{"id":138,"date":"2020-11-19T04:40:06","date_gmt":"2020-11-19T09:40:06","guid":{"rendered":"https:\/\/on-linelearning.ca\/sherrimelrosepublications\/chapter\/an-exploration-of-students-personal-constructs-implications-for-clinical-teaching-in-psychiatric-mental-health-nursing\/"},"modified":"2020-11-19T04:40:06","modified_gmt":"2020-11-19T09:40:06","slug":"an-exploration-of-students-personal-constructs-implications-for-clinical-teaching-in-psychiatric-mental-health-nursing","status":"publish","type":"chapter","link":"https:\/\/on-linelearning.ca\/sherrimelrosepublications\/chapter\/an-exploration-of-students-personal-constructs-implications-for-clinical-teaching-in-psychiatric-mental-health-nursing\/","title":{"raw":"An exploration of students' personal constructs: Implications for clinical teaching in psychiatric mental health nursing","rendered":"An exploration of students’ personal constructs: Implications for clinical teaching in psychiatric mental health nursing"},"content":{"raw":"\n[caption id=\"attachment_1589\" align=\"alignnone\" width=\"187\"]\"An<\/a> [PDF - 14.1 MB][\/caption]\n
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Citation<\/p>\n\n<\/header>\n

\n\nMelrose, 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 Unpublished PhD dissertation, 1998, University of Calgary, Alberta, Canada.\n\n<\/div>\n<\/div>\n
\n

Abstract<\/p>\n\n<\/header>\n

\n\nDespite 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. \u0422his thesis was designed to understand students' own ways of knowing during their six-week mental health practicums \u043e\u043f acute hospital units. \u0410 constructivist conceptual perspective and George Kelly's personal construct psychology \u0430r\u0435 the theoretical bases of the research. Qualitative methodology using the case study approach was used to describe the experiences of six Canadian second \u0443\u0435\u0430r nursing students from their own perspectives. Data sources included before and after repertory grids, \u0430 questionnaire and audiotape-recorded transcribed interviews. Content was theme analyzed, V\u0435\u0435 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 \u0430 result of the course. \u0422he study spanned three years, included \u0430 pilot project and incorporated the resulting student \"stories\" int\u043e \u0430 clinical curriculum. \u0422h\u0435 case reports are snapshot portrayals of how student nurses construed the professional activities they observed \u043e\u043f hospital units which recently underwent organizational changes. \u0422hey reflect human faces b\u0435hind the paradigm shifts occurring in nursing education and health car\u0435. \u0422h\u0435 following four overarching themes represent key findings. \u0422he research \u0430\u0440\u0440r\u043e\u0430\u0441h invited constructivist teaching. Students' anxiety related more to f\u0435\u0435ling unable to help than to mentally ill patients. Students felt \u0430 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 \u0441\u0430n 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 b\u0443 developing \u0430 pedagogical mode of inquiry which extends clinical instruction beyond demonstration and evaluation to creating \u0430 space for student perceptions.\n\n<\/div>\n<\/div>\n

TABLE OF CONTENTS<\/h1>\nCHAPTER ONE: INTRODUCTION AND PROBLEM ..................................................................... 1\n

Purpose Questions and Significance...................................................................................... 1<\/p>\n

The Organization of the Study.............................................................................................. 4<\/p>\n

Personal Connections to the Research .................................................................................. 6<\/p>\n

A Constructivist Conceptual Perspective ............................................................................ 10<\/p>\n

Overview of Personal Construct Theory............................................................................... 13<\/p>\n

George Kelly...................................................................................................... 13<\/p>\n

Fundamental Postulate and Corollaries................................................................... 14<\/p>\n

Personal Construct Theory in Psychotherapy .......................................................... 17<\/p>\n

Personal Construct Theory in Higher Education....................................................... 18<\/p>\n

