Men in Nursing

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MALE STUDENTS PERCEPTIONS OF THEIR M ATERNITY
NURSING CLINICAL EXPERIENCE
A THESIS
SUBMITTED TO THE FACULTY OF THE
DEPARTMENT OF NURSING AND THE GRADUATE SCHOOL
OF GONZAGA UNIVERSITY
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
by
Linda K. Gambill
March 19S5
UMI Number: 1374555
Copyright 1995 by
Gambill, Linda Kay
All rights reserved.
UMI Microform 1374555

Copyright 1995, by UMI Company. All rights reserved.
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Copyright by Linda K. Gambill
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ii
Susan L. Norwood, EdD, ARNP
Thesis CommitteeChairperson
Dale Abendroth Lenski, MN, RN

Committee Member
Barbara E. Morrison, MN, ARNP

Committee Member
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 choose this specialty less
frequently.
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 questionnaire was
used to collect the data.
In general, the students responded favorably to their maternity rotation.
Almost all of the subjects thought that all nursing students should be required to
have the same maternity nursing clinical experience. The students were
moderately comfortable with providing care to maternity patients. There were no
significant relationships between demographic characteristics and students'
perceptions of their maternity experience. Analyses of suggestions to optimize
their rotation did not reveal any one common theme.
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.
iv
Acknowledgments
There are a number of people I would like to acknowledge who have
significantly influenced the writing of this thesis. I am indebted to Dr. Susan
Norwood, my Thesis Committee Chairperson, for her continued support and
encouragement. Also, I would like to thank Dale Abendroth Lenski and Bobbi
Morrison, Thesis Committee Members, for their assistance in completing this
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
thesis. Finally, I am indebted to Jill W. Smith, my friend and typist.
Table of Contents
CHAPTER I. INTRODUCTION .......................................................................... 1
The Research Problem .......................................................................... 1
Purpose Statement .......................................................................... 6
Research Questions .......................................................................... 6
CHAPTER II. REVIEW OF L IT E R A T U R E ........................................................ 7
History of Men in Nursing ............................................................... 7
Characteristics of the Men Who Are in Nursing ................................ 10
Attitudes Toward Men in Nursing........................................................... 17
Men in Maternity Nursing ....................................................................... 21
Summary ............................................................................................... 25
CHAPTER III. RESEARCH METHODOLOGY ........................................... 27
Setting for the Study ......................................................................... 27
Sample and Sampling Procedure ......................................................... 27
Instrumentation .................................................................................... 28
Data Collection Procedures ............................................................. 30
Protection of Human Rights ............................................................. 30
Data Analyses ......................................................................................... 31
CHAPTER IV. STUDY F IN D IN G S .................................................................... 33
Characteristics of the Sample ........................................................... 33
Major Findings .................................................................................... 37
vi
CHAPTER V. DISCUSSION AND CONCLUSIONS .................................. 57
Summary of Findings............................................................................. 57
Limitations of the Study ...................................................................... 67
Implications of Findings ....................................................................... 68
Conclusion ........................................................................................... 69
REFERENCES ................................................................................................. 71
APPENDIXES ................................................................................................. 76
A Letter of Approval ........................................................................ 76
B Instrument ................................................................................... 77
C Letter of Information and Informed Consent............................ 84
vii
List of Tables
1. Characteristics of the Sample ................................................................ 34
2. Qualities of the Subject ......................................................................... 37
3. W hat the Clinical Rotation W as L ik e ......................................................... 38
4. The Most Difficult Aspect ....................................................................... 39
5. The Most Rewarding Aspect ..................................................................... 40
6. Thoughts and Feelings about Refusal by Maternity Patient .............. 42
7. Support on Maternity Unit ....................................................................... 43
8. Being Treated Differently ....................................................................... 44
9. Perceived Gender-Related A d van tag es................................................... 46
10. Evaluation of the Maternity R o tation......................................................... 47
11. How Helpful Would It Have Been for a Female to Accompany You? . . 50
12. Most Important Quality in Providing Nursing Care ................................. 52
13. Suggestions to Optimize Clinical Experience ....................................... 54
14. Career in Maternity Nursing ..................................................................... 56
1
CHAPTER I
INTRODUCTION
The Research Problem
In Western culture, nursing is considered a feminine career. Florence
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
long been promoted as a career for women--especially single women--and as
preparation for motherhood (Williams, 1989). Men, however, currently constitute
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
do with gender. Nursing offers job security, a challenging career, opportunity to
help others, extensive employment opportunities, and flexible hours (Cyr, 1992;
Perkins, Bennett, & Dorman, 1993).
