Joshua Lincoln, B.A., R.N., M.S.N. - Home



Scholarly Project Synthesis Paper

Joshua C. Lincoln

Ferris State University

Abstract

This paper describes the scholarly project completed in the spring of 2013. The project was to provide a professional development for the full-time nursing education staff of Montcalm Community College (MCC) on gender specific multiculturalism in the classroom. This paper will describe the process necessary to implement the project. It will also detail any barriers, issues, ethics, legalities that are faced during creation and implementation. This paper also contains an evaluation of the project from the project preceptor, the participants, and project creator. It also discusses any suggestions for future implementation of this project.

Keywords: men in nursing, gender barriers, micro-inequities, sexualization of male touch

Scholarly Project on the Barriers Facing Men in Nursing

The lack of understanding of the barriers males face in nursing today is enormous. Unfortunately it is not frequently a focus of nursing faculty’s (Rajapaksa & Rothstein, 2009). Some of the issues surrounding the lack of males in nursing schools and in the profession are: female dominated field, stereotypical sex roles in society, lack of positive male role models in nursing, feelings of isolation, and the sexualization of male touch (Harding, 2008).

The modern nurse educator must be culturally competent to facilitate a classroom environment conducive for learning (National League for Nursing [NLN], 2005). Initial feelings of prospective nurses begin with the climate of the nursing program in which they matriculate. If the nursing pedagogy is steeped in inequities and gender-biased practice, attrition rates will increase, and the numbers of males entering the field are likely to decrease (Roth & Coleman, 2008). Educators should strive to create a program and classroom environment inviting to all students. Bell-Scriber (2008) describes how educators should be aware of how gender issues influence teaching and learning. Faculty must be aware of how they present material and the micro-inequities that may be affecting male learners. Micro-inequities can project the true feelings of a person when they are not unaware they are doing so. (Insight Education Systems, 2007). Some nursing instructors feel men cannot be as good at nursing as females as they lack caring and are not as suited for the role (Bell-Scriber, 2008) This can contribute to unwelcome feelings for men and increase attrition rates while decrease clinical performance (Clemetson, 2008). It will also contribute to the critical projections to the shortages in nursing in the future.

There are critical shortages in nursing. According to the United States Bureau of Labor Statistics the number of male registered nurses climbed 71% from 1983 to 2002 (U.S. Department of Labor, 2004-2005). However, men comprise only 5.9% of the registered nurses in the United States (U.S.) (Schoonover-Shoffner, 2006). According to the Bureau of Labor and Statistics (2008) the projections for the year 2020 are that we, as a nation, will only be able to fill 64% of registered nursing positions (Unites States Bureau of Labor and Statistics, 2008). This will obviously increase patient loads for existing nurses and decrease patient safety as a result. It seems obvious that encouraging more men to enter the field of nursing is good for the profession and future patients. My goal in this scholarly project was to raise awareness of these issues. This project addresses these issues by providing professional development for nursing educators at Montcalm Community College (MCC) in an effort to raise awareness for a more culturally competent classroom and learning environment.

Goals and Activities

This scholarly project was designed as a professional development session for the nursing faculty at MCC. The goals needed to achieve this were an extensive literature search on gender bias against men in nursing, barriers men face, micro-inequities and the sexualization of male touch. I then created a questionnaire for the faculty at MCC regarding these issues. The questionnaire was utilized to help create a PowerPoint presentation which was developed for the professional development session. The session was held on April 17th, 2013. It was followed by a focus group to discuss any possible gender based issues the faculty at MCC wanted to address.