Summary....................................................................................................................... 21<\/p>\nCHAPTER TWO: REVIEW OF RELEVANT NURSING EDUCATION LITERATURE                        22\n\nSECTION ONE: CLINICAL TEACHING........................................................................... 22\n

Sociohistorical Perspective................................................................................... 23<\/p>\n

The Nature of Psychiatric Nursing.......................................................................... 33<\/p>\n

The Role of the Psychiatric Nurse........................................................................... 39<\/p>\n

The View of Clinical Teaching From the Perspective of Faculty....................................................................................... 42<\/p>\n

The View of Clinical Teaching From the<\/p>\n

Perspective of Students..................................................................................... 46<\/p>\n

Anxiety................................................................................................... 46<\/p>\n

Evaluation .............................................................................................. 47<\/p>\n

Unacknowledged Learning.............................................................................. 49<\/p>\n

Research in the Psychiatric Mental Health Clinical Area............................................. 51<\/p>\nSECTION TWO: PERSONAL CONSTRUCT THEORY .................................................... 54\n

Community Psychiatric Nurses............................................................................. 55<\/p>\n

Nursing Administrators........................................................................................ 56<\/p>\n

Nurses and Social Workers .................................................................................. 57<\/p>\n

Novice Nurses..................................................................................................... 58<\/p>\n

Nursing Students................................................................................................ 59<\/p>\n

Post Basic Programs ................................................................................... 59<\/p>\n

Basic Programs.......................................................................................... 60<\/p>\nSummary....................................................................................................................... 65\n\nCHAPTER THREE: RESEARCH DESIGN AND PROCEDURES                        67\n\nIntroduction...................................................................................................................... 67\n\nThe Repertory Grid Technique............................................................................................ 69\n

Stage One: Construction of Grids ........................................................................... 71<\/p>\n

Elements.................................................................................................... 71<\/p>\n

Personal Constructs........................................................................................ 72<\/p>\n

Stage Two: Dichotomizing. Rating or Ranking Elements............................................ 74<\/p>\n

Stage Three: Analysis .......................................................................................... 75<\/p>\nThe Pilot Study .............................................................................................................. 76\n\nSample Selection.............................................................................................................. 81\n\nResearch Methodology...................................................................................................... 82\n

The Interviews..................................................................................................... 82<\/p>\n

Member Checking by Correspondence...................................................................... 87<\/p>\nData Analysis ................................................................................................................  89\n

A Naturalistic Case Study Design............................................................................ 89<\/p>\n

Rigor Procedures which Enhance the Authenticity and Credibility of the Work .... 91<\/p>\n

Truth Value, Applicability, Consistency and Neutrality...................................................... 91<\/p>\n

Validity and Reliability....................................................................................... 94<\/p>\n

Diagraming a Vee Heuristic ................................................................................. 100<\/p>\n

Data Sources Used in the Construction of the Case Reports........................................ 104<\/p>\n

Comparing Before and After Repertory Grids......................................... 104<\/p>\n

Analyzing and Benchmarking Perese's (1996)\nQuestionnaire Responses............................................................................... 105<\/p>\n

Audiotape-Recorded and Transcribed Interviews......................................................... 106<\/p>\n

Developing Concept Maps..................................................................................... 108<\/p>\n

The Emergence of Themes.................................................................................... 110<\/p>\n

Constructing Collaborative Case Study Reports....................................................... 116<\/p>\nEthical Considerations..................................................................................................... 117\n

Type of Participants and Age Range....................................................................... 117<\/p>\n

Specifics of the Group ......................................................................................... 117<\/p>\n

Recruitment of Participants................................................................................... 118<\/p>\n

Informed Consent................................................................................................ 118<\/p>\n

Risks to Participants........................................................................................... 119<\/p>\n

Anonymity of Participants.................................................................................... 119<\/p>\n

