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MALE STUDENTS PERCEPTIONS OF THEIR M ATERNITY
A THESIS
OF GONZAGA UNIVERSITY
by
Linda K. Gambill
March 19S5
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UMI Number: 1374555
Copyright 1995 by
Gambill, Linda Kay
All rights reserved.
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Copyright by Linda K. Gambill
ii
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Susan L. Norwood, EdD, ARNP
Thesis CommitteeChairperson
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MALE STUDENTS' PERCEPTIONS OF THEIR MATERNITY NURSING
CLINICAL EXPERIENCE
Linda K. Gambill
Gonzaga University
Abstract
are moving toward greater representation in nursing. Male nurses have usually
been associated with certain areas of health care. They are generally
uncomfortable with staff and patients in obstetrics and choose this specialty less
frequently.
comfort in providing care to mothers and babies, and their suggestions for
Almost all of the subjects thought that all nursing students should be required to
have the same maternity nursing clinical experience. The students were
and the barriers they encounter in order to improve quality of education for male
iv
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Acknowledgments
encouragement. Also, I would like to thank Dale Abendroth Lenski and Bobbi
study. Thanks to all the male nursing students for their involvement. I would like
to acknowledge the support of my family and friends during the writing of this
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Table of Contents
Summary ............................................................................................... 25
Instrumentation .................................................................................... 28
vi
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CHAPTER V. DISCUSSION AND CONCLUSIONS .................................. 57
Summary of Findings............................................................................. 57
Conclusion ........................................................................................... 69
REFERENCES ................................................................................................. 71
APPENDIXES ................................................................................................. 76
B Instrument ................................................................................... 77
vii
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List of Tables
11. How Helpful Would It Have Been for a Female to Accompany You? . . 50
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1
CHAPTER I
INTRODUCTION
Nightingale, the founder of modern nursing, closely linked nursing and femininity
in order to raise the status of nursing to a level suitable for ladies. Nursing has
5.6% of the nursing work force (Employment and Earnings. 1993); this is an
increase from 3% in 1984 (Facts About Nursing. 1987). Men do not enter
nursing to defy traditional sex roles but, rather, for reasons that have very little to
help others, extensive employment opportunities, and flexible hours (Cyr, 1992;
It has been reported that men in nursing frequently experience role strain
because of their nontraditional career choice. They often attempt to reduce this
characteristics that might explain how they function as areas where role strain
these specialty areas, male nurses may perceive their role as special and above
involve minimal intimate physical contact with patients (Egeland & Brown, 1988;
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2
1989).
preconception that they are effeminate (Alvarez, 1984; Egeland & Brown, 1988;
Gordon & Green, 1981; Hull, 1982). A masculine person is typically viewed as
daintiness, and primness that are associated with femininity. Male nurses have
maternity nursing. Men are uncomfortable with staff and patients in obstetrics
and choose this specialty less frequently. Some female nurses consider the
maternity units as areas where only a female can understand the provision of
for whom they must provide care? McPhee (1984) reminds us that
and care for any patient in need. A professional nurse-m ale or fem ale-can
effectively care for ail patients, male and female, while maintaining the patient's
dignity. Patients are more concerned about the quality of their nursing care than
the gender of the caregiver (Brown, 1986b; Cox, 1987; Greenlaw, 1982; Ketter,
1994).
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3
labor and delivery unit, without advanced notice of their feelings regarding
questionable because the judges only analyzed testimony and evidence on how
from labor and delivery patients who had been assigned to male staff nurses.
Female nurses caring for male patients must put their sensitivities aside and
the same training and dedication can function without violating the privacy and
dignity of female patients (Brown, 1986a; Cox, 1987; Greenlaw, 1982; Ketter,
1994).
According to Marks (1980), nursing has been slow to recognize the need
assertive, and self-confident. Nurses must accept the idea that male nurses can
profession of nursing must be a joint liberation for men and women in which
gender stereotypes are discarded and men and women share the same
imagination, empathy, tenderness, concern for others, or motor skill ability. All
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4
nurses, male and female, are important health care providers. Gordon and
Green (1981) state that nursing, in its most traditional posture, is conceived of
and taught in ways that limit the risk-taking and role-breaking capacity of
learners. Stereotypes limit freedom and bind human beings from functioning
independently. Male nurses can help break down the male/female stereotype
and encourage doctors and nurses to relate to one another as persons for
improved patient care (Christman, 1980; Phillips, 1975; Starr, 1974). Any
profession that is exclusively one sex is not whole and balanced (Robinson,
1973; Starr, 1974). Nurse educators bear the prime responsibility for promoting
patients. However, male nursing students may not have many role models in
in his nursing skills? Or, is the source of uneasiness for the male nurse a
the maternity unit, male nursing students may be treated as visitors because it is
assumed they will not work on a maternity unit after graduation. An instructor
assigned a male student. This action might imply to a patient that giving care to
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5
most cases, a male patient is not polled before a female nursing student is
school and instructor for assigning him to only male patients (Foote, 1980). The
instructor then assigned the male student to a fem ale-after asking the patient's
permission first. Female students, however, were routinely allowed to care for
both males and femaies. The nursing school changed its practices after the
Male nurses should not focus only on those areas of nursing that are
congruent with society's image of the masculine role. With proper strategies,
men in nursing can change stereotypical attitudes. Male nurses can make
unique contributions to areas of care that are traditionally associated with female
nurses. A positive image of male nursing students on the maternity unit needs
nursing students can serve as role models to the fathers on the maternity unit.
How can the educator optimize this learning experience for male nursing
students who are entering this historically female domain? Educators can gain
greater insight into nursing care provided by men in maternity nursing and make
a conscious effort to recognize the contributions that men can make to maternity
nursing. Educators can help dispel myths and eliminate barriers and restrictions
that have prevented male nurses from practicing in maternity nursing. Strategies
can be developed to support the male nursing student in his maternity clinical
rotation. The educator can act as a role model and as a support person.
competence, mature understanding, and self-confidence that will ease them over
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the numerous hurdles of providing intimate physical or emotional patient care
(Jenny, 1975).
Purpose Statement
also explored.
Research Questions
The specific questions that formed the focus for this study are:
2. What is male nursing students' comfort level with regard to providing care to
general?
4. What factors are associated with a male student's description of his maternity
experience?
nursing?
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7
CHAPTER II
REVIEW OF LITERATURE
men in nursing and attitudes of men in nursing, and 3) male nurses in maternity
nursing. The literature review will be divided into these three sections. These
topics provide context for exploring the issue of male students in maternity
nursing.
men. At the time of Hippocrates in the fifth century B.C., male assistants,
during the thirteenth century, the Crusades brought the military nursing orders--
the most famous of these were the Knight Hospitalers of St. John of Jerusalem.
The Hospitalers provided nursing care in a hospital setting to men who were
returning from the battlefields of the Crusades. Women also served as members
hospitalized women. This practice of deciding who shall care for whom on the
basis of the gender of the patient and the caregiver would have far-reaching
Little has been written about men in nursing during the Renaissance.
During the Reformation, the Brothers Hospitalers of St. John of God were
established in part as a means of nursing the mentally ill. The Italian Camillus
also trained men to care for the sick and dying. By the early 1500s, though,
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8
characterized the early orders of male nurses, however, was later adopted by
the secular nursing orders of women (Kelly, 1992; Levine & Levine, 1965;
Mericle, 1983).
Nightingale Training School. The Crimean W ar was a low point for England; the
army and the bureaucracy were disorganized and ill-prepared to care for the
thousands of soldiers both wounded and ill from cholera epidemics. Florence
to one percent by the end of the war. As a result of introducing women nurses
into the British army, she succeeded in overcoming prejudices and in elevating
nursing into an honorable and respectable profession for women (Brown &
Stones, 1973; Kalisch & Kalisch, 1986; Kelly, 1992; Levine & Levine, 1965;
Mericle, 1983).