The overall goal of this project was to increase the understanding and awareness of some of the barriers men may face while in nursing and nursing school. To do this I created a professional development session using a PowerPoint (PPT) presentation. This presentation was followed by a focus group to try to find some solutions to the barriers men face. Focus groups are a good medium to facilitate learning and discussion within a safe environment among peers. They produce valid results for qualitative data especially when dealing with sensitive subjects (Papastavrou & Panayiota, 2012). A detailed account of the goals and objectives can be seen in Appendix A. The first aspect of this project was to do a thorough literature search to ensure that I had comprehensive knowledge of the topics and issues related to the project

Research

The first goal of this scholarly project was to do a literature search on the issue. I utilized CinHal and Google scholar for most of my research. The search words used were gender, discrimination, men in nursing, sexualization of male touch, and gender barriers in nursing. After reading many papers I narrowed my focus to barriers men face in nursing, micro-inequities, nursing shortages, the sexualization of male touch, and the history of men in nursing. This research allowed me to formulate a questionnaire with the help of my preceptor and a nursing instructor with whom I work.

Questionnaire

The questionnaire was difficult because it asked leading questions to try to elicit responses specifically regarding men in nursing and any barriers they may face. I learned a great deal from doing the questionnaire. I realize now, I made the questionnaire too long and that may have hindered my chances of getting responses. Surveys are an effective tool for eliciting information (Polit & Beck, 2008). I used open ended questions to elicit responses from the nursing faculty at MCC. I utilized the questionnaires to help personalize the professional development session to increase its effectiveness. One of the tenets of Malcolm Knowles Adult Learning Theory is personalization of material should increase the effectiveness of the presentation (Mitchell & Courtney, 2005). One issue I faced was asking questions that were too leading. It was very difficult to ask questions that would elicit voluntary answers without leading the respondent to the answers. A well written survey must word questions clearly and simply (Polit & Beck, 2008). I was also faced with this questionnaire not being directed randomly, but to the full-time faculty of MCC. This does not make the data I received unreliable, but it does weaken the validity of it as it pertains to widespread applicability (Polit & Beck, 2008). However, the goal of this questionnaire was to use the responses of the nursing faculty at MCC to assist me in developing a PPT presentation for the professional development session. Due to the specific goal of the questionnaire, I feel it was ethically appropriate and valid given its designed purpose.

An ethical issue I was faced with was that I was the writer and sole receiver and interpreter of the questionnaires responses. I took great care to insure the privacy of the respondents by making sure I was the only person to see their responses. I also used the answers thematically and did not directly quote any answer from any questionnaire. I did this because in presenting my PPT I did not want any participant to feel as I had singled out their answer and make them feel as their privacy had been violated. Privacy is a main concern when administering any type of survey (Polit & Beck, 2008). It is important not only to receive more cooperation amongst potential recipients, but also to receive more accurate data (Polit & Beck, 2008). I received five responses, all of which were from the full-time faculty. The qualitative data was useful in the development of the PPT used in the professional development session.

PowerPoint

PPT is a good medium for teaching that allows instructors to give students an outline while expanding upon the ideas on the slides (Williamson, Clow, & Stevens, 2011). I encountered some issues while making the PPT for the professional development session. The dean of nursing informed me I would be limited to 30 minutes to present and 30 minutes for our focus group. This forced me to radically change my PPT which made me restrict the information I was able to convey. This was frustrating as I felt I was not being taken seriously, however I was later asked to present the material to a nursing leadership class at MCC. I used my original PPT in the presentation. Beth Mowatt, dean of nursing at MCC, attended the presentation and I was then informed I would be given an hour in which to present the PPT and an hour for the focus group. This allowed me to use most of my original PPT for the professional development session. I also presented the professional development session to faculty of Baker College of Cadillac on March 28th, 2013 and received positive feedback. I then presented the PPT as a professional development session on April 17th, 2013 for the full-time nursing faculty at MCC. The presentation went wonderfully and the focus group developed some ideas for changing the atmosphere to make it more culturally competent and more inviting to men. I do not think however they plan on implementing any changes, but I do know they are considering it for the future. Cultural competency is an important focus of the National League for Nursing (NLN). A professional nursing instructor needs to insure the classroom environment is culturally competent (NLN, 2005).