It has been reported that men in nursing frequently experience role strain
because of their nontraditional career choice. They often attempt to reduce this
role strain by choosing specialty areas such as psychiatry, anesthesia, intensive
care, emergency room, and administration; these areas have certain
characteristics that might explain how they function as areas where role strain
might be reduced. Each of these specialties enables men to escape explicit
identification as a nurse by avoiding the traditional nurse's uniform. Also, in
these specialty areas, male nurses may perceive their role as special and above
that of other nurses. Psychiatric nursing, anesthesiology, and administration all
involve minimal intimate physical contact with patients (Egeland & Brown, 1988;
Greenberg & Levine, 1971; London, 1987). Additionally, men distinguish
themselves from female nurses by their willingness to perform heavy lifting
Reproduced with permission o f the copyright owner. Further reproduction prohibited without permission.
2
assignments--in defining lifting as masculine, it enhances masculine traits.
Some men in nursing reportedly view themselves as making an important
contribution to nursing because of their superior physical strength (Williams,
1989).
Outsiders often stereotype male nurses as homosexual because of the
preconception that they are effeminate (Alvarez, 1984; Egeland & Brown, 1988;
Gordon & Green, 1981; Hull, 1982). A masculine person is typically viewed as
one who denies and degrades qualities such as weakness, emotionalism,
daintiness, and primness that are associated with femininity. Male nurses have
their work cut out for them-preserving an image of masculinity in an
environment so closely associated with femininity can be a challenge.
According to London (1987), male nurses are moving toward greater
representation in nursing, especially in the better-paying and policy-making
positions. However, men continue to face limited opportunities to practice in
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
nursing care. What about burns, transurethral resections, cancers, myocardial
infarctions, cardiovascular accidents, and amputations? If nurses have not
experienced any of these conditions, do they understand the needs of patients
for whom they must provide care? McPhee (1984) reminds us that
professionalism is genderless. Professionalism implies the ability to relate to
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).
3
Can hospital administrators restrict nurses' practice in certain areas of the
hospital wiihoui being guilty of discrimination? According to Bennett (1987),
sexually nonprejudicial employment within professional nursing must be weighed
against a patient's right to privacy. The unexpected arrival of patients to the
labor and delivery unit, without advanced notice of their feelings regarding
intimate contact by a member of the opposite sex, makes it impractical to deal
with persons on an individual basis. A blanket rule must be implemented,
therefore, for administrative efficiency. Federal courts in Arkansas and
Oklahoma have ruled that female gender is a valid requirement for an
intrapartum nurse. According to Brown (1987), however, these conclusions are
questionable because the judges only analyzed testimony and evidence on how
parturients supposedly would respond to male staff nurses--not empirical data
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
practice in a professional manner; likewise, it is expected that male nurses with
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
for more maie nurses. Female nurses ciaim to be independent, aggressive,
assertive, and self-confident. Nurses must accept the idea that male nurses can
demonstrate moral sensitivity, tenderness, compassion, and spirituality. The
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
characteristics. According to Christman (1988), no one race, gender, or ethnic
group has a monopoly on the qualities of intelligence, scientific competence,
imagination, empathy, tenderness, concern for others, or motor skill ability. All
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
the liberation of nursing.
Little research has been conducted on men's perceptions of their
experiences in nursing. This researcher was particularly interested in the
perceptions of male nursing students in the maternity unit. According to
Turnipseed (1986), students learn maternity care by caring for maternity
patients. However, male nursing students may not have many role models in
maternity nursing. Is it embarrassing for a male student to care for a maternity
patient? Does rejection by a maternity patient undermine a student's confidence
in his nursing skills? Or, is the source of uneasiness for the male nurse a
patient's husband or significant other? Do nurse educators create barriers for
the male nursing student?
The male nursing student may be perceived as lacking credibility because
of a paucity of personal experience about pregnancy and delivering a baby. On
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
may assign a male student only to the nursery or to observational experiences.
