Group One: Two steps forward, one step back

step back

For Sylvia, Bobbi, Jo, Tina and Rose, all from East Asian backgrounds, confidence in communicating rose and fell through the placement, while increasing overall. Often a defining moment of crisis or critical feedback precipitated a change in behaviour and a subsequent confidence „spurt‟. Patterns of confidence at each stage of placement are described below.

Pre-placement: anxiety

At the pre-placement interview, the most common attitude to communication on placement was anxiety, perhaps because these students had all experienced previous problems. In response to the question „What do you think will be the most difficult thing for you?‟ all these students focussed on aspects of communication, such as using the telephone, contacting other staff and taking health histories (see Table 5.3).

Table 5.3: Group one – predicted difficulties in placement Interview One:

Q: What do you think will be the most difficult thing in placement?

Sylvia That one, before, I told you that interview things. Bobbi I think to deal with the staff.

Jo Maybe answering phone? Answering phone.

Tina To know how to contact different multidiscipline team members. Like how to contact the doctors, social workers, occupational therapist, like that.

Rose It‟s still hard for me to pick up the phone, to answer the phone. It‟s very hard for me to understand over the phone.

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Of the three main groups they would interact with on placement - patients, preceptors and other health professionals - students were most confident about communicating with patients. The exceptions were Sylvia and Jo, who were also the only two who had not worked in a New Zealand healthcare setting either during or before their study (for example as part-time care assistants). Students were slightly less confident about communicating with their preceptor and least confident about communicating with other health professionals.

Mid placement: Up and down

The first week was difficult for most students, as they struggled to become familiar with the communication patterns and terminology associated with the new environment. By the time of their mid- placement interview, however, students had settled in and their confidence in interacting with patients and preceptors had grown. Sylvia relaxed as she realised that some of the patients‟ difficulties in understanding her were due to factors other than her level of English. Bobbi‟s preceptor was “very patient” in taking time to explain things, and always supportive and encouraging; because of this, Bobbi felt she was learning a lot.

In contrast, students‟ confidence in communicating with health professionals had dipped. Students worried about their command of terminology, and that they would not be able to understand or be understood, and that this might lead to a negative reaction from colleagues. Some students had already experienced these angry or negative responses, and so were trying to avoid further communication. For one student, understanding and remembering colleagues‟ names was difficult and led her to withdraw from interaction so as to avoid embarrassment.

Terminology was also problematic at this point, especially the names of conditions, procedures and medications. For Bobbi, working in recovery, this made handovers particularly difficult. She felt that

105 other staff members were “in a hurry”, and had an in-depth knowledge of conditions and medications which she hadn‟t yet acquired. This added to the pressure and anxiety she felt.

Post-placement: Tentatively confident

At this point, the students all knew they had passed the placement and were looking forward tentatively to their futures as registered nurses. They had all either maintained or increased their initial confidence in communicating with patients, and were fully confident in communicating with their preceptors. Most students had also begun to develop a measure of confidence in interacting with other health professionals.

This new-found confidence had typically developed in response to a defining, critical moment, which prompted them to move „out of the comfort zone‟ and try new strategies.

For Tina and Jo, the „critical moment‟ was direct feedback that their communication must improve in order to meet the standards for the placement. Jo was given clear feedback that she needed to improve her communication skills and interact more with the team, by talking to the nurses, anaesthetists and technicians. Jo realised that she had to make a change, and decided to use her colleagues‟ speech as a model:

In the last week I really change, and I really tried to communicate with other health professionals, yeah. And then I copied like what the nurses say to others, and that works and I got the confidence so I could communicate with others. (Jo 3)

As a result, she described the last week of the placement as “really great!” Her confidence had increased enormously, and she had an obvious sense of achievement and excitement for the future.

Tina‟s critical moment also occurred in response to feedback. She found the placement tiring, and had started to ring in sick in the fifth

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week. Feedback from the preceptor was that her attitude wasn‟t right: she looked “totally pissed off”. Most critically, a patient had complained about her. As Tina said, “People is thinking am I not happy to be there, I‟m not happy to dealing with them, or am I grump” (Tina 3). With the support of her preceptor, the clinical lecturer agreed to allow Tina an extra week in placement to see if she could make necessary improvements.

This feedback, and the real possibility of failure, prompted Tina to make a concerted effort to change her attitude and also make sure she got plenty of sleep. These strategies worked well, and the lecturer commented that she seemed like a “completely different person”.

For this group, the experience of placement had resulted in an increased sense of self-efficacy, or assessment of their own competence and effectiveness in communicating (Gecas, 1989). This was linked to increased confidence and to an increased willingness to participate in the interactions of the placement. However, communication was still perceived as problematic. When asked to describe the most difficult aspect of placement, all students talked about aspects of communication (see Table 5.4 below), especially understanding, using and pronouncing medical terminology.

Table 5.4: Group one – actual difficulties in placement

Interview Three

Q: What was the most difficult thing in placement/?

Sylvia Still some medical term, yeah

Pronounce some particular medical terms or medication Bobbi The handover

Medical words

Jo The name of instruments and suture name Telephone talking

Tina The pronunciation about the drug names

Rose

Some nurse talk very fast and some surgeon is just ... some thing is new for me so I found it‟s very hard to catch. I have no idea what they talking about

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