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                                                         CHAPTER ONE


Background of study

The study was focused on exploring and describing reasons for poor Responsible Behaviour among nursing students at a public nursing college in the Nigeria.

The nursing profession needs nursing students who are responsible and accountable, and practise good Responsible Behaviour. Positive Responsible Behaviour is essential to the nursing profession because nursing is based on the values of respect and human dignity and it is assumed that nursing education is received in a place where compassionate and civilized relationships exist (Clark & Carnosso 2008: 11, cited by Vink & Adejumo 2013: 2).

In South Africa, nursing is regulated by the Nigeria Nursing Council (NNC). Nursing colleges, hospitals and clinical facilities fall under the jurisdiction of Nursing Act, Act No.143 of 2004. The objectives of the Council are to serve and protect the public in matters involving health services generally, and nursing services in particular, while performing its functions in the best interest of the public and in accordance with the national health policy as determined by the Minister.

Further objectives included promoting the provision of nursing services to the inhabitants of the Republic that complies with universal norms and values. Maintaining professional conduct and practice standards for practitioners within the ambit of any applicable law. Upholding and maintaining professional and ethical standards within nursing.Nurse educators should play an important role in constructing a learning environment that fosters the positive formation of future nurses. The students‟ construction of a nursing identity is grounded in their social interactions with nurse educators and is shaped by values and norms learned in both the formal and informal curriculum (Prato 2013: 286).

When people hear the word nurse they think of qualities such as compassion and patience. While these are essential characteristics, nurses must go even beyond these when striving for professionalism. They also need strong morals and ethics, and the commitment to always act in the best interest of their patients (William 2012: 1). Gokenbach (2012: 1) states that, in order to understand the concept of professionalism, we first need to define a profession.

According to Cruess, Johnston and Cruess, as quoted by Yusoff (2009: 1), a profession is “an occupation whose core element is work based upon the mastery of a complex body of knowledge and skills”. Gokenbach (2012: 1) affirms that a profession is a “chosen, paid occupation requiring prolonged training and formal education”. The above author further mentions that professionals are individuals expected to display competent and skilful behaviours in alignment with their profession (Gokenbach 2012: 1).

Being a professional is referred to as an act of “behaving in a manner defined and expected by the chosen profession” (Gokenbach 2012: 1). Yusoff (2009: 1) argues that professionalism is the combination of all qualities connected with trained and skilled people.

Vitez (2012: 1) agrees that professionalism concerns a strict adherence to courtesy, honesty and responsibility when dealing with individuals. Members of the profession are governed by a code of ethics and they profess a commitment to competence, integrity and altruism (Yusoff 2009: 1).Yusoff (2009: 1) affirms that the root word of professionalism and of professional is the word profession. The same author outlines a profession as a type of work which needs a particular skill that is respected and involves a high level of educational performance. Muller (2009: 4) also refers to a profession as a specific career where work of an intellectual nature is performed.

In the nursing profession the socialisation process for students is important as they are required to display Responsible Behaviour in the performance of their duties. According to Mellish, Oosthuizen and Paton (2010: 126), nursing students learn professional values and norms through professional socialisation. The process of professional socialisation starts when nursing students commence nursing training and continues throughout their lives (Mellish et al. 2010: 91).

Muller (2009: 7) states that the novice is socialised professionally in order to make the norms and values of the profession her own, and the professionally mature practitioner will display the characteristics of professionalism. Meyer and Van Niekerk (2008: 91) affirm that nursing students should be accompanied in their development towards professional maturity in such a way that they attain freedom of choice and responsibility of moral independence.

Good Responsible Behaviour is evident when nursing students demonstrate professionalism by attending classes and clinical experiences and exhibiting courteous behaviour. Nursing students who display positive Responsible Behaviour take initiative in all learning areas, are prepared for class and clinical assignments and are punctual in class and in the clinical area. Such nursing students address members of the discipline professionally when they are engaged in class discussions and when they ask questions in class, and offer constructive criticism.

Student nurses are honest about their work both in class and in the clinical areas. They display a pleasant attitude when dealing with patients / clients, show respect and are always available and attend to patients‟ needs. The professional nursing student is always actively involved in the clinical area and the registered nurse relies on her. Gokenback (2012: 5) supports that good Responsible Behaviour involves the manner in which a professional presents herself to all those around her and possesses the capacity to care for others.

