The participants reported many factors that motivated them to improve their skill in this stage. Nearly half thought that wanting to be skilful in basic nursing skills was the significant driving motive that encouraged them to continuously develop their skill. They revealed that many influences could inspire them to meet their goals, such as not performing procedures awkwardly, wanting to be as skilful nursing providers as the nurses they had observed, hoping to be skilful from practising, attempting to do their best after finding they had not paid attention to their studies, making mistakes, being blamed and/or punished, and being refused by patients. A fourth year participant with high GPA stated that:
Like, sometimes, patients refused...For example, an iv injection, yes! in the first time, if I couldn‟t [complete it], then the second time, patients would begin to lose trust in me. Yes! they might ask me whether they could ask for another nurse to continue or not. That made me lose a bit of confidence. ...I thought the next time(s), I couldn‟t do like that. I had to do it more accurately because if something like that frequently happened, it was sure I always couldn‟t do it. As patients didn‟t allow me to do it again and again. ...Yes! Next time, I had to train myself more. ... (Arun, Interview 3, page 34)
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However, wanting to be nurses and/or hoping they could be nurses to fulfil their families‘ wishes were the important reasons that together facilitated more than half of the participants‘ attempts to improve their basic nursing skills. In this study, I found that some of the students who had low GPAs had to study nursing because of their families‘ wishes. The students reported they and/or their families had many reasons for wanting them to be nurses such as helping patients to get better, getting a scholarship and working in their hometown, being government staff members, having a permanent job after graduating, being perceived as an attractive person by others, and being a good model for family members. A participant with low GPA who studied in the fourth year disclosed:
...One more thing, at first, I didn‟t quite like nursing. I mean my family supported me to study this. So, I had to adapt myself. I mean I had to love this career more. … (Nutsaree, Interview 1, page 7)
Alternatively, some of the students revealed that the caring of their supervisors could promote them to further their practical studies. They also indicated that getting trust or admiration from their supervisors and/or patients, and/or discovering the value of nursing could combine with the other motives to encourage them to make an effort to improve their nursing skill. A fourth year participant with moderate GPA said:
...I even broke an injection amp...and even prepared for an injection by taking a very long time [speaking with high volume]. Anyway, my instructor didn‟t blame me anything. She said, “That‟s alright”, things like that. I felt she tried to support me, so I didn‟t feel bias [to nursing] anymore. ….and like, I had encouragement. When my instructor or preceptors praised me, I felt I would like to improve my skill. I mean I needed to do it better and better. … (Laina, Interview 1, page 13, 17)
Other participants who had a moderate-high GPA attempted to improve their skill because they needed to get good grades to further their studies after graduating and make their families satisfied and proud of them. Some of this group, however, also reported other reasons that had power to motivate them to pay attention to their practice. They disclosed that being part of the Project put them under pressure to make an effort to develop their nursing skills to prove that they were competent. Also, one of them described that because her parents did not agree with her choice of programme, she tried to develop her nursing skills to show that she could make a success out of nursing.
In addition, some participants reported that the support of their families, the help and support from the patients and the patients‘ families motivated them to improve their
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skill in this stage. For instance, when having some difficulties from settings, the participants‘ families tried to support and told them to be strong. They could also get help and support from patients‘ relatives and patients. Some relatives helped the students to complete the routine care for their patients. Particularly, when seeing the students were reprimanded for not completing the nursing care they were responsible for in time, relatives were enthusiastic to help. They sometimes also encouraged the students with some words to make them feel better after being reprimanded by a preceptor or nurse. These students perceived relatives and their patients as very nice. Relatives and their patients allowed them to do procedures even though they were students. When the students could not achieve procedures the first time, they gave them encouraging words, as well as allowing them one more opportunity to try. This made the students feel good and more motivated to learn. A third year participant talked about this experience:
...That nurse?...She was so serious in everything. Like, I was in the first block of the ward, while she was in the last [one], she could shout at me! Sometimes, patients said ah, “It doesn‟t matter, just be patient”. Patients tried to encourage me, “It doesn‟t matter, not a long time to graduate”, things like that. She really reprimanded, so sometimes patients told me not to be interested that. …One day, while a little boy was drinking milk and I would record the nurse‟s note, she asked me what about his I/O20. ...He just drank like that; it was enough or not. …I responded to her, “Not enough”. ….I told her, “Feed milk more” she said yes! Go and do that now! If he couldn‟t, you weren‟t allowed to finish [that shift]. Anyway, it was good that his mother [helped me]. “Ah, you [a little boy] drink this milk otherwise your nurse [I] can‟t take a rest” [laugh]. …She [the mother] helped me to feed milk until it was finished. That made me feel better. Sometimes, patients could influence me too. …Their encouragement motivated me too. … (Nirin, Interview 1, page 7)
Although having awareness of the need for best care and learning motives to develop their nursing skills, some of the participants revealed that not wanting to study nursing often influenced them to have lack of motivation to learn.