THE INFLUENCE OF THE HIDDEN CURRICULUM ON PROFESSIONAL SOCIALISATION OF STUDENT NURSES IN A MILITARY NURSING CONTEXT by KAREN ZÄGENHAGEN submitted in accordance with the requirements for the degree of DOCTOR OF LITERATURE AND PHILOSOPHY in the subject HEALTH STUDIES at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF GH VAN RENSBURG CO-SUPERVISOR: PROF MJ OOSTHUIZEN November 2016 “In his grace, God has given us different gifts for doing certain things well. So if God has given you the ability to prophesy, speak out with as much faith as God has given you. If your gift is serving others, serve them well. If you are a teacher, teach well.” Romans 12:6-7 DECLARATION Name: Karen Zägenhagen Student number: 31822932 Degree: Doctor of Literature and Philosophy THE INFLUENCE OF THE HIDDEN CURRICULUM ON PROFESSIONAL SOCIALISATION OF STUDENT NURSES IN A MILITARY NURSING CONTEXT I declare that the above thesis is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. ____________________ __________________ Karen Zägenhagen Date ACKNOWLEDGEMENTS During the course of this study, I became aware of the subtle influences that various people have had on my life – though most probably unbeknown to or hidden from themselves – not only during my own journey in pursuit of nursing and military professionalism, but also in my personal, spiritual and academic development. By being able to complete this study, I can confidently say that these influences have indeed been positive. I will remain forever grateful to especially my parents, Annatjie and Peter Zägenhagen for giving me a solid foundation and teaching me perseverance: You enabled me to shape my life and achieve my goals. Ansie, who stood by me every step of the way. Gisela, for believing in me, for guiding me and for being the role model you are. all my friends, who, after all of this, have nevertheless remained my friends. Prof Oosthuizen and Deirdré – I wish we could have finished this journey together. above all, to God be the glory, honour and praise for blessing me with these people! My sincere appreciation also goes to the following people and organisations for their selfless contributions and support: Professor SP Human and Professor E Pretorius for the independent coding. The nursing educators and students of the South African Military Health Service Nursing College who volunteered to participate in this study. All my colleagues at the South African Military Health Service Nursing College who deputised for me while I was on study leave. Marelize Meyer for transcribing the data. The expert reviewers who agreed to evaluate the model, for their valuable time and inputs. Engela and Marius Pretorius, not only for doing the language and technical editing of the thesis but also for their love, support, encouragement and unselfish assistance. The South African National Defence Force for affording me the opportunity to conduct this study. The University of South Africa for financial support. Sigma Theta Tau International for the Alpha Eta Collaborative Research Grant. “Wat ek is, is net genade. Wat ek het is net geleen.” Koos du Plessis THE INFLUENCE OF THE HIDDEN CURRICULUM ON PROFESSIONAL SOCIALISATION OF STUDENT NURSES IN A MILITARY NURSING CONTEXT STUDENT NUMBER: 31822932 STUDENT: KAREN ZÄGENHAGEN DEGREE: DOCTOR OF LITERATURE AND PHILOSOPHY DEPARTMENT: HEALTH STUDIES SUPERVISOR: PROF GH VAN RENSBURG CO-SUPERVISOR: PROF MJ OOSTHUIZEN ABSTRACT The South African Military Health Service (SAMHS) Nursing College offers a four-year integrated nursing programme leading to registration as a professional nurse at the South African Nursing Council (SANC). Student nurses assume a dual role when entering the SAMHS to commence with nurse training – that of a soldier and a nurse. Because student nurses have to assume dual roles, hidden aspects of military culture may influence the professional socialisation of student nurses in one way or another. With a view to determining whether the military environment does indeed impose any influence on student nurses’ professional socialisation, this study set out to explore the multifaceted context in which these students find themselves. Given the organisational and locational complexity of the SAMHS Nursing College, its campuses and the three military hospitals in South Africa, the population was narrowed down to an accessible target population comprising nurse educators and student nurses of the SAMHS Nursing College (Main Campus). Included in the two samples were nurse educators at the SAMHS Nursing College who had at least three years’ experience as nurse educators and who were registered with the SANC as nurse educators, and student nurses registered at the SANC for the four- year Integrated Nursing Programme and who were in their fourth year of training. A qualitative constructivist grounded theory study was conducted based on the researcher’s philosophical assumptions. The researcher made use of focus groups and critical-incident narratives to collect data. In keeping with the constructivist paradigm adopted for this study, Charmaz’s (2014) data-analysis approach was followed. Concepts derived from the qualitative data were used to develop a substantive model to create an awareness of the existence of a hidden curriculum, to guide role players through the impact of the hidden curriculum on students’ professional socialisation and to help them to understand how their contribution could improve the outcome of the professional socialisation process. KEY CONCEPTS Curriculum; grounded theory; hidden curriculum; military culture; military nursing; model development nursing; nursing education; professional socialisation; substantive model. Table of contents Page CHAPTER 1 ORIENTATION TO THE STUDY 1.1 INTRODUCTION ................................................................................................. 1 1.2 BACKGROUND TO THE RESEARCH PROBLEM ............................................+ 1 1.3 CONTEXTUAL BACKGROUND .......................................................................... 5 1.3.1 Historical background........................................................................................... 5 1.3.1.1 Military nursing ..................................................................................................... 6 1.3.1.2 Military nursing education .................................................................................... 7 1.3.2 The organisational context of SAMHS and the SAMHS Nursing College ............. 8 1.3.3 The military teaching and learning environment ...................................................10 1.3.3.1 Military training .....................................................................................................10 1.3.3.2 Professional nursing training ................................................................................11 1.4 STATEMENT OF THE RESEARCH PROBLEM ..................................................12 1.5 THE RESEARCH QUESTION .............................................................................12 1.6 PURPOSE OF THE STUDY ................................................................................12 1.7 OBJECTIVES ......................................................................................................12 1.8 SIGNIFICANCE OF THE STUDY.........................................................................13 1.9 DEFINITIONS OF KEY CONCEPTS ....................................................................13 1.9.1 The hidden curriculum ..........................................................................................13 1.9.2 Professional socialisation .....................................................................................14 1.9.3 Nurse educator ....................................................................................................14 1.9.4 Student nurse ......................................................................................................14 1.9.5 Healthcare professional .......................................................................................1 5 1.9.6 Theoretical learning environment .........................................................................15 1.9.7 Clinical learning environment ...............................................................................15 1.9.8 Teaching and learning environment .....................................................................15 1.9.9 Professional nurse ...............................................................................................1 6 1.9.10 Professional soldier ..............................................................................................16 1.9.11 Nursing professionalism .......................................................................................16 1.9.12 Military professionalism ........................................................................................16 1.10 RESEARCH DESIGN AND METHODS ...............................................................16 1.11 RESEARCH SETTING .........................................................................................18 1.12 ETHICAL CONSIDERATIONS .............................................................................18 1.13 TRUSTWORTHINESS .........................................................................................1 9 1.14 SCOPE OF THE STUDY .....................................................................................1