Poor Responsible Behaviour is evident when nursing students lack knowledge about their work, are not practicing procedures and are not competent in their skills. This may be the result of high absenteeism in the clinical area. A nursing student with poor Responsible Behaviour is not a good communicator and is always shouting and yelling at other students and patients.

Jackson, Steven and Clarke (2013: 3) also argue that poor Responsible Behaviour is seen in poor attendance in clinical practice and in class, lack of diligence and reliability.

According to Muller (2009: 30), nursing in Nigeria is controlled or regulated by the South African Nursing Council in accordance with the international guidelines provided by the International Council of Nurses (ICN) (1997). The ICN guidelines are in line with the Constitution of the Republic of South Africa (Act 108 of 1996), with specific reference to the principles of co-operative governance and the Bill of Rights in the South African Constitution (Act 108 of 1996), as well as basic health-related rights.

Muller (2009: 30) states that “The intention of the Nursing Act (Act 33 of 2005 ) is to promote professional accountability, to transform the regulatory framework / environment applicable to the nursing midwifery profession and to create a legislative environment ensuring that the community receives care from competent nurse / midwives that are responsive to societal needs.

One of the most important features of nursing as a profession is that it has a professional code of ethics based on personal morality, which is the foundation of trust for the patient and the community. Individual moral integrity is regarded as the key to a safe standard of practice (Searle, et al. 2009: 265).

Boykin and Schoenhofer (1993) in their theoretical framework support that nursing is the response to the “unique human need to be recognized as, and supported in being a caring person” (George 2014: 674). Third-year nursing students must treat the patient with care, and should take nursing actions that seek to nurture the patient in living and growing in caring.

Nursing students are governed by a code of conduct designed by members of the profession, which acts as a social instrument to guide and control nurse practitioners (Searle, Human & Mogotlane 2009: 11). Searle & Human et al. (2009: 11) state that the code of conduct exists to protect the public and the good name of the profession.

A code of ethics is described by Yoder-Wise (2011: 9) as formal statements that articulate the values and beliefs of a nursing professional; serve as a standard of professional action; and reflect ethical principles shared by nurses. The nursing code of ethics also provides a basis for ethical analysis and decision making in clinical situations Yoder-Wise (2011: 91).

Mellish et al. (2010: 125) affirm that codes of ethics foster and maintain ethical standards of professional conduct by cultivating moral character and encouraging nurses to engage in moral reflection.

Nursing as a profession embodies many values inherent in those who pursue nursing careers. Nurses display responsibility, integrity, pursuit of knowledge, belief in human dignity, equality of all patients and the desire to prevent and alleviate suffering (Gokenbach 2012: 1).

The theorists also mention honesty as a positive concept that implies openness, genuineness and seeing truly (George 2014: 672). This means that third-year nursing students must be honest with the patients, especially in the clinical area, and perform all the procedures and allocated work diligently.

They should show respect and caring when dealing with patients and not discriminate against patients, so as to build a trusting relationship between patients and nurses.Nursing is deemed a highly ethical profession and relies on the moral integrity of individual practitioners to provide safe nursing care (Searle et al. 2009: 265).

The code of ethics requires that nursing students follow the professional nurse‟s code in addition to their own Responsible Behaviour, because upholding professional standards ensures accountability and optimal care for their patients. Such behaviour enables nursing students to maintain the public‟s trust and respect (Balchucci 2012: 2).

Professional nurses are expected to display competent and skillful behavior, be ethically and legally accountable for the standards of practice and nursing actions they are delegating to nursing students (Yoder -Wise, 2011: 64).

The above mentioned author further states that professional nurses are responsible to direct care to nursing students, create a conducive environment for learning and manages while providing professional role modeling to develop future managers and leaders (Yoder –Wise, 2011: 64) .

Marreli (2004:51) concurs that professional nurses should foster the development of future leaders by nurturing nursing student‟s clinical and leadership potential, leading by example and serving as a role model, sharing a vision to support organizational culture.

Nursing students are expected to adhere to the code of conduct and observe the rules, regulations, norms and values of the nursing profession while exhibiting a sense of duty, accountability, responsibility and loyalty.