Ultimate Disposal of Records................................................................................ 119<\/p>\nSummary diagram: Features in the Process of Constructing the Case Study Reports.................... 121\n\nCHAPTER FOUR: THE SIX COLLABORATIVE CASE STUDY REPORTS                        122\n\nLinking Analysis. Interpretation and the Assessment of Authenticity\nwith the Epistemological Stance of the Research............................................................... 122\n\nThe Organization of the Case Study Reports........................................................................ 123\n\nCase Repent I: Sandra...................................................................................................... 126\n

Sandra \u2014 The Independent Learner................................................................................ 126<\/p>\n

\u201cCompletely unprepared\u201d........................................................................ 128<\/p>\n

The many sides of evaluation.................................................................. 131<\/p>\n

Questions............................................................................................ 132<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion....................................................... 136<\/p>\nCase Report II: Nathan..................................................................................................... 144\n

Nathan \u2014 The Team Player........................................................................................ 144<\/p>\n

The value of instructor, peers and patients.................................................... 145<\/p>\n

Disturbing staff role models....................................................................... 147<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion........................................................ 150<\/p>\nCase Report III: Simone................................................................................................... 153\n

Simone \u2014 The Caring Friend..................................................................................... 153<\/p>\n

Lack of curriculum preparation and a closed staff group.................................. 154<\/p>\n

Meaningful discussions with a friend.......................................................... 156<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion........................................................ 160<\/p>\nCase Report IV Heather.................................................................................................... 163\n

Heather \u2014 The Novice Psychiatric Nurse........................................................................... 163<\/p>\n

Personal and professional growth............................................................... 165<\/p>\n

Reflective time....................................................................................... 168<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion....................................................... 172<\/p>\nCase Report V: Beth........................................................................................................ 176\n

Beth \u2014 The Professional............................................................................................ 176<\/p>\n

A well-read self directed student................................................................ 176<\/p>\n

\u201cPro-counseling\u201d background and beliefs.................................................... 179<\/p>\n

\u201cLimited guidelines\u201d.............................................................................. 180<\/p>\n

Exhaustioa........................................................................................... 182<\/p>\n

Instructor time....................................................................................... 184<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion........................................................ 187<\/p>\nCase Report VI: Casandra................................................................................................ 191\n

Casandra \u2014 The Gentle Helper.................................................................................... 191<\/p>\n

Thorough preparation.............................................................................. 192<\/p>\n

Personal insights.................................................................................... 193<\/p>\n

Painful memories................................................................................... 196<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion........................................................ 202<\/p>\nCHAPTER FIVE; IMPLICATIONS OF THE STUDY..................................................................... 206\n

Reflecting on the Research Approach: Listening to the Students' Voices.................................... 206<\/p>\n

A Fresh View of Clinical Teaching<\/em>........................................................................................ 208<\/p>\n

Sandra\u2019s experience: Engaging an independent learner............................................ 209<\/p>\n

Nathan\u2019s experience: Facilitating inclusion within the learning group....................... 210<\/p>\n

Simone\u2019s experience: Recognizing a learning partnership....................................... 211<\/p>\n

Heather\u2019s experience: Enhancing motivation........................................................ 212<\/p>\n

Beth\u2019s experience: Challenging a strong student................................................... 213<\/p>\n

Casandra\u2019s experience: Caring for a student caregiver............................................. 214<\/p>\n

Students\u2019 Responses to the \"Stories\u201d<\/em>...................................................................................... 217<\/p>\n

Four Overarching Themes of the Case Reports<\/em>............................................................................ 219<\/p>\n

Theme One: The research approach: An invitation to constructivist teaching............. 219<\/p>\n

Theme Two: Anxiety related more to feeling unable to help than to mentally ill patients................................................................................................. 220<\/p>\n

Theme Three: The lack of feeling included as a part of the staff group....................... 222<\/p>\n

Theme Four: The vital importance of non-evaluated student-instructor discussion time.......................................................................................... 224<\/p>\n