Little has been written about men in American nursing prior to the 1860s
casualties. In the peaceful years following the Civil War, though, the
responsibility for nursing again fell to women. Although there were a number of
training programs for nurses and midwives before the Civil War, the first nursing
1872. Ten years after the first nursing school graduated its first nurse, the Mills
School of Nursing for Men at Bellevue Hospital in New York was established
During World Wars I and il, male nurses volunteered for military service but
were absorbed into army divisions where there was no opportunity for them to
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9
contribute to the nursing needs of the service. A law enacted in 1901 barred
men from the Army Nurse Corps because it designated the corps as
"Army Nurse Corps, Female" (Kalisch & Kalisch, 1986). The army needed
nurses and spent huge sums in advertising and urging nurses to volunteer--but
registered male nurses didn't merit recognition. In the 1940s, several nursing
groups appealed to the W ar Department to secure rank for men nurses, but such
requests were consistently opposed by the Army Nurse Corps. "The image of
the male nurse had deteriorated since the thirteenth century, when military-
nursing orders such as the Knights Hospitalers had both battled for the Holy
Land and supplied excellent nursing care" (Kalisch & Kalisch, 1986, p. 628). In
addition, most nurses and the general public seemed to adhere to the view that
the man's place in wartime was on the battlefield, and that, at all times, women
constitute the minority in nursing (Halloran, 1990; Kalisch & Kalisch, 1986; Kelly,
At the onset of modem nursing, men were pushed out of the profession. In
1910, 7.4% of nurses were men. By 1920, male nurses dwindled to 3.7% of the
work force; in 1930, only 2% of all nurses were men. In 1960, just 1.6% of the
profession was male. In 1970, male nurses increased to 2.6%. The total
in 1984. From 1984 to 1988, the number of men in nursing increased to 3.3%
(Facts About Nursing. 1987; Health Personnel in the United States. 1991; Men
of registered nurse work force was maie (Employment and Earnings. 1993).
This increase has taken place over a long period of time. A major impact on the
presence of men in nursing was the economy after World Wars I and II. The
relatively low salary levels of nurses discouraged men from entering nursing.
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Another impact was a federai law in place from 1901 to 1955 that barred men
from the Army Nurse Corps. In August 1955, President Eisenhower signed the
Bolton Amendment to the Army-Navy Act--male nurses were then eligible for
commission as officers. Even as late as the 1960s, male nurses did not have full
addition, to the trend away from gender-linked occupations opened the door to
men in nursing. Also, in the 1970s and 1980s, because of an increased demand
for nursing services and nursing personnel, greater effort was directed toward
recruiting men into the nursing profession. Furthermore, men who chose
nursing must have found some satisfaction in their work; and their presence and
experience has encouraged other males to enter the profession (Aldag, 1970;
Cyr, 1992; Garvin, 1976; Kalisch & Kalisch, 1986; Marks, 1980; Mericle, 1983;
Okrainec, 1986).
identities. Several studies have examined why men choose nursing and whether
nursing students and 480 graduate male nurses in 33 states of the United
States, the District of Columbia, Japan, Germany, and Iceland. The reason most
frequently cited by these men for choosing nursing as a career was that they
liked people and enjoyed helping them. Most of the respondents also replied
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11
Mannino (1963), there is evidence that once a man enters the profession as a
Bush (1976) conducted focused interviews with six students and four
graduates in nursing at a midwestern university to find out how and why men go
into nursing. The reasons for choosing nursing were job security and
leaders.
indicated that they chose nursing as a career because of job availability and,
Taylor, Dwiggins, Albert, and Dearner (1983) surveyed 510 male registered
The subjects in this study were 247 male nonnursing and 94 male nursing
about selecting nursing as a career. Results of the study indicated that men
economic benefits.
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12
their attitudes or perceptions of the nursing profession. In the final section of the
study's questionnaire, subjects were asked why they chose nursing as a career.
The reasons given were: 1) helping others and a challenging career, and 2) job
career attributes were their chief reasons for choosing to go into nursing. These
Demographic Characteristics
married, older, and to have had a military health care experience or other
employment in the health fields than his female counterpart (Auster, 1979;
Becker & Sands, 1988; Bush, 1976; Faught, 1989; Garvin, 1976; Johnson etal.,
Williams, 1973). Galbraith (1991) and Perkins et al. (1993) found that men in
nursing continue to be older; many report having had two or more previous
careers. These researchers found, however, that men in nursing were less likely
to be married than male nurses in past years. They attributed the difference to
current societal acceptance of divorce and single iife rather than a characteristic
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Exploring the personality profile of male nursing students has been the
college students, and 29 female junior college students. The personality profile
of the male nursing students was more similar to that of the female nursing
students than the profile of male junior college students was to the female junior
college students. Both male and female nursing students tended to have more
feminine interests than male and female junior college students. The nursing
were the junior college students. They also were more likely to be passive-
students.
sample of 145 male nursing students, 145 female nursing students, 145 male
college students, and 145 female college students. The study compared
college males, and college females. The findings of this study suggest that
regardless of their gender. The maie nursing studenis in this study also
students.
34 male nursing students and 841 female nursing students at Ohio State
University. The findings revealed that the male students scored higher on the
theoretical scale and lower on the religious scale than did the women. The
values of the male nursing students were more like those of the female nursing
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14
students than those of the nonnursing male college students. Male nursing
study, the students' interests are more related to the vocation than to gender
assumptions of nursing.
Royal Air Force male nurses revealed similar findings. The Personal Proforma,
the Eysenck Personality Questionnaire (EPQ), and the Level of Aspiration Test
(LOA) were administered to the subjects; the results were compared to those
a similar age. Male nurses were found to be less extroverted and more stable
than other servicemen. The findings also revealed more feminine aspects of
personality among the male nurses. The male nurses exhibited a higher degree
comparable to those obtained from a general adult male sample. Although the
study had a small sample size, the results were unable to identify a single trait or
group of traits that were valid predictors of which man would be inclined to
become a nurse. This suggests that men who enter nursing are a
career for men because of the career opportunities available. The 18% who
would not recommend nursing as a career reported poor pay, rotating shifts,
74 female nurses, and 103 male engineers. Data were collected by means of
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15
Personality Factor measure, the Bern Sex Role Inventory, and a demographic
other occupational groups took responsibility for having been their own primary
influence (rather than having role models) in deciding on a career. The men in
nursing also reported that their career was somewhat better than they expected.
In terms of the sex role identity of the sample, the men and women in nursing
Gender-Specific Traits
control over nursing and health care. Some studies have focused on the
personality traits of the "ideal" nurse by examining male and female personality
traits in male and female nurses. Simpson and Green (1975) reported that the
society and the nursing profession. Robinson (1973) and Starr (1974) also
suggest that any profession that is exclusively one sex is not whole and
balanced.
nursing students in order to examine the concept of the "ideal" nurse. The
findings suggested that the "ideal" nurse is both highly feminine and highly
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16
support the premise that nursing does not only need women--it needs qualified
coexist to some degree in every individual. Hull (1982) suggests the need to
well as women and that nursing is wrongly viewed as a profession requiring just
masculine and feminine roles are learned and are not bipolar opposites. London
(1987) states that the skills actually needed in nursing require both masculine
Krausz, Kedem, Tal, and Amir (1992) also found that it was preferable for
nurses to have both high feminine and high masculine orientations. This study
was carried out with 154 male nurses employed in seven Israeli hospitals. A
were the "best" adapted while the feminine-type male nurses were the least
The results suggest that the nature of the nursing profession has evolved into
technical and scientific skills. The ideal nurse must possess not only expressive
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17
Earlier research studies (Aldag, 1970; Aldag & Christenson, 1967; Garvin,
1976; Gumley et al., 1979) reported that both male and female nursing students
and nurses had more "feminine" profiles than did male and female nonnursing
students or men and women in general. The traditional nursing profile gave a
of the status quo, more interested in serving than in economic gains, and highly
studies, however, indicate that the profile of nurses is changing (Alvarez, 1984;
Galbraith, 1991; Krausz et al., 1992; Minnigerode et al., 1978). In today's health
care environment, the "ideal" nurse requires both masculine and feminine
characteristics.
qualities such as sensitivity have had their masculinity questioned (Gordon &
however, points out that while there are male nurses who fit these stereotypes,
there are also female nurses who fit them. Nursing is not an effeminate
profession.
