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This is to certify that the

dissertation entitled
A COMPARISON OF THE PERCEPTIONS
OF NURSING DIPLOMA STUDENTS AND PRECEPTORS

WITH RESPECT TO LEVELS OF STUDENTS' SELF-ESTEEM
presented by

SANDY LEADBEATER

has been accepted towards fulfillment
of the requirements for

PhD Educational Administration

 

degree in

 

 

 

 

Date December 10, 1993

 

MSU is an Afﬁrmative Action/Equal Opportunity Institution 0- 12771

 

 

 

 

 

 

 

 

 

 

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MSU In An Afﬁrmative Action/Equal Opportunity Institution
W

 

A COMPARISON OF THE PERCEPTIONS
OF NURSING DIPLOMA STUDENTS AND PRECEPTORS
WITH RESPECT TO LEVELS OF STUDENTS'
SELF-ESTEEM DURING THE PRE-GRADUATE
CONSOLIDATION SEMESTER
AT
HUMBER COLLEGE OF APPLIED ARTS AND TECHNOLOGY

by

Sandy Leadbeater

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements

for the degree of

DOCTOR OF PHILOSOPHY
in
EDUCATION ADMINISTRATION
1993

ABSTRACT

A COMPARISON OF THE PERCEPTIONS OF NURSING DIPLOMA STUDENTS AND
PRECEPTORS WITH RESPECT TO LEVELS OF STUDENTS' SELF-ESTEEM
DURING THE PRE-GRADUATE CONSOLIDATION SEMESTER

By
Sandy Leadbeater

The primary purpose of this study was to determine whether there were any
perceptual changes in students' awareness of their self-esteem level as they
experienced the pre-graduate work opportunity within the four month consolidation
semester. The investigator focused on total self-esteem and its subcomponents of
general self-esteem, social self-esteem, school-academic self-esteem and home,
parents-family self-esteem.

The population was composed of volunteers from pre-graduate students of
the nursing diploma program at Humber College of Applied Arts and Technology
and nurse preceptors working with these students. The survey instruments were
the Coopersmith Self-Esteem Inventory: Adult Form and a Variables form,
identifying demographic and socio-psychological constituents. Preceptor
interviews were focused to address subcomponent areas. The Kuder—Ftichardson
formula 21 was used to determine test-retest reliability and the t Test for
Nonindependent Samples was employed as the appropriate test of significance.

Data analysis produced the following findings. Upon completion of the four
month semester the majority of students experienced signiﬁcant positive change in
their perceived total self-esteem level and in each of the four self-esteem

subcomponents. Age groupings showed the largest positive growth being

experienced by the twenty-one to twenty-five year old group. Those who are
parents, presented a slight decrease, and those living with a spouse or significant
other, displayed an overall growth in perceived levels of self-esteem. The
variables of previous full-time employment, present part-time employment, extra
curricular course participation, previous semester repeats or supplemental exams,
were linked with clear growth in perceived self-esteem on the final inventories.
Interviews with preceptors provided a melange of perspectives, not necessarily
congruent with students' inventoried perceptions of their self-esteem.

Further research studies would provide for support and diversification of the
findings of this work. Studies conducted in the same format which drew their
population from other college and university programs would address the potential
of data reliability. Cross-references with further variables would provide
stratification and detail establishing definitive criteria for the effects of identified
variables. Alterations in length of time covered by the study and/or placements of
inventory completions, would also increase the data related to fluctuating of

perceived self-esteem levels throughout the educational process.

Copyright by

SANDRA GAIL LEADBEATER

1 993

ACKNOWLEDGEMENTS:

It is with sincere appreciation that I thank Dr. Louis Hekhuis for agreeing to
become my major adviser and chairperson of my guidance committee. Dr. Hekhuis
has provided unfailing encouragement and guidance, with patience and a sense of
humor.

I also wish to thank Dr. Cas Heilman, Dr. Howard Hickey and Dr. Jim
Snoddy, committee members, for asking thought provoking questions, providing
expert advice and for ongoing support.

A special thank-you to the administrators at Humber College and Michigan
State University and to Drs. Roy Giroux and Howard Hickey, for having an idea and
making it happen. it has been an extraordinarily positive experience to be a
student of the Education Administration program.

I wish to thank the members of the King Howard Society for their ongoing
support and encouragement.

Thanks to Bev Galway for always being available, and to Jim, AdaFIae, Jill

and Leigh for believing in lifelong education.

TABLE OF CONTENTS

PAGE
LIST OF TABLES ............................................. x
LIST OF FIGURES ............................................. xi
LIST OF SUMMARY CHARTS ..................................... xi
CHAPTER I - INTRODUCTION
Background .................................. 1
Self Concept And The Role Of Education ................. 4
Self-Esteem .................................. 7
Statement Of The Problem and Purpose ................. 12
Research Questions ............................. 15
Limitations ................................... 1 6
Signiﬁcance Of The Research ....................... 18
Hypotheses .................................. 20
Definitions 01 Terminology ......................... 21
Organization Of The Study ......................... 23
CHAPTER ll - REVIEW OF RELATED LITERATURE
Introduction .................................. 24
Students And The Role Of Self-Esteem .................. 26
Self-Esteem And Nursing Education Students .............. 28
Self-Esteem And Pre-Graduate Clinical Experience ........... 32
Self-Esteem And Nursing Graduates .................... 34

vi

Summary .................................... 36

CHAPTER III - RESEARCH METHODOLOGY

Introduction .................................. 38
Survey Instrument - The Coopersmith Self-Esteem Inventories . . . . 39
Normative Data ................................ 40
Population Of The Study ........................... 41
Data Collection ................................ 45
The Interview ................................ . 47

CHAPTER IV - DATA ANALYSIS AND FINDINGS

introduction .................................. 48
Influencing Factors And Events ....................... 50
Section One
General Data Group Information .................. 52
Self-Esteem Subscale Components ................ 55
General Self-Esteem Area ...................... 56
Social Peer Group Area ....................... 56
Home Parents And Family Area ................... 57
School-Academic Area ........................ 58
Section Two
Identified Student Grouping ..................... 59
Null-Hypothesis ............................ 59
Pregraduate Consolidation Student Variables Form ....... 60
Self-Esteem Change By Age-Grouping .............. 65
Self-Esteem Change By Parenthood ............... 66

vii

Self-Esteem Change When Living With A Spouse

Or Signiﬁcant Other ......................... 66
Self-Esteem Change When Previously Employed ........ 67
Self-Esteem Change And Part-Time Employment ........ 67
Self-Esteem Change And Extracurricular Courses ........ 68
Self-Esteem Change And Previous Academic Failure ..... 68
Section Three
Proﬁles ................................. 69
Student A: Female - 24 Years ................... 70
Student B: Female - 22 Years ................... 73
Student C: Female - 22 Years ................... 76
Student D: Female - 20 Years ................... 79
Student E: Female - 27 Years ................... 82
Student F: Male - 44 Years ..................... 85
Student G: Female - 25 Years ................... 88
Student H: Female 21 Years .................... 91

CHAPTER V - OBSERVATIONS, RECOMMENDATIONS

Introduction .................................. 94
The Research Questions ........................... 95
The Design And Procedure Of The Study ................. 96
Summary Of The Study ............................ 98
Conclusions .................................. 1 12

Reflections From The Compilation And Interpretation

Of The Study ................................. 114
Implications For Further Study ........................ 118
Implications For Educators .......................... 120

viii

APPENDIX A

Standards for Diploma Nursing Programs ................ 123
APPENDIX B
Coopersmith Self-Esteem Inventory - Adult Form ............. 129
Permission Agreement ....................... 130
Permission Agreement Sample Items ............... 132
APPENDIX 0
Interview Consent ............................... 135
APPENDIX D
Pregraduate Consolidation Student Variables Form ........... 137
APPENDIX E
Preceptor Interview .............................. 141
APPENDIX F
UCRIHS Approval ............................... 143
APPENDIX G
Self-Esteem Graphs .............................. 145
BIBLIOGRAPHY .................................... 147

ix

LIST OF TABLES

TABLE PAGE
1. General Self-Esteem Area ........................ 56
2. Social Peer Group Area ......................... 56
3. Home - Parents And Family Area ................... 57
4. School-Academic Area ......................... 58
5. Self-Esteem Change By Age Grouping ................ 65
6. Student A - Total Self-Esteem Scores ................. 70
7. Student 8 - Total Self-Esteem Scores ................. 73
a. Student C - Total Self-Esteem Scores ................. 76
9. Student D - Total Self-Esteem Scores ................. 79
10. Student E - Total Self-Esteem Scores ................. 82
11. Student F - Total Self-Esteem Scores ................. 85
12. Student G - Total Self-Esteem Scores ................. 88
13. Student H - Total Self-Esteem Scores ................. 91
14. Data For Self-Esteem Subscale Components ............. 101
15. Age Range Groupings .......................... 102

LIST OF FIGURES

FIGURE PAGE
1. Frequency Polygon - January Data 102 Students .......... 54
2. Frequency Polygon - April Data 85 Students ............. 54
3. Self-Esteem Subscale Components .................. 55
4. Frequency Polygon - January Data 25 Students ........... 63
5. Student A - Self-Esteem Scores - Female 24 Years ......... 71
6. Student B - Self-Esteem Scores - Female 22 Years ......... 74
7. Student C - Self-Esteem Scores - Female 22 Years ......... 77
a. Student D - Self-Esteem Scores - Female 20 Years ......... 80
9. Student E - Self-Esteem Scores - Female 27 Years ......... 83
10. Student F - Self-Esteem Scores - Male 44 Years ........... 86
11. Student G - Self-Esteem Scores - Female 25 Years ......... 89
12. Student H - Self-Esteem Scores - Female 21 Years ......... 92

LIST OF SUMMARY CHARTS

SUMMARY CHART PAGE
1. Identified Student Grouping ....................... 63
2. Comparison Of Group Range Of Scores And Means ......... 64

xi

CHAPTER I
INTRODUCTION

BACKGROUND

An overview of the process which formulated the components for this study
is presented to provide perspective.

In 1967, the province of Ontario established a community college system for
post-secondary or adult student education. Programs in this system operate under
the aegis of the Provincial Ministry of Colleges and Universities. [In 1993 this
Ministry was restructured as the Ministry of Education and Training]. Program
standards for implementation and reference are the product of recommendations of
the Committees of the Minister of Colleges and Universities, and the Council of
Regents for Colleges of Applied Arts and Technology. At this time (1967), diploma
nursing programs were established within, or transferred to, the community
colleges.

The program standards for diploma nursing programs were reviewed by the
Provincial Advisory Committee on Nursing Education in relation to the 'Standards
of Nursing Practice for Registered Nurses and Registered Nursing Assistants“, as
revised by the College of Nurses of Ontario, May 1, 1979.

On January 9, 1980, the revised program standards were released from the
Ofﬁce of the Chairman, Council of Regents for Colleges of Applied Arts and
Technology, Province of Ontario, Appendix A. These standards must be met to
_ ensure that graduates are eligible for admission to the examination conducted by

the Ontario College of Nurses, for registration and certiﬁcation of nurses in Ontario.

'4.

The following provision is delineated within this document.

The total nursing experience shall include a continuous pre-graduate
experience of 525 hours (14 weeks) in the ﬁnal semester which will provide
for synthesis and consolidation of previous Ieaming and opportunities for
increasing judgement, skill and independence in a work experience similar
to that of the beginning staff nurse.

The specific objectives shall include:

setting priorities based on individual patient needs,

0 planning and organizing nursing care for an increasing number of
patients and complexity of care,

- adjusting activities to cope with unanticipated events,

- implementing planned nursing care in a reasonable length of time
with due attention to conservation of energy and supplies.

0 developing an understanding of the interaction of the health care
team,

0 developing the ability to provide direction and supervision of the
registered nursing assistant and others to whom the registered nurse
delegates activities,

0 providing an opportunity to function independently of the teacher.

The experience shall take place in hospitals and of the 14 continuous weeks

no fewer than 6 consecutive weeks shall be on one medical-surgical unit

(any age group) in a general hospital. The placement of the student for the

remainder of the pro-graduate experience will take into consideration

student Ieaming needs and the availability of clinical resources. The student
hours shall coincide with the regular shift of service personnel. The student

experience shall include all tours of duty.

The experience shall be planned, supervised and evaluated jointly by
service and educational personnel. The day to day supervision of the
student shallbecarried out by nursing service personnel and college
clinical teachers shall be available or on call for consultation.“

Standards, Appendix A, p. 4

SELF-CONCEPT AND THE ROLE OF EDUCATION

The goals of fostering judgement, skill and independence, and the specific
objectives as delineated by the Standards document are demonstrations of
positive self-concept and socio-psychological growth. The setting of priorities,
planning, adapting, efficient use of time and providing leadership are examples of
self-actualizing behaviors. The pregraduate semester provides the opportunities to
promote this growth. Working effectively within a constantly changing profession
demands this change.

Technologic, socio-economic and political change, are fundamental facets
of the current North American life-style. It is the moral imperative of education and
educators, to prepare graduates for a world where knowledge and practice are no
longer a product of evolution alone, but rather, the output of explosive

technologies.

'...one recurrent educational goal with some consistency is that of
equipping the student with the necessary skills to live effectively and
productively in the world of tomorrow...“

(Harvey 1970, p. 67)

Abraham Maslow has defined a hierarchy of the evolution of human needs.

The base is composed of the physical and life-sustaining requisites such as air,
warmth, water and food. Once these needs are met, or satisfactorily partially met,
mankind progresses to the pursuit of security, love and belonging, self-esteem and
ultimately, self-actualization. The adult student can enter or re-enter the school
world while at any of several points on this continuum. Likewise, graduation from a
course or completion of a program also will occur for the insecure, the alienated, or

I those with low self-esteem. When these needs are recognized by education than

they are more likely to be nurtured. 'lncreasingly, nursing education is advocating

goals of self-actualization as appropriate for the nurse', (Watson 1978, p. 151).
Obviously, one cannot place self-actualization within the nursing theory curriculum
and evaluate the results through the traditional examination methods. If self-
actualization is indeed to be a realistic goal for nursing education than previous
needs must be attended to and progress up the hierarchy must be nurtured. The
placement of the pre-graduate consolidation experience in the ﬁnal semester lends
itself to supporting this progression. Self-actualization, according to Maslow, 'is to
become more and more what one is to become, everything one is capable of
becoming, requiring the individual to make full use of unique talents and potentials
by going beyond the immediate primitive needs of hunger, thirst, and so on and
realizing fully the higher needs for love, esteem, cognition, recognition, aesthetic
beauty', (Maslow 1970, p. 92).

If, for educators, it is important to promote the individual's growth of self, as
well as theoretical knowledge and technical skills then environments must be
structured and experiences sought which will promote positive perceptions of self-
concept. Hamachek describes self-concept and school achievement as
'interrelated and interactive", (Hamachek 1992, p. 310). He explains that
nourishing or rewarding either self-concept or achievement, will provide a positive
reinforcement for the other.

From the times of Descartes, Spinoza and Leibnitz, philosophers have
pondered the mysteries of the non-physical aspects of functioning man. At the turn
of the nineteenth century, William James authored his Principles of Psychology, a
two volume treatise, the longest chapter of which was entitled, "The Consciousness
of Self.‘ In the early 1900's, Freud placed 'self' under his concept of 'ego'. His
. daughter Anna, entrenched this within her own approach to therapy.

As interest in self-concept developed, so did theories which had a strong

influence on teachers' approach to education. Purkey (1970), in his introduction to

'Self Concept and School Achievement', notes that during the lull of interest in self
which occurred during the 1920's and lasted until the 1940's, education also
neglected to nurture or even pay lip-service to student self-concept.

By the 1960s, many excellent writings and theories emerged by eloquent
and significant authors such as Coopersmith (1967), whose research studies have
provided a comprehension of the "dynamics of the self in determining behavior.“
Carl Rogers theory (1969), impacted greatly on the assumptions of self. His
linkages of earlier notions and his presentations resulted in the “self-theory.“

Rogers stated that:

...the self is the central aspect of personality. He viewed the self as a
phenomenological concept (a pattern of conscious perceptions
experienced by the individual) which is of central importance to that
individual's behavior and adjustment.

(Purkey 1970, p. 6)

From Roger's basic assumptions one can realistically support Watson's
(1978), observations that, “nursing education is advocating goals of self-
actualization as appropriate for the nurse', because Rogers believed that in every
human being there is a tendency toward self-actualization and growth so long as
this is permitted by [encouraged promoted and structured into...) the environment.

The building blocks which support the behaviors of self-actualization include
self concept, role function and interdependence. Each of these building blocks
contains within its components the positive valuing of one's self, also known as

self-esteem.

SELF-ESTEEM

The standards of nursing practice for registered nurses set specific
objectives for the pre-graduate experience, which include leadership,
independence and adaptability. To increase one's level of functioning and
competence during this experience involves an increase in self-esteem,
(Coopersmith 1967, p. 20). This section will explain in more detail the role of self-
esteem.

As an assessment tool to organize the planning and implementation of
comprehensive patient care, Sister Callista Roy (Perley 1976), views humanity as
integrated physiological/psychosocial beings. Her assessment package consists
of the following adaptive modes:

1. Basic Physiological Needs; exercise and rest, nutrition, elimination, fluids
and electrolytes, oxygen and circulation, regulation: temperature, regulation:
the senses, and regulation: endocrine system.

2. Self Concept; physical self, moral-ethical self, self-consistency, self-ideal
and expectancy, self-esteem.

3. Role Function; perception of self and role behaviors, performance and
consistency social-integrity, self-concept, congruency of self-concept and
roles, statements and acknowledgements related to current and former
roles.

4. Interdependence; defense mechanisms, problem-solving level, seeking and
getting behaviors, need-meeting and self-esteem, ceping styles, self-
concept, perception.

The second of these sections represents the self-concept mode. Roy (Perley
1976, p. 174), defines self-concept as the 'composite of beliefs and feelings that

one holds about oneself at a given time, formed from perceptions particularly of

others' reactions, and directing the person's behavior." Hamachek (1992, p. 27),
describes the self-concept as four areas of separate but interrelated components
which possess influence upon one another; a physical self-concept, a social self-
concept, an emotional self-concept and an intellectual self-concept. Driever
(Perley 1976, Chapter 11), in the 'Theory of Self-concept", defines two basic
components of self-concept, the physical self and the personal self. The personal
self is then divided into the moral-ethical self, self-consistency and self-ideal/self-
expectancy. Driever believes that the individual's perception of his worth is an
integral element of each component of the self-concept. This individualized
perception of worth is Driever's definition of self-esteem.

Maslow (1954), felt it self-evident that all people have a need to esteem or
value themselves. Self—esteem accompanies values and security, which
diminishes anxiety and promotes environmental interaction.

The concept of self-esteem is described by Coopersmith (1967, p. 20), as
"an abstraction that is formed and elaborated in social intercourse, private
reactions to himself, mastery in solving developmental tasks and competence in
dealing with life situations." He utilized the term when referring to self-evaluation.

