466  Dear My name i s Susan Greathouse. I am a nurse educator c u r r e n t l y e n r o l e d i n graduate s t u d i e s i n n u r s i n g a t the U n i v e r s i t y o f B r i t i s h Coltimbia. My master's t h e s i s e n t i t l e d The Impact of A s s i g n i n g a F a i l i n g Grade t o a Student i n the F i n a l C l i n i c a l Semester i s d i r e c t e d toward d e s c r i b i n g t h i s experience from the p e r s p e c t i v e o f c o l l e g e nurse e d u c a t o r s . I t has been my o b s e r v a t i o n that f a i l u r e t o complete the f i n a l c l i n i c a l semester o f a n u r s i n g program o f t e n r e s u l t s i n student responses d i f f e r e n t from and more exaggerated than c l i n i c a l f a i l u r e s i n e a r l i e r semesters. These s i t u a t i o n s which are o f t e n coupled w i t h h i g h l y e m o t i o n a l l y charged student responses, may have a major and l a s t i n g impact on nurse e d u c a t o r s . The l a c k of researched-based data on t h i s t o p i c has l e a d t o the development o f t h i s study. Being aware o f t h e f e e l i n g s and r e a c t i o n s that may r e s u l t from such s i t u a t i o n s may a s s i s t nurse educators t o cope w i t h t h i s aspect o f c l i n i c a l e v a l u a t i o n more e f f e c t i v e l y . My purpose i n w r i t i n g t o you i s two f o l d : (1) t o request consent from you t o d i s c u s s the study w i t h i n t e r e s t e d f a c u l t y members and (2) t o request an o p p o r t u n i t y t o meet w i t h your i n s t r u c t o r s t o e x p l a i n the study. I welcome the o p p o r t u n i t y t o meet and present itry p r o p o s a l and respond t o any q u e s t i o n s you o r your f a c u l t y may have.  I t i s my i n t e n t i o n to i n t e r v i e w nurse educators who have a s s i g n e d a f a i l i n g grade to at l e a s t one n u r s i n g student i n the f i n a l c l i n i c a l semester. F a c u l t y who agree t o p a r t i c i p a t e i n t h i s study would r e q u i r e a s e r i e s of two o r perhaps t h r e e onehour u n s t r u c t u r e d audio-taped i n t e r v i e w s . In a d d i t i o n , each p a r t i c i p a n t w i l l be asked to answer a few demographic q u e s t i o n s . A l l information obtained i s c o n f i d e n t i a l . The name o f the agency, s t u d e n t ( s ) or f a c u l t y member w i l l not be r e v e a l e d . An a b s t r a c t w i l l be a v a i l a b l e t o you and t o any i n t e r e s t e d f a c u l t y member on request once the study i s complete. For purposes of the U n i v e r s i t y of B r i t i s h Columbia e t h i c a l review committee, w r i t t e n evidence of agency consent i s r e q u i r e d f o r a p p r o v a l of the study. Please f i n d e n c l o s e d the agency consent form. Please contact me t o arrange an appointment. My home phone number i s Thank you f o r your c o o p e r a t i o n .  Sincerely  Susan E. Greathouse, RN, BN  Thesis chair: Dr. M a r i l y n D. Willman  Ill  Appendix B A g e n c y C o n s e n t Form  I, the undersigned, g i v e permission to Susan Greathouse to meet w i t h f a c u l t y r e g a r d i n g p a r t i c i p a t i o n i n her study e n t i t l e d The Impact of A s s i g n i n g a F a i l i n g Grade to a Student i n the F i n a l C l i n i c a l Semester.  Signature  of Department Head:  Agency: Signature  of Researcher:  Date:  Thesis Chair: Dr. M a r i l y n D.  Willman  Appendix C Letter to  Informants  THE  UNIVERSITY  OF BRITISH  COLUMBIA  School of Nursing T. 206-2211 Wesbrook Mall Vancouver, B.C. Canada V6T 2B5 Fax: (604) 822-7466  Dear N u r s i n g C o l l e a g u e : My name i s Susan Greathouse. I am a nurse educator c u r r e n t l y e n r o l e d i n graduate s t u d i e s i n n u r s i n g a t the U n i v e r s i t y o f B r i t i s h Columbia. My master's t h e s i s e n t i t l e d The Impact o f A s s i g n i n g a F a i l i n g Grade t o a Student i n the F i n a l C l i n i c a l Semester i s d i r e c t e d toward d e s c r i b i n g t h i s e x p e r i e n c e from the p e r s p e c t i v e of c o l l e g e nurse e d u c a t o r s . I t has been m/ o b s e r v a t i o n that f a i l u r e t o complete the f i n a l c l i n i c a l semester o f a n u r s i n g program r e s u l t s i n student responses d i f f e r e n t from and more exaggerated than c l i n i c a l f a i l u r e s i n e a r l i e r semesters. These s i t u a t i o n s , which a r e o f t e n coupled w i t h h i g h l y e m o t i o n a l l y charged student responses, may .have a major and l a s t i n g impact on nurse e d u c a t o r s . The l a c k o f researched-based data on t h i s t o p i c has l e a d t o the development of t h i s study. Being aware of t h e f e e l i n g s and r e a c t i o n s that may r e s u l t from such s i t u a t i o n s may a s s i s t nurse educators t o cope w i t h t h i s aspect o f c l i n i c a l e v a l u a t i o n