Vaz (1968) studied male high school students' attitudes towards nursing as
might tend to prevent men from entering the profession. The sample for this
study was 506 male senior high school students in six public high schools in
scale and a checklist. Part I of the questionnaire asked the students to consider
seven separate occupations for men and to compare to each other on the basis
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18
masculinity, and ambition. The findings revealed that the sample ranked nursing
lowest on masculinity. In Part II, the subjects ranked five values considered
from among three statements the one that best described his degree of
identified negative factor about being a male nurse was the sex stereotyping that
results from the general perception that nursing is a female profession. Lack of
challenge and security, being able to help others, and the ability to bring a
York State; a 63% response rate was achieved (n = 126). Seventy-five percent
males from the practice of nursing. The majority of the nurses felt that male
classmates in nursing school. The male students reported facing isolation and
loneliness, lack of adequate role models, and having to deal with other people's
ignorance and stereotypes. The students in this study expressed a need for a
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19
male role model in nursing or a desire to talk to a male nurse about the role of
men in nursing.
and females towards the nursing education that prepares them to pursue the
career of their choice. Auster studied 335 male and 508 female nursing students
at 32 associate degree and diploma programs in the East and Midwest. The
research tool was a combination of fixed and open-ended items and personal
interviews with 80 male students. Among the men, 42.4% stated that nursing
school was harder for them than for women. Very few women felt it more difficult
for their own gender; approximately one third of the women maintained that it
was harder for men. Men also indicated somewhat less satisfaction than women
only 13.1 % of the women. Male students (35.3% ) also thought female nursing
concluded that men are likely to staff the nursing profession differently than
relationship with the physician when providing health care and therapy.
tokenism to male nursing students. "Tokens" are individuals who enter a job
pressure, social isolation, and role entrapment. The sample in this study
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20
included 322 nursing students~41 males and 281 females-from two similar
significant token dynamics among the male nursing students. The males were
researchers implied that gender differences may reduce token effects since
explanation given by the researchers for the reduction of token effects is the
male nurses can be very real (Auster, 1979; Greenberg & Levine, 1971). Male
nurses cope with role strain by choosing areas of specialization that tend to
specialties that do not require giving personal care and that allow nontraditional
avoid specialties such as pediatrics and obstetrics (Bush, 1976; Greenberg &
Levine, 1971; Williams, 1973). in some studies, male nursing siudents viewed
medicine (Bush, 1976; Garvin, 1976; Mannino, 1963). In the study by Perkins et
Okrainec (1986) studied the level of job satisfaction of 163 Canadian male
nurses. The majority of the respondents were either satisfied or very satisfied
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21
with their choice of nursing as a career. The items ranked as causing the most
job satisfaction were: 1) the attitude of male patients toward male nurses, 2) the
within the community and with colleagues and patients and their families. The
male nurses believed female colleagues enjoyed working with them. Most
(58.7% ) believed, however, that expectant mothers would rather have female
nurses care for them than male nurses. The investigators offered several
explanations for the genera! lack of severe role strain among these male nurses:
1) the assumption that nursing is incompatible with the stereotypical male sex
role may be incorrect, 2) perhaps cultural stereotypes about sex roles and about
androgynous and less included to accept the stereotypical male sex role, 4) men
in nursing choose the less intimate specialization areas, and 5) men in nursing
resolve their difficulties by weighing the rewards of their work against its
disadvantages.
nursing. The men considered the experience valuable and thought that it gave
however, that feeding babies in the nursery or watching women in labor was
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22
questions about their initial reactions to the idea of maternity care by male
nurses and whether they would agree to allow male nurses to provide specific
care activities during labor and delivery and the postpartum period. Seventeen
with personal care activities such as bathing and breast feeding was less
accepted by the patients than were technical care activities such as placing
monitor equipment, observing the delivery, and palpating uterine position and
subjects said they would agree to having a male nurse observe a delivery than
to having one view and touch the vaginal area after delivery. According to the
researchers, the majority of women favored the idea of male maternity nurses;
this was interpreted as indicating that they were not concerned about the gender
experience. This research suggests more study of mothers who have actually
Several male nurses employed in labor and delivery suites have shared
their experiences. In nearly eight years as a nurse on a labor and delivery unit,
Jim Murphy has only had a couple of patients object to him; he says that he is
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23
Rochester, New York. Two other male nurses had previously been employed in
labor and delivery in the hospital. According to Grossman (1986), this hospital,
Cox (1987) is a perinatal nurse specialist. He states that male nurses are
forced into traditional roles because of the attitudes of nurses, nurse executives,
and physicians. In the maternity setting, the goal of the client is a positive
experience. Caring and concern, competent nursing and medical care, and
experience. "The nurse's gender is not a factor in the realization of this goal"
As a labor and delivery nurse for three years, Hall (1993) has encountered
only four situations in which a patient preferred a female nurse. Three patients
were from cultures with religious beliefs that forbid men from viewing female
bodies. In the fourth situation, a couple did not want any men involved in their
birth experience. Hall (1993) applied for a position in Abilene, Texas, in a labor
and delivery unit. The hospital told him that he was not a qualified, bona fide
the hospital solely on the basis of gender without being guilty of discrimination?
privacy. The unexpected arrival of patients to the labor and delivery area,
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24
efficiency. Federal courts in Arkansas and Oklahoma have ruled that female
respond to male staff nurses, not on empirical data from labor and delivery
In Bakus v. Baptist Medical Center (510 F. Supp. 1191 - E.D. Ark. 1981),
Gregory Bakus sued the hospital on grounds that its refusal to hire male
hospital's defense argued two main points: 1) concern of privacy and dignity of
the female patient, and 2) concern for economic loss. Judge Elsijane T. Roy
found the evidence the hospital offered convincing and ruled in its favor saying,
"due to the intimate touching required in labor and delivery, services of all male
Korenchuk, 1981).
Phil Wynn was prevented from requesting a transfer to labor and delivery in
experience in two other hospitals (EEOC v. Mercy Health Center, 29 FEP Cases
159-S.D. Okla. 1982). Mercy Health Center testified that, partly because 40 to
50% of the approximately 148 deliveries monthly are high risk, male staff nurses
should not be employed in labor and delivery. Mercy claimed such nurses could
add undesired stress to the already tense childbirth situation. The Equal
illegal job discrimination based on gender. The judge, however, ruled that
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25
Hospitals considers the availability of, not mandatory care by, a nurse of the
same gender during intimate procedures as a privacy right that the consumer
can exercise on demand (Bennett, 1984; Brown, 1986a, 1987; George &
Quattrone, 1989).
Summary
about male nurses in maternity nursing. The studies of males in nursing that
have been reviewed describe why men choose nursing, characteristics of men in
nursing.
do, however, elect to ignore cultural pressure and choose nursing as a career.
Several studies provide data to support the argument that the nursing profession
et al., 1978; Simpson & Green, 1975). Sex-stereotypical attitudes against the
men in their choice of nursing as a career. According to both Benda (1981) and
perpetuate the attitude that the maternity rotation has little relevance to the male
female hygiene, teaching, and nursing care and is a nursing specialty that has
traditionally been performed by women for women. The instructor must learn to
present maternity nursing as an option for all students. Nursing students are
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26
expected to give quality, professional nursing care to all patients. The gender of
the patient should not prevent learning opportunities. Male nursing students can
only learn maternity care by caring for these female patients (Turnipseed, 1986).
nursing. Through this research, the nurse educator may be able to facilitate and
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27
Chapter III
RESEARCH METHODOLOGY
rotation. This design was chosen because the variables could not be
this researcher.
