Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

The effect of a relationship-building activity on nursing student anxiety in the clinical setting Sundberg, Sharon Eloise 1988

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1988_A5_7 S96.pdf [ 4.44MB ]
Metadata
JSON: 831-1.0097602.json
JSON-LD: 831-1.0097602-ld.json
RDF/XML (Pretty): 831-1.0097602-rdf.xml
RDF/JSON: 831-1.0097602-rdf.json
Turtle: 831-1.0097602-turtle.txt
N-Triples: 831-1.0097602-rdf-ntriples.txt
Original Record: 831-1.0097602-source.json
Full Text
831-1.0097602-fulltext.txt
Citation
831-1.0097602.ris

Full Text

THE EFFECT OF A RELATIONSHIP-BUILDING ACTIVITY ON NURSING STUDENT ANXIETY IN THE CLINICAL SETTING  by  SHARON ELOISE SUNDBERG BSNf The U n i v e r s i t y of B r i t i s h Columbia, 1969  A THESIS SUBMITTED  IN PARTIAL FULFILMENT OF  THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING  in THE FACULTY OF GRADUATE STUDIES. School of Nursing  We a c c e p t t h i s t h e s i s as conforming to the required  standard  THE UNIVERSITY OF BRITISH COLUMBIA August 1988 ©  Sharon E. Sundberg/ 1988  In presenting  this thesis in partial fulfilment  of the  requirements for an advanced  degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department  or  by  his  or  her  representatives.  It  is  understood  that  copying  or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department of  Nursing  The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date  August 15, 1988  ii Abstract A p r e - t e s t p o s t - t e s t group d e s i g n was used t o d e t e r m i n e whether s t u d e n t n u r s e s who r e c e i v e d  a relationship-building  i n t e r v e n t i o n would r a t e t h e i r r e l a t i o n s h i p w i t h t h e i n s t r u c t o r h i g h e r than t h o s e who r e c e i v e d whether s t u d e n t n u r s e s who r e c e i v e d have l e s s s t a t e a n x i e t y  a placebo/  t h e i n t e r v e n t i o n would  than t h o s e who r e c e i v e d  a placebo/  and whether t h e r e was a r e l a t i o n s h i p between r a t i n g s o f s t a t e a n x i e t y and s t u d e n t - i n s t r u c t o r  relationships.  i n t e r v e n t i o n was d e s i g n e d t o occur over a t h r e e - d a y  The period.  Data were c o l l e c t e d from a homogenous sample o f 30 c o n t r o l nursing  s t u d e n t s and 31 e x p e r i m e n t a l n u r s i n g  Effectiveness  o f t h e i n t e r v e n t i o n was determined by  measuring s t u d e n t a n x i e t y l e v e l s u s i n g Anxiety Inventory (Spielberger/ and  students.  Gorsuch/ & Lushene/ 1970)  by measuring t h e s t u d e n t - i n s t r u c t o r  the R e l a t i o n s h i p C a r k h u f f / 1967).  the S t a t e - T r a i t  r e l a t i o n s h i p using  Q u e s t i o n n a i r e (adapted from Truax & A d d i t i o n a l d a t a were c o l l e c t e d from a  S t r e s s f u l Event Q u e s t i o n n a i r e / a demographic d a t a form/ and a debriefing session with p a r t i c i p a t i n g instructors. A n a l y s i s o f d a t a i n d i c a t e d a t r e a t m e n t main e f f e c t was statistically significant. group r a t e d t h e p e r c e i v e d  Members o f t h e e x p e r i m e n t a l r e l a t i o n s h i p with the i n s t r u c t o r  h i g h e r t h a n members o f t h e c o n t r o l group.  There was no  s i g n i f i c a n t d i f f e r e n c e between groups i n t h e i r r a t i n g s o f anxiety.  There was a t r e n d / however/ f o r those i n t h e  e x p e r i m e n t a l g r o u p t o have l o w e r s t a t e in  the  control  group.  student-instructor s c o r e s were low direction.  Correlations  anxiety than  between  r e l a t i o n s h i p s c o r e s and  b u t were i n t h e  anticipated  tho  the the  anxiety  negative  iv Table  of Contents Page  Abstract  i  List  v i i i  of Tables  Acknowledgements CHAPTER  i  i x  ONE  Introduction  1  Background  t o the Problem  1  Problem  4  Purpose  5  Definition  o f Terms  . . . . .  5  Assumptions  7  Ethics  8  a n d Human R i g h t s  Significance CHAPTER  t o Nursing  9  TWO  Conceptual  Framework  and L i t e r a t u r e Review  10  Conceptual  Framework  10  Literature  Review  14  The C l i n i c a l of  Anxiety  S e t t i n g as a  and S t r e s s  Interventions  f o rAnxiety  Groups o f Nursing The  Source 14 i n  Students  Effect of Interpersonal  on Student A n x i e t y  Levels  23 Relationships 27  V  Page CHAPTER THREE Methodology  34  Research Design  34  Control of V a r i a b l e s  34  S e t t i n g and Sample  38  Instruments  39  State-Trait Anxiety  Inventory  39  Relationship Questionnaire  40  S t r e s s f u l Event Q u e s t i o n n a i r e  42  Demographic Data  43  Procedure  43  Data A n a l y s i s  46  CHAPTER FOUR R e s u l t s and D i s c u s s i o n  48  Results  48  Attrition  48  Demographic C h a r a c t e r i s t i c s o f S u b j e c t s H y p o t h e s i s One:  48  E f f e c t of Intervention  on S t u d e n t - I n s t r u c t o r H y p o t h e s i s Two:  ...  Relationship  49  E f f e c t of Intervention  on S t a t e A n x i e t y  52  H y p o t h e s i s Three:  R e l a t i o n s h i p Between  Student-Instructor  R e l a t i o n s h i p Score  and S t a t e A n x i e t y Score  55  vi Page A Comparison o f T r a i t A n x i e t y of C o n t r o l and E x p e r i m e n t a l  Scores  Groups  56  Data from S t r e s s Q u e s t i o n n a i r e  56  D e s c r i p t i v e I n f o r m a t i o n from a D e b r i e f i n g Session with I n s t r u c t o r s  58  Discussion  60  I n t e r v e n t i o n E f f e c t on S t u d e n t Instructor Relationship  60  I n t e r v e n t i o n E f f e c t on Student State Anxiety  61  C o r r e l a t i o n Between Scores o f S t u d e n t I n s t r u c t o r R e l a t i o n s h i p and A n x i e t y Limitations  . . . .  63 63  CHAPTER FIVE Summary/ C o n c l u s i o n s / and Recommendations f o r F u r t h e r Research  65  Summary o f t h e Study  65  Conclusions  68  I m p l i c a t i o n s f o r Nursing Education  69  Recommendations f o r F u r t h e r Research  71  References  74  Appendixes A.  S e l f - E v a l u a t i o n Questionnaire STAI FORM X - l  81  vii Page B.  Self-Evaluation  Questionnaire  STAI FORM X-2  84  C.  Relationship Questionnaire  87  D.  R e l a t i o n s h i p - b u i l d i n g A c t i v i t i e s Package . .  91  E.  Explanatory L e t t e r - Directorr  Level I  Co-ordinator F.  100  Explanatory L e t t e r - P a r t i c i p a t i n g F i r s t Year I n s t r u c t o r s  G.  Explanatory Letter - Subjects f o r Instrument V a l i d a t i o n Test  H.  103  Explanatory L e t t e r -  106  Control  and E x p e r i m e n t a l S u b j e c t s  109  I.  S t r e s s f u l Event Q u e s t i o n n a i r e  112  J.  Demographic  114  K.  F i g u r e 1:  Data Form P l o t of S t a t e A n x i e t y  S c o r e s by Treatment Group L.  F i g u r e 2:  116  P l o t of S t a t e A n x i e t y  S c o r e s by I n s t r u c t o r s  118  viii L i s t of Tables Table  Page  1.  P l a n f o r C o n t r o l Group  36  2.  Plan f o r Experimental  3.  A Comparison o f E x p e r i m e n t a l  Group  37 and C o n t r o l  S u b j e c t s by Age/ Sex* M a r i t a l S t a t u s * and Occupation 4.  P r i o r t o Enrollment  49  Response Rates and Mean StudentI n s t r u c t o r R e l a t i o n s h i p Scores o f C o n t r o l and E x p e r i m e n t a l Groups  5.  50  Summary o f A n a l y s i s o f V a r i a n c e f o r I n t e r v e n t i o n and I n s t r u c t o r E f f e c t on S t u d e n t - I n s t r u c t o r R e l a t i o n s h i p  6.  52  Response Rates and Mean S t a t e A n x i e t y Scores o f C o n t r o l and Experimental  7.  Groups  53  Summary o f A n a l y s i s o f C o v a r i a n c e f o r I n t e r v e n t i o n and I n s t r u c t o r E f f e c t on S t a t e A n x i e t y  8.  54  A Comparison o f E x p e r i m e n t a l and Control Subjects* Experience of S t r e s s f u l Events i n 24 Hours P r i o r t o P o s t - t e s t Data C o l l e c t i o n  9.  56  C l a s s i f i c a t i o n o f S t r e s s f u l Events P e r c e i v e d by C o n t r o l and E x p e r i m e n t a l  Subjects  58  Acknowledgements The s t u d y w o u l d n o t have been c o m p l e t e d continued my a u n t /  interest and my  A special committee/  and e n c o u r a g e m e n t  a p p r e c i a t i o n i s expressed  Roberta  addition/  Statistical  of  time/  I would l i k e  thesis  I would l i k e  Milne  who  expertise.  t o a c k n o w l e d g e members  o f t h e UBC  Laboratory f o r their  aspects of the study.  t o thank t h e f a c u l t y Hospital  and s t u d e n t s  S c h o o l o f N u r s i n g who so  participated  i n the study.  c o - o p e r a t i o n was t r u l y  inspirational  researcher.  mother/  p a t i e n c e / and v a l u e d  C o n s u l t i n g and R e s e a r c h  t h e Vancouver General  willingly  t o my  Hewat/ C h a i r m a n / and B a r b a r a  assistance with the s t a t i s t i c a l Lastly/  p r o v i d e d by my  friends.  g e n e r o u s l y gave t h e i r In  without the  Their s p i r i t of to a beginning  1 CHAPTER  ONE  Introduction  Background t o Problem E v i d e n c e t h a t a n x i e t y i n f l u e n c e s l e a r n i n g has l o n g been r e c o g n i z e d by e d u c a t o r s  (Meisenhelder/  O ' N e i l / & T o b i a s r 1977;  S p i e l b e r g e r & Sarason/ 1975).  Although  m i l d a n x i e t y may  1987;  Sieber/  augment l e a r n i n g by p r o v i d i n g a  m o t i v a t i n g f o r c e / moderate t o severe a n x i e t y may s e r i o u s l y i n h i b i t the l e a r n i n g p r o c e s s Nursing  ( B l a i n e y / 1980).  r e s e a r c h l i t e r a t u r e has c o n s i s t e n t l y i d e n t i f i e d  a n x i e t y as a common response e x p e r i e n c e d students 1978;  (Charlesworth/  M i l l e r / 1984).  by  nursing  Murphy/ & B e u t l e r / 1981;  Although  McKay/  s e v e r a l s o u r c e s of a n x i e t y  have been i d e n t i f i e d / a dominant source of a n x i e t y i s p r a c t i s e i n the c l i n i c a l s e t t i n g .  I n f a n t e (1985) d e s c r i b e s  the p r o f e s s i o n a l e d u c a t i o n of the nurse as a b r i d g e between the w o r l d of thought and t h e w o r l d of a c t i o n . T r a d i t i o n a l l y / e d u c a t i o n f o r the "world of a c t i o n " has occurred w i t h i n t h i s c l i n i c a l The  setting.  consequences of an i m p a i r e d l e a r n i n g  process  r e s u l t i n g from a n x i e t y have s e r i o u s i m p l i c a t i o n s f o r t h a t p o r t i o n of t h e e d u c a t i o n a l p r o c e s s of n u r s i n g which in this practise setting.  occurs  Research f i n d i n g s have  demonstrated t h a t h i g h l y a n x i o u s l e a r n e r s have i n c r e a s e d d i f f i c u l t y w i t h performance of psychomotor s k i l l s  (Combs &  2 T a y l o r / 1952;  E r b e r / 1984;  l e a r n i n g of concepts/ M a r t i n / 1974)  Weinberg & Ragan/ 1978)/ w i t h  t h e i r r e t e n t i o n and  recall  (Meyers &  and w i t h development of i n t e r p e r s o n a l  relationships.  Crow and Crow (1972) suggest t h a t the  nurse's a b i l i t y  t o c o n t r o l her emotions p l a y s a major r o l e  i n t h e n u r s e - c l i e n t r e l a t i o n s h i p / w h i l e Brown and (1971) b e l i e v e t h a t i f a s t u d e n t nurse difficulty process  Fowler  experiences  d e a l i n g w i t h s t r e s s d u r i n g the  educational  the a n x i e t y g e n e r a t e d a f f e c t s those w i t h whom she  i s i n personal contact. by Johnson (1979) who  This l a t t e r f i n d i n g i s  supported  r e p o r t s t h a t i n c r e a s e d l e v e l s of  nurse a n x i e t y have a n e g a t i v e e f f e c t on the amount of d i s c l o s u r e between nurse and  client.  Furthermore/ I n f a n t e (1985) s u g g e s t s t h a t i n o r d e r promote c r i t i c a l t h i n k i n g i n s t u d e n t s  i n the  to  clinical  s e t t i n g the t e a c h e r must p r o v i d e an environment i n which s t u d e n t s are f r e e from a n x i e t y and The  anxious  nursing student p r a c t i c i n g w i t h i n the  s e t t i n g / t h e r e f o r e / may which may  f e e l i n g s of inadequacy.  provide l e s s than optimal  clinical care  l e a d t o c l i e n t p h y s i c a l and p s y c h o s o c i a l needs  b e i n g i n e f f e c t i v e l y met I n a d d i t i o n / a n x i e t y may d e p r e s s i o n and  and  standards  of c a r e  jeopardized.  r e s u l t i n l e a r n e r anger  and  i n h i b i t s t u d e n t p e r s o n a l development  (McMaster/ 1979). Aspy and Roebuck (1977) suggest t h a t one method by which s t u d e n t a n x i e t y can be d e c r e a s e d and l e a r n i n g  3  enhanced i s through the t e a c h e r ' s  use of s t r a t e g i e s t o  enhance 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 . A l t h o u g h open communication appears t o d e c r e a s e student  anxiety  and  enhance l e a r n i n g / e v i d e n c e i n d i c a t e s t h a t d e l i b e r a t e use  of  i n t e r p e r s o n a l s k i l l s i n the t e a c h e r - l e a r n e r r e l a t i o n s h i p w i l l f u r t h e r f a c i l i t a t e the l e a r n i n g p r o c e s s and may a r e a f o r f u r t h e r study Educational  r e s e a r c h on a n x i e t y and l e a r n i n g has  which i s r e f l e c t e d i n c h a r a c t e r i s t i c t e a c h e r be r e l a t e d t o a n x i e t y l e v e l s ( H i l l / 1967; P o l l i e / & Speisman/ 1955;  Oner/ 1977;  and p u p i l s /  responses/ t o  McKeachie/  Oner (1977)  r e p o r t s t h a t c h i l d r e n ' s a n x i e t y i s a f u n c t i o n of the they perceive t h e i r teacher.  found  Sarason & Davidson/  Sarason/ Davidson/ & B l a t t / 1962).  For example/  way  teachers  p e r c e i v e d as p u n i t i v e and a u t h o r i t a r i a n tend t o m o b i l i z e student  a n x i e t y and  deteriorates. nonpunitive/ students  as a r e s u l t c l a s s r o o m  performance  In c o n t r a s t / t e a c h e r s p e r c e i v e d n o n a u t h o r i t a r i a n / and  as  interested in giving  every o p p o r t u n i t y t o communicate dependency  need f o r h e l p reduce a n x i e t y c o n s i d e r a b l y .  and  The  d e b i l i t a t i n g e f f e c t s of a n x i e t y / t h e r e f o r e / o f t e n r e s u l t from the n a t u r e of the s i t u a t i o n a l c o n t e x t and  the  individual's interpersonal relationships. A l t h o u g h the i n v e s t i g a t o r r e c o g n i z e s t h a t n u r s i n g i n s t r u c t o r s may decrease student  an  (Aspy & Roebuck/ 1977).  the 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 between t e a c h e r  1962;  be  individual  use s t r a t e g i e s a t t e m p t i n g  to  a n x i e t y / McKay (1978) s u g g e s t s t h a t  4 "historically# foresight assist  nursing faculty  i n planning learning  the student  investigator  have e x e r c i s e d  e x p e r i e n c e s which  i n coping with  anxiety"  believes that deliberate  i m p l e m e n t e d by n u r s i n g i n s t r u c t o r s interpersonal decreased  little  relationships with  will  (p. 378).  The  strategies  to establish  s t u d e n t s may r e s u l t i n  student anxiety i n the c l i n i c a l  setting.  Problem  Both nursing research f i n d i n g s observational anxiety  experience  setting.  among c l i n i c a l Although  helpful  relate  anxiety*  t h a t an i m p r o v e d  i n student  to relate  student-instructor levels.  may  few documented I t i s the  t h a t may c o n t r i b u t e  anxiety level  interpersonal r e l a t i o n s h i p with T h i s study  and s t u d e n t  t h e two c o n c e p t s .  o p i n i o n t h a t one f a c t o r  the v a r i a b i l i t y  anxiety  suggests  r e l a t i o n s h i p between t e a c h e r  investigator's  attempting  literature  i n decreasing student  instructor.  revealed  groups.  studies directly  perceived  i nthe  o f n u r s i n g s t u d e n t s appear t o v a r y  available  interpersonal  from p r a c t i s e  P e r s o n a l o b s e r v a t i o n s have a l s o  that anxiety l e v e l s  to  t h a t a dominant source o f  f o r nursing students a r i s e s  clinical  be  suggest  and t h e i n v e s t i g a t o r ' s  attempts t o f i l l  may be t h e  the c l i n i c a l a r e s e a r c h v o i d by  the student's perception of the  interpersonal relationship  t o student  5  Purpose The  purpose o f t h e s t u d y was t o t e s t t h e p r o p o s i t i o n  that nursing students' anxiety i n the c l i n i c a l  setting  would be l o w e r e d by i m p l e m e n t a t i o n o f a r e l a t i o n s h i p b u i l d i n g a c t i v i t y by t h e i n s t r u c t o r . hypotheses were HI:  In p a r t i c u l a r * three  tested:  Student n u r s e s who r e c e i v e  intervention w i l l  a relationship-building  rate t h e i r relationship with the  i n s t r u c t o r higher than student nurses r e c e i v i n g  a placebo  intervention. H2:  S t u d e n t n u r s e s who r e c e i v e  a relationship-building  i n t e r v e n t i o n w i l l have l e s s s t a t e a n x i e t y t h a n s t u d e n t nurses r e c e i v i n g a placebo H3:  intervention.  There i s a r e l a t i o n s h i p between s t a t e  anxiety  l e v e l s o f s t u d e n t n u r s e s and t h e i r p e r c e p t i o n o f t h e r e l a t i o n s h i p with the i n s t r u c t o r .  D e f i n i t i o n of  Terms  State anxiety: condition  "a t r a n s i t o r y e m o t i o n a l s t a t e o r  o f t h e human organism t h a t i s c h a r a c t e r i z e d  subjective*  by  c o n s c i o u s l y p e r c e i v e d f e e l i n g s o f t e n s i o n and  a p p r e h e n s i o n * and h e i g h t e n e d autonomic nervous system activity.  A - s t a t e s may v a r y i n i n t e n s i t y and f l u c t u a t e  over t i m e " ( S p i e l b e r g e r *  Gorsuch* & Lushene* 1970* p. 3 ) *  as measured by STAI Form X - l  (see Appendix A ) .  6 T r a i t anxiety:  "the r e l a t i v e l y s t a b l e i n d i v i d u a l  d i f f e r e n c e i n a n x i e t y proneness* t h a t i s * the d i f f e r e n c e s between p e o p l e i n the tendency t o respond t o s i t u a t i o n s p e r c e i v e d as t h r e a t e n i n g w i t h e l e v a t i o n s i n the intensity"  A-state  ( S p i e l b e r g e r e t a l . * 1970* p. 3 ) / as measured by  STAI Form X-2  (see Appendix B ) .  Student-instructor relationship;  the  student's  p e r c e p t i o n of the r e l a t i o n s h i p w i t h the i n s t r u c t o r measured by the R e l a t i o n s h i p Q u e s t i o n n a i r e Truax & C a r k h u f f *  1967)  (adapted  three  interactional  t h a t occur on c o n s e c u t i v e days between one  member and a group of seven t o e i g h t s t u d e n t s . episodes  faculty  These  have been developed t o have f a c u l t y demonstrate  empathy* congruence* and p o s i t i v e r e g a r d d u r i n g with students Empathy; your own"  from  (see Appendix C ) .  Relationship-building activity; episodes  as  interaction  (see Appendix D). " t o sense the c l i e n t ' s w o r l d as i f i t were  (Rogers*  1961*  p. 284).  The  concept i s  o p e r a t i o n a l i z e d through i n s t r u c t o r v e r b a l i z a t i o n of s t a t e m e n t s which convey s t u d e n t u n d e r s t a n d i n g *  realistic  e x p e c t a t i o n s * c a r i n g about s t u d e n t s * knowledge of w i l l i n g n e s s t o h e l p * and r e c a l l of her p r e v i o u s as a s t u d e n t  students*  experience  (Karns & Schwab* 1982).  Congruence;  " a c c u r a t e matching of e x p e r i e n c e  awareness" (Rogers*  1961*  p. 282).  with  I t i s operationalized  by i n s t r u c t o r s t a t e m e n t s " s h a r i n g s e l f * a d m i t t i n g  mistakes*  7 e v a l u a t i n g s e l f as human/ acknowledging l i m i t a t i o n s / a c c e p t i n g c r i t i c i s m / and b e i n g honest" 1982/  (Karns & Schwab/  p. 6 ) .  P o s i t i v e regard;  "a warm c a r i n g f o r the c l i e n t - a  c a r i n g which i s not p o s s e s s i v e / w h i c h demands no gratification"  (Rogers/  1961/  p. 283).  