Reconstructing Clinical Teaching From a Student Centered Perspective.................................... 227<\/p>\n

Towards a Curriculum which Includes the Voices of Student Nurses in the Scholarly\n<\/em>Dialogue Surrounding their Learning<\/em>.................................................................................. 228<\/p>\n

Suggestions for Clinical Teaching Strategies<\/em>............................................................................... 230<\/p>\n

Area one: Organizing information....................................................................... 231<\/p>\n

Area two: Creating a climate for listening and speaking about experiences................. 235<\/p>\n

Area three: Ensuring time for reflections and formulating questions........................... 237<\/p>\n

Future Research<\/em>............................................................................................................ 238<\/p>\n

In Endings there are Beginnings<\/em>........................................................................................... 239<\/p>\nREFERENCES ........................................................................................................................ 241\n\nAPPENDIX 1: List of Elements or Nurses\u2019 Activities....................................................................... 257\n\nAPPENDIX 2: Personal Constructs Form (Shapiro. 1991)................................................................. 258\n\nAPPENDIX 3: Students\u2019 Perceptions of Their Psychiatric\/Mental Health Nursing Practicum\n(Perese. 1996)................................................................................................ 259\n\nAPPENDIX 4: Letter of Introduction.............................................................................................. 260\n\nAPPENDIX 5: Participant Consent Form........................................................................................ 261\n\nAPPENDIX 6: Confidmtiality Pledge............................................................................................. 264\n\nAPPENDIX 7: Concept Map: DISABLING MENTAL DISORDERS.................................................. 265\n\nAPPENDIX 8: Concept Map: COMMON PSYCHIATRIC DRUGS.................................................... 266\n\n \n

LIST OF FIGURES<\/h1>\nFigure 1. Vee Heuristic Diagram........ 103\n\nFigure 2. Summary Diagram: Features in the Process of Constructing the Case Study Reports........ 121\n\nFigure 3. Repertory Grid illustrating Sandra\u2019s Personal Construct Changes........ 135\n\nFigure 4. Concept Map: Sandra\u2019s Personal Constructions of Psychiatric Mental Health Nursing Activities... 143\n\nFigure 5. Repertory Grid illustrating Nathan's Personal Construct Changes........ 149\n\nFigure 6. Concept Map: Nathan\u2019s Ratings of his Personal Constructions of Psychiatric Mental Health Nursing Activities........ 152\n\nFigure 7. Repertory Grid illustrating Simone\u2019s Personal Construct Changes........ 159\n\nFigure 8. Concept Map: Simone\u2019s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities........ 162\n\nFigure 9. Repertory Grid illustrating Heather\u2019s Personal Construct Changes........ 171\n\nFigure 10. Concept Map: Discussing Heather\u2019s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities........ 175\n\nFigure 11. Repertory Grid illustrating Beth\u2019s Personal Construct Changes........ 186\n\nFigure 12. Concept Map: Discussing Beth\u2019s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities........ 190\n\nFigure 13. Repertory Grid illustrating Casandra\u2019s Personal Construct Changes........ 201\n\nFigure 14. Concept Map: Discussing Casandra\u2019s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities........ 205\n

CHAPTER ONE<\/h1>\n

INTRODUCTION AND PROBLEM<\/h2>\n

Purpose, Questions and Significance<\/h3>\nThis 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.\n\nThree 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?\n\nA 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).\n\nPersonal 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).\n\nGeorge 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.\n
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).<\/blockquote>\nIn 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.\n\nThe 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.\n\nFinally, two key areas of research in nursing education are pertinent to this study\u2014clinical 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.\n\nGiven 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.\n\n \n","rendered":"
\"An<\/a>
[PDF – 14.1 MB]<\/figcaption><\/figure>\n
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Citation<\/p>\n<\/header>\n

