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Challenges Facing Male Students Nurses during Attending Maternity Nursing Clinical Course: Suggested Guidelines of Actions

Nahed Mousa Saber, Rasha El Sayed Ibrahim*

Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt

Abstract: Background: Men are entering the field of nursing in increasing numbers. As men enter nursing programs, they may be facing challenges during their training mainly maternity sections. Aim: explore the challenges facing male nursing students during their training in the maternity department and suggest a guideline of actions to overcome these challenges. Methods: A descriptive exploratory research design was utilized, data were collected using three tools: (I) structured interview questionnaire sheet: consisted of demographic data and assessment of male nursing students' experience in clinical training and theoretical course for maternity nursing, and (II) students' attitudes towards clinical training. 91 male students who just finished the clinic maternity course in Faculty of Nursing, Beni-Suef University were recruited for the study. Results: The most embarrassing clinical procedures were the vaginal examination and breast examination but the most favorable was immediate baby care and abdominal examination. Studies sample found that theoretical course was interested in the male. The total mean score for studied male student’s attitudes toward practical training was negative. No significant difference between studied male student’s attitude and rural area and significant difference regarding the urban area. A negative correlation between total teaching activities and practical training scores but there was no correlation between attitude and both teaching activities and practical training scores. Conclusion: Male nursing students should be maintained during nursing students training, as the rate at which males enter the profession is increasing, that by assessing the challenges facing male students nursing in maternity course. Recommendations: male students should be oriented to and encouraged to identify with the role model of male obstetricians.

Keywords: challenges, male nursing students, maternity training, suggested guidelines for actions

Received November 16, 2018; Revised December 29, 2018; Accepted January 23, 2019

Citation: Nahed Mousa Saber, Rasha El Sayed Ibrahim, Challenges Facing Male Students Nurses during Attending Maternity Nursing Clinical Course: Suggested Guidelines of Actions. American Journal of Nursing Research, 7 (2). 160-166. January 2019. doi:10.12691/ajnr-7-2-7

1. Introduction

Verifiably nursing has advanced as a feminine profession in spite of a few men having performed men jobs since the calling's earliest stages. Men avoided from training as nurses. Nowadays, there is a growth in the number of men entering the nursing profession, and they remain a minority in the female overwhelmed profession [1].

Midwifery is an art, consequently, every student in a program of midwifery will be presented to clinical experiences. As well, for maternity students to reduce Severity practice to live patients, they must be professionally bolstered and guided along the way to getting to be capable experts. A few expert have created clinical practice rules for use in clinical settings and incorporate male in this branch [2].

There is evidence, in any case, that there is increasing in the number of men entering the calling. In the United Unified states, obstetric for male attendants has been acknowledged since 1960. This was made conceivable on account league for Nursing. This announced that the essential nursing educational programs ought to have no differentiation for men and women [3].

Generally males have also played a big role in nursing and loving for patients and being employed in the health care sectors. these roles include, not forced, to males nurses of various religious orders providing nursing care and protection to the sick, wounded and dying in the time of war and peace also woman in labor. The inability to perceive men's commitment to nursing leaves male medical caretakers with following to no data about their expert foundation [4].

Difficulties males encounter in their work as nurses. These incorporate inquiries regarding their masculinity or sexuality, discrimination because of their gender, the absence of suitable role models, lack of support, feelings of isolation, poor instruction on the appropriate utilization of touch and unequal clinical changes. These challenges may influence males who enlist for education and training in nursing [5].

In the face of the consistent changes that affect health services, the sex imbalance of nursing profession remains constant. This attributed to both historical and social rationale. After Nightingale moved to modernize nursing, men were purposefully excluded from entering the profession [6].

The social setting of men entering the profession of nursing has advanced from this historical context and is currently observed as the real obstruction for men to enter the nursing profession. The issue rotates around the view of role strain for men working in the female-dominated profession [7].