An instructor may also poll maternity patients to determine objections to being
assigned a male student. This action might imply to a patient that giving care to
5
a female patient is not a routine expectation of a male nurse (Turnipseed, 1986).
These actions could be perceived as prejudicial and discriminatory since, in
most cases, a male patient is not polled before a female nursing student is
assigned to him. In one case, a male nursing student challenged a nursing
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
case was filed with the Equal Employment Opportunity Commission.
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
to be supported. With the current emphasis on family-centered care, male
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.
Successful nurses of both genders must develop an attitude of professional
competence, mature understanding, and self-confidence that will ease them over
the numerous hurdles of providing intimate physical or emotional patient care
(Jenny, 1975).
Purpose Statement
The purpose of this study was to explore male nursing students'
perceptions of their clinical experiences on the maternity unit. More specifically,
the purpose was to explore Associate Degree male nursing students'
perceptions of their obstetrical clinical rotation. The relationship between
selected demographic and curriculum characteristics and these perceptions was
also explored.
Research Questions
The specific questions that formed the focus for this study are:
1. How do male nursing students describe their maternity nursing rotation?
2. What is male nursing students' comfort level with regard to providing care to
the maternity client?
3. What are male nursing students' attitudes toward maternity nursing in
general?
4. What factors are associated with a male student's description of his maternity
nursing experience as positive versus negative?
5. What do male nursing students suggest to optimize their maternity clinical
experience?
6. To what extent are male nursing students considering a career in maternity
nursing?
7
CHAPTER II
REVIEW OF LITERATURE
A review of the literature revealed limited studies about male nursing
students in maternity nursing. Therefore, the following related topics were
reviewed: 1) the historical aspects of men in nursing, 2) the characteristics of
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.
The History of Men in Nursing
In most ancient civilizations, the sick were attended almost exclusively by
men. At the time of Hippocrates in the fifth century B.C., male assistants,
referred to as "nursing workers," provided nursing care to the patient. Later,
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
of the Hospitalers; their services, however, were restricted io care of other
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
implications for nursing.
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,
8
male nurses had almost disappeared. The code of discipline which
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).
In England, the foundations of modern nursing were developed during the
nineteenth century by Elizabeth Fry's Sisters of Charity and the Florence
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
Nightingale, however, accomplished miracles and the mortality rate decreased
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
the status of women. The reforms initiated by Florence Nightingale turned
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
(Mericle, 1983). During the Civil War, convalescent infantrymen attended
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
schools based on the guidelines established by Florence Nightingale began in
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
(Kalisch & Kalisch, 1986).
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
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
alone should take care of nursing needs. Consequently, men continued to
constitute the minority in nursing (Halloran, 1990; Kalisch & Kalisch, 1986; Kelly,
1992; Mannino, 1963; Mericle, 1983).
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
percentage of maie registered nurses increased siightiy from 2.7% in 1980 to 3%
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
in nursing: Up go the statistics!, 1973; Nelson, 1993). In January of 1993, 5.6%
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.
10
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
rights and privileges except in psychiatric nursing. In the 1970s, societal
changes related to minority groups and discrimination against individuals, in
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).
Characteristics of the Men Who Are in Nursing
Reasons for Choosing Nursing as a Career
Historically, there has been a relationship between gender and selected--as
well as acceptable-occupation. The male nurse challenges traditional role
identities. Several studies have examined why men choose nursing and whether
they would choose it as a career again. Mannino (1963) surveyed 36 men
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
that they would recommend nursing as a career to other men. According to
11
Mannino (1963), there is evidence that once a man enters the profession as a
graduate nurse, he is likely to remain in nursing or some related health field.
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
opportunity, interest in the biological sciences, and a desire to work in a
humanistic field. These men viewed themselves as innovators or pioneers.
They perceived their gender as an advantage since others expected them to be
leaders.
Schoenmaker and Radosevich (1976) surveyed 33 men and 58 women
enrolled in a nursing program at the University of Iowa. The male respondents
indicated that they chose nursing as a career because of job availability and,
secondly, for their "interest in people." Women indicated humanitarian
concerns as first in importance and job availability, second.
