Power
The issue of power was evident in relation to justice, respect
and having a voice. Respect was tied up with notions of being
taken seriously and having a good relationship with members
of staff – in essence being treated as an equal adult. Many
students gave accounts that reflected the empowering experience
of having a voice. Some had challenged practice in the
name of acting as patient advocate, but more specifically
because that had conceived of practice as poor or erroneous:
A patient was being checked for surgery on a trolley ready to go (to
theatre)…I noticed that it was the left knee which was marked for
surgery but on the notes it was the right. This difference that I had
noticed was thoroughly checked out. The correct knee was marked,
but the wrong knee had been identified on the nursing assessment
form…(however), I had noticed and did something about the error.
(student 2/11)
Advocacy appeared to have a positive effect on the esteem of
students, and some conveyed a sense of confidence following
their empowering experience:
It has helped me to be able to understand my own strengths and
realize that I will have the confidence in myself to challenge other
professionals in protection of my patient. (student 3/11)
Many students, however, gave clear accounts of disempowering
situations where they had felt disrespected. Typically
this was illustrated by the behaviour of other people:
The sister of the ward (nurse manager) introduced me to my new
mentor and she replied, ‘Oh great, have I got HER as a student’ –
which instantly made me think, ‘This placement is now going to be
ruined’. (student 2/01)
Another important issue related to lack of voice. For many
this meant silent acquiescence, but perhaps the most worrying
type of disempowerment related to witnessing poor
practice. Some students felt unable to challenge practice, even
though they sensed that something was wrong:
My mentor was off sick so I worked with another nurse. We were
giving a patient her medication through her NG (naso-gastric) tube…
the nurse mixed them together… my mentor had taught me and other
nurses on the ward that when feeding medication down an NG tube
that each medication should be put down separately. I didn’t say
anything as it is not my place as a student. (student 1/03)
Students who had been subject to disrespect, injustice and
lack of voice described feeling ‘useless’, ‘thick’, ‘stupid’,
‘inadequate’, ‘inferior’ and ‘angry’. The detrimental effect
was captured by this student:
The outcome was that I didn’t like the placement and I just wanted to
leave. (student 2/13)