Associate Degree Nursing (ADN) programs in the Inland Northwest during the
Washington and northern Idaho; six were located in central Washington; nine
were located in western Washington; and one was located in eastern Montana.
who were enrolled in ADN programs and who consented to participate in the
study. The male nursing students were either currently enrolled in or had
the program. After contact by telephone with the director of the nursing program
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28
sent two weeks after the letter and questionnaires were mailed. The subjects in
this study were 52 male nursing students enrolled in ADN programs. Twenty-
three percent of the subjects were in the first year of their nursing program;
seventy-five percent were in the second year; and one percent of the subjects
Instrumentation
forms assisted in the development of the categories for providing nursing care to
The first section of the instrument consists of 10 items about whether male
nursing students think they should have a maternity clinical rotation, the length
of iheir rotation, and when in the curriculum their experience occurred. The next
sections explore the subjects' comfort level with performing actual physical care
and teaching a maternity patient and compares their level of comfort in providing
care to a maternity patient and a male patient and another female patient. The
accompany them would have been helpful when providing intimate nursing care,
maternity nursing care. The instrument also includes items about experiences of
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29
refusal to have care provided by the male student, whether their instructor asked
question allows the subjects to provide suggestions on how the rotation could be
about interest in a career in maternity nursing. There are two questions about
whether they thought they were treated differently on the maternity unit because
of their gender and whether they thought they had advantages because of their
gender; another question asks them to rate their maternity rotation overall. For
the purpose of adequately describing the sample, the final portion of the
status, number of children and whether they participated in the birth of these
categories; a subscale score for each category was obtained. The categories
(items 7-11), genera! patient care (items 12-17), maternity patient care (items
18-25), and education (items 26-34). The higher the score in each of these
categories, the more uncomfortable the student was when providing that type of
nursing care to maternity patients. The range of possible scores for each of
0-15 for performing maternity physical assessment, 0-18 for performing general
patient care, 0-24 for performing maternity patient care, and 0-27 for educating
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30
establish content validity. A pilot test was completed on seven male nursing
Some minor revisions in wording were made based on the responses from the
pilot study.
questionnaire. A follow-up postcard was sent to the instructor two weeks after
Prior to initiation of this study, approval for the study was obtained from the
Approval for implementation of the study was also obtained from the appropriate
Participation in this study was voluntary. Student names were not used.
The subjects were identified by a code number that indicated the college in
which the student was enrolled. All data were maintained in a locked file in the
office of the researcher. Data obtained from this study were kept in computer
during the course of this study were shared by the researcher only with her
thesis committee. Results of the study are reported in group form only.
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31
Data Analyses
The data obtained from this study were analyzed on the VAX-VMS
mainframe computer at Gonzaga University using the Statistical Package for the
Social Sciences (SPSS), Version 4.1. The level of significance was set at .05.
items #1 through 7 , 1 2 , 1 4 through 17, and 19 through 25. Survey item #11 was
scored across by first dividing the question into categories which included
between age, marital status, and the number of children of the male student and
t-tests were used to look at the effects of age, marital status, and children of the
student on comfort level with providing nursing care to the maternity patient.
Content analysis was applied to items #8, 9,10, and 18. Patterns within
the data were explored for commonalities. A category system was established-
items #8, 9, and 10. Item #18 regarding suggestions on how this rotation could
For item #22, frequency distributions were used to compare the differences
members, instructors, and physicians. The higher the score, the more
groups with providing nursing care to the maternity patient. The students were
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32
health care versus no employment in health care, other college degrees versus
no other educational background, and whether the student was in the first versus
the second year of the nursing program. Individual t-tests, the Chi-squared
variables and subjects' ratings of the maternity clinical rotation. The t-test is a
basic parametric procedure to test differences between two group means. Chi-
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33
CHAPTER IV
STUDY FINDINGS
The purpose of this study was to explore Associate Degree maie nursing
male students who were currently involved with or had completed their maternity
sample of ADN students who had completed their maternity nursing clinical
rotation. The subjects ranged in age from 21 to 53; the mean age was 34 (SD =
7.98). Twenty-seven (51.9% ) subjects were married and 29 (55.7% ) had one or
more children. Fifty percent of the subjects with families had school-aged
children. Most (86.2% ) of the subjects had been present for the birth of their
children. Forty-six (88.5%) of the subjects were Caucasian. The typical subject
and in the second year of the nursing program (n = 38, or 73.1%). Twenty-four
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34
Table 1
Characteristic Frequency
n %
Aae
21-25 9 17.3
26-30 11 21.0
31-35 12 23.1
36-39 7 13.4
41-45 8 15.2
r-
46-53 5 y.o
Marital Status
Single 14 26.9
Married 27 51.9
Divorced 11 21.2
No. of Children
None 23 44.2
9 17.3
2 7 13.5
3 12 23.1
5 1 1.9
0-5 5 9.6
6-10 7 13.5
11-15 6 11.5
16-19 2 3.8
20 or Older 9 17.3
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35
Table 1 (Continued)
No 4 7.7
Yes 25 48.1
Ethnic Background
Caucasian 46 88.5
Other 6 11.5
Employment
No 14 26.9
Yes 38 73.1
No 14 26.9
Yes 24 46.2
First 14 26.9
Second 38 73.1
Other Degrees
Associate 13 54.2
Bachelor 8 15.4
Post Graduate Studies 2 3.8
Graduate Degree 3 5.7
(44.2%) of the subjects indicated that their maternity clinical rotation was under
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36
all areas of maternity nursing. The third part of item #6 asked how many weeks
the subject spent in labor and delivery and the mother-baby unit. W eeks in labor
they did not spend any time in labor and delivery. W eeks in the mother-baby
weeks.
Item #7 on the tool asked when in the nursing curriculum the student had
their maternity clinical rotation. Most (n = 43, or 82.7% ) of the subjects had their
maternity clinical rotation in the first year of their program. Some (n = 22, or
42.3% ) of the subjects indicated they had a split maternity clinical rotation with
mother-baby in the first year and labor and delivery in the second year.
Item #12 on the tool asked the subjects to rate themselves on each of the
skills, and clinical skills. The subjects were to rate themselves from 0 (not at all
obstetrics was somewhat like me, 10 (19.2%) indicated a lot like me, 8 (15.4%)
indicated a little like me, and 1 (1.9%) indicated not at all like me. The mean for
like me, 11 (21.2%) indicated somewhat like me, 5 (9.6% ) indicated a little like
(88.5%) indicated a lot like me, and 6 (11.5%) indicated somewhat like me
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37
(69.2%) indicated a lot like me, 15 (28.8%) indicated somewhat like me, and 1
(1.9%) indicated a little like me (mean = 2.67, SD = .51). Clinical skills were
rated as follows: 23 (44.2% ) a lot like me, 27 (51.9%) indicated somewhat like
me, and 2 (3.8%) indicated a little like me (mean = 2.39, SD = .66). Table 2
Table 2
Knowledge of
Obstetrics 10 19.2 33 63.5 8 15.4 1 1.9 2.02
Communication
Skills 36 69.2 15 28.8 1 1.9 2.67
Major Findings
Research question one asked how male nursing students describe their
maternity clinical rotation. Content analysis was used to analyze the responses
Frequency distributions and descriptive statistics were used for analyzing the
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38
Item #8 asked the student to describe what the ciinical rotation was like for
Table 3
Mixed/Okay b u t. . . 1 1.9 "It was better than expected, but not something I
would want to do for a living. Some of the
discrimination (for being a student as well as for
being male) got a little old."
Other Negative 9 17.3 "I felt a little lost due to the fact that I am a male
and I have no kids of my own."
Item #9 on the tool asked the subjects to describe the most difficult aspect
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39
Table 4
Acceptance as a Nurse 11 21.2 "The sense that I had that my presence at times
made some women uncomfortable. It was hard
at times to remember I was a 'male' nurse in the
clients' eyes and not just a nurse, which I usually
feel. It's becoming hard to remember as time
goes on that I'm a 'male' nurse."
Other/School Related 9 17.3 "Learning all the information in such a short time
and not having enough clinical experience to feel
comfortable in OB-Gyn."
Own Perceptions 5 9.6 "My difficulty was how the mothers would perceive
me taking care of them. There were no problems."
