NurseEducation Today (1991) 11, XI-36 0 Longman Group UK Ltd 1991
Nursing education and definition of the professional nurse role. Expectations and knowledge of the nurse role. Henny M Olsson and Mats T Gullberg
The aim of nursing education is a development of the nursing profession. One way to promote development is to clarify the professional role. The role definition for nursing is mostly transmitted through tacit knowledge. We consider that the professional development of the nursing profession in Sweden requires a clear and well-defined nurse role. Stated goals of professional programmes for nursing do not include the entire body of tacit knowledge. The overall development requires recognition of a professional status together with a clear and well-defined role. We have found a significant change in the distribution of role-conceptions which occurred after the nurses had experienced their first year as registered nurses, and which did not occur during the educational process. This indicates that the conceptions of the need for a more clearly.defined nursing role are assimilated during work experience. This confirms the necessity and importance of role modelling, role repetition and interactions with a professional group as part of the educational process.
detailed regulations. An educational ref.or-m requires, as do other social reforms, a balance
BACKGROUND In December ment) adopted
1979 the Swedish Riksdag a Government
health care education 1978:50).
Bill to reform
the
which occurs at university
level, with the exception (SOU
(Parlia-
It reflects
of physicians’
training
modernised
views on
health care in Sweden, and its new objectives are mirrored in educational structures rather than Henny M Olson PhD BSc, UC in Nursing, BSc in Midwifery, BSc in Public Health Nursing, UD in Nursing, Research Supervisor and Mats T Gullberg BSc in Behavioural Sciences and Personnel Management, Research Assistant, Faculty of Health Sciences, Department of Caring Sciences, Linkoping University,,Linkoping, Sweden and Centre for Caring Sciences, Orebro, Sweden. (Requests for offprints to HO) Manuscript accepted 4 July 1990
30
between settings
the alteration
of economic
and the change
in values,
and social ideas,
and
ideals. In 1982 the County Sweden,
initiated
following
objectives:
Council
a research
of iistergotland, project
with the
of a) to examine and analyse expectations hospital staff and student nurses regarding the nursing role and its future possibilities within the paramedical professions; to re-examine expectations of student nurses at the final stage of their modified and modernised training; c) to examine the attitudes and conceptions of nurses who have completed 1 year of pracb)
tice as registered
nurses;
4
to compare
the last mentioned
with the expectations
findings
of student
nurses at
In earlier studies (Olsson & Gullberg, 1983, 1984, 1985, 1986a, 198613, 1987c, 1988) we have found that the attitudes of Swedish student and their
conceptions
and goal expectations development intended
nurses is in harmony
goals of nursing
that this contributes
education
We
also
1!)87a:
have
that it can be hoped
found
(Olsson
the
role occur in very traditional that newly graduated
are mostly mediated
acquire
clearly
iilclude
what
eclucational
the con-
role mainly through is formed
of experiences
and these
by what we call interchange-
maintenance-routine.
towards
the
ways. It is evident
This tacit knowledge
during a long tradition and
into
of the nursing
nurses
tents of their professional
ritual
of the
& Gullberg.
socialisation
and the acquisition
t;icit knowledge.
with the
role of the Swedish nurse.
19871~) that
profession
nur-
and health
to the development
professional
Skill
by both student
care in Sweden. We contend future
education
are mainly positive.
as perceived
ses and practising
about
defined
A
must
change-drama
and practice
By way of introduction
oriented
in both
activities.
we give a brief descrip-
tion of’post-secondary
paramedical
Sweden,
for nursing.
in particular
change
role-expectations
we call
education
in
Most of‘ the post-secondary f’unctions involving advanced great responsibilities As part of the entitled
paramedical
lead to independent
V%rd 77)
study programmes secondary school
of
reform
fabric
education.