personal  I t i s characterized  by i n s t r u c t o r a c t i o n s " p r o v i d i n g p o s i t i v e feedback/ demonstrating  w i l l i n g n e s s to l i s t e n to students/  d i s c u s s i o n and q u e s t i o n s / t r e a t i n g s t u d e n t s as i n d i v i d u a l s / and by statements of s t u d e n t s "  conveying  (Karns & Schwab/ 1982/  Clinical setting:  p.  intelligent  t r u s t and  respect  41).  "a p l a c e i n which t h e s t u d e n t i s  g i v i n g d i r e c t c a r e t o r e a l c l i e n t s as p a r t o f a learning a c t i v i t y "  promoting  (O'Shea & Parsons/  t h i s study the c l i n i c a l s e t t i n g was  1979/  planned  p. 411).  f i v e wards i n an  care f a c i l i t y i n a l a r g e metropolitan area.  In acute  The wards  s e l e c t e d were c l a s s i f i e d as e i t h e r a c u t e s u r g i c a l a r e a s  or  acute m e d i c a l - s u r g i c a l a r e a s .  Assumptions The  assumptions of the study were:  1.  Respondents had the a b i l i t y t o a s s e s s t h e i r c u r r e n t  feeling states. 2.  Respondents answered q u e s t i o n n a i r e s h o n e s t l y and  the b e s t o f t h e i r 3.  ability.  I n s t r u c t o r s implemented the t r e a t m e n t  a c c o r d i n g t o the d i r e c t i o n s p r o v i d e d .  procedure  to  8 E t h i c s and Human R i g h t s Prior  t o commencement o f t h e s t u d y  submitted British and  for ethical  Columbia  parent  ethical  review  of the School  of the School o f Nursing* E).  was  the University of committee  committee.  t o t h e s u b j e c t p o o l was g a i n e d  institution  Appendix  t o both  behavioral sciences screening  the i n s t i t u t i o n ' s Access  review  the proposal  through the  of Nursing*  the Director  and t h e L e v e l 1 C o - o r d i n a t o r ( s e e  I n s t r u c t o r s who  participated  i n the study  were p r o v i d e d w i t h a v e r b a l and w r i t t e n e x p l a n a t i o n o f their  role  i n the study  of the treatment  (see Appendix F ) .  package c o n s t i t u t e d  Implementation  consent t o  participate. Student  subjects participating  i n t h e s t u d y were  also  p r o v i d e d w i t h a v e r b a l and w r i t t e n e x p l a n a t i o n o f t h e s t u d y (see Appendices constituted the p i l o t All  G and H ) .  consent  test  Completion  to participate.  that  Procedures  their  instructors  affect  that  their  were a s s u r e d t h e d a t a were  their class  were  p a r t i c i p a t i o n was v o l u n t a r y and t h e y  c o u l d w i t h d r a w a t any t i m e d u r i n g t h e s t u d y . informed  f o r both  and t h e s t u d y were t h e same.  s u b j e c t s and p a r t i c i p a t i n g  informed  of the questionnaire  refusal  or withdrawal  They were  would  i n no way  s t a n d i n g o r employment s t a t u s .  t h a t q u e s t i o n n a i r e s w o u l d be d e s t r o y e d analyzed.  Subjects after  9 Significance The and  to  Nursing  s t u d y has  practise.  significance  Presently/  f o r both nursing  programs f o r n u r s e  educator  p r e p a r a t i o n have l i t t l e  c o n t e n t on  relationship  I f s t u d e n t a n x i e t y can  building.  significantly strategies/ on  decreased  i t may  such c o n t e n t  methods o f  in nursing  may  of  such  a need f o r  s e r v e as  be  teaching  increased  curricula.  effectively building  relationships  student-teacher  t h r o u g h use  indicate  education  emphasis  Additionally/  student-instructor  a focus for  faculty  development  workshops. In  the  c h o i c e of  practise faculty  setting/  for  findings  clinical  may  teaching  suggest take i n t o  not  only a candidate's t h e o r e t i c a l  and  but  also  e f f e c t i v e l y to  his/her  ability  Additionally/ use  of  that  s t u d e n t s may  more r e a d i l y .  s t r e n g t h e n e d by  relate  when i n s t r u c t o r s  helping-relationship  m o d e l s so skills  to  demonstrate  skills/ learn  Students'  practical  client  knowledge students.  role  communication  interpersonal  s u c h a p p r o a c h e s and  account  effective  t h e y s e r v e as  therapeutic  that  s k i l l s may  care  be  may  benefit. Knowledge o f better  which impair  p r e p a r e n u r s e s t o meet t h e  physical factors  factors  and  psychosocial  p r o c e s s most  effective.  increasingly  needs of  which enhance l e a r n i n g  learning  will  clients. make t h a t  will  help  complex  Knowledge  of  preparation  us  10 CHAPTER Conceptual  Conceptual The was  theoretical  As  framework  used  a perceptual  to learning  introduces  defines  as  learning  as  by  Review  the term  p.  Rogers  learning"  i n the  1961/ (1969)  which  280).  he  It i s  individual's  his attitudes/  affective  study  (1951/  accumulation of f a c t s .  (Rogers/ 1961/ as an  Rogers  the  of p e r s o n a l meaning.  "significant  h i s course of action/  conceptualized  Carl  the discovery  "more t h a n an  personality"  to structure  psychologist/  t h a t makes a d i f f e r e n c e  behavior/  Literature  Framework  1983).  refers  is  and  drawn from t h e o r y proposed  1969/  He  Framework  TWO  Learning/  as w e l l  as  a  and  his  therefore/ cognitive  experience. The  field  behavior  of perceptual  i s a function  psychology suggests that a l l  of a person's perceptions or  p e r s o n a l meanings and  i s determined/  objective  b u t by  environment  perceiving  which  i s unique  a personal/  to that  specifically/  b e h a v i o r c a n be  an  sees himself/  individual  him/  and  each  person's perceptual & Perkey/  field  he v i e w s  n o t by  individual  individual.  described  how  the i n t e r r e l a t i o n s h i p  (Combs/ D o n a l d /  therefore/  as  way  a result  of  how  about  At the core  are p e r c e p t i o n s about  1978).  of  More  the world  o f t h e two.  the  of  self  11 Rogers (1961) a l s o f e e l s "a person l e a r n s s i g n i f i c a n t l y o n l y t h o s e t h i n g s which he p e r c e i v e s as b e i n g i n v o l v e d i n t h e maintenance or enhancement o f t h e s t r u c t u r e o f s e l f " (p. 389) .  He f u r t h e r b e l i e v e s t h a t t h e s t r u c t u r e and  o r g a n i z a t i o n o f s e l f appear t o become more r i g i d under t h r e a t and more r e l a x e d when c o m p l e t e l y  f r e e from t h r e a t .  He f e e l s s i g n i f i c a n t l e a r n i n g i s most e f f e c t i v e l y promoted i n a s i t u a t i o n i n which t h r e a t t o t h e s e l f o f t h e l e a r n e r i s reduced t o a minimum and p e r c e p t i o n i s f a c i l i t a t e d (Rogers/  1951).  W i t h i n t h i s context anything that i s construed  as a  t h r e a t t o s e l f has t h e p o t e n t i a l t o produce a b a r r i e r t o effective learning.  Two e f f e c t s of t h r e a t t o s e l f a r e  d e s c r i b e d by p e r c e p t u a l p s y c h o l o g i s t s . "tunnel v i s i o n "  The f i r s t i s termed  (Combs/ Donald/ & Perkey/ 1978/ p. 5 9 ) .  When t h e i n d i v i d u a l f e e l s t h r e a t e n e d  the perceptual  narrows and f o c u s e s on t h e o b j e c t o f t h r e a t .  field  I f the threat  i s p e r c e i v e d as g r e a t / a t t e n t i o n becomes s h a r p l y f o c u s e d the t h r e a t e n i n g event e x c l u d i n g a l l o t h e r  on  perceptions.  This r e s t r i c t i n g e f f e c t of threat i s i n h i b i t o r y to effective learning. A second e f f e c t o f t h r e a t upon p e r c e p t i o n o c c u r s when the i n d i v i d u a l f e e l s t h r e a t e n e d  and i s f o r c e d t o defend t h e  p e r c e p t i o n s he a l r e a d y has (Combs/ Donald/ & Perkey/ 1978). T h i s d e f e n s i v e s t a n c e under t h r e a t i s e x a c t l y t h e r e v e r s e of what p r o v i d e s f o r e f f e c t i v e l e a r n i n g .  12 Rogers (1951) b e l i e v e s l e a r n i n g w i l l be f a c i l i t a t e d i f students  are p r o v i d e d  the o p p o r t u n i t y t o e x p l o r e  d i s c o v e r meanings of m a t e r i a l s .  and  Exploration i s curtailed  i n an atmosphere i n which the l e a r n e r spends e x c e s s i v e a v o i d i n g or r e d u c i n g  the e x p e r i e n c e  time  of a n x i e t y brought  about by t h r e a t t o s e l f . As a consequence* removal of t h r e a t i s seen as a s i g n i f i c a n t f a c t o r i n the r e l e a s e of the i n d i v i d u a l p e r c e i v e more a d e q u a t e l y .  to  Rogers (1969) b e l i e v e s t h a t  f r e e i n g the i n d i v i d u a l t o f a c i l i t a t e p e r c e p t i o n i s a c c o m p l i s h e d t h r o u g h p r o v i s i o n of a p e r m i s s i v e * t h r e a t e n i n g r e l a t i o n s h i p . He compares t h e  non-  teacher-student  r e l a t i o n s h i p t o t h a t of the p s y c h o t h e r a p i s t - c l i e n t r e l a t i o n s h i p (Rogers* 1961).  W i t h i n both t h e s e h e l p i n g  r e l a t i o n s h i p s * Rogers s u g g e s t s t h a t f a c i l i t a t i o n  of  s i g n i f i c a n t l e a r n i n g r e s t s upon c e r t a i n a t t i t u d i n a l q u a l i t i e s between f a c i l i t a t o r and The  learner.  most b a s i c of t h e s e e s s e n t i a l a t t i t u d e s i s  " r e a l n e s s or g e n u i n e n e s s .  When the f a c i l i t a t o r i s a r e a l  person* b e i n g what he i s * e n t e r i n g i n t o a r e l a t i o n s h i p w i t h the l e a r n e r w i t h o u t  p r e s e n t i n g a f r o n t or facade*  much more l i k e l y t o be e f f e c t i v e "  he i s  (Rogers* 1969* p.  206).  Rogers and Stevens (1967) used the term "congruence" t o mean "the f e e l i n g s the c o u n s e l o r  i s experiencing  are  a v a i l a b l e t o him* a v a i l a b l e t o h i s awareness* t h a t he i s  13 a b l e t o l i v e t h e s e f e e l i n g s / be them i n the r e l a t i o n s h i p / and be a b l e t o communicate them i f a p p r o p r i a t e " A second a t t i t u d e Rogers and  (p.  90).  Stevens (1967) note i n  s u c c e s s f u l f a c i l i t a t i o n of l e a r n i n g i s termed " p o s i t i v e regard"  (p. 105).  I t i s described  as "a f e e l i n g which i s  not p a t e r n a l i s t i c / not s e n t i m e n t a l / and  agreeable.  nor s p e c i f i c a l l y  social  I t r e s p e c t s the o t h e r p e r s o n as a s e p a r a t e  i n d i v i d u a l and does not p o s s e s s him" (1969) d e s c r i b e s  (p. 94).  Rogers  i t f u r t h e r as " p r i z i n g the l e a r n e r /  p r i z i n g h i s f e e l i n g s / h i s opinions/ h i s person . . .  It is  a b a s i c t r u s t - a b e l i e f t h a t t h i s o t h e r p e r s o n i s somehow fundamentally trustworthy" The  (p.  109).  t h i r d a t t i t u d e Rogers (1969) f e e l s e s t a b l i s h e s a  c l i m a t e f o r s u c c e s s f u l l e a r n i n g i s "empathic u n d e r s t a n d i n g " (p. I l l ) . When the t e a c h e r  has the a b i l i t y t o u n d e r s t a n d  s t u d e n t r e a c t i o n s from the i n s i d e / t h a t i s / has a s e n s i t i v e awareness of how t o the s t u d e n t /  the p r o c e s s of e d u c a t i o n  and  l e a r n i n g seem  the l i k e l i h o o d of s i g n i f i c a n t l e a r n i n g  increases. According of t h e t e a c h e r  t o Rogers/ one of the major  responsibilities  i s t o c r e a t e a f a c i l i t a t i n g c l i m a t e i n which  s i g n i f i c a n t l e a r n i n g can be a c c o m p l i s h e d .  P r o v i s i o n of  such a c l i m a t e m i n i m i z e s t h r e a t t o s e l f and r e s u l t i n g anxiety. I n t h i s s t u d y the e f f e c t of an i n t e r v e n t i o n d e s i g n e d t o reduce f e e l i n g s of t h r e a t t o the i n d i v i d u a l was  evaluated.  14  Since  the experience of anxiety  feelings of threat may  to self*  reduce a n x i e t y .  may be p r e c i p i t a t e d by  a c t i v i t i e s minimizing  The i n t e r v e n t i o n i m p l e m e n t e d was a  series of relationship-building a c t i v i t i e s the  attitudinal  positive  qualities  regard.  facilitate  o f empathy*  These t h r e e  c o n g r u e n c e * and  constructs  were u s e d t o  interpersonal  relationship.  The s t u d y  to relate a p o s i t i v e l y perceived  r e l a t i o n s h i p b e t w e e n i n s t r u c t o r and n u r s i n g reduced  student  Literature  anxiety  first  that of  review i s d i v i d e d  that  students.  students.  s t u d i e s which emphasize relationships  Clinical for  setting  students  Diamond* W a l s h *  f o r reducing  The f i n a l  reviews  anxiety i n  s e c t i o n focuses  on  as  a source  i n students.  of  identified  anxiety  and  as a major  (Birch* 1979; E l f e r t *  Knopf*  source  the s i g n i f i c a n c e of interpersonal  e x p e r i e n c e has been  nursing  evidence  The s e c o n d s e c t i o n  i n control of anxiety  clinical  sections.  s e t t i n g i s a dominant  assess interventions  groups o f nursing  into three  on s t u d i e s which p r o v i d e  i n the c l i n i c a l  stress f o r nursing  The  student t o  levels.  s e c t i o n focuses  anxiety  studies  interpersonal  Review  The l i t e r a t u r e The  incorporating  development o f a p o s i t i v e l y p e r c e i v e d non-  threatening attempted  threat  1976;  & Hodgin* 1 9 6 5 ; G a r r e t t *  stress.  stress  Fox* Manuel* &  15 V i n c e n t / 1976).  A v a r i e t y o f r e s e a r c h methodologies/  as  w e l l as a number o f n u r s i n g s t u d e n t p o p u l a t i o n s / have been used i n s t u d i e s which have c o n t r i b u t e d t o t h i s f i n d i n g .  A  c l a s s i c study by Fox e t a l . (1965) used the c r i t i c a l i n c i d e n t t e c h n i q u e and i d e n t i f i e d f o u r major a r e a s i n which n u r s i n g s t u d e n t s may  experience s t r e s s - personal/ s o c i a l /  academic/ and c l i n i c a l .  In t h i s study 80/000 f r e e  response  d e s c r i p t i o n s of s a t i s f y i n g and s t r e s s f u l i n c i d e n t s were c o l l e c t e d from 4/000 n u r s i n g s t u d e n t s e n r o l l e d i n 23 diploma and 6 b a c c a l a u r e a t e degree programs t h a t were randomly s e l e c t e d from the New  York a r e a .  Results revealed  t h a t 71% of responses were r e l a t e d t o the s t r e s s a s s o c i a t e d w i t h t h e c l i n i c a l a s p e c t s of n u r s i n g s c h o o l e x p e r i e n c e . In another s t u d y G a r r e t t / Manuel/ and V i n c e n t (1976) attempted  t o g e n e r a l i z e t h e f i n d i n g s o f Fox e t a l .  One  hundred and e l e v e n sophomore/ j u n i o r / and s e n i o r n u r s i n g s t u d e n t s between t h e ages of 18 and 23 y e a r s e n r o l l e d i n a c o l l e g i a t e s e t t i n g were s t u d i e d .  Although s t r e s s  was  u n d e f i n e d i n t h e p r e v i o u s study/ i n t h i s s t u d y s t r e s s d e f i n e d as "a s t a t e always p r e s e n t i n man  was  but t h a t i s  i n t e n s i f i e d when t h e r e i s a change or t h r e a t w i t h which  the  i n d i v i d u a l must cope" (p. 6 ) . S t u d e n t s ' r e p o r t s were i n d e p e n d e n t l y i n t e r p r e t e d by of  t h r e e r e s e a r c h e r s who  had 100%  agreement on t h e  c a t e g o r i z a t i o n of s t r e s s f u l r e s p o n s e s . percentage  two  The  largest  o f sophomore responses/ 47.8%/ were c a t e g o r i z e d  16 as c l i n i c a l e x p e r i e n c e w h i l e o n l y 22.8% o f j u n i o r responses f e l l i n t h i s group.  The l a r g e s t p e r c e n t a g e o f s e n i o r  responses were c l a s s i f i e d as academic e x p e r i e n c e s ;  clinical  e x p e r i e n c e s were d e s c r i b e d i n o n l y 16.7% o f responses. Study f i n d i n g s o f t h e d i s t r i b u t i o n o f s t r e s s f u l i n c i d e n t s r e v e a l e d * however* t h a t t h e l a r g e s t p e r c e n t a g e o f t o t a l responses*  28.8%* were c a t e g o r i z e d as c l i n i c a l  U s i n g t h e same t e c h n i q u e E l f e r t  experience.  (1976) s t u d i e d b a s i c  s t u d e n t s e n r o l l e d i n t h e f i r s t two y e a r s o f a new b a c c a l a u r e a t e program a t t h e U n i v e r s i t y o f B r i t i s h Columbia.  Her study was l o n g i t u d i n a l and e v a l u a t e d  data  c o l l e c t e d a t t h e end o f each o f t h r e e terms over two years.  Although  t h e a c t u a l number o f p a r t i c i p a n t s was n o t  r e p o r t e d * t h e p r o p o r t i o n o f respondents v a r i e d from 79% t o 91% o f those e n r o l l e d . of s t r e s s f u l e p i s o d e s the s i x terms.  R e s u l t s i n d i c a t e d t h a t t h e number  i n t h e c l i n i c a l a r e a i n c r e a s e d over  The number o f s t r e s s f u l i n c i d e n t s r e l a t e d  t o c l i n i c a l e x p e r i e n c e * however* remained c o n s i s t e n t l y fewer than t h e number o f s a t i s f y i n g i n c i d e n t s r e l a t e d i n the same a r e a . In a d d i t i o n t o t h e c r i t i c a l i n c i d e n t t e c h n i q u e *  rating  s c a l e s have a l s o been used t o study a n x i e t y i n n u r s i n g students.  B i r c h (1979) s t u d i e d 207 n u r s i n g  e n r o l l e d i n f o u r s c h o o l s i n England.  students  The r e s e a r c h  design  i n c l u d e d use o f t h e P e r s o n a l i t y T e s t i n g and A b i l i t y T e s t i n g A n x i e t y S c a l e [IPAT] d e v i s e d by C a t t e l l and a s e l f - d e v i s e d  questionnaire clinical during  practice.  the f i r s t  Cattell's  at  of hospital  and a t t h r e e  four  of  and occurred  experience.  after  Analysis of findings t h a t over  scheduled  eight-monthly  intervals.  a n x i e t y q u e s t i o n n a i r e was c o m p l e t e d  e i g h t months and two y e a r s  revealed  a n x i e t y i n 56 a r e a s  The s t u d y was l o n g i t u d i n a l  two y e a r s  course  self-devised  training.  as  expressed  A n x i e t y S c a l e was a d m i n i s t e r e d d u r i n g t h e  introductory The  testing  commencement o f  determined  50% o f s u b j e c t s scored  testings  at levels  b o r d e r l i n e h i g h and r e q u i r i n g  only  which  from  t h e IPAT  on t h r e e o f t h e  Cattell  described  follow-up f o r stress  management. Although of  the study  d i d not differentiate  anxiety* the self-devised  items  of professional  investigator rank  order  clinical stress  causes  questionnaire contained  experience  to likely  as t o  cause  thought  anxiety.  56  by t h e  Areas  of stress i n  r e v e a l e d 9 o f t h e t o p 10 t o b e a s s o c i a t e d w i t h  experience  and a n a l y s i s  suggested  d i d n o t change s i g n i f i c a n t l y  t h a t causes  between  of  8 a n d 24  months. Graduate nurses  assuming  described  as anxious.  Linn  students  i n two c o h o r t  nurse  University  of California  the  and P e r s o n a l  Course  composed  a student  role  (1975) p r e s e n t e d practitioner  [UCLA]. Experience  of the Physiological  have a l s o data  been  on 21  programs a t t h e  The i n s t r u m e n t  used  Inventory which  S t r e s s Indexr  was  the Social  was  18 Stress  Index/  Index. class  and  the  the  stress  18-week c o u r s e . f o r each  levels.  first  experience  Data  the  seemed t o be  peak  every  index  scores  day  two  score  classroom  to  of  content  the  and  course.  was higher  related  to course  stress.  a  some The  increased c l i n i c a l  of  weeks  reflected  w i t h p r e s e n t a t i o n of  beginning  limited  final  total  first  r e v e a l e d t h r e e peak p o i n t s o f  amount o f  at the  A  student; high  peak c o r r e l a t e d  considerable  the  Total Stress  q u e s t i o n n a i r e s were completed  calculated  and  P s y c h o l o g i c a l and  B a s e l i n e d a t a were a c q u i r e d on  during  The  the  clinical  second  peak  responsibility  termination  and  examinations. Feelings nursing  o f a n x i e t y and  students  education.  early  stress  are  i n the process  Grassi-Russo  and  Morris  asked  hopes and  beginning  f e a r s at the  e i g h t months l a t e r  asked  and  experiences.  