Coopersmith's definition of self-esteem incorporates the approving or
disapproving judgement of an individual as each self-evaluates his/her capability,
significance, successfulness and worthiness (Coopersmith 1990, p. 5). Hamachek
echoes this when he addresses, "Self-Esteem: How We Feel About Ourselves"
(Hamachek 1992, p. 31), where self-concept relates to the cognitive aspect of self-
perception and self-esteem is the affective dimension of self-perception. Roy states
that self-esteem is an integral aspect of each component of the self concept (Perley
. 1976, p. 176). Rosenberg supports the self-evaluative nature of this concept with
the addendum of, "it expresses an attitude of approval or disapproval" (Rosenberg

1965, p. 5). Rosenberg addresses his Iow-self-esteem population as "ego phobes'

and states that their personalities incorporate neurotic tendencies, experience
difficulties in socialization and that these people tend to have lower aspirations for
success than do those with high self-esteem, (Rosenberg's agaphiles). One of
Rosenberg's studies (1979), found that marks or grades confer status as a student
but that most people feel that grades are not necessarily related to being, "clear-
thinking and clever" or "imaginative and original." He found in fact, that even fully
acknowledging good or poor grades, nearly three-quarters of the students
surveyed went on to indicate a good level of self-esteem through other
mechanisms. This then, is the counterpart or obverse of Bachman, O'Malley and
Johnson's (1978), findings as quoted by Hamachek (1992 p. 27). In that nine year
study of a population of over 1,600 males in grade 10 and above, the "average
level of self-esteem of those who eventually dropped out was consistently lower
than that of all other students."

Gruber in 'Self In Transition', talks about change and continuity in self-
esteem after high school. He feels that an individual's level of self-esteem is
developed from achievement levels and satisfaction within a particular role, very
much affected by prior background, previous and present expectations and
feelings of value.

"... a sense of control originates either from a person's past experiences or
from his (or her) satisfaction and achievement within a particular setting. An
important determinant of self-esteem is the sense of control persons derive from
their experiences.“

(Gruber 1979, p. 94)

Gruber types the four major determinants of self-esteem as:

_ ' background or input variables such as race, sex, class and ability, those

which one arrives with,

10

0 environmental variables such as activity state, curriculum placement, extra-
curricular activity and number of hours worked,
0 performance, grades, income and/or past grades,
0 socio-psychological status as in expectations for the future,
educational/occupational satisfaction and locus of control.
(Gruber1979, p. 13)

"The research literature shows that locus of control has generally, a positive
correlation to self-esteem.“

(Gruber 1979, p. 25)

Low status and performance are co-related with low extemai locus of
control. This in turn results in low self-esteem. Often, holding on to a situation
where the locus of control is external may be a defense mechanism, a face-saving
device. When one does not feel the need to accept responsibility for one's
situation or low status one doesn‘t feel as unworthy. Fate or the power of others, is
often more acceptable than the concept of personal responsibility.

While popular literature pays lip-service to phrases such as "self-esteem
theory' and "self-esteem hypothesis' (Wells 1976, footnote #13, p. 36), these
phrases have not emerged from rigorous or systematic research projects or
findings. Self-esteem is characterized as a sense or awareness, a perception of
personal competence or efficacy. Relevant foundations or constructs to these
senses or perceptions are: _

Self-esteem is reflected in the level of task difficulty that the person will
attempt or in the person's projected probability of success (Wells 1976, p. 34).

People behave in a manner which is consistent with their level of self-
. esteem (ibid, p. 36).

Low self-esteem is emerging in the forefront of causative or catalyst

mechanisms for failure in any and every aspect of life. Magazines, journal articles

11

and contemporary books both fiction and non-fiction are utilizing the concept of low
self-esteem interchangeably with lack of success, security and even ﬁnances.
Nevertheless, self-esteem as a trait to be nourished should not be undervalued
because of its current contemporary trendiness.

Self-esteem seems to be emerging as one of the key, "social indicators" in
current analyses of social growth and progress (Wells 1976, p. 250). Conferences,
seminars and focus groups consistently ﬁnd that self-esteem is one of the key
facets in discussing society and the issues of racism, sexism, unemployment and
school dropouts. How persons feel about themselves and their personal
worthiness is not entirely determined by how good they think they are in a utilitarian
sense. How people think of and evaluate themselves, both as a consequence of
basic social conditions and as a predisposition for subsequent behaviors, is an

essential behavioral construct for interpreting human conduct (ibid).

12

STATEMENT OF THE PROBLEM AND PURPOSE

There have been many research projects in which the persistent and
significant relationships between self-esteem, self-concept and academic
achievement have been identified. The majority of studies on self-esteem
inventory children and classroom, primary and secondary school students, i.e.: K.
to 12. Most post-secondary studies have employed self-concept scales.
Statements by the investigators of these studies have addressed self-esteem
without having carried out specific assessment of self-esteem traits.

With an ever increasing portion of the adult population continuing or
returning to school (Vision 2000, 1989, p. 28), the adult student is becoming a
substantive portion of the community college population (ACAATO, 1993). This
adult student is entering a world quite different from his/her previous workplace and
often is self-conscious and unsure of his/her ability to perform as a successful
student. This student will beneﬁt from reassurances about capabilities as provided
by objective testing and attaining delineated performance levels. This adult
student will also benefit from experiences which positively impact upon self-esteem
and this benefit is a plus upon graduating and once again beginning a new-role-
experience.

Writings by Nutter et al (1991), Mezei (1988), and Terenzini and Wright
(1987), have addressed the adult student's behavior as also being linked to and
inﬂuenced by that student's 'perceptions of self.‘

The problem is that the majority of studies of self-esteem have been
conducted with primary and secondary students. Data is not available for the adult,
. post-secondary school students' perceptions of self-esteem levels. The purpose of

this study is to determine whether there are any perceptual changes in students'

13

awareness of their level of self-esteem, as they experience the pre-graduate work
opportunity within the time-frame of the consolidation semester.

Coopersmith addresses the nature of self-esteem as that of a personal and
private concept which consists of, "the individual's observations of his own
behavior and the way other individuals respond to his attitudes, appearance and
performance" (Coopersmith 1967, p. 20).

The final semester of the three year nursing diploma program is designated
as the pre-graduate semester and finds the senior nursing student working along
with a specific registered nurse (preceptor) or staff nurses, in a designated medical-
surgicai area of a general hospital. The student is expected to show a consistency
in improving both problem-solving skills and general level of performance
throughout this semester. An assessment of the student's perception of their level
of self-esteem upon entering and completing this semester would provide a vehicle
for extrapolation of their skills development and change in work environment as it
may impact on their perceptions of the aspects and components which comprise
one's self-esteem level. Coopersmith (ibid). believes that self-esteem level is an
abstraction that is formed and elaborated in social intercourse, private reactions to
himself (or herself), mastery in solving developmental tasks and competence in
dealing with life situations. The pre-graduate experience should provide the above
components in an atmosphere where the community college teacher will be on call
but not in constant attendance as is common in previous segments of the nursing
diploma program.

The pre-graduate semester provides a change of framework, where the
student moves out of the classroom setting to experience the full impact of working
, in the culture of the hospital. This unique demanding experience is a major
change from previous semesters. This constructs a setting for investigation of how

clinical experiences can impact on self-esteem, for development of different social,

14

peer group relationships and which impinges on the student's home, parent, family
role.

The self-esteem inventory used as a pre and post-treatment survey will
assist the researcher in determining if there is any change in the evaluation that the

students make of themselves and their worthiness, (Coopersmith 1990, p. 1).

15

RESEARCH QUESTIONS

The following research questions will be addressed in this study:

Do students perceive any changes in their level of self-esteem as they

experience the continuity of the pre-graduate consolidation semester?

Do the students' perceptions of self-esteem show consistency in their
positive feelings about themselves in relation to general self-esteem, social
self-esteem, school-academic self-esteem and home-parents, family self-

esteem, before and after this consolidation assignment?

is there a variation in the means of scores of perceived levels of self-esteem,
when students are grouped by age range, parenthood, living with a spouse

or significant other?

Are perceived levels of self-esteem reflective of demographic variables such
as previous full-time employment, present part-time employment and
whether the student is taking part-time or sessional courses as well as the
required assignment, or whether the student has written a supplemental

exam or repeated a semester, during the program?

Does the preceptors perception of the student's self-esteem throughout the
pre-graduate consolidation semester reflect the student's self-esteem

inventory?

16

LIMITATIONS

This study will be limited by:

The sample subjects all being students in the same college, course and

year.

The selection of pre-graduate placement sites will be limited to those

under contract with Humber College of Applied Arts and Technology.

The inability of any on-paper-questionnaire to define, survey and otherwise
tabulate, all of the effect of life-style items that will be a part of each student's

environment over the course of the pre and post-consolidation surveys.

The inability to control for past experiences of each individual student

and the uniqueness of the impact of those events.

Participation by students and their R.N. preceptors will be on a volunteer
basis with the knowledge that participation may be retracted, refusal to
answer any question or questions will be respected, and that interviews may

be discontinued at any time.

Of the students who filled out the pre and post survey and the variables
forms, only twenty-five students fully completed every survey item and every
area of the variables form. These twenty-five students formed the identified

student grouping of the non-independent sample.

17

The investigator endeavored to arrange interviews with the preceptors of the
twenty-five identified students. However, work schedules, preceptor illness,
hesitancy to comment and staff downsizing resulted in a profile group of

eight student/preceptor matchings.

The survey instrument is limited at a ceiling level of one hundred percent.
Therefore, a student scoring one hundred percent on the ﬁrst survey cannot

be measured for growth.

The sample population consisted of those students who had met the
admission and passing grades criteria of the Nursing Diploma Program of

Humber College.

18

SIGNIFICANCE OF THE RESEARCH

A study finding that indicates changes in the students' perceived level of
self-esteem could be helpful in raising awareness of the significance of the
continuous pre-graduate work experience. An awareness of areas in which self-
esteem change occurs and its relationship to student age groups, life style
commitments and other variables, will assist the co-ordinating professor to optimize
placement and structure of future experiences. The Standards for Diploma Nursing
Programs within Colleges of Applied Arts and Technology, describe the pre-
graduate experience as an opportunity to, "provide for synthesis and consolidation
of previous learning and opportunities for increasing judgement, skill and
independence in a work experience similar to that of the beginning staff nurse"
(Standards, Appendix A, p. 4). This study will highlight the perceived self-esteem
changes which occur during the pre-graduate consolidation semester.

"Structural changes in the economy arising from the increased pace of
technological change and increased competition in the global economy, when
combined with large numbers of baby-boomers reaching a plateau in their careers,
will spark this age group's interest in additional training/education' (Vision 2000,
1989, p. 28).

Formal education is indeed a part of lifelong Ieaming. New employment
arenas are constantly emerging and very few people will invest in a one-time
formalized education which will carry them through to retirement. The impact of a
positive or negative perception of self-esteem upon the optimal functioning of the
learner is a factor which must be taken into consideration when structuring program
. format.

"Between 1987 and 2000, the population aged 25-54 is projected to
increase by almost 1,000,000 or 25%." (ibid.)

19

The relationship of age groups and life style commitments to self-esteem will
be of increasing consequence as the population curve moves into the middle age
bracket. The downsizing of middle management positions is providing impetus for
many people in this age range to return to school. Study findings which increase
awareness of the interplay of factors which affect self-esteem will increase ability to

modify the environment and increase support for students.

20

HYPOTHESES
The following hypotheses will be tested in this study:
1. Hypothesis

The pregraduate students' perceptions of their self-esteem will show an
increase in percentage level when a post-semester survey is compared to a pre-
semester survey. '

The subscale components of self-esteem will show a comparable increase.

The demographic variables of students will show as event factors which
impact on students' perceptions.

The preceptors' perceptions often are similar to their assigned students' self-

esteem inventory.

2. NULL-HYPOTHESIS

There are no perceived changes in level of self-esteem in the pre-graduate

students as they experience the consolidation semester.

21

DEFINITIONS OF TERMINOLOGY

academic achievement: a level of performance in an educational setting or
endeavor which is positively related to self-concept.
(Hamachek, 1992, p. 268)

awareness: marked by realization, perception of knowledge, often of something
not generally realized, perceived or known.
(Merriam-Webster Thesaurus,
Massachusetts, 1989)

components of self-esteem:
in the connotation of senses of self-esteem;
(1) self-love, (2) self-acceptance, and (3) a sense of competence.
(Wells, 1976, p. 61)

in the connotation of packages of perspective;
general self, social self-peers, home-parents, and school-academic.
(Coopersmith, 1990, p. 8)

consolidation: a semester where the student experiences the opportunity to
unite and apply their total program leamings.

experience: experience selected in any nursing laboratory in the educational
institution, the home, the community or the institutional setting which
provides Ieaming opportunities specifically related to the practice of nursing.
(Standards, Appendix A, p. 6)

Input variables: distinguishing features which the student possessed before the
semester commenced.

knowledge: recall of specifics and universals. The fact of knowing a thing.
lnfonnation acquired by study and/or experience.
(Standards, Appendix A, p. 6)
on call: to maintain availability by means of a pre-arranged form of contact.
perceptions: subjective awareness, comprehension and/or discernment.

preceptor: a graduate who accepts the responsibility for being a role model, tutor
and mentor.

pre-graduate semester: that semester which precedes the granting of an
academic diploma.

rotation: as a noun, areas of practice or experience assigned to each student.

22

self-concept: ...that particular cluster of ideas and attitudes we have about
ourselves at any given moment.
...the organized cognitive structure of ourselves as individuals derived from
the sum of all our experiences.
...our own private mental image of ourselves, a collection of beliefs about the
kind of person we are.
(Hamachek, 1992, p. 26)

self-esteem: the evaluation a person makes and customarily maintains with
regard to him or herself. It expresses an attitude of approval or disapproval
and indicates the extent to which a person believes him or herself capable,
significant, successful, and worthy.
(Coopersmith, 1990, p. 5)

semester: a timetabled division of the academic year.

skill: practical knowledge in combination with ability. Ability to use one's
knowledge effectively in doing something. Developed or acquired ability.
(Standards, Appendix A, p. 6)

understanding: the knowledge and ability to apply judgement. Implies ability to
judge and comprehend.

(Standards, Appendix A, p. 6)

sin

lir

pil

23

ORGANIZATION OF THE STUDY

For the purpose of convenience and systematic consideration, this study is
structured in five chapters.

Chapter I contains an introduction to the study and background, a statement
of the problem and purpose of the study, the significance of the research and the
limitations of the project. It addresses the research questions and hypothesis and
provides deﬁnitions of the specific terminology.

Chapter II contains a review of the literature, focussing on research involving
college students, nursing students and pre-graduate, consolidation semesters.

Chapter III contains an introduction and description of the process of survey
instrument choice, the survey instrument and method, method of implementation of
the study and analysis of data, with a note addressing the functions of the
supplementary interviews.

Chapter IV contains a discussion of the ﬁndings.

Chapter V contains the summary, conclusions, implications for further study

and recommendations.

CHAPTER II
REVIEW OF RELATED LITERATURE

INTRODUCTION

This chapter introduces nursing specific research studies which include self-
esteem components in their reports. The following areas will be addressed;
Students and the Role of Self-Esteem, Self-Esteem and Nursing Education
Students, Self-Esteem and Pro-Graduate Clinical Experience, Self-Esteem and
Nursing Graduates, and a Summary of the conclusions of some of these studies.

It is increasingly apparent to anyone who ventures through the halls of a
community college today, (or tonight, or this weekend), that the median age of the
post-secondary student is advancing. In fact, between the years 1987 and 2000,
the population of Ontario in the age range between twenty-five and ﬁfty-four, is
projected to increase by almost one million people or twenty-five percent. (Vision
2000, p. 28) During this period the recessive economy, free trade agreements and
political upheavals, are all contributing to the 'right-sizing' phenomenon, company
closures and plant location transfers. More than ever before liberated-employees
are seeking further education, skills and new professions.

Basic education objectives have tended to rely on measurable applied
actions and activities. Learning theories have developed around these objectives
to promote cognitive content and competency guidelines, with stimulators and
rewards built in as motivators. The adult students returning to the educational
setting arrive with their motivators in place. They have made the difficult decision to

continue their formal education and they bring their past experiences in life with

24

25

them. These mature students will benefit more from academic approaches which
nourish self-esteem, than from policies which threaten through fear of failure.

A look at nursing specific research studies indicates that a low self-concept
may actually be fostered during the educational process and also that self-concept
and self-confidence may even be destroyed by certain teaching methods (Ellis
1988; Windsor 1987; Woolf 1984). Self-esteem studies have tended to focus on
primary and secondary students, giving rise to the belief that self-esteem develops
within childhood and locks into place in adolescence. Whether this is so or not,
self-esteem is vulnerable to life's interjections and can dip and dive in response to

traumatic experiences (Coopersmith 1981).

26

STUDENTS AND THE ROLE OF SELF-ESTEEM

Higher education with its diversified goals and outcomes must learn to
assess the level of self-esteem of its incoming students and to nourish and foster
self-esteem throughout its programs, to graduate people who are not hesitant to
continue development towards areas of self-actualization.

"The two major factors which influence locus of control and self-esteem after
high school are the social setting or environment that persons enter, and the
rewards and satisfaction gained from participation in the setting" (Gruber 1979, p.
20).

The building blocks for a successful professional seem to have a large
measure of self-esteem in their recipe. Coopersmith has defined self-esteem many
times and with many elaborations. Simply put, Coopersmith addresses self-
esteem as "the extent to which the person believes himself [or herself], to be
capable, significant, successful and worthy" (Coopersmith 1967, p. 5). There will
always be people who feel that the world is their oyster, while others question the
worth of their existence and of course most people vacillate betwixt and between.
Any discussion of the role of self-esteem as it affects a person's functioning or of
the value of self-esteem in contributing to effective functioning, is constantly in
danger of evolving into a polarized dialogue with educators strongly and
passionately defending their individual pre-conceptions.

The literature abounds with empirical statements, with global perceptions of
the status, value and role of a positive self-concept. The nursing specific literature
tends to link self-esteem and empowerment. If nursing is to be in a key position in
. the restructuring of the health industry than nurses must possess and effectively

utilize their potentials for assertive input and participation. In "The Politics of Self-

27

Esteem', Greenleaf addresses the cyclical nature of energy as vigor or power in

action and understanding of self-esteem as a power base.

"We know from experience that when we feel good about ourselves
we have energy or enabling power to accomplish our tasks

Self Esteem -> Energy

And we know that when we are skilled at doing something, we
experience self-confidence and pride.

Competence -> Conﬁdence -> Self-Esteem"

(G reen leaf 1 978, p. 6)

People can meet the expectations of others, fulfill their job or role
descriptions and still feel inadequate if they do not internalize their successes.
Seeking out new Ieaming experiences, decision making and instituting change,
are not typically exemplified behaviors of the employee who is working at a job

mainly for a salary.

28

SELF-ESTEEM AND NURSING EDUCATION STUDENTS

Ellis (1980, p. 389), found that: "Nursing service administrators and head
nurses have a preconceived set of standards which they expect new graduates to
attain", and that new graduates are not making the impact expected of them, on the
health care system. Other nursing educators echo this sentiment. Kramer (1974),
feels that it is undisputed that there is an evident lack of self-confidence in new
graduates. A study conducted by Meleis and Farrell (1974), reported that all senior
students in three nursing programs valued themselves strikingly low in self-esteem.