\n

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.<\/p>\n<\/div>\n<\/div>\n

\n
\n

Abstract<\/p>\n<\/header>\n

\n

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. \u0422his thesis was designed to understand students’ own ways of knowing during their six-week mental health practicums \u043e\u043f acute hospital units. \u0410 constructivist conceptual perspective and George Kelly’s personal construct psychology \u0430r\u0435 the theoretical bases of the research. Qualitative methodology using the case study approach was used to describe the experiences of six Canadian second \u0443\u0435\u0430r nursing students from their own perspectives. Data sources included before and after repertory grids, \u0430 questionnaire and audiotape-recorded transcribed interviews. Content was theme analyzed, V\u0435\u0435 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 \u0430 result of the course. \u0422he study spanned three years, included \u0430 pilot project and incorporated the resulting student “stories” int\u043e \u0430 clinical curriculum. \u0422h\u0435 case reports are snapshot portrayals of how student nurses construed the professional activities they observed \u043e\u043f hospital units which recently underwent organizational changes. \u0422hey reflect human faces b\u0435hind the paradigm shifts occurring in nursing education and health car\u0435. \u0422h\u0435 following four overarching themes represent key findings. \u0422he research \u0430\u0440\u0440r\u043e\u0430\u0441h invited constructivist teaching. Students’ anxiety related more to f\u0435\u0435ling unable to help than to mentally ill patients. Students felt \u0430 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 \u0441\u0430n 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 b\u0443 developing \u0430 pedagogical mode of inquiry which extends clinical instruction beyond demonstration and evaluation to creating \u0430 space for student perceptions.<\/p>\n<\/div>\n<\/div>\n

TABLE OF CONTENTS<\/h1>\n

CHAPTER ONE: INTRODUCTION AND PROBLEM …………………………………………………………… 1<\/p>\n

Purpose Questions and Significance………………………………………………………………………….. 1<\/p>\n

The Organization of the Study…………………………………………………………………………………. 4<\/p>\n

Personal Connections to the Research ………………………………………………………………………. 6<\/p>\n

A Constructivist Conceptual Perspective …………………………………………………………………. 10<\/p>\n

Overview of Personal Construct Theory……………………………………………………………………. 13<\/p>\n

George Kelly………………………………………………………………………………………… 13<\/p>\n

Fundamental Postulate and Corollaries…………………………………………………………. 14<\/p>\n

Personal Construct Theory in Psychotherapy …………………………………………………. 17<\/p>\n

Personal Construct Theory in Higher Education………………………………………………. 18<\/p>\n

Summary……………………………………………………………………………………………………….. 21<\/p>\n

CHAPTER TWO: REVIEW OF RELEVANT NURSING EDUCATION LITERATURE                        22<\/p>\n

SECTION ONE: CLINICAL TEACHING………………………………………………………………… 22<\/p>\n

Sociohistorical Perspective……………………………………………………………………….. 23<\/p>\n

The Nature of Psychiatric Nursing……………………………………………………………….. 33<\/p>\n

The Role of the Psychiatric Nurse………………………………………………………………… 39<\/p>\n

The View of Clinical Teaching From the Perspective of Faculty…………………………………………………………………………… 42<\/p>\n