two  recorded  unpleasant  and  unpleasant  and  a n x i e t y about c l i n i c a l  year  experiences  comparison of nursing  accident  and  The  rank  program  prior  order  identified  and  of  to record  two  and  pleasant of  taking responsibility/  fears making  sick  a  people.  were o v e r - a l l  stress  experience.  anxiety levels  students  their  d e a l i n g w i t h death  Two  A  i n a study  participants of  by  professional  s u b j e c t s t o r e c o r d two  included failure/  dangerous mistake/  of t h e i r  (1978)/  freshman nursing students* two  experienced  between f i r s t  to c l i n i c a l  emergency d e p a r t m e n t and  and  experience  trauma area  in was  third an  19 completed by B r u n t was  (1984).  A self-devised questionnaire  a d m i n i s t e r e d t o a t o t a l of n i n e p a r t i c i p a n t s w i t h i n one  hour of a r r i v i n g i n the department and t h r e e weeks l a t e r . Two  questions related to anxiety.  The  f i r s t q u e s t i o n asked  the s t u d e n t s t o d e s c r i b e t h e i r f e e l i n g s about working the a r e a .  B o t h l e v e l s of s t u d e n t s expressed  emotions such as "apprehensive/ nervous" (p. 3 7 ) .  The  in  negative  w o r r i e d / dubious/  second q u e s t i o n l i s t e d 26  and clinical  s i t u a t i o n s and s t u d e n t s were asked t o r a t e t h e i r f e e l i n g s on a L i k e r t 4 - p o i n t s c a l e .  Responses v a r i e d from  unworried  to very worried w i t h a higher score i n d i c a t i n g a greater degree of w o r r y .  Students  a t both l e v e l s on both  s c o r e d above 40 out of a maximum t o t a l s c o r e of 60  occasions (p.  38)  c o n f i r m i n g a n x i e t y t o be a f a c t o r i n s t u d e n t ' s l e a r n i n g experience. In an attempt t o add a c r o s s c u l t u r a l d i m e n s i o n t o the study of n u r s i n g s t u d e n t s t r e s s / D a v i t z (1972) sought t o compare s i m i l a r i t i e s and d i f f e r e n c e s i n s t r e s s r e p o r t e d by N i g e r i a n and American n u r s i n g s t u d e n t s .  The 37 N i g e r i a n  p a r t i c i p a n t s between 18 and 19 y e a r s of age were e n r o l l e d i n a t h r e e and o n e - h a l f y e a r program.  Data on the American  s t u d e n t s were a c q u i r e d from the study conducted by Fox al.  et  (1965). Each s u b j e c t ' s r e c o u n t i n g of a s t r e s s f u l i n c i d e n t  c o n t a i n e d an average of two d e t a i l s n e c e s s a r y and  to  i n t e r p r e t the e x p e r i e n c e and c l a s s i f y i t u s i n g  understand the  o r i g i n a l f o u r c a t e g o r i e s / p e r s o n a l / s o c i a l / academic/ clinical/  developed by Fox e t a l (1965).  Two  and  coders  i n d e p e n d e n t l y r a t e d s t u d e n t responses and a g a i n coder agreement was  100%.  "The  r e s u l t s i n terms of the f o u r  major c a t e g o r i e s were s t r i k i n g l y c o n s i s t e n t . Of t h e 37 s t u d e n t s / 36 r e p o r t e d s t r e s s f u l e x p e r i e n c e s concerned t h e c l i n i c a l a r e a " ( D a v i t z / 1972/  p. 354).  Areas of  c o n c e r n e l a b o r a t e d on by respondents were p h y s i c a l e m o t i o n a l c a r e of p a t i e n t s / s t r e s s of s h i f t / c l i n i c a l e x p e r i e n c e s and procedure  with  and  initial  implementation.  In  a d d i t i o n / "ten r e p o r t s i d e n t i f i e d 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 as t h e p r i m a r y source o f s t r e s s .  Nine  i n v o l v e d s e n i o r nurse t u t o r s and s t a f f n u r s e s " (p. 355). D a v i t z (1972) noted t h a t b o t h American and N i g e r i a n n u r s i n g s t u d e n t s r e p o r t e d t h e i r most f r e q u e n t s t r e s s e x p e r i e n c e i n terms of c l i n i c a l i n t e r a c t i o n and that " i n t r i n s i c  concluded  t o t h e e d u c a t i o n of n u r s e s / r e g a r d l e s s o f  t h e s p e c i f i c c u l t u r e i n which the t r a i n i n g o c c u r s / the c l i n i c a l p r a c t i c u m a s p e c t s of t r a i n i n g r e p r e s e n t t h e p r i m a r y a r e a s of s t r e s s f o r s t u d e n t s " (p. 356). 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 as a s p e c i f i c s o u r c e of s t r e s s a s s o c i a t e d w i t h c l i n i c a l e x p e r i e n c e are d e s c r i b e d by authors  ( B l a i n e y / 1980; D a v i t z / 1972).  B l a i n e y (1980) i n  her d i s c u s s i o n of a n x i e t y i n m e d i c a l - s u r g i c a l s t u d e n t s suggested t h a t a f r e q u e n t a n x i e t y t h a t s t u d e n t s e x p e r i e n c e i s that related to interpersonal relationships.  These  21 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 i n v o l v e c l i e n t s * other h e a l t h c a r e team members* and n u r s i n g  instructors.  A m o d i f i c a t i o n of the c r i t i c a l  i n c i d e n t technique  used by McMaster (1979) t o study s t u d e n t s i n a  was  baccalaureate  n u r s i n g program a t the U n i v e r s i t y of Western O n t a r i o . S t r e s s was  d e f i n e d a c c o r d i n g t o S e l y e ' s d e s c r i p t i o n of  d i s t r e s s ; t h a t i s * "damaging or u n p l e a s a n t (McMaster* 1979* p.  stress"  891).  P a r t i c i p a n t s were p r e s e n t e d  with possible behavioral  m a n i f e s t a t i o n s of s t r e s s and were asked t o r e c a l l and  report  i n c i d e n t s from the p r e v i o u s term t h a t they had p e r c e i v e d stressful.  Data were c o l l e c t e d a t the end of f i r s t  second term; of the 216  as  and  s t u d e n t s e n r o l l e d * 79% and  74%  participated respectively. Responses were a n a l y z e d  and c a t e g o r i z e d by  two  independent c o d e r s and t h r e e major c a t e g o r i e s emerged: "academic* c l i n i c a l * p. 8 9 ) .  and s o c i a l - p e r s o n a l " (McMaster* 1979*  F i n d i n g s a f t e r f i r s t term Year 1 suggested t h a t the  academic a r e a was  the g r e a t e s t source of s t r e s s .  investigator felt  t h i s was  e x p e r i e n c e was  experiences  clinical  l i m i t e d a t t h i s p o i n t i n the program.  most commonly expressed e x p e r i e n c e was  t o be expected as  The  concern r e l a t e d t o  The  clinical  t o do w i t h a p p r e h e n s i o n about f i r s t  in hospital.  I n c o n t r a s t * second y e a r s t u d e n t s a t the end of term p e r c e i v e d t h e c l i n i c a l  first  a r e a as the source of g r e a t e s t  22 s t r e s s w h i l e a t t h e end o f second term emphasis r e t u r n e d t o t h e academic a r e a .  Responses from t h i r d y e a r s t u d e n t s a t  t h e end o f f i r s t term i n d i c a t e d almost e q u a l concerns r e l a t e d t o academic and c l i n i c a l a r e a s b u t d u r i n g second term t h e c l i n i c a l a r e a a g a i n took  precedence.  "The main c l i n i c a l c o n c e r n f o r t h i s c l a s s r e l a t e d t o faculty.  Many s t u d e n t s p e r c e i v e d some o f t h e t e a c h e r s t o  be ' t h r e a t e n i n g ' and ' u n h e l p f u l ' i n t h e c l i n i c a l a r e a " (McMaster/  1979r p. 9 4 ) . D u r i n g term one o f f o u r t h y e a r  most o f t h e concerns "arose from r e l a t i o n s h i p s w i t h f a c u l t y i n t h e academic a r e a * some h a v i n g a p e r c e p t i o n o f t e a c h e r s as ' h o s t i l e / *  ' t h r e a t e n i n g / and ' i n s e n s i t i v e ' " 1  (p. 9 4 ) .  The study c o n c l u d e d t h a t major concerns r e s u l t i n g  from  p r o f i l e s o f s t r e s s were i n t h e academic and c l i n i c a l and t h a t " c l i n i c a l c o n c e r n s were o f p a r t i c u l a r  area  interest  because they f o c u s e d on t e a c h e r b e h a v i o r " (p. 9 5 ) . McMaster*s f i n d i n g s a r e f u r t h e r s u p p o r t e d by t h o s e o f Zujewskyj and D a v i s (1985).  A l t h o u g h w o r k l o a d was t h e most  f r e q u e n t l y i d e n t i f i e d source of s t r e s s f o r t h i r d year baccalaureate students a t the U n i v e r s i t y of Albertar the second most f r e q u e n t l y c i t e d s o u r c e o f s t r e s s was t h e clinical  instructor.  Despite the lack of a consistent d e f i n i t i o n of the concept o f s t r e s s o r a n x i e t y / a l l s t u d i e s c l e a r l y  identify  c l i n i c a l e x p e r i e n c e as a dominant theme i n n u r s i n g students' reports of s t r e s s f u l experiences.  Within this  23 arena*  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 as a s p e c i f i c s o u r c e o f  s t r e s s a r e d e s c r i b e d by some r e s e a r c h e r s  ( B l a i n e y * 1980;  D a v i t z * 1972; McMaster* 1979; Zujewskyj & D a v i s * 1985).  I n t e r v e n t i o n f o r a n x i e t y i n groups o f n u r s i n g  students.  Attempts t o d e a l w i t h n u r s i n g s t u d e n t a n x i e t y have been documented i n t h e l i t e r a t u r e .  An e a r l y d e s c r i p t i v e s t u d y  r e p o r t e d by Rosenberg and F u l l e r  (1955) d e s c r i b e d an  experiment t h a t r e s u l t e d from a f e l t need o f t h e f a c u l t y i n a diploma  s c h o o l o f n u r s i n g " t o handle a h i g h  r a t e and e m o t i o n a l t e n s i o n s o f t h e s t u d e n t s "  withdrawal (p. 4 3 1 ) . The  i n t e r v e n t i o n planned was a seminar i n human r e l a t i o n s f o r f i r s t y e a r s t u d e n t s which began t h e second week o f t h e s c h o o l y e a r and t e r m i n a t e d i n t h e t w e l f t h week. P s y c h i a t r i c a l l y o r i e n t e d group l e a d e r s conducted t h e one and o n e - h a l f hour weekly s e s s i o n s u s i n g " s t r u c t u r e d group t h e r a p y t e c h n i q u e which was v a r i e d t o f i t needs o f adolescents"  (p. 4 3 1 ) . E v a l u a t i o n was based on s t u d e n t s '  i m p r e s s i o n s o f seminars*  f a c u l t y i n t e r p r e t a t i o n and  r e a c t i o n s * t h e p s y c h o l o g i s t ' s a n a l y s i s o f t h e meetings* and t h e more o b j e c t i v e o b s e r v a b l e  r e s u l t s which took p l a c e on  t h e wards and i n t h e c l a s s r o o m .  Subjective findings  r e v e a l e d t h a t " e m o t i o n a l t e n s i o n s o f t h e s t u d e n t s had been reduced and t h e w i t h d r a w a l 431).  r a t e was o b v i o u s l y l o w e r " (p.  A d d i t i o n a l l y * t h e r e appeared t o be "fewer  expressions of anxiety t o the i n s t r u c t o r "  student  (p. 4 2 6 ) .  24 A l o n g i t u d i n a l study conducted by G o w e l l  (1966)  attempted t o g e n e r a l i z e f i n d i n g s of Rosenberg and  Fuller.  Group work methods and p r o c e s s were a g a i n employed w i t h groups of 6 t o 15 u n i v e r s i t y s t u d e n t n u r s e s over a p e r i o d of f i v e y e a r s .  Meetings were h e l d weekly " f o r the purpose  of d i s c u s s i n g common problems of s t u d e n t adjustment t o n u r s i n g s c h o o l or o t h e r d i f f i c u l t i e s they important"  (p. 355).  s u b j e c t i v e r e p o r t s and  Study r e s u l t s were  consider completely  i n c l u d e d comments such as " t h e r e  l e s s i n t e n s e f e e l i n g s of a u t h o r i t y as evidenced  by  are  their  a b i l i t y t o d i s c u s s d i f f i c u l t i e s w i t h f a c u l t y w i t h whom they have f o r m e r l y been unable t o communicate" (p. 361)  and  " t h e r e were a l s o fewer i n c i d e n t s of p s y c h o s o m a t i c complaints sessions"  among s t u d e n t s who (p.  Although  had p a r t i c i p a t e d i n the  361). f i n d i n g s of the two c i t e d s t u d i e s suggest t h a t  i n t e r v e n t i o n s were s u c c e s s f u l i n r e d u c i n g s t r e s s of n u r s i n g students* methodological  l i m i t a t i o n s are e v i d e n t .  Neither  study employed v a l i d * r e l i a b l e t o o l s f o r the measurement of a n x i e t y * attempted t o measure a n x i e t y l e v e l s p r i o r t o i n t e r v e n t i o n or p r o v i d e d comparisons w i t h  appropriate  c o n t r o l groups* making i t i m p o s s i b l e t o d i f f e r e n t i a t e between the e f f e c t s of t h e i n t e r v e n t i o n and f a c t o r s such as normal p e r s o n a l i t y development. A more r i g o r o u s p r e - t e s t * p o s t - t e s t group d e s i g n used by Mancine* L a v e c c h i a *  and Clegg  was  (1983) t o i n v e s t i g a t e  25 the e f f e c t s o f a s t r e s s management program [SMP] s t r e s s response The  SMP  on  the  of f u l l time g r a d u a t e n u r s i n g s t u d e n t s .  c o n s i s t e d of 8 weekly one-hour s e s s i o n s of  demonstration  and p r a c t i c e o f r e l a x a t i o n /  diaphragmatic  b r e a t h i n g / and a commitment t o  caffeine intake.  imagery/ reduced  T h i r t y female s u b j e c t s between the ages  of 25 t o 43 y e a r s were randomly a s s i g n e d t o an and a c o n t r o l group. seven and n i n e / Instruments  A t t r i t i o n reduced  experimental  the f i n a l sample t o  respectively. used f o r d a t a c o l l e c t i o n were the Rahe  Recent L i f e Changes Q u e s t i o n n a i r e  tRLCQ]/ the  A-State  A n x i e t y I n v e n t o r y / the Palmar Sweat P r i n t [PSP]/ b l o o d p r e s s u r e r e a d i n g s / and the Weekly S e l f Report measured SMP  [WSR]  which  adherence by the e x p e r i m e n t a l group and  p e r c e i v e d s t r e s s by both groups.  The PSP  indicator  demonstrated a s i g n i f i c a n t d i f f e r e n c e (p<.05) between groups.  The WSR  a l s o r e v e a l e d t h a t the e x p e r i m e n t a l group  r e p o r t e d s i g n i f i c a n t l y fewer s t r e s s f u l e x p e r i e n c e s and used s i g n i f i c a n t l y more c o p i n g s t r a t e g i e s t h a n the c o n t r o l group. C h a r l e s w o r t h e t a l . (1981) conducted designed  a similarly  study t o a s s e s s t h e e f f e c t i v e n e s s of a 1 0 - s e s s i o n /  5-week/ g r o u p - a d m i n i s t e r e d student nurses.  The  s t r e s s management program f o r  i n t e r v e n t i o n c o n s i s t e d o f s e s s i o n s on  p r o g r e s s i v e r e l a x a t i o n / deep muscle r e l a x a t i o n /  autogenic  t r a i n i n g / v i s u a l imagery/ and m o d i f i e d s y s t e m a t i c  26 d e s e n s i t i z a t i o n conducted by the n u r s i n g e x p e r i m e n t a l group was students while  instructor.  comprised of t e n female  seven males and  one  The  nursing  female n u r s i n g  student  s e r v e d as a c o n t r o l . The  effectiveness  of s t r e s s t r a i n i n g was  assessed  at  t h r e e p o i n t s t h r o u g h o u t the s t u d y :  p r e t e s t * b e f o r e mid-  term e x a m i n a t i o n s * and  examinations.  Spielberger [STAI] was  before f i n a l  e t a l . (1970) S t a t e - T r a i t A n x i e t y I n v e n t o r y used t o measure a n x i e t y .  Findings  indicated  t h a t t h e i n t e r v e n t i o n e f f e c t i v e l y reduced t r a i t (p<.05)* w h i l e  the c o n t r o l group's t r a i t a n x i e t y  r e l a t i v e l y unchanged. showed r e d u c t i o n final  remained  I n a d d i t i o n * the e x p e r i m e n t a l group  i n state anxiety  examinations* while  increase  anxiety  from mid-semester t o  the c o n t r o l group showed an  f o r the same p e r i o d .  A l t h o u g h b o t h s t u d i e s demonstrated u s e f u l n e s s of  an  i n t e r v e n t i o n w i t h i n a group s e t t i n g * m e t h o d o l o g i c l i m i t a t i o n s are e v i d e n t .  The  ability  of an  intervention  employed f o r o n l y f i v e weeks t o e f f e c t i v e l y lower anxiety  i s questionable.  second s t u d y may  I n a d d i t i o n * f i n d i n g s from  the  r e f l e c t gender d i f f e r e n c e s i n groups as  opposed t o the e f f e c t of the i n t e r v e n t i o n . s i z e and  trait  S m a l l sample  f a i l u r e t o employ p l a c e b o i n t e r v e n t i o n s  for  c o n t r o l groups a l s o impose l i m i t a t i o n s on the f i n d i n g s both s t u d i e s .  of  27 The  research  i n nursing  on group methods used t o d e c r e a s e  students i s inconclusive.  anxiety  Although studies  fail  t o c o n s i s t e n t l y r e p o r t s t a t i s t i c a l l y s i g n i f i c a n t e f f e c t s of such i n t e r v e n t i o n s * d e s c r i p t i v e f i n d i n g s suggest t h e r e i s a r o l e f o r such approaches t o be used w i t h s t u d e n t n u r s e s .  The  e f f e c t of 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 on  anxiety l e v e l s .  Research has demonstrated t h a t  student the  f a c i l i t a t i v e c o n d i t i o n s of genuineness* n o n - p o s s e s s i v e warmth* and  a c c u r a t e empathy a r e p o s i t i v e l y r e l a t e d t o  s t u d e n t e m o t i o n a l and Roebuck* 1972;  i n t e l l e c t u a l functioning  Reed* 1961;  (Aspy &  S t o f f e r * 1970).  Reed (1961) proposed t h a t s e l e c t e d c h a r a c t e r i s t i c s of t e a c h e r s had p a r t i c u l a r e f f e c t s upon s t u d e n t s .  He  summarized f i n d i n g s from f o u r e a r l i e r s t u d i e s of over thousand grade 6 and  grade 11 s u b j e c t s .  t h a t the r e l a t i o n s h i p s between s t u d e n t s '  Results  suggested  perceptions  teacher behaviors that relax interpersonal tension* he d e f i n e d  as warmth* and  one  of which  s t u d e n t change as measured by  academic achievement g a i n s and  a t t i t u d i n a l g a i n s measured  by amounts of s e l f i n i t i a t e d s c h o o l work* were c o r r e l a t e d significantly  (p<.00D* p o s i t i v e l y and m o d e r a t e l y (r =  f o r males; r = .28 Aspy and  f o r females) (p.  .20  333).  Roebuck (1972) i n v e s t i g a t e d the r e l a t i o n s h i p  between t e a c h e r s '  c l a s s r o o m b e h a v i o r and  of c o g n i t i v e f u n c t i o n i n g .  students'  Data were o b t a i n e d  from  levels 40  28 female tape  elementary  recording of  teachers' for  teachers  instruction  p e r f o r m a n c e was  empathy*  Interaction cognitive  congruence*  level  levels  by  was  functioning  beyond  level  higher  levels  related not  teacher  one of  obtained  c h i l d r e n who  levels  of  use  Bloom's  of  Ratings  2-6;  higher  from  levels  two  indicated  i n t e r p e r s o n a l f u n c t i o n i n g were  r a t e r s whose  inter-rater  a t p<.01. levels  classroom  positive  An  a n a l y s i s of  the  the  of c o g n i t i v e  behavior  levels  indicated  attained cognitive levels  regard hour.  c o n s t r u c t s of  (1970)  than  those  Significant  empathy and  who  significantly remained  findings  congruence  were  study. studied the  warmth*  and  effects  empathic  of  genuineness*  understanding  were e x p e r i e n c i n g b e h a v i o r a l and i n g r a d e s one  worked  Flander's  o f B l o o m ' s Taxonomy p r o v i d e d  i n the  non-possessive  females  trained  throughout  Stoffer  of  whose s t u d e n t s  to the  difficulty  levels  between student  teachers  one  levels  significant  and  Scales  cognitive functioning.  three  relationship  level  through  The  Carkhuff's  regard*  students'  audio  taxomony were c o l l a p s e d i n t o  1 and  teachers'  reliability  that  of  the  groups.  using  positive  their  a one-hour  reading  Educational Objectives.  categories*  assessed  of  f u n c t i o n i n g determined  measurements u s i n g  The  submitted  evaluated and  A n a l y s i s and  Taxonomy o f  higher  who  through  individually  with  six. one  of  on  academic  Thirty-five 35  children  adult twice  at  29 per  week f o r t h r e e months.  instructed child  only  to establish  by c h o o s i n g  relationship  The a d u l t h e l p e r s  their  were  a good r e l a t i o n s h i p w i t h  own a c t i v i t i e s  each  and s t r u c t u r i n g t h e  individually.  Interviews  between a d u l t h e l p e r  and c h i l d  were  taped  near the i n i t i a t i o n  and t e r m i n a t i o n o f t h e r e l a t i o n s h i p and  were r a t e d on t h r e e  s c a l e s m e a s u r i n g empathy*  and  positive  regard.  