Other 4 7.7 "Dealing with a mother who did not seem to care
for her baby."
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40
Item #10 asked subjects to identify the most rewarding aspect of their
maternity rotation. Nineteen (36.5%) thought the birth experience was the most
rewarding aspect. Eight (15.4%) thought the care of the newborn was the most
rewarding aspect. Seven (13.5%) thought that being "identified as a nurse" was
Table 5
Negative Experience 1 1.9 "Seeing the clock hit 5 p.m. on my last day."
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41
Table 5 (Continued)
NICU Experience 2 3.8 "I got to spend some time in NICU. I found that
to be a very exciting experience."
Mother/Baby Care 1 1.9 "Seeing mom and infant together, and caring for
them both."
Follow through Experience 3 5.8 "Ability to observe and follow through with labor
and delivery and postpartum experience."
Item #16 on the tool asked whether the instructor or staff had obtained
permission from the patient before assigning a student to her. Thirty-one (62% )
of the subjects stated that either the instructor or staff got permission from the
patient before assigning them to a maternity patient. Item #17 asked whether an
obstetric patient refused to have the male student provide nursing care for them;
21 (40.4% ) of the subjects had this experience. Nine (17.3%) of the subjects
indicated the patient refusal occurred in labor and delivery. Other refusals given
(3.8% ) specifically for vaginal exam, and 4 (7.7%) in the hospital. Item #17 also
asked the subjects about their thoughts and feelings in regard to these refusals.
Forty-one (78.9%) of the subjects thought a patient had a right to refuse care by
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42
Table 6
Patient right, respect 34 65.4 "It is their right as a patient--a right that I fuily and
completely accept ar.d respect."
Patient right, but mixed 7 13.5 "They have that right-most women I've taken
feelings. . . care of (OB or not) seem very appreciative of my
care. They do, however, wonder when I'll be a
doctor. So the stereotypes remain."
Frustrating, not accepted 5 9.6 "Frustrating. I'm sure they have had male
as a nurse physicians in the past. I would also like to be
accepted as a professional."
Item #22 on the tool asked subjects to indicate on a scale from 0 (not at all
patients' families, instructors, and physicians. The subjects reported the most
support from their instructors (40, or 76.9%) and other nursing students (39, or
supportive. Eight (15.4% ) of the subjects thought the staff was a little supportive
and 17 (32.7%) thought the staff were somewhat supportive. Maternity patients
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43
(20, or 38.5%), a little supportive (6, or 11.5%), and not supportive (2, or 3.8%).
Support from family members were rated as either somewhat or most supportive
by 37 (71.1 %) of the subjects; five (9.6%) of the subjects rated the family
summarizes these support ratings and presents the mean support ratings for
Table 7
Item #23 on the research tool asked the subjects whether they thought they
were treated differently on the maternity unit because of their gender. The
subjects were also asked to explain their answer. Thirty-two (61.5%) of the
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44
subjects indicated that they thought they were treated differently on the maternity
unit because of their gender. When the subjects were asked to explain how they
of the patient for a male nurse, 4) patient preference for male nurse, 5) patient
refusal for male nurse, 6) requirement for female to accompany them during an
exam, 7) treated with curiosity, and 8) special effort to offer experiences or make
8.
Table 8
Treated negatively by staff 14 26.9 "I felt looked down on by 80% of the staff (all of
whom were female)."
Treated apprehensively by 2 3.8 'Not by staff, but clients seemed a little tense.
patient
Permission asked of the 5 9.6 In asking the client about having a male student.
patient before assignment to
male nurse
Requirement for female to 1 1.9 "For liability reasons, when performing a breast
accompany exam and such, I had to take my time and another
person's time to perform these procedures."
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45
Table 8 (Continued)
Special effort to offer 3 5.8 "I felt like I may have been given more learning
experiences or make them opportunities."
comfortable
Item #24 on the questionnaire asked subjects whether they thought they
had any advantages because of their gender. They were also asked to explain
their response. Twenty-nine (55.8%) of the subjects thought they did have
advantages because of their gender. When the subjects were asked to explain,
the following themes were identified: 1) more job opportunities, 2) more overall
these themes.
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46
Table 9
More Job Opportunities 4 7.7 "There are not a lot of male nurses. I might get
hired over a female because of my gender."
More Overall Support 6 11.5 "I think the staff and the mothers were more
understanding and much more patient with me."
Added Dimension to Nursing 3 5.8 "I have often found that a different perspective
can make beneficial changes."
Patient Preference for Male 3 5.8 "Some female patients preferred a male . . .
Nurse postpartum."
Item #25 was the last item to focus on subjects' descriptions of their
maternity rotation. This question asked subjects to rate their maternity rotation
from 0 (not worthwhile) to 3 (very worthwhile) and to explain their answer. The
(SD = .84). The following themes were identified in the comments: 1) positive,
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47
Table 10
Positive/question 1 1.9 "I enjoyed the experience, but all staff nurses
usefulness or value stated that men don't work here, or are not
received well when one would like to work in
this field."
Neutral/ learned 8 15.4 "It was fascinating and I learned and used new
som ething.. skills, but Im in the program for a very specific
and different area."
Negative/no value 3 5.8 "I was there when my 3 kids were born and
received training as an Army Medic in
Emergency Child Birth. Educational experience
was primarily supplemental."
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48
Research question two asked about male nursing students' comfort level
Item #11 asked the subjects how uncomfortable it was for them to provide
care (6 skills), maternity patient care (8 skills), and education (9 items). The
highest scores possible, indicating a great deal of a problem for the subject,
were 18 for the general assessment category, 15 for the maternity assessment
category, 18 for the general patient care category, 24 for the maternity patient
possible score of 18 with a mean rating of .91 (SD = 1.47). The maternity
and had a mean rating of 4.15 (SD = 4.41). General patient care category
rating of 1.06 (SD = 1.34). Maternity patient care category scores ranged from 0
to 9 out of a possible score of 24; the mean rating for this category was 5.5
Item #14 consisted of two parts. Subjects compared their comfort level
performing nursing care to a maternity patient with their comfort providing care to
both a male patient and another female patient. Comfort with the following
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49
communication, assistance with personal care, and education. The rating for
In the first part, the subject compared his comfort level with providing care
Twenty-two (42.3% ) of the subjects indicated that a head to toe assessment was
communication was rated the same on both types of patients by 39 (75%) of the
students. Seven (13.5%) of the subjects indicated that communication was more
difficult with the maternity patient than a male patient. Six (11.5%) of the
with a male patient. The following ratings were obtained for assisting with
personal care of a maternity patient versus a male patient: more difficult (n = 24,
or 46.2%), the same (n = 25, or 48.1%), and not as difficult (n = 3, or 5.8%). The
following ratings were given for education of a maternity patient versus a male
patient: more difficult (n = 5, or 9.6%), the same (n = 41, or 78.8%), and not as
difficult (n = 6, or 11.5%).
The second part of question #14 asked subjects to compare their comfort
with performing nursing care to a maternity patient to their comfort with providing
care to another female patient. The following ratings were obtained for head to
were: more difficult (n = 5, or 9.6%), the same (n = 42, or 80.8%), not as difficult
(n = 5, or 9.6%). Assisting with personal care was rated as: more difficult (n = 8,
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50
Item #15 on the tool asked the subjects how helpful would it have been for
assistance with breast feeding, and catheterization. The ratings were 0 (not at
all helpful) to 4 (very helpful). Mean helpfulness ratings ranged from 1.46
(SD = 1.61) for education on perineal care to 2.47 (SD = 1.52) for assisting the
mother with breast feeding. These scores indicated that, in general, having a
female accompany them for these tasks would have been only somewhat
helpful. The task that received the highest number of "very helpful" responses
Table 11
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51
Table 11 (Continued)
3, 4, 19, and 20 of the questionnaire. Content analysis was carried out on the
Item #1 on the tool asked the male nursing students if they thought they
should have the option of not doing a maternity clinical rotation. The following
disagree (n = 44, or 84.6%). Item #2 asked the students whether they thought
they should have the option of only giving nursing care to the newborn rather
than the maternity patient. The following responses were obtained: agree
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52
Item #4 asked the subjects their agreement with the statement that all
nursing students, men and women, should be required to have the same
maternity nursing clinical experience. The responses to this item were: agree
Item #13 on the tool asked the subjects what they considered the most
11) honesty. Comments reflective of these themes are presented in Table 12.