The View of Clinical Teaching From the<\/p>\n

Perspective of Students…………………………………………………………………………. 46<\/p>\n

Anxiety……………………………………………………………………………………… 46<\/p>\n

Evaluation …………………………………………………………………………………. 47<\/p>\n

Unacknowledged Learning…………………………………………………………………… 49<\/p>\n

Research in the Psychiatric Mental Health Clinical Area……………………………………… 51<\/p>\n

SECTION TWO: PERSONAL CONSTRUCT THEORY ……………………………………………. 54<\/p>\n

Community Psychiatric Nurses………………………………………………………………….. 55<\/p>\n

Nursing Administrators……………………………………………………………………………. 56<\/p>\n

Nurses and Social Workers ………………………………………………………………………. 57<\/p>\n

Novice Nurses……………………………………………………………………………………….. 58<\/p>\n

Nursing Students…………………………………………………………………………………… 59<\/p>\n

Post Basic Programs ……………………………………………………………………….. 59<\/p>\n

Basic Programs……………………………………………………………………………… 60<\/p>\n

Summary……………………………………………………………………………………………………….. 65<\/p>\n

CHAPTER THREE: RESEARCH DESIGN AND PROCEDURES                        67<\/p>\n

Introduction………………………………………………………………………………………………………. 67<\/p>\n

The Repertory Grid Technique……………………………………………………………………………….. 69<\/p>\n

Stage One: Construction of Grids ………………………………………………………………… 71<\/p>\n

Elements………………………………………………………………………………………. 71<\/p>\n

Personal Constructs……………………………………………………………………………. 72<\/p>\n

Stage Two: Dichotomizing. Rating or Ranking Elements…………………………………….. 74<\/p>\n

Stage Three: Analysis ……………………………………………………………………………… 75<\/p>\n

The Pilot Study ……………………………………………………………………………………………….. 76<\/p>\n

Sample Selection……………………………………………………………………………………………….. 81<\/p>\n

Research Methodology………………………………………………………………………………………… 82<\/p>\n

The Interviews……………………………………………………………………………………….. 82<\/p>\n

Member Checking by Correspondence……………………………………………………………. 87<\/p>\n

Data Analysis ………………………………………………………………………………………………….  89<\/p>\n

A Naturalistic Case Study Design…………………………………………………………………. 89<\/p>\n

Rigor Procedures which Enhance the Authenticity and Credibility of the Work …. 91<\/p>\n

Truth Value, Applicability, Consistency and Neutrality……………………………………………… 91<\/p>\n

Validity and Reliability…………………………………………………………………………… 94<\/p>\n

Diagraming a Vee Heuristic ……………………………………………………………………… 100<\/p>\n

Data Sources Used in the Construction of the Case Reports…………………………………. 104<\/p>\n

Comparing Before and After Repertory Grids………………………………….. 104<\/p>\n

Analyzing and Benchmarking Perese’s (1996)
\nQuestionnaire Responses……………………………………………………………………. 105<\/p>\n

Audiotape-Recorded and Transcribed Interviews………………………………………………… 106<\/p>\n

Developing Concept Maps…………………………………………………………………………. 108<\/p>\n

The Emergence of Themes………………………………………………………………………… 110<\/p>\n

Constructing Collaborative Case Study Reports………………………………………………. 116<\/p>\n

Ethical Considerations……………………………………………………………………………………….. 117<\/p>\n

Type of Participants and Age Range…………………………………………………………….. 117<\/p>\n

Specifics of the Group …………………………………………………………………………….. 117<\/p>\n

Recruitment of Participants……………………………………………………………………….. 118<\/p>\n

Informed Consent…………………………………………………………………………………… 118<\/p>\n

Risks to Participants………………………………………………………………………………. 119<\/p>\n

Anonymity of Participants………………………………………………………………………… 119<\/p>\n

Ultimate Disposal of Records…………………………………………………………………….. 119<\/p>\n

Summary diagram: Features in the Process of Constructing the Case Study Reports……………….. 121<\/p>\n

CHAPTER FOUR: THE SIX COLLABORATIVE CASE STUDY REPORTS                        122<\/p>\n

Linking Analysis. Interpretation and the Assessment of Authenticity
\nwith the Epistemological Stance of the Research……………………………………………………… 122<\/p>\n

The Organization of the Case Study Reports……………………………………………………………… 123<\/p>\n

Case Repent I: Sandra………………………………………………………………………………………… 126<\/p>\n

Sandra \u2014 The Independent Learner…………………………………………………………………….. 126<\/p>\n

\u201cCompletely unprepared\u201d……………………………………………………………… 128<\/p>\n

The many sides of evaluation………………………………………………………… 131<\/p>\n

Questions……………………………………………………………………………….. 132<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion………………………………………………. 136<\/p>\n