 Problem statement

The researcher is a lecturer at a nursing college at a Campus in the Eastern Cape where the study was undertaken and where she has encountered poor Responsible Behaviour displayed by nursing students. The researcher is familiar with poor Responsible Behaviour among students in the class and in the clinical setting. There has been an outcry from lecturers and other health care professionals regarding the poor Responsible Behaviour of nursing students.

Students, for example, engage in conversations on the side while faculty members are teaching and when attending to patients in the clinical setting. At times, students are busy with their phones, neglecting calls from patients. They report late on duty, take long tea and lunch breaks, and do not wear proper uniform when allocated in the wards.

The Code of ethics for nursing practitioners of the Nigeria Nursing Council (2013: 3) states that this code serves as a declaration by nurses that they will provide due care to the public and healthcare consumers to the best of their ability while supporting each other in the process.

In the past, nursing students at training colleges in the observed professionalism by showing respect for their seniors, observing proper dress code with well- groomed hair, well-groomed beards and neat appearance when attending lectures and when allocated in the clinical area. LaSala and Nelson (2005: 2) state that the dress code and Responsible Behaviour for nursing students were dictated strongly by strict disciplinary protocols developed by hospital administrators in charge of nursing students. The dress code for college nursing students is now defined by college management.

In the past, nursing students also were keen to work, even in class, were actively involved in group work and class discussions and meeting deadlines. They were well-disciplined and dignified, attended to patients‟ needs and were always available to help patients in need of their care. They were knowledgeable and curious to know and learn, not defensive, but displayed good general behaviour and respected the patients and significant others. Nursing was a calling and nurses adhered to the pledge of service, but they now follow nursing as a career.

Nowadays, nursing students investigated for this research are not punctual in class and absent themselves without a valid reason when allocated in the clinical area. Some students are disrespectful towards the lecturers, unruly in the clinical settings, report late from tea and lunch breaks and some do not even report back from the lunch break. Nursing students do not show commitment when given assignments and are not responsible regarding their work. Others use disrespectful language with intimidating behaviour.

The researcher recognised the need for conducting research to examine the reasons for poor Responsible Behaviour among college nursing students.

Vink and Adejumo (2013: 2) have also mentioned that poor Responsible Behaviour in the field of nursing and nursing education is becoming noticeable in nursing schools and nursing classrooms. Earlier, Bjorklund and Rehling (2010: 16) and Elder, Seaton and Swiney (2010: 105), as cited by Vink and Adejumo (2013: 3), reported evidence indicating an increase in problematic classroom behaviours such as academic misconduct, absenteeism, aggression, coarse language, hostility, inappropriate remarks, inattentiveness, lack of respect, late coming, physical and verbal abuse, rudeness, tardiness, threats and yelling and the use of cell phones as becoming a norm in some schools.

Aim of the study

The aim of the study was to explore and describe reasons for poor Responsible Behaviour among nursing students at a nursing college in order to uplift the image of the nursing profession.

 Research questions

The research questions that guided the study were as follows:

What do you understand by Responsible Behaviour?

What are the reasons for poor Responsible Behaviour among nursing students at the college in question in  Nigeria?

What could be done to improve professionalism among college nursing students in Nigeria?

 Research objectives

The objectives of this research were as follows:

Explore and describe the reasons for poor Responsible Behaviour among nursing students at a college in Nigeria.

 Describe strategies to improve poor Responsible Behaviour amongst nursing students at this nursing college in Nigeria.

 Significance of the study

It was important to undertake this study for the following reasons:

The study has significance for the college management, college staff, nursing students, registered nurses and everyone involved in professional development of nursing students. Nursing colleges may have to reshape the curriculum and evaluate the course of professional practice for professional development. The  Department of Health will be able to employ professional nurses with good quality training regarding maintaining professional standards in the nursing profession.

The study may help to reinforce the implementation of good Responsible Behaviour among college nursing students to uplift the professional image. Patients will enjoy quality nursing care and a comfortable stay in the hospital.

The results will assist in the identification of strategies to improve poor Responsible Behaviour by nursing students and identify strategies to improve and promote professionalism in the college and in clinical facilities.

Recommendations from this study will contribute towards assisting college staff and clinical staff in instilling Responsible Behaviour among nursing students and inform them about the role that can be played to maintain a high level of professionalism by the Department of Health, nurse educators and registered nurses in the nursing profession

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