Ellis (1988), administered questionnaires to 177 four year baccalaureate
program nursing education students, during the third week of the fall semester of
their final year. This study investigated whether student self-concept levels during
the baccalaureate program in nursing, altered during the four years and/or showed
differences between freshman, sophomore, junior and senior self-concept levels.
The chosen study format employed the Tennessee Self-Concept Scale (T 805).
The Tennessee Self-Concept Scale (Fitts, 1965), is a designed and standardized
measurement of self-concept and the valuation placed upon one's self-concept.
The overall level of self-esteem is measured by the total positive score which is the
most important single score (Ellis 1988). A high score on this scale correlates with
self-confidence, self-worth or value and generalized comfon with 'self'. Low scores
have linkages with individuals who express doubt about their worth and/or their
desirableness as acquaintances, have low self-confidence and exhibit anxiety and
depression. Ellis found that, "from an empirical and observational point of view, it
appeared that self-concept levels did very, being highest at the beginning of the
sophomore year and lowest at the beginning of the senior year. Statistically these
variances, with the exception of self-criticism, could not be proven" (Ellis 1988, p.
389).

29

Peggy Woolf has several proposals for curriculum change and student
empowerment. She clearly and definitively believes; "Nurses lack self-esteem"
(Woolf 1984, p. 78). She references sources such as Fitzsimons (1977) and
Maslow (1943), that inadequate self-esteem is in truth a very real problem because
low self-esteem or a lack of feelings of self-worth, interfere with the positive self-
image necessary for the freedom to take charge of one's future. All three of these
authors accept that self-esteem or self-respect is very closely tied to achievement
and that nurses will never achieve their potential in contributions to health care
unless their self-esteem needs are met.

A number of authors have approached self-esteem in nursing students from
the standpoint of what nursing educators do or should do to enhance positive self-
image among students. Hammer and Tufts (1985), discuss how educators can
foster student feelings of inadequacy, lack of conﬁdence and the fear of initiative in
students. Certain faculty utilize authoritarianism, intellectual elitism and a general
lack of respect for and belief in student competence and potential, establishing
through this atmosphere an academic environment which promulgates low student
self-esteem and self-image. The faculty members" open acceptance, approval and
respectful collaboration with nursing staff, fosters role modelling and sets value to
the students' goals. Hammer and Tufts, "truly believe that the shaping of a self-
image of a confident professional is a significant and profound undertaking" (ibid,
p.283)

To this end, Burns has organized the following guidelines:

1. Show unconditional acceptance for each student and believe in his abilities
and potential, (foster initiative).

. 2. Provide opportunities for success as well as some challenges. Experiences

must be geared toward or suitable to the student's potential, (facilitate

success)

30

3. Accentuate the positive without denying failings or shortcomings, (foster self-
worth in pr0per perspective).

4. Don't be overly critical. Make the criticism equal to the gravity of the
problem, (provide positive feedback).

5. Don't stifle a desire to try, by a constant threat of failure, (foster initiative
through potential for success).

6. Give credit for trying and encourage such attempts, even if success is not
always achieved, (foster conﬁdence).

7. Keep criticism centered where it belongs, on the inappropriate behavior, so
that the student doesn't feel a failure or rejected as a whole, (reduce
humiliation).

(Burns 1980)
This self-concept, self-esteem basis of empowerment and self-actualization
in the nursing graduate has been explored by a variety of studies and tackled from

a host of differing and varied perspectives. Burgess noted that while nursing has

historically displayed an interest in the self-concept of patients, the profession, "has

not manifested an equal interest in the development of nursing practitioners as
persons, a seeming paradox" (Burgess 1980, p. 38). Utilizing the Tennessee Self-

Concept Scale (TSCS), the following findings emerged from this study a

significant positive correlation between marital status and self-esteem among the

students tested and higher scores for those students having children; however, this
ﬁnding is close to the normative values reported in the general standardization of
the TSCS as an instrument. Burgess refers to an unpublished paper by Frerichs,

1971, which also describes a significant positive relationship between age, marital

status and self-esteem (ibid.). Frerichs utilized the Coopersmith Self-Esteem

Inventory. Frerichs, "attributed the difference to married students having fulﬁlled an

important developmental task, thereby increasing their self-esteem" (Burgess

31

1980, p. 43). in the discussion of the Burgess study, the statistical findings
indicated that the overall level of self-esteem displayed by the sample group was
almost identical to group norms used in standardizing the TSCS test. Burgess
suggests that additional samples might focus on whether the difficulty of program
content in the School of Nursing might explain in part, over all high levels of self-
esteem in nursing students. Burgess feels that experiences of the nursing student
provide potential for personal growth which enhances professional effectiveness
and is in turn reciprocal, taking on, "immense importance when viewed in the light
of the quality of care that the individual is capable of delivering" (Burgess 1980, p.
44).

These findings appear to indicate an opposing polarity to those of Kramer
(1974), which related that new baccalaureate nursing graduates lack self-esteem
and that this lack contributes to their feelings of inadequacy in meeting employers'
expectations. Ellis (1988), also reported that in the population under study, self-
esteem and self-confidence was higher at the beginning of the nursing education

program and decreased with each subsequent year.

32

SELF-ESTEEM AND PRE-GRADUATE CLINICAL EXPERIENCE

Undergraduate clinical experience has been highlighted by a number of
studies as the most stressful aspect of the educational process. To this end,
various findings have presented a strong case for an undergraduate clinical
internship where students have the opportunity to form positive colleague
relationships with staff as well as faculty (Ellis 1988; Garrett, Manuel and Vincent
1976; Kramer 1974; Pascareila, Terenzini and Hibel 1978; Sobol 1978; Armstrong
1974).

Three of the assumptions studied by Olsen et al (1984), are as follows;

1. Self-confidence and self-esteem decrease with each year in the nursing
curriculum.
2. New baccalaureate nursing graduates lack self-esteem and feel inadequate

in meeting employers' expectations.

3. Self-confidence and self-esteem are important predictors of success in the

ﬁrst position assumed after graduation (Olsen et al. 1984, p. 106).

Their findings, extrapolated from measurements of the Tennessee Self-
Concept Scale and comparing pre-test to post-test, showed no significant
differences in self-concept for the total group of students regardless of participation
in a clinical internship or attendance of only the straight didactic components.
Olsen et al. did not find that the pre-graduate internship experience had any
signiﬁcant effect on the self-concept of the participating nursing students when
compared and contrasted with those students who learned through class and
course content exclusively.

Time and again, research studies emerge from the researchers belief that,
"Having a feeling of self-confidence and self-worth is basic to developing

leadership skills essential for baccalaureate nursing graduates" (King 1989, p. 7).

33

Klug's hypothesis that there would be an increase in positive self-identified self-
concept characteristics as the university program progressed, was not supported
through statistical data analysis. "Findings revealed that 44% of the nursing
students studied reported more characteristics reflective of a negative self-concept
at the completion of their senior year, compared with responses at the beginning of
the nursing program. Twenty-eight percent of the participants showed no change
from beginning to completion; 28% made more positive statements at the
completion;" (Klug 1989, p. 11). The conundrum expressed in these reports is
exemplified by comments throughout the articles which tend to downplay the data
analysis and emphasize student generated verbal comments, that the clinical
experiences increased their self-esteem and by the inclusion of global statements
such as this one by Klug, "It was also evident from their responses that increased
self-esteem improves the quality of nursing care" (ibid).

in a recent values study, Choudry administered the Jackson Personality
inventory to beginning and senior nursing students. She found that both of these
groups scored notably higher than the normative sample, on self-esteem. Actually,
the mean for the beginning students (13.01), was higher than that of the graduating
students' sample (12.92). Her conclusion was that, 'There was no change as a

result of nursing education on self-esteem“ (Choudry 1993, p. 12).

34

SELF-ESTEEM AND NURSING GRADUATES

Utilizing pregraduate preceptorship is an increasingly popular approach to
the final clinical nursing course. Dobbs administered Corwin's Nursing Role
Conception Scale prior to and after this experience, with generic baccalaureate
nursing students. Her findings demonstrated an effective and marked change in
self-image, an increasing beginning competency prior to graduation which it was
felt would, "increase the likelihood of graduates finding their new jobs rewarding,
and vehicles that can be used for continual learning" (Dobbs 1988, p. 170).
indeed, studies as documented in nursing literature illustrate and support the value
of both the clinical practice component and the role of the preceptor and staff
nurses in the clinical environment. Improvement is evidenced in student
competence, self-confidence and the positive aspects of interdependence (Dobbs
1988; Windsor 1987; Chickerella et al. 1981 ).

Effective functioning, positive assertive input and participation in the work
force, and ultimately the facets of self-actualization, are intertwined with positive
self-esteem. Until our nursing graduates accept and esteem themselves and their
abilities they will be ineffectual in capitalizing on their knowledge and talents; they
will be content to allow others to make decisions, formulate policy and generate the
work environment. Self-esteem is the prime ingredient for graduates to treat
themselves with the respect that they deserve and to function with the conﬁdence
that their patients and co-workers have a right to expect. Many studies are
showing, "a persistent correlation between it [self-esteem], and such school
concerns as participation, completion, self-direction and various types of
. achievement" (Beans 1991, p. 25).

Self-esteem has both philosophical and sociological components in its

make-up. It is a product of personal interaction with one's environment and on a

35

more intellectual level it is a core element of human dignity, of self-respect. it is
also a product molded by those one relates to, works with and chooses for
friendship. "Assertations of the new graduate nurses" low self-concept and lack of
self-confidence in their perceived roles continue to occupy considerable space in
the nursing literature" (Hughes 1991, p. 69). Experiences such as ﬁeld placement,
work-shadowing, clinical components, applied assignments and consolidation,
when incorporated into program objectives provide opportunities for focussing on

ways to build and enhance students" self-esteem.

36

SUMMARY

Self-esteem is not a necessary component to "doing a good job". One can
work to a job description or task objectives without feeling good about being
successful, capable and significant. The value of self-esteem comes in its support
of self-actualization, of feeling good about being a worthy somebody.

Most self-esteem studies have highlighted the process in relationship to
growth and development throughout K to 12. Yet, the growth area in education
today is adult education and re-entry. Past experiences and current life
happenings often combine to cause marked fluctuations in the adult students" self-
esteem level.

Educators who wish to provide the best learning environment and the best
Ieaming experiences possible, must pay awareness to each individual's
perceptions of their self-esteem levels. Self-esteem is indeed a not very visible
status and a number of factors must be considered, especially the student's
subjective view, before attempting to diagnose a high, medium or low level of self-
esteem within a student.

The self-esteem components of studies involving undergraduate nursing
students vary markedly in their conclusions and pronouncements.

The 1974 study by Meleis and Farrell, identified all senior students in three
nursing programs as rating themselves strikingly low in self-esteem. Ellis (1988),
investigated self-concept differences over four year nursing education programs
and found the lowest scores at the beginning of the senior year. Self-esteem was
measured by the total positive score on the questionnaire.

Burgess (1980), found a significant positive correlation between marital

status and self-esteem, with higher scores for those students having children.

37

Frerichs (1974), describes a significant positive relationship between age, marital
status and self-esteem.

Burgess (1980), looked for explanations for sample group norms which
indicated generally high levels of self-esteem in nursing students. Choudry (1993),
employing the Jackson Personality Inventory with beginning and senior nursing
students, found that both of these groups scored notably higher than the normative
sample, on self-esteem.

Kramer (1974), and Olsen et al. (1984), reported that new baccalaureate
nursing graduates lack self-esteem. Olsen went further, to conclude that the pre-
graduate internship experience had no significant effect on the [total] self-concept,
i.e.: self-esteem of the participating nursing students.

The studies reviewed in this chapter employed a variety of instruments
which measured self-esteem, or self-esteem as a component of their greater
inventory. The populations appear to have usually been from four year
baccalaureate programs. The findings point to diversity in total self-esteem levels
of student groups, and to correlations to student demographics and statistics. This
literature review has proven not only pertinent to this study, but helpful in

formulating the research questions and hypothesis.

CHAPTER III
RESEARCH METHODOLOGY

INTRODUCTION

Any study of self-esteem must be a perceptual study or self-appraisal, an
evaluation or judgement that a person makes of themselves and their worthiness.
The purpose of this study is to determine whether there are any perceptual
changes in students" awareness of their level of self-esteem, as they experience
the pre-graduate work opportunity within the time-frame of the consolidation
semester.

The choice of survey instrument must relate to its function in the study, to
measure in a reliable and valid manner the intended focus of the study. The
instruments and methods employed in the study should be reliable in subsequent
investigations. Relationship with such data as age groups and role considerations
should be identified. Personal interviews complement the inventory findings and
provide description support of the data.

Positive feelings about oneself and the perceptions of self as being of value
in the world, are prime factors in increasing involvement in one's environment and
in successful performance. When offered in-service education or professional
development, new teachers and caring teachers opt in significant numbers to
review techniques for motivating students. Building self-esteem is the basic
component in any program geared to foster and motivate Ieaming.

Many inventory scales have been developed to address self-concept. The
issue of level of self-esteem has been less well represented, although self-esteem

is frequently incorporated into the larger self-concept survey, e.g. W.H. Fitts, The

38

39

Tennessee Self-Concept Scale, E.V. Piers and G. Harris, Children's Self-Concept
Scale.

Other instruments such as E.L. Shostrom"s Personal Orientation Inventory
go beyond level of self-esteem to survey potential for Maslow"s theory step of 'self-
actualization'.

Morris Rosenberg has constructed an instrument which utilizes cross-
sectional sample surveys and a Guttman (i.e. unidimensional) scale. His
population on which he bases his theories, was a nonrandomly selected grouping
of 85 white, middle-class males.

S. Coopersmith and R. Gilberts' Behavior Academic Self-Esteem, and EL.
McDaniels" Inferred Self-Concept Scale, are rated by teachers, parents or

professionals, and focus on the primary school level.

SURVEY INSTRUMENT - THE COOPERSMITH SELF-ESTEEM INVENTORIES

A Canadian Self-Esteem Inventory has been constructed to approximate the
Coopersmith SEI and both tests may reasonably be considered as alternate forms.

However, well over 100 studies have been conducted on the reliability and
validity of the COOpersmith forms and so, this is the form chosen for this study.
Developed and designed by the late Stanley Coopersmith subsequent to the
publication of The Antecedents of Self-Esteem (1967), these inventories measure
attitudes or perceptions of one's self-esteem, in the personal, social, academic and
familial contexts.

They have been utilized in research projects on thousands of subjects. They
demonstrate significant relationships between academic achievement and

personal satisfaction with school and adult life. A Behavioral Academic Self-

40

Esteem rating scale for teacher utilization, a school form for children and
adolescents under sixteen and an adult form, for people over 16 years of age are
also available.

The adult form, "consists of twenty-five items adapted from the School Short
Form. The correlation of total scores on the School Short Form and the Adult Form,
exceeds .80 for three samples of high school and college students, (N = 647)"
(Cappersmith 1990, p. 2).

Sample items from this inventory, i.e.: Coopersmith Self-Esteem Inventories
Adult Form Test Booklet, may be found in Appendix B.

NORMATIVE DATA

Reliability: In one study of 103 college students, Bedeian, Geagud and
Zmud (1977), reported Kuder-Richardson reliability estimates of .74 for males and
.71 for females. Computed test-retest reliability estimate coefficients were .80 for
males and .82 for females.

Norms: The Adult Form of the SEI was administered to 226 college or
university students in Northern California. The mean age of these students was
21.5 years with a standard deviation of 3.5 and a range of 16 to 34 years. The
mean difference in scores between those aged 16-19 and those aged 20-34
approached statistical significance (p = .06). This trend reflects slightly higher self-
esteem for those subjects no longer in their teens. There were no significant
gender or school effects. The reliabilities ranged from .78 to .85.

(Coopersmith 1990, p. 19)

41

POPULATION OF THE STUDY

Each year during the latter half of the consolidation semester the pre-
graduate teachers comment on how noticeably some of the students "blossom'.
The students increasingly demonstrate improvement in their appearance of self-
confidence, their manner of presentation of self, their approach to conversations
with others and the thoughtfulness that they invest in choosing appropriate word
choices and articulate wording when they are reporting, discussing or describing
their work. These students formed the study participant group for pre and post
semester inventories of their perceptions of their self-esteem levels.

This survey received the support and approval of the Chair of the Nursing
Diploma Program of Humber College of Applied Arts and Technology, and was
conducted through the participation of the students of the 1993 graduating class of
the Nursing Diploma Program. The population was because of this, limited to
those persons who met the qualifications to enter and successfully travel through
this nursing program. Obviously, this constitutes a group with common make-up
factors as opposed to absolute random selection.

A sample bias is inherent in any survey where the population consists of the
available group and where participation and/or depth of participation in the process
is by volunteering.

Collated data from the Variables form and the pre and post semester
inventories was divided into three operational packages. Section one focussed on
data analysis and interpretation drawn from the Variables form and pre and post
semester surveys of the total participating student population, (102 students in
. January, 85 students in April, due to assignment and timetable changes and

inevitably, people who misplaced or just forgot to fill out the April form).

42

The April returns by 85 students represent an 87.55% return rate. This is
satisfactory because when the percentage returns are not at least 70% the
samaple will not necessarily represent the population (Gay 1987).

Measures of central tendency were calculated in parallel for the January and
April inventories, enabling comparison and contrast of Range of Scores, Mean,
Mode and Standard Deviation. Rationale equivalence reliability to estimate
internal consistency was determined through application of the Kuder—Richardson
formula 21, which results in a conservative estimate of reliability when measuring a
one trait inventory. Frequency polygons were constructed to provide a graphic
depiction of frequency and range of scores.

The Coopersmith Self-Esteem Inventory, Adult Form, is composed of four
subscale components. The twelve questions of the general self-esteem group
comprise 48% of the inventory. Social or peer group self-esteem is represented
through four questions for 16%. There are six questions relating to home life,
parent and family role, for a further 24%, and academic self-esteem is the subject

area covered by the remaining three questions or 12%.

FIGURE 3: SELF-ESTEEM SUBSCALE COMPONENTS

Academic Self-Esteem

    
  

GeneaalQSelfiigsteem
“93 ns Home: Parent, Family Role

Self-Esteem
6 Questions

Social-Peer Group
Self-Esteem
4 Questions

43

The means of the January and April surveys were computed for all students
for each question, and the total means calculated to enable component area
comparison or contrast.

Area two was created by matching the exact pre and post inventories for an
identified grouping of twenty-ﬁve students. This enabled testing for signiﬁcance as
well as collating the measures of central tendency. In this grouping, a t test was
employed to determine whether the two means are significantly different at a
selected probability level. The t test for nonindependent samples was chosen as it
is speciﬁcally focussed for the same sample group when surveyed at two different
times. When used with an alpha level of .05 and degrees of freedom of N-1, this
test of significance can determine whether to reject or accept the null hypothesis.
i.e.: When the calculated t value is equal to or greater than the table value, then
the null hypothesis is rejected.