Taylor, Dwiggins, Albert, and Dearner (1983) surveyed 510 male registered
nurses practicing in Oklahoma. Twenty-five percent (n = 127) of the male
nurses completed the questionnaire. The respondents indicated their primary
reason for choosing nursing was a desire to be in a helping profession.
A study by Johnson, Goad, and Canada (1984) explored differences in
attitudes toward nursing as a career among men in various academic majors.
The subjects in this study were 247 male nonnursing and 94 male nursing
community college students in Texas. The survey instrument, developed by the
investigators, was a questionnaire that measured five categories of attitudes
about selecting nursing as a career. Results of the study indicated that men
entered nursing not because they were rejected by traditionally male-dominated
health programs, but because of job availability, interest in people, and
economic benefits.
12
Gyr (1992) conducted an informal survey of 25 male nurses to determine
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
security and the work itself.
Finally, Perkins et al. (1993) surveyed 146 male undergraduate nursing
students enrolled in both associate and baccalaureate degree nursing programs
in a large southeastern state. Respondents indicated that factors related to
career attributes were their chief reasons for choosing to go into nursing. These
perceived attributes were job opportunity and availability, financial incentives,
job security, and career flexibility and options.
Demographic Characteristics
Researchers have been consistently interested in the demographic
characteristics and areas of interest of male nurses. Investigators have also
studied the vocational interest and personalities of men in nursing. According to
a number of studies, the typical male nursing student is more likely to be
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.,
1984; Mannino, 1963; Robinson, 1973; Schoenmaker & Radosevich, 1976;
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
unique to men who choose nursing.
13
Exploring the personality profile of male nursing students has been the
purpose of various studies. In 1967, Aidag and Christenson administered a
short form of the Minnesota Multiphasic Personality Inventory (MMPI) to a
sample of 29 male nursing students, 29 female nursing students, 29 male junior
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
students were more likely to appear as responsible-generous individuals than
were the junior college students. They also were more likely to be passive-
dependent and less likely to be aggressive-rebellious than the junior college
students.
Aldag (1970) administered the Strong Vocational Interest Blank (SVIB) to a
sample of 145 male nursing students, 145 female nursing students, 145 male
college students, and 145 female college students. The study compared
occupational and nonoccupational interests of male nurses, female nurses,
college males, and college females. The findings of this study suggest that
nursing students had a vocational rather than sex-linked interest in nursing,
regardless of their gender. The maie nursing studenis in this study also
appeared to have more feminine personality characteristics than male college
students.
Garvin (1976) administered the Allport-Vernon-Lindzey Study of Values to
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
14
students than those of the nonnursing male college students. Male nursing
students scored particularly high in socialization. Consistent with Aldag's (1970)
study, the students' interests are more related to the vocation than to gender
assumptions of nursing.
A study by Gumley, McKenzie, Ormerod, and Keys (1979) of 91 British
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
obtained from comparison groups of nonmilitary male nurses and servicemen of
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
of qualities such as empathy, tenderness, and nurturance.
Alvarez (1984) studied the relationship between career choice and
personality characteristics. Thirty-two male registered nurses in New Jersey
completed Edwards Personal Preference Schedule (EPPS); their results were
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
heterogeneous group in regards to personality traits (Alvarez, 1984). Eighty-
two percent of the respondents stated they would recommend nursing as 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,
weekend duty, and low prestige as influencing their lack of recommendation.
Galbraith (1991) surveyed 76 male and 77 female educators, 57 male and
74 female nurses, and 103 male engineers. Data were collected by means of
15
four instruments: the Important Components of a Career scales, the Cattell 16
Personality Factor measure, the Bern Sex Role Inventory, and a demographic
information questionnaire. A larger proportion of the men in nursing than in the
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
had a similar frequency of androgynous and undifferentiated classifications. The
men in both nursing and education rated relationship-oriented items as more
important in their careers than did the engineers.
Gender-Specific Traits
According to Ashley (1975), the history of nursing shows that an
overemphasis on femininity has handicapped the profession by allowing
physicians and hospital administrators to remain in positions of dominance and
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
ideal nurse should be psychologically androgynous in order to benefit both
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.
