Nursing students in high proportions choose the profession because of healthcare experiences they’ve had with family members or in their own lives. These experiences are profound, identity changing, and career directing for many of them. This blog is ultimately about what happened when I gave them the opportunity to write about it. It is also a wakeup call for the many personal crises our students experience while they study.
I’ve been using an academic paper to teach synthesis thinking in the undergraduate course I teach, Research and Scholarship in Nursing, for about six years. I get bored easily so I am continuously on the hunt for new ways to implement this assignment. One consistent feature of that assignment is the requirement to find five primary studies on a particular research focus. The first version of the paper was very method focused and the second looked to see how well the media was doing with presenting research to the public. I’ve written about the first two incarnations of the paper here.
Because I wanted to increase the qualitative research content of my course, this year I developed a third version of the paper and required all students choose five qualitative studies to address their topic. The main requirement is to synthesize the themes identified in those studies. Any topic is fair game as long as it can be connected to nursing and or health. I am a strong believer that writing about a topic you are passionate about makes for more engaged writing. So I asked students to choose their topic based on a personal experience, a clinical experience, or they could springboard off a documentary or a media article as well. They are required to write about a page long narrative that describes their inspiration.
Seemed simple enough. Seemed non-threatening. The second version of this paper also suggested that students choose their topic based on an idea that they were personally connected to as well.
What I was not prepared for were some of the deep and personal reflections that reading qualitative research stimulated in some students. Some of them wrote things that broke my heart. It also has become evidence for the complicated lives our students live while they attempt to complete a very grueling accelerated nursing program.
I tweet periodically and selectively about my own emotional experience (and grading biases) while grading these papers:
Now not all students are going to get personal with a teacher, nor do they feel safe doing so. This is a reality I accept. About 26% of the 162 papers I graded this year chose topics based on the more benign routes to inspiration: a clinical patient they’d had, a topic that was just “of interest,” or was inspired by a documentary, blog, or media article. But for the other 74% this is what I heard about:
They wrote about the health issues of their first degree relatives, mothers, fathers, siblings, spouses or children (23.5%).
They wrote about the deaths of their parents from cancer, their loved ones with autism, food allergies, ADHD, anorexia, obesity, and mental illness.
In their immediate families they’ve been caregivers (both directly and vicariously) for cancer, colitis, heart conditions, diabetes, postpartum depression, alcoholism, MS, chronic pain, arthritis, and infertility.
A student had a child who died at 2 years from a brain tumor.
They wrote about second degree relatives and friends – grandparents, aunts, and uncles (24.7%).
Cancer was still common as were heart conditions, drug and alcohol abuse, and mental illness including postpartum depression.
They had friends who’ve committed suicide.
They were present at the hospital when a family member went into cardiac arrest.
They investigated the experience of living with a host of other medical conditions and procedures: cystic fibrosis, acute brain injury, bariatric surgery, abortion, premature births, caring for special needs adults, chronic pain, Parkinson’s, and stroke.
Their family members died surrounding conditions of poor person-centered hospital care.
A student had a family member request an assisted death before it was legal and watched his frustration and suffering.
Most poignant was when they wrote about their own health challenges (16%) – the present, the past and the anticipated.
They’ve manage their studies while also managing type I diabetes.
More than one have had pernicious acne they’ve lived with since adolescence and have faced body image and self-esteem challenges as a result.
One is undergoing the diagnostic procedures to rule out a significant neurological disorder.
Two struggle with irritable bowel syndrome and wrote about the constant struggle to have to keep tabs on bathroom locations, the social isolation that often occurs, and wearing diapers, in some circumstances — Just in case.
An astounding number of them are depressed or experienced postpartum depression — some of them were still in the stage of thinking they might be depressed but were not quite sure, or were not quite ready to admit it to themselves.
Two students wrote about the decision making they’d had to do to have an abortion and their awareness of the stigma surrounding that decision. Both students had had these abortions within the current academic year.
Many of these students are parents and several talked of past health issues that were childbirth related – Four wrote about complications they’d had in pregnancy, one of which was a student who almost died in childbirth. I learned a new term … “perinatal near miss.”
One student was a teen mother.
One student had experienced and survived a hemorrhagic stroke and her difficult cognitive recovery.
Two talked about being sexually abused as children or sexually harassed by authority figures in their lives. Two out of 162 is far under the average abuse rate for women. Many, I am sure, would never have dared write about it – not to a teacher.
Genetic conditions were the trend for anticipated health problems.
They live with worry about their ability to have children in the future due to these genetic health threats. Many of our students come from communities with very fundamentalist Christian values and these possible genetic issues that they may pass onto their children have them worried they may one day have to consider an abortion.
They have a genetic inabilities to develop immunities to infectious diseases often prevented by vaccination.
A student had made the decision after her grandmother, mother, cousins, aunts all developed breast cancer to have prophylactic bilateral mastectomies. She was positive for the BRCA1 gene so she made what to her was a no brainer decision. When you live with this knowledge, you become easily detached from your breasts anyway.
But most appalling to me was those that wrote about the nursing profession (10.5%) — the bullying and “eating their young” attitudes they experienced and witnessed on the units they were assigned to for clinical practice. Some of this bullying came from teachers.
Only 4.3% were willing to come out and say they’d been bullied, but another group addressed this issue through the backdoor by talking about academic anxiety, or the high rates of stress and burnout in the nursing profession which affected the behavior of nurses. They wanted to look at burnout because they needed a rationale for why sometimes the nurses they encountered were just plain mean.
And these are just the students willing to disclose these issues and struggles. I read their stories and I respond. I thank them for sharing their story, sometimes I ask them questions (for which no one has ever emailed to answer after feedback). Sometimes they don’t tell me how the story ends… But it doesn’t matter. This story ends by acknowledging that it brought to light for me, evidence that we have a problem that we are not doing enough to correct. Our students have lived traumas, they are vulnerable, some of them are being treated very poorly as students, and they are survivors.
We are also not doing enough to listen. The rates of these family and social issues students face in their day lives are astoundingly high. They affect the ability of students to function in the classroom. Chances are, when they beg for an extension, are absent from class or a test, they have a good reason.