77)
of post-secondar!,
l’his
of paramedical
review
studies
led to a
effected
I Juh
1982. The purpose of that reform
was I( 1bring study
programmes
in line with developments
and medical
care and changing
care
Another
policy.
study programmes higher education, on scientific
in health
goals of health
aim was to :tdapt
sing:
i.e. the organisation
foundations
‘l‘his programme
era1 Nursing,
oi‘ studies
and the promotion
Nursing,
has
Psychiatric
Technology
and
of
01 ,\‘u-
specialities:
SIX
(ien-
Nur(rinp, Ophthalmic
Nursing.
Operating
Diagnostic
Radiology.
all of which prepare
the student
employment
these
to the general goals stated for
personal development. Gelleral rkscriptlorr ff the stlrcf: fm~p~rrrmr
Koom
ant1 Ontology, f OI-
prot~essional
as a Iiurse in the fieltl concerned.
The programme
is based
line of upper secondary
the ‘I-\,ear nursing
on
school. l‘hr duration
01
the various specialiCes ranges from HO-90 points (One term of full-time
studies corrrspontLs
points,
that
which
means
studies with lectures, dent
studv,
Universit)
assignments,
this programme
(tertificate
study programme
;111dindeprnStudents
arc elltitletl
(UC:)
in Nt~rsirig.
leads to State reglstralion
National
Koard
complies
with the standards
of
Health
International
Council
Those
started
who
to ‘LO
I week ot I’ull-time
usually gives one poinl).
who complete
before
as a
is issurtl b\ the
ant1
\VelI’xr
ad
laid doi\,n b\ thtb
01‘ Nul-se\ (Stvles, their
to ;i The
nursing
1985).
education
1Julv 1982 are treated on the $amr termr.
study
nursing duties and
reform
(SOU
paramedical
safety.
THEORETICAL
FRAMEWORK
1978:50, education,
were transferred from upper to higher education, where
they were established as general and supplementary study programmes in the sector for education for health professions, parallel, for example, pathology
the entire
(V&d
professional
for the patient’s 1977
to review
a Committee
nurse (KN). This authorization
Post-secondary paramedical education in Sweden - a brief description programmes
appointed
paramedical
their initial and final stage of training.
nurses
Government
to medicine, pharmacy, and speech and therapy. In June 1977 the
Meleis (1975) clarification.
stressed During
Ihe importance socialisation
into
ot rolea pro-
fessional role a person must be aware of what the role means in relation to expected attitudes and patterns
of behaviour
as bell as losses and gains
or other things which shape the role in a negative or positive way. In order to athievt, role clarif’ication Meleis considers it necrssar\ that role
32
NURSE EDUCATION
modelling,
role repetition
a professional consider
TODAY
reference
and interactions
that the Swedish
nursing
profession
in need of a clear and well-defined role together
with
group should occur. We
with recognition
is
professional
of professional
status.
on individual
1) role-expectations, 3) role-relations,
Figure
social action
Through
history
remembered Drama
man
lived
on
rituals and survived
contains
something
thing new or includes some people nothing
has
on routines.
unexpected,
change
everything
sions, We
of some kind. To
stages
is drama and to others
of experiencing
may miss
nuances.
When
1 represents relations, mean
that
development These future
actions
theoretical
It can be expected
nurses experience
that newly graduated
most activities as drama.
If the role-conceptions are not congruent
of the nurse
with the experienced
reality then this may decrease optimal
development
knowledge internalise
perform
role-
the possibility basic
for
professional
consequence
of
could be that the student
will
a role-conception
an erroneous dation
of
and skills. A further
this inconsistency
student
which is based on
‘ideal’ role-model
in reality. When the nursing
with no foun-
the student
later has to
role in the real working
world this can be experienced
as a reality-shock.
One important element, when considering the three stages of action, is the historic-dialectic perspective,
of previous
events.
time is an important
these
nursing
important
role.
because
evolve from their pre-
actions.
On a practical level: What is needed to develop nursing
role? Can nursing edu-
cation supply a base to promote
development
a more clearly defined
role.