According to Minnigerode, Kayser-Jones, and Garcia (1978), both men and
women may display either masculine or feminine behavior depending on which
is more appropriate in a given situation. They studied 186 undergraduate
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
masculine. Their findings also suggested that, apparently, a nurse is
16
psychologically androgynous rather than sex-role stereotyped. These findings
support the premise that nursing does not only need women--it needs qualified
individuals of both genders.
According to Spence and Helmreich (1978), masculinity and femininity
coexist to some degree in every individual. Hull (1982) suggests the need to
emphasize that nurturing characteristics are distributed by nature among men as
well as women and that nursing is wrongly viewed as a profession requiring just
one set of characteristics. Flannelly and Flannelly (1984) suggest that
masculine and feminine roles are learned and are not bipolar opposites. London
(1987) states that the skills actually needed in nursing require both masculine
and feminine characteristics; depending on the situation, a nurse may need to
be assertive or yielding, instrumental or expressive.
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
sample of 54 female nurses served as a comparison group. The results
revealed that, even in a female-dominated profession, masculine-type nurses
were the "best" adapted while the feminine-type male nurses were the least
adapted. The androgynous-type nurses ranked highest in work satisfaction.
The results suggest that the nature of the nursing profession has evolved into
consisting of more "masculine" tasks. The hospital is a large bureaucratic
institution that requires staff to handle many administrative duties in addition to
technical and scientific skills. The ideal nurse must possess not only expressive
but also instrumental qualities such as independence, competitiveness, self-
confidence, and decision-making abilities. "This combination of expressive and
instrumental characteristics was found among the androgynous subjects in this
sample" (Krausz et al., 1992, p. 397).
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
markedly feminine picture-dependent, high in religious orientation, advocators
of the status quo, more interested in serving than in economic gains, and highly
oriented to being submissive to those in authority. Compilations of more recent
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.
Attitudes Toward Men in Nursing
Traditionally, men who have "feminine" occupations or have "feminine"
qualities such as sensitivity have had their masculinity questioned (Gordon &
Green, 1981). According to Alvarez (1984), men in nursing are plagued by
being stereotyped as social misfits and homosexuals. Robinson (1973),
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
a male occupation in an attempt to identify some of the attitudinal factors that
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
Rhode Island and Massachusetts. The questionnaire included both an attitude
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
18
of five separate dimensions. Nurses were compared with architectural
engineers, social workers, pharmacists, chemists, school counselors, and
teachers on the basis of interest in people, leadership ability, intelligence,
masculinity, and ambition. The findings revealed that the sample ranked nursing
lowest on masculinity. In Part II, the subjects ranked five values considered
important in considering a vocational choice. In Part III, the subjects selected
from among three statements the one that best described his degree of
vocational commitment. The sample viewed nurses as having a high interest in
people, moderate leadership, but as being low in intelligence and ambition.
In Cyr's (1992) informal survey of 25 male nurses, the most frequently
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
camaraderie was also perceived as a negative factor. Positive factors included
increased recognition associated with minority status, career opportunities, job
challenge and security, being able to help others, and the ability to bring a
different perspective to nursing.
Fottler (1976) studied female nurses' attitudes toward male nurses. A
questionnaire was mailed to 200 nurses selected at random in western New
York State; a 63% response rate was achieved (n = 126). Seventy-five percent
of the nurses surveyed indicated positive attitudes and no desire to exclude
males from the practice of nursing. The majority of the nurses felt that male
nurses should be utilized in all areas of nursing.
Rogness (1976) administered an open-ended questionnaire to 15 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
19
male role model in nursing or a desire to talk to a male nurse about the role of
men in nursing.
Austers (1979) study demonstrated a difference in the attitudes of males
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
with nursing curricula--19.3% of men held unfavorable opinions compared with
only 13.1 % of the women. Male students (35.3% ) also thought female nursing
faculty wanted to iimit the profession to a small number of men. Auster
concluded that men are likely to staff the nursing profession differently than
women because of the sex differences in course interests and curriculum
evaluations. The interests and orientation of the male students tend to be
toward a "professionalizer" rather than a "traditionalizer" or "utilizer" type of
nursing role. The "professionalizer" relies on acquired knowledge, accumulated
technical competency, and a "limited" partnership rather than a servant
relationship with the physician when providing health care and therapy.
