TRANSFORMING STUDENT NURSES' IMAGE OF NURSING

322 Pages·2014·2.32 MB·English

TRANSFORMING STUDENT NURSES' IMAGE OF NURSING: AN APPRECIATIVE
INQUIRY APPROACH

by

MOTSHEDISI EUNICE CHAUKE

submitted in accordance with the requirements

for the degree of

DOCTOR OF LITERATURE AND PHILOSOPHY

in the subject

HEALTH STUDIES

at the

UNIVERSITY OF SOUTH AFRICA

SUPERVISOR: PROF DM VAN DER WAL

CO-SUPERVISOR: PROF ADH BOTHA

JUNE 2014
Student Number: 05115515

DECLARATION

I declare that TRANSFORMING STUDENT NURSES’IMAGE OF NURSING: AN
APPRECIATIVE INQUIRY APPROACH is my own work and that all sources that I have
used or quoted have been indicated and acknowledged by means of complete
references and that this work has not been submitted before for any other degree at any
other institution.

______________________________ _________________
Motshedisi Eunice Chauke Date
TRANSFORMING STUDENT NURSES’ IMAGE OF NURSING: AN APPRECIATIVE
INQUIRY APPROACH

STUDENT NUMBER: 05115115
STUDENT: Motshedisi Eunice Chauke
DEGREE: Doctor of Literature and Philosophy
DEPARTMENT: Health Studies. UNISA
SUPERVISOR: Prof DM van der Wal
CO-SUPERVISOR: Prof ADH Botha

ABSTRACT
Research has shown that, worldwide the nursing profession is faced with image-related
challenges impacting on its status, prestige, power and the ability to attract more young
and suitably qualified students to nursing. There is adequate evidence of a link between
the image of nursing and the number of young people entering and leaving the
profession. A positive image of nursing attracts applicants and the intention to leave
nursing correlates positively with holding a negative image of nursing. There is also
evidence of poor perception of the image of nursing among student nurses.
The study aimed at exploring the potential of appreciative inquiry (AI) as a teaching
rd th
strategy to transform the image of nursing among 3 and 4 year, college and
university student nurses in the Gauteng province of South Africa. The second aim was
to describe student nurses’ experiences regarding their participation in the process of
AI.
A qualitatively dominant, sequentially embedded, mixed methods design with
explorative-descriptive and quasi-experimental features was utilised. Sequential data
collection and analysis were conducted during five stages comprising: a pre-test survey,
intervention (appreciative inquiry), a post-test, description of the experiences of student
nurses of AI and an integration stage.
The pre-test results showed more positive than negative perceptions of the image of
nursing among student nurses. The negative perceptions of the image of nursing
among student nurses that needed intervention included the working conditions of
nurses and the perception of nursing as a profession that was not respected and
appreciated. The student nurses who took part in appreciative inquiry showed a
significant and positive change in their perception of the image of nursing as a
respected and appreciated profession. From the individual interviews on the student
nurses’ experiences of AI, the themes “experience of positive emotions” and
“experiential learning” emerged. The student nurses experiences described their
engagement in AI as a positive and enjoyable experience from which multidimensional
learning resulted
Key words
Appreciative inquiry; image of nursing; career choices; nursing profession and nursing
values.
ACKNOWLEDGEMENTS

Thanks be to God for helping me through the pain and overwhelming grief due to the
deaths of my mother and brother which occurred during the data collection and the
write-up of this study respectively. My heart and spirit were crushed and He did not
abandon me, instead He showed me compassion, provided the strength and wisdom
that enabled me to complete this research. God's love never failed me.
I wish to acknowledge:

• Prof DM van der Wal and Prof ADH Botha, my promoters. I am appreciative of
the countless hours you spent on providing supportive guidance, reviewing and
making recommendations to improve the quality of the content of this thesis.

• Gauteng Provincial Department of Health for the permission to conduct the study.

• The management of the nursing education institutions at which the research was
conducted for the permission to conduct the study and for making the necessary
arrangements for the researcher to meet with the student nurses.

• Mrs H Muller for statistical skills that provided invaluable contribution to this
study.

• Mrs Julia Nemaxwi for volunteering her IT expertise, encouragement and humour
that I needed so badly to carry on with this study.

• Prof M C Matlakala for the critical reviews, comprehensive feedback and the
generous support.

• Mrs R Coetzer for the excellent technical editing done on this thesis

• Mr J Chokwe, the professional language editor.