Case Report II: Nathan……………………………………………………………………………………….. 144<\/p>\n

Nathan \u2014 The Team Player……………………………………………………………………………. 144<\/p>\n

The value of instructor, peers and patients……………………………………………. 145<\/p>\n

Disturbing staff role models…………………………………………………………….. 147<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion……………………………………………….. 150<\/p>\n

Case Report III: Simone……………………………………………………………………………………… 153<\/p>\n

Simone \u2014 The Caring Friend…………………………………………………………………………. 153<\/p>\n

Lack of curriculum preparation and a closed staff group……………………………. 154<\/p>\n

Meaningful discussions with a friend…………………………………………………. 156<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion……………………………………………….. 160<\/p>\n

Case Report IV Heather………………………………………………………………………………………. 163<\/p>\n

Heather \u2014 The Novice Psychiatric Nurse………………………………………………………………… 163<\/p>\n

Personal and professional growth……………………………………………………… 165<\/p>\n

Reflective time…………………………………………………………………………… 168<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion………………………………………………. 172<\/p>\n

Case Report V: Beth………………………………………………………………………………………….. 176<\/p>\n

Beth \u2014 The Professional……………………………………………………………………………….. 176<\/p>\n

A well-read self directed student………………………………………………………. 176<\/p>\n

\u201cPro-counseling\u201d background and beliefs……………………………………………. 179<\/p>\n

\u201cLimited guidelines\u201d…………………………………………………………………… 180<\/p>\n

Exhaustioa………………………………………………………………………………. 182<\/p>\n

Instructor time…………………………………………………………………………… 184<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion……………………………………………….. 187<\/p>\n

Case Report VI: Casandra…………………………………………………………………………………… 191<\/p>\n

Casandra \u2014 The Gentle Helper………………………………………………………………………… 191<\/p>\n

Thorough preparation…………………………………………………………………… 192<\/p>\n

Personal insights………………………………………………………………………… 193<\/p>\n

Painful memories……………………………………………………………………….. 196<\/p>\n

Personal Construct Changes and Reflections \u2014 Discussion……………………………………………….. 202<\/p>\n

CHAPTER FIVE; IMPLICATIONS OF THE STUDY…………………………………………………………… 206<\/p>\n

Reflecting on the Research Approach: Listening to the Students’ Voices……………………………… 206<\/p>\n

A Fresh View of Clinical Teaching<\/em>……………………………………………………………………………. 208<\/p>\n

Sandra\u2019s experience: Engaging an independent learner…………………………………….. 209<\/p>\n

Nathan\u2019s experience: Facilitating inclusion within the learning group………………….. 210<\/p>\n

Simone\u2019s experience: Recognizing a learning partnership………………………………… 211<\/p>\n

Heather\u2019s experience: Enhancing motivation……………………………………………….. 212<\/p>\n

Beth\u2019s experience: Challenging a strong student…………………………………………… 213<\/p>\n

Casandra\u2019s experience: Caring for a student caregiver……………………………………… 214<\/p>\n

Students\u2019 Responses to the “Stories\u201d<\/em>………………………………………………………………………….. 217<\/p>\n

Four Overarching Themes of the Case Reports<\/em>…………………………………………………………………. 219<\/p>\n

Theme One: The research approach: An invitation to constructivist teaching…………. 219<\/p>\n

Theme Two: Anxiety related more to feeling unable to help than to mentally ill patients……………………………………………………………………………………. 220<\/p>\n

Theme Three: The lack of feeling included as a part of the staff group………………….. 222<\/p>\n

Theme Four: The vital importance of non-evaluated student-instructor discussion time……………………………………………………………………………… 224<\/p>\n

Reconstructing Clinical Teaching From a Student Centered Perspective……………………………… 227<\/p>\n