Snavely and Fairhurst (1984) studied the applicability of Kanter's theory of
tokenism to male nursing students. "Tokens" are individuals who enter a job
environment with a history of their social category being numerically scarce in a
given occupation. According to Kanter's theory, numerical underrepresentation,
not cultural factors, causes "tokens" to experience greater performance
pressure, social isolation, and role entrapment. The sample in this study
20
included 322 nursing students~41 males and 281 females-from two similar
midwestern nursing schools. The respondents completed a questionnaire that
measured social isolation, upward communication distortion, performance
pressure, and communication apprehension. The research findings failed to find
significant token dynamics among the male nursing students. The males were
not found to be more socially isolated, distorted in their upward communication,
or under greater pressure to perform than female nursing students. The
researchers implied that gender differences may reduce token effects since
society generally attributes higher status to males than to females. Another
explanation given by the researchers for the reduction of token effects is the
need for people entering nursing to help others.
Since nursing is a status contradictory occupation for men, role strain in
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
minimize itpsychiatry, urology, coronary and intensive care, surgery,
anesthesia, and education. Role strain can be reduced by the selection of
specialties that do not require giving personal care and that allow nontraditional
clothing (e.g., "street clothes" or scrubs) to be worn . Male nurses generally
avoid specialties such as pediatrics and obstetrics (Bush, 1976; Greenberg &
Levine, 1971; Williams, 1973). in some studies, male nursing siudents viewed
nursing as a stepping stone to other fields such as hospital administration or
medicine (Bush, 1976; Garvin, 1976; Mannino, 1963). In the study by Perkins et
al. (1993), male nursing students envisioned themselves in a wide variety of
nursing positions. Nurse anesthesia emerged as the most popular option,
emergency room was second, and intensive care was third.
Okrainec (1986) studied the level of job satisfaction of 163 Canadian male
nurses. The majority of the respondents were either satisfied or very satisfied
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
acceptance as a nurse by female co-workers, and 3) the attitude of female
patients toward men in nursing.
Egeland and Brown (1988) administered a Likert-type instrument to 367
male registered nurses in Oregon to determine their perceptions of role strain
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
nursing have lessened recently, 3) men in nursing might tend to be more
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.
Men in Maternity Nursing
A few studies specifically address men in maternity nursing. Fogg (1961)
questioned 30 male nursing students about their experiences in obstetric
nursing. The men considered the experience valuable and thought that it gave
them a better understanding of total patient care. The respondents commented,
however, that feeding babies in the nursery or watching women in labor was
monotonous. They described their experience on the postpartum unit as being
22
too limited to be evaluated. The students did, however, feel competent to
function in an obstetric emergency.
Mynaugh (1984) conducted an informal study of 400 postpartum mothers
who were hospitalized in a major metropolitan teaching hospital. These women
were both primigravidas and multigravidas who had experienced full-term
vaginal deliveries. The mothers completed a questionnaire that included
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
different aspects of maternity care were included in the questionnaire. Assisting
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
firmness. "Educational activities such as discussions or birth control and infant
care received the greatest acceptance" (Mynaugh, 1984, p. 374). More
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
of the individual providing maternity care. The postpartum respondents believed
that professional advancements should be based on capabilities and
experience. This research suggests more study of mothers who have actually
received maternity care from male nurses is needed.
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
very careful to protect a patient's privacy (Grossman, 1986). Murphy is currently
23
the only male nurse employed in obstetrics at Strong Memorial Hospital in
Rochester, New York. Two other male nurses had previously been employed in
labor and delivery in the hospital. According to Grossman (1986), this hospital,
which is part of the University of Rochester system, is one of the forerunners in
the country in many areas of nursing.
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
promotion of parent-child interaction are important elements in the birth
experience. "The nurse's gender is not a factor in the realization of this goal"
(Cox, 1987, p. 10).
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
female labor and delivery nurse.
Can a hospital administration restrict a nurse's practice in certain areas of
the hospital solely on the basis of gender without being guilty of discrimination?