• The nursing students who participated in this study.

• I wish to thank heartily the NRF and UNISA for providing funds and study leave
to conduct this research.
Dedication

This thesis is dedicated posthumously to and in loving memory of my husband
Jack Rigwa Chauke (1953-2005)

and

My mother, Christinah Matsietsi Thakadu (1931-2012) who passed away when
the data collection of this thesis was still in progress

and

My one and only brother Itumeleng Euphrates Thakadu (1964-2013)
who passed away when the write-up of this thesis was still in progress.

You are all loved and sorely missed.

I also dedicate this thesis with love to my daughters,
Ipeleng and Nkateko

They are ‘the world’ to me
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Table of contents Page

CHAPTER 1

ORIENTATION TO THE STUDY

1.1 INTRODUCTION ..................................................................................................................................... 1

1.2 BACKGROUND TO THE RESEARCH PROBLEM ................................................................................. 4

1.3 THE RESEARCH PROBLEM .................................................................................................................. 7

1.4 AIM OF THE STUDY ............................................................................................................................... 7

1.4.1 Purpose and objectives ........................................................................................................................... 8
1.4.2 Research questions ................................................................................................................................. 8

1.5 SIGNIFICANCE OF THE STUDY ............................................................................................................ 9

1.6 DEFINITIONS OF KEY CONCEPTS ..................................................................................................... 11

1.6.1 Appreciation ........................................................................................................................................... 11
1.6.2 Inquiry .................................................................................................................................................... 11
1.6.3 Appreciative inquiry ............................................................................................................................... 11
1.6.4 Image..................................................................................................................................................... 12
1.6.5 Peak experiences .................................................................................................................................. 12
1.6.6 Perceptions ............................................................................................................................................ 12
1.6.7 Student nurses ...................................................................................................................................... 13
1.6.8 Nursing .................................................................................................................................................. 13
1.6.9 Nursing education institutions ................................................................................................................ 13

1.6.10 Transformation ...................................................................................................................................... 13

1.7 FOUNDATIONS OF THE STUDY ......................................................................................................... 14

1.7.1 Pragmatism ........................................................................................................................................... 15
1.7.2 Philosophical grounding ........................................................................................................................ 16
1.7.3 Assumptions on which the study was founded ...................................................................................... 19

1.7.3.1 Ontology ................................................................................................................................................ 19
1.7.3.2 Epistemology ......................................................................................................................................... 20
1.7.3.3 Methodology .......................................................................................................................................... 21
1.7.3.4 Axiology ................................................................................................................................................. 21
1.7.3.5 Rhetoric ................................................................................................................................................. 22

1.8 RESEARCH DESIGN ............................................................................................................................ 22
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1.9 RESEARCH METHODS ........................................................................................................................ 23

1.9.1 Research setting .................................................................................................................................... 23
1.9.2 Stages of the study ................................................................................................................................ 23

1.10 LITERATURE REVIEW AND CONTROL .............................................................................................. 25

1.11 MEASURES TO ENSURE VALIDITY, RELIABILITY AND TRUSTWORTHINESS ............................... 25

1.12 ETHICAL CONSIDERATIONS .............................................................................................................. 26

1.13 ORGANISATION OF THE THESIS ....................................................................................................... 26

1.14 CONCLUSION ....................................................................................................................................... 26

CHAPTER 2

PHILOSOPHICAL AND THEORETICAL FOUNDATIONS

2.1 INTRODUCTION ................................................................................................................................... 28

2.2 FRANKL’S EXISTENTIALISM ............................................................................................................... 28

2.2.1 Concepts of Frankl’s theory ................................................................................................................... 29

2.2.1.1 The will to meaning ................................................................................................................................ 29
2.2.1.2 Freedom of the will ................................................................................................................................ 30
2.2.1.3 Meaning of life and human suffering ...................................................................................................... 32

2.2.2 Avenues to meaning .............................................................................................................................. 33

2.2.2.1 Creative values ...................................................................................................................................... 33
2.2.2.2 Experiential values ................................................................................................................................ 34
2.2.2.3 Attitudinal values ................................................................................................................................... 35

2.2.3 The existential vacuum .......................................................................................................................... 37

2.3 APPRECIATIVE INQUIRY (AI) .............................................................................................................. 38