Legal, Ethical, Nursing, and Organizational Standards

Any professional research or project involving humans or animals must address the legal and ethical issues related to the project (Polit & Beck, 2008). Polit and Beck suggest that sometimes ethics in nursing research can get complicated by the desire to produce results. This project was not a research project, however adherence to ethics and legal issues still pertain. One major issue faced early in the process was related to the desire to produce more validity from the questionnaire. The questionnaires were created for instructors, students, and clinical nurses. Initially it was thought having three different perspectives would provide more valid quantifiable data to use in the professional development session. After further consideration it was decided that the internal review board (IRB) would have to be involved if students were to be questioned. This would have overtly changed and complicated the initial goals of the scholarly project. That aside, adherence to ethical standards is still important in a scholarly project.

The Belmont Report is used by many organizations as the standard for research guidelines (Polit & Beck, 2008). Three main ideas considered when writing the questionnaire and implementing the proposal were beneficence, respect for human dignity, and justice. Beneficence encompasses the idea to do no harm and to insure the research is beneficial. The questionnaire was implemented simply to gain thematic responses to questions involving men in nursing. Respondents were assured their responses would not be used against them and their anonymity would be protected. To ensure anonymity, a single party was the only person to see the responses of the faculty members who returned the surveys. That fact does mitigate the reliability and validity of the data as the party had a vested interest in the data. If this were done as a research project it would have to set up a system where the researcher could mitigate any personal feelings by having non-interested parties collect the data. The researcher involved in this project was very cognizant of his inability to separate himself from the issues surrounding the project.

The second main principle from the Belmont Report is the respect for human dignity (Polit & Beck, 2008). The important aspect of this considered was the right to full disclosure and self-determination. The purpose of the questionnaire was fully disclosed to each recipient. In retrospect, more could have been done to insure potential respondents were aware of how the project leader was going to use their responses in a thematic manner to protect their privacy. The questionnaire was voluntary, thus adhered to the right of self-determination. This may have limited the number of responses received, but it was important not to impose the questionnaire on reluctant participants. According to Polit and Beck a person has the right not to feel coerced to respond to a survey. This is important not only for human dignity, but also to receive accurate data (Polit & Beck, 2008).

The third main principle from the Belmont Report is the idea of justice. The most important aspect of this considered was the right to privacy. Most research with humans involves probing into their private feelings (Polit & Beck, 2008). The writers of the questionnaire tried to ensure it was not more intrusive than needed, but they found it a difficult balance while writing the questionnaire as responses were needed specifically related to men in nursing. Thus questions were slightly leading and in retrospect it may have been better to conduct personal interviews. However, personal interviews were not practical for this project as objectivity and logistics would have hampered results. Participants in personal interviews may have felt more coerced (Polit & Beck, 2008).

Reliance on the project preceptor and the dean of nursing of MCC ensured adherence to organizational standards. After addressing Dean Mowatt’s nursing leadership class with the PPT presentation she gave no indication that there were any organizational issues in this area. In presenting a sensitive subject one must ensure care is used to protect any participants (Polit and Beck, 2008). The participants of the questionnaire were protected, but the students of the leadership class had no choice about attending the presentation. While the presentation to that class was not a part of the scholarly project, it is still important that voluntary participation was warranted. This however was not something under the control of the presenter as it was controlled by Dean Mowatt.

Personal and Professional Accountability

It is the duty of any researcher to adhere to accepted policies regarding research (Polit & Beck, 2008). During this scholarly project the major issue I faced was my inability to remain objective about the content. It is not that I did not attempt to remain objective; it is that it is not possible when you have a vested interest in the outcome (Polit & Beck, 2008). In quantitative research the ideas of reliability and validity are used to ensure scientific merit (Polit & Beck, 2008). My project is qualitative and thus to enhance it the concern is bias (Polit & Beck, 2008). According to Polit & Beck, one of the main tenets of bias is researcher subjectivity. As previously discussed the fact that I am the sole reviewer of the responses of the data reduces the objectivity. I do not feel that hindered the overall goal of this project as it was to provide awareness of the issues men face in nursing. The importance of the responses of the questionnaire are limited by the fact that peer reviewed research supports the claims I have made in my presentation regardless of the responses I received in the questionnaires. With that in mind, I believe the professional development session was well conceived and achieved the goal of increasing awareness. What the MCC faculty does with the information is their responsibility.

