Anxiety Levels of a New Graduate Family Nurse Practitioners - Essay Example

THE ANXIETY LEVEL OF NEW GRADUATE FAMILY NURSE PRACTITIONERS IN FAMILY PRACTICE SETTINGS Nurses have a critical role to undertake in the healing process of patients. But they, too, undergo stages of learning, beginning as neophytes and eventually progressing as experts. This study investigates this learning process in light of the anxiety experienced by new graduate family nurse practitioners, specifically engaged in family practice settings. The independent variable that shall be focused on is length of tenure, with respondents having at least 3 months of practice in this setting, to a maximum of 12 months. Four levels of length of practice (3, 6, 9 and 12 months) shall be compared in terms of the level of anxiety experienced by the nurses. Results shall have implications on the means to facilitate the learning process and make it as effective, efficient, and as less stressful as possible. Introduction Numerous empirical studies have noted that nursing as a profession is intense and stressful. In fact, it has been noted that the likelihood of occupational stress-related burnout is specifically high in this field (Bégat, Ellefsen, & Severinsson, 2005). In fact, nurses’ psychosocial work environment, including their experience of anxiety and stress level, does strongly influence their sense of well-being (Bégat, Ellefsen, & Severinsson, 2005). The current study asserts that newly graduate nurses, particularly those in family practice settings, similarly experience stressful situations. Such stress may be discussed in light of the framework proposed by Benner (1982) taking off from the work begun by Dreyfus & Dreyfus (1980), which depicts the learning process undergone in becoming an expert in the profession (Benner, 1982). These stages, beginning from novice and incrementally progressing to expertise level, have been specially adapted to the learning stages that a nurse goes through (Davidson, 1992). The current study aims to determine the anxiety levels of new graduate family nurse practitioners in family practice settings. Apart from establishing these levels, these shall also be compared across time, through 3, 6, 9, and 12 months. In doing so, the research may impart data on how to address these anxieties, and to effectively expedite the learning process. Review of Related Literature Anxiety and the Nature of Nursing Menzies (1960) investigation of nursing services in a general hospital is popular, and depicts numerous ways of dealing with the intense and complicated anxieties arising from the job. Nurses are in intensive and frequent contact with people who are physically ill or injured, often gravely. The recovery of patients is uncertain and will not always be full. Nursing patients who have incurable diseases is one of the nurses most distressing tasks. Nurses are faced with the threat and the reality of suffering and death as few lay people are. Their work deals with accomplishing tasks which, by conventional standards, are unappealing, or even disgusting, and frightening. Close physical contact with patients elicits strong libidinal and erotic wishes and impulses that may be hard to control. Moreover, the nature of their work arouses very strong and mixed feelings in the nurse: pity, compassion and love; guilt and anxiety; hatred and resentment of the patients who arouse these strong feelings; envy of the care given the patient (Menzies, 1960; p III). Menzies distinguishes the techniques which nurses used for addressing these issues as essentially defensive and maladaptive. For instance, splitting up the nurse-patient relationship by preoccupation with tasks, depersonalization, categorization and denial of the significance of the individual (the liver in bed 10, the pneumonia in bed 15) and so on. In all, nine aspects of the nurses and the hospitals social defense system are described, the characteristic feature [of all of which is their] orientation to helping the individual avoid the experience of anxiety, guilt, doubt and uncertainty (Menzies, 1960; p XIV). There are also facets of the organization of staff which Menzies acknowledges induce still more anxiety and veer away from job satisfaction, but which are argued as examples of the social defense system in practice. This is so in that they function mainly to disorientate staff even more from their purpose and thus hide these defenses. The outcome is not only evasion of anxiety, but mystification (Laing, 1965) as to what has occurred. This social defense system as a whole, Menzies asserts, represented the institutionalization of very primitive psychic defense mechanisms, a main characteristic of which is that they facilitate the evasion of anxiety, but contribute little to its true modification and reduction (Menzies, 1960; XXII).’ Benner’s Learning Stages Patricia Benner (1982) has expertly adopted a skills and acquisition development model which has been initially discussed by Dreyfus & Dreyfus (1980). While the original model has proposed this for other professions, Benner (1982) has been successful at customizing it for the nursing profession. According to her model, a nurse goes through the five stages of novice, advance beginner, competent, proficient, and expert. In the novice stage, procedures and operations patients underwent are studied lengthily; moreover, they eagerly learn by asking more senior staff with queries, more frequently dealing with technical matters. Acquisition of General Nursing Skills The advanced beginner takes note, based on actual experience, ‘the recurrent meaningful situational components (Benner, 1982, p. 403). Transformation occurs when the nurse starts to acknowledge facets of situations that require from her a specific response (Benner, 1982). This recognition does not emanate from a book or from similar learning material, but from exposure to or familiarity to the situation. Under this stage, the nurse already has the capacity to change ones view or approach as appropriate response to changes which would seem ‘unintelligible nuances in the situation (Benner, 1982). Finally, the expert level is beyond proficiency; for instance, there ceases to be a struggle to employ novel approaches as