Drawbacks associated with t values for tests of significance include the
following:

1. They negate the reality of differing individuals in the survey group
experiencing differing opportunities to grow.

2. This calculation doesn't account for the fact that the individual with a very
high score on the ﬁrst survey has only a very small amount of gain available
before hitting the ceiling. Nevertheless, the t test has found its ultimate
match when the same sample group receives a pretest before a treatment,
(pre-grad semester), and then is post-tested. The question of focus is: "Is
there a significant difference, i.e. equal to or larger than, between the means
of one sample at two different times?".

(Gay 1987, Kirk 1990)

This section enables comparison of identiﬁed students so that the identical

group could be matched on pre and post experience scores. Also comparisons

44

could be made by age range grouping, parenthood, life with a spouse or significant
other, previous full-time employment, present part-time employment, co-curriculum
enrollment in extra courses and whether having experienced a supplemental exam
or course repeat, showed as an effect on perceptions of self-esteem.

The third operational package was constructed by proﬁling existing data on
a known student and interviews with the student and their preceptor. This brought
forth samples of data which were not possible through the questionnaire alone.
This also proved to be the smallest of the three sampling sizes employed in this
study plan. This section was constructed in profile format, with data from the
Variables form, followed by total self-esteem scores and area scores for the
pre-experience and post-experience inventories. Excerpts from student comments
in January and April are appended and point form précis of preceptor interviews
complete each proﬁle.

With these sections in place, it became feasible to categorize the data
analysis and interpretation and to address the study hypothesis, null hypothesis
and research questions.

It should be noted also at this time, that the selection of preceptor R.N.s to be
interviewed was very much affected by limitations imposed through unit closings,
staff layoffs, staff transfers, enforced vacation times, enforced leaves of absence
and changes in scheduled working rotations.

Throughout this study, the current state of the economy and the health

system ﬂux has impinged on the data.

45

DATA COLLECTION

The study consent form, the variables form and the pre-experience survey,
(Coopersmith Self-Esteem Inventory, Adult Form), were introduced during the
January semester orientation meeting. Students who were not present during this
ﬁrst class time, the first day of the semester, were thusly the ﬁrst of the potential
population to be omitted from the study. Also at this time, the right of any student
who chose to abstain was respected.

Before the survey inventory was administered, prior to the pre-graduates"
consolidation semester experience subjects" rights were explained on the consent
form, (see Appendix C), confidentiality was assured and participants chose their
own coding designation. Participation in the study was emphasized as being a
voluntary endeavor. In the same manner, only those R.N. preceptors who
volunteered to comment were considered for an interview.

Four months later, at the completion of the pregraduate consolidation
semester, the Coopersmith Self-Esteem Inventories, Adult Forms, were again
distributed. This time, because the students involved were not meeting as a group,
the surveys were packaged and distributed individually throughout the contracted
hospital areas. The completed forms were collected by the individual professors
assigned as liaison to each hospital. Due to changed assignments, early or
extended completion dates, and community experience opportunities, there was an
attrition in the number of post-experience inventories collected.

The SEI has been used on a pre-post test basis to judge the effectiveness of
self-esteem programs. The researcher employed it on this basis to evaluate
changes in perceived levels of self-esteem at the commencement and conclusion
of a clinical semester which does not have formalized self-esteem promotion in its

written objectives.

46

Each student also filled out a Pregraduate Consolidation Student Variables
form, (see Appendix D). This form assisted in identifying some of the distinctive
characteristics of each student; The form was constructed in four sections to
address socio-psychological variables, performance variables, environmental
variables and input variables. Student originated code numbers linked the pre and

post semester surveys and the variables form.

47

THE INTERVIEW

A survey form or inventory, is by virtue of its answer choice scale an
objective data collection. Unless the participant reverts to detailed essay-type
response, in-depth data are not assured by this type of questionnaire. However,
mass in-depth interviews are subject to the vagaries of extraneous variables, are
expensive and are very time consuming.

A compromise to the extremes of exclusively utilizing one or the other form of
data collection is to interview a selection of the inventoried population and use the
information collected as an adjunct to the inventory. Completely objective and
standardized measurement is structured and inflexible. The individual meaning of
responses, the respondent's motivation, the "way the day is coming down', and
other happenings, are not taken into account. The use of a loosely structured
technique such as an interview enables access to personal meanings and
interpretations. An interview can uncover values, emotions, and other variables
which might not have been foreseen or correctly interpreted.

The preceptors of those students who were interviewed were also provided
with the opportunity to share their perceptions about their assigned students. The
background of the study was explained to these R.N.s and an interview guide was
constructed, (see Appendix E), which consisted of seven broad questions. These
questions were formulated to address those areas collated from the student
responses of their perceived levels of self-esteem, i.e.: general self-esteem, social-
peer group self-esteem, home: parents, family self-esteem and school: academic
self-esteem. Additional prompting was provided to elicit observations about

Changes which might have taken place throughout the student's four month

rotation.

CHAPTER IV
DATA ANALYSIS AND FINDINGS

INTRODUCTION

Responses to the hypotheses of this investigation can be interpreted from
the answers to the ﬁve research questions. To facilitate this process this chapter is
divided into three sections or operational packages. The first section will focus on
data analysis and interpretation from the pre and post semester surveys of the total
participating student population. Calculations of measures of central tendency and
rationale equivalence reliability will provide the findings necessary to formulate
answers to research questions one and two.

i.e.: 1. Do students perceive any changes in their level of self-esteem as they
experience the continuity of the pre-graduate consolidation
semester?

2. Do the students' perceptions of self-esteem show consistency in their
positive feelings about themselves in relation to general self-esteem,
social self-esteem, school-academic self-esteem and home-parents,
family self-esteem, before and after this consolidation assignment?

Section two was created by matching the exact pre and post inventories and

the variables forms for an identified group of twenty-five students. This produced a

same sample group for the two surveys, enabling a test for significance and the

comparisons necessary to respond to questions three and four.

i.e.: 3. Is there a variation in the means of scores of perceived levels of self-
esteem, when students are grouped by age range, parenthood, living

with a spouse or significant other?

48

49

4. Are perceived levels of self-esteem reflective of demographic
variables such as previous full-time employment, present part-time
employment and whether the student is taking part-time or sessional
courses as well as the required assignment, or whether the student
has written a supplemental exam or repeated a semester, during the
program?

The third section compiled the existing profile on an identified student, with
student and registered nurse preceptor interviews. This provided a base for
comments in response to question five.

5. Does the preceptors perception of the student's self-esteem

throughout the pre-graduate consolidation semester reflect the

student's self-esteem inventory?

50

INFLUENCING FACTORS AND EVENTS

The following are the important influencing factors and events that affect this
study. When approaching data analysis it is wise to commence with a refresher on
the foregoing variables because they are both in occurrence and in effect

throughout the collations, calculations and interpretations.

The Independent Variable is that activity or characteristic believed to make a
difference. In this study the independent variable was the clinical experience of the

pregraduate consolidation semester.

Threats to Internal Validity; changes other than or as well as the

manipulation of the independent variable include the following...

Maturation: the physical and mental changes that may occur within these

students over this four month period.

Mortality: attrition, most likely to occur in longer studies but present to an
extent in a four month period. This refers to the fact that those students who drop
out of the study may share a characteristic such that their absence has a signiﬁcant

effect on the results of the study.

Dependent Variable: the criterion variable or post-experience inventory, the
outcome of the study, the change or difference that occurs as a result of the

happenings of the independent variable.

51

Threats to External Validity: The specificity of variables refers to the fact that
a given study is conducted with a specific kind of subject, (Humber College pre-
graduate nursing diploma students), based on a particular operational definition of
the independent variable, (consolidation semester), using specific measuring
instruments, (SEI, Adult form), at specific times and under a specific set of
circumstances.

This study is influenced by those short and/or long term events which occur
while the study is taking place interactions of history and treatment effects. With
these students, family, health and money problems, are very real examples. Study
results will be altered by the interaction of time of measurement and treatment
effects. The second inventory was conducted after graduation was assured and
much closer to the challenge of the registration/certification exams.

Reactive Arrangements are factors associated with the way in which a study
is conducted and the feelings and attitudes of the students involved. Two
examples of reactive arrangements are the Hawthome effect and the Novelty effect.
The Hawthorne effect, the feeling on the students' part that they are special
because of participating and receiving special attention is, in the researcher's
belief, minimized with this subject group. Studies, surveys and questionnaires are
an endemic component of being a Humber College student. The special effects of
being involved in this specific pre and post semester experience inventory would
be minimized. The Novelty effect of participation in an educational research study

would also be decreased by the nature and impact of having attained the

pregraduate semester level and the impending process of graduation.

52

SECTION ONE
GENERAL DATA GROUP INFORMATION

in January, 102 inventories were completed by the pregraduate nursing
diploma students prior to embarking upon a four month clinical consolidation
experience which would find them working in tandem with the hospital staff and
gradually assuming a full assignment. During the last two weeks of April, a second
set of inventories was dispatched and 85 inventories were completed and returned.
This second number of 85 inventories is 87.55% of the January number and is
within range for conclusions to be considered representative. The following data
is found in Figure 1 (self-esteem pre-treatment inventory) and Figure 2 (self-
esteem post-treatment inventory).

Range of scores: The January range of scores stretches over 80 units which
decreases noticeably in spread by April to 64 units. It is interesting to note the
growth in the number of students who have increased their self-esteem to the
100% ceiling. This provides an approximate measure of variability and hopefully
points towards an increase in self-esteem and an increase in population in the
upper percentiles.

The mean, deﬁnitely affected by extreme scores, is a more frequently used
measure of central tendency. The January mean of 72.6 reﬂects the wide range of
scores, which clusters as it rises to the April mean of 78.6.

When one has a variance in population over two surveys, frequently the
mode more clearly represents the typical score pattern. The modes in these two
inventories exemplify that tendency, with January showing a single mode at 80 and

April demonstrating a bimodal, 84 and 100.

53

In most studies SEI scores have been negatively skewed, that is, they cluster
in the direction of high self-esteem. This happening is illustrated in the frequency
polygons, Figure 1 and Figure 2.

The standard deviation is the most stable measure of variability and it takes
into account every score. Calculations produced a January SD. of 17.5 and for
April a SD. of 15.6. This finding is compatible with the SD norms of college and
university students for the adult form of the Coopersmith Self-Esteem Inventory.
The smaller SD. for April indicates that the scores are starting to cluster.

Rationale equivalence reliability estimates internal consistency or how well
the items on a survey relate to each other. The KR - 21 formula provides a
conservative estimate of reliability which considers the sub-components of self-
esteem. Both the January and April KR - 21 coefficients calculated out at .94,
indicating that this survey is highly reliable (1.0 = 100%) and consistent over time,

an excellent test-retest reliability.

Answer to research question #1: Yes, students do appear to perceive
changes in their level of self-esteem as they experience the continuity of the pre-

graduate consolidation semester.

 

54

 

FIGURE 1: JANUARY DATA 102 STUDENTS

 

 

 

 
  
 
 
  
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

m I: Sell-esteem re-treatment invento
0- 1 4 Range of Scores = 20% - 100%
.§ 13 Mean = 'X' = 72.6
3 Median = one of the 76 scores
’5 1 2 Mode = 30%
'5 1 1 Standard Deviation = 17.5
E 10 Kuder-Richardson - 21 r = .94
E 9 (reliability total test
g 8 coefficient)
7
6
5
4
3
2
1
0 l l I I l I l I I l
10 20 so 40 50 60 70 so 90 100
Score in Percentiies
FIGURE 2: APRIL DATA 85 STUDENTS
1 6
g 1 5 Self-esteem est-treatment invento
o 1 4 Range of Scores = 36% - 100%
B 13 Mean =T=78.6
co 1 2 Median = one of the 80 scores
'8 Mode = bimodal: 84% and 100%
*- 1 1 Standard Deviation = 15.6
g 1 O Kuder-Richardson - 21 r = .94
a 9 (reliability total test
2 8 coefficient)
7
6
5
4
3
2
1
0 l I l l I I l l l l

 

10 20 3) 40 50 60 70 so 90 100
Score in Percentiies

 

 

55

SELF-ESTEEM SUBSCALE COMPONENTS

Self-esteem is composed of self-attitude and can be affected by or can affect
many areas in life. The Coopersmith Self-Esteem Inventory: Adult Form, contains
four areas of self-esteem subscale components. Forty-eight percent of the
statements reflect total or general self-esteem, sixteen percent address social and
peer group relations, twenty-four percent assess home factors, parent and family
role and relationships. The remaining twelve percent of the inventory statements

report comfort and esteem in the academic, school role.

FIGURE 3: SELF-ESTEEM SUBSCALE COMPONENTS

Academic Self-Esteem
.. . . 3 Questions

    
 

Geneaal Self-Esteem

Questions Home: Parent, Family Role

Self-Esteem
6 Questions

 

Social-Peer Group
Self-Esteem
4 Questions

Within the general data group, of 102 and 85 students respectively, the
subscale components evidenced the following self-esteem rating percentages,

ranges and means.

56

TABLE 1: GENERAL SELF-ESTEEM AREA

 

Seltesteemiﬂating

E
E

52

52

72.5
77.5
59.8
64.7
74.5
77.5
77.5
70.6
81.4
6.62

Score range = 52 - 88.2
Y = 70.7

CDCDNOIOIthQN-l

 

Questions April
1 67.1
2 69.4
3 83.5
4 85.9
5 63.5
6 82.4
7 67.1
8 82.4
9 82.4

10 75.3
11 85.9
12 81.1

Score range = 63.5 - 87.1
Y = 77.7

 

 

 

in Table 1, the general self-esteem score range narrowed from 36.2 units to

23.6 units and the arithmetic average increased by 7%, indicating a growth pattern

 

in this area.
TABLE 2: seem. PEER enoup AREA
59W
1 88.2 1 85.9
2 77.5 2 82.4
3 73.5 3 85.9
4 79.4 4 82.4
Score range = 73.5 - 88.2 Score range = 82.4 - 85.9

Y = 79.7

7 =84.2

 

 

57
In Table 2, a narrowing in the score range, accompanied by a growth in the

mean, indicates that the students are expressing a more positive feeling of self-

esteem in their interactions of a social or peer group nature.

TABLE 3: HOME - PARENTS AND FAMILY AREA

 

Wins

1 60.8 1 65.9

2 71.6 2 82.4

3 60.8 3 69.4

4 61.8 4 74.1

5 67.6 5 76.5

6 67.6 6 76.5
Score range = 60.8 - 71.6 Score range = 65.9 - 82.4

7 = 65 Y = 74

 

 

 

In this section, the score range increased from 10.8 units in January to 16.5
units in April, indicating an increase in self-esteem and home-life but also possibly
some inconsistency in response to areas covered by the differing "questions".
When the inventories were collated they indicated that this ﬁnding might occur, in
as much as a number of the over 21 year olds, living at home, indicated parental
pressure, that their parents didn't understand them and that they frequently felt like
moving out. The April inventory was ﬁlled out at the completion of the semester
and of the program, so that it is difficult to say with any certainty that the self-esteem
growth in this area is due to happenings throughout the four month experience,
possibly it is a celebration of survival. Nonetheless this area retains a lower April

mean than social-peer or general self-esteem.

Sci

coll

slu:

clia

the

incr

00H

COI‘

est

sell

.IIII'IIIIII

1 ill 1

58

TABLE 4: SCHOOL-ACADEMIC AREA

 

 

Seltesteemiﬂating
1 44.1 1 52.9
2 84.3 2 87.1
3 79.4 3 80
Score range = 44.1 - 84.3 Score range = 52.9 - 87.1
Y = 69.3 Y = 73.3

 

The one area which was not resolved by completing the semester and the
college academic program was this area. Upon becoming eligible to graduate, the
student must write the registration/certification exams. Possibly, this impending
challenge is reflected in the April academic area mean of 73.3, the lowest mean of
the four self-esteem components. There is growth here, which may reflect some
increase in self-esteem possibly related to having successfully emerged from the

college exams.

Answer to research question #2: Yes, the students do appear to show
consistency in their positive feelings about themselves in relation to general self-
esteem, social self-esteem, school-academic self-esteem and home-parents, family

self-esteem, before and after this consolidation assignment.

 

 

80C

Pro

Ilml

[QVI

Cor

59

SECTION TWO
IDENTIFIED STUDENT GROUPING

The variables form and the pre and post experience inventories for twenty-
ﬁve students were pulled and packaged so that the exact variables and fluctuations
for each individual student could be assessed. This also enabled the calculation of
a test of significance, i.e.: the t test for nonindependent samples, which led to
acceptance or rejection of the null hypothesis.

The t test for nonindependent samples is used to determine whether there is
probably a significant difference between the means of one sample at two different

times, 9.9. one group which is pretested before a treatment and then is post tested.

NULL-HYPOTHESIS

In this study, the null-hypothesis was: There are no perceived changes in
level of self-esteem in the pregraduate students as they experience the

consolidation semester.

Calculations for t = 2.1

assuming or = .05

degrees of freedom for the t test for nonindependent samples = N - 1 = 24
the t table value for t required for rejection of the null hypothesis is 2.06
The t table value 2.06 s the calculated t value 2.1

Therefore consequently the null hypothesis was rejected.

60

Pregraduate Consolidation Student
Variables Form

The following pages present the results of the pregraduate consolidation students"
variables forms for the 102 students that were surveyed in January. The data
totals may add to more or less than the 102 students if the answers applied to
more than one area or the student chose not to respond to a question.

Soda-Psychological Variables:

1.

After graduation, my goals for the future will include :
(may have chosen more than one area)

 

 

 

 

 

 

 

 

 

 

 

full or part-time employment: 72
full or part-time degree or post-graduate education: 67
2. At this time, I feel that the Humber College Nursing Diploma Program
will have adequately prepared me for my desired future occupation(s).
Agree: 98 Disagree: 3
3. At this time, I feel that l have adequate control over my present and
my future.
Agree: 87 Disagree: 16
Comments ? Worries about the present absence of a job-market in
Canada and the economic recession throughout North America.
Performance Variables: (may have been doing more than one choice).
4. Before joining the nursing diploma program, I was:
a) a hospital or health care agency: 22
b) industry/business: 38
c) secondary school: 23
d) post secondary: 18
e) did not attend school or work for a salary: 6
5. During this program I have written a supplemental exam or repeated

a SBITIBSIBI‘.

Yes: 24 No: 77

 

 

61

6. I expect to have worries about ﬁnances between now and graduation.

Yes: 52 No: 50

 

 

Comments ? Many who were working regular part-time feel that the

rotating shifts of the pregraduate semester will interfere with opportunities
for employment. Also graduation and RN. exams costs were mentioned

as added burdens.

Environmental Variables:

 

 

 

 

7. I live with:
a) a spouse or significant other: 30
b) a child or children: 26
c) a room-mate: ) some of each i.e.: school vs days off 10
d) parents: ) 41
e) othen (family, siblings, on own, boarding) 15

 

8. I intend to take a part-time, evening or sessional course, this semester.

Yes: 15 No: 86

 

 

(one of the part-time courses available was the pre-R.N.-nursing-review).