Recommendations for Future Implementation

In researching, developing, and implementing this scholarly project, it has become evident that there is a need for further research and awareness of the barriers men face in nursing. While I discovered and enormous amount of research on the topic, the issues currently being discussed are the same as those being discussed ten years ago (McLaughlin, Muldoon, & Moutray, 2010). This indicates either a lack of awareness or a lack of desire to address the issues. I think future scholarly or research projects need to focus more on how to alleviate some of the issues faced by men in nursing. Some of the recommendations in current literature suggest men and woman not be taught differently (Harding, North, & Perkins, 2008). The problem is that it does not address the central issue that men are in fact treated differently within the profession and ignoring this is detrimental. I addressed this issue with the faculty of MCC specifically with the concept of the sexualization of male touch. None of the faculty thought male students should be taught how to touch differently than female students. The faculty’s feeling is that teaching men differently confirms the stereotype. I do not disagree, but if we as faculty do not teach men how to protect themselves against baseless accusations we are hurting male nursing reputations even more. I do not know what the correct answer is, but this area specifically warrants further investigation.

According to the evaluations I received from both the professional development session and the presentation of the project at Baker College of Cadillac, I need to include more solutions to problems facing men in nursing. The difficulty with that is my presentation was designed to create a dialog to help staff provide their own solutions. It is not professional of me to dictate to nursing faculty how to administer their programs. The goal of this project was to increase awareness and to encourage a dialog and that is exactly what was done. Future implementation of any similar project should include a perspective from students. Although this would have to be approved by IRB, it would greatly influence the validity of the information. I would also place more emphasis on how increasing men in nursing will benefit patient safety as we face a national shortage of nursing faculty, thus a shortage of nurses (American Association of Colleges of Nursing, 2012). Increasing the presence of males in both nursing and in nursing education will help to reduce societal bias and hopefully increase the amount of men in nursing (MacWilliams, Schmidt, & Bleich, 2013).

The faculty, students, and administrators that I presented this information to were unaware of the idea of micro-inequities. A micro-inequity is something not intended, but a reflection of underlying feelings (Insight Education Systems, 2007). As previously written, these can create a classroom atmosphere that is not welcoming to males in nursing (Bell-Scriber, 2008). The issue is not overt sexism, but societal and psychological influences that create inequitable feelings about males in nursing (McLaughlin, Muldoon, & Moutray, 2010). Faculties must address these issues to adequately conform to the NLN’s call for cultural competence within the classroom.

Evaluations

The evaluation of this scholarly project was done by my preceptor and me. I am very pleased with the evaluation of my preceptor. To summarize, my preceptor felt the professional development was well constructed and important for the development of nursing educators. During the focus group we discussed how little most educators know about the issues facing men in nursing (Harding et al., 2008). Understanding the theoretical basis for why and how gender bias begins is important. Garnet and Pleck’s Gender-Role Conflict Model can enlighten faculty on how and why they may develop micro-inequities and unintended gender bias (Garnets & Pleck, 1979). Nursing had been predominantly a female profession for so long that societal norms have been established. These can create an inherent conflict between feminine and masculine stereotypes (Keogh & O’Lynn, 2007). My preceptor and the participants of the PD session agreed they feel more informed about the possibilities of their own inherent bias. Being aware of these biases is an important step for eliminating them. According to the evaluations the MCC staff feels they will now be better equipped to address gender bias within their classroom. The evaluations indicated they are now more comfortable with facing their own potential bias. The MCC nursing faculty recognizes any gender operating out of its societally accepted role can have negative psychological consequences (Oneil, Helms, Gable, David, & Wrightsman). I achieved the goals of my scholarly project by increasing awareness of these issues addressed in this paper. In reading the evaluation of my preceptor it is clear that I have helped them begin a dialog to initiate possible changes that will benefit men in nursing. My self-evaluation is more critical as I feel I could do a much better job if I were to implement this project again. I recognize how the questionnaire developed for this project was too long. Shortening it could have brought better results. Using a Likert scale as an assessment for attitudes was a good medium for data collection of sensitive material (Croasmun & Ostrum, 2011). I also learned a great deal about how people learn. The application of Malcolm Knowles Adult Learning Theory (ALT) during this project allowed me to understand how to teach this material to the MCC nursing faculty. Knowles ALT recognized that adults must understand why it is important, must take responsibility for their learning, must be able to apply it to their lives, both professionally and personally, and must be able to recognize the necessity of learning (Mitchell & Courtney, 2005). I was successful in addressing these aspects of ALT by demonstrating to the MCC faculty the need for learning about the barriers facing men, the necessity of understanding the problems, how they need to, as a faculty, try to change bias behaviors, and how it applies to their current situation. By applying Knowles theory, I believe I achieved the goal of raising the awareness of MCC’s nursing faculty about gender biases men facing in nursing.