Maternal-child nursing seen by male students as a woman’s area, in which they were visitors. Students undertook exceptional safeguards when accomplishment postpartum assessment. Several researchers found that midwifery staff was cold and hostile through the placement and a male student was made of feeling uncomfortable during the round, many male students not permitted to participate in the full possibility of caring intervention [8].‏

Male nursing students need to guidelines support and action plane in the clinical setting in order to overcome situations that prevent them from fully participating in nursing care. Action of a plan or guidelines mainly about the issues of gender in nursing as a female-dominated profession is essential. This orientation should preferably be carried out by a male clinical supervisor or a lecturer. This will ensure that students are fully prepared spiritually and emotionally to deal with the challenges they will face in a clinical setting. Educators, and professional nurses should be alert of gender differences and need to make an effort to provide a teaching and learning environment that is neutral in terms of its gender expectations. Attempts need to be made to allocate responsibilities without basing it on gender differences. Learning opportunities should be equally allocated to students irrespective of their gender. Professional and practicing nurses should allow students to practice nursing skills according to their learning ideas [9].

1.1. Significant of the Study

As there are few studies finding of challenges facing male nursing students especially in maternity clinical areas as well as, suggested guidelines of actions. Filling the gaps in midwifery literature by shedding light on role conflicts related to cultural constraints and barriers of students, midwives course and patients. As in Beni-Suef is considered a rural area in Egypt and accordingly the culture could affect caring provided by male students to an Egyptian woman which cause a source of challenges for male students. By so doing, the study reinforced the urgent need to describe the challenges facing male nursing students during training in maternity departments and suggesting guidelines of actions.

1.2. The Aim of the Study

The current study aims to explore the challenges facing male nursing students during their training in the maternity department and suggest a guideline of actions to overcome these challenges.

1.3. Research Question

What are the challenges facing male nursing students during training in maternity departments?

Research design: A descriptive exploratory research design was utilized to fulfill the aim of this study.

1.4. Technical Design

Setting: This study was conducted at the maternity department in the Faculty of nursing, Beni-Suef University.

Subjects: Purposive sampling was used to select participants (91) male nursing students. Who just finished their training in the maternity department in the faculty of Nursing, Beni-Suef University was recruited for the study and who are willing to participate in the study.

Tools: Data pertinent to the study were collected, using the following three tools:

Tool (I): Structured Interview Questionnaire Sheet:

The researchers developed the interview questionnaire sheet for male nursing students: aimed to assess their clinical experience regarding theoretical and practical training in the maternity department.

It consisted of three parts:

- First part: Demographic and related data includes age, residence, and male student's academic year achievement.

- The second part: Assessment of students clinical training nursing assessment, and theoretical part.

- Third part: a- It includes teaching and learning activities as the demonstration and re demonstration, Case study, reading the assignment, manual procedures, nursing records, and posters.

Scoring System

Using Likert Scale if it is not used it takes (Zero) if used but not effective it is not used it takes (1 score), if used but effective it is not used it take (2 scores).

b. Assessment of embarrassing procedures during clinical training as Abdominal examination, breast care, vaginal exam, episiotomy care, uterine massage, uterine contractions, and immediate baby care.

Scoring System:

The scoring system for this tool consider if it unfavorable procedure takes (Zero), and if it is favorable procedure it takes (1 score).

Tool II: Students' Attitudes towards Practical Training:

The researchers was developed this tool from [10] for male nursing students aimed to assess the student’s attitude towards clinical training by the suggestion to optimize maternity nursing course, future career plan, and way of being treated differently in maternity units.

Scoring system for the answer was:

Using Likert Scale the scoring system for this tool consider if it strongly not agree it takes (zero), if not agree it takes (1) if it not important it takes (2) if it agrees it takes (3) if it strongly agrees it takes (4).

The women's total knowledge score: The total scores =60.

The total scores were classified as the following if it is < 50 % it considers negative attitude if it >50 % it considers positive attitude.

