Attachment, belonging and identity are important to effective health curricula
Article Outline
- Introduction
- Research and self-assurance
- Attachments
- Nursing and attachments
- Childhood determinants of occupational choice
- Providing a secure base
- Acknowledgement
- References
- Copyright
Introduction
Encouraging student nurses, midwives and related professionals to contribute to the advancement of their educational programmes is important. Actively participating in laying down firm foundations for their professional development, may bring gains in the form of a greater sense of belonging along with feelings of self-confidence and security.
While avoiding overburdening undergraduates, harnessing their abilities to contribute to professional education and preparation can bring benefits to educational programmes and fellow learners. Students of different specialities can learn from one another, develop trust and the ability to nurture each other at times of difficulty. This might enhance a sense of psychological resilience, important to managing emotionally difficult situations in both educational and clinical settings.
In addition, preparing student healthcare professionals to function effectively in multidisciplinary teams is likely to be critical to providing effective health care. Interdisciplinary education can contribute to helping students clarify roles and associated values, develop effective communication skills and build up competencies in conflict resolution. This would enable learners to function as situational leaders (Hall and Weaver, 2001). However, achieving these goals demands a sense of personal security and professional confidence.
Research and self-assurance
It seems important therefore, that we understand the varied factors influencing a student’s ability to engage effectively with health and social care curricula, including clinical practice. A recent research study by Vallint and Neville (2006) in New Zealand, found that student nurses reported sometimes feeling unnoticed while undertaking clinical placements. They also described an enmeshment in the role of student nurse so losing a sense of their identity and personhood with an accompanying lowering of confidence. The students taking part in this study told of clinicians being preoccupied with their own concerns and responsibilities and as a result, nurse learners spoke of needing nurture to combat anxiety, develop self-assurance and maintain a sense of personal identity separate to that of a nurse.
Although a single research study, these findings seem important, in that the challenges concerned with being a nurse require a measure of balance to maintain physical and mental health. With judicious planning, nursing educational programmes might enhance learners’ abilities to achieve and sustain overall self-assurance and well-being, contributing to student nurses feeling confident in their dealings with patients and other professionals.
Attachments
In order to engage effectively with educational work and clinical practice, it is likely to be helpful if learners view their overall educational experience as what the Tavistock psychoanalyst Bowlby (1969) has described as a ‘secure base’. This is an idea linked to attachment theory. We form attachments in order to feel self-assured, important to exploring the world and ourselves and relationships with others. Attachment theory suggests that a threat to an attachment, or a representation of an attachment, can result in feelings of insecurity. Insecurity can lead to anger and despondency, subsequently influencing the quality of personal and professional relationships with implications for professional effectiveness.
Attachments are primarily concerned with relationships between children and caretakers spanning in nature from secure to various forms of anxious, ambivalent and avoidant with corresponding patterns of interpersonal behaviour. Consequently, senses of belonging and identity are important to individual feelings of trust in oneself and others together with personal well-being and self-confidence.
Although formed in early childhood our attachment styles can have an effect on adult life, including patterns of communication consequently influencing how we view humankind. The social psychologist Ainsworth (1969) brought our attention to the role attachments play in adult life as providing the psychological foundations for feeling emotionally safe and confident. They are preconditions for effective learning and developing satisfying relationships with oneself and others With regard to neophyte healthcare professionals, feeling secure can enhance personal performance, contributing to attaining satisfactory outcomes.
Bowlby (1997) cited the analyst Karen Horney (1951), in her book Neurosis and Human Growth, as stating that parents or surrogates are sometimes:
‘…too wrapped up in their own neurosis to love the child or even conceive of him as the particular individual he is’.
This statement concerns conditions, which cause a child to develop an insecure attachment style and although written over 48 years ago, reflects closely the reported experiences of the student nurses in Vallint and Neville’s (2006) research study. It seems clear from the literature that some nursing students experience various aspects of their educational experiences as having a negative influence on their feelings of security and sense of identity.
