THE UNIVERSITY OF HULL Lifeworld Perspective Transformations in Student Nurses during the period of a three year nursing course Being a thesis submitted for the degree of Doctor of Philosophy In the University of Hull by By Michael Frank Taylor, BA(Hons) University of Hallam Submitted: July, 2000 ABSTRACT This thesis that concerns research undertaken in a school of nursing in reference to the students experience on a nursing course. Two major features are present in this thesis. Firstly, the accounts of student nurses of their experience on the nursing course. Secondly, the lifeworld sociology of Alfred Schutz that enabled structure and meaning to be derived from the student accounts. During my talks with student nurses, I noticed a certain enthusiasm of some students towards the course and a nursing future. In contrast, another group of students interpreted their experience of the course in more pessimistic terms. This group of students appeared to struggle, not with the technical or other requirements of the nursing course but in terms of questioning their place on the course and the meaning of the course in their lives. The former group was later defined as vocational and the latter were called pragmatic in orientation. Another issue also arose and concerned the considerable changes that some students experienced as a result of being on the nursing course. These responses were defined as lifeworld perspective transformations (LPT's), a concept derived by later authors in relation to Schutz's concept of the lifeworld. The thesis is split into three sections. An introduction, followed by part one which comprises a theoretical chapter that moves within sociological notions of the self to the topic of LPT's and integrates different work that defines the environment of nursing. Part two contains the data and analysis of the student accounts and experience of the nursing course. Part three comprises a review and consideration of the implications of the research. CHAPTER ONE: INTRODUCTION TO THESIS Page 1.1 Introduction 1 1.2 The Research Context 1 1.3 The Location of the School of Nursing 2 1.4 Clinical Issues 2 1.5 Previous and Present Nursing Courses 3 1.6 The Project 2000 Nursing Course 4 1.7 The Origins of the Research 7 1.8 Personal Experience 8 1.9 Informal Talks with Students 11 1.10 The Pilot Study 12 1.11 Research Questions 14 1.12 Ramifications of the Vocational and Pragmatic Dimensions 15 1.13 The Aims of the Research 16 1.14 Structure of the Thesis 17 1.15 Thesis Name Title: Contractions 17 1.16 Conclusion 18 PART ONE CHAPTER TWO: THEOERETICAL CONTEXT AND NURSING EXPERIENCE 2.1 Introduction 20 2.2 The Relationship between Theory and Practice 21 2.3 The Environment of Nursing 23 2.4 General Theoretical Considerations 25 2.5 Rite of Passage 25 2.6 The Experience of Marginality 26 2.7 The Stranger Role 28 2.8 The Sociology of the Self 28 2.9 Belief as Action 30 2.10 The Sociology of Meaning 31 2.11 Boundary Experiences 33 2.12 Summary: General Theoretical Considerations 35 2.13 Theoretical Views of the Self 35 2.14 The Phenomenological Account of the Self 39 2.15 The lifeworld 42 2.16 The Structures of the Lifeworld 46 2.17 The Stock of Knowledge 46 2.18 The "And so forth" Idealisation, the "As it was before" Assumption and the Taken For-Granted World 47 2.19 Finite Provinces of Meaning 48 2.20 The Spatial and Temporal Structure of the Lifeworld 49 2.21 The World-Within-Future-Reach 51 2.22 Zones of Relevance 51 2.23 Lifeworld Horizons 52 2.24 Interpersonal Relationships 53 2.25 Summary: Lifeworld Concepts 54 2.26 The Dynamic Aspects of the Lifeworld Concept 54 2.27 Lifeworld Perspective Transformations 55 2.28 The Lifeworld as the Site of Communication 59 2.29 Additional Comments on Lifeworld Transformations 60 2.30 Sectors of the Lifeworld: Finite Provinces of Meaning, Sub- universes of Meaning, Small Lifeworlds and the Home-worlds 61 2.31 Summary: Lifeworld Perspective Transformations 62 2.32 Conclusion 62 CHAPTER THREE: THE RESEARCH METHODOLOGY 3.1 Introduction 66 3.2 Research Paradigms 67 3.3 The Researcher Role 67 3.4 Ethical Concerns 68 3.5 The Research Method 70 3.6 The Interviews 71 3.7 Practical Problems: Time Pressure 71 3.8 The Interview Process 73 3.9 The Temporal Arrangement of the Interviews 74 3.10 The Biographical Articulation of Student Experience: The Production of Narratives 76 3.11 Qualitative Research 78 3.12 'Thick' Description 79 3.13 Student Narratives 82 3.14 Analytical Methods 84 3.15 Conclusion 85 PART TWO CHAPTER FOUR: THE PRAGMATIC-VOCATIONAL STUDENTS 4.1 Introduction 87 4.2 The "Always" Desire and Drift into Nursing 89 4.3 