2. Validity & Reliability

The tool was submitted to a panel of three experts in the field of Maternity Nursing, Obstetric Medicine and Medical Surgical Nursing to revise the questions traveled challenges, the study was seeking to understand and checked for proper sequencing of the questions, spelling, grammar, and researcher bias. This resulted in the interview protocol being revised several times until the group was in agreement that it was acceptable to disseminate. The field test helped to ensure that credibility and dependability of the questionnaire were existing when conducting the research. The reliability test was assessed by using Cronbach's alpha test and equal 0.9 and pilot study by using test-retest.

3. Methods of Data Collection

3.1. Pilot Study

The pilot study carried out on 9 (10%) male nursing students to test the clarity and feasibility of the study tools and test stability reliability of the tools was invested by test-retest reliability. It has also provided an estimate of the time needed to fill out the tools; no change was done in the assessment sheet, so the 9 male nursing students who tested as a pilot study were included in the main study.

3.2. Ethical Considerations

Official permission was obtained from the dean of the faculty of nursing, Beni-Suef University to conduct the study.

Before conducting the actual study, oral consent was obtained from the male students after they informed about the nature and objectives of the study after being assured that the data were to be confidential.

3.3. Fieldwork

The data were collected over a period of a full year starting from August 2017up to the end of July 2018. The data collection was done as the following:

The researcher conduct face-to-face interviews with all participant and the tool was filled in about 30 minutes to 45 minutes and each student received individually verbal and written information. The researchers filled out the interview questionnaire sheet to obtain studied sample demographic data, and their academic achievement. Then the researcher assessment of students clinical training and theoretical part.

The researchers asked the studied students 12 questions which were the components of the student’s attitudes towards practical training sheet to assess their attitude toward practical training they receive at the labs and hospital.

3.4. Administrative Design

Written letter including the aims of the study was issued from the Dean of the Faculty of Nursing to seek approval for carrying out the study.

3.5. Statistical Design

Data assembled from the participants by transposing the interview questionnaire and scattered data using a commercial software platform. The results of the survey responses from the participants were converted into a Microsoft Office Excel spreadsheet, which was a feature offered through a commercial qualitative analysis software program (SPSS version 20), which coded and analyzed the data. Qualitative data were expressed as number and percent (No & %) then analyzed by applying a chi-square test. Statistical significance was considered at P-value <0.05 and highly Significance at P-value <0.00.

4. Results

Table 1. Percentage distribution of demographic data among studied male students N. =91

This table showed that; the mean studied students' ages were 20.75±.834 and 68.1% were coming from rural areas

Table 2. Distribution of studied male students according to their final academic achievement N. = 91

This table showed t as regarding the student's final academic achievement, 53.8 % of the studied male students were good.

Table 3. Percentage distribution of studied male students in clinical training and the theoretical course in maternity nursing N. =91

This table showed that 52.7% of studied male students were interested to the theoretical course, but 87.9% were not interested from clinical training that due to embarrassment from women, the absence of male staff in maternity department, Non-welcoming by male students, but not related to any religious and cultural factors

Table 4. Percentage distribution of teaching and learning activity that used in clinical training areas among studied male students N. =91

This table founded that case study was the most method used in clinical training areas but demonstration and redemonstration used and the most effective methods but in the other hand reading assignment and poster were the most methods used and not effective.

Table 5. Percentage distribution among studied male students for most embarrassing clinical procedures N.=91

This table showed that the most embarrassing clinical procedures that are experienced by students are performing a vaginal examination and breast examination (100%), and (92.3%) respectively. But the most favorable was immediate baby care and abdominal examination.

Table 6. Percentage distribution for studied male students attitudes towards practical training N. =91

This table mentioned that studied male students can provide nursing care in the maternity ward (50.5%) in addition to that (52.7%) of studied male students agreed that they gained a lot of skills during the study of maternity nursing.

Table 7. Total means score for studied male students attitudes towards practical training N. =91

This table showed that the total mean score for student’s attitudes toward practical training was (30.27±6.85) which consider negative attitude.

