Theme 3: Low self-esteem

Louw and Edwards (2011:449) note that self-esteem, which ranks high on Maslow’s hierarchy of human needs, concerns personal prestige, a sense of independence, competence and self-respect that is indispensable for interpersonal relationships and mental health. Tajfel (2010:33) observes that self-esteem should be empowered by its own imprimatur and energy to justify itself. Feldman (2005:123) emphasises that unlike the self-concept, which encapsulates the overall self-image or profile – like a self- portrait in the round including personal traits in general – held of him- or herself by the person concerned, self-esteem is a valuation placed on the self by a person in virtue of a generality of impressions produced endogenously as well as in reaction to the external environment, including especially other persons.

According to Swart et al (2008:132), low self-esteem proceeds from a perceived inability to meet a self-imposed standard. Once this perception has taken root the person’s will to achieve will be undermined because the person will regard him- or herself as inherently inclined to fail.

Sub-themes: feeling useless, estranged and lacking in confidence. Each of these subthemes will be considered separately.

3.2.3.1 Sub-theme 3.1: Feeling useless

Tajfel (2010:337) explains that a person who considers him- or herself incapable of meeting goals set by the group to which he or she belongs will tend to feel useless in the group and will therefore tend to leave the group. Participants in the study at hand considered themselves to be in this category because of their perceived failure to meet the common goal of the nursing profession, which is to preserve life. They expressed this perception as indicated by the following examples:

“I felt so useless and guilty for not knowing how a dead person looks like.”

“I did some passive exercises on the corpse, thinking I am helping the patient, only to find that I am killing the patient. I feel so useless.”

3.2.3.2 Sub-theme 3.2: Not belonging

Tajfel (2010:67) explains that belonging is a process whereby a person is located within a system of social categorisation according to his own or a collective extraneous valuation. It also subsists, thus Tajfel (2010:68), in a person’s sense, born of a secure awareness, of belonging to the group concerned. That is to say, it subsists in an emotional bond that ties the person to the group. A sense of not belonging occurs when a person cannot be located in a social category as indicated above.

Participants engaged in the study at hand voiced their subjective sense of not belonging in utterances such as the following:

“I feel that I do not belong to this profession. If I do belong, then why is it that two patients − two patients died in my care?”

would have saved this patient’s life. Now I feel that I do not belong in this profession as I cannot save life.”

“I actually wanted to quit the course because I felt that I do not belong.”

3.2.3.3 Sub-theme 3.3: Loss of confidence

The Oxford English Dictionary (2007:94) defines confidence as certainty of the ability to achieve or accomplish a feat of some sort. Loss of confidence therefore means the opposite, namely a sense of incapacity that saps or undermines the person’s ability to achieve or accomplish the feat concerned. This sense of incapacity then becomes a sense of being inferior to others and of doubtful self-worth and, therefore, self-mistrust and inhibited behaviour. According to Nelson (2010:6), loss of confidence is synonymous with hopelessness, pessimism, dejection, depression, despair, disappointment, discomfiture, dismay, downheartedness, melancholy, sadness, cold feet, low spirit and the blues. Participants in the study under review vowed loss of confidence in utterances such as the following:

“I do not feel confident at all. Every time there is a patient who is dying, I make sure that I stay away. I do not feel like a nurse at all. We, students, feel useless in the wards.”

“Every time I see the screen closed, I will suspect that it is a corpse and ‘I take short-left’- meaning I run away or I make sure that I stay away and I do not feel like I am a nurse at all.”

Mutto, Erra’zquin, Rabhansl and Villar (2010:1445) affirm that when student nurses have to take care of the dying without being briefed for the purpose, they are inclined to fall prey to bouts of anxiety emanating from a fear of death and therefore tend to shy away from dying patients, with the result that they develop a sense of inferiority and unworthiness that tends to harden as a conviction of not belonging to the profession. Kelly and Nisker (2010:426) note that students identified death of a patient as a failure to provide adequate care, with the result that they avoid reflection on death and dying and therefore fail to develop a very necessary element in the complement of professional competencies required of them. According to Peterson, Johnson

Halverson, Apmann, Chang, Kershek, Scherr, Ogi and Pincon (2010:182) student nurses who do not cope effectively with the death of their patients are inclined to become increasingly distant and uncommitted in their attitude towards and treatment of patients.