measure t h e c h i l d ' s  A relationship  and a f t e r  treatment  tests*  gains  teacher-rated behavior An outcome i n d e x individual  gains  scores  from  individual  i n achievement*  p r o b l e m s and g a i n s  was d e r i v e d  reduction i n i n motivation.  from t o t a l l i n g  of high  levels  scores  of non-possessive  empathy were s i g n i f i c a n t l y  achievement* and  was examined  from the  tests.  Provision accurate  Each c h i l d  and i n d i c e s o f b e h a v i o r a l c h a n g e  were d e t e r m i n e d by c o m b i n i n g intelligence  i n v e n t o r y was u s e d t o  and h e l p e r ' s p e r c e p t i o n o f t h e l e v e l s  of t h e r a p e u t i c c o n d i t i o n s o f f e r e d . before  congruence*  related  warmth and  to gains i n  reduction i n teacher-rated behavior  reflected  by t h e t o t a l  outcome i n d e x .  problems* Lack of  agreement between j u d g e s r e s u l t e d i n e x c l u s i o n o f t h e variable indicated with  o f genuineness from a n a l y s i s .  findings  that the c h i l d ' s perception of the r e l a t i o n s h i p  t h e a d u l t h e l p e r was  reduction  Further  significantly  related to  i n t e a c h e r - r a t e d b e h a v i o r a l p r o b l e m s and g a i n s  m e a s u r e d by t h e t o t a l  outcome  index.  as  30 The above r e s e a r c h f i n d i n g s p r o v i d e e v i d e n c e suggests f a c i l i t a t i v e  teacher  behavioral  students.  The b e h a v i o r a l  indirectly  to  changes i n  examined  related  subjects  i n the  only school  employed i n t e r v e n t i o n g r o u p s and f a i l e d for  behaviors are  age y e a r s .  related  anxiety  changes  and  utilized  define  the  include  used  subjects.  u s e d an e x p e r i m e n t a l effects  of  self-concept*  d e s i g n and r a t i n g  human r e l a t i o n s anxiety  level*  r a n d o m l y a s s i g n e d t o one o f p l a c e b o - t y p e group*  training weeks.  for  leaderless learning  group.  human  training  critical  experience*  group f i v e  training.  and n o n - v e r b a l  a  experimental  for  a  seven either  a  in their  (control)*  sensitivity  growth  opportunity*  in  lives  journal  or  cognitively  interaction.  members m a i n t a i n e d  incidents  were  c o n s i s t e d of  communication experience w i t h t r a i n i n g  (placebo-type)  56  g r o u p e x p e r i e n c e w h i c h f o c u s e d on  through d i r e c t  verbal  measured  relations  hours weekly  e x p e r i e n c e w i t h an a f f e c t - o r i e n t e d  oriented  The  who  examine  three treatment groups*  one and o n e - h a l f  structured  Volunteers  three types of  The human r e l a t i o n s  upon t h e  (1974)  and g r o u p a w a r e n e s s o f  or a c o n t r o l  g r o u p r e c e i v e d one o f  s c a l e s to  training  a s s o c i a t e degree n u r s i n g freshmen.  like  control  intervention  A more r i g o r o u s s t u d y d e s i g n was u s e d by Dye  the  to  Study d e s i g n s which  treatments d i d not  to c l e a r l y  that  Group four  recordings  of  as n u r s i n g s t u d e n t s  r e c e i v e d no human  relations  and*  a  31 A n x i e t y l e v e l was measured by t h e M a n i f e s t Scale* S t a t e - T r a i t Anxiety Inventory*  Anxiety  and A f f e c t A d j e c t i v e  Check L i s t - G .  I n v e n t o r i e s were a d m i n i s t e r e d p r e - and  post-treatment  and a f t e r a one month p o s t - t e s t i n t e r v a l .  F i n d i n g s on a l l a n x i e t y i n v e n t o r i e s " i n d i c a t e d a d e c r e a s e i n mean s c o r e s f o r a l l groups a c r o s s t i m e " I n v e s t i g a t o r s f e l t the instruments  (p. 305).  "measured r e l a t i v e l y  s t a b l e i n d i v i d u a l d i f f e r e n c e s i n a n x i e t y l e v e l rather than the e f f e c t s o f e n v i r o n m e n t a l l y 305).  i n f l u e n c e d a n x i e t y " (p.  Data i m p l i e d t h a t "the s i g n i f i c a n t d e c r e a s e i n  measured a n x i e t y r e f l e c t e d a change over t i m e f o r a l l groups r a t h e r than a change r e s u l t i n g from a p a r t i c u l a r t y p e o f human r e l a t i o n s t r e a t m e n t "  (p. 3 0 5 ) .  Absence o f  treatment  e f f e c t was f e l t t o be "a n a t u r a l consequence o f g r e a t e r f a m i l i a r i t y w i t h t h e p r o f e s s i o n a l demands o f n u r s i n g and w i t h t h e h o s p i t a l as a c l i n i c a l l a b o r a t o r y "  (p. 3 0 5 ) .  F o r s y t h e and L a y t o n (1985) completed a c o r r e l a t i o n a l study w h i c h examined a n x i e t y i n n u r s i n g s t u d e n t s and t e a c h e r empathy.  They s t u d i e d 130 n u r s i n g s t u d e n t s from two p r i v a t e  s c h o o l s i n t h e i r f i n a l two y e a r s o f n u r s i n g S t u d e n t s r a t e d b o t h t h e empathy o f t h e i r  education.  clinical  i n s t r u c t o r s u s i n g t h e Empathy C o n s t r u c t R a t i n g S c a l e and t h e i r own a n x i e t y u s i n g t h e s t a t e s e c t i o n o f t h e S t a t e - T r a i t Anxiety Inventory. significant  Results indicated a  statistically  (p<.01) n e g a t i v e c o r r e l a t i o n ( r = -.42) between  s t u d e n t a n x i e t y and i n s t r u c t o r  empathy.  32 Evidence  suggests  that f a c i l i t a t i v e  related  positively  limited  evidence  related  to selected facilitative  faculty.  student In in  nursing student  review  summary*  the c l i n i c a l  and  anxiety i s  c o n d i t i o n s demonstrated  of literature  fails  relates  r e l a t i o n s h i p between student  anxiety  nursing  suggests  any r e s e a r c h t h a t d i r e c t l y  interpersonal  behavior i s  t o d e s i r a b l e changes i n students*  A thorough  however*  teacher  to  by  reveal*  the perceived and t e a c h e r  to  levels. research consistently setting  students.  as a major  Within this  identifies  source  setting*  experience  of anxiety f o r  the interpersonal  relationship with the c l i n i c a l  instructor  described  of anxiety f o r the student.  as a s p e c i f i c  Group methods designed dealing  Finally*  that  teacher  with  positive  correlated attempts  a limited  nursing students i n  facilitative change  to f i l l  student's  inconsistent  number o f s t u d i e s  behavior  i n student  with nursing student  interpersonal is  to assist  w i t h a n x i e t y have been s t u d i e d w i t h  results.  the  source  has been  indicate  i s positively  correlated  behaviors  and n e g a t i v e l y  anxiety.  This  a r e s e a r c h v o i d by a t t e m p t i n g  study to  relate  perception of the student-instructor relationship  hypothesized  t o student  that student  relationship-building  nurses  anxiety levels.  who  intervention w i l l  receive a rate  their  than  student  relationship with the instructor  higher  receiving  and t h a t student  a placebo  intervention  I t  nurses  nurses  33 who  receive  less  state  a  anxiety  intervention. have the of  relationship-building  The  instructor  empathy*  implemented  than  within  student nurses  intervention demonstrate  congruence*  intervention  and  a group  planned the  positive setting.  receiving was  and  have  placebo  designed  facilitative regard  will  to  conditions was  to  be  34  CHAPTER THREE Methodology  Research  Design  An experimental p r e - t e s t /  post-test  group d e s i g n was  used t o t e s t the t h r e e study hypotheses.  A convenience  sample of f i r s t year n u r s i n g students was randomly a s s i g n e d to t e n groups.  Of the t e n groups/  c o n t r o l group and f i v e c o n s t i t u t e d  Control of v a r i a b l e s .  f i v e c o n s t i t u t e d the the experimental  group.  Each of f i v e i n s t r u c t o r s had  assigned t o her two groups of s t u d e n t s ; one group formed the c o n t r o l group and the second the experimental group. one  Having  i n s t r u c t o r work w i t h both a c o n t r o l and an experimental  group decreased the chance of i n h e r e n t i n d i v i d u a l i n s t r u c t o r characteristics influencing  study r e s u l t s .  In order t o prevent study contamination  instructors  worked w i t h c o n t r o l groups f i r s t .  Having  intervention  the placebo  implemented f o l l o w i n g  the treatment intervention  prevented a c a r r y - o v e r e f f e c t which c o u l d have o c c u r r e d i f the sequence o f the i n t e r v e n t i o n Instructors  was randomized.  working with c o n t r o l groups Week 2 would have  been s e n s i t i z e d by the treatment c a r r i e d out the p r e v i o u s week r e s u l t i n g i n decreased study v a l i d i t y . P r i o r t o working with the experimental group the same f i v e p a r t i c i p a t i n g i n s t r u c t o r s were i n t r o d u c e d t o the  35 treatment attempt  intervention  t o ensure  instructors  package  (see Appendix D).  consistency of implementation  the investigator  presented  Written  each of the a c t i v i t i e s  planned  was a l s o  Baseline  placebo  or post  data  and p o s t  d a t a were c o l l e c t e d by t h e i n v e s t i g a t o r experimental control  subjects  with the treatment  Attempts influence clinical  control  stress  ratings  settings  by study  f o r the study  clients  controlled which  The  control Data  and  from  first  they  ward.  Variation  level  students  clinical  experimental clinical  week  surgical  experience  Students  of  complexity  was  of types of t o care f o r .  during  begin  the sixth  rotations  setting weeks.  five  hours  Because of  subjects i n the control  p r i o r t o the study.  both  t o t h e same  are allowed  groups had p a r t i c i p a t e d  hours  The  Because  i n client  are i n the c l i n i c a l  rotation*  would  s e t t i n g and a c u i t y  c o n s e c u t i v e mornings on a l t e r n a t e  alternate  which  participants.  by t h e narrow d e f i n i t i o n  students begin  which  variables  groups were a s s i g n e d  week o f t h e n u r s i n g p r o g r a m .  the  from  were f o u r acute  variation i n clinical  was m i n i m i z e d .  clients  three  intervention  1 a n d 2).  medical-surgical  and e x p e r i m e n t a l  areas*  during  provided.  group.  w e r e made t o c o n t r o l  wards and one a c u t e  partly  instructions  s u b j e c t s were c o l l e c t e d p r i o r t o i n s t r u c t o r  involvement  five  (see Tables  among  the intervention  package t o a l l i n s t r u c t o r s i n person. for  I n an  and  i n t h e same number o f Members o f b o t h t h e  36 Table 1 Plan  f o r C o n t r o l Group:  Implemented  by each o f 5  i n s t r u c t o r s Week 1  Monday  Tuesday  Wednesday  Thursday  Activity 30-minute  post-conference  implemented  each o f three  by i n s t r u c t o r  using  agenda o f d i s c u s s i o n r e l a t e d concerns and c l i e n t Data  data  collection  from  conventional  t o student  care.  Collection  Baseline  days  Pata  Data  Collection  collection  subjects  from  i ncontrol  subjects i n  group which  control  completion  of  (1)  Anxiety  which  group  includes  completion o f (1) S t a t e / T r a i t  State  includes  Questionnaire/ (2) I n s t r u c t o r -  Anxiety  Relationship  Questionnaire.  Questionnaire/ (3)  Stressful  Event  Questionnaire/ and (4)  Demographic  Data  Questionnaire.  37  Table 2 P l a n f o r E x p e r i m e n t a l Group:  Implemented by each o f 5  i n s t r u c t o r s Week 2  Monday  Tuesday  Wednesday  Thursday  /Activity  30-minute p o s t - c o n f e r e n c e  each o f t h r e e days  incorporating structured relationshipb u i l d i n g a c t i v i t y p r o v i d e d by i n v e s t i g a t o r . Pate  collection  Data C o l l e c t i o n  Baseline data  Data c o l l e c t i o n  c o l l e c t i o n from  from s u b j e c t s i n  subjects i n  experimental  experimental  which i n c l u d e s  group w h i c h  completion of  includes  (1) S t a t e A n x i e t y  completion of (1) S t a t e / T r a i t  group  Questionnaire* (2) I n s t r u c t o r -  Anxiety  Relationship  Questionnaire.  Questionnaire* (3) S t r e s s f u l Event Questionnaire* and (4) Demographic  Data  Questionnaire.  38 control clinical  and e x p e r i m e n t a l area  groups had been i n t h e s e l e c t e d  o n e week b e f o r e  therefore both participating  groups  the study  took  p l a c e and  o f s u b j e c t s had c o n t a c t w i t h t h e  instructor  prior  t o commencement  of the  study.  Setting The Nursing The  study  took  place  i n a three-year  i n a l a r g e metropolitan area  School  care  of Nursing  diploma  i n British  School  of  Columbia.  was a s s o c i a t e d w i t h a l a r g e /  acute  hospital. The  care The  and Sample  clinical  surgical placebo  conference  settings  f o r t h e study were f o u r  wards and one a c u t e  and i n t e r v e n t i o n  acute  m e d i c a l - s u r g i c a l ward.  treatments  rooms on each o f t h e f i v e  took  place i n  wards i n the  clinical  setting. P a r t i c i p a n t s were v o l u n t e e r s from t h e f i r s t of  nursing students.  provides concurrent experience. first  year  program. specific as  The f i r s t classroom  year  of the nursing  instruction  Instructors participating nursing  instructors  year  and  class program  clinical  i n the study  i n the three-year  were  diploma  I n s t r u c t o r s were r e s p o n s i b l e f o r t e a c h i n g i n clinical  part of planned  areas  and f o r c o n d u c t i n g  learning  experiences.  post  conferences  Instruments Four  q u e s t i o n n a i r e s were u s e d  instruments  were u s e d  t o measure the e f f e c t  relationship-building State-Trait  Anxiety  activities.  Inventory  ( s e e A p p e n d i c e s A and anxiety. and  The  Carkhuff  1967)  second  B) was  The  of  the the 1970)  (Spielberger et a l .  w h i c h was an  Two  f i r s t was  used  adapted  t o measure  student  v e r s i o n of the  Relationship Questionnaire  (Truax  &  Truax  Carkhuff*  ( s e e A p p e n d i x C) w h i c h measured t h e p e r c e i v e d  student-instructor A third  and  investigator. Appendix  relationship.  f o u r t h q u e s t i o n n a i r e were d e v i s e d by The  I) was  perceived if  i n the study.  they  Stressful  used had  t o determine  experienced  so t o d e t e r m i n e  q u e s t i o n n a i r e was  the nature used  al.*  1970).  Anxiety  trait  achievable  80.  score i s  i s hypothesized  also  d a t a on  fSTAII  exhibit  separate  anxiety.  level  will  of t h a t event.  Inventory  score the higher the  subjects event  The  and  fourth  subject  (see Appendix J ) .  t o measure two  s t a t e a n x i e t y and  (see  whether or not  (Spielberger et  T h i s i n v e n t o r y c o n s i s t s o f two  scales designed  It  Questionnaire  a recent s t r e s s f u l  to c o l l e c t  demographic c h a r a c t e r i s t i c s  State-Trait  Event  the  The  of anxiety.  that people  self-report  anxiety  higher the The  concepts* anxiety  maximum  exhibiting  high  A-trait  A - s t a t e e l e v a t i o n s more o f t e n t h a n  low  40 A - t r a i t i n d i v i d u a l s "because they tend t o r e a c t t o a w i d e r range of s i t u a t i o n s as dangerous or t h r e a t e n i n g " ( S p i e l b e r g e r e t a l . / 1970/  p. 3 ) .  S p i e l b e r g e r e t a l . (1970) r e p o r t e d t h a t t e s t - r e t e s t c o r r e l a t i o n s of the A - t r a i t component a r e r e l a t i v e l y h i g h r a n g i n g from .73 t o .86  (p. 9 ) .  Due  t o the t r a n s i t o r y  n a t u r e o f a n x i e t y s t a t e s / the t e s t - r e t e s t c o r r e l a t i o n s of the A - s t a t e component a r e low/ 9).  Low  r a n g i n g from .16 t o .54  (p.  c o r r e l a t i o n s appear v a l i d as A - s t a t e s c o r e s s h o u l d  r e f l e c t the i n f l u e n c e of unique s i t u a t i o n a l e x i s t i n g a t the time of t e s t i n g .  Internal  factors reliability  u s i n g Cronbach A l p h a c o e f f i c i e n t s i s h i g h / however/ r a n g i n g from .83 t o .92  (p. 9 ) .  In a d d i t i o n / c o n s t r u c t v a l i d i t y  and c o n c u r r e n t v a l i d i t y have been e s t a b l i s h e d by developers  test  (p. 1 0 ) .  R e l a t i o n s h i p Q u e s t i o n n a i r e (adapted from Truax & C a r k h u f f / 1967).  The R e l a t i o n s h i p Q u e s t i o n n a i r e  adapted by t h e i n v e s t i g a t o r .  was  T h i r t y items measuring the  c o n s t r u c t s empathy/ congruence/ and p o s i t i v e r e g a r d were s e l e c t e d from t h e o r i g i n a l q u e s t i o n n a i r e of 141  items.  items f o r each c o n s t r u c t were chosen.  4-point  r a t i n g s c a l e was  A Likert  used t o have respondents  p e r c e p t i o n s of the r e l a t i o n s h i p w i t h t h e i r S u b j e c t s r a t e d d e s c r i p t i v e statements to  "not a t a l l " .  Ten  rate their instructor.  from " v e r y much so"  To h e l p break response p a t t e r n b i a s / a  41 phenomenon o f t e n a s s o c i a t e d w i t h q u e s t i o n n a i r e s i n t h e a f f e c t i v e area* items were worded so t h a t h a l f were p o s i t i v e l y worded and h a l f were n e g a t i v e l y worded. P o s i t i v e l y worded items were g i v e n a v a l u e o f 4 f o r a response o f "very much s o " t h r o u g h one f o r a response o f "not a t a l l " .  The n e g a t i v e l y worded items were r e v e r s e l y  s c o r e d w i t h a v a l u e o f one f o r t h e response "very much s o " through 4 f o r "not a t a l l " .  The h i g h e s t s c o r e a t t a i n a b l e  on t h e q u e s t i o n n a i r e was 120 and r e f l e c t e d a more s a t i s f y i n g 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 with the i n s t r u c t o r . Because t h e R e l a t i o n s h i p Q u e s t i o n n a i r e used t o measure s t u d e n t - i n s t r u c t o r r e l a t i o n s h i p was adapted by t h e i n v e s t i g a t o r / t h e q u e s t i o n n a i r e was p i l o t t e s t e d f o r t e s t retest r e l i a b i l i t y  and i n t e r n a l c o n s i s t e n c y .  The  q u e s t i o n n a i r e was t e s t e d on an a l t e r n a t e c l a s s o f f i r s t y e a r s t u d e n t s who were i n t h e i r f i n a l month o f t h e f i r s t year course.  The a l t e r n a t e c l a s s was t h e r e s p o n s i b i l i t y o f  a s e p a r a t e group o f i n s t r u c t o r s . V o l u n t e e r s from t h e c l a s s were asked t o complete t h e q u e s t i o n n a i r e on two s e p a r a t e o c c a s i o n s one week a p a r t . The i n v e s t i g a t o r asked v o l u n t e e r s t o t h i n k o f a t e a c h e r they had known and complete t h e q u e s t i o n n a i r e r a t i n g t h a t specific individual.  The q u e s t i o n n a i r e was completed t h e  f i r s t time f o l l o w i n g a classroom  session.  Twenty-three  v o l u n t e e r s submitted  questionnaires.  The i n v e s t i g a t o r  v i s i t e d the c l i n i c a l  a r e a s one week l a t e r and requested t h e  42 same 23 v o l u n t e e r s t o a g a i n complete t h e q u e s t i o n n a i r e t h i n k i n g o f t h e same t e a c h e r .  Because t h e s t u d e n t s  i n the  a l t e r n a t e c l a s s o f f i r s t year s t u d e n t s were s u b j e c t s f o r the p i l o t study*  t h e i n v e s t i g a t o r v e r b a l l y requested t h e  volunteers completing  t h e q u e s t i o n n a i r e t o r e f r a i n from  s h a r i n g i n f o r m a t i o n on t h e q u e s t i o n n a i r e s w i t h f e l l o w students. A s c a t t e r p l o t was c o n s t r u c t e d u s i n g t h e 23 p a i r e d d a t a and  showed e v i d e n c e o f a s t r o n g p o s i t i v e r e l a t i o n s h i p  between s c o r e s on t h e q u e s t i o n n a i r e a d m i n i s t e r e d occasions.  Pearson's sample c o r r e l a t i o n c o e f f i c i e n t was  c a l c u l a t e d t o be r = .87. (1986)/  on t h e two  According  t o Devore and Peck  t h e r e l a t i o n s h i p i s c l a s s i f i e d as s t r o n g i f g r e a t e r  t h a n .8 (p. 1 1 6 ) . Cronbach's a l p h a was used t o o b t a i n  reliability  c o e f f i c i e n t s f o r each o f t h e t h r e e s u b s c a l e s .  