Table 8. Comparison between studied male students residence and their attitude N. =91

Use Pearson chi-square (cross tabs test) Cross tabulation

This table showed that there was no statistically significant difference between studied male students attitude and their residence rural area, although there was a significant difference regarding the urban area.

Table 9. Relationship between studied male students attitude and total teaching activities score and practical training scores N. =91

This table showed that no statistical significance difference regarding student’s attitude and total teaching activities score, while there was a statistically significant difference regarding total practical training score.

Table 10. Correlations between studied male students total attitude, teaching activities and practical training scores N. =91

This table showed the negative correlation between total teaching activities and practical training scores but there was no correlation between attitude and both teaching activities and practical training scores.

5. Discussion

The aim of the present study was to explore the challenges facing male nursing students during their training in the maternity department and suggest a guideline of actions to overcome these challenges

The results specified that; the mean studied students' ages were 20.75±.834 that because the sample was from selected male students who just finished the maternity course and more than half of them were from rural areas, the rural background may explain the finding of this study. This finding was in the same line with Eswi and El Sayed, [11].

As regarding student’s Academic achievement, the majority of the studied male students had a good degree in the maternity course .this may be due to the male nurse students, and social image of nursing as profession considered one of the main reasons that put the male students under tension. This finding not in the equal line with Wang et al., [12] in which the students had poor learning scores, utmost of them having to take–up exams, also, male students were regularly absent from nursing courses.

Regarding male students' experience in the practical and theoretical course for maternity nursing. The study revealed that more than half of male nursing students were interested in theoretical course, on the other side, the most of students were not interested with clinical training that may be due to embarrassment from women, less co-operation, absence of male students in maternity department, and Non-welcoming by male students from medical and nursing staff toward male. This dissenting with Hunter et al., [13] who found that male nursing students were very worried about maternal theoretical and practical training and they were not aggressive in this practice.

From the present study, case study considered the most method used as teaching and learning activities in maternity course. However, demonstration and re-demonstration used and most effective. On the other hand, reading assignment and poster were the most methods used and not effective. It may be due to demonstration and re demonstration considering psychomotor skills, and according to Learning methods theories psychomotor skills help students to remember about 70% because it gives chance for applying skills by their hands, otherwise case study most methods used because it is an alternative means of learning to convey experience with male and female students as female contact with mother (cases) as transferring knowledge to their male students.

This finding supported with Hunter et al., [13] who mentioned that students, generally, the favorite clinical demonstration which considered more effective than other methods. Add that it was important to increase the amount of time in the clinical setting. Students preferred rotation in units similar to medical care such as risk pregnancy unit to labor and delivery room and antenatal and gynecology clinics rather than the theoretical part.

Berman, [14] described simulation as an endeavor to reproduce most aspects that are considered essential in a clinical setting to facilitate that it be more readily understood and managed when it occurs in the real clinical surrounding. Simulation plays a crucial role in the development of competencies since working directly with patients bears a risk. This is especially relevant to the practice of midwifery since the lives of both mother and infant may be at risk. The simulation also facilitates the process of becoming more adept and self-confident during clinical training.

Study results also exposed that the most embarrassing clinical procedures were the vaginal examination and breast examination but the most favorable were immediate baby care and abdominal examination. This may due to society view of male nursing, these students may be teenager. Eswi and El Sayed, [11] found that male nursing students were very fretful about maternal clinical practice and that was not hostile in this practice, and women not like care, which offered by male nursing students, especially, care related to breast and perineal. One of the factors that affected the student's experience was negative, the un helpful attitude of the instructors.

As regarding student's attitude towards practical training, the study mentioned that males’ students can provide nursing care in the maternity ward. In addition, nearly all male nursing students strongly agreed that they gained a lot of skills during the study of maternity nursing. This not in the same line with Sabin et al., [15] who reported that rejection and incorporation of women to receive care by the male student during their clinical training.