more e f f e c t i v e l y . I am seeking your p a r t i c i p a t i o n i n t h i s study i f you have had t o f a i l one o r more students i n the f i n a l c l i n i c a l semester. Your involvement i n t h i s study w i l l i n c l u d e s h a r i n g your experiences i n a s e r i e s of two o r perhaps t h r e e one-hour u n s t r u c t u r e d audio-taped i n t e r v i e w s . These i n t e r v i e w s w i l l be • conducted a t a convenient time f o r you and i n a m u t u a l l y agreed upon l o c a t i o n . In a d d i t i o n , you w i l l be asked t o answer a  few demographic q u e s t i o n s . A l l i n f o r m a t i o n o b t a i n e d w i l l remain c o n f i d e n t i a l . The name o f t h e agency, s t u d e n t ( s ) o r f a c u l t y member w i l l n o t be r e v e a l e d . Upon c o m p l e t i o n o f t h e s t u d y a l l a u d i o - t a p e s and w r i t t e n t r a n s c r i p t s o f i n t e r v i e w s w i l l be d e s t r o y e d . You a r e under no o b l i g a t i o n t o p a r t i c i p a t e i n t h i s s t u d y and r e f u s a l t o do so w i l l i n no way a f f e c t your t e a c h i n g p o s i t i o n . You may w i t h d r a w from t h e study a t any time o r r e f u s e t o answer any q u e s t i o n s . I f you a r e i n t e r e s t e d i n p a r t i c i p a t i n g i n t h i s study, o r need more i n f o r m a t i o n , p l e a s e c o n t a c t me a t  Sincerely,  Susan Greathouse, RN, BN  Thesis c h a i r : Dr. M a r i l y n D. Willman  Appendix D S u b j e c t C o n s e n t Form  The Impact o f A s s i g n i n g a F a i l i n g Grade t o a Student i n t h e F i n a l C l i n i c a l Semester I u n d e r s t a n d t h a t Susan Greathouse's s t u d y c o n c e r n s my e x p e r i e n c e w i t h a s s i g n i n g a f a i l i n g c l i n i c a l grade t o a n u r s i n g s t u d e n t i n t h e f i n a l c l i n i c a l semester o f a d i p l o m a n u r s i n g program. I understand that being a subject w i l l i n v o l v e two t o t h r e e i n t e r v i e w s , each a p p r o x i m a t e l y one hour i n l e n g t h . The i n t e r v i e w s w i l l be a u d i o - t a p e d and t r a n s c r i b e d and w i l l t a k e p l a c e a t a m u t u a l l y agreed upon p l a c e and t i m e . I u n d e r s t a n d t h a t c o n f i d e n t i a l i t y w i l l be m a i n t a i n e d by c o d i n g o f t h e t r a n s c r i p t s . My name and any i d e n t i f y i n g i n f o r m a t i o n o b t a i n e d i n t h e study w i l l not be r e v e a l e d . I u n d e r s t a n d I am under no o b l i g a t i o n t o p a r t i c i p a t e i n t h i s s t u d y and r e f u s a l t o p a r t i c i p a t e w i l l n o t a f f e c t my t e a c h i n g position. I may withdraw a t any time o r r e f u s e t o answer any questions. My q u e s t i o n s have been answered and I u n d e r s t a n d t h a t I can c o n t a c t Susan Greathouse a t i f I have f u r t h e r q u e r i e s . I, t h e u n d e r s i g n e d , understand t h e n a t u r e o f Susan Greathouse's s t u d y and g i v e my consent t o p a r t i c i p a t e . I acknowledge r e c e i v i n g a copy o f t h i s consent. NAME PHONE NUMBER SIGNATURE DATE  Appendix E D e m o g r a p h i c D a t a Form  The f o l l o w i n g data a r e t o be used i n aggregate from o n l y . check the a p p r o p r i a t e response and/or f i l l i n the b l a n k s .  Please  PERSONAL BACKGROUND DATA; 1.  What ( ) ( ) ( ) ( )  i s your age bracket? 20-29 30-39 40-49 50 and Over  2.  What have ( ) ( ) ( ) ( ) ( )  i s the h i g h e s t l e v e l of e d u c a t i o n a l p r e p a r a t i o n you obtained? BScN MSN MEd PhD Other (Please s p e c i f y )  3.  How many ( ) 0-12 ( ) From ( ) From ( ) From ( ) Over  years of t e a c h i n g experience do you have? months 1 t o 3 years 3 t o 6 years . • 6 t o 10 years 10 years  4.  How long teaching ( ) Less ( ) From ( ) From ( ) From ( ) Over  have you been employed i n your c u r r e n t position? than 1 year 1 t o 3 years 3 t o 5 years 6 t o 10 years 10 years  5.  How many students who have been i n t h e i r f i n a l c l i n i c a l semester have you f a i l e d d u r i n g your t e a c h i n g career? ( ) 1 student ( ) 2 students ( ) 3 students ( ) 4-5 students ( ) More than 6 students  Appendix F Interview Questions  Trigger  Questions:  Primary : 1.  D e s c r i b e what i t i s l i k e (from a n u r s i n g educator's p e r s p e c t i v e ) t o inform a n u r s i n g student that h/she has not met the c l i n i c a l course o b j e c t i v e s i n the f i n a l c l i n i c a l semester.  Secondary: 1.  D e s c r i b e how you f e l t when you had t o f a i l a student c l i n i c a l l y i n the f i n a l semester of a diploma n u r s i n g program?  2.  What h e l p s you d e a l w i t h the f e e l i n g s that may a r i s e i n this situation?  3.  What makes the s i t u a t i o n more  difficult?  

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