Results of  a n a l y s i s i n d i c a t e d r = .45 f o r empathy/ r = .71 f o r congruence/ and r = .80 f o r p o s i t i v e r e g a r d .  S t r e s s f u l Event Q u e s t i o n n a i r e . recognized  The i n v e s t i g a t o r  t h a t any a n x i e t y - p r o d u c i n g  event t h a t  occurred  between t h e measurement o f s t a t e a n x i e t y p r i o r t o p l a c e b o or t r e a t m e n t  i n t e r v e n t i o n and t h e measurement o f s t a t e  a n x i e t y p o s t i n t e r v e n t i o n would c o n s t i t u t e an i n t e r v e n i n g variable.  Consequently/ s u b j e c t s were asked t o s t a t e  whether o r n o t they had e x p e r i e n c e d  any s t r e s s - p r o d u c i n g  43  s i t u a t i o n during the intervening three days.  Those stating  "yes" were asked to describe the event i n their own words (see Appendix I ) .  Demographic Data.  Demographic data on subject ager  sexr and marital status were c o l l e c t e d .  In addition/ the  c l i n i c a l area to which the subject was assigned  was  reported. Subjects were asked to report absenteeism from the c l i n i c a l area.  In the event that large numbers of students  had been absent i n one c l i n i c a l group during the course of the study/ data from t h i s group would have been excluded from the  study.  The fact that some subjects could have considerably more experience than others i n dealing with c l i e n t situations/ thus perhaps p r e c i p i t a t i n g l e s s anxiety/ also recognized.  was  Subjects/ therefore/ were asked to record  their occupation p r i o r to commencing the nursing program (see Appendix J ) .  Procedure  When subjects f i r s t entered the nursing program they were randomly assigned to one of ten c l i n i c a l groups using a table of random numbers.  Of the ten groups/ f i v e were  selected by a drawing process.  These f i v e groups  constituted the control group and the remaining  five  44 constituted  t h e experimental group.  instructors  had assigned  experimental The  The  to her a control  designed  planned  which  post  conferences  relationship-building  activity  was d e s i g n e d  were Tuesday/ Wednesday and Thursday  treatment  planned/  to receiving  group  control  group c o n s i s t e d of a c t i v i t i e s  a thirty  discussion  (seeTable  minute post  of client  t o occur days  mornings.  any i n f o r m a t i o n on  t h e i n s t r u c t o r worked w i t h t h e  control  for  and a c o n s u l t a n t .  on t h r e e s u c c e s s i v e c l i n i c a l  D u r i n g Week 1/ p r i o r the  was a  by t h e i n v e s t i g a t o r  relationship-building  during  group and an  group.  intervention  activity  Each o f f i v e  1).  The p l a c e b o  conference.  problems a r i s i n g  treatment  normally Student from  f o r the  scheduled concerns and  clinical  e x p e r i e n c e w a s a common a g e n d a f o r t h e c o n f e r e n c e . Prior  t o working  w i t h t h e e x p e r i m e n t a l g r o u p i n Week 2/  the  same f i v e  the  relationship-building  A)  which  Week  p a r t i c i p a t i n g i n s t r u c t o r s were i n t r o d u c e d t o  constituted  2/ f o l l o w i n g  activities  activities  the treatment  introduction  package/  package  i n the study.  t h e same f i v e  instructors  activities  w i t h t h e experimental group  The  activities  were planned  post  conference  t o occur  implemented  (seeTable 2 ) .  during the regularly  time.  B a s e l i n e data were c o l l e c t e d subjects  During  to the relationship-building  the  scheduled  (see Appendix  o n t h e Monday p r i o r  from  a l l control  t o placebo  group  intervention  on  45 T u e s d a y * Wednesday* and  Thursday  who  were t o a t t e n d c l i n i c a l  and  who  volunteered  questionnaire. approximately On  (see T a b l e 1 ) .  experience  Subjects  t h a t p a r t i c u l a r week  t o p a r t i c i p a t e completed  D a t a were c o l l e c t e d by  the  the  investigator  20 m i n u t e s f o l l o w i n g a c l a s s r o o m  lecture*  members o f t h e c o n t r o l  t o c o m p l e t e t h e A - s t a t e component o f t h e questionnaire* Stressful  Questionnaire*  and  to a  g r o u p were  asked  STAI  the R e l a t i o n s h i p Questionnaire*  Event  in  lecture.  T h u r s d a y a f t e r n o o n o f t h e same week p r i o r  classroom  STAI  the  the Demographic Data  Form. The  A - t r a i t was  t o m e a s u r e how therefore  not  anxious  relatively  experimental  took  30  minutes.  g r o u p were r e q u e s t e d  sharing  information related  g r o u p s u b j e c t s on  investigator  and  is  control  investigator  to r e f r a i n  the  from  group. from  a l l experimental  on T u e s d a y * Wednesday* and  i n the  the  Subjects comprising  t h e Monday p r i o r t o  Again  by  to the q u e s t i o n n a i r e s with  i n the experimental  2).  used  A-trait  homogeneity of  verbally  B a s e l i n e d a t a were c o l l e c t e d  (see T a b l e  from  a g a i n completed  control  intervention  i t was  groups.  approximately  classmates  Scores  to determine  D a t a c o l l e c t i o n was and  a g a i n as  individuals generally feel  stable.  i n v e n t o r i e s were u s e d and  administered  treatment T h u r s d a y o f Week 2  d a t a were c o l l e c t e d by  same manner a s  i t was  the  collected  from  46 control  group s u b j e c t s .  On T h u r s d a y a f t e r n o o n o f t h e same  week members o f t h e e x p e r i m e n t a l g r o u p were a s k e d t o c o m p l e t e t h e same q u e s t i o n n a i r e c o l l e c t i o n was c o n d u c t e d control At  the completion held  participating  addition* elicited  o f t h e two weeks* a c t i v i t i e s  a half  hour d e b r i e f i n g  session  Informal verbal  about t h e e f f e c t s  the  with  comments on  o f t h e s t u d y and t h e  p a c k a g e were s o l i c i t e d  and r e c o r d e d .  In  comments f r o m s u b j e c t s who had p a r t i c i p a t e d  were  from t h e i n s t r u c t o r s .  Analysis Parametric  data  Data  i n t h e same manner a s i t was f o r  instructors.  feelings  intervention  Data  group.  subjects.  investigator  their  as t h e c o n t r o l  related  statistical  p r o c e d u r e s were u s e d t o a n a l y z e  t o the study hypotheses.  A two-way  of v a r i a n c e  (ANOVA) was u s e d t o t e s t  differences  between means on t h e s c o r e s o b t a i n e d  Relationship covariance  Questionnaire.  for statistical  A two-way a n a l y s i s  (ANCOVA) was u s e d t o t e s t  b e t w e e n means o b t a i n e d significance  level  from s t a t e  equal  from the of  f o r differences  anxiety  t o or l e s s  analysis  than  scores.  A  .05 was u s e d .  A  P e a r s o n product-moment c o e f f i c i e n t c o r r e l a t i o n was computed to  test  for relationships  relationship  between  s c o r e s and s t a t e  student-instructor  anxiety  scores.  47 A  t-test  was  d i f f e r e n c e was the  of  square  procedure  the  prior  control was  control  number o f  to determine  present  scores  between the  used  and  the  Data  Form.  experimental  used and  to post-test data  from  significant anxiety  groups.  The  chi  t o measure the d i f f e r e n c e s  experimental events  groups w i t h  experienced  respect  i n the  24  to  hours  collection.  statistics  Stressful  a  b e t w e e n t h e mean t r a i t  stressful  Descriptive  whether  were used  to analyze  E v e n t Q u e s t i o n n a i r e and  the  the  data  Demographic  48 C H A P T E R FOUR Results  and D i s c u s s i o n  Results The  results  of the study  are presented  i n the  following  manner.  D e s c r i p t i v e i n f o r m a t i o n on s u b j e c t demographics i s  reported  first.  to  hypotheses  study  information debriefing  from  (90%)  volunteered  total  from  students  to participate  the demographic  control prior the  the  descriptive  the  year  revealed that nursing  i n the study.  Due  of subjects.  characteristics  class to  illness  o r 87% o f t h e  A  comparison  of the experimental status/  i n t h e n u r s i n g program  groups were s i m i l a r .  63  study.  g r o u p s by age/ s e x / m a r i t a l  to enrollment  the  experimental  6 1 o f t h e 63 p a r t i c i p a n t s /  completed  related  i s included.  study  i n the f i r s t  Demographic c h a r a c t e r i s t i c s of  Finally/  instructors  Data obtained  the study/ class  findings  t h e S t r e s s Q u e s t i o n n a i r e and from  p o s t - t e s t group design  o f 70  during  the s t a t i s t i c a l  are described.  session with  Attrition. pre-test/  Secondly/  These data  and  and  occupation  indicated  are contained  that  i n Table  3. A comparison subjects  o f t h e number o f c l i n i c a l d a y s m i s s e d  i n the experimental  and c o n t r o l  groups  by  indicated  49 t h a t t h e m a j o r i t y o f group members were p r e s e n t i n each group on a l l t h r e e days when e i t h e r t h e p l a c e b o o r treatment i n t e r v e n t i o n occurred.  One s u b j e c t missed one  e x p e r i e n c e i n t h e e x p e r i m e n t a l group* w h i l e one s u b j e c t missed one e x p e r i e n c e and one s u b j e c t missed two e x p e r i e n c e s i n t h e c o n t r o l group.  Table 3 A Comparison o f E x p e r i m e n t a l and C o n t r o l S u b j e c t s by Age/Sex* M a r i t a l S t a t u s * and O c c u p a t i o n  P r i o r t o E n r o l l m e n t (N = 61) Groups Experimental n = 31  Age  (years)  17-20 21-25 26-29 30-35  23 (74) 8 (26)  Sex  Female Male  M a r i t a l Status Occupation P r i o r to Enrollment  Note.  Control n = 30 21 7 1 1  (70) (23) (3) (3)  30 (97) 1 (3)  30  (100)  Single Married  30 (97) 1 (3)  30  (100)  Student Nurse A i d e Other  15 (48) 4 (13) 12 (39)  14 (47) 2 (7) 14 (47)  —  -  —  Numbers i n b r a c k e t s a r e p e r c e n t .  H y p o t h e s i s one;  E f f e c t o f i n t e r v e n t i o n on s t u d e n t -  instructor relationship.  The i n v e s t i g a t o r h y p o t h e s i z e d t h a t  50 s t u d e n t n u r s e s who  received a relationship-building  i n t e r v e n t i o n would r a t e t h e i r r e l a t i o n s h i p w i t h the i n s t r u c t o r h i g h e r than s t u d e n t n u r s e s who  received a  placebo i n t e r v e n t i o n .  i n the c o n t r o l  T h i r t y respondents  group and 31 respondents completed The  i n the e x p e r i m e n t a l group  the R e l a t i o n s h i p Q u e s t i o n n a i r e (see Appendix C ) .  response  r a t e and the mean s c o r e f o r each  s t u d e n t - i n s t r u c t o r c o m b i n a t i o n i s shown i n T a b l e  4.  Table 4 Response Rates and Mean S t u d e n t - I n s t r u c t o r R e l a t i o n s h i p S c o r e s of C o n t r o l and E x p e r i m e n t a l Groups Group  Instructor  No.  Response Rate  Mean Score  Control  5  3/7  110.00  Control  6  7/7  102.86  Control  7  6/7  85.83  Control  8  7/7  95.86  Control  9  7/7  103.57  Experimental  5  7/7  106.57  Experimental  6  6/7  107.00  Experimental  7  7/7  93.71  Experimental  8  7/7  106.86  Experimental  9  4/7  108.25  51 A two-way a n a l y s i s used  t o analyze  intervention and  levels). in  the data;  effect  t h e second  of variance the f i r s t  (two l e v e l s :  factor  f o r unbalanced  Diagnostic  checking  analysis.  and p l a c e b o ) / (five  numbers o f  combination  d e s i g n was  group*  respondents an ANOVA  used.  o f t h e ANOVA model was b a s e d  I t was c o n c l u d e d  was  i s the  treatment  S i n c e t h e r e were u n e q u a l  procedure  factor  i s the instructor e f f e c t  each s t u d e n t - i n s t r u c t o r  residual  (ANOVA) p r o c e d u r e  that  on  t h e two-way ANOVA  model was a p p r o p r i a t e f o r t h e s t u d e n t - i n s t r u c t o r relationship The  data.  r e s u l t s o f t h e ANOVA  was a s t a t i s t i c a l l y experimental effect.  The e x p e r i m e n t a l  experimental instructor analysis  than  there  between t h e  group f o r t h e i n t e r v e n t i o n  main  group rated  the student-instructor  the control  group.  group appeared  r e l a t i o n s h i p than  also  difference effect.  significant difference  and c o n t r o l  relationship higher  ( T a b l e 5) showed t h a t  t o have a b e t t e r the control  revealed a s t a t i s t i c a l l y  That  i s / the  student-  group.  Data  significant  b e t w e e n t h e two g r o u p s f o r t h e i n s t r u c t o r main  The d i f f e r e n c e  between t h e c o n t r o l and  experimental  g r o u p s seemed t o be t h e same f o r a l l f i v e  instructors/  however.  statistically  S i n c e t h e i n t e r a c t i o n e f f e c t was n o t  s i g n i f i c a n t / the difference  between t h e two  g r o u p s c a n be c o n s i d e r e d t o be due t o t h e p l a n n e d  52 intervention.  H y p o t h e s i s number one i s t h e r e f o r e  supported.  Table 5 Summary o f A n a l y s i s o f V a r i a n c e f o r I n t e r v e n t i o n I n s t r u c t o r E f f e c t on S t u d e n t - I n s t r u c t o r Degrees of Freedom  Source  and  Relationship  Sum o f Squares  Mean Square  Fstatistic  Pvalue  Intervention  1  332.18  332.18  6.07  0.02  Instructor  4  2513.12  628.28  11.49  0.00  Interaction  4  299.07  74.77  1.37  0.26  Error  51  2789.01  54.69  Total  60  5912.75  H y p o t h e s i s two: anxiety.  E f f e c t o f i n t e r v e n t i o n on s t a t e  The i n v e s t i g a t o r h y p o t h e s i z e d t h a t s t u d e n t n u r s e s  who r e c e i v e d  a r e l a t i o n s h i p - b u i l d i n g i n t e r v e n t i o n would have  l e s s s t a t e a n x i e t y t h a n s t u d e n t n u r s e s who r e c e i v e d placebo i n t e r v e n t i o n .  a  F o r each s u b j e c t who responded* a  p r e - t e s t and a p o s t - t e s t s t a t e a n x i e t y from t h e STAI Form X - l q u e s t i o n n a i r e  s c o r e was  derived  (see Appendix A ) .  The  response r a t e and t h e mean s c o r e s o f t h e two t e s t s f o r each student-instructor  c o m b i n a t i o n group i s shown i n T a b l e 6.  53 Table 6 Response Rates and Mean S t a t e A n x i e t y S c o r e s o f C o n t r o l and E x p e r i m e n t a l Groups Instructor Number  Group  Response Rate  Mean P r e T e s t Score  Mean P o s t T e s t Score  Control  5  3/7  37.37  38.33  Control  6  7/7  38.14  47.14  Control  7  6/7  42.67  48.67  Control  8  7/7  40.14  45.57  Control  9  6/7  40.50  42.00  Experimental  5  6/7  41.67  39.00  Experimental  6  6/7  41.83  41.50  Experimental  7  6/7  41.50  42.50  Experimental  8  7/7  43.86  38.29  Experimental  9  4/7  39.50  42.00  A two-way a n a l y s i s o f c o v a r i a n c e (ANCOVA) p r o c e d u r e was used f o r t h e a n a l y s i s o f t h e d a t a .  The dependent v a r i a b l e  was t h e p o s t - t e s t s t a t e a n x i e t y s c o r e * t h e f i r s t f a c t o r was the i n t e r v e n t i o n e f f e c t placebo)t  (two l e v e l s :  t r e a t m e n t and  t h e second f a c t o r was t h e i n s t r u c t o r e f f e c t  (five  l e v e l s ) / and t h e c o v a r i a t e was t h e p r e - t e s t s t a t e - a n x i e t y score.  S i n c e t h e r e were unequal numbers o f r e s p o n d e n t s i n  each s t u d e n t - i n s t r u c t o r c o m b i n a t i o n group* an a n a l y s i s o f c o v a r i a n c e p r o c e d u r e f o r unbalanced d e s i g n was used.  54 Diagnostic  c h e c k i n g of the c o v a r i a n c e model was  on r e s i d u a l a n a l y s i s . model was  appropriate  Results i n Table  I t was  c o n c l u d e d t h a t the  based  covariance  f o r the p o s t - t e s t s t a t e a n x i e t y  data.  of the two-way a n a l y s i s of c o v a r i a n c e are shown  7.  Table 7 Summary of A n a l y s i s of C o v a r i a n c e f o r I n t e r v e n t i o n I n s t r u c t o r E f f e c t on S t a t e  Source  Degrees of Freedom  and  Anxiety  Sum of Squares  Mean Square  Fstatistic  Pvalue  Pre-test  1  2268.04  2268.04  18.76  0.00  Intervention  1  312.75  312.75  2.59  0.11  Instructor  4  231.91  57.98  0.48  0.75  Interaction  4  193.34  48.34  0.40  0.81  Error  47  5680.96  120.87  Total  60  8647.52  Findings  from the F - t e s t  i n d i c a t e d t h a t adjustment  p r o v i d e d by the i n c l u s i o n of the c o v a r i a t e state anxiety There was  s c o r e ) was  necessary  no s t a t i s t i c a l l y  (the  pre-test  (p<0.00).  significant difference  between the e x p e r i m e n t a l and  c o n t r o l groups i n t h e i r p o s t -  test state anxiety  There was  ratings.  no s i g n i f i c a n t  i n s t r u c t o r main e f f e c t * i n t e r v e n t i o n main e f f e c t *  nor  55  significant  instructor-intervention  H y p o t h e s i s number two Analysis by  of  tended  that  t o be  a scatter  groups d i d  post  lower  than i n the  unsupported.  p l o t of post  not was  the  intervention  group.  i n the  anxiety  establish  for subjects  achieve  trend  state  intervention  control  the  1  instructors  the  instructor  anxiety  i n the  experimental  This  have h e l p e d subjects/  p l o t of 2  but  state  (see  i n lowering  three:  K)  levels group  between p<0.11/  significance/  suggests  that  in  lowering  not  enough  was  state the  to  the  versus revealed  instructor  anxiety  levels  no  was and  most s i g n i f i c a n t f a c t o r .  Relationship  r e l a t i o n s h i p s c o r e and  anxiety  A p p e n d i x L)  suggested that  intervention  Hypothesis  Appendix  scores  significance.  shown i n F i g u r e  a major f a c t o r  therefore  the  a scatter  This  anxiety  Although d i f f e r e n c e s  t r e a t m e n t may  obvious pattern.  (see  state  statistical  i n some o f  of  state  right direction.  statistical  Analysis  not  i s therefore  t r e a t m e n t g r o u p shown i n F i g u r e  indicated  interaction effect.  between  state  student-  anxiety  score.  P e a r s o n ' s product-moment c o r r e l a t i o n c o e f f i c i e n t b e t w e e n student-instructor  r e l a t i o n s h i p s c o r e s and  anxiety  calculated  s c o r e s was  the  control  the  trend  and  was  t o be  -0.36  post-test and  -0.50/  experimental groups r e s p e c t i v e l y .  not  strong/  the  the  r e l a t i o n s h i p between t h e  student/  the  lower the  state  anxiety  for  Although  r e s u l t suggests that  stronger  state  the  i n s t r u c t o r and f o r the  student.  the  56 A comparison o f t r a i t a n x i e t y s c o r e s o f c o n t r o l and e x p e r i m e n t a l groups.  To determine  i f differences i n t r a i t  a n x i e t y e x i s t e d between t h e c o n t r o l and e x p e r i m e n t a l groups a t - t e s t was completed on t r a i t a n x i e t y s c o r e s .  Results  r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e between t h e mean s c o r e s f o r the two groups.  Data from S t r e s s Q u e s t i o n n a i r e .  The e f f e c t of a p e r c e i v e d  s t r e s s f u l event i n t h e 24-hour p e r i o d p r i o r t o d a t a  collection  on p o s t i n t e r v e n t i o n s t a t e a n x i e t y was a p o s s i b l e i n t e r v e n i n g variable.  T h e r e f o r e s u b j e c t s were r e q u e s t e d t o p r o v i d e d a t a  on such o c c u r r e n c e s .  Table 8 presents t h i s i n f o r m a t i o n .  U s i n g t h e C h i Square procedure  a statistical difference  was n o t found between t h e c o n t r o l and e x p e r i m e n t a l groups i n r e l a t i o n s h i p t o t h e number o f s t r e s s f u l e v e n t s p e r c e i v e d .  Table 8 A Comparison o f E x p e r i m e n t a l and C o n t r o l S u b j e c t s E x p e r i e n c e of S t r e s s f u l Events i n 24 Hours P r i o r t o P o s t - t e s t Data C o l l e c t i o n (N = 61) Groups  Experience  Note.  Experimental  n = 31  Yes  13 (42)  No  18 (58)  Numbers i n b r a c k e t s a r e p e r c e n t .  Control n = 30 9  (30)  21 (70)  57 Subjects a  stressful  own  words.  