The current study showed that the total mean score for student’s attitude toward practical training was (30.27±6.85) which consider negative attitude. This may be due to the stereotypes tie nursing to femininity and thus discourage men from becoming nurses. This result was in the same line with Power et al., [16]. They found that male student's attitude toward practical skills during the study of maternity course was negative. The finding focus on the role of the nursing male in Egypt for woman care is not accepted which put them in stress and effect on the attitude of male nursing students.

These findings were in consensus with the findings of Meyer, [2] who conducted a study on the experiences of male nurses in midwifery clinical training at a regional hospital in the Eastern Cape. The study initiated that participants reported that many female patients showed a preference for a female midwifery service provided by refusing the care that was offered by males. In addition, participants themselves expressed the discomfort that they experienced whilst caring for female patients.

Hodges et al., [17] highlighted some of these encounters, which include a deficiency in the history of men in nursing, a lack of role models, role strain, gender discrimination, and isolation. Gender- friendliness was proposed as part of the nursing curriculum design so that instructors could understand certain differences, and use their understanding to plan and deliver effective instruction.

The present study found no statistically significant difference between male student’s attitude and their residence rural area and statistically significant difference regarding the urban area. That finding was supported by Pruet et al., [18] who mentioned that the residence of the students' effects on the attitude of them toward the practical and theoretical maternity course. Residence of the students considers one of the contributions to their stressful experience.

A negative correlation between total teaching activities and practical training scores but there was no correlation between attitude scores and both teaching activities and practical training scores found in the current study. This may be due to there was a gap between theoretical and clinical training because students not practiced the clinical procedures in the hospital.

That was not in the same line with Bas and Beyhab [19] who found a highly significance differences between the attitude of the students and the methods of teaching that used during the course training and their academic achievement.

6. Conclusion

Based on the finding results it concluded that:

• The most embarrassing clinical procedures for studied male students were the vaginal examination and breast examination but the most favorable was immediate baby care and abdominal examination.

• Studies sample found that theoretical course was interesting for the male.

• The total mean score for student’s attitudes toward practical training was negative.

• No statistically significant difference between male student’s attitude and their residence rural area, but statistically significant difference regarding the urban area.

• A negative correlation between total teaching activities and practical training scores but there was no correlation between attitude and both teaching activities and practical training scores

7. Recommendations

Based on the study findings,

• Design the midwifery casebook in a simple manner and ensure that students are fully orientated on filling in the register.

• Monitor students’ clinical progress on an ongoing basis and formulate a skills evaluation schedule. When satisfied with the students’ progress, the nurse educator should inform them of skill evaluation dates earlier to ensure that they are adequately prepared.

• Lastly, male students must be concerned with encouraged to identify with the role model of male obstetricians.

8. Suggested Guidelines

• Male nurses must be supported in clinical training, as the rate of males enter the profession is increasing.

• Re-plan of specific clinical procedures of maternity nursing to include additional clinical experience for the male students should be considered to develop strategies to change male student's attitude.

• Accentuate practical training, which includes the performance of procedures to increase student midwives' confidence and develop their basic skills in the clinical field of maternity.

• Increasing nursing faculty awareness of male students perceived experience while learning to nurse

• Providing proactive solutions to address the alienation men experience in nursing education

• Programs such as establishing mentors between new nursing students and practicing men in nursing may decrease the social isolation that male students experience

• Dialogue about changes in caring behaviors across gender is important.

• Clinical skills need to be arranged for prepare male students to easily provide care to women in the maternity care setting.

• Restructure stories about nursing's history with the inclusion of important roles men have undertaken as caregivers

• Request to the university community on the importance of male faculty members in the department of maternal health nursing.

• Welcoming male students by hospital staff

• The interest of male students in participating in the special subjects program of obstetrics and gynecological nursing

• Supporting male students by faculty members

• Facilitate barriers to the curriculum and work to increase male students' interest in practical aspects such as the theoretical course.

• Working on the existence of manuals to guide the special skills of maternity health nursing.

References

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