necessary. The incumbent is able to reframe most easily, and transpires at the preconscious level. This suggests that she is free to address other tasks (Benner, 1982). Nursing undergraduates’ knowledge development and style of reasoning style forms their rule-based reasoning (ONeill & Dluhy, 2005). This implies that they are still highly dependent on rules as a gauge of their performance, which are based on scientific principles and nursing processes, and are aptly guided by the American Nurses Association standards of nursing practice. These prescriptive standards present the manner in which nurses are expected to carry out patient care (American Nurses Association, 1998). When new graduate students enter the nursing practice for the first time, they do not have the benefit of experience; in essence, the meaning and relevance of these rules and their expected behavior remains ambivalent. Moreover, because of the lack of clinical experience, they strongly depend on rules and abstract principles, developing gradually to the use of past concrete experiences to guide actions. They still do not possess a tangible understanding of the contextual definitions of medical jargon. Skills Acquisition for the Novice The novice acquires clinical judgment and skill over time. Knowledge is refined through actual clinical experience; this moves her from a rule-based, context-free stage to a more analytical, logical and intentional pattern of thinking (Benner, Tanner, & Chelsea, 1996). To effectively provide a conducive learning environment, new nurses need venues for examining and developing their problem solving and reasoning skills towards making clinical judgments (Miller, 1992). Such venues transpire through numerous learning experiences. Participating in varied learning experiences offers the chance to apply classroom theory in the clinical setting. These experiences can help them in developing the learner from the novice phase to advanced beginner. The advanced beginner has been exposed to choice real-life situations and therefore has more contextual rules. Advanced beginners, however, are in greater need for supervision and guidance. They are only starting to learn repetitive meaningful patterns in clinical practice. Clinical experiences enable the formation of meaningful related information on the basis of what the nurse has learned in the classroom. There is an expectation that with more experience, this novice can move from the level of advanced beginner to the level of competence by program completion (Carnaveli & Thomas, 1993). Clinical judgment is defined as nursing decisions about which areas to assess, analyzing health data, prioritizing which task to do, and who should carry it out (Carnaveli & Thomas, 1993). For clinical judgment to be assessed as sound, it should be arrived at using critical thinking and logical reasoning, that will enable the deduction of valid conclusions, and the decisions that may be borne from these. Critical thinking is a cognitive process of dexterously undertaking analysis, synthesis, and evaluation of data gathered from observation, experience, reflection, or communication as a guide to belief or action (Paul, 1993). Several researchers have presented critical thinking as a reflective, reasoned thinking process (Ennis, 1985; Halpern, 1989; Wilkinson, 1996). It is utilized to allow clinical judgments to act based on the information analyzed or processed (Ennis, 1985; Halpern, 1989; Wilkinson, 1996). Clinical reasoning is a cognitive process of progressing from what one already knows to more knowledge (Anderson, 1990). Reasoning is used to make a clinical judgment. Reasoning entails a capacity to remember facts, organize them in a meaningful whole, and then apply the information in a clinical patient care situation. Individuals can make use of reasoning to help in formulating principles or guidelines as a basis for their practice judgment decisions. Skill acquisition acknowledges that proficiency and expertise are a function of the exposure to a variety of situations. These circumstances become experiences for the learner to elicit apt responses. Bandura (1977) emphasized that most learning transpires by observing and modeling behaviors. Information is then stored and coded cognitively and utilized as guide for action. He further noted that the development of a realistic learning setting incorporating environment, behavior, and thought promotes the acquisition of complex clinical skills. Moreover, simulation can help in providing this realistic exposure for new graduates (Bandura, 1977). Theoretical Framework Patricia Benner (1982) has proposed a model for acquisition and development of skills. The original framework has been brought forth by Dreyfus & Dreyfus (1980), presenting it for chess players and pilots. The Benner model primarily explains the process of becoming a nurse, adapting it to specific circumstances of the nursing profession. She discusses the five stages that a nurse undertakes in her paper From Novice to Expert (Benner, 1982). These stages include novice, advanced beginner, competent, proficient and expert. She has provided two principles for the progression through each of these stages. The following quote vividly depicts this: ‘One is a movement from reliance on abstract principles to the use of [ones own] past concrete experience as paradigms. The other is a change in the perception and understanding of a demand situation so that situation is seen less as a compilation of equally relevant bits and more as a complete whole in which only certain parts are relevant (Benner, 1982; p. 402). Since the nurses of interest in the study are just beginning to practice, these nurses are presumably in the novice level. The independent variable shall be the length of time of practice of a new graduate with four levels, namely, 3, 6, 9, and 12 months. The dependent variable shall be anxiety level which shall be measured using the State / Trait Level Anxiety Tool. Research Question / Hypothesis The present study aims to answer the following research problem: What is the level of anxiety of new graduate family nurse practitioners in family practice settings? The following specific problems shall be addressed: 1.) What is the level of anxiety of the new graduate nurses in family practice settings, who have been practicing for: a.) 3 months b.) 6 months c.) 9 months d.) 12 months? 