who  responded  to describe  Subjects  the  Although  the  death  a  of  friend  different  types  be  -  by  et  Table  fact  both  similar that  with  impending  plans  accident  examples  very  the  a l l the  categories Academic*  events.  type  of  comments of  and  Clinical were  Several  event.  responses  or  of  These c a t e g o r i e s  i n d e s c r i b i n g the  the  the  c o n t r o l and  situations. first  The  i s displayed  with  a poor  examinations  were predominantly  Several  in  time  results  and  i n j e c t i o n was  completion  individual  of  health  or  related  nursing  Personal  to  given.  clients  Academic concerns  restraints. of  groups  comments r e l a t e d  caring f o r nauseated  prognosis.  associated  experimental  intramuscular  comments r e l a t e d t o  clients to  their  control  reported  that  Social*  of  and  in  9.  described  Other  and  the  a l . (1965).  classification  Members o f  the  into  more t h a n one  event  a car  Upon a n a l y s i s o f  Personal*  subjects described and  given  perceived  classified  experienced  events.  i n v e s t i g a t o r noted  Fox  therefore*  frequency  of  f a m i l y member a s  events.  events -  developed  used*  the  or  subjects  of  readily  stressful  types  the  experimental  i n v e s t i g a t o r had  events*  descriptions  i n both  similar  stressful  could  to having  event were asked  groups described  the  positively  care  stresses problems.  58 Table 9 C l a s s i f i c a t i o n o f S t r e s s f u l Events P e r c e i v e d by C o n t r o l and Experimental  Subjects  (N = 61) Groups Experimental n = 31  S t r e s s Reported (number o f s u b j e c t s )  13  T o t a l number o f comments  17  C l a s s i f i c a t i o n of S t r e s s f u l Events Personal Social Academic Clinical Unclassified No S t r e s s Reported (number o f s u b j e c t s ) Note.  Control n = 30  (42)  9 (30) 12  2 (12)  4 (33)  -  -  9 (53) 5 (29) 1 (6)  2 (17) 6 (50)  —  18 (58)  21  (70)  Numbers i n b r a c k e t s a r e p e r c e n t .  Descriptive  instructors.  information  from  a debriefing  session  with  I n s t r u c t o r s were asked t o comment on t h e i r  e x p e r i e n c e d u r i n g an i n f o r m a l h a l f - h o u r m e e t i n g .  Comments  from s t u d e n t s u b j e c t s r e p o r t e d by i n s t r u c t o r s a r e r e p o r t e d f i r s t ; comments by i n s t r u c t o r s a r e r e p o r t e d Students  last.  r e c e i v i n g the i n t e r v e n t i o n treatment  they d i d n o t mind h a v i n g t h e i r p o s t - c o n f e r e n c e  stated  time  filled  w i t h communication e x e r c i s e s f o r one week b u t they would  59 not l i k e  i t continuously.  beneficial  taped  and  one  concern  especially liked participate  the f a c t  i n the  Initially/  she  than u s u a l . that  stated  a n s w e r s were found  had  Finally/  i n s t r u c t o r s had  been unable  late  one  20 day  Generally They f o u n d t h e r e was time  stated  t o 30  out  the  day.  a pre-arranged  found  format  "no".  i n t o the  often their  individual  on  All  instructor  stayed  completed.  t h a n normal  which d i d not a l l o w to  learners.  and  useful  felt  as  t o p r o v i d e more of  t h e y l e a r n e d more  f i r s t p e r c e p t i o n s of  They a l l f e l t nature  as  any  Because of the nature  instructors  l e a r n e r were n o t c o n f i r m e d .  group  the  the e x e r c i s e s p a r t i c u l a r l y  "yes" or  the  i n s t r u c t o r s were f a v o r a b l e .  a l l students to p a r t i c i p a t e  s t u d e n t s and  insight  One  t h e p o s t c o n f e r e n c e more r e l a x i n g  i n f o r m a t i o n shared/  about  out  one  the e x e r c i s e s  t h e e x e r c i s e s were  comments f r o m  information than  their  the ward.  carried  t o p r o v i d e n e g a t i v e feedback  forced  actively  Only  to carry  leaving  t h e y had  minutes each  t o ensure  Instructors it  to  package.  i n s t r u c t i o n s p r o v i d e d w i t h t h e p a c k a g e and from  students  f o r use w i t h the e x p e r i m e n t a l  t h r e e as s t u d e n t s were l a t e  took  the  experience.  she  instructors  a  rotation.  i n s t r u c t o r s were q u e s t i o n e d a b o u t  exercises designed  other  their  t o implement t h e i n t e r v e n t i o n  instructor  day  that  i t w o u l d be i n each  student confessed  c o n f e r e n c e s more s t r e s s f u l  ability  felt  e x e r c i s e t o have i n i t i a l l y  Some s u b j e c t s e x p r e s s e d being  Others  of t h e i r  they  the  gained  students.  60 Interestingly/ experience  stated  s t u d e n t g r o u p on feelings  to  use  one  new  instructor  that  she  felt  the of  limited  much more a t  s e c o n d day.  the  with  She  intervention  ease w i t h  attributed  on  teaching  day  her  these  one.  Discussion  Intervention The  fact  that  relationship the  control  effect  the  on  experimental  with  the  that  nursing  program  the  relationship  instructor  effectiveness is directly  the  effective  instructors 1982; and  Kiker* behavior  related  to  identified  Since  a large  learned  by  behavior  (Kiker*  instructor  who  1973;  they  students provides  a pattern  area of  interpersonal  Several  authors have with  the  ability  1974;  as  &  nursing  Stuebbe* to  and  s e r v e s as  a  skill  directly  in their  ability  an  Schwab*  nursing  is  the  to  clinical  of  students  of  students.  Karns  part  observe  Rauen*  demonstrates  1981;  (1976)  kind  relationships  1973).  nursing  the  with  effective  than  clinical  to  the  higher  Gebbie  total  establishes  Brown*  the  relationship  the  1965;  instructor  the  of  component of  (Barham*  their  S c h w e e r and  interpersonal  behavioral  relationship.  significantly  proportional  instructor  A u t h o r s have c o n s i s t e n t l y  integral  group rated  group i s important.  suggest  establish  student-instructor  1981)*  an  relate  well  to  role  model  in  relationships. suggested  instructor  that  is a  the  interpersonal  source of  stress  for  61 nursing  students  1979).  Rogers  effectively was  1980;  Davitz*  (1961) s u g g e s t e d  promoted  minimized  and  interpersonal likely  (Blainey/  learning  advocated measures t o  therefore/  instructor.  understood  t o d e v e l o p t h r o u g h an  students experiencing i n s t r u c t o r s are  development of  provided  the  intervention  the  experimental group to  the  trend  higher  i n the  meaningful. study  the  A  thus decreasing significant.  concept  student  self  concept  is  relationships for  (Rogers/  state anxiety. to lower  statistically  1961).  Although  state anxiety  in  significant levels/  state anxiety  scores  to  be  experimental group i s  explanations  for  the  offered. one  i n s t r u c t o r was  i n t e r v e n t i o n p l a n n e d on  h i g h e r mean s t a t e  the  opportunity  number o f p o s s i b l e  f a c t that  student  f a c u l t y members/  c o n t r o l group than the  r e s u l t s are  The  an  intervention  i s more  individual's relationship  treatment f a i l e d  for post  self  r e l a t i o n s h i p with  positive interpersonal  e f f e c t on  to  enhance  since  including  a positive self  Instructor  most  i n s i t u a t i o n s where a  Furthermore/  with s i g n i f i c a n t others/  with  was  Significant learning  experiences a p o s i t i v e interpersonal his/her  McMaster/  i n a s i t u a t i o n where t h r e a t  relationships.  to occur/  that  1972;  anxiety  the  day  scores  unable to c a r r y  three  i n the  chance f o r s c o r e s  In a d d i t i o n /  may  research  out  have r e s u l t e d  experimental  t o be  in  group/  statistically  treatment  effects  often  62  do n o t o c c u r u n t i l w e l l a f t e r t h e i n t e r v e n t i o n . change may o c c u r over a p e r i o d individual rates.  Expected  o f time and a t d i f f e r e n t  M u l t i p l e measurements o f v a r i a b l e s may  have produced d i f f e r e n t f i n d i n g s . Furthermore* numerous s o u r c e s o f s t r e s s f o r n u r s i n g s t u d e n t s have been i d e n t i f i e d .  D e s c r i p t i v e d a t a from t h e  S t r e s s Q u e s t i o n n a i r e suggested t h a t s t r e s s was due p r e d o m i n a n t l y t o c l i n i c a l and academic c o n c e r n s . consistent with f i n d i n g s of E l f e r t  T h i s was  (1976)* Fox e t a l .  (1965)* and McMaster (1979). W i t h i n t h e c l i n i c a l s e t t i n g * however* some r e s e a r c h e r s have suggested t h a t t h e i n t e r p e r s o n a l i n s t r u c t o r and n u r s i n g  r e l a t i o n s h i p between  s t u d e n t i s n o t as i m p o r t a n t a s o u r c e  of s t r e s s as o t h e r i d e n t i f i e d f a c t o r s (McMaster* 1979; Zujewskyj & D a v i s * 1985).  Davitz  (1972) and McMaster  (1979) both noted t h a t i n i t i a l e x p e r i e n c e s evoke a n x i e t y . T h i s f i n d i n g i s s u p p o r t e d by d a t a a c q u i r e d which students f r e q u e n t l y intramuscular  i n t h i s study i n  i d e n t i f i e d the a d m i n i s t r a t i o n of  i n j e c t i o n s f o r t h e f i r s t time t o be  stressful. The l a c k o f s t a t i s t i c a l  s i g n i f i c a n c e a c h i e v e d when  d e t e r m i n i n g t h e e f f e c t o f t h e i n t e r v e n t i o n on p o s t s t a t e anxiety  s c o r e s may i n d i c a t e t h e i n t e r v e n t i o n was s u c c e s s f u l  i n dealing only with selected sources of s t r e s s .  The  i n t e r v e n t i o n may be u s e f u l i n d e c r e a s i n g s t r e s s r e s u l t i n g from n e g a t i v e l y  perceived  interpersonal  relationships with  63 i n s t r u c t o r s but unsuccessful other  i n d e a l i n g w i t h s t r e s s from  s o u r c e s such as t h o s e a s s o c i a t e d w i t h  experiences/  personal  initial  h e a l t h problems/ o r academic  concerns.  C o r r e l a t i o n between s c o r e s o f s t u d e n t - i n s t r u c t o r r e l a t i o n s h i p s and a n x i e t y . c o r r e l a t i n g the higher  A l t h o u g h the f i n d i n g s  rated  instructor-student  r e l a t i o n s h i p w i t h lower r a t i n g s o f s t a t e a n x i e t y were n o t s t r o n g / they were i n t h e a n t i c i p a t e d d i r e c t i o n and were s u p p o r t e d by f i n d i n g s o f F o r s y t h and L a y t o n (1985).  A  l a r g e r sample s i z e and an i n t e r v e n t i o n which o c c u r s over a l o n g e r p e r i o d o f time may have s t r e n g t h e n e d the correlations.  Limitations The l i m i t a t i o n s o f t h e study a r e : 1.  F a c t o r s other t h a n t h e t r e a t m e n t i n t e r v e n t i o n may  have i n f l u e n c e d the p e r c e i v e d  student-instructor  relationship. 2.  F a c t o r s other t h a n t h e t r e a t m e n t i n t e r v e n t i o n may  have i n f l u e n c e d s t a t e a n x i e t y . 3.  The dependent v a r i a b l e s used i n t h e study r e l y on  s e l f - r e p o r t measures and t h e r e f o r e a r e s u b j e c t t o t h e l i m i t a t i o n s o f t h i s measurement  technique.  64 4. and  Sample s i z e was s m a l l * c o n f i n e d t o one i n s t i t u t i o n  c o n s i s t e d o f o n l y one l e v e l o f s t u d e n t as s u b j e c t s ;  t h e r e f o r e * r e s u l t s a r e n o t g e n e r a l i z a b l e except t o a population with similar 5.  characteristics.  Having t h e t r e a t m e n t  group second i n a l l c a s e s  r a i s e s t h e p o s s i b i l i t y t h a t d i f f e r e n c e s may be due t o order effect. 6.  The i n h e r e n t v a r i a b i l i t y o f i n s t r u c t o r s t o c a r r y  out t h e t r e a t m e n t 7.  package may have a f f e c t e d r e s u l t s .  The a b i l i t y o f t h e developed STAI q u e s t i o n n a i r e t o  a c c u r a t e l y measure t h e type o f a n x i e t y e x p e r i e n c e d s t u d e n t n u r s e s must be 8.  by  considered.  Use o f a r a t i n g s c a l e i n t h e R e l a t i o n s h i p  Questionnaire  t o measure t h e phenomena o f empathy*  congruence* and p o s i t i v e r e g a r d suggests t h e y can be reduced t o q u a n t i f i a b l e e l e m e n t s .  S t e w a r t (1956) argues  t h a t empathy cannot be s t u d i e d by t h e use o f t r a d i t i o n a l methods and s u g g e s t s a more h o l i s t i c p e r s p e c t i v e t o measurement.  T h i s view i s supported  s u g g e s t s no i n s t r u m e n t  by Hackney (1978) who  may be a b l e t o measure t h e  p r o j e c t i o n o f an i n d i v i d u a l ' s own f e e l i n g s i n t o  another.  Cronbach's a l p h a performed on t h e R e l a t i o n s h i p Questionnaire  revealed i n t e r n a l consistency f o r the  c o n s t r u c t o f empathy t o be o n l y .45.  65 CHAPTER FIVE Summary^ C o n c l u s i o n s / and Recommendations f o r F u r t h e r Research  Summary  The  of  the  study  purpose o f t h e study was t o determine i f an  i n t e r v e n t i o n d e s i g n e d t o enhance t h e 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 between t h e n u r s i n g i n s t r u c t o r and a group o f n u r s i n g s t u d e n t s would lower s t u d e n t s ' a n x i e t y clinical setting. who r e c e i v e d  i n the  I t was h y p o t h e s i z e d t h a t s t u d e n t n u r s e s  a r e l a t i o n s h i p - b u i l d i n g i n t e r v e n t i o n would  r a t e t h e i r r e l a t i o n s h i p with the i n s t r u c t o r higher than s t u d e n t n u r s e s who r e c e i v e d  a p l a c e b o i n t e r v e n t i o n / and  t h a t s t u d e n t n u r s e s who r e c e i v e d  a relationship-building  i n t e r v e n t i o n would have l e s s s t a t e a n x i e t y nurses r e c e i v i n g a placebo i n t e r v e n t i o n .  than student A secondary  purpose o f t h e study was t o d e t e r m i n e t h e r e l a t i o n s h i p between t h e v a r i a b l e s o f i n t e r e s t / s t a t e a n x i e t y and student-instructor The  relationship.  t h e o r e t i c a l u n d e r p i n n i n g s o f t h e study were drawn  from t h e work o f C a r l Rogers (1951/ 1961/ 1969/ 1983). suggests t h a t l e a r n i n g cognitive  i s an a f f e c t i v e as w e l l as a  e x p e r i e n c e and t h a t a n x i e t y  f e e l i n g s of threat t o s e l f could  r e s u l t i n g from  be m i n i m i z e d by  establishing a positive interpersonal t e a c h e r and l e a r n e r .  He  r e l a t i o n s h i p between  He f u r t h e r suggests t h a t  three  66 constructs/ facilitate  empathy/  development o f such  A review in  of selected  the c l i n i c a l  setting  nursing  students.  clinical  setting  with  congruence/  interpersonal learner  relationship  methods d e s i g n e d  curiosity  arising  from  experimental nursing positive  The involved  and  prior  that the  anxiety i n nursing  p r e - t e s t / p o s t - t e s t group  three hypotheses.  took  The  i n t h e s t u d y was d e s i g n e d  The p l a c e b o  t o have  c o n g r u e n c e / and  regard during three successive post  study  students  l i t e r a t u r e and  conferences  i n t e r v e n t i o n was  post conference d i s c u s s i o n . p l a c e over  participants  a two-week p e r i o d and  i n a three-year diploma  The 30 member c o n t r o l  nursing  group p a r t i c i p a t e d  b e f o r e t h e 31 member e x p e r i m e n t a l  post  relationship  personal observations provided the  intervention  scheduled  group.  i n t e r v e n t i o n d a t a were c o l l e c t e d  from  i n the  Baseline each  group  t o and f o l l o w i n g t h e r e s p e c t i v e i n t e r v e n t i o n s .  collection  this  a n x i e t y and t h a t g r o u p  i n s t r u c t o r s d e m o n s t r a t e empathy/  program. study  of anxiety f o r  of anxiety within  suggest  F i n d i n g s from  to test  with nursing students. normally  also  t o student  i m p e t u s f o r an e x p e r i m e n t a l d e s i g n t o be u s e d  source  practise  e s t a b l i s h e d between t e a c h e r a n d  to deal with  have b e e n e f f e c t i v e .  reveals that  t o be a s t u d e n t ' s  Authors  regard/  relationship.  i s a dominant source  i s noted  c a n be r e l a t e d  a  literature  A specific  the instructor.  and p o s i t i v e  t o o l s were:  a demographic q u e s t i o n n a i r e / a  Data  67 S t r e s s f u l Event Q u e s t i o n n a i r e / t h e S t a t e - T r a i t A n x i e t y Inventory (Spielberger  e t a l . / 1970)/ and t h e R e l a t i o n s h i p  Q u e s t i o n n a i r e (adapted from Truax and C a r k h u f f / 1967). Descriptive  information  from i n s t r u c t o r s and s t u d e n t s was  g a t h e r e d i n f o r m a l l y a t s t u d y end. A n a l y s i s o f d a t a i n d i c a t e d t h a t members o f b o t h groups were s i m i l a r i n demographic c h a r a c t e r i s t i c s and t r a i t anxiety  ratings.  A n a l y s i s o f d a t a from t h e R e l a t i o n s h i p  Q u e s t i o n n a i r e i n d i c a t e d a t r e a t m e n t and i n s t r u c t o r main e f f e c t were s t a t i s t i c a l l y  s i g n i f i c a n t . Members o f t h e  e x p e r i m e n t a l group r a t e d t h e p e r c e i v e d the i n s t r u c t o r s t a t i s t i c a l l y  r e l a t i o n s h i p with  s i g n i f i c a n t l y h i g h e r than  members o f t h e c o n t r o l group. There was no s t a t i s t i c a l l y  significant difference  between t h e c o n t r o l and t h e e x p e r i m e n t a l groups i n t h e i r r a t i n g s of state anxiety.  There was a t r e n d /  however/ f o r  t h o s e i n t h e e x p e r i m e n t a l group t o have lower s t a t e  anxiety  r a t i n g s than t h o s e i n t h e c o n t r o l group. W h i l e c o r r e l a t i o n s c i t e d between t h e p e r c e i v e d instructor interpersonal  student-  r e l a t i o n s h i p and a n x i e t y were low/  t h e y were i n t h e a n t i c i p a t e d d i r e c t i o n and suggested important r e l a t i o n s h i p s . The  d i f f e r e n c e s between c o n t r o l and e x p e r i m e n t a l groups  were n o t s t a t i s t i c a l l y  s i g n i f i c a n t i n r e l a t i o n s h i p t o the  number o f r e c e n t l y e x p e r i e n c e d s t r e s s f u l e v e n t s nor were they d i f f e r e n t i n the types of events perceived  as  68 stressful. with  The t y p e s o f e v e n t s i d e n t i f i e d  f i n d i n g s of other  were  consistent  researchers.  I n f o r m a l d a t a f r o m i n s t r u c t o r s and s t u d e n t s that  t h e i n t e r v e n t i o n was  determined  p o s i t i v e l y received  indicated  and  t o be u s e f u l .  Conclusions 1.  Experimental  r e l a t i o n s h i p higher concluded*  the  that  and s t u d e n t .  This  2. anxiety  s t u d e n t s may  component  subjects  r e s u l t i n an  nursing  of nursing  designed  education.  to foster  d i d not report  than c o n t r o l s u b j e c t s . that  intervention  this  valuable.  Experimental  concluded nursing  seem  I t c a n be  relationship i s integral to  of l e a r n i n g a c t i v i t i e s  relationship  student-instructor  r e l a t i o n s h i p between  success of the c l i n i c a l  Inclusion  the  a planned  i n a group of nursing  interpersonal  instructor  rated  than c o n t r o l s u b j e c t s .  therefore*  implemented improved  subjects  Therefore*  a p o s i t i v e l y perceived  instructor will  less  state  i t cannot  be  r e l a t i o n s h i p with a  r e s u l t i n decreased  student  anxiety. 3.  The c o r r e l a t i o n between  relationship and  greater  scores  and s t a t e  student-instructor  anxiety  were  negative  f o r the experimental group than the c o n t r o l  group.  I t c a n be c o n c l u d e d *  inverse  r e l a t i o n s h i p between n u r s i n g  the  scores  perceived  therefore*  that  there  i s an  student anxiety  r e l a t i o n s h i p with the i n s t r u c t o r .  and  69 4.  The  findings  of t h i s study  p r o p o s e d by C a r l R o g e r s c o n s t r u c t s o f empathy/ significant perceived  (1957/  support  1961/  congruence/  and  components f o r d e v e l o p i n g  interpersonal  1969/  the  theory  1983).  