The
hypotheses
nursing
for
consideration
of
are
as
follows: 1. The nurse students’ nursing
education
well-defined
initial expectations
and existence
professional
verified, and generally
role
of the
of a clear and are
more accepted
sustained, after their
period of training. 2. The
nurses’ conceptions
cation and existence professional generally employed
role
are
sustained,
more accepted registered
of the nursing
edu-
of a clear and well-defined verified,
and
after their first year as
nurses.
shows future
actions
as evolving
From this
from
present
towards or end up in a situation where their activity is concentrated solely on maintaining existing routines. In this situation they miss the opportunity ideas and
to accept and act according to new thoughts. The change-drama has disappeared as a stimulating and developing source of energy. outcome
of a professional
METHOD
factor in that it
and previous actions. We consider that the dialectic perspective contains a theoretical point of balance. No professional group must strive
The
between
for a constructive
in which each new event influences
value judgements perspective
are
of nurses
the professional
ence.
perspective.
of the professional
interactions
dimen-
of a professional
interactions
are a vital necessity
somebody learns a professional role, these three stages are involved. They can be found in as well as in practical experi-
expectations,
and sections
vious and present
learning
the three aspects (stages) of
considering
role, all within a dialectic
some-
is. People in the latter category
the possibility
drama,
and
4) role-sections.
change-ritual
maintenance-routine.
of:
2) role-dimensions,
Morris (1972) states that all social action can be grouped into three stages: change-drama, interand
social actions. These social actions,
in turn, are consequences
role depends
Design: Three studies, in time separated, of expectations and attitudes of nurse students, both at the beginning and at the end of their nursing education as well as one year after their University Certificate (UC) in Nursing (State registration included Nursing
as a nurse,
RN). The
three
studies
respondents from three Colleges situated in different counties
of in
Sweden. Sample: The three samples (studies) consisted of N = 143, N = 96, and N = 30. All samples were derived from the same three clusters, i.e. the
Role-expectations Rde-&nemions Role-sections Role-relations CHANGE-DRAMA
MAINTENANCE-ROUTINE
Fig 1 Three aspects of social action and professional role acquisition considering expectations, dimensions, sections, and relations of a professional role, all within a dialectic perspective. (The three aspects changedrama, interchange-ritual, and maintenance-routine after Morris 1972).
Nursing education and definition of the professional nurse role. Expectations and knowledge of the nurse role. Henny M Olsson and Mats T Gullberg
The aim of nursing education is a development of the nursing profession. One way to promote development is to clarify the professional role. The role definition for nursing is mostly transmitted through tacit knowledge. We consider that the professional development of the nursing profession in Sweden requires a clear and well-defined nurse role. Stated goals of professional programmes for nursing do not include the entire body of tacit knowledge. The overall development requires recognition of a professional status together with a clear and well-defined role. We have found a significant change in the distribution of role-conceptions which occurred after the nurses had experienced their first year as registered nurses, and which did not occur during the educational process. This indicates that the conceptions of the need for a more clearly.defined nursing role are assimilated during work experience. This confirms the necessity and importance of role modelling, role repetition and interactions with a professional group as part of the educational process.
detailed regulations. An educational ref.or-m requires, as do other social reforms, a balance
BACKGROUND In December ment) adopted
1979 the Swedish Riksdag a Government
health care education 1978:50).
Bill to reform
the
which occurs at university
level, with the exception (SOU
(Parlia-
It reflects
of physicians’
training
modernised
views on
health care in Sweden, and its new objectives are mirrored in educational structures rather than Henny M Olson PhD BSc, UC in Nursing, BSc in Midwifery, BSc in Public Health Nursing, UD in Nursing, Research Supervisor and Mats T Gullberg BSc in Behavioural Sciences and Personnel Management, Research Assistant, Faculty of Health Sciences, Department of Caring Sciences, Linkoping University,,Linkoping, Sweden and Centre for Caring Sciences, Orebro, Sweden. (Requests for offprints to HO) Manuscript accepted 4 July 1990
30
between settings
the alteration
of economic
and the change
in values,
and social ideas,
and
ideals. In 1982 the County Sweden,
initiated
following
objectives:
Council
a research
of iistergotland, project
with the
of a) to examine and analyse expectations hospital staff and student nurses regarding the nursing role and its future possibilities within the paramedical professions; to re-examine expectations of student nurses at the final stage of their modified and modernised training; c) to examine the attitudes and conceptions of nurses who have completed 1 year of pracb)
tice as registered
nurses;
4
to compare
the last mentioned
with the expectations
findings
of student
nurses at
In earlier studies (Olsson & Gullberg, 1983, 1984, 1985, 1986a, 198613, 1987c, 1988) we have found that the attitudes of Swedish student and their
conceptions
and goal expectations development intended
nurses is in harmony
goals of nursing
that this contributes
education
We
also
1!)87a:
have
that it can be hoped
found
(Olsson
the
role occur in very traditional that newly graduated
are mostly mediated
acquire
clearly
iilclude
what
eclucational
the con-
role mainly through is formed
of experiences
and these
by what we call interchange-
maintenance-routine.