9. I will be working for salary, part-time during this semester.

 

 

 

 

Yes: 48 No: 49
I estimate that l will'be employed up to: 8 hours per week: 13
8 > 16 hours: 27
> 16: 10

 

Comments ? A couple of students expected to maintain a 35 - 40 hour
work week as well as the 35 - 40 hour student assignment week.

 

Input Variables:

10. I obtained my previous education at:
an Ontario school: 83
an out of province school: 4

 

an out of the country school: 6

 

62

 

 

 

 

 

 

11. I am: Male 6 Female 89
12. My age is: 19 or 20: 4
21 - 25: 52
26 - 30: 14
31 - 40: 19
> 41: 8

 

13. My ethnic background is:

Canadian-Afro

 

Asian

 

Black

 

Chinese-Jamaican

 

Muslim

 

Native North American

 

Uruguay

 

European 1

 

Filipino

 

Ghana

 

Indian

 

Jamaican

 

South American,
Guyana

h mNdﬂwd-‘J-‘N-‘N

 

The socio-psychological variables, were responded to by positive answer choices,
with the area of control over present and future reflecting the present decrease in
health dollar allotment. In the section on performance variables, more students
entered the program from the workforce (60), than from school or unemployment
(47). One quarter of the students had experienced previous academic failure and
one-half of the students anticipated financial worries.

When addressing environmental variables, almost one-half of the students (56),
lived with a spouse and/or children. Most students were not enrolled in extra-
curricular courses and one-half of the students maintained part-time employment.

The input variables section showed that most students were educated in Ontario
and the majority of the students were between 21 and 25 years of age.

This data will be further utilized when responding to research questions three and
four in this section.

 

63

The following frequency polygons; Figure 4, January data 25 students and

Figure 5, April data 25 students, and Summary Chart #3, will provide the measures

of central tendency for the identified student grouping.

Number of Students

0'

03-5

 

FIGURE 4: FREQUENCY POLYGON - JANUARY/APRIL DATA 25 STUDENTS

 

I I I I I J I l I I

10 20 30 4O 50 60 70 so 90 100
Score in Percentiies

 

 

SUMMARY CHART 1: IDENTIFIED STUDENT GROUPING

January April
Range of Scores 20%- 96% 36% -100%
Mean 70.6% 76.5%
Median one of the 80's 80
Mode 84% 92%
SD. 21.1 18.9

 

 

 

64

A comparison of the score ranges and means of the identified twenty-five
students with the larger population of 102 students from January and 85 students
from April is presented to confirm that the identified twenty-ﬁve students group is

representative of the total group.

SUMMARY CHART 2: COMPARISON OF GROUP RANGE OF SCORES AND MEANS

 

Large Group Sub-group
January January

Range of scores = 20% - 100% Range of scores = 20% - 96%

 

Mean = 72.6% Mean = 70.6%
Large Group Sub-group
April April

Range of scores = 36% - 100% Range of scores = 36% - 100%

Mean = 78.6% Mean = 76.5%

 

 

 

Range ﬂuctuation and growth in means is comparable between groups over time.

t i i

65

TABLE 5: SELF-ESTEEM CHANGE BY AGE GROUPING

 

 

Perceived levels of self-esteem when identified students are Wags.

No. Of Students Age Range Range of Scores Y
2 students 19 +/or 20 Jan. 68 - 92 Jan. 80
Apr. 84 - 88 Apr. 86
11 students 21 - 25 Jan. 20 - 92 Jan. 63.6
Apr. 36 - 100 Apr. 74.5
5 students 26 - 30 Jan. 56 - 96 Jan. 80
Apr. 60 - 100 Apr. 83.2
6 students 31 - 40 Jan. 44 - 84 Jan. 69.3
Apr. 36 - 100 Apr. 73.3
1 student > 41 Jan. 88 Jan.
Apr. 64 Apr,

 

A variation of range of scores does occur in this compilation, but also a

marked variation in the number of students in each age-grouping could be affecting

the range.

An interesting happening here is the large increase in the self-esteem mean

for those students between 21 and 25 years of age. They also have the

consisteme largest range of scores.

Therefore, the students between the ages of 21 and 25 years of age showed

the largest post-experience inventory self-esteem gain.

 

66

SELF-ESTEEM CHANGE BY PARENTHOOD

The following information is based on the responses of the eight students
who identified themselves as parents, from the 25 students.

Their January self-esteem scores ranged from 44 - 96 and their April self-
esteem scores ranged from 36 - 92.

The January mean of 75 dropped to 71.5 in April.

Based on this small sampling of eight parents, it appears that combining
parenthood with a four month clinical work semester does not increase one's self-

esteem.

SELF-ESTEEM CHANGE WHEN LIVING WITH A SPOUSE OR SIGNIFICANT OTHER

The following information is based on the responses of the nine students (in
the 25 group), who indicated that they were living with a spouse or significant other.
Their January score ranges of 28 - 96 moved upward in April to 36 - 100. The
mean fell slightly from January at 72.4 to April at 71.1.

When the range improves but the mean declines then the assumed
happening is that some mid-range participants must have fallen in self-esteem to a
degree that lowered the overall average.

The conclusion here is that living with a spouse or significant other may

correlate positively or negatively with perceived self-esteem status.

67

Answer to research question #3: Yes, there is a variation in the means of
scores of perceived levels of self-esteem, when students are grouped by age

range, parenthood, living with a spouse or significant other.

 

SELF-ESTEEM CHANGE WHEN PREVIOUSLY EMPLOYED

The following information is based upon the responses of the eleven
students in this group who came into the nursing diploma from areas of previous
full-time employment. Their January score ranges were 28 - 92 with a mean of
66.5. In April these score ranges raised to 36 - 100 with a mean of 71.3.

These eleven students from previous full-time employment areas, all
perceived themselves as having a marked increase in self-esteem level after the

four month pregraduate semester.

SELF-ESTEEM CHANGE AND PART-TIME EMPLOYMENT

Presently maintaining part-time employment are 14 of these 25 students. in
January their self-esteem scores ranged from 28 - 92 with a mean of 69.7. Four
months of school and part-time employment showed an April self-esteem score
range of 36 - 100 with a mean of 77.1. As with those students who worked full-time
before returning to school, it appears that working part-time during this semester at

least, does not have any adverse effects on one's perceived self-esteem level.

68

SELF-ESTEEM CHANGE AND EXTRACURRICULAR COURSES

Only two of these identified students took extra courses while in the
pregraduate semester. Their scores of 28 and 80 in January, moved to 36 and 100
in April. Obviously their perceived self-esteem levels grew even with this extra
activity.

SELF-ESTEEM CHANGE AND PREVIOUS ACADEMIC FAILURE

The following lnfonnation is based upon the responses of six of the twenty-
ﬁve students in the total data group who had during the nursing diploma program,
written a supplemental exam or repeated 3 course. Their January range of scores,
20 - 80 and their mean of 55.3 raised markedly to an April range of 56 - 92 with a
mean of 77.3. Here again, completing their program successfully and arriving at
the end of the last semester was obviously a very positive influence on their

perceived levels of self-esteem.

Answer to research question #4: Yes, perceived levels of self-esteem are
reﬂective of the following demographic variables; previous full-time employment,
present part-time employment, whether the student is taking part-time or sessional
courses as well as the required assignment, whether the student has written a

supplemental exam or repeated a semester during the program.

69

SECTION THREE
PROFILES

Eight students and their preceptors, were matched to create proﬁles. Details
from the variables sheet provided a snapshot of the students' goals, feelings,
background and extra-curricular obligations. Each student's total self-esteem
scores and the sub-scale component scores were listed as well as one or two
relevant points from student comments. Précis of RN. preceptor interviews

followed to complete each profile.

The variables sheet was filled out the first day of school in January, pre-
experience, and the R.N. preceptor's comments were collated from a post-
experience interview. The January sub-scale component scores were inventoried
at the same time as the variables sheet was completed and may differ markedly

from the post-experience subscores and the R.N. preceptor commentary.

7O

STUDENT A: FEMALE - 24 YEARS OLD

The profile for Student A is as follows:

Attained previous community college diploma.

Previous full-time employment in the business world.

Future goals: to be a general medical-surgical staff nurse in a hospital.
Feels that her present education will provide adequate preparation for this
role.

Realizes the dearth of generalist nursing jobs in Ontario, at the present time.
Has taken out student loans and borrowed monies from relatives.

Living with her parents at this time.

TABLE 6: STUDENT A - Total Self-Esteem Scores

 

 

Pre-experience Post-experience
January 56% April 68%
general self-esteem 50% ........................................ 75%

social self-esteem 100% ........................................ 1 00%

home: parents-family 33% ........................................ 66%

school: academic 66% ........................................ rated zero

 

 

71

FIGURE 5: STUDENT A -
% Self Esteem Scores
Female 24 Years

     

Total General Social Home School

 

* January - April

 

Relevant January student comments are as follows: feels that she is not, "happy
with herself", has no 'real' immediate future plans, feels all mixed up about careers

and futures, finding it hard to live with her parents and with their expectations.

Relevant April student comments are as follows: still wishes she was someone
else, expressing low self-opinions and "life is tough", continues to feel pressure

from the family, discouraged with her work performance.

Ergogpjgr interview:

This student demonstrated an ever increasing comfort with the workload and
with staff and patient relationships throughout the four months. Her self-confidence
and professionalism appeared to develop during the latter half of the experience.
Her self-esteem and nursing self-concept "seemed to blossom', with staff
reinforcement and praise. She appeared knowledgeable, with a good deal of

common sense and was comfortable in social situations.

72

Qbsematicns:

This is one of a number of students who mentioned being previously
employed full-time, then returning to school and moving back in with the parents.
The questions addressing parents" expectations and pressures on the students to
do well were frequently answered at or below the 66% level of positive self-esteem
by these students.

There are of course, many possible reasons for this and a prime one is
whether these expectations are truly on the parents" part or are they projections
from the student?

Academic self-esteem nose-dived, (this area only had three questions to
begin with). When one has taken out student loans and borrowed monies from
relatives, there is again an implicit pressure on the student to achieve. This in itself
could cause stress enough to lower perceived self-esteem in this area.

A high rating for this student, was social skills and the RM preceptor noticed

and seconded this perception.

73

STUDENT B: FEMALE - 22 YEARS OLD

The proﬁle for Student 8 is as follows:

Came into the nursing program directly from secondary school.

Has experienced some academic failure as well as success.

Future goals: to work full-time for a while, and then to get a degree.

Does not feel at this time, that this program has prepared her adequately for
the work place. '

Lives with her parents - has no ﬁnancial worries and does not have a part-

time job.

TABLE 7: STUDENT B - Total Self-Esteem Scores

 

 

Pre-experience Post-experience
January 20% April 76%
general self-esteem 1 7% .......................................... 67%

social self-esteem 25% .......................................... 75%

home: parents-family 17% .......................................... 100%

school: academic rated zero ...................................... 33%

 

 

74

FIGURE 6: STUDENT B -

% Self Esteem Scores

 

 

 

Ferrale - 22 Years
1 00 -
80 -
60 '1
40 4
20 I

0 d . . .
Total General Social Home School
[I January I April

 

Relevant January student comments are as follows: things are all mixed up and I'm
not much good at changing, I feel that my family is pushing me, I'm discouraged

and I wouldn't mind just getting away from everything.

Relevant April student comments are as follows: I have trouble adjusting to new
assignments and I worry about things, i don‘t do as well as I would like to and, I

don‘t feel like I'm much fun when I am with others.

E l . l i ,

This student is a hard worker. She was very accepting of challenging
assignments and she was always pleasant to work with. Her decision making
ability improved markedly with experience. She always sounded positive and
projected a positive attitude. She did express her concerns about the impending

exams and about going on with future schooling.

75

lesematiens:

When scores alter this dramatically, the ﬁrst thing that comes to mind is, was
this first inventory filled out on a "blue" day or a 'downer' week? Certainly an
academic self-esteem rating of zero could follow program failures and the student's
perception that she isn't ready for employment, (remember this was the first class
morning in January).

Here again is a student direct from secondary school, although a year or two
older than her peers, who is expressing some parental pressures while still living at
home.

The preceptor's view of this student and her comments were positive
throughout. Did this contribute in a significant way to this marked rise in total and

sub-component self-esteem?

76

STUDENT C: FEMALE - 22 YEARS OLD

The profile for Student C is as follows:

Entered the nursing course directly from secondary school.

Looking forward to graduating and to the future.

Has experienced academic failure in the nursing diploma program, as well
as success.

Living with her parents.

Working pan-time, (12 hours a week).

States she has no financial worries.

TABLE 8: STUDENT C - Total Self-Esteem Scores

 

 

Pre-experience Post-experience
January 80% April 92%
general self-esteem 83% .......................................... 92%

social self-esteem 100% .......................................... 100%

home: parents-family 67% .......................................... 100%

school: academic 67% .......................................... 67%

 

 

77

FIGURE 7: STUDENT C -
% Self Esteem Scores
Female - 22 Years

 

Total General Social Home School

 

 

'53??? January I April

 

Relevant January student comments are as follows: I find changes difficult but I like
to improve myself, I find family pressure on me is upsetting, l have high standards

for myself.

Relevant April student comments are as follows: I'm really not doing as well as i
should, I really find giving report, speaking out, talking in class, or asking questions,

is difficult.

r r l w:

She is always bright and willing to take on a workload but is not always able
to complete her full assignment. Towards the end of the semester this student
expressed the feeling that it would have been easier to have taken the nursing
assistant, [or practical nurse], program. She never became independent but she
showed some slight improvement in decision making. Towards the end of the
semester she appeared more confident, yet i don't believe she ever had a "good

feeling' about herself and her performance. She made attempts to fit in with staff

78

and other students, but in the end "clung to her preceptor". Toward the end of the
semester the student stated that she did not want to be an RN. and was looking at
a mortician course. She was always very very nervous about her exams and the

quality of her legal documentation.

Qbssnlaticns:

This student entered the semester with an upper quartile self-esteem rating
and it grew during the four month semester. She is in her twenties, living at home,
and does mention perceived family pressures. Finances do not appear to be a
problem and possibly this helps to keep other stressors in perspective.

Her academic self-esteem seems to be a vulnerable area possibly related to
that past academic failure.

Her preceptor saw a likeable person who couldn't always complete the
entire obligation and who tended to cling to the known and familiar. Is she
rationalizing for possible future academic failure, the R.N.‘s for example, when she

states that she thinks she should be in a different occupation?

79

STUDENT D: FEMALE - 20 YEARS OLD

The proﬁle for Student D is as follows:

Entered the nursing diploma course direct from secondary school
graduation.

Feels that the nursing program met her expectations, but

Is very aware that there is no job market at the present time.

She has experienced academic failure as well as success during this three-
year program.

Works part-time and lives with her parents.

Took a part-time course during the pre-graduate semester.

TABLE 9: STUDENT D - Total Self-Esteem Scores

 

 

Pre-experience Post-experience
January 68% April 84%
general self-esteem 92% ............................................ 100%

social self-esteem 100% ........................................... 75%

home: parents-family zero rating ............................... 50%

school: academic 67% ........................................... 100%

 

 

80

FIGURE 8: STUDENT D -
% Self Esteem Scores
Female - 20 Years

 

Total General Social Home School

 

January I April J

 

Relevant January student comments are as follows: I really feel family pressure
and I think that they have unrealistic expectations, my family doesn't seem to

understand me, I find it really hard to live at home.

Relevant April student comments are as follows: my family still can't see my
perspective, I won't mind moving on, I find it real hard to work shifts and weekends
and still go out with friends, I haven't been anywhere...

r in i w:

This student was always willing to try new assignments. She had a co-
operative attitude which showed a bit of "burn out' toward the semester end. She
did improve in her ability to adjust to change and she always projected comfort with
her role. She was friendly to others. She did express concerns about her
upcoming exams and about the stress of always being aware of legalities, [as a

nurse-practitioner].

81

Qbsenratiens:

This student grew in general self-esteem, home relationships and perceived
academic self-esteem. She also mentioned past academic failure, which may
have inﬂuenced her January inventory perceptions, (the April inventory was ﬁlled
out after all college exams had been successfully completed).

Family expectations whether perceived or real, were bothering this student
to a considerable extent in January, (zero rating). By the end of April the student
was looking forward to a lifestyle which would possibly liberate her from the
parental home but not in Ontario.

The preceptor mentioned "burn out', and possibly this stress-reaction was a
by-product of the same circumstances that she felt made her family life so implicit a
part of a perceived low-self-esteem level. The preceptor was the recipient of
verbalized concerns about the student's perceived stressors. Could the effort
necessary for improved self-esteem about academic entities have contributed to

the drop in social self-esteem?

82

STUDENT E: FEMALE - 27 YEARS OLD

The profile for Student E is as follows:

Future goals: "getting my degree, any degree".
This program has met my expectations, and I feel prepared to move on.
Was previously employed full-time in business.
Married, with children.

No ﬁnancial worries, no academic worries.

TABLE 10: STUDENT E - Total Self-Esteem Scores

 

 

Pre-experience Post-experience
January 96% April 92%
general self-esteem 100% ............................................ 83%

social self-esteem 100% ............................................ 1 00%

home: parents-family100% ........................................... 1 00%

school: academic 67% ........................................... 100%

 

 

83

FIGURE 9: STUDENT E -
% Self Esteem Scores
emale - 27 Years

 

Total General Social Home School

Relevant January student comments are as follows: I'm most uncomfortable when l

 

 

January I April

have to talk in front of a group, give report, conduct a conference or speak out in

class.

Relevant April student comments are as follows: I'm pregnant and we're in the

middle of moving to a new place to live, I'm really uncertain of what to try to plan for

the future.

She was sometimes hesitant to accept the workload as assigned, still she
was always a good team player and showed early indications of team leader
qualities. She appeared confident right from the beginning. She did share her
personal life and worries toward the end of the rotation. She was always friendly

and a pleasure to work with.

84

Qbsematicns:

The change in this student's rating from 96% to 92% could be a reﬂection of
a change in perspective in looking at one or two (at the most), of the inventory
items.

The student's comments about impending life-style changes might very well
have changed her perception of her general self-esteem. Her world is changing
from her planned future to a new one.

The preceptor comments dwell on social skills and mention an occasional
hesitancy to accept the assignment this area might possibly be interpreted by the
student concerned with a totally different perspective. The preceptors were the last
to be interviewed, after the students had graduated, so an added student interview
was not possible.

The ceiling effect, illustrated in the 100% January and April scores,
minimizes any conclusions about self-esteem change for social or home: parents-

family.

85

STUDENT F: MALE - 44 YEARS OLD

The proﬁle for Student F is as follows:

Has had a variety of educational experiences at the college and university
level.

Came into nursing from the corporate business world.

Feels that the nursing program has met his expectations and that life is
progressing according to his aspirations and expectations.

He is married, with children.

Part-time employment of sixteen hours each week.

TABLE 11: STUDENT F - Total Self-Esteem Scores

 

 

Pre-experience Post-experience
January 88% April 64%
general self-esteem 83% ............................................ 67%

social self-esteem 75% ............................................ 100%

home: parents-family100% .......................................... 50%

school: academic 100% .......................................... 33%

 

 

86

FIGURE 10: STUDENT F -
Self-Esteem Scores
Male - 44 Years

 

Total General Social Home School

 

 

January I April

 

Relevant January student comments'are as follows: things are "going okay".