positive  The  regard  are  a positively  r e l a t i o n s h i p between t e a c h e r  and  learner. 5.  In t h i s p a r t i c u l a r  which suggest relationship  learners  study/  will  to the teacher  be  a s p e c t s of Roger's  l e s s anxious  theory  i f the  i s p o s i t i v e l y p e r c e i v e d i s not  supported.  Implications  f o r Nursing  Because c l i n i c a l the c l i n i c a l include  instructors  cannot  of c l i n i c a l  e x p e r i e n c e s which w i l l  instruction  facilitate  relationships  with  of a c l i n i c a l  strategically  placed a c t i v i t i e s  be most u s e f u l . may  help decrease  Building  benefit.  learning  should  The  activity  positive deliberate  at  the  or a group of throughout  of r e l a t i o n s h i p s  a rotation with  may  students  t h e i r a n x i e t y i n the s t r e s s f u l  environment of c l i n i c a l anxiety/  they  learning  students.  rotation  manipulate  development of  placement of a r e l a t i o n s h i p - b u i l d i n g beginning  totally  s i t u a t i o n t o promote l e a r n i n g /  as p a r t  interpersonal  Education  practise.  s h o u l d be  As  a r e s u l t of  e n h a n c e d and  client  decreased  care  may  70 Incorporation largely  on  the  instructors preparing  repertoire  Curricula  have l i m i t e d  of  Furthermore*  such In  of  regard.  use  addition*  the  programs  clinical  methods c o n t r i b u t i n g  of  to  relationships. expanded t o  area i s  ensure  the  the  offered.  significant nursing  congruence*  encouraged  such c r i t i c a l  on  c o u l d be  aware o f  empathy*  that  included.  c o m m u n i c a t i o n have on  to  and  regularly  communication  w i t h development or  sensitivity  anxiety within  as  Criteria should  source of  selection  include  modification  relate  of  e f f e c t i v e l y to  indicators  s t u d e n t s f o r whom their  e m o t i o n and  r e s p o n s e may  faculty  also  to  Evaluating  the  those r e l a t e d  p r a c t i c a l knowledge but to  faculty  groups of  to d e a l w i t h the  for  of  i s important.  a possible  activity  ability  on  clinical  skills.  behavior  and  r o l e of  s h o u l d be  They s h o u l d be  responsible  roles  Current  relationships  seek a s s i s t a n c e  increasing  an  strategies  development workshops f o c u s e d  s t r i v e to p r a c t i s e  they are  of  the  this essential  t h e i r p a t t e r n s of  and  them.  content  instructors  e v a l u a t e t h e i r own  of  to  student-instructor  s t u d e n t s and  skills  teaching  student-instructor  faculty  Clinical  positive  e x p e r i e n c e s depends  s u c h p r o g r a m s c o u l d be  content addressing  effects  of  have a v a i l a b l e  development of  theme o f  such l e a r n i n g  nurse educators f o r  instructor the  of  not  for  indicated.  clinical  those related students.  inclusion  be  only to  own  teaching  theoretical to  their  Students  often  71 are not  t h e most i m p o r t a n t  Pressure  t o be  r e s e a r c h and services/  priority  productive i n scholarly  publication  or  academic s e t t i n g .  Furthermore/  recognition.  for  e x c e l l e n c e i n t e a c h i n g and/  Faculty valued  evaluation tools  instructors  i n s t r u c t o r s need t o be specifically/  often support  rewarded  for  interpersonal s k i l l s .  should  reflect  assessment of  these  qualities.  If high anxiety situations e x i s t research  findings  are e s s e n t i a l and  as  l e a r n e r s i n the  o p p o r t u n i t y f o r peer  and  of f a c i l i t a t i v e  such  i n community  clinical  work i n i s o l a t i o n w i t h l i m i t e d Clinical  over  education.  activities/  involvement  o f t e n takes precedence  demonstration  i n nursing  suggest/  both  i n the  strategies interest  i n nursing/  as  f o r coping with  of enhancing  them  learning  i n providing future health professionals with  techniques valuing  they  c a n use w i t h  a positive  i n s t r u c t o r s may  source  towards development of  clients/  improve  particular  Increasing  such one  Research  requires further  internal  with  anxieties.  R e l a t i o n s h i p Q u e s t i o n n a i r e adapted  investigator  nurses  thus p r o v i d i n g c l i e n t s with  of d e a l i n g with t h e i r  Recommendations f o r F u r t h e r The  Student  interpersonal relationship  strive  relationships with  clients.  by  d e v e l o p m e n t and  the refinement  to  c o n s i s t e n c y o f t h e c o n s t r u c t empathy.  t h e number o f r e s p o n s e s  rating  the c o n s t r u c t of  72 empathy  from the  instrument higher  on  diploma the  programs as  of  setting.  sources  interesting.  as  w h i c h was anxiety  levels  student  research  clinical  from  the  include  at other  two-year  levels  within  indicated  a  clinical  findings in this  area  methodology would influenced  setting  and  by  interactions  Identification instructors  be  with  of  these  knowledge  intervention.  over  were not  e f f e c t i v e n e s s of a three-day lowered  significance.  sample s i z e  and  a longer  should  anxiety w i t h i n the  clinical  statistical  over  characteristics*  Stress Questionnaire  t e s t e d the  employed  in  study's  p r o g r a m s and  students  h e a l t h team members.  study  result  program.  of  provide  the  whose  a n x i e t y c o u l d be  type  plan appropriate The  samples  using q u a l i t a t i v e  Student  f a c t o r s would to  of  as  A comparison of  other  the  academic c o n d i t i o n s d i f f e r  well  from the  such  testing  to test  students  Other  diploma  t h a t were a c q u i r e d  with  and  groups from baccalaureate  Findings  factors  and  study.  three-year  variety  i s needed  to nursing  setting*  in this  clinical  t o 20  readings.  research  generalizability geographic  10  a m o r e h e t e r o g e n o u s p o p u l a t i o n may  correlation  Further  sample  present  employing  p e r i o d of  A  period.  sufficiently  replicate  a similar time  may  an i n t e r v e n t i o n  study  Student to  reach  using  a  larger  i n t e r v e n t i o n package  improve  results.  73 In  addition/  primarily  students.  conditions  of  conditions  between t e a c h e r  and  t h i s study  student anxiety  into  the  interpersonal  the  of  i n the  This  was  facilitative relationship  i s a r e s u l t of dynamic  and  strategies  available  demonstrated  nursing  interaction  to  techniques.  clinical  with  suggests interaction deserves  setting.  believes  established  student  clinical  i n improving into  The  the  this  learning  be  Teaching  have relationship  an  helpful  enhancing the experience.  the  clinical  instructor's  consequences of  indicated.  that  between  instructors  deal  Research  is significant.  r e l a t i o n s h i p may  clinical  method t o  o t h e r g r o u p methods i s  s t u d e n t a n x i e t y and  valued  o n l y one  investigator  incorporated  student-instructor minimizing  of  effectiveness  s h o u l d be teaching  employed  relationship  instructor  the  present  i n the  effectiveness  In c o n c l u s i o n /  of  level  student.  with  of  the  instructor  investigation.  Finally/  and  for  the  There i s c o n s i d e r a b l e evidence which  level  further  s t u d y assumed t h a t  responsible  interpersonal  the  the  repertoire improved  i n both effectiveness  References American P s y c h o l o g i c a l  (1983).  Association.  manual o f t h e A m e r i c a n P s y c h o l o g i c a l ed.).  (1972).  r e l a t i o n s h i p between s t u d e n t  functioning Journal  An i n v e s t i g a t i o n o f  levels of cognitive  and t h e t e a c h e r ' s c l a s s r o o m b e h a v i o r . The  of Educational  R e s e a r c h * £5. (8)* 365-368.  Aspy* D. N.* & Roebuck* F . N. learn  (3rd  Association  W a s h i n g t o n * DC: A u t h o r .  Aspy* D. N.* & Roebuck* F . N. the  Publication  (1977).  (Eds.).  from people they don't l i k e .  Kids  don't  A m h e r s t : Human  Resource Development. Barham* V . Z . of  (1965).  the nursing  Identifying  e f f e c t i v e behaviours  i n s t r u c t o r s through c r i t i c a l  incidents.  N u r s i n g R e s e a r c h * 2A (1)> 65-69. Birch*  J.  H E  Blainey*  (1979).  The a n x i o u s l e a r n e r s .  Nursing  Mirror*  (6)* 1722. C. G.  (1980).  medical-surgical  Anxiety  student.  i n the undergraduate  Journal  of Nursing  Education'  15. (8)* 33-36. Brown* M. M.* & F o w l e r * nursing:  G. R.  A biological  (1971).  orientation.  Psychodynamic Philadelphia:  Saunders. Brown* S. T. effective  (1981). clinical  Faculty teachers.  E d u c a t i o n * 2SL (9)* 4-15.  and s t u d e n t p e r c e p t i o n s Journal  of Nursing  of  Brunt/  C.  (1984) .  Times/ 8_&  Assessing  anxiety l e v e l s .  Nursing  ( 8 ) / 37-38. E. A w  Charlesworthf  Murphy/ S./  & B e u t l e r / L. E.  (1981).  S t r e s s management s k i l l f o r n u r s i n g s t u d e n t s . of C l i n i c a l Psychology/ 21 Combs/ A. W./ Helping  Donald/ L. A./  Journal  ( 2 ) / 284-290. & Perkey/ W.  W.  (1978).  r e l a t i o n s h i p s : B a s i c c o n c e p t s f o r the  professions Combs/ A. W./  (2nd e d . ) .  helping  B o s t o n : A l l y n & Bacon.  & T a y l o r / C.  (1952).  The  e f f e c t of  p e r c e p t i o n of m i l d degrees of t h r e a t on performance. J o u r n a l of Abnormal and S o c i a l Psychology/ Air Crow/ L. D./  & Crow/ A.  (1972).  relations in nursing. D a v i t z / L. J .  (1972).  New  Understanding  York:  personal  Macmillan.  I d e n t i f i c a t i o n of  stressful  s i t u a t i o n s i n a N i g e r i a n s c h o o l of n u r s i n g . Research/ 2 1  420-424.  Nursing  (4)/ 352-357.  Devore/ J . / & Peck/ R.  (1986).  S t a t i s t i c s - the  e x p l o r a t i o n and a n a l y s i s of d a t a .  S t . P a u l : West  Publishing. Dye/  C. A.  (1974).  participation. E l f e r t / H.  Self-concept/ Nursing  (1976).  a n x i e t y / and  Research/ 21  group  ( 4 ) / 301-306.  S a t i s f y i n g and s t r e s s f u l i n c i d e n t s  r e p o r t e d by s t u d e n t s d u r i n g the f i r s t 2 y e a r s of a baccalaureate (2)/ 36-43.  program i n n u r s i n g .  Nursing  new  Papers/ 8_  Erber/  (1984).  j .  anxiety  5_9_/  Fox/  (5)/  (1985).  J . M.  empathy t o s t u d e n t  7;  P e r c e p t u a l and  162-167.  P. L . / & L a y t o n /  instructor IH  i n self-reported  and p s y c h o m o t o r p e r f o r m a n c e .  Motor S k i l l s / Forsythe/  Age d i f f e r e n c e s  Relationship of  anxiety.  Nurse  38.  D. J . / Diamond/ L . K./ W a l s h / L . C./ Knopf/ L./ & (1965).  Hodgin/ J .  C o r r e l a t e s o f s a t i s f a c t i o n and  stress with nursing school experience. Research/  Garrett/  12  use  & Vincent/  identified  (1966/  E . C.  Nursing  83-88.  C.  by s t u d e n t  E d u c a t i o n , 15. ( 6 ) /  Nursing Gowell/  (2)/  A./ Manuel/ D./  experiences  (1976).  nurses.  Nursing,  9-18.  July-August).  An e x p e r i e n c e w i t h t h e  a period of 5 years.  N./ & M o r r i s / P. B.  The a t t i t u d e s  Journal Hackney/ H.  K. T.  test  nurse  Journal of Psychiatric  of Nursing (1978).  (1967).  (1978).  o f freshman n u r s i n g  Education/  2H (6)/  Hopes and students.  7-17.  The e v a l u a t i o n o f empathy.  G u i d a n c e J o u r n a l , 5_7_/  and  student  351-362.  Grassi-Russo/ fears:  Stressful  Journal of  o f g r o u p work methods and p r o c e s s w i t h  groups over  Hill/  Educator/  Social  35-38. reinforcement  a n x i e t y and s u c c e s s / f a i l u r e  D e v e l o p m e n t , 3_&/ 7 2 3 - 7 3 7 .  Personnel  as a f u n c t i o n o f  experiences.  Child  M. S .  Infante*  (1985).  The c l i n i c a l  (2nd ed.).  education  (1979).  J o h n s o n * M.  New Y o r k :  Karns*  11*  and p a t i e n t .  Advanced  (1982).  Therapeutic  c o m m u n i c a t i o n and c l i n i c a l  Kiker*  3_Q_ ( 1 ) * (1973).  M.  teacher. Linn*  Journal  Characteristics Outlook*  (1975).  Primer  of Nursing  nursing  (8)*  Nursing  students.  Nursing  and s t r e s s .  of the e f f e c t i v e  (11)/  721-723.  t r a i n e e s under  Sources  Mancine* J . * L a v e c c h i a * nurses  21  14.  Education*  (1979).  MacMaster* E .  instruction.  39-43.  Nursing  L . S.  Nursing  1-20.  P. J . * & Schwab* T. A.  Outlook*  Wiley.  A n x i e t y / s t r e s s and t h e e f f e c t s on  d i s c l o s u r e between n u r s e science*  laboratory i n nursing  (21)*  of stress H  Papers*  C.* & C l e g g *  stress.  10-19. i n university (4)*  87-96.  (1983).  R.  Journal of Nursing  Graduate  Education*  22  329-334.  McKay* S.  (1978).  programs.  A review  Nursing  Abnormal  R.*  and  Social  J. B.  Nurse Educator*  education  376-393.  examination.  Psychology*  (1987).  i n nursing  & Speisman* J .  anxiety i n classroom  Meisenhelder* learning.  (4)*  Forum* H  M c K e a c h i e * W. J . * P o l l i e * Relieving  of stress  5£*  (1955). Journal of  93-98.  Anxiety: A block to c l i n i c a l 12  (6)*  27-30.  78 Meyers* J . * & M a r t i n * R.  (1974).  R e l a t i o n s h i p s of s t a t e  and t r a i t a n x i e t y t o concept l e a r n i n g  performance.  J o u r n a l o f E d u c a t i o n a l Psychology* ££ ( 1 ) * 33-39. M i l l e r * Y.  (1984).  clinical?  Do you s l e e p t h e n i g h t b e f o r e  Canadian Nurse* JLQ_ ( 9 ) * 47-48.  Oner* N. P.  (1977).  Impact of t e a c h e r b e h a v i o r s and  t e a c h i n g t e c h n i q u e on l e a r n i n g by a n x i o u s c h i l d r e n . C. D. S p i e l b e r g e r & I . G. Sarason a n x i e t y : V o l . 4 (pp. 171-188). O'Shea* H. S.* & Parsons* M. K.  In  ( E d s . ) * S t r e s s and  New York: W i l e y . (1979).  Clinical  i n s t r u c t i o n : E f f e c t i v e and i n e f f e c t i v e t e a c h e r behaviors. Rauen* K. C. model. Reed* H. B.  N u r s i n g Outlook* 2 1 ( 6 ) * 411-415. (1974).  J o u r n a l of N u r s i n g E d u c a t i o n * 13. ( 8 ) * 33-38. (1961).  J o u r n a l of. Teacher Rogers*  C.  The c l i n i c a l i n s t r u c t o r as r o l e  (1951).  The e f f e c t s o f t e a c h e r warmth.  The  E d u c a t i o n / 1 2 ( 3 ) * 330-334. C l i e n t - c e n t r e d therapy.  Boston:  Houghton M i f f l i n . Rogers* C.  (1961).  On becoming a person - a t h e r a p i s t ' s  view of psychotherapy.  B o s t o n : Houghton M i f f l i n .  Rogers*  C.  (1969).  Freedom t o l e a r n .  Rogers*  C.  (1983).  Freedom  Toronto: Rogers* C *  Columbus:  Merrill.  t o l e a r n f o r t h e 80's.  Merrill. & Stevens* B.  problem o f b e i n g human.  (1967).  Person t o p e r s o n : The  L a f a y e t t e : R e a l People P r e s s .  Rosenberg/  P.  P./  & Fuller/  M.  (1955).  L.  s e m i n a r : A g r o u p work e x p e r i m e n t Mental Hygiene/ Sarason/  S.  teacher  B./  Sarason/  & Davidson/  B./  Davidson/  K.  of teachers:  education.  New  in  clinical  Sieber/  J . E./  Anxiety,  York:  (1970).  C.  S./ An  Spielberger/  & Blatt/  unstudied  K.  (3rd e d . ) .  O'Neil/  H.  S t r e s s and  D./  F./  & Tobias/  instruction.  Gorsuch/  R.  & Sarason/  anxiety;  of in  624).  problem  The  in  Vol  1.  Creative  St. Louis:  L./  S. New  state-trait  I . G.  teaching  Mosby.  (1977). York:  Wiley.  & L u s h e n e / R.  Palo A l t o : Consulting C.  study  (1962).  B.  (1976).  M.  STAI manual f o r t h e  inventory.  A  to children d i f f e r i n g  nursing  D./  (1962).  S.  Wiley.  & Gebbie/  l e a r n i n g and  Spielberger/  education.  R e s e a r c h P r o j e c t No.  preparation  Schweer/ J . E./  K.  in relation  (Co-operative  S.  i n nursing  21r 406-432.  behavior  anxiety.  Human r e l a t i o n s  E.  anxiety  Psychologists (Eds.).  Washington:  Press.  (1975).  Hemisphere  Publishing.  (1956).  S t e w a r t / D.  Preface  t o empathy.  New  York:  Philosophical Library. Stoffer/  (1970).  D.  change as warmth/  I n v e s t i g a t i o n of p o s i t i v e b e h a v i o r a l  a f u n c t i o n of genuineness/  and  Educational  empathic understanding. Research/  nonpossessive The  £1 ( 5 ) / 226-228.  Journal  of  Stuebbe* B.  (1981).  Student and f a c u l t y p e r s p e c t i v e on  the r o l e o f n u r s i n g i n s t r u c t o r s .  Journal of Nursing  E d u c a t i o n * 2 ( 9 ) * 4-9. Truax* C. B.* & C a r k h u f f * R. R. c o u n s e l i n g and psychotherapy:  (1967).  Toward e f f e c t i v e  T r a i n i n g and p r a c t i c e .  Chicago: A l d i n e . Weinberg* R.* & Ragan* J .  (1978).  Motor performance under  t h r e e l e v e l s o f t r a i t a n x i e t y and s t r e s s . Motor,  Behavior*  i d * 169-176.  Z u j e w s k y j * T.* & D a v i s * L.  (1985).  Sources and e f f e c t s o f  anxiety i n videotape l e a r n i n g experience. Papers*  Journal of  12 ( 3 ) * 75-85.  Nursing  APPENDIX A  Self-Evaluation  Questionnaire  STAI FORM X - l  Self-Evaluation Questionnaire STAI FORM X - l Q u e s t i o n n a i r e Number: Student Number DIRECTIONS: A number o f s t a t e m e n t s w h i c h p e o p l e have used t o d e s c r i b e themselves a r e g i v e n below. Read each statement and then c i r c l e t o t h e r i g h t of t h e statement t h e number which i n d i c a t e s how you f e e l r i g h t now* t h a t i s * a t t h i s moment. There a r e no r i g h t or wrong answers. Do n o t spend too much t i m e on any one statement b u t g i v e t h e answer which seems t o d e s c r i b e your p r e s e n t f e e l i n g s b e s t . 1.  I  2.  I  3.  I  4.  I  5.  I  6.  I  7.  I am p r e s e n t l y w o r r y i n g over  8.  I  9.  I  10.  I  11.  I  12.  I  13.  I  14.  I  15.  I  Date  ^ n ^ > ^  g a o  1-3  w  o w w £  s  w  O  >  1-3  >  tr tr< 1  M S!  a  >  i-3  F K  i-3  cn O  16.  I f e e l content  1  2  3  17.  I am w o r r i e d  1  2  3  18.  I f e e l o v e r - e x c i t e d and " r a t t l e d "  2  3  19.  I feel joyful  2  3  . . 1 1  20. I f e e l p l e a s a n t 1 2 3 Note: From STAI manual f o r t h e s t a t e - t r a i t a n x i e t y i n v e n t o r y by C. D. S p i e l b e r g e r / R. L. Gorsuch/ & R. E. Lushene/ 1970/ P a l o A l t o / CA: C o n s u l t i n g P s y c h o l o g i s t s P r e s s . C o p y r i g h t 1968 by C. D. S p i e l b e r g e r .  84  APPENDIX B  Self-Evaluation  Questionnaire  STAI FORM  X-2  Self-Evaluation  Questionnaire  STAI FORM X-2 Questionnaire  Number:  Student Number  Date  DIRECTIONS: A number of s t a t e m e n t s w h i c h p e o p l e have used t o d e s c r i b e themselves a r e g i v e n below. Read each statement and then c i r c l e t o t h e r i g h t of t h e statement t h e number which i n d i c a t e s how you g e n e r a l l y f e e l . There a r e no r i g h t or wrong answers. Do n o t spend t o o much t i m e on any one statement but g i v e t h e answer w h i c h seems t o d e s c r i b e how you g e n e r a l l y feel.  > § ° 1-3 g £3 w *  21.  I f e e l pleasant  1  22.  I t i r e quickly  1  23.  I feel l i k e crying  1  24.  I w i s h I c o u l d be as happy as o t h e r s seem t o be  1  25.  I am l o s i n g out on t h i n g s because I c a n ' t make up my mind soon enough ..  1  26.  I feel rested  1  27.  I am "calm* c o o l r and c o l l e c t e d " ...  1  28.  I f e e l t h a t d i f f i c u l t i e s are p i l i n g up so t h a t I cannot overcome them ..  1  29.  I worry t o o much over  something  t h a t r e a l l y doesn't matter  1  30.  I am happy  1  31.  I am i n c l i n e d  32.  I lack self-confidence  1  33. 34.  I f e e l secure I t r y t o a v o i d f a c i n g a c r i s i s or difficulty  1  t o t a k e t h i n g s hard ...  1  1  86 >  > K  O cn 2  W < W  g  cn o  i-3  H  W  W  S  CO  cn O  tr] H3  2  >  I  cn  35.  I f e e l blue  1  2  3  36.  I am c o n t e n t  1  2  3  37.  Some unimportant thought runs t h r o u g h my mind and b o t h e r s me  1  2  3  I t a k e d i s a p p o i n t m e n t s so k e e n l y t h a t I c a n ' t p u t them out o f my mind ....  1  2  3  4  39.  I am a steady person  1  2  3  4  40.  I get i n a s t a t e of t e n s i o n or t u r m o i l as I t h i n k over my r e c e n t concerns and i n t e r e s t s  1  2  3  38.  