An exploration of students’ personal constructs: Implications for clinical teaching in psychiatric mental health nursing
Citation
Melrose, S. (1998). An exploration of students’ personal constructs: Implications for clinical teaching in psychiatric mental health nursing. Unpublished PhD dissertation, 1998, University of Calgary, Alberta, Canada.
Abstract
Despite revolutionary rhetoric in the nursing education literature calling for collaborative student centered learning, few opportunities actually exist, particularly in the psychiatric clinical teaching area, to include the voices of student nurses in the scholarly dialogue surrounding their learning. Тhis thesis was designed to understand students’ own ways of knowing during their six-week mental health practicums оп acute hospital units. А constructivist conceptual perspective and George Kelly’s personal construct psychology аrе the theoretical bases of the research. Qualitative methodology using the case study approach was used to describe the experiences of six Canadian second уеаr nursing students from their own perspectives. Data sources included before and after repertory grids, а questionnaire and audiotape-recorded transcribed interviews. Content was theme analyzed, Vее Heuristic diagramed and concept mapped. The case studies were written collaboratively with students and member checking by correspondence six months after the practicum ended confirmed that the reports authentically narrated the personal construct changes which occurred, or did not occur, as а result of the course. Тhe study spanned three years, included а pilot project and incorporated the resulting student “stories” intо а clinical curriculum. Тhе case reports are snapshot portrayals of how student nurses construed the professional activities they observed оп hospital units which recently underwent organizational changes. Тhey reflect human faces bеhind the paradigm shifts occurring in nursing education and health carе. Тhе following four overarching themes represent key findings. Тhe research аррrоасh invited constructivist teaching. Students’ anxiety related more to fееling unable to help than to mentally ill patients. Students felt а lack of inclusion in staff nurse groups. Non evaluated student-instructor discussion time was vitally important. Suggestions for clinical teaching strategies are made to assist instructors in the selection of experiences which саn help link university curricula to hospital practicum sites. The research contributes to the conceptualization of how students learn nursing by re-valuing what they bring to clinical experiences, by increasing understanding of what students find engaging or difficult and bу developing а pedagogical mode of inquiry which extends clinical instruction beyond demonstration and evaluation to creating а space for student perceptions.
TABLE OF CONTENTS
CHAPTER ONE: INTRODUCTION AND PROBLEM …………………………………………………………… 1
Purpose Questions and Significance………………………………………………………………………….. 1
The Organization of the Study…………………………………………………………………………………. 4
Personal Connections to the Research ………………………………………………………………………. 6
A Constructivist Conceptual Perspective …………………………………………………………………. 10
Overview of Personal Construct Theory……………………………………………………………………. 13
George Kelly………………………………………………………………………………………… 13
Fundamental Postulate and Corollaries…………………………………………………………. 14
Personal Construct Theory in Psychotherapy …………………………………………………. 17
Personal Construct Theory in Higher Education………………………………………………. 18
Summary……………………………………………………………………………………………………….. 21
CHAPTER TWO: REVIEW OF RELEVANT NURSING EDUCATION LITERATURE 22
SECTION ONE: CLINICAL TEACHING………………………………………………………………… 22
Sociohistorical Perspective……………………………………………………………………….. 23
The Nature of Psychiatric Nursing……………………………………………………………….. 33
The Role of the Psychiatric Nurse………………………………………………………………… 39
The View of Clinical Teaching From the Perspective of Faculty…………………………………………………………………………… 42
The View of Clinical Teaching From the
Perspective of Students…………………………………………………………………………. 46
Anxiety……………………………………………………………………………………… 46
Evaluation …………………………………………………………………………………. 47
Unacknowledged Learning…………………………………………………………………… 49
Research in the Psychiatric Mental Health Clinical Area……………………………………… 51
SECTION TWO: PERSONAL CONSTRUCT THEORY ……………………………………………. 54
Community Psychiatric Nurses………………………………………………………………….. 55
Nursing Administrators……………………………………………………………………………. 56
Nurses and Social Workers ………………………………………………………………………. 57
Novice Nurses……………………………………………………………………………………….. 58
Nursing Students…………………………………………………………………………………… 59