Relevant April student comments are as follows: really starting to feel the
pressures of the registration/certification exams coming up, I'm really tired, it seems

like I've been working alot of shift work and I'm trying to search for a job.

r r I
He progressed noticeably throughout the semester. He was confident and
unafraid of assignment challenges by the end. He was a team player throughout
and demonstrated consistent improvement in decision making ability. He always
got along well with staff and with other students. He discussed private matters with
the appropriate staff members. There was a noticeable improvement in his
confidence toward the end of the semester. He really did share his worries about

those registration exams.

87

Obsematlcns:

While perceived social-skills have grown over this four month period, all of
the other self-esteem components seem to have dropped. From the student
comments it seems like this workload has produced a very real physical drain. Is
this a case where the student's perceptions on the self-esteem inventory in April
were a product of exhaustion and possibly worries about the job search?

His preceptor saw a hard-working student, progressing consistently.
Sixteen hours part-time per week sound like both of his days off school were spent

working. Is this a major contributor to the drop in family self-esteem ratings?

88

STUDENT G: FEMALE - 25 YEARS OLD

The proﬁle for Student G is as follows:

Future goals: to work in community nursing and starting on obtaining a
degree.

Feels adequately prepared for the work-world but quite unsure "of my overall
abilities".

Feels that her self-confidence and self-esteem are lower than they should be
has always successfully passed all subjects each semester.

Previous community college education was followed by a career in retail
business management.

Happily married, no children, no financial worries.

intended to take an evening course during the pregraduate semester.

TABLE 12: STUDENT G - Total Self-Esteem Scores

 

 

Pre-experience Post-experience
January 28% April 36%
general self-esteem 25% ........................................... 33%

social self-esteem 75% ........................................... 75%

home: parents-family17% ........................................... 33%

 

school: academic rated zero ....................................... rated zero

 

89

FIGURE 11: STUDENT G -
Self Esteem Scores
Female - 25 Years

 

Total General Social Home School

 

 

 

Relevant January student comments are as follows: I get along well with other
students but I feel alot of pressure and stress comes from my family's expectations

and meeting the school standards.

Relevant April student comments are as follows: I'm really very unsure about the
immediate future, about these exams, about finding employment, I don't feel very

positive about any of it.

She always has a positive attitude and is an excellent team member. From
the outset she has shown improvement on an ongoing basis, in decision making
ability. She projected a positive outlook and maintained good relationships with
others throughout the semester. She really appeared worried about school and

about exams.

90

Qbsenlaticns;

This student has never had an academic failure, states that her marriage is
happy, and isn't worried about ﬁnances. This is a graphic example that perceived
self-esteem does not equate with meeting the imposed performance standards of
others, nor is it linked to a set recipe of life and lifestyle happenings.

The first inventory was completed as the ﬁrst task of the ﬁrst class of the
semester (January), and the second inventory was ﬁlled out when the student
although assured of graduating, still had the challenge of major R.N. exams and a
job search. In this profile one wonders whether an added inventory for example,
half-way through the semester, would have conﬁrmed a perennial low self-esteem
rating or might have indicated some lability.

Other than an awareness of the impact of exams upon the student, the
preceptor saw a positive co-worker. However, the preceptors comments do tend to
focus on social skills and relations to the detriment of competency and knowledge

application.

91

STUDENT H: FEMALE - 21 YEARS OLD

The profile for Student H is as follows:
Future goals: to find employment and to start a part-time university degree.
Feels positive about her preparedness for the work—world.

Entered the nursing diploma program directly from secondary school.

Worries about the expense-drain on her parents, lives at home.

TABLE 13: STUDENT H - Total Self-Esteem Scores

 

 

Pre-experience Post-experience
January 92% April 96%
general self-esteem 100% ........................................... 1 00%

social self-esteem 75% ........................................... 100%

home: parents-family100% ........................................... 100%

school: academic 66% ........................................... 66%

 

 

92

FIGURE 12: STUDENT H -
% Self Esteem Scores
Female - 21 Years

 

Total General Social Home School

 

 

January I April ]

 

Relevant January student comments are as follows: a bit unsure about the

demands of this "different kind of semester".

Relevant April student comments are as follows: I think that I did okay, it sure is

wonderful to have made it through.

r r ' i
This student has been excellent from the beginning. She has a positive
attitude and really seemed to enjoy working with others. She always welcomed
increased responsibilities. How to describe her? Motivated, confident, competent,
self directed and fits in well with others. Sure, she is nervous about her impending

R.N. exams. She really has been above average throughout.

93

Qbsenlaticns:

The school-academic portion of the SEI is only three questions, therefore a
66% in this area, indicates that the student did not respond positively to one
question. Of interest with this précis is the congruence between the scores
obtained on the inventories and the RM preceptors comments. Even more telling
was the fact that at the interview time, many other staff nurses in the area where the
student was assigned made a point of dropping by to tell about what a positive,
refreshing, student this girl had been.

Here again, the ceiling effect precludes commentary on possible growth of

general or home: parents-family self-esteem.

Answer to research question #5: The preceptors' perceptions of the
students with which they worked vary amongst individuals. Relationship to the
students perceptions from their self-esteem inventories also show distinct

variations.

CHAPTER V
OBSERVATIONS, RECOMMENDATIONS

INTRODUCTION

The primary focus of this study was to determine whether there were any
perceptual changes in diploma nursing students" responses to inventories which
assess levels of self-esteem and to conduct those inventories prior to and at the
completion of the pre-graduate consolidation semester. A sampling of student and
registered nurse-preceptor interviews has been included to complement the
objectivity of the inventory analysis.

Additional areas were identified, such as self-esteem subscale components,
and relationship of scores to age groupings, students who are parents, students
who live with a spouse or significant other, previous full-time employment, present
part-time employment, students taking extra courses and students who have
experienced academic failure during the program.

This study was conducted during the first four months of 1993, with students
from one specific diploma nursing course. One hundred and two self-esteem
inventories and demographic variables sheets were completed at the commencing
of the semester and eighty-five self-esteem inventories were submitted at the
completion of the students" experience. Eight registered nurses who had been
student preceptors, contributed their perspectives on the students with whom they
had been working.

In this chapter each of the research questions will be addressed, and further
observations and recommendations will be offered. Comments will be included

along with purely objective data. These comments are based upon the

94

95

investigator's integrated review of the data, variables sheets and in some specified

instances, interviews.

THE RESEARCH QUESTIONS

1. Do students perceive any changes in their level of self-esteem as they
experience the continuity of the pregraduate consolidation semester?

2. Do the students" perceptions of self-esteem show consistency in their
positive feelings about themselves in relation to general self-esteem levels,
social self-esteem levels, school-academic self-esteem levels, and home,
parent, family self-esteem levels, before and after this consolidation
assignment?

3. is there a variation in the means of scores of perceived levels of self-esteem
when students are grouped by age range, parenthood, or living with a
spouse or significant other?

4. Are perceived levels of self-esteem reflective of demographic variables such
as previous full-time employment, present part-time employment, whether
the student is taking part-time or sessional courses as well as the required
assignment, and/or whether the student has written a supplemental exam or
repeated 9 semester, during their program?

5. Does the preceptors perception of the student's self-esteem throughout the
pregraduate consolidation semester reflect the student's self-esteem

inventory?

96

THE DESIGN AND PROCEDURE OF THE STUDY

The pre and post experience self-esteem rating was administered to the
population of the ﬁrst class period during the winter semester, pregraduate nursing
course. The survey instrument consisted of a twenty-five item inventory addressing
attitudes and beliefs of a self-esteem nature. Self-esteem items focussed on
subscales of general self; social self, peer relationships; home, parents, family
relationships; and school, academic relationships. The students responded to the
statements on the form by indicating either, "like me" or "unlike me".

Previous college student studies utilizing the Coopersmith Self-Esteem
inventory have indicated internal consistency and test-retest reliability through
calculation of the Kuder-Richardson reliability estimates. The investigator
employed this formula for pretest-posttest comparison.

A grouping of twenty-five identified students were isolated to form a
nonindependent sample. This facilitated the use of the t test for nonindependent
samples to determine whether there was a significant difference between the
means of one sample at two different times. This was calculated with a = .05 and
the formula for degrees of freedom as N-1.

Also completed during the first class, was an informed consent form and a
variables form. The variables form addressed issues of the following nature:
Socio-Psychological; goals, feelings of competency, feelings of control over the
future... Performance; occupation pre-program, past academic failures, status of
ﬁnances... Environment; living arrangements, part-time or additional courses, part-
time employment and demographic input such as location of previous education,
sex, age and ethnicity.

Completion of this form provided a basis for comparison of self-esteem

scores by relationship to variables.

97

A further eight students and their registered nurse preceptors were identified
to focus on personal non-objective perceptions. These interviews followed the

areas covered by the self-esteem subscale components.

98

SUMMARY OF THE STUDY

The conclusion obtained from the inventories, comparisons by variables and

interviews, will be addressed through responses to the research questions.

Research Question 1: Do students perceive any changes in their level of
self-esteem as they experience the continuity of the pre-graduate consolidation

semester?

The range of inventory scores altered from between 20% and 100% in the
pre-experience survey, to 36% and 100% in the post-experience survey. The
mean of the scores also rose from 72.6 on the first inventory, to 78.6 on the post-
semester inventory. it is also apparent that there was an increase in the
percentage of students who moved into the upper quartile of the scale, a fact further
demonstrated by the bimodal (84% and 100%) polygon, representing the post-
experience data. The measures of Central Tendency, support the increase in
inventoried perceived levels of self-esteem for this group of students over the four
month semester. The K-R 21 results of .94 indicates a high coefficient of stability for
this test-retest process.

Descriptive statistics derived from the major pre and post inventory groups,
provide generalized population data. Therefore, further refinement of the
inventories data was employed with a view to demonstrating links between
ﬂuctuations and variables and to enable a test of significance to be conducted.

When the scores of each of twenty-ﬁve individual students were compared,
. for pre and post inventory change, a t test for nonindependent samples produced
a calculated t value equal to or greater than the table value, for a rejection of the

null hypothesis.

99

There are no perceived changes in level of self-esteem in the pre-
graduate students as they experience the consolidation semester.

t = 2.1 2 2.0, therefore the null hypothesis was rejected.

Further selectivity resulted in samplings which demonstrated self-esteem
ﬂuctuation by sub-component grouping, by variables and in the profiles section by
individual student.

In generalized data analysis, self-esteem increased on the average and the
range climbed in score, with a narrowing in parameter. The computation of the K-R
21 rand the t test for nonindependent samples support the reliability and validity of
the measuring instrument.

The reports on the remaining questions will provide a focus for the nature of
some of the self-esteem change identified by the students' perceptions on their
inventory responses.

The inventory pre and post experience, has indicated that students do
perceive changes in their self-esteem levels and that the majority of the students
perceive this change in a positive manner. it is difficult to relate this finding to
previous studies such as those mentioned in the literature search because the
qualifiers do not equate.

Kramer 1974, felt that new baccalaureate nursing graduates lack self-
esteem. His finding is not consistent with this diploma group's general scale mean
of 78.6.

Olsen et al 1984, and Ellis 1988, stated that self-esteem (and self-
conﬁdence) decreased with each subsequent year. This present study met the

students only four months before their graduation. However, the results in this last

100

four month period indicate a rise in perceived self-esteem levels of these
participants.

Choudry 1993, found that there was no change as a result of nursing
education on self-esteem. This study has not attempted to isolate the causes of
ﬂuctuation on self-esteem inventory reports but rather to at best, link some of the
student demographics and lifestyle variables to perceived self-esteem as rated.
This makes it very difficult to attempt to correlate any of the present ﬁndings with the
Choudry study.

In a broad sense and in a statistical sense, the self-esteem inventory did
indicate perceived changes in self-esteem level when surveyed at the

commencement and the completion of the pre-graduate consolidation semester.

Research Question 2: Do the students' perceptions of self-esteem show
consistency in their positive feelings about themselves in relation to general self-
esteem, social self-esteem, school-academic self-esteem, home-parents, family

self-esteem, before and after this consolidation assignment?

The inventories as completed for the pre and post experience procedures,
have proven internally consistent in reliability analysis, in data analysis and
interpretation. When directing attention to consistency of positive feelings,
consistency is defined in the sense of its coherence and congruity. The scoring of
the SEI: Adult Form, reflects the positive results attained by the respondent.

The January data has a range of scores between 20% and 100%, with a
mean of 72.6. The April data describes a range of scores of 36% to 100% with a
_ rise in mean to 78.6. The SD. narrows from 17.5 to 15.6 post-experience, which
supports the rise in scores and means. Further indication of clustering occuring in

the upper quartile is presented by the change in the pre-experience mode of 80%

 

101

to the post-experience bi-modal 84% and 100%. The SEI manual indicates in the
section on interpretation, that positions in the upper quartile can be (generally)
considered as indicative of high self-esteem.

It is congruent with previous SEI studies to observe a negatively skewed
range of scores. These scores demonstrate a logical consistency, i.e.: a
coherence, in their growth pattern. in the setting of total self-esteem, the students"

perceptions appear to show consistency in their positive feelings.

 

 

TABLE 14:
WW
January Range Y April Range '2'
general 52 - 88.2 70.7 63.5 - 87.1 77.7
social 73.5 - 93.2 79.7 82.4 - 95.9 84.2
school-academic 44.1 - 84.3 69.3 52.9 - 87.1 73.3
home-parents—famiiy 60.8 - 71.6 65 65.9 - 82.4 74

 

While the means display a recurring progression when comparing the pre
and post experience subcomponent scales, the narrowing in the range of scores
did not extend to home, parents and family. This result will be further discussed in
the analysis of the identiﬁed twenty-ﬁve students where they are parents or living
with others. it is also alluded to in the interview section when adult students found
that living with parents was stressful.

For the average student in this section, the means indicate a regular growth
pattern in level of perceived self-esteem related to all four subcomponent areas.

The range of scores and the top score for home-parents and family are indicative of

 

 

102

an individualized perceptual happening peculiar to this area. This does not appear
to affect the growth pattern as both the lowest and highest scores improved, but it

does point to this area which maintains these low means.

Research Question 3. Is there a variation in the means of the scores of
perceived levels of self-esteem when students are grouped by age range,

parenthood, living with a spouse or significant other?

 

 

TABLE 15:
Age Range Groupings January '2' April "It
19 + 20 years 80 86
21 to 25 years 63 74
26 to 30 years 80 83
31 to 40 years 69 73
" over 41 years 88 64

 

 

" This area was analyzed from the identiﬁed twenty-five student grouping. In that

grouping there was only one student in the over 41 years age range.

The largest variation in perceived self-esteem scores is found in the pre and
post experience means of the 21 years to 25 years age group and the single
example of the over 41 years of age. For this student then, it would be totally
inappropriate to comment other than to note a marked score decrease. it does offer
an opening however, for a new research study which focuses on self-esteem

change and subcomponents in the over forty age grouping of students.

103

In the remaining age groups, the eleven point gain amongst the twenty-one
to twenty-five year olds stands out from the other score means. This too helps to
center out these students for further investigative study. Possibly, through
ungrouping and adding variables such as entry into the nursing diploma program
from secondary school, compared to entry from university or from previous full-time
employment.

There is definitely a variation in the means of scores of perceived levels of
self-esteem when students are grouped by age range.

There were eight students among the identified twenty-five group, who are
parents. The means for these students was 75 in January, and dropped to 71.5 in
April. This April mean is lower than any of those calculated for the age groupings
for April, except for the lone over forty-one year old.

To turn to the range of scores for these students who are parents, will identify
a marked divergence of range such that it will definitely account for the decreasing
mean. In January the perceived self-esteem scores for this group ranged from 44%
to 96%. In April the range spread to 36% and 92%, lowering four percentage
points at the top and by eight percentage points on the low score.

Whereas the average student or the overall student body, rose in perceived
self-esteem over the four month pre-graduate experience, the self-esteem ratings
for the parents appears to have decreased. A closer look at these respondents
might provide some answers. Possible areas to be looked at are; the effect of the
recently past Christmas and New year holiday period upon their answer choices in
January, and/or the effect of shift-work and weekend work upon their perceived
self-esteem as parents, after a four month period. Self-esteem is a qualitative trait
alluding to respect of oneself. Further investigation could pursue the effects of shift

work and weekend work on one's perceptions about the quality of their parenting.

104

In the category indicating that students were living with a spouse or
significant other, nine students were identiﬁed. In this grouping the January mean
of 72.4 fell slightly in April to 71 .1. Accompanying this calculation was an upward
movement in score range from 28 - 96 in January, to 36 - 100 in April. Both the low
and high ends of the range improved but the mean still dropped, indicating that
within this group, a couple of respondents may have fallen in perceived self-
esteem to such a degree that it affected the overall average. It appears that living
with a spouse or significant other does indeed have a relationship to variations in
the means of scores of perceived levels of self-esteem. With this nature of finding,
supportive measures such as interviews and more detailed analyses becomes
meaningful before formulating an interpretation.

Burgess 1980, found a significant positive correlation between marital status
and self-esteem among the students tested. Burgess also noted higher scores for
those students having children. Burgess" survey consisted of a single study, in
contrast to the present pre and post treatment inventories. Burgess does not
identify the nature of the programs in which his adult students were enrolled and he
did specify marital status as opposed to living with With these things and the
possibility of other intervening variables kept in mind, it is still relevant to return to
the means and score ranges of the "married" and "with children", subjects of the
present study.

The living with a spouse or significant other students, revealed pre and post
experience means of 72.4 and 71.1. These means are in the interquartile range of
the SEI scoring which generally is indicative of medium self-esteem. The actual
score ranges of 28 to 96 and 36 to 100, does of course point to some students in
the upper quartile, who would be considered to feel high self-esteem. For students
having children, much the same results were calculated. Pre and post experience

means of 75 and 71.5 accompanied score ranges of 44 to 96 and 36 to 92.

105

Frerichs 1971, concluded that married students have fulfilled an important
developmental task thereby increasing their self-esteem. This is in contrast to this
present study which evidenced self-esteem means in the eighties for 19 and 20
year olds and 26 to 30 year olds, when grouped by age range, and means in the
lower seventies when calculated by "marital status" or "having children".

This study did not duplicate Frerichs" findings of significant positive

relationship between age, marital status and self-esteem.

Research Question 4: Are perceived levels of self-esteem reflective of
demographic variables such as: previous full time employment, present part-time
employment, whether the student is taking part-time or sessional courses as well
as the required assignment, whether the student has written a supplemental exam

or repeated a semester during the program?

The eleven students who indicated that they entered the nursing diploma
course from previous full-time employment showed a noticeable increase in
perceived self-esteem level at the completion of the pregraduate semester. Score
ranges raised from 28 and 92, to 36 and 100. The mean climbed from 66.5 to 71.3.
This growth sets the stage for questions which could be pursued in interviews or
further surveys...

e.g. - Did these students voluntarily leave their previous employment to enter
the nursing diploma course?

- ls successful completion of the final semester of greater importance to

the self-esteem of these students who have experienced the work force,
than it is important to students who entered the nursing diploma course

directly from secondary school?