Conclusion

The experience that I have gained from doing this scholarly project has given me a new understanding the complexities of doing any type of research. The overall objective of this project was to increase MCC’s nursing faculty’s awareness and understanding of the issues facing men in nursing and to create a dialog from which solutions can be drawn. The goal of increasing understanding and awareness was certainly met. Implementation of the project had some setbacks. That aside, the responses I received from the presentation were all favorable and I think this issue warrants further study. Changing the attitudes of society about men in nursing is a difficult task. It is one that must be addressed if we are ever going to make any true progress. The issues men face in nursing is just one prejudice in nursing, but it needs to be addressed to affect change.

References

American Association of Colleges of Nursing. (2012, October 24). Nursing Faculty Shortage. Retrieved from http:/​/​aacn.nche.edu/​media-relations/​fact-sheets/​nursing-faculty-shortage.

Bell-Scriber, J. (2008). Warming the nursing education climate for traditional-age learners who are male. Nursing Education Perspectives, 29(3), 143-150.

Bell-Scriber, M. (2008). Warming the Nursing Education Climate for traditional-age learners who are male. Nursing Education Research, 29(3), 143-150.

Clemetson, R. (2008). Men in nursing. Nursing Journal North Tec, 12, 37-43.

Croasmun, J., & Ostrum, L. (2011). Using Likert-type scales in the social sciences. Journal of Adult Education, 40(1), 19-22.

Mitchell, M., & Coutney, M. (2005). Improving trnasfer from the intensice care unit: The development, implementation and evaluation of a brochure based on Knowles' Adult Learning Theory. Internation Journal of Nursing Practice, 11(6), 257-268.

Garnets, L. and Pleck, J. H. (1979), Sex Role Identity, Androgyny, and Sex Role Transcendence: A Sex Role Strain Analysis. Psychology of Women Quarterly, 3: 270–283. doi: 10.1111/j.1471-6402.1979.tb00545.x

Harding, T. (2008). Suspect touch: A problem for men in nursing. Nursing Journal North Tec, 12, 28-34.

Harding, T., North, N., & Perkins, R. (2008). Sexualizing men's touch: Male nurses and the use of intimate touch in clinical practice. Research and Theory for Nursing Practice: an International Journal, 22(2), 88-102.

Insight Education Systems. (2007). Micro inequities: At a glance. Retrieved from http:/​/​​AtAGlance.htm

Keogh, B.J., & O’lynn, C.E. (2007). Gender-based barriers for male student nurses in general nursing education programs, an Irish perspective. In C.E. O’lynn & R.E. Tranbarger, Men in Nursing: History, challenges and opportunities. (pp. 241-254). New York: Springer.

MacWilliams, B., Schmidt, B., & Bleich, M. (2013). Men in nursing. American Journal of Nursing, 113(1), 38-44.

McLaighlin, K., Muldoon, O., & Moutray, M. (2010). Gender, gender roles and completion of nursing education: A longitudinal study. Nurse Education Today, 30(4), 303-307.

Mitchell, M., & Courtney, M. (2005). Improving transfer from the intensive care unit: The development, implementation, and evaluation of a brochure based on Knowles' Adult Learning Theory. International Journal of Nursing Practice, 11(6), 257-268.