Post Basic Programs ……………………………………………………………………….. 59
Basic Programs……………………………………………………………………………… 60
Summary……………………………………………………………………………………………………….. 65
CHAPTER THREE: RESEARCH DESIGN AND PROCEDURES 67
Introduction………………………………………………………………………………………………………. 67
The Repertory Grid Technique……………………………………………………………………………….. 69
Stage One: Construction of Grids ………………………………………………………………… 71
Elements………………………………………………………………………………………. 71
Personal Constructs……………………………………………………………………………. 72
Stage Two: Dichotomizing. Rating or Ranking Elements…………………………………….. 74
Stage Three: Analysis ……………………………………………………………………………… 75
The Pilot Study ……………………………………………………………………………………………….. 76
Sample Selection……………………………………………………………………………………………….. 81
Research Methodology………………………………………………………………………………………… 82
The Interviews……………………………………………………………………………………….. 82
Member Checking by Correspondence……………………………………………………………. 87
Data Analysis …………………………………………………………………………………………………. 89
A Naturalistic Case Study Design…………………………………………………………………. 89
Rigor Procedures which Enhance the Authenticity and Credibility of the Work …. 91
Truth Value, Applicability, Consistency and Neutrality……………………………………………… 91
Validity and Reliability…………………………………………………………………………… 94
Diagraming a Vee Heuristic ……………………………………………………………………… 100
Data Sources Used in the Construction of the Case Reports…………………………………. 104
Comparing Before and After Repertory Grids………………………………….. 104
Analyzing and Benchmarking Perese’s (1996)
Questionnaire Responses……………………………………………………………………. 105
Audiotape-Recorded and Transcribed Interviews………………………………………………… 106
Developing Concept Maps…………………………………………………………………………. 108
The Emergence of Themes………………………………………………………………………… 110
Constructing Collaborative Case Study Reports………………………………………………. 116
Ethical Considerations……………………………………………………………………………………….. 117
Type of Participants and Age Range…………………………………………………………….. 117
Specifics of the Group …………………………………………………………………………….. 117
Recruitment of Participants……………………………………………………………………….. 118
Informed Consent…………………………………………………………………………………… 118
Risks to Participants………………………………………………………………………………. 119
Anonymity of Participants………………………………………………………………………… 119
Ultimate Disposal of Records…………………………………………………………………….. 119
Summary diagram: Features in the Process of Constructing the Case Study Reports……………….. 121
CHAPTER FOUR: THE SIX COLLABORATIVE CASE STUDY REPORTS 122
Linking Analysis. Interpretation and the Assessment of Authenticity
with the Epistemological Stance of the Research……………………………………………………… 122
The Organization of the Case Study Reports……………………………………………………………… 123
Case Repent I: Sandra………………………………………………………………………………………… 126
Sandra — The Independent Learner…………………………………………………………………….. 126
“Completely unprepared”……………………………………………………………… 128
The many sides of evaluation………………………………………………………… 131
Questions……………………………………………………………………………….. 132
Personal Construct Changes and Reflections — Discussion………………………………………………. 136
Case Report II: Nathan……………………………………………………………………………………….. 144
Nathan — The Team Player……………………………………………………………………………. 144
The value of instructor, peers and patients……………………………………………. 145
Disturbing staff role models…………………………………………………………….. 147
Personal Construct Changes and Reflections — Discussion……………………………………………….. 150
Case Report III: Simone……………………………………………………………………………………… 153
Simone — The Caring Friend…………………………………………………………………………. 153
Lack of curriculum preparation and a closed staff group……………………………. 154
Meaningful discussions with a friend…………………………………………………. 156
Personal Construct Changes and Reflections — Discussion……………………………………………….. 160
Case Report IV Heather………………………………………………………………………………………. 163
Heather — The Novice Psychiatric Nurse………………………………………………………………… 163
Personal and professional growth……………………………………………………… 165
Reflective time…………………………………………………………………………… 168
Personal Construct Changes and Reflections — Discussion………………………………………………. 172
Case Report V: Beth………………………………………………………………………………………….. 176
Beth — The Professional……………………………………………………………………………….. 176
A well-read self directed student………………………………………………………. 176
“Pro-counseling” background and beliefs……………………………………………. 179
“Limited guidelines”…………………………………………………………………… 180
Exhaustioa………………………………………………………………………………. 182
Instructor time…………………………………………………………………………… 184
Personal Construct Changes and Reflections — Discussion……………………………………………….. 187
Case Report VI: Casandra…………………………………………………………………………………… 191
Casandra — The Gentle Helper………………………………………………………………………… 191
Thorough preparation…………………………………………………………………… 192