towards
the
ways. It is evident
This tacit knowledge
during a long tradition and
into
of the nursing
nurses
tents of their professional
ritual
of the
& Gullberg.
socialisation
and the acquisition
t;icit knowledge.
with the
role of the Swedish nurse.
19871~) that
profession
nur-
and health
to the development
professional
Skill
by both student
care in Sweden. We contend future
education
are mainly positive.
as perceived
ses and practising
about
defined
A
must
change-drama
and practice
By way of introduction
oriented
in both
activities.
we give a brief descrip-
tion of’post-secondary
paramedical
Sweden,
for nursing.
in particular
change
role-expectations
we call
education
in
Most of‘ the post-secondary f’unctions involving advanced great responsibilities As part of the entitled
paramedical
lead to independent
V%rd 77)
study programmes secondary school
of
reform
fabric
education.
77)
of post-secondar!,
l’his
of paramedical
review
studies
led to a
effected
I Juh
1982. The purpose of that reform
was I( 1bring study
programmes
in line with developments
and medical
care and changing
care
Another
policy.
study programmes higher education, on scientific
in health
goals of health
aim was to :tdapt
sing:
i.e. the organisation
foundations
‘l‘his programme
era1 Nursing,
oi‘ studies
and the promotion
Nursing,
has
Psychiatric
Technology
and
of
01 ,\‘u-
specialities:
SIX
(ien-
Nur(rinp, Ophthalmic
Nursing.
Operating
Diagnostic
Radiology.
all of which prepare
the student
employment
these
to the general goals stated for
personal development. Gelleral rkscriptlorr ff the stlrcf: fm~p~rrrmr
Koom
ant1 Ontology, f OI-
prot~essional
as a Iiurse in the fieltl concerned.
The programme
is based
line of upper secondary
the ‘I-\,ear nursing
on
school. l‘hr duration
01
the various specialiCes ranges from HO-90 points (One term of full-time
studies corrrspontLs
points,
that
which
means
studies with lectures, dent
studv,
Universit)
assignments,
this programme
(tertificate
study programme
;111dindeprnStudents
arc elltitletl
(UC:)
in Nt~rsirig.
leads to State reglstralion
National
Koard
complies
with the standards
of
Health
International
Council
Those
started
who
to ‘LO
I week ot I’ull-time
usually gives one poinl).
who complete
before
as a
is issurtl b\ the
ant1
\VelI’xr
ad
laid doi\,n b\ thtb
01‘ Nul-se\ (Stvles, their
to ;i The
nursing
1985).
education
1Julv 1982 are treated on the $amr termr.
study
nursing duties and
reform
(SOU
paramedical
safety.