Nursing and attachments
In an earlier editorial concerning student nurses’ experiences, I argued that in some instances student nurses do not identify themselves as a part of nursing or wider university settings (Jones, 2007). There are typically conflicting demands made of them by being both a university student and nurse trainee, which can give rise to feelings of dislocation, insecurity and an uncertain identity. In some instances, such experiences might lead to resentment together with learners feeling unvalued.
Consequently, mind-sets are established concerned with isolation along with separateness. They are factors that can prevent student nurses from engaging satisfactorily with educational programmes. Insecurity may influence their sense of significance and worth both personally and professionally. Sometimes these experiences can relate to earlier and existing patterns of individual relating linked to families of origin and reawakened by the challenges of higher education and clinical practice.
Childhood determinants of occupational choice
According to Parker and Merrylees (2002), emotionally traumatic events within the family or living environment together with faulty parenting in early childhood often, influences a person’s choice of health or social care professional as an occupation. The authors believe that by giving attention to the biographies of aspirant healthcare professionals, we can build important safeguards into educational programmes concerned with health care.
Correspondingly, Hawkins et al. (2005) later on suggested that attachment styles influence how nurses adapt to stressful situations. These researchers measured adult attachment style, stress and coping in 84 nurses recruited from five hospices. They found that nurses with secure attachment styles handled their feelings and coped with stress. Nurses with insecure attachment styles found difficulty managing testing situations in clinical settings. The researchers recommended professional supervision and appropriate professional support to encourage a sense of safety and security for nurses.
Typically, nursing programmes do not consider individual attachment styles or early life events. In my experience, people can come to nursing from backgrounds of insecurity because of separations and loss. Research programmes investigating relational styles, organisational settings and occupational health provide us with a better understanding of factors influencing nurses’ job satisfaction and their effectiveness (for example, see, Boogar et al. (2007)).
Providing a secure base
In spite of current knowledge, we need to know more about undergraduate nurses’ educational experiences as a whole entity including activities, which cause them to feel secure or insecure. Listening to learners’ experiences may allow important security factors to become a part of organisational models of education and clinical practice providing a ‘secure base’ for student nurses and other healthcare professionals.
Students would contribute to programme development by identifying their own learning, maturation and security needs. Subsequently, nursing education would help student nurses to gain the maximum benefits from their studies and maintain psychological health and security while developing the capability to pass similar benefits onto others.
Acknowledgement
Thank you to Dr. Sarah Kendal, The University of Manchester, School of Nursing, Midwifery and Social Work for providing helpful comments regarding this paper.
References
- . Object relations, dependency, and attachment: a theoretical review of the infant–mother relationship. Child Development. 1969;40(4):969–1025
- . Relationship between adult attachment styles with job satisfaction and job stress in nurses. Iranian Journal of Psychiatry and Clinical Psychology. 2007;13(2):148–157
- . Attachment. Attachment and Loss. vol. 1. London: Hogarth Press; 1969;(Basic Books, New York; Penguin, Harmondsworth (1971))
- . A Secure Base, Clinical Applications of Attachment Theory. London: Routledge; 1997;
- . Education and teamwork: a long and winding road. Medical Education. 2001;35(9):867–875
- . Stress and coping in hospice nursing staff. The impact of attachment styles. Psycho-Oncology. 2005;16(6):563–572
- . Neurosis and Human Growth. London: Routledge and Kegan Paul; 1951;
- . Still crazy after all these years. Nurse Education Today. 2007;27(5):365–366
- . Why become a professional? Experiences of care-giving and the decision to enter social work or nursing education. Learning in Health and Social Care. 2002;1(2):105–114
- Vallint, S., Neville, S., 2006. The Relationship between Student Nurse and Nurse Clinician: Impact on Student Learning. Nursing Praxis in New Zealand. http://findarticles.com/p/articles/mi_m5PXL/is_3_22/ai_n25002075/pg_2/?tag=content; col1 (retrieved 2009).
PII: S0260-6917(09)00198-1
doi:10.1016/j.nedt.2009.10.008
© 2009 Elsevier Ltd. All rights reserved.