Vocational Students and the "Always" Desire 89 4.4 The "Always" Desire 90 4.5 Vocational Students: The Diverted Desire 94 4.6 The Pragmatic Students: The Drift into Nursing 98 4.7 Summary: Drift and the "Always" Desire 103 4.8 Work Unhappiness 104 4.9 The Pragmatic Students' Experience 104 4.10 The Vocational Students' Experience 106 4.11 Summary: Work Unhappiness 108 4.12 Ulterior Motives and Caring for Others 108 4.13 Pragmatic Students and Ulterior Motives 109 4.14 Vocational Students and Caring for Others 111 4.15 Summary: Ulterior and Caring Motives for Nursing 113 4.16 Conclusion 113 CHAPTER FIVE: BEING A STUDENT: FITTING-IN, BEING ACCEPTED AND BEING AN OUTSIDER 5.1 Introduction 114 5.2 Fitting-In to the Clinical/Nursing Team 118 5.3 Fitting-In: The Vocational Students 118 5.4 Fitting-In: The Vocational Initiate Students 119 5.5 Fitting-In: The Vocational Specialist Students 124 5.6 Fitting-In: The Vocational Retrospective Students 125 5.7 Summary: Fitting-In: The Vocational Students 127 5.8 Fitting-In: The Pragmatic Students 129 5.9 Fitting-In: The Pragmatic Initiate Students 129 5.10 Fitting-In: The Pragmatic Specialist Students 135 5.11 Fitting-In: The Pragmatic Retrospective Students 138 5.12 Summary: Fitting-In: The Pragmatic Students' Experience 139 5.13 Summary: Fitting-In 141 5.14 Being Accepted 141 5.15 Being Accepted: The Experience of the Pragmatic Students 142 5.16 Being Accepted: The Experience of the Vocational Students 146 5.17 Summary: Being Accepted 148 5.18 Being an Outsider 149 5.19 Being an Outsider: The Experience of the Pragmatic Students 149 5.20 Summary: A Lifeworld Explanation of the Pragmatic Outsider Perspective 155 5.21 Being an Outsider: The Experience of the Vocational Student 157 5.22 Summary: Being an Outsider 159 5.23 Conclusion 159 CHAPTER SIX: BOUNDARY EXPERIENCES 6.1 Introduction 162 6.2 The Structure of Boundary Experiences 163 6.3 Types of Boundary Experience 164 6.4 The Encounter with Strangeness 164 6.5 Dealing with Pathology 165 6.6 Fulfilling Boundary Experiences 165 6.7 Interpretations of Strangeness 167 6.8 The Body 168 6.9 The Experiences of Clients' Psychological States 172 6.10 Summary: The Students' Experience of Strangeness 174 6.11 The Experience of Pathology 174 6.12 The Encounter with Death and Dying 175 6.13 The Experience of Physical Illness 181 6.14 Summary: The Experience of Pathology 185 6.15 Boundary Experiences as Pleasant 186 6.16 Summary: Boundary Experiences as Pleasant 189 6.17 Conclusion 189 CHAPTER SEVEN: LIFEWORLD PERSPECTIVE TRANSFORMATIONS 7.1 Introduction 191 7.2 Pragmatic Student Accounts: Lifeworld Perspective Transformations. 192 7.3 Catherine 192 7.4 Esther 192 7.5 Dawn 197 7.6 Jan 198 7.7 Susan 199 7.8 Gillian 201 7.9 Thomas 203 7.10 Rachel 205 7.11 Summary: Lifeworld Perspective Transformations: Pragmatic Students 210 7.12 Vocational Students: Towards Lifeworld Perspective Transformations 212 7.13 Jean 212 7.14 Karen 213 7.15 Cheryl 214 7.16 Lynn 214 7.17 Sarah 214 7.18 Sally 215 7.19 Jayne 215 7.20 Ruth 216 7.21 Summary: Changes in Vocational Students 217 7.22 Conclusion 217 PART THREE CHAPTER 8: SUMMARY AND CONCLUSION TO THE RESEARCH 8.1 Introduction 220 8.2 The Aims of the Research 220 8.3 Reasons that Students Joined the Nursing Course 220 8.4 The Experience of Nursing 223 8.5 Ramifications of the Thesis 226 8.6 Sociological Implications 226 8.7 Professional Implications 230 8.8 Student Nurse Recruitment 230 8.9 Nursing Education 230 8.10 Conclusion 231 Appendix One: Table: Interviews According to Pragmatic Orientation, with Frequency and Notes as Applicable Appendix Two: Table: Interviews According to Vocational Orientation, with Frequency and Notes as Applicable Appendix Three: Question Themes of the Research CONTENTS OF TABLES AND DIAGRAMS Page Chapter 1. Introduction to Thesis. Table 1.1: Comparison of Project 2000 and Traditional Nursing Courses 4 at Maintown. Table 1.2: Characteristics of the Common Foundation and Branch Programmes 5 Table 1.3: Numbers of Students on the Nursing Course. 6 Chapter 2. Theoretical Context and Nursing Experience. Table 2.1: Main Authors Used in Explaining the Lifeworld Concept. 55 Chapter 3. The Research Methodology. Table 3.1: Groups and Frequency of Interviews. 75 Table 3.2: The Frequency of Interviews Related to Student Group Designation 76 Chapter 4. The Pragmatic-Vocational Students. Table 4.1: Differences between Pragmatic and Vocational Groups. 88 Chapter 6. Boundary Experiences. Diagram 6.1 Differences in Amount and Frequency of Boundary Accounts. 166 Chapter 8. Table 8.1: The 'Typical' Vocational and Pragmatic Student Characteristics.