National League for Nursing. (2005). The scope of practice for academic nurse educators. New York, NY.: : National League for Nursing.

Oneil, J., Helms, B., Gable, R., David, L., & Wrightsman, L. (1986). Gender-role conflict scale: College men’s fear of femininity. Sex Roles 14(5/6), 335-350.

Papastavrou, E., & Panayiota, A. (2012). Exploring sensitive nursing issues through focus group approaches. Health Science Journal, 6(2), 185-200.

Polit, D., & Beck, C. (2008). Nursing research: Generating and assessing evidence for nursing practice (8th ed.). Philadelphia: Lippincott, Williams, & Wolters.

Rajapaksa, S., & Rothstein, W. (2009). Factors that influence the decisions of men and women nurses to leave nursing. Nursing Forum, 44(3), 195-206.

Roth, J., & Coleman, C. (2008). Perceived and real barriets for men entering nursing: Implications for gender diversity. Journal of Cultual Diversity, 15(3), 148-152.

Williamson, S., Clow, K. E., & Stevens, R. E. (2011). To the point: How management faculty use PowerPoint slides and quizzes. Editorial Board, 144, 144-154.

Appendix A

|Goals |Objectives |Activities |Timeline |

|Goal 1: Develop of Professional |1.1 Review Literature and data |1.1a Compile Literature list |1.1a To be completed by 1/20/13 |

|development session for Montcalm |sources related to gender | | |

|Community College nursing faculty |inequality and bias within nursing | | |

|regarding gender specific |and nursing education. | | |

|multiculturalism within the |Review sources and literature on | | |

|classroom. |how micro-inequalities and gender | | |

| |bias can affect the learning | | |

| |environment in the classroom. | | |

| |1.2 Obtain input and relevant |1.2a Create questionnaire with |1.2a To be completed 02/07/13 |

| |information necessary to complete |preceptor input. | |

| |questionnaire on gender based | | |

| |inequalities. |1.2b Finalize questionnaire for |1.2b To be completed 02/10/13 |

| | |nursing faculty | |

| | | | |

| | |1.2c Administer questionnaire to |1.2c To be completed 02/10/13 |

| | |faculty | |

| | | | |

| | |1.2d Compile thematic data from |1.2d To be completed 03/05/13 |

| | |questionnaire. | |

| |1.3 Create outline for professional|1.3a Create/Finish PowerPoint with |1.3a To be completed 03/10/13 |

| |development session. Applying |thematic data from questionnaire | |

| |themes developed from research to |and literature. | |

| |create PowerPoint | | |

| |1.4 Conduct a professional |1.4a Do professional development |1.4a To be completed 04/15/13 |

| |development session |session with MCC nursing faculty, | |

| | |including PowerPoint, question and | |

| | |answer session and discussion | |

| | | | |

| | |1.4b Use focus group as evaluation| |

| | |of presentation effectiveness | |

| | |1.4c Collect all ideas from faculty|1.4b To be completed 04/15/13 |

| | |in regards to increase gender | |

| | |awareness. | |

| | | |1.4c To be completed 04/15/13 |

| | |1.4d Collect ideas from the focus | |

| | |group and deliver to the Dean of | |

| | |nursing. | |

| | | |1.4d To be completed 05/30/13 |

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Appendix B

SCHOLARLY PROJECT SYNTHESIS PAPER 20

SCHOLARLY PROJECT SYNTHESIS PAPER 21

SCHOLARLY PROJECT SYNTHESIS PAPER 21

SCHOLARLY PROJECT SYNTHESIS PAPER 21

SCHOLARLY PROJECT SYNTHESIS PAPER 22

SCHOLARLY PROJECT SYNTHESIS PAPER 23

SCHOLARLY PROJECT SYNTHESIS PAPER 24

SCHOLARLY PROJECT SYNTHESIS PAPER 25

SCHOLARLY PROJECT SYNTHESIS PAPER 26

SCHOLARLY PROJECT SYNTHESIS PAPER 27

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