Table 12
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53
Table 12 (Continued)
Research question four explored factors that were associated with a male
standard deviations were completed on items #5, 7,12, 23, 24, and 25 of the
research tool. Content analysis was carried out on narrative responses to items
Item #5 on the tool asked students whether they had a role model during
their maternity clinical rotation. Only five (9.6%) of the subjects indicated they
had a role model. One of the students commented, "There was one in particular,
but I didn't work with him. It was good to know there is someone just like myself
who is a nurse." Another one said, "He didn't waik on water but came dose." A
third student stated," . . . He was very professional, had a great aptitude for
teaching students."
whether or not they had a role model, length of the maternity clinical rotation,
and when in the curriculum the maternity rotation occurred. These variables
were explored for their relationships with whether students thought they were
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54
treated differently because of gender, whether they thought they had advantages
related to gender, and their overall rating of thieir maternity clinical rotation.
responses to item #18 on the tool. The following themes were identified: 1) no
regarding having a male nurse, 5) male nursing students follow other female
nurses, 6) provide more support to the male nursing student, 7) male nursing
student buddy with another student, 8) view the male nursing students as
11) school related suggestions, and 12) other. Comments reflective of these
Table 13
Optional Rotation 2 3.8 "Break the rotation up into two or even three
portions and make the nursery rotation the
mandatory rotation and the L&D-PP & Gyn
rotations optional."
Offer Choices 3 5.8 "I would have spent more time in L&D or
nursery. Less in postpartum."
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Table 13 (Continued)
Follow Other Nurses 3.8 "Less hands on, more observation with
explanations by nurse or instructor."
View us as Nurses 5.8 "Be less suggestive to the patients about the
'student' stigma without emphasis on the
'male' aspect. Refer to us as a nursing
student, not 'male' nursing student when
asking permission from the patient."
School Related Suggestions 6 11.5 "We went one day a week for 9 hours. A lot
of times there was nothing to do. We were
caring for only one patient. I think two days a
week (1/2 days) would give a lot more
experience."
The final research question explored to what extent these male nursing
students are considering a career in maternity nursing. Item #19 on the tool
asked the subjects whether they thought male nurses should be encouraged to
(40.4% ) were unsure; and 11 (21.2% ) said "no." Item #20 on the tool asked if
the subjects thought male nurses should be excluded from maternity nursing.
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56
Only 1 subject (1.9%) said "yes"; 2 (3.8%) were unsure. The remaining 49
(94.2%) said "no." Item #21 on the tool asked the students whether they were
no (n = 38, or 73.1 %). The second part of item #21 asked the subjects to rank
their interest in the following areas from most interested (1) to least interested
(7): labor and delivery, mother-baby unit, midwife, OB-GYN nurse practitioner,
postpartum, newborn nursery, and neonatal intensive care unit (NICU). Nine
subjects responded to this part of the question. Two others indicated interest
only in newborn nursery and NICU. Mean ratings ranged from 2.6 for the
Table 14.
Table 14
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57
CHAPTER V
this study explored Associate Degree male nursing students' satisfaction with
this clinical experience, their degree of comfort in providing care to mothers and
babies, and their suggestions for improving the obstetrical clinical rotation.
The mean age of the students (n = 52) who participated in this study was
34 years; most of the subjects were married and had one or more children. The
Becker & Sands, 1988; Bush, 1976; Faught, 1989; Garvin, 1976; Johnson etal.,
Williams, 1973). Most (86.2%) of the subjects had been present for the birth of
their children. Typically, the subjects were employed; about half were employed
Summary of Findings
their maternity nursing clinical rotation. Most of the subjects rated the maternity
majority of the
subjects disagreed with the statement that male nursing students should have
the option of not doing a maternity clinical rotation; and disagreed that male
nursing students should have the option of giving care to only the newborn
rather than the maternity patient. These findings are consistent with those
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58
the experience valuable and thought that it gave them a better understanding of
The statement in this present study's tool about whether male nursing
(n = 21) were in agreement with the statement, 11.5% (n = 6) were unsure, and
48.1 % (n = 25) of the sample disagreed. One student said, "Only if females are
Most of the subjects thought that all nursing students, men and women,
should be required to have the same maternity nursing clinical experience. One
to be separated from the rest of the class due only to our gender."
Two similar questions asked the subjects to consider whether male nurses
should be excluded from maternity nursing. The subjects were uncertain about
(n = 20) saying" yes," 21.2% (n = 11) saying "no," and 40.4% (n = 21) being
one stated, "If that's the area they choose. It would also allow males to be more
accepted in the future." Another stated, "Only if you want to be a pioneer in the
nursing field and probably unemployed." A third one stated, "Why encourage
someone to work in a field that seems to have a lot of resentment toward sex?"
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59
Almost all (94.2%) of the subjects indicated that male nurses should not be
excluded from maternity nursing. One student gave the following comment:
Another one provided this remark, "No one should be excluded from anything
they want to do and are competent at." A third shared this comment, "A nurse is
a nurse. And a good one is good regardless of sex." These findings are
students reported facing isolation and loneliness, lack of adequate role models,
somewhat like them or a lot like them. Forty-seven (90.4%) thought the quality
of calmness was either somewhat like them or a lot like them. Forty-six (88.5%)
of the subjects thought caring was a lot like them; six (11.5%) additional subjects
thought caring was somewhat like them. Fifty-one (98.1 %) rated communication
skills as either a lot like them or somewhat like them. Fifty (96.2%) rated clinical
skills as either a lot like them or somewhat like them. The high ratings on caring
are consistent with the study by Gumley et al. (1979) in which male nurses
One question on the tool asked the subjects to consider the most important
themes were identified. Eight (15.4%) of the subjects thought caring was the
most important quality. Six (11.5%) of the subjects thought either empathy or
teaching was the most important quality. Five (9.6%) of the subjects thought
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60
(7.7%) thought calmness was the most important quality, three (5.8%) thought
Half of the male nursing students in this study described their maternity
student stated, "While I enjoyed the rotation, I was treated like I shouldn't be
there... kind of like a relative who ends up staying in the house (tolerated but
not accepted)." Another student made this comment, "It was a good experience.
I learned a great deal from it. Initially I was very concerned about being
accepted by the mothers; however, with only a few exceptions, that was not a
problem." A third student stated, "Very positive. I enjoyed the experience and
For some subjects, one of the most difficult aspects of the rotation was the
intimate assessment and care of the maternity patient. Another difficult aspect
was the lack of acceptance as a nurse. Others indicated that school related
issues (e.g., specific assignments) were the most difficult aspect. Only seven
experience. Five students (9.6%) shared thai their own perceptions of how
difficult the clinical experience was going to be was the most difficult aspect.
One (1.9% ) subject stated that he experienced no difficulties. Two (3.8%) said
they lacked motivation and that the experience was not worthwhile. One student
stated, "Facing the first patient was difficult; asking her to lie on her side to
inspect her episiotomy was a hurdle. But once I made it through the first one, I
realized the women viewed the experience the same way I did, purely clinical."