2.) Is there a significant difference among the anxiety levels of nurses, practicing for 3, 6, 9, and 12 months? Definition of Terms Anxiety. Feelings of apprehension and fear distinguished by physical symptoms such as palpitations, sweating, and feelings of stress. Anxiety disorders are grave medical illnesses that inflict about 19 million American adults. These disorders fill peoples lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, pervasive, and can grow progressively worse if left untreated (MedicineNet.com, 2005). In the present study, it is operationally defined as the scores of the respondents on the State / Trait Level Anxiety Tool. Family nurse practitioner. Nurse practitioners are registered nurses who have accelerated clinical training and educational preparation and accomplish health care interventions at an "advanced practice level". Registered nurses can have their basic nursing experience and knowledge to a higher level of practice as a nurse practitioner. Nurse practitioners are engaged in a various clinical settings including outpatient clinics, ambulatory care settings, emergency departments, community health agencies, private practice settings as co-owners and operators with other nurse practitioners, physicians and providers (Samuel Merritt College, 2005). In the current study, it is operationally defined as the family nurse practitioners who have qualified as respondents using the following purposive criteria: 1) should be a family nurse practitioner working in a family practice setting for at least 3 months, but no longer than 12 months; 2) explicitly expresses willingness to participate in the study. Family practice. The medical specialty which offers constant and comprehensive health care for the individual and family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family practice encompasses all ages, both sexes, each organ system, and every disease entity (MedicineNet.com, 2005). State-Trait Anxiety Inventory (STAI). An instument that was originally designed as a research tool for the investigation of anxiety in adults. It is a self-report assessment instrument that includes individual measures of state and trait anxiety. It reflects a "transitory emotional state or condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity" (Spielberger, Gorsuch, & Lushene, 1970). State anxiety may change over time and can fluctuate in intensity. On the contrary, trait anxiety suggests "relatively stable individual differences in anxiety proneness" and refers to a general tendency to respond with anxiety to perceived threats in the environment. This instrument has been effectively utilized in hospice care (Heaven & Maguire, 1997). Chapter 2 Methodology Research Design The current research is a descriptive, longitudinal, between subjects study. It is descriptive because it aims to establish baseline data on the level of anxiety of new graduate family nursing practitioners. Moreover, it intends to determine whether the length of time in the practice affects this level of anxiety, comparing it across practitioners who have practiced in 3, 6, 9, and 12 month durations. Sampling Design The study shall use non-probability sampling, specifically purposive sampling. Three criteria shall be used for inclusion into the sample; these are 1) length of practice of the family nursing practitioner being at least 3 months but not exceeding 12 months, 2) involved in a family practice setting, and 3) explicit permission to participate in the study. Instrument The State-Trait Anxiety Inventory (STAI) was originally designed as a research tool for the investigation of anxiety in adults. It is a self-report assessment instrument that includes individual measures of state and trait anxiety. It reflects a "transitory emotional state or condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity" (Spielberger, Gorsuch, & Lushene, 1970). State anxiety may change over time and can fluctuate in intensity. On the contrary, trait anxiety suggests "relatively stable individual differences in anxiety proneness" and refers to a general tendency to respond with anxiety to perceived threats in the environment. This instrument has been effectively utilized in hospice care (Heaven & Maguire, 1997). Data Collection Secondary data are collected through books, journals, and internet sources to provide a comprehensive background of the problem. This then composed the review of related literature. Following this, primary data collection shall be undertaken. Permission shall be asked from the necessary parties (or from the nurses themselves) to administer the STAI tool. Once permission is secured, the survey sheets shall be administered. Accomplished questionnaires shall be collated, encoded and analyzed. The analysis shall form the basis of conclusions, and recommendations on how to alleviate the plight of neophyte nurses and expedite their learning, and possibly lesson the anxiety associated with these initial stages of learning. Method of Data Analysis Means and percentage distributions shall be constructed for all the scales of the STAI, for nurses practicing 3, 6, 9 and 12 months. One-way analysis of variance shall then be conducted to determine if length of practice significantly affects the nurses’ level of anxiety. If such a significant result is yielded in the F-test, Tukey’s test shall be computed to determine which particular pairwise comparisons are statistically significant. References American Nurses Association. (1998). Standards of clinical nursing practice, 2nd ed. Washington, DC: American Nurses Association. Anderson, J.R. (1990). Cognitive psychology and its implications, 3rd ed. New York: WH Freeman. Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavior change. Psych Rev . 1977;84:191–215. Bégat I., Ellefsen B. & Severinsson E. (2005). Nurses satisfaction with their work environment and the outcomes of clinical nursing supervision on nurses experiences of well-being a Norwegian study. Journal of Nursing Management,13, 221230. Benner P., Tanner C.A., & Chelsea C.A. (1996). 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