106

- Do enough of the students who were previously employed full-time, fall
within the twenty-six to thirty year old age group, to prove a significance
between these two sets of variables scores?

As a variable, previous full-time employment does have a relationship to
growth of perceived self-esteem level as indicated by the inventories, before and
after the pregraduate semester.

Fourteen of the identified group of twenty-five pregraduate nursing diploma
students were employed part-time during this semester. Their score range
improved from 28 and 92 to between 36 and 100. The growth in means, brought
the pre—experience mean of sixty-nine, up to a post-experience mean of seventy-
seven point one. Clearly for these students, the co-existence of part-time
employment and a full forty-hour student work week, contained no negative
repercussions on perceived self-esteem levels. The growth in the mean of eight
points during this four month period moved this student group from the medium
self-esteem level of the interquartile to the high self-esteem level of the upper
quartile.

Many areas can be looked at in relation to this ﬁnding:

e.g. - is it a sign of impending growth of self-esteem level to be able to handle
a part-time job and full-time student status?

0 Is there some factor in a part-time job such as decrease in money
worries, need to keep an organized, timetabled life, etc. that is a catalyst
for a rise in perceived self-esteem?

This growth in self-esteem does not show routinely with all variables, a
ﬁnding that would be supportive of the tenet that self-esteem levels would improve
by so much. Therefore, it would appear that the variable of part-time employment,
is reﬂective of or of pertinence in, the growth of perceptions of self-esteem in this

group.

107

Only two of these students completed part-time or sessional courses while
they were enrolled in the pregraduate semester. One student had a low self-
esteem rating of twenty-eight, which moved to the more moderate rating of thirty-
six, by the end of the semester. The second student scored eighty in January and
met the ceiling score of one hundred at the end of April.

As was found with part-time employment, the commitment of added time-
consuming obligations does not seem to be a threat to self-esteem level growth in
the surveyed students who chose extra courses.

If in addition to isolating a larger number of students enrolled in part-time
courses, the questioning was directed to the nature and functions of the courses,
this data would become much more meaningful. Was the part-time course content
in synchronization with the semester content? If so, then this experience would
provide a reinforcement and catalyst action toward perceived level of self-esteem.
Did the part-time course provide relaxation and stress relief, thereby promoting
chances of success in the school's assigned work place and thus increasing self-
esteem levels?

The remaining variable identiﬁed in this section, refers to students who have
written supplemental exams or repeated 3 course during their nursing diploma
program. Six members of this student group responded to this category and again,
their statistics indicate a decisive increment in self-esteem score range and mean.
The January range of scores spread between 20 and 80. This range of scores
narrowed and grew to 56 and 92 by the end of April. The pre-experience mean of
55.3 topped out at a healthy high level of self-esteem post-experience of 77.3.

Remember that these students who have previously experienced academic
failure in their lives, had successfully completed the nursing diploma program

requirements at the time they responded to the post-experience inventory. This

108

would of course, be a major catalyst, an important boost to perceived self-esteem
levels.

The pressure of the lower scores, which rose but did not leave the
interquartile range, reinforces the reality of self-esteem levels as not being totally
linked to one's success at output or performance in life. The values or valuing of
self may usually relate to effective functioning but many people manage to
experience failures without a resultant effect on their perceived self-esteem level.
Conversely, for some people who for example, have achieved the nursing diploma
program objectives, they can oppress any tendency to noticeable growth of self-
esteem by looking toward the next challenge, in this instance the registration
exams and letting that happening reinforce their denial of positive self-worth.

For question four, the identified variables of employment and academia did
reﬂect and in most instances reflect entirely positively, on growth of perceptions of

self-esteem level, over the four month period.

Research Question 5: Does the preceptors perception of the student's self-
esteem throughout the pre-graduate consolidation semester reﬂect the student's

self-esteem inventory?

In chapter one a clarification is presented to differentiate between self-
concept and self-esteem. Roy (Perley 1976). delineates self-concept as physical
self, moral-ethical self, self-consistency, self-ideal and expectancy, and self-
esteem. Hamachek 1992, states that self-concept relates to the cognitive aspect of
self-perception and self-esteem is the affective dimension of self-perception. What
is being addressed by this question is, whether the registered nurse preceptor

could discern in his/her student the behaviors and attitudes reflective of self-esteem

109

level and are this preceptor's views congruent with the compilations from the
student's self-esteem inventory.

in focussing the interviews with the preceptors, the investigator created
seven open-ended questions which embraced the four subcomponent areas of the
self-esteem inventory. General self-esteem was addressed through questions on
ability to adjust to new assignments and to adjust to changes in plans, and whether
the student appeared to feel capable and of value when working with others in a
team setting. Did the student's appearance, actions and general comfort with self,
show for example, through a positive attitude? Social self-esteem assessment
was the basis for the question about "fit" with staff and other students. The
preceptor was asked whether the student shared home, family and future plans,
during light conversation, formally if appropriate, or over coffee during break
periods. Academic self-esteem was the reason for questioning whether the student
shared his/her feelings about the in-semester exams and registration exams and
his/her reactions and behaviors when coping with the legalities of nursing practice
and nursing documentation.

Three-quarters of the students in this grouping had a growth in the mean of
their total self-esteem levels during this four month assignment. Two of the
students who had a noticeable rise in inventoried self-esteem level, (20 - 76 and 80
- 92), had preceptors who thoroughly enjoyed being preceptors and who
established excellent relationships with their students. The preceptor for the ﬁrst
student saw the student as a hard worker, willing to accept challenging tasks with a
positive attitude that was reﬂected in continuing ongoing improvement on the part
of the student. This preceptor was aware of the student's academic concerns. This
preceptor's perceptions certainly reflected the post-experience inventory. The
second example shows the variance between self-esteem and self-concept.

Except for academic self-esteem, this student placed herself in the top quartile or

110

high self-esteem portion of the inventory. She talked of high standards and family
expectations. The preceptor described someone who was not always able to
complete the undertaken tasks. This student mentioned being in the wrong
program and mentioned a program which is equally as difficult, as a possible
future. The preceptor felt that this student lacked the ability to be independent,
"clung to the preceptor" when socializing and never seemed to act as if she "felt
good" about herself. It appears that this student's self-concept of her capabilities,
her social skills and her ability to work effectively in this role, was really in a state of
flux. The inventoried self-esteem levels showed general self-esteem of ninety-two
and social skills of one hundred percent, at the end of the semester. This positive
set of feelings about herself was not exhibited in her behaviors. The preceptors
perceptions were quite at odds with the student's self-esteem inventory.

Two of the students dropped in reported self-esteem levels over the four
month experience. The first student registered a total self-esteem of ninety-six and
a general self-esteem of one hundred, as she entered the semester in January.
Toward the semester's end the student became unexpectedly pregnant, found that
she and her husband had to move to a new town and that she would be job-
searching in an area that was strange to her. Her total self-esteem dropped four
points and her general self-esteem dropped seventeen points. This happening is
congruent with observations made by the preceptor, that this student was always
hesitant when accepting a new assignment and frequently unsure when adjusting
to change. This preceptors perceptions were indeed congruent with the student's
self-esteem inventory. The second student, who experienced a twenty-four point
drop in total self-esteem was married, the supporter of a family, non-employed wife
. and children, working sixteen hours a week and carrying the thirty-ﬁve to forty hour
student workload. This student's preceptor commented on consistent improvement

in capability, noticeable progress in all areas and that the student was a valued

111

team player. During this time, the student's general self-esteem fell by sixteen
percent, his family role self-esteem dropped to one-half of what it had been and his
academic self-esteem fell to one-third of the inventoried January level.

It appears that the factors behind the self-esteem drop were not apparent to
the preceptor. This preceptors perceptions of the student's self-esteem levels
reﬂected the initial inventory but were quite discrepant when compared to the post-
experience inventory.

Of two other students who received positive to excellent commentary from
their preceptors, it is interesting to note that one student posted self-esteem
inventory levels of twenty-eight and thirty-six, the other student had a pre
experience total self-esteem inventory of ninety-two, and a post experience rating
of ninety-six. In these instances, the preceptors comments by behavior and
performance, reflected the trend of the self-esteem inventories but did not
necessarily relate to the computed scale.

The preceptor group's perceptions of the students" self-esteem throughout
the pre-graduate consolidation semester did not show consistency in reﬂecting the
students' self-esteem inventories. What the interviews of students and preceptors
did accomplish was to provide some "food for thought".

The student with the extremely low total self-esteem inventory level was
married, no financial problems, not a parent and had not experienced any
academic set-backs. The student whose general self-esteem dropped so markedly
when her life-style plans changed had been registering high nineties and one
hundred percents. The other student who dropped to markedly over the semester
appears to have had an exhausting life-style but the self-esteem inventory rating
dr0p which was very dramatic, was not noticeable to his preceptor and co-workers.

Apparently the self-reporting instrument picks up and reflects students

perceptions of self, which may or may not be noticed and reported by co-workers.

112

CONCLUSIONS

An analysis of these findings indicate that the majority of students
experienced signiﬁcant positive change in their perceived self-esteem level. This
analysis demonstrated consistency in total and over all four self-esteem
subcomponents, when studied on an individual basis.

When students were grouped by age range there was a marked variation in
self-esteem inventory results, with the largest positive growth, being experienced
by the twenty-one to twenty-five year old group. This study showed that for this
student group in this four month semester, self-esteem in those students who are
also parents was perceived to decrease slightly. Living with a spouse or
significant other showed a slight overall growth in self-esteem, with some students
experiencing marked drops in perceived self-esteem levels.

Four variables were linked with clear growth in perceived self-esteem on the
inventories. These areas are; previous full-time employment, present part-time
employment, extracurricular course participation and previous semester repeats or
supplemental exams.

Comments obtained through interviews with preceptors proved to be
interesting but not necessarily congruent with the students' perceptions of their self-
esteem as reflected by the inventories.

The pregraduate consolidation semester is unique in the nursing diploma
program in that it is primarily a clinical or hands-on work experience. The students
work closely with staff, on staff timetables, including shift work and weekend work.
Their in-hospital time duplicates the staff work-week of thirty-five to forty hours. Out
. of hospital or around this work schedule, students are expected to study for the
comprehensive college exams, four examinations over two days and the

registration exams, also four sets over two days. Teachers are available to staff or

113

students, on an on-call basis and student performance evaluation is completed by
staff and students.

One of the happenings that appears to occur during this semester each year
is a growth in self-confidence and valuing of self on the part of most of the students.
Positive perceptions of self, by an individual, is known as self-esteem. This study
was constructed to determine whether there are any perceptual changes in
students' awareness of their level of self-esteem, as they experience the pre-
graduate work opportunity within the time-frame of the consolidation semester. The
instrument used to obtain pre and post-experience data was the Coopersmith Self-
Esteem Inventory: Adult Form. The resultant data was linked to Grubers (1979),
four major determinants of self-esteem, through 3 variables form completed by the
students. Results of the self-esteem inventory were compared to; background or
input variables such as age groupings, socio-psychological variables such as
goals and locus of control, performance variables such as previous academic
success, finances and employment. and environmental variables which include
living arrangements and part-time employment. Interviews were held with a
selection of students and staff nurses to allow for descriptive support or contrast to
the objective inventoried data.

In this study positive changes in students" perceived levels of self-esteem as
they completed the pre-graduate consolidation semester of the nursing diploma
program at Humber College of Applied Arts and Technology, were indicated
through comparison of pre and post experience self-esteem inventories.
Perceived self-esteem changes were also linked to identified variables from the

student's life and to interview collated data from the student's preceptors.

114

REFLECTIONS FROM THE COMPILATION AND INTERPRETATION
OF THE SELF-ESTEEM INVENTORIES:

The students received and responded to the January inventories within a
single class period. The April inventories were left with the students, who filled
them out at their leisure before returning them. It is conceivable that the January
responses contain an element of knee-jerk reaction, i.e.: was the student having a
particularly good or bad day? Possibly the April inventory was subject to a much
more thoughtful response process. Definitely the April responses would be
affected through the simple happening of this being the students" second time to

respond to the form.

The interviews with the students upheld the inventory data that indicated
lowered self-esteem levels related to parents' perceptions and expectations of the
student. It must be remembered that this observation is very much complicated by
the fact that this is a self-report inventory. This means that the students are
responding to their own (the students") perception that the parents are imposing
expectations and standards that are at least stressful and possibly not realistic.
The reality may be so, i.e.: the parents may hold these expectations, but the

students may be projecting their own expectations onto their parents.

Many of the interviews with the preceptors reflect a positive outlook and an
‘ optimism towards the students" continued growth. It is possible that this inclination

to place the best possible construct upon student activities and happenings,

115

preceded the student's actual performance. This would indicate that instead of the
preceptor providing their perceptions of the student's actual self-esteem responses
and behaviors, the student was adjusting and growing in performance to meet the

implied criteria of the preceptors expectations.

Referring once again, to the fact that the April inventory was already familiar
to the student and was completed at a more leisurely pace than the January
inventory, it is within the possible, that some of the growth on the second
compilation was due to the students filling in that which they thought was the
desired response. Progress inventories rather than only pre and post experience,

might help to indicate if this was happening.

No effort has been invested to identify possible linkages or relationships
between self-esteem subcomponent areas. In this survey the subcomponent areas
are not inventoried in equal proportions. This leads to the following questions:
Does the degree of effort invested or changes occuring in a situation that result in
an increased level of perceived self-esteem in one subcomponent area contribute
to or result in, a decrease in perceived self-esteem levels in another subcomponent
area(s)? Should varying weightings be assigned to each subcomponent area to
equalize emphasis? Should rationale be provided for the variations in

proportions?

116

The students were interviewed during the calendar boundaries of their
pregraduate semester. The nurse preceptor interviews took place after the
students had graduated. It must be considered that this variation in time frame may
have altered either the students' or the preceptors' perspectives. If the interviews
had taken place within the same timelines there is a possibility that some of the

comments and observations would differ.

The April survey was completed after program graduation was assured and
this must have contributed a positive effect on the self-esteem inventory ratings.
The amount of the contribution would vary of course, with the individuality of each
student. As a converse to this observation, the April survey was filled out just as the
students were refocussing perspective toward the reality of the impending
registration examinations, a formidable set of four examinations to be completed
over a two day period. This could very well have had an effect, especially upon the

academic self-esteem inventory results.

The January inventory was completed only by those students who came to
the ﬁrst class, the first day of the winter semester. The April survey was short of the
January number by seventeen respondents. The implications of these two
happenings could have very real effects on the nature of the responses. Some
questions are: Was there a particular trait or happening which would show in
inventoried self-esteem levels, that the missing January students and non-
compliant April respondents would have contributed to the results? Would the

inclusion of inventories completed by these students have altered the findings?

117

While a consistent effort has been invested in reporting clearly and
objectively throughout this study, the investigator obviously arrived with a set of
biases created by experience and the environment of Humber College of Applied
Arts and Technology. Those biases despite conscious efforts to minimize their
effect, have probably flavored the structure and tone of the interviews, the

comments, the précis and word choices.

118

IMPLICATIONS FOR FURTHER STUDY

Positive self-esteem change emerging from a field-work experience need
not be confined to a nursing program. Further studies could track any area of
education which incorporates field placement and emerge with some very useful
data on the relationship between perceived self-esteem levels and student work-
force experience in a variety of areas.

This study concerned itself with pregraduate nursing diploma students in
their final semester at a community college. Further studies which were conducted
in the same format would increase the population and their reliability. Studies
which changed one or more of the above criteria, would broaden the scope of our
understanding of change and perceived self-esteem levels of students, e.g.
different semesters, university instead of college.

Cross reference with further study would identify the presence of any
difference related to the philosophy of the school, the composition of the student
body and possibly the size of the class groupings.

The areas linked with identified variables could be stratified and looked at in
much more detail to establish definite criteria which connects with the effects of the
variables.

Further study could pursue students over a longer period of time, even
several semesters and/or several times over one semester which would classify the
effect of where each student starts, on the self-esteem scale.

An extraneous finding arose from students who had been previously
employed full-time and returned home to live while in school. ln-depth interviews
with students who identified factors such as pressures of parent expectations would

assist with gaining insight into this stressor. Further study could attempt to

119

determine whether there exists concrete data to support the student reaction or
whether this perception is a self-induced inference on the students' behalf.

This study investigated a self-reported process, in a mostly assessment and
process format. In most respects, this is an initial research inquiry into an area of
behavioral component known as self-esteem, which must be met to a state of self-
satisfaction before self-actualization can take place within an individual. Leaders,
decision-makers and inquiring minds have all reached some degree of self—

actualization. The scope for further research-studies in this area is unlimited.

120

IMPLICATIONS FOR EDUCATORS

Students' comments about their own perceptions of their self-esteem levels
usually paralleled their inventory scores. There is room for error in assuming that a
weak student has a low self-esteem or that a competent student has a high self-
esteem level. Mentioning an interest in their feelings of self-worth will encourage
identification of low levels of self-esteem, so that situations for success can be
arranged.

Comparison of inventory scores and variables, identified some risk groups.
Parenthood and adult students living with parents or spouses can affect self-
esteem levels negatively as well as positively. Once identiﬁed, students in these
situations can be introduced to others for support. This can be carried out formally
or informally.

The responses of teachers, peers and co-workers to each student's
attitudes, behaviors and appearance could also have an impact on the student's
self-esteem levels. Accept the student as wanting to learn, while remembering that
not all students want to work to one hundred percent may also be helpful. Many
are satisfied with a passing grade. Find areas to praise and when criticism is
called for, focus on criticizing the act, not the person. Offer suggestions for
altemative behaviors or refer to counselling.

Structure opportunities for success. Students who have previously
experienced failure will respond with a rise in self-esteem levels.

Should appearance become a problem, discussion and student input will
often maintain self-esteem. Authoritarianism and intellectual elitism on the part of
. the educator could decrease the student's level of self-esteem. Identifying and

discussing role-models with the student could also be helpful.

121

A drop in academic self-esteem may accompany financial problems. Often
the educator has the experience and the knowledge of the system, to help the
students, to help themselves.

The successful graduate is adaptable to change, can cope with
unanticipated events, interacts effectively with others, functions independently and
provides leadership. The successful educator maintains an awareness of students
in risk groups, discusses self-esteem with students and provides an environment

which nourishes increased self-esteem levels in the students.

APPENDIX A:
STANDARDS FOR DIPLOMA NURSING PROGRAMS

122

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owe-«m- Council of Regents «mum £3,332“
'0' 001.6965 Of - _ guun's Pan
Applied Arts and ﬁflffmm
Technology
Mammoun ‘
TD: Presidents

Heads of Health Sciences
Heads of Diploma Nursing and Nursing Assistant Programs

FROM: J.A. chlitsh

SUBJECT: a) Standards for Diploma Nursing Programs within
Colleges of Applied Arts and Technology

b) Standards for Nursing Assistant Programs under the
Aegis of the Ministry of Colleges and Universities

DATE: January 9. 1980

.e -

 

At the meeting of December. l979. the Council of Regents received
the Ninister's communication of December 3, 1979. containing the
announcement of the acceptance of the report and recommendations

of the Comittee of the Minister of Colleges and Universities on
Clinical Experience for Diploma Nursing, dated October I. 1979.

