Gender mainstreaming in nursing education: a study on the professional socialisation processes of Malawian student male nurses during undergraduate training

Abstract

Gender mainstreaming is a major global strategy of promoting gender equality. In an effort to achieve gender mainstreaming, governments are encouraged to mainstream gender at all levels as this helps prevent gender discrimination and bias. Unlike other professions, gender mainstreaming in nursing means recruiting and retaining men because for many years nursing has been regarded as a woman’s profession; nowadays, both men and women are becoming nurses and midwives. Florence Nightingale, upon founding the modern nursing profession, objected to the recruitment of men to be trained as nurses. Although in theory there could be policies to encourage equal opportunities for males and females in all areas of employment men still remain a minority in nursing and face many challenges. It was envisaged in this study that, by means of a professional socialisation process some of the challenges men face in nursing could be addressed. Studies on socialisation of male nurses have been reported in other countries but not in African countries and literature on socialisation of male nurses in Malawi is scanty. Following ethical clearance to conduct the study, a three phased mixed methods study was conducted using a sequential exploratory descriptive design (Creswell, 2009). The purpose of the study was to design and validate professional socialisation materials that could be utilised in the recruitment and education of student male nurses. The overall aim was to understand and address challenges experienced by student male nurses hindering their education during undergraduate training thereby, contributing to the nursing education knowledge base regarding recruitment and retention of men in nursing. It was envisaged that the challenges could be explored and described based on experiences of the student male nurses and from contributions of stakeholders (Lecturers, Deans of Students and Nurse midwife clinicians) contributing towards the students’ education. The study was guided by philosophical underpinnings based on pragmatism. Pragmatists advocate the use of all available approaches, procedures and resources to study the phenomenon at hand (Johnson& Onwuegbuzie, 2004). In this study, both qualitative and quantitative methods were employed to obtain objective and subjective information regarding the professional socialisation process of student male nurses and in validating the designed professional socialisation materials in the form of a booklet and a brochure. However, qualitative methods carried more weight. Social role theory provided an epistemological framework in understanding the phenomenon at hand. During Phase 1 of the study, in-depth interviews (n=30) (M= 14, F= 16) were conducted with qualified nurse midwives, lecturers, Deans of Students and clinical nurse midwives. The qualified staff were utilised as informants in the study. Twelve focus group discussions were conducted with (n=70) male student nurses in purposively selected nursing colleges (n = 6) and central hospitals (n=4). Non-probability purposive sampling was conducted in identifying all data sources. Semi-structured interview guides were utilised. Data organisation and management were aided by the use of MAXQDA software version 11. Thematic content analysis (Braun & Clarke, 2006) was used to analyse the transcripts. Documentary reviews of relevant policy guidelines addressing the recruitment and retention of students were also conducted in Phase 1 using a checklist. Content analysis helped analyse the data for the documentary reviews that were conducted. All data in this study were collected by the researcher. Findings in Phase 1revealed that, during the professional socialisation process of student male nurses, they encountered both positive and negative experiences in nursing, but the negative experiences were on the increase. This was confirmed during the in-depth interviews with the informants (lecturers and nurse midwife clinicians) where three major themes were uncovered. Contributing factors to the negative experiences are that nursing is perceived to be a feminine profession, men felt that they were discriminated against because of their gender and the majority of men who joined nursing did not make an informed choice due to lack of career guidance. During Phase 2, a brochure and booklet were designed. The brochure aimed at providing information to prospective student nurse midwives and males in particular. The booklet was designed based on the recommendations obtained from the study participants in Phase 1 and is envisaged to help address challenges faced during the socialisation processes of male nurses. Both the brochure and the booklet were validated in Phase 3 of the study using the Nominal Group Technique (Vagra-Atkins, McIsaac, Bunyan & Fewtrell, 2011) and the Modified Delphi Technique (Slaughter, Katz & Grass, 1999) respectively. Student nurses and a ‘panel of nurses’ validated the brochure and booklet by completing questionnaires. Descriptive statistics were computed using Statistica version 12. Five Nominal Group Technique discussions took place in four nursing colleges (n=37). Findings revealed that four of the five Nominal Groups found the brochure to be relevant and motivating to prospective students. A group of nurse midwives (n=35) comprising lecturers (n=12), policy makers (n=2), nurse clinicians (n= 12) and student male nurses (n= 9) validated the booklet. Consensus, ranging from 85.71% to 97.14%, was reached during Round 1 of the exercise. In Round 2, all except one participant maintained “don’t agree” response on one statement. Overall, the study findings could help in understanding the challenges and processes male student nurses undergo during education and beyond. The recommendations made by the study participants, as compiled in the booklet and those made by the researcher, could help equip nurse educators and nurse clinicians in the education of nurses and males in particular. The brochure could be a useful tool during career guidance for prospective nurse midwives in Malawi. Use of the Modified Delphi technique helped arrive at a consensus in the validation of gender-inclusive teaching and learning material. Appropriate amendments to the booklet have been implemented. Based on the consensus rate, the booklet, if utilised appropriately, could aid in the professional socialisation process of student male nurses in Malawi.