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61
Nineteen (36.5%) subjects thought the birth experience was the most
coaching during labor, follow through care from labor, delivery to postpartum,
patient teaching, and the NICU experience. Only one student experienced a
negative maternity clinical rotation without any rewarding aspects. One student
stated, "The most rewarding was in labor and delivery. I don't have children and
never saw a live birth and have never taken care of a newborn before. I was
One half (62%) of the subjects stated that either the instructor or staff got
permission from the patient before assigning them to a maternity patient; three
(5.8%) of the subjects indicated that this was a protocol on any unit within the
refused to have them provide nursing care. Of the refusals, most (17.3% ) were
refused in labor and delivery. Patients in labor and delivery frequently refuse to
personal time. Most (78.9%) of the subjects thought a patient had a right to
them during the maternity clinical rotation. Instructors and other nursing
students were rated as being the most supportive. One student shared this
remark about his instructor, "Helped me get through it. Assisted when I needed
but gave me room to handle situations myself." Another student stated this
about other nursing students, "We all work as a team and are easily supportive
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62
of each other." Nursing staff were rated most supportive by 48.1 % of the
students. Some thought it was great, some did not." Another student came to
this conclusion: "Younger RNs, less than three years after graduation are the
most helpful, followed closely by near retirement RNs, and then the middle
group.. . . " Maternity patients were rated by 42.3% of the subjects as most
supportive. One student stated, "As in most areas, your patient responds to you
Another student said, "Some accepted male nurses, some didn't." A third
student stated, "I had only one out of approximately 25 females that were
worried about me being male." These findings are consistent with a study by
Mynaugh (1984) in which 400 postpartum mothers were surveyed about their
reactions to the idea of maternity care by male nurses and the majority of women
supportive 34.6% of the time. The subjects shared a variety of comments about
patients' families. One student stated, "The husband seemed more prone to ask
me questions." Another student said, "The patient's husband stated that he was
glad men were entering nursing in greater numbers." A third one stated, "Most
moms and children were fine. Many husbands obviously did not approve of me
doing such intimate care." Another student said, "Most of them were
uncomfortable. This is where the real problem lies." A student shared this about
physicians, "The few that had contact with treated me as a health care
professional offering advice and encouragement." Another said, "Some are very
good teachers.. .some could be better, and a very few should take a course in
Manners 101."
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63
Male nurses are generally more accepted by instructors and other nursing
students than staff, maternity patients, patients' families, and physicians. The
lower ratings for patients' families and physicians may be attributed to the limited
students if they thought they were treated differently because of gender. Over
half (61.5% ) of the subjects thought that they were treated differently on the
maternity unit because of their gender. The relatively high percentage that said
"yes" could be related to the lack of many male role models on the unit; only five
(9.6%) of the subjects indicated they had a role model. One student said, "I was
treated differently by nursing staff; they were unsure of me helping the obstetric
patients and taking care of the babies. My teacher was more confident than the
other staff." These findings are consistent with those from Cyr's (1992) survey of
25 male nurses in which the most frequently identified negative factor about
being a male nurse was the sex stereotyping that results from the general
The questionnaire also asked the students if they thought they had more
advantages because of their gender; more than half (55.8%) of the subjects
were provided for ihe explanation and included: more job opportunities, physical
strength, more overall support, patient preference for male nurses in general,
and more respect by physicians. These findings are also consistent with those
from the informal survey completed by Cyr (1992) of 25 male nurses. Positive
minority status, career opportunities, job challenges and security, being able to
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64
interest is whether female nursing students would rate their overall maternity
rotation similarly.
The male nursing students in this study were moderately comfortable with
providing care to maternity patients. One of the questions in the tool asked
about the subjects' comfort level when providing nursing care to a maternity
category. The highest score in the educational category was 23 out of 27. Six
out of 18 was the highest score in the general assessment category and a score
of 4 out of 18 was the highest score in the general patient care category. The
results of these data could be distorted because not ail the subjects performed
One of the questions in this study asked the subjects to compare their
comfort level with caring for a maternity patient versus a male patient. More
than half (57.7%) of the subjects claimed they were equally comfortable
communication was rated by most students (75%) as being the same on both
types of patients. The results in regard to assisting with personal care were
providing personal care the same on a maternity patient as a male patient. Most
for both types of patients. Of the four areas, personal care would
understandably cause the most difficulty for the male students because of the
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65
intimacy involved with this area of nursing care. Perhaps the similar comfort
ratings for providing personal care could be attributed to the tendency for
The second part of the same question asked the students to compare
to another female patient. Most of the subjects rated their comfort level
providing nursing care as the same for both types of patients in all four areas:
education (75%).
One item on the tool asked the subjects if they thought it would have been
helpful for a female to accompany them for the following activities: examination
assistance with breast feeding, and catheterization. More than half of the
subjects thought it would have been either helpful or very helpful to have a
(34.6%) were indicated as helpful or very helpful by almost half of the subjects.
indicated that it would not be at all helpful to have a female accompany them
during the more intimate aspects of nursing care to a maternity patient. Female
accompanied a male nursing student for personal care of the maternity patient?
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66
versus negative. One explanation for this might be related to the complexity of
clinical skills. The quality of caring was rated "a lot like me" by the majority
(88.5%) of students. This quality was followed in frequency of "a lot like me"
obstetrics (63.5%), and clinical skills (44.2%). Nursing has been called the
practice of caring (Bishop & Scudder, 1991). Males who select nursing as a
The subjects did not identify any one common theme when asked about
Finally, only three (5.8%) of the subjects indicated they were considering a
career in maternity nursing after graduation. Subjects tended to rate labor and
delivery, newborn nursery, and NICU as the areas in which they would be most
interested working. Based on these data, it appears that male nurses will
with other studies that have indicated that male nurses generally avoid
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67
specialties such as obstetrics (Bush, 1976; Greenberg & Levine, 1971; Williams,
1973).
students used in this study from ADN programs in the Inland Northwest comprise
a convenience sample that might be atypical of the target population of all male
nursing students. For example, these students may differ from other groups of
male students in terms of age, marital status, number of children, and current
might be different. The study's findings are, therefore, applicable only to this
sample. Also, the small sample (n = 52) compromises the power of the
statistical tests.
developed by the researcher. The instrument was reviewed by two experts who
are nurse educators in maternity nursing to establish content validitythat is, the
sampling adequacy of the content area being measured (Polit & Hungler, 1991).
The questionnaire was pilot tested with a sample population to evaluate clarity,
made following the pilot test. The questionnaire contained both open-ended and
and to give richer meaning to the categorical tabulations. One study, however,
may not provide a representative sample with which to predict a scoring pattern.
Replication of the study would increase the reliability and validity of the tool.
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68
varied from school to school. It is possible that the interval between course
on the tool. A lapse in time between the experience and the data collection
involving humans--i.e., the complexity of the human being. Each human being is
values, and lifestyle. This makes research concerning human behaviors and
study, for example, reliability and validity could have been compromised
because of lack of interest or lack of clarity of the research tool. There may also
Implications of Findings
insight into male ADN students' attitudes toward the maternity clinical rotation.
From this study, it was found that most maie students consider the maternity
care becomes more meaningful. Though male nurses may not plan to choose
this area of nursing for their future practice, the students in this study expressed
a desire for competence and efficiency in case they should be called upon to
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69
Nurse educators should treat all of the students as equals. Men in nursing
that the maternity rotation has little relevance to the male student's learning. In
addition, educators should support male students in maternity nursing and serve
as a role model for staff on the unit. For the most part, the male student should
not receive special attention and consideration from the nurse educator above
and beyond that of the female nursing student. However, in some unique
situations when working with female patients, a male student may require a
female to accompany him. This same type of situation may occur for a female
nursing student caring for male patients. With the emphasis of family-centered
maternity care, male nurses in maternity can provide unique contributions and
an added dimension to nursing. Male nurses can provide support and serve as
students toward maternity nursing as well as the barriers they encounter in order
to improve the quality of education for male nurses and optimize male students'
with nursing care provided by a male nurse. This present study considered only
male nursing students. Female nursing students might respond similarly to their
Conclusion
Male nurses have usually been associated with certain areas of health
sometimes been denied the opportunity to practice in certain clinical areas such
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70
as maternity nursing. Male nurses can make unique contributions to areas that
Nurse educators are responsible for providing male students with learning
receives the complete content and clinical experiences the course was designed
educator acts not only as a role model, but also as a support person and the
dignity must be respected. Male students are just as capable as female students
nurse--male or fem ale-can effectively care for all patients while maintaining
patients' dignity.
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71
REFERENCES
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120 .
Bishop, A., & Scudder, J. (1991). Nursing: The practice of caring. New York:
National League for Nursing Press.