2.3.1 Theoretical background of AI ................................................................................................................. 38
2.3.2 Characteristics of AI .............................................................................................................................. 40
2.3.3 Assumptions of AI .................................................................................................................................. 42
2.3.4 Principles of AI ....................................................................................................................................... 42
2.3.5 The appreciative inquiry process ........................................................................................................... 43
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2.3.5.1 The affirmative topic .............................................................................................................................. 43
2.3.5.2 Phases of AI .......................................................................................................................................... 44

2.3.6 Appreciative inquiry interviews .............................................................................................................. 47
2.3.7 Various approaches and formats of AI .................................................................................................. 48
2.3.8 Relevance of Appreciative Inquiry to the study ...................................................................................... 48
2.3.9 Criticism levelled against AI ................................................................................................................... 51

2.4 INTERFACE BETWEEN AI AND FRANKL’S EXISTENTIALISM .......................................................... 52

2.5 CONCLUSION ....................................................................................................................................... 53

CHAPTER 3

LITERATURE REVIEW

3.1 INTRODUCTION ................................................................................................................................... 54

3.2 SCOPE OF THE LITERATURE REVIEW ............................................................................................. 54

3.3 THE IMAGE OF NURSING ................................................................................................................... 54

3.3.1 The significance of the image of nursing ............................................................................................... 55
3.3.2 The student nurses’ image of nursing.................................................................................................... 56

3.3.2.1 Student nurses’ perceptions of the nurses and the nature of nursing .................................................... 57
3.3.2.2 Student nurses’ perceptions of nursing as a career and a profession ................................................... 58
3.3.2.3 Student nurses’ perceptions of nursing as an occupation ..................................................................... 60
3.3.2.4 Student nurses’ perceptions regarding the nurses’ own professional self-image .................................. 61
3.3.2.5 Student nurses’ perceptions of gender in nursing ................................................................................. 62
3.3.2.6 Student nurses’ perceptions of their clinical learning experience .......................................................... 64
3.3.2.7 The student nurses’ perceptions of the social status of nursing ............................................................ 66
3.3.2.8 The student nurses’ perceptions of the public image of nursing ............................................................ 67

3.3.3 The need for change of the image of nursing ........................................................................................ 68
3.3.4 The evolving perceptions of nursing among student nurses.................................................................. 69
3.3.5 Strategies to transform the image of nursing among student nurses .................................................... 70

3.4 CONCLUSION ...................................................................................................................................... 71
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CHAPTER 4

RESEARCH DESIGN AND METHODS

4.1 INTRODUCTION ................................................................................................................................... 73

4.2 RESEARCH OBJECTIVES ................................................................................................................... 73

4.3 RESEARCH QUESTIONS..................................................................................................................... 73

4.3.1 Quantitative research questions ............................................................................................................ 74
4.3.2 Qualitative research questions .............................................................................................................. 74
4.3.3 Mixed method research questions ......................................................................................................... 74

4.4 RESEARCH DESIGN ............................................................................................................................ 75

4.4.1 Mixed methods designs ......................................................................................................................... 75
4.4.2 Characterizing the current design .......................................................................................................... 80

4.4.2.1 Explorative-descriptive design ............................................................................................................... 80
4.4.2.2 Embedded quasi-experimental design .................................................................................................. 81
4.4.2.3 The intervention: Appreciative inquiry .................................................................................................... 82

4.5 RESEARCH CONTEXT AND SETTING ............................................................................................... 83

4.6 RESEARCH METHODS ........................................................................................................................ 83

4.6.1 Population .............................................................................................................................................. 84
4.6.2 Sample and sampling procedures ......................................................................................................... 85
4.6.3 Data collection ....................................................................................................................................... 89

4.6.3.1 Quantitative data collection ................................................................................................................... 89
4.6.3.2 Qualitative data collection ...................................................................................................................... 93

4.6.3.2.1 Appreciative interviews .......................................................................................................................... 94
4.6.3.2.2 Individual interviews .............................................................................................................................. 98

4.6.4 Data analysis ......................................................................................................................................... 99

4.6.4.1 Quantitative data analysis ................................................................................................................... 100
4.6.4.2 Qualitative data analysis ...................................................................................................................... 101

4.7 MEASURES TO ENSURE TRUSTWORTHINESS ............................................................................. 103

4.7.1 Credibility ............................................................................................................................................. 104
4.7.2 Transferability ...................................................................................................................................... 107
4.7.3 Dependability ....................................................................................................................................... 108