Peter Kellett MN Ph.D. (c) RN Monique Sedgwick Ph.D. RN (PI)

1. Contradictions and Tensions: Masculinity, Marginalization, and Belonging among Male Undergraduate Nursing Students during Practice Education Peter Kellett MN Ph.D. (c) RN Monique Sedgwick Ph.D. RN (PI) Nursing Education in Southwestern Alberta (NESA) BN Programs University of Lethbridge

2. BACKGROUND Growing body of literature on men in nursing • Emphasis on recruitment & retention in response to pervasive low numbers • Strong identification of nursing as a feminine profession and patriarchal scripts that situate caring in the realm of the feminine (Harding, 2007; Jinks & Bradley, 2004; Kouta & Kaite, 2011) • Evidence of barriers to success during nursing education(Bartfay, Bartfay, Clow, & Wu, 2010; Brady & Sherrod, 2003; Keogh & O'Lynn, 2007; Okrainec, 1994; Stott, 2004, 2007; Strong Anthony, 2004; Tosh-Kennedy, 2007) • Accounts of social marginalization during nursing education that may hamper the development of a sense of belonging (O’Lynn, 2004; Stott, 2007) • Examining men’s sense of belonging in nursing, may illuminate one element that is contributing to low numbers and high attrition (Tosh-Kennedy, 2007)

3. Importance of Belonging • Belonging is a pre-requisite for optimizing learning (Levett-Jones & Lathlean, 2008) • Described as a universal human characteristic and a basic human need (Maslow, 1970) • Failure to feel connected to others  cognitive, affective, & behavioural consequences (Andersen, Chen, & Carter, 2000; Baumeister, Twenge, & Nuss, 2002; Hagerty & Williams, 1999) • Although belonging is a personal experience, the degree to which individuals perceive belonging is influenced by their social environment & the groups that they interact with(Hagerty, Lynch-Sauer, Patusky, & Bouwsema, 1993; Levett-Jones, Lathlean, McMillian, & Higgins, 2009). • Diminished belonging may decrease nursing students’ motivation to learn & willingness to engage in questioning clinical practice (Levett-Jones & Lathlean; Treadwell, 1996)

4. Belonging in the Current Study Conceptualized as composed of 3 concepts: • Self-efficacy – dynamic, changeable self-evaluation  academic persistence, confidence, and willingness to engage with and learn from colleagues • Connectedness – involvement with others contributes to a sense of comfort, well-being, and reduced anxiety • Self Esteem – internal beliefs, values, & attitudes developed through interaction that contribute to a positive self-image, self-respect, & and a sense of becoming a nurse (Bandura, 1986, 1997; Gilovitch, Keltner, & Nisbett, 2006; Hagerty et al., 1993;Levett-Jones et al., 2009; Randle, 2001)

5. PURPOSE Aim of the study was to determine if there was a difference in feelings of belongingness between male and female nursing students during clinical practice experiences

6. METHOD • Cross-sectional survey • Data were collected during winter semester • Ensured all respondents had participated in at least one clinical practice course • Ethical approval received from the Human Subjects Research Committee (HSRC) • Purpose of the study and participant rights explained during an in-class presentation prior to distribution of survey • Return of the completed questionnaire implied consent

7. SAMPLE • n= 462 (Response 88.5% of 522) • Represented all years of the basic and BN after-degree programs • lower response by 4th year basic students -7.7% • Gender distribution • Female – 92.9% • Male – 7.1% • Program representation • 4 year basic program – 89.1% • 2 year after-degree program -10.9% • Limited diversity • Caucasian – 90.1% • Visible minority – 9.9%

8. THE SURVEY TOOL Belongingness Scale – Clinical Placement Experience (BES-CPE) • Originally developed by Somers (1999) & adapted by Levett-Jones et al. (2009) • 34 items scored on a 5-point Likert scale (1=never true, 2=rarely true, 3=sometimes true, 4= often true, 5=always true) • Overall score of belongingness and 3 sub-scales • Overall (Cronbach’s Alpha=0.92) • Esteem (0.90) • Connectedness (0.82) • Efficacy (0.80) • In current study: Overall alpha (0.88); esteem (0.86); connectedness (0.86); efficacy (0.75) (Levett-Jones et al., 2009)