The Council passed a recommendation to modify the program standards
for diploma nursing programs as per Minister‘s Corrmittee recomnenda-

tions. Enclosed are the revised program standards for implementation
and reference.

The new program standards for diploma nursing programs reflect the
extension of clinical experience to 1625 hours and a requirement of
a continuous pre-graduate experience of 525 hours. along with
objectives for this component of the program.

It should be noted that program standards for both diploma nursing
and nursing assistant programs were reviewed by the Provincial “
Advisory Comittee on Nursing Education in relation to the
'Standards of Nursing Practice for Registered Nurses and Registered
Nursing Assistants“. revised by the College of Nurses of Ontario.
May 1. 1979. It was concluded that the program standards continue
to reflect the practice standards.

In view of the above. the program standards for the nursing assistant
programs remain unchanged. ”' .
The standards for diploma nursing and nursing assistant programs
continue to require that length. content. enrolment. location and
other significant aspects shall not be changed without the approval
of the Council of Regents.

124
Page 2 ...

'Criterie for the Evaluation'bf Diploma Nursing Programs and Nursing
Assistant Programs‘. and the ”Guidelines on Se ection of Faculty and
Administration fbr Diploma Nursing Programs Conducted by Colleges of
Applied Arts and Technology“. contained with the previously approved
standards. are included to complete the pertinent documentation.

Should clarification be required. please contact Regina Borowska at

965-2450.
4 ﬂ "

.Jo Ann Poglitsh
Executive Secretary

125

The total nursing experience shall include a continuous

pre- raduate experience of 525 hours (14 weeks) in the

fine

semester.which will provide for synthesis and

consolidation of previous learning and opportunities
for increasing Judment. skill and independence in a
work experience similar to that of the beginning staff
nurse.

(I) The specific objectives shall include:

(2)

(3)

- setting priorities based on individual patient
ﬂCOdSe

- planning and organizing nursing care for an
increas ng number of patients and complexity
O Car‘s

- adjusting activities to cope with unanticipated
events.

- implementing planned nursing care in a reason-
able length of time with due attention to
conservation of energy and supplies.

- developing an understanding of the interaction
of the health care team.

- developing the ability to provide direction
and_supervision of the registered nursing
assistant and others to whom the registered

enurse delegates activities.

- providing an opportunity to function
independently of the teacher.

The experience shall take place in hospitals and
of the 14 continuous weeks no fewer than 6 con-
secutive weeks shall be on one medical-surgical
unit (any age group) in a general hospital. The
placement of the student for the remainder of
the pre-graduate experience will take into con-
sideration student learning needs and the
availability of clinical resources. The student
hours shall coincide with the regular shift of '
service personnel. The student experience shall
include all tours of duty.

The experience shall be planned. supervised and
evaluated Jointly by service and educational
personnel. The day-to-day supervision of the
student shall be carried out by nursing service
personnel and college clinical teachers shall be
available or on cal for consultation.

126

The total student clinical experience is the ultimate respon-
sibility of the colleges and is planned. supervised and
evaluated by the faculty of the diploma nursing program with
the understanding that for the pre-graduate experience Joint
planning. supervision and evaluation with nursing service
personnel is a pre-requisite.

December. 1979

127

GLOSSARY OF TERMS

IDIDIILEDGE - Recall of specifics and universals.
The fact of knowing a thing. Information
acquired by study and/or experience.

UNDERSTANDING - The knowledge and ability to apply
Judgement. Implies ability to Judge
and comprehend.

SKILL - Practical knowledge in combination with
ability. Ability to use one's knowledge
effectively in doing something.
Developed or acquired ability.

EXPERIENCE - Experience selected in any nursing
laboratory in the educational institution.
the home. the comunity or the institutional
setting which provides learning opportuni-
ties specifically related to the practice

of nursing .

128

APPENDIX B:
COOPERSMITH SELF-ESTEEM INVENTORY - ADULT FORM
Permlsslon Agreement

Permlsslon Agreement Sample Items

129

  

Consulting

, /

Psychologists
Press, Inc.

SAMPLE ITEMS FOR THE

COOPERSMITH SELF-ESTEEM INVENTORY - ADULT FORM

by Stanley Coopersmith, Ph.D.

You will ﬁnd here a list of statements about feelings. If a statement describes how you usually

feel, put an X in the column ”Like Me. " If the statement does not describe how you usually
feel, put an X in the column ”Unlike Me." There are no right or wrong answers.

Like Unlike
_M¢__Me_

I. It's pretty tough to be me.

 

2. I often feel upset with my work.
3. People usually follow my ideas.
4. Most people are better liked than I am.

 

 

 

 

 

 

From Coopersmith Self-Esteem Inventory - Adult Form by Stanley Coopersmith. Copyright 1975 by Stanley
Coopersmith. Published in 1981 by Consulting Psychologists Press, Inc. All rights reserved. Further
reproduction is prohibited without the Publisher's written consent.

You may change the format of thee items to fit your needs, but the wording may not be altered. Please do
not praent these items to your readers as any kind of "mini-test." but rather- as an illustrative sample of
items from this imtnru .-ent. We have provided thee items as samples so that we may maintain control over
which itans appear in published media. This avoids an entire instrument appearing at once or in segments
which may be pieced together to form a working'instmment, protecting the validity and reliability of the
tat. Thank you for your cooperation. Consulting Psychologists Press, Inc, Permissions & Contracts
Department.

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130

 

 

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Permission Code: 1 10

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this signed Permission Agreement and payment of the Permission Fee, permission is hereby granted to you to include .
quotations from pages 2, 12, 13, and 19 of W as shown in Exhibit A within your thesis
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Students' Self-Fateem During the Pre-Graduate Consolidation Semester at Humber College of Applied Arts and
Technology'. These quotations may remain in your thesis for microﬁlming and individual copies may be distributed upon
demand. This Permission Agreement shall automatically terminate upon violation of this Permission Agreement including,
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This Permission Agreement shall be subject to the following conditions:

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(b) Any material reproduced must contain the following credit lines:

 

'chroducod by special permission of the Publisher, Consulting Psychologists Press, Inc., Palo Alto, CA 94303 from
SEI, Self-Estean Inventories by Stanley Coopersmith. Copyright 1981 by Stanley Coopersmith Published in 1981 by
Consulting Psychologists Press, Inc. All rights reserved. Further reproduction is prohibited without the Publisher's
consent.“

 

(c) None of the materials may be sold or used for purposes other than those mentioned above, including, but not
limited to, any commercial or for-proﬁt use. Commercial and/or for proﬁt use of the SE1 and/or any
modiﬁcation of the SE is speciﬁcally excluded from the permission granted herein.

(d) CPP subscribes to the general principles of test use as set forth in the Standards for Educational and
hydrological Testing Copyright 1985 by the American Psychological Association. The customer's/user's
attention is drawn to the following statements:

I"Ihetestuscr,irrselectingorimerprlctingattest,shouldknowthepur'posettofthefrostingaradtheprobahleconsequences.
The usershmddknowdreprocedureenecesurybfacﬂihteeﬁecﬁvcnessandbnduce biasintcstuse. Although thetest
developcrandpublidter mould provide informationonthe strengthssndwcakncsscs of memmeultimatereeponsibility for
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alsooomrmrmcate‘ thismformataon' ‘ ,asappropriate,toothcrs.

6.1 Test users shoal i evaluate the available written documentation on the validity and reliability of tests for the speciﬁc use

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131

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ormisuseofCPPmateﬁalsandservicesandinnoeventshallCPPliabilityexceedthecontr-actfeesoflicenseof
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hereby assigns all right, title, and interest in any such derivative work created under this Permission Agreement in
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Date 6%."): \A «a:

132

,/

 

 

 

 

 

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( ,r Psychologists
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’ Sandy new... PERMISSION AGREEMENT FOR
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Islington, Ontario M98 4157 Asreunmt Issued: October 5.13993
Cumin Cmtomer Number: '6"; 75¢.
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Permission Code: 1710

In response to your request of September 19, 1993, upon concurrent receipt by Consulting Psychologists Press, Inc. , of
this signed Permission Agreement and payment of the Permission Fee, permission is hereby granted to you to include
sample items, selected and provided by Consulting Psychologists Press, Inc. from the Coopersmith Self-Esteem
Inventory - Adult Form (CSEIA) in your thesis entitled "A Comparison of the Perceptions of Nursing Diploma Students
and Preceptors with Respect to Levels of Students' Self-Esteem During the Pre-Graduate Consolidation Semester at
Humber College of Applied Arts and Technology". These items may remain in your thesis for microﬁlming and
individual copies may be distributed upon demand. This Permission Agreement shall automatically terminate upon
violation of this Permission Agreement including, but not limited to, failure to pay the Permission Fee of m
m or by failure to sign and return this Permission Agreement within 45 days from October 5, 1993.

The permission granted hereunder- is limited to this one-time use only.
The permission granted hereunder is speciﬁcally limited as speciﬁed in this agreanent.

This Permission Agreement shall be subject to the following conditions:

(a) Any material reproduced must be used in accordance with the guidelines of the American Psychological
Association.

(b) Any material reproduced must contain the following credit lines:

 

'Reproduced by special permission of the Publisher, Consulting Psychologists Press, Inc., Palo Alto, CA 94303 from
Coopermrith Self-Estean Inventory - Adult Form by Stanley Coopersmith. Copyright 1975 by Stanley Coopersmith

 

Published in 1981 by Consulting Psychologists Press, Inc. All rights reserved. Further reproduction is prohibited without
the Publisher's consent. '

(c) None of the materials may be sold or used for purposes other than those mentioned above, including, but not
limited to, any commercial or for-proﬁt use. Commercial and/or for proﬁt use of the CSEIA and/or any
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I AGREE TO THE ABOVE CONDITIONS

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134

APPENDIX C:
INTERVIEW CONSENT

 

 

135

MICHIGAN STATE UNIVERSITY Winter Semester 1993

INTERVIEW CONSENT Nursing Diploma Program
Health Sciences Division
Humber College of Applied
Arts and Technology

The purpose of this Interview Is to collate information and
insights from the Humber College Nursing Diploma students and their
preceptors around their perceptions of self-esteem levels during the
pre-graduate consolidation semester of the Nursing Diploma program.

I volunteer to freely participate in this interview. I understand that I may
choose to retract my participation, may refuse to respond to any question and may
discontinue the interview at any time.

It is understood that all results will be treated with strict confidence, that
participants will remain anonymous in any report or research findings, and that
upon request, within these restrictions, results may be made available to
participants.

I understand that if I have any questions or require further instructions or
information that I may contact:

My signature indicates my voluntary agreement to participate in this

interview process.

 

 

Name Date

 

 

Hospital Floor, Level or Unit

 

 

136

APPENDIX D:

PREGRADUATE CONSOLIDATION STUDENT
VARIABLES FORM

 

 

137

Pregraduate Consolidation Student
Variables Form

* My selected code number is / / / I

SocIo-Psychological Variables:

1.

After graduation, my goals for the future will include :

 

 

 

 

 

 

 

 

 

 

 

 

2. At this time, I feel that the Humber College Nursing Diploma Program
will have adequately prepared me for my desired future occupation(s).
Agree: Disagree:
3. At this time, I feel that I have adequate control over my present and
my future.
Agree: Disagree:
Comments ?
Performance Variables:
4. Before joining the nursing diploma program, I was:

a) employee full-time at:

 

b) a full or part-time student at/of:

 

c) did not attend school or work for a salary:

 

 

 

 

 

138

Pregraduate Consolidation Student
Variables Form

5. During this program I have written a supplemental exam or repeated
a semester.

Yes: No:

 

 

6. I expect to have worries about finances between now
and graduation.

Yes: No:

 

Comments ?

 

 

 

 

Environmental Variables:

7. I live with:
a) a spouse or significant other:
b) a child or children:
0) a room-mate:
d) parents:
e) other.

 

 

 

 

 

8. I intend to take a part-time, evening or sessional course, this semester.

Yes: No:

 

 

 

 

 

139

Pregraduate Consolidation Student
Variables Form

9. I will be working for salary, part-time during this semester.

Yes: No:

 

 

I estimate that I will be employed hours per week.

 

Comments ?

 

 

 

 

Input Variables:

10. I obtained my previous education at:

 

 

11. I am: Male Female

 

 

12. My age is:

 

13. My ethnic background is:
(Please note: Canadian is a satisfactory choice if you wish
to use that designation)

 

Comments ?

 

 

 

 

I think that this should help me to
categorize background variables.

Thanks so much. Sandy

 

 

140

APPENDIX E:
PRECEPTOR INTERVIEW

 

 

141

PRECEPTOR INTERVIEW

W

During the months of January to April 1993, the Humber College pre-graduate nursing
students ﬁlled out questionnaires and interview data sheets, providing information and insights
related to their perceptions of their self-esteem levels.

This information is the basis of a Ph.D. dissertation that I am producing with the support and
approval of Humber College, under the guidance and direction of the Department of Education
Administration at Michigan State University. The proposal has been reviewed by and received
approval of the University Committee on Research Involving Human Subjects.

The students of each hospital that Humber College has contracts with, signed interview consent
forms, (the results will remain anonymous when reported), and they have indicated that
preceptor and staff comments could be included.

Thank you,
Sandy Leadbeater

Throughout the January to April 1993 period:

1. Did you notice any changes in the student's reactions to receiving assignments and to
staff and/or patient requests? For better or worse?

2. Did the student ever convey the attitude that being a team-player was a "bother"? Early
on? Throughout? Toward the rotation's end?

3. Was there any improvement in the student's ability to adjust to changes and to make
decisions?

4. Did the student(s) project a ”Good feeling” about themselves, their actions, their
attitudes, their appearance, their self-esteem? Early on? Throughout? Toward the
rotation's end?

5. Did the student(s) ”ﬁt-in" well with staff and/or other students? Early on?

Throughout? Toward the rotation's end?

6. Did the student(s) seem comfortable when talking about home, family and future plans?
Early on? Throughout? Toward the rotation's end?

7. .Did the student(s) share their degree of comfort or fears about ongoing school exams?
The R.N.'s? Documenting and charting appropriately and legally? Future schooling?

. Please, feel free to add your own comments .....

 

 

 

 

142

APPENDIX F:
UCRIHS APPROVAL

143

MICHIGAN STATE UNIVERSITY

 

OFFICE OF VICE PRESIDENT TOR RESEARCH EAST LANSING 0 MICHIGAN 0 «824-1066
AND DEAN Of THE GRADUATE SCHOOL

December 30. 1992

TO: Ms. Sandy Leadbeater
30 Jopling Avenue. North
Islington, Ontario M98 4E7

CANADA
RE: IRB I: 92-619
TITLE: A COMPARISON OF THE PERCEPTIONS OF NURSING DIPLOMA STUDENT S

AND PRECEPTORS WITH RESPECT TO LEVELS OF STUDENTS’ SELF-ESTEEM
DURING THE PRE-GRADUATE CONSOLIDATION SEMESTER AT HUMBER
COLLEGE OF APPLIED ARTS AND TECHNOLOGY

CATEGORY: 2-l

REVISION REQUESTED: NIA

APPROVAL DATE: December 23, 1992

The University Committee'on Research Involving Human Subjects‘ (UCRIHS) review of this project is complete.
I am pleased to advise that the rights and welfare of the human subjects appear to be adequately protected and
methods to obtain informed consent are appropriate. Therefore, the UCRIHS approved this project including any
revision listed above.

UCRIHS approval is valid for one calendar year, beginning with the approval date shown above. Investigators
planning to continue a project beyond one year must seek updated certification. Request for renewed approval must
be accompanied by all four of the following mandatory assurances.

l. The human subjects protocol is the same as in previous studies.

2. There have been no ill effects suffered by the subjects due to their participation in the study.

3. There have been no complaints by the subjects or their representatives related to their participation in the
study.

4. There has not been a change in the research environment nor new information which would indicate greater

risk to human subjects than that assumed when the protocol was initially reviewed and approved.

There is a maximum of four such expedited renewals possible. Investigators wishing to continue a project beyond
that time need to submit it again for complete review.

UCRIHS must review any changes in procedures involving human subjects, prior to initiation of the change.
Investigators must notify UCRIHS promptly of any problems (unexpected side effects, complaints, etc.) involving
human subjects during the course of the work.

Ifwe can be of any future help, please do not hesitate to contact us at (517) 355-2180 or FAX (517) 336-1171.

Sincerely,
David E. Wright. Ph.D.wé

UCRIHS Chair

  
 

DEW:pjm

cc: Dr. Louis Hekhuis
MSU is an Afﬁrmative Action IEqaal Opporraairy lurirurion

144

APPENDIX G:
IDENTIFIED STUDENT GROUPING DATA

145

GENERAL SELF-ESTEEM

 

|°'-January *April 1

 

 

17 19 21 23 25

11 13 15
NumberofStudents

SOCIAL SELF-ESTEEM

 

I'“January *April

 

 

 

5
4 f- a
3... a a » « . I—I a . . a—aw—A
V
I

1.. C .I a I
0i'rfili'rii‘riiliiiiﬁiifi‘ri

1 3 5 15 17 19 21 23 25

11 13
NumberofStudents

146

HOME-PARENTS-FAMILY SELF-ESTEEM

 

I ...an gm. I

 

 

6 . I . f.-
5 ‘ I a . a
3 .
2 . . II
1 II
0 .
9 11 13 15 17 19 21 23 25
NumberofStudents

ACADEMIC SCHOOL SELF-ESTEEM

 

°'- January ‘A' April

 

2‘ DWIII—I ..a—a

 

O- . I

1 3 5 7 9 11 15 17 19 21 23 25

13
Number of Students

BIBLIOGRAPHY

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Brown, S. T., Faculty and Student Perceptions of Effective Clinical Teachers,

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Burgess, Gloria, R. N. Ph. D., The Self-Concept of Undergraduate Nursing Students
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Undergraduate Nursing Students, AW, Vol. 81, pp.
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Choudry, Ushi, Values Can Differ Greatly With Students, W, The
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Coopersmith, Stanley, PhD. WWW Consulting
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Coopersmith, Stanley, W, W.H. Freeman and Co.,
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Ellis, Lois S., An Investigation of Nursing Student Self-Concept Levels: A Pilot
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Fitzsimons, V.M., Value of Positive Self-Esteem, Wins. Vol. 2 (2)
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Freud, Anna, WW lntemational Universities
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' , Volume 19, The Hogarth Press and
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Merrill Publishing Company, Columbus, Ohio, 1987.

Gergan, Kenneth J., W, Holt, Rinehart and Winston, Inc., New
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Goble, Frank, ID8181313282. Grossman, New York, 1970.

Greenleaf, Nancy R, The Politics of Self-Esteem, W Vol. 6, No. 3, Fall
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Gunter, L.M., The Developing Nursing Student: A Study of Self-Actualization
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Hall, Sarah F, Wray, Linda M, Codependency Nurses Who Give Too Much,
AWLQLNMLSIDQ pp 1456-1460 Nov 1989

Hamachek, Don E., WWII. Fort Worth, Harcourt Brace
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