Note-. From STAI manual f o r t h e s t a t e - t r a i t a n x i e t y i n v e n t o r y by C. D. S p i e l b e r g e r * R. L. Gorsuch* & R. E. Lushene* 1970* P a l o A l t o * CA: C o n s u l t i n g P s y c h o l o g i s t s P r e s s . C o p y r i g h t 1968 by C. D. S p i e l b e r g e r .  APPENDIX  C  Relationship Questionnaire  Relationship Questionnaire Questionnaire Student  Number:  Number  Date  DIRECTIONS: People f e e l d i f f e r e n t l y a b o u t some p e o p l e t h a n t h e y d o a b o u t others. T h e r e a r e a number o f statements below t h a t d e s c r i b e a v a r i e t y o f w a y s t h a t o n e p e r s o n may f e e l about a n o t h e r p e r s o n * o r ways t h a t o n e p e r s o n may a c t t o w a r d a n o t h e r person. Consider each statement c a r e f u l l y a n d d e c i d e how c l o s e l y i t describes your present r e l a t i o n s h i p with your i n s t r u c t o r . Circle the number t o t h e r i g h t o f e a c h s t a t e m e n t which best d e s c r i b e s your response. 1. 2. 3. 4.  S h e s e e m s t o l i k e me what I say t o h e r She n e v e r her sound  no  1-3  > F  matter 1  says anything that l i k e a real person  She u n d e r s t a n d s see t h i n g s  § ^ >  exactly  how  makes 1 I 1  I f I made m i s t a k e s o r m i s s a c l a s s * s h e r e a l l y g i v e s me t r o u b l e about i t  1  5.  S h e i s i m p a t i e n t w i t h me  1  6.  She u s u a l l y knows e x a c t l y w h a t I mean* s o m e t i m e s e v e n b e f o r e I f i n i s h saying i t  1  S h e d o e s n ' t l i k e me a s a p e r s o n * b u t c o n t i n u e s t o s e e me a s a s t u d e n t anyway  1  8.  S h e a p p r e c i a t e s me  1  9.  Even i f I were t o c r i t i c i z e s h e w o u l d s t i l l l i k e me  7.  10.  She l i k e s with her  me  better  when  I  her* 1 agree 1  89  8  <  W  K  O  O  cn  i-a  O  >  2  i-3  >  rg  td  bd  g  C  H S! SS  f K  O SS  >  i-3  cn O  co  1  2  3  4  way she uses s t r a n g e words  1  2  3  4  13.  I am j u s t another s t u d e n t t o her ...  1  2  3  4  14.  I can l e a r n a l o t about m y s e l f from t a l k i n g w i t h her  1  2  3  4  15.  She l i k e s t o see me  1  3  4  16.  I f e e l she i s b e i n g genuine w i t h me She f e e l s i n d i f f e r e n t about me Sometimes I f e e l what she says t o me i s v e r y d i f f e r e n t from t h e way she r e a l l y f e e l s  >  tr  1  f  11. 12.  I o f t e n cannot understand what she i s t r y i n g t o t e l l me  O  O f t e n she makes me f e e l s t u p i d / t h e  2  1 1  2 2  3 3  4 4  1  2  3  4  She sometimes seems more i n t e r e s t e d i n what she h e r s e l f says t h a n i n what I say  1  2  3  4  20.  She i g n o r e s some o f my f e e l i n g s ....  1  2  3  4  21.  I would n o t be a f r a i d t o ask her for help  1  2  3  4  22.  She a c t s t o o p r o f e s s i o n a l  1  2  3  4  23.  She r e a l l y l i s t e n s t o e v e r y t h i n g I say  1  2  3  4  24.  She i g n o r e s some o f my f e e l i n g s ....  1  2  3  4  25.  I f e e l I can t r u s t her t o be honest w i t h me She seems w i l l i n g t o share her own e x p e r i e n c e s as a s t u d e n t  1  2  3  4  1  2  3  4  17. 18.  19.  26.  90  BD  W O  H W t> H3  2  W  c!  a  K  K  2!  O H >  H3  >  27. 28.  29. 30.  <M  H EC  f  5S  *  g  n  She sometimes p r e t e n d s t o understand me when she r e a l l y does not She i s u s u a l l y n o t v e r y i n t e r e s t e d  F  >  cn  cn  1  2  3  4  i n what I have t o say  1  2  3  4  I am a f r a i d o f her  1  2  3  4  ^  I f e e l I can count on her t o t e l l me what she r e a l l y t h i n k s or f e e l s .... 1 2 3 4 Notet Adapted from Toward e f f e c t i v e c o u n s e l i n g and psychotherapy.T r a i n i n g and p r a c t i c e by C. B. Truax & R. R. C a r k h u f f r 1967* C h i c a g o : A l d i n e . C o p y r i g h t 1963 by C. B. Truax.  APPENDIX  Relationship-building  D  Activities  Package  This packet of  c o n t a i n s an  outline  a c t i v i t i e s which I'd l i k e you  to complete w i t h your groups next  week.  There a r e t h r e e episodes".  individual  "interactional  Please  complete  number one on T u e s d a y d u r i n g post conference/  number two on  Wednesday d u r i n g p o s t and  number t h r e e on T h u r s d a y  during  post  conference.  Thank y o u f o r y o u r  The  conference/  teacher  important  than  technician. effect  as a  than  cooperation.  person i s  more  the teacher  as a  What  he i s has  anything  more  he d o e s .  Jack  Canfield  93 Interactional During your  post c l i n i c  regular  discussion/  Explain  t o your  conventional focused  The  please carry  clinical  group  on communication  Exercise  rather  will  that*  be  I  than carrying  out the following  post conference* t h i s  exercises  rather  o u t your exercises.  than the  week a d i f f e r e n t  format  followed.  s h o u l d t a k e a p p r o x i m a t e l y 30 m i n u t e s .  1  Divide three in  time*  Episode  t h e group  into  and one group  two g r o u p s  of four.  of four*  o r one group o f  The i n s t r u c t o r  i s included  one o f t h e g r o u p s .  Have t h e t w o g r o u p s not have a p a r t n e r f i l l s  s i t facing initially).  i n the following  Each  (one p e r s o n  can write  time f o rthought  After  each  may  member o f t h e p a i r  * I feel  Allow  pair  other  phrase:  "When I s e e (Instructor  each  the phrase  " on t h e board.)  formulation.  has completed  the exercise*  one row o f  four  m o v e s o n e s e a t a l o n g s o t w o new p a r t n e r s a r e f a c i n g  each  other.  person using original  pair  The p h r a s e w i l l new w o r d s . are facing  t h e n be c o m p l e t e d  The row keeps each  other.  changing  by  each  until the  Exercise 2 E a c h g r o u p member complete  (including  the instructor)  will  the statement: " I am  "  Complete  t h e statement using  yourself  and t h e n rank o r d e r them i n t e r m s o f  importance  five  adjectives  t o y o u a s an i n d i v i d u a l .  answers i n d e p e n d e n t l y .  Go a r o u n d  g r o u p member s h a r e s t h e i r t h e most s i g n i f i c a n t  the group  adjectives  reported  Record  describing  your and e a c h  i n rank o r d e r w i t h  last.  Exercise 3 The  instructor  s h a r e s w i t h t h e group an anecdote  t h e m s e l v e s a s a s t u d e n t o r a n amusing themselves  episode  about  involving  a s an i n s t r u c t o r .  Exercise 4 Closure  exercise.  Instructor  to write  on b o a r d :  I think I feel I learned  Each  s t u d e n t and i n s t r u c t o r  and v e r b a l l y go-round.  fills  i n one o f t h e b l a n k s  shares i t w i t h t h e group.  Complete  i n one  95  Every person needs It  i s expressed  l a d who  says*  play darts.  recognition.  c o g e n t l y by t h e  "Mother*  I ' l l throw t h e  d a r t s and y o u s a y  'wonderful.'"  M. D a l e Baughman*  Educator's  Handbook o f S t o r i e s * Quotes*  let's  and Humour  96 Interactional During  your post c l i n i c  timer  Episode I I  r a t h e r than  c a r r y i n g out your  regular discussion/ please carry out the following exercises.  The  e x e r c i s e s should  take  approximately  30 m i n u t e s .  Exercise 1 D i v i d e t h e g r o u p i n t o two g r o u p s o f f o u r / o r one g r o u p of  t h r e e a n d one g r o u p o f f o u r .  included  i n one o f t h e g r o u p s .  Have t h e two g r o u p s s i t f a c i n g may n o t h a v e a p a r t n e r pair  The i n s t r u c t o r i s  each o t h e r  initially).  answers t h e f o l l o w i n g t h r e e  (one p e r s o n  E a c h member o f t h e  questions:  "What do y o u f e e l ? " "What do y o u want?" "What a r e y o u a f r a i d o f ? " Instructor  can w r i t e questions  Allow  time  f o r thought  After  e a c h member o f t h e p a i r  questions/  formulation.  t h e n be c o m p l e t e d  each  keeps changing other.  has answered t h e  one row o f f o u r moves one s e a t a l o n g  new p a r t n e r s a r e f a c i n g  row  on t h e b o a r d .  each o t h e r .  by e a c h p e r s o n until  s o two  The q u e s t i o n s  u s i n g new w o r d s .  the original  pair  will The  are facing  97 Exercise  2  Students their and  share w i t h the i n s t r u c t o r  e x p e c t a t i o n s of the  clinical  instructor.  behaviors they l i k e dislike  Exercise  and  instructor For  or f i n d  other  as a  example*  helpful  students  professional  instructor  and  those  they  or f i n d u n h e l p f u l .  3  Closure  exercise.  Instructor  t o w r i t e on b o a r d :  I think I feel I learned  E a c h s t u d e n t and and  verbally  instructor  shares  fills  i n one  i t w i t h the group.  of the  Complete i n  go-round.  If  facts  later  produce  wisdom* and  are the  then  seeds  the  are the f e r t i l e  i n which the  seeds  Rachel  and  emotions  the impressions of  senses  that  knowledge  blanks  the soil  must grow.  Carson*  S e n s e o f Wonder  The  one  98 Interactional During your  post c l i n i c  regular discussion*  time*  Episode I I I  r a t h e r than  please carry  carrying  o u t your  out the following  exercises.  The  e x e r c i s e s should take approximately  30  minutes.  Exercise 1 Students member  and i n s t r u c t o r  (including  two p o s i t i v e during least  to s i ti n a c i r c l e .  the instructor)  t h e p a s t week.  shares w i t h t h e group  Ask t h a t p a r t i c i p a n t s c h o o s e a t  one e x p e r i e n c e t h a t p e r t a i n s t o c l i n i c a l  g r o u p member  group  e x p e r i e n c e s i n w h i c h t h e y were i n v o l v e d  A l l o w a few m i n u t e s f o r t h o u g h t  their  Each  (including  formulation.  the instructor)  share  work. Have  each  verbally  two e x p e r i e n c e s .  Exercise 2 Students  and i n s t r u c t o r  negative  experience  F o r example* trouble with  they  a statement  t o share with identified  t h e g r o u p one  d u r i n g t h e week.  might b e g i n :  "One t h i n g  " o r "One t h i n g  I didn't  I had like  Exercise 3 G r o u p members and i n s t r u c t o r " T h i s week I e s p e c i a l l y  Exercise  one r e s p o n s e t o  appreciated  "  4  Group t o share f e e l i n g s with  t o give  each  about  interactional  other.  The End  With thanks f o r your cooperation.  episodes  100  APPENDIX E  Explanatory Director^  Level 1  Letter Co-ordinator  101 Dear D i r e c t o r / C o - o r d i n a t o r : In  order t o complete  the U n i v e r s i t y thesis.  My  Columbia  involving clinical  and  their  like  one  effect  to conduct  class  on  t o do  a  interpersonal  student a n x i e t y i n the  an  of f i r s t  experimental  level  study  s t u d e n t s and  their  instructors.  I propose  t o have e a c h  w i t h both  a control  treatment  involved consists  episodes" designed  and  of the f i v e  an e x p e r i m e n t a l of t h r e e  to f a c i l i t a t e  The  "control"  hours  hours.  orientation completed  during the  "treatment"  by  t o the  work  The  "interactional interpersonal  students. a two-week p e r i o d .  second  implement  the  week would  package.  in addition During  group.  i n s t r u c t o r would  amount o f i n s t r u c t o r  t o two  clinical  week t h e  p a c k a g e and  implement t h e The  and  s t u d y would t a k e p l a c e o v e r  the f i r s t  instructors  positive  r e l a t i o n s h i p s between i n s t r u c t o r  one  I have e l e c t e d  at  setting.  I would  During  Degree i n N u r s i n g  r e s e a r c h i s i n the area of  relationships clinical  of B r i t i s h  a Master's  time  i n v o l v e d w o u l d be  t o her  t h e one  regularly  t o two  about  scheduled  hour p e r i o d /  "package" would o c c u r .  T h i s would  be  myself.  I propose  t o have s t u d e n t s  instructor-student entirely voluntary.  r a t e both  relationships. I would l i k e  anxiety  and  Their participation t o have  approximately  is  102 one h a l f hour f o r d a t a c o l l e c t i o n on Monday and Thursday of two c o n s e c u t i v e weeks a t 1300 n e c e s s a r y f o r me t o p r e t e s t my  hours.  In a d d i t i o n * i t i s  i n s t r u m e n t t o measure  instructor-student relationships.  I would l i k e t o do  this  w i t h a group of twenty f i r s t l e v e l s t u d e n t s who would not be i n v o l v e d i n t h e s t u d y . complete  I would l i k e t o have them  t h e q u e s t i o n n a i r e on two o c c a s i o n s i n o r d e r t o  establish test-retest r e l i a b i l i t y . be completed  i n a p p r o x i m a t e l y twenty  The q u e s t i o n n a i r e c o u l d minutes.  I l o o k f o r w a r d t o h e a r i n g from you and w o r k i n g w i t h you.  Sharon Sundberg*  BSN  APPENDIX F  Explanatory Participating  First  Letter Year  Instructors  104 Dear  Colleague: In order  The  to complete a Master's  University  thesis.  My  and  their  effect  on  to conduct  an  student  students.  Your involvement  groups of a c t i v i t i e s w i t h  Thursday of t h e i r instructions  myself  prior  "activities  second  a t any  i n no way  time  actions are  be  of the  grouped  shredded  group would  T u e s d a y * Wednesday*  week on y o u r  ward.  t a k e one  and  The o b j e c t i v e s provided  O r i e n t a t i o n to  probably  three  by  the  h o u r and  time  allowed. i n the  reflect  d u r i n g the  study  on y o u r  study you  i s entirely  voluntary  employment s t a t u s .  wish  t o withdraw*  If  your  acceptable.  Students part  of  group.  f o r the experimental  package" w i l l  Your p a r t i c i p a t i o n will  a  which  implementing  experimental  to implementation.  be  study  groups  f o r t h e a c t i v i t i e s w o u l d be  for questions w i l l  and  two  would e n t a i l  the  three a c t i v i t i e s  your  take place during post conference  and  t o do  a n x i e t y i n the  experimental  i n v o l v e b o t h y o u r s e l f and  The  I have s e l e c t e d  setting.  I would l i k e would  Columbia  at  research i s i n the area of i n t e r p e r s o n a l  relationships clinical  of B r i t i s h  Program i n N u r s i n g  will  be  study.  t o c o m p l e t e q u e s t i o n n a i r e s as  F i n d i n g s from  t o ensure  once d a t a  asked  anonymity.  i s coded.  a  these q u e s t i o n n a i r e s w i l l Questionnaires w i l l  be  105 Implementation students w i l l  of the planned  constitute  consent  a c t i v i t i e s with  to p a r t i c i p a t e  your  i n the  study. Thank y o u working  with  f o r your  cooperation.  I look  forward  you.  Sharon Sundberg*  BSN  to  APPENDIX G  Explanatory  Letter  Subjects f o r Instrument V a l i d a t i o n  Test  107 My  name i s S h a r o n S u n d b e r g and  in  the Master's  of  B r i t i s h Columbia.  titled  "The  Nursing The of  I am  planning to conduct  Anxiety  i n the C l i n i c a l study  questionnaires students*  faculty  F i n d i n g s of the and  setting.  students  The  study has  choose not  study  i s t o examine t h r o u g h  study w i l l  i n enhancing  Your p a r t i c i p a t i o n you  a  University  be  by  in this  of b e n e f i t  by  to participate*  to  use  of  both  this  the e t h i c a l  the School study  the  clinical  learning within  been approved  on  Setting".  anxiety i n the  c o m m i t t e e o f t h i s a g e n c y and  If  a t The  student  of a R e l a t i o n s h i p - B u i l d i n g A c t i v i t y  purpose of t h i s  setting.  a graduate  Degree Program i n N u r s i n g  Effect  Student  I am  review  Nursing.  i s entirely voluntary.  no u n t o w a r d a c t i o n s w i l l  ensue. Participation which w i l l to  take  approximately  one  to establish  week a p a r t .  test-retest  a r e anonymous/ b u t you  15  c o m p l e t e t h e q u e s t i o n n a i r e on  approximately is  involves completion  p r e f e r not Data from  once d a t a  I would l i k e  you  occasions  purpose of t h i s  reliability.  i t / your  testing  Questionnaires  of the q u e s t i o n n a i r e  actions are be  Findings w i l l  respondents.  i s coded.  two  The  questionnaires w i l l study.  minutes.  completion  t o submit  purpose of t h i s anonymity of  i f on  of a q u e s t i o n n a i r e  used be  acceptable.  solely  for  grouped t o  Questionnaires w i l l  be  the ensure  shredded  108 Grouped faculty  findings  of t h i s School  the p a r t i c i p a t i n g Completion consent  o f t h e s t u d y may  class  of Nursing of  shared w i t h  the  w i t h t h e members o f  students.  of the q u e s t i o n n a i r e w i l l  for participation  Thank y o u  and  be  i n the  constitute  study.  f o r your a s s i s t a n c e .  S h a r o n Sundberg*  BSN  your  APPENDIX H  Explanatory Control  and  Letter  Experimental  Subjects  110 My name i s Sharon Sundberg and I am a graduate i n the Master*s Degree Program i n N u r s i n g a t The of B r i t i s h Columbia. titled  "The  student  University  I am p l a n n i n g t o conduct a s t u d y  E f f e c t of a R e l a t i o n s h i p - B u i l d i n g A c t i v i t y  N u r s i n g Student A n x i e t y i n the C l i n i c a l  on  Setting".  The purpose of t h i s study i s t o examine through t h e use of q u e s t i o n n a i r e s s t u d e n t s ' a n x i e t y i n t h e setting. faculty setting.  clinical  F i n d i n g s of t h e study w i l l be of b e n e f i t t o both and s t u d e n t s i n enhancing The  learning within  this  study has been approved by t h e e t h i c a l  review  committee of t h i s agency and by the S c h o o l of N u r s i n g . Your p a r t i c i p a t i o n  i n t h i s study i s e n t i r e l y v o l u n t a r y .  I f you choose not t o p a r t i c i p a t e /  no untoward a c t i o n s w i l l  ensue. Participation  i n v o l v e s c o m p l e t i o n of q u e s t i o n n a i r e s  which w i l l t a k e a p p r o x i m a t e l y 30 minutes.  Questionnaires  a r e anonymous/ but i f on c o m p l e t i o n of t h e q u e s t i o n n a i r e you p r e f e r not t o submit i t / your a c t i o n s a r e a c c e p t a b l e . Data from q u e s t i o n n a i r e s w i l l be used s o l e l y f o r t h e purpose o f t h i s s t u d y .  F i n d i n g s w i l l be grouped t o  anonymity o f r e s p o n d e n t s .  Q u e s t i o n n a i r e s w i l l be  ensure  shredded  once d a t a i s coded. Grouped f i n d i n g s o f t h e study may faculty  be shared w i t h t h e  of t h i s S c h o o l o f N u r s i n g and w i t h t h e members of  the p a r t i c i p a t i n g  c l a s s of s t u d e n t s .  Completion of the  questionnaire  consent f o r p a r t i c i p a t i o n i n the Thank you  for  will  constitute  study.  assistance.  S h a r o n Sundberg*  BSN  your  112  APPENDIX I  Stressful  Event  Questionnaire  113 Stressful  Questionnaire  Number:  Do y o u f e e l y o u have e x p e r i e n c e d event  during  I f yes*  the past  24  event.  f a m i l y member o r  Yes  •  No  •  F o r example* friend.  an u n u s u a l l y  stressful  hours?  p l e a s e d e s c r i b e i n your  stressful  Event  own words t h e n a t u r e a car accident* death  of the of a  APPENDIX J  D e m o g r a p h i c D a t a Form  115 Demographic Data Form Q u e s t i o n n a i r e Number: P l e a s e complete t h e f o l l o w i n g q u e s t i o n s by f i l l i n g  i n the  c o r r e c t box. Age  17-20 • 21-25  Sex  Male •  Q  Marital  Female Q  status  26-29 •  Q  Married  Q  Divorced  30-39 • Occupation  Single  Separated  p r i o r t o enrolment i n t h e VGH N u r s i n g program: Student  •  P r a c t i c a l Nurse  Q  Nurse a i d e  Q  Other  •  D u r i n g t h e p a s t week your c l i n i c a l e x p e r i e n c e was on:  Were you i n attendance  A3  •  E7  •  W7  •  E9  •  E10  •  on a l l t h r e e c l i n i c a l Yes  •  No  •  1.  •  2.  •  3.  •  I f nor d i d you m i s s :  days?  •  116  APPENDIX K  Figure  1:  Plot  S c o r e s by  of State  Treatment  Anxiety Group  118  APPENDIX L  Figure  2:  P l o t of S t a t e  S c o r e s by  Anxiety  Instructors  119  Figure  30  2 Plot of State Anxiety Scores by Instructors  40  SO  Pre-test State Anxiety Score  60  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0097602/manifest

Comment

Related Items