Personal insights………………………………………………………………………… 193
Painful memories……………………………………………………………………….. 196
Personal Construct Changes and Reflections — Discussion……………………………………………….. 202
CHAPTER FIVE; IMPLICATIONS OF THE STUDY…………………………………………………………… 206
Reflecting on the Research Approach: Listening to the Students’ Voices……………………………… 206
A Fresh View of Clinical Teaching……………………………………………………………………………. 208
Sandra’s experience: Engaging an independent learner…………………………………….. 209
Nathan’s experience: Facilitating inclusion within the learning group………………….. 210
Simone’s experience: Recognizing a learning partnership………………………………… 211
Heather’s experience: Enhancing motivation……………………………………………….. 212
Beth’s experience: Challenging a strong student…………………………………………… 213
Casandra’s experience: Caring for a student caregiver……………………………………… 214
Students’ Responses to the “Stories”………………………………………………………………………….. 217
Four Overarching Themes of the Case Reports…………………………………………………………………. 219
Theme One: The research approach: An invitation to constructivist teaching…………. 219
Theme Two: Anxiety related more to feeling unable to help than to mentally ill patients……………………………………………………………………………………. 220
Theme Three: The lack of feeling included as a part of the staff group………………….. 222
Theme Four: The vital importance of non-evaluated student-instructor discussion time……………………………………………………………………………… 224
Reconstructing Clinical Teaching From a Student Centered Perspective……………………………… 227
Towards a Curriculum which Includes the Voices of Student Nurses in the Scholarly
Dialogue Surrounding their Learning………………………………………………………………………. 228
Suggestions for Clinical Teaching Strategies……………………………………………………………………. 230
Area one: Organizing information…………………………………………………………….. 231
Area two: Creating a climate for listening and speaking about experiences…………….. 235
Area three: Ensuring time for reflections and formulating questions……………………… 237
Future Research……………………………………………………………………………………………… 238
In Endings there are Beginnings………………………………………………………………………………. 239
REFERENCES ………………………………………………………………………………………………………… 241
APPENDIX 1: List of Elements or Nurses’ Activities…………………………………………………………….. 257
APPENDIX 2: Personal Constructs Form (Shapiro. 1991)……………………………………………………….. 258
APPENDIX 3: Students’ Perceptions of Their Psychiatric/Mental Health Nursing Practicum
(Perese. 1996)…………………………………………………………………………………… 259
APPENDIX 4: Letter of Introduction…………………………………………………………………………………. 260
APPENDIX 5: Participant Consent Form……………………………………………………………………………. 261
APPENDIX 6: Confidmtiality Pledge………………………………………………………………………………… 264
APPENDIX 7: Concept Map: DISABLING MENTAL DISORDERS………………………………………….. 265
APPENDIX 8: Concept Map: COMMON PSYCHIATRIC DRUGS……………………………………………. 266
LIST OF FIGURES
Figure 1. Vee Heuristic Diagram…….. 103
Figure 2. Summary Diagram: Features in the Process of Constructing the Case Study Reports…….. 121
Figure 3. Repertory Grid illustrating Sandra’s Personal Construct Changes…….. 135
Figure 4. Concept Map: Sandra’s Personal Constructions of Psychiatric Mental Health Nursing Activities… 143
Figure 5. Repertory Grid illustrating Nathan’s Personal Construct Changes…….. 149
Figure 6. Concept Map: Nathan’s Ratings of his Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 152
Figure 7. Repertory Grid illustrating Simone’s Personal Construct Changes…….. 159
Figure 8. Concept Map: Simone’s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 162
Figure 9. Repertory Grid illustrating Heather’s Personal Construct Changes…….. 171
Figure 10. Concept Map: Discussing Heather’s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 175
Figure 11. Repertory Grid illustrating Beth’s Personal Construct Changes…….. 186
Figure 12. Concept Map: Discussing Beth’s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 190
Figure 13. Repertory Grid illustrating Casandra’s Personal Construct Changes…….. 201
Figure 14. Concept Map: Discussing Casandra’s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 205
CHAPTER ONE
INTRODUCTION AND PROBLEM
Purpose, Questions and Significance
This thesis is a naturalistic study which explored students’ ideas about mental health nursing. The research emphasized the importance of incorporating students’ perceptions into nursing education. The investigation uses a case study design. The main purpose of the research was to investigate how student nurses develop personally meaningful constructs during their psychiatric mental health clinical rotation. A secondary purpose of the study was to examine the role that personal construct theory can play in the learning/development process.