9. DATA ANALYSIS • Analysis performed with IBM SPSS™ 20 • Descriptive statistics & the distribution of scores were assessed prior to analysis with inferential statistics • Independent samples t-tests performed when the distribution approximated normality • Mann-Whitney U non-parametric test performed when normality of scores could not be assumed (reporting standardized Z scores )

10. RESULTS

13. DISCUSSION... • Absence of overall significant differences in BES-CPE scores based on gender – inconsistent with previous reports of social isolation and marginalization among men (Keogh & O’Lynn, 2007; O’Lynn, 2004; Stott, 2007) • Sub-scale scores and individual item scores not all supportive of men’s sense of belonging and examining these contradictory findings illuminates the potential source of reports of social isolation • Lower belongingness scores on Esteem and Connectedness items – Why? • Perhaps these men are experiencing some marginalization or discrimination OR could it be aggrieved entitlement (Kimmel, 2010) • Privilege is invisible to those that have it until they lose it. Patriarchal paradox for men in nursing  maybe perceived as discrimination or marginalization

14. DISCUSSION • Significantly lower scores on Efficacy sub-scale – Why? • Tension exists - adhering to traditional masculinities emphasizing independence and autonomy may undermine these men’s efficacy as nurses in a learning & practice environment that emphasizes collaborative social interaction (Evans & Frank, 2003; Forrester, 1988; Kellett, 2010) • Reluctance to ask for help or advice may undermine the establishment of collaborative and supportive relationships with nursing colleagues  self-fulfilling prophesy of remaining on the margins • Additionally, men’s reluctance to ask for help may also have the potential of impacting the quality of care or patient safety (Gregory et al., 2009)

15. IMPLICATIONS... • Both male and female students must confront their well-established perspectives on gender  consider how these views may influence their social performances in nursing practice • Facilitate this by creating structured and supportive approaches throughout the nursing curriculum to explore and deconstruct the influence of gendered scripts in society • Nurse educators must challenge existing models of caring in nursing to acknowledge the multiple ways of demonstrating caring (Grady et al., 2008) • Mentorship programs using electronic technologies to assist men to reflect on and navigate the contradictions & tensions inherent in men’s nursing practice(Evans & Frank, 2003; Stott, 2004)

16. IMPLICATIONS • At the program level, nursing program leaders should establish strategies that support and educated faculty about the inherently socio-political nature of gender and encourage the critical examination of acceptable care • Nursing educators must also be encouraged to implement strategies to support men in navigating the challenges associated with intimate physical care & the sexualization of men’s touch (Evans, 2002; Harding et al., 2008; Kellett, 2010) • Nurse educators should also critically evaluate teaching strategies used in both the classroom and clinical settings and identify those that may promote differential treatment of male or diverse learners (Bell-Scriber, 2008; Paterson et al., 2004) • Strive to deinstitutionalize the traditional linkage between the performance of femininities and caring – supporting the inherent diversity in caring practices (Kellett et al., 2014; Rajachich et al., 2013)

17. LIMITATIONS • The quantitative survey design makes it difficult to capture the complex factors that may contribute to men’s feelings of discrimination or marginalization within nursing - Further study is warranted • Respondents’ experiences represent feelings at only one point in time, in the social context of a small and fairly socially homogenous nursing program • Generalization of findings to all nursing students or male students in particular may be problematic • Longitudinal studies to track patterns over time would be beneficial • Other socially constructed categories, such as those established by racialization, likely intersect with and moderate the impact of gender on feelings of belonging (Hancock, 2007) • Replication of the study in a larger and more diverse nursing program may be beneficial

18. UPCOMING PUBLICATION Sedgwick, M., & Kellett, P. (2015 – In Press). Exploring masculinity and marginalization of male undergraduate nursing students’ experience of belonging during clinical experiences. Journal of Nursing Education, 54 (3) March 2015

19. CONTACT INFO Peter Kellett Monique Sedgwick monique.sedgwick@uleth.ca http://directory.uleth.ca/users/ monique.sedgwick peter.kellett@uleth.ca @GAPSinHealth www.gapsinhealth.com Journal of Nursing Heterodoxy www.journalofnursingheterodoxy.com @nsgheterodoxy

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