Brown, M. (1986b). "Why won't they let us help deliver babies?" RN, 49 (7), 61-
62.
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Brown, R., & Stones, R. (1973). The male nurse. Birkenhead, England: Wiilmer
Brothers Limited.
Egeland, J., & Brown, J. (1988). Sex role stereotyping and role strain of male
registered nurses. Research in Nursing & Health. H (4), 257-267.
Facts about nursing: 86-87. (1987) (p. 5). Kansas City, Missouri: American
Nurses' Association.
Flannelly, L., & Flannelly, K. (1984). The masculine and feminine in nursing.
Nursing Forum. XXI (4), 162-165.
Fottler, M. (1976). Attitudes of female nurses toward the male nurse: A study of
occupational segregation. Journal of Health and Social Behavior, 17 (6),
98-110.
Galbraith, M. (1991). Attracting men to nursing: W hat will they find important in
their career? Journal of Nursing Education. 30 (4), 182-186.
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George, J., & Quattrone, M. (1989). Law and the emergency nurse: Opposite sex
stand-in nurses. Journal of Emergency Nursing. 15 (1), 53-54.
Gordon, I., & Green, C. (1981). The impact of sex-role stereotyping on health
care: A nursing education workshop. Journal of Nursing Education, 20 (4),
9-16.
Greenberg, E., & Levine, B. (1971). Role strain in men nurses. Nursing Forum,
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correlates in a sample of male nurses in the British Royal Air Force. Journal
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Hall, R. (1993). Letter to the editor: Male nurses in obstetrics. The Journal of
Nursing Administration. 23 (1), 68.
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(p. 129). U. S. Department of Health and Human Servicces. Washington,
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Jenny, J. (1975). The masculine minority. The Canadian Nurse. 71 (12), 21-22.
Johnson, M., Goad, S., & Canada, B. (1984). Attitudes toward nursing as
expressed by nursing and nonnursing college males. Journal of Nursing
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KfauszTM: , KedemrF:, T a irZ :, & Amir, Y. (1992). Sex-role orientation and work
adaptation of male nurses. Research in Nursing & Health. 15 (5), 391-398.
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81-86.
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Polit, D., & Hungler, B. (1991). Nursing research: Principles and methods (4th
ed.). Philadelphia: J. B. Lippincott.
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Robinson, A. (1973). Men in nursing: Their career goals and image are
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Schoenmaker, A., & Radosevich, D. (1976). Men nursing students: How they
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76
APPENDIX A
Letter of Approval
completed their maternity clinical rotation. The study will take approximately 20
physical care to a maternity patient and the support they received from the
instructor, staff, other nursing students, and maternity patients. There are also
the questionnaire will be kept confidential. Student names will not be requested.
Data obtained from this study will be shared with my thesis committee. I believe
the results of this study will give nursing educators greater insight into the issue
of nursing care by men and will support men in nursing as professionals capable
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77
APPENDIX B
Questionnaire
Please provide a response to the following questions: Agree Not Sure Disagree
(2) (1) (0)
1. Male nursing students should have the option of not doing
a maternity clinical rotation. ( ) ( ) ( )
Comments:
5. Did you have a male nursing role model during your clinical rotation Yes No If yes, how many
to maternity nursing?
(1) (0)
Comments on their role:
C. How many weeks did you spend in labor and delivery?_________ Mother-Baby?_______
7. When in the nursing curriculum did you have your maternity rotation? Q tr., Sem.
9. What was the most difficult aspect for you in this rotation?
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78
10. What was the most rewarding aspect for you in this rotation?
11. How uncomfortable was it for you to provide nursing care to the maternity patient? Mark the appropriate
box for each of the following procedures:
A little Bit A Moderate A great Deal Not
No Problemof a Problem Amount of a Problem Perf.
(0) (1) (2) (3) (4)
(1) Take vital signs
(2) Assess lung, heart, bowel sounds
(3) Examine CVA (costo-vertebral angle)
tenderness
(4) Assess bladder distention
(5) Examine leg for edema/phlebitis
(6) Assess for constipation
(7) Breast/nipple examination
(8) Assess uterus
(9) Examine episiotomy/hemorrhoids/
peripads
(10) Assess and rate uterine cramping
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79
12. How would you rate yourself on each of the qualities listed below? Please circle.
A lot like me Somewhat like me A little like me Not at ail like me
Knowledgeable
about obstetrics 3 2 1 0
Calmness 3 2 1 0
Caring 3 2 1 0
Communication Skills 3 2 1 0
Clinical Skills 3 2 1 0
13. What do you consider the most important quality in providing maternity nursing care?
14. In caring for the maternity patient, consider your comfort level when performing the following
interventions:
A. On a maternity patient vs. a male patient:
(4) Education
B. On a maternity patient vs. another female patient:
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80
15. How helpful would it have been to you for a female to accompany you for the following activities?
Very Somewhat A little Not at all
Helpful Helpful Helpful Helpful Helpful
(4) (3) (2) ( 1) (0)
16. As a male nursing student on the obstetrical unit, did your instructor or staff get permission from the
patient before assigning you to the patient?
Yes No
(1) (0)
1
Comments:
17. Did an obstetric patient ever refuse to have you provide nursing care to her?
Yes No
(1) (0)
What are your thoughts and feelings regarding refusals by maternity patients to provide care?
18. What are your suggestions on how this rotation could be changed to optimize your clinical experiences?
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81
If yes, indicate the areas you are interested in by ranking them from 1 to 7 with 1 being the most
interested area and 7 being the least interested area.
22. As a male nursing student on the maternity unit, how supportive were the following people? Please
describe how they were or were not supportive.
Most Somewhat A little Not at all
Supportive Supportive Supportive Supportive
(3) (2) (1) (0)
Maternity Patients ( ) ( ) ( ) ( )
Comments:
Instructor ( ) ( ) ( ) ( )
Comments:
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82
Physicians ( ) ( ) ( ) ( )
Comments:
23. Do you think you were treated differently on the maternity unit because of your gender?
(1)Yes (0) No
Explain:
24. As a nursing student, do you think you have had any advantages because of your gender?
25. How would you rate your maternity rotation overall? Please circle.
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83
BACKGROUND INFORMATION
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84
APPENDIX C
are being invited to participate in this study because you are a male student who
clinical rotation. I believe the results of this study will give educators greater
insight into the issue of nursing care by men, and support men in nursing as
The study will take approximately 20 minutes of your time to complete. You
will be asked to fill out a brief questionnaire about your age, marital status,
number and ages of your children, religion, race, and previous employment and
other college degrees. You will also answer questions about your maternity
clinical rotation. These questions ask about your comfort level in providing
physical care to maternity patients, the support you received from your
instructor, staff, other nursing students, and the patients, and whether you are
not will have no affect on the grade you obtain in your nursing courses or other
courses. Your instructor will not see your responses. There will be no cost to
you nor will you be financially compensated for your involvement. I hope that
Data obtained from this study will be shared with my thesis committee. Results
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85
Graduate Student
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MALE STUDENTS' PERCEPTIONS OF THEIR MATERNITY NURSING
CLINICAL EXPERIENCE
Linda K. Gambill
Gonzaga University
Abstract
In Western culture, nursing is considered a feminine career. However, men are moving
toward greater representation in nursing. Male nurses have usually been associated with certain
areas of health care. They are generally uncomfortable with staff and patients in obstetrics and
This study investigated 52 Associate Degree male nursing students' perceptions of their
clinical experience on the maternity unit, their degree of comfort in providing care to mothers
and babies, and their suggestions for improving the obstetrical rotation. A researcher-designed
In general, the students responded favorably to their maternity rotation. Almost all of the
subjects thought that ajl nursing students should be required to have the same maternity nursing
clinical experience. The students were moderately comfortable with providing care to maternity
Research must continue to explore the attitudes of male nursing students and the barriers
they encounter in order to improve quality of education for male nurses and optimize learning.
'kw uuxcL
Committee Chairpei
By V v ^ ^ a o u
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