Towards a Curriculum which Includes the Voices of Student Nurses in the Scholarly
\n<\/em>Dialogue Surrounding their Learning<\/em>………………………………………………………………………. 228<\/p>\n

Suggestions for Clinical Teaching Strategies<\/em>……………………………………………………………………. 230<\/p>\n

Area one: Organizing information…………………………………………………………….. 231<\/p>\n

Area two: Creating a climate for listening and speaking about experiences…………….. 235<\/p>\n

Area three: Ensuring time for reflections and formulating questions……………………… 237<\/p>\n

Future Research<\/em>……………………………………………………………………………………………… 238<\/p>\n

In Endings there are Beginnings<\/em>………………………………………………………………………………. 239<\/p>\n

REFERENCES ………………………………………………………………………………………………………… 241<\/p>\n

APPENDIX 1: List of Elements or Nurses\u2019 Activities…………………………………………………………….. 257<\/p>\n

APPENDIX 2: Personal Constructs Form (Shapiro. 1991)……………………………………………………….. 258<\/p>\n

APPENDIX 3: Students\u2019 Perceptions of Their Psychiatric\/Mental Health Nursing Practicum
\n(Perese. 1996)…………………………………………………………………………………… 259<\/p>\n

APPENDIX 4: Letter of Introduction…………………………………………………………………………………. 260<\/p>\n

APPENDIX 5: Participant Consent Form……………………………………………………………………………. 261<\/p>\n

APPENDIX 6: Confidmtiality Pledge………………………………………………………………………………… 264<\/p>\n

APPENDIX 7: Concept Map: DISABLING MENTAL DISORDERS………………………………………….. 265<\/p>\n

APPENDIX 8: Concept Map: COMMON PSYCHIATRIC DRUGS……………………………………………. 266<\/p>\n

 <\/p>\n

LIST OF FIGURES<\/h1>\n

Figure 1. Vee Heuristic Diagram…….. 103<\/p>\n

Figure 2. Summary Diagram: Features in the Process of Constructing the Case Study Reports…….. 121<\/p>\n

Figure 3. Repertory Grid illustrating Sandra\u2019s Personal Construct Changes…….. 135<\/p>\n

Figure 4. Concept Map: Sandra\u2019s Personal Constructions of Psychiatric Mental Health Nursing Activities… 143<\/p>\n

Figure 5. Repertory Grid illustrating Nathan’s Personal Construct Changes…….. 149<\/p>\n

Figure 6. Concept Map: Nathan\u2019s Ratings of his Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 152<\/p>\n

Figure 7. Repertory Grid illustrating Simone\u2019s Personal Construct Changes…….. 159<\/p>\n

Figure 8. Concept Map: Simone\u2019s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 162<\/p>\n

Figure 9. Repertory Grid illustrating Heather\u2019s Personal Construct Changes…….. 171<\/p>\n

Figure 10. Concept Map: Discussing Heather\u2019s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 175<\/p>\n

Figure 11. Repertory Grid illustrating Beth\u2019s Personal Construct Changes…….. 186<\/p>\n

Figure 12. Concept Map: Discussing Beth\u2019s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 190<\/p>\n

Figure 13. Repertory Grid illustrating Casandra\u2019s Personal Construct Changes…….. 201<\/p>\n

Figure 14. Concept Map: Discussing Casandra\u2019s Ratings of her Personal Constructions of Psychiatric Mental Health Nursing Activities…….. 205<\/p>\n

CHAPTER ONE<\/h1>\n

INTRODUCTION AND PROBLEM<\/h2>\n

Purpose, Questions and Significance<\/h3>\n

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.<\/p>\n

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?<\/p>\n

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).<\/p>\n

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).<\/p>\n

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.<\/p>\n

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).<\/p><\/blockquote>\n

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.<\/p>\n

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.<\/p>\n

Finally, two key areas of research in nursing education are pertinent to this study\u2014clinical 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.<\/p>\n

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.<\/p>\n

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