Three questions guide the research. First, how do student nurses construe professional staff activities? Second, what changes, if any, do student nurses perceive in their personal ways of knowing about mental health nursing? Third, does the construction and discussion of a repertory grid help student nurses to articulate what they learn?
A constructivist conceptual perspective undergirds the project. In a constructivist approach to learning, the individual is viewed not as a passive recipient of knowledge, but as an active constructor of meaning (Shapiro, 1994).
Personal construct theory is an outgrowth of a constructivist world view and lends itself to exploration and inquiry in complex interactive situations. The techniques involved in the use of repertory grids or repgrids logically derive from the theory (Costigan, 1985; Pollock, 1986; Rawlinson, 1995). According to Bannister and Fransella (1971) “personal construct theory is elegant in its formal logic, precise in its methodological implications and rich in its imagination” (p.10).
George Kelly’s (1955/1991) theory of personal construct psychology provides a framework for understanding self and the perceptions of others. Costigan (1987) described the essential aspects of the theory as follows.
The fundamental postulate of Kelly’s theory states that “a person’s processes are psychologically channelized by the way in which he anticipates events” (Kelly, 1955). This means that individuals choose to interpret or form constructions of events in ways which are most meaningful for them. Personal constructs are “templets of reality” (Kelly, 1955) or categories of thought which determine subsequent expectations and behavior. The meaning of events is ascribed within the context of those events. Constructs form patterns of reality which may be unique according to the Individuality corollary,; shared by a group according to the Commonality corollary; understood by others according to the Sociality corollary, or even inconsistent according to the Fragmentation corollary. Constructs are chosen because they are the most meaningful in a given situation according to the Choice corollary. Once chosen they are tested in the light of experience according the Experience corollary and can be consolidated, modified or elaborated in the process of personal development according to the Modulation corollary. The individual’s idiosyncratic construct system must be seen to be firm to prevent anxiety or chaos. Constructs which are preemptive (‘nothing but’ type construing) or constellatory (‘stereotyped or typological thinking’) serve to keep the system tight and impermeable (Costigan, 1987).
In the field of nursing education, there is a paucity of current research in the area of psychiatric mental health clinical teaching. This study makes a contribution to this literature and is significant in four ways. First, it provided in-depth insight into the current learning needs of participating student nurses. Second, it informed practice in terms of recommending collaborative nursing educational experiences from a personal construct theory approach. Third, this research suggested important changes in our understanding of clinical teaching in psychiatric mental health rotations. Fourth, publications extending from this study will contribute a Canadian perspective to the developing body of international literature linking personal construct theory and nursing education.
The project provides a detailed description of learning in one local nursing program. The study emphasized the importance of discovering personal meaning as opposed to an assumption of universal meaning, and therefore limited generalization is warranted.
Finally, two key areas of research in nursing education are pertinent to this study—clinical teaching and personal construct theory. It was the objective of this investigation to weave a common thread between these two research strands in order to provide students, educators and practitioners with insights into student nurses’ ways of knowing in mental health nursing. The heart of the project involved listening to the students themselves and collaborating with them to create a meaningful report of their experiences.
Given the above, in this thesis, I argue for the importance of the inclusion of student voices in the scholarly dialogue surrounding their learning. In order to accomplish this aim, the research is arranged into five chapters. The following section outlines the organization of this project.