THEORETICAL
FRAMEWORK
1978:50, education,
were transferred from upper to higher education, where
they were established as general and supplementary study programmes in the sector for education for health professions, parallel, for example, pathology
the entire
(V&d
professional
for the patient’s 1977
to review
a Committee
nurse (KN). This authorization
Post-secondary paramedical education in Sweden - a brief description programmes
appointed
paramedical
their initial and final stage of training.
nurses
Government
to medicine, pharmacy, and speech and therapy. In June 1977 the
Meleis (1975) clarification.
stressed During
Ihe importance socialisation
into
ot rolea pro-
fessional role a person must be aware of what the role means in relation to expected attitudes and patterns
of behaviour
as bell as losses and gains
or other things which shape the role in a negative or positive way. In order to athievt, role clarif’ication Meleis considers it necrssar\ that role
32
NURSE EDUCATION
modelling,
role repetition
a professional consider
TODAY
reference
and interactions
that the Swedish
nursing
profession
in need of a clear and well-defined role together
with
group should occur. We
with recognition
is
professional
of professional
status.
on individual
1) role-expectations, 3) role-relations,
Figure
social action
Through
history
remembered Drama
man
lived
on
rituals and survived
contains
something
thing new or includes some people nothing
has
on routines.
unexpected,
change
everything
sions, We
of some kind. To
stages
is drama and to others
of experiencing
may miss
nuances.
When
1 represents relations, mean
that
development These future
actions
theoretical
It can be expected
nurses experience
that newly graduated
most activities as drama.
If the role-conceptions are not congruent
of the nurse
with the experienced
reality then this may decrease optimal
development
knowledge internalise
perform
role-
the possibility basic
for
professional
consequence
of
could be that the student
will
a role-conception
an erroneous dation
of
and skills. A further
this inconsistency
student
which is based on
‘ideal’ role-model
in reality. When the nursing
with no foun-
the student
later has to
role in the real working
world this can be experienced
as a reality-shock.
One important element, when considering the three stages of action, is the historic-dialectic perspective,
of previous
events.
time is an important
these
nursing
important
role.
because
evolve from their pre-
actions.
On a practical level: What is needed to develop nursing
role? Can nursing edu-
cation supply a base to promote
development
a more clearly defined
role.
The
hypotheses
nursing
for
consideration
of
are
as
follows: 1. The nurse students’ nursing
education
well-defined
initial expectations
and existence
professional
verified, and generally
role
of the
of a clear and are
more accepted
sustained, after their
period of training. 2. The
nurses’ conceptions
cation and existence professional generally employed
role
are
sustained,
more accepted registered
of the nursing
edu-
of a clear and well-defined verified,
and
after their first year as
nurses.
shows future
actions
as evolving
From this
from
present
towards or end up in a situation where their activity is concentrated solely on maintaining existing routines. In this situation they miss the opportunity ideas and
to accept and act according to new thoughts. The change-drama has disappeared as a stimulating and developing source of energy. outcome
of a professional
METHOD
factor in that it
and previous actions. We consider that the dialectic perspective contains a theoretical point of balance. No professional group must strive
The
between
for a constructive
in which each new event influences
value judgements perspective
are
of nurses
the professional
ence.
perspective.
of the professional
interactions
dimen-
of a professional
interactions
are a vital necessity
somebody learns a professional role, these three stages are involved. They can be found in as well as in practical experi-
expectations,
and sections
vious and present
learning
the three aspects (stages) of
considering
role, all within a dialectic
some-
is. People in the latter category
the possibility
drama,
and
4) role-sections.
change-ritual
maintenance-routine.
of:
2) role-dimensions,
Morris (1972) states that all social action can be grouped into three stages: change-drama, interand
social actions. These social actions,
in turn, are consequences
role depends
Design: Three studies, in time separated, of expectations and attitudes of nurse students, both at the beginning and at the end of their nursing education as well as one year after their University Certificate (UC) in Nursing (State registration included Nursing
as a nurse,
RN). The
three
studies
respondents from three Colleges situated in different counties
of in
Sweden. Sample: The three samples (studies) consisted of N = 143, N = 96, and N = 30. All samples were derived from the same three clusters, i.e. the
Role-expectations Rde-&nemions Role-sections Role-relations CHANGE-DRAMA
MAINTENANCE-ROUTINE
Fig 1 Three aspects of social action and professional role acquisition considering expectations, dimensions, sections, and relations of a professional role, all within a dialectic perspective. (The three aspects changedrama, interchange-ritual, and maintenance-routine after Morris 1972).