According to Bennett (1987), sexually nonprejudicial employment within
professional nursing must be weighed against an individual patient's right to
privacy. The unexpected arrival of patients to the labor and delivery area,
without advanced notice of their feelings regarding intimate contact by a member
of the opposite sex, makes it impractical to deal with persons on an individual
basis. A blanket rule must be implemented, therefore, for administrative
24
efficiency. Federal courts in Arkansas and Oklahoma have ruled that female
gender is a valid requirement for an intrapartum nurse. According to Brown
(1987), however, these conclusions are questionable because the judges
analyzed testimony and evidence only on how parturients supposedly would
respond to male staff nurses, not on empirical data from labor and delivery
patients who were actually assigned male staff nurses.
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
registered nurses in obstetrics-gynecology was gender discrimination. The
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
nurses are inappropriate" (Greenlaw, 1982; Trandel-Korenchuk &Trandel-
Korenchuk, 1981).
Phil Wynn was prevented from requesting a transfer to labor and delivery in
an Oklahoma hospital despite having more than two years intrapartum
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
Employment Opportunity Commission (EEOC) claimed that this may constitute
illegal job discrimination based on gender. The judge, however, ruled that
female gender is a "bona fide occupational qualification reasonably necessary to
the normal operation of an intrapartum nursing unit."
25
From an operational standpoint, the Joint Commission on Accreditation of
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
A historical perspective of nurses seems pertinent to the present study
because of cultural attitudes about male nurses in general and, specifically,
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, the personality profile of male nurses, masculine versus feminine
characteristics, attitudes about male nurses, and male nurses in maternity
nursing.
Cultural attitudes still label nursing as primarily a female profession. Men
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
isgenderless (Alvarez, 1984; Galbraith, 1991; Krausz et al., 1992; Minnigerode
et al., 1978; Simpson & Green, 1975). Sex-stereotypical attitudes against the
male as a nurse must be overcome. Strategies must be developed to support
men in their choice of nursing as a career. According to both Benda (1981) and
Blundell (1990), the nursing instructor either knowingly or unknowingly may
perpetuate the attitude that the maternity rotation has little relevance to the male
students' learning. Postpartum nursing deals with highly personal aspects of
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
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).
A positive image of male nursing students on the maternity unit needs to be
supported. Professional competence, rather than gender, is necessary in
nursing. Through this research, the nurse educator may be able to facilitate and
enhance the learning experience for the male student.
27
Chapter III
RESEARCH METHODOLOGY
This study used a nonexperimental descriptive design to explore male
nursing students' perceptions of experiences during their maternity clinical
rotation. This design was chosen because the variables could not be
manipulated and had to be investigated as they operated in the natural setting.
Male nursing students were asked to complete a questionnaire developed by
this researcher.
Setting for the Study
This study involved male nursing students who were enrolled in 18
Associate Degree Nursing (ADN) programs in the Inland Northwest during the
1994-1995 school year. Two of the programs were located in eastern
Washington and northern Idaho; six were located in central Washington; nine
were located in western Washington; and one was located in eastern Montana.
Sample and Sampling Procedure
The nonprobability convenience sample was comprised of male students
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
completed their maternity clinical rotation. The sample was accessed by
obtaining a list of ADN programs in Washington State and contacting the
director of the nursing program at each of the colleges by telephone to obtain
permission to access students and to identify the parent-child unit coordinator of
the program. After contact by telephone with the director of the nursing program
or the parent-child unit coordinator, a letter (Appendix A) and copies of the
28
instrument (Appendix B) were mailed to this individual. A follow-up postcard was
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
had just completed the program.
Instrumentation
A researcher-designed questionnaire was used to collect the data for this
study. The tool consisted of 74 Likert-type statements, 6 open-ended items, 10
general information questions regarding clinical experience, and a personal
characteristics inquiry. The questionnaire was constructed after a
comprehensive review of the literature demonstrated a iack of any previous
instrument measuring male nursing students' perceptions of their maternity
nursing clinical experiences. Review of the literature and patient assessment
forms assisted in the development of the categories for providing nursing care to
the maternity patient.
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
questionnaire also explores students' thoughts about whether having a female
accompany them would have been helpful when providing intimate nursing care,
qualities a subject thinks he possesses, and qualities perceived as important for
maternity nursing care. The instrument also includes items about experiences of
29
refusal to have care provided by the male student, whether their instructor asked
permission of the patients to whom they were to be assigned, and how
supportive specific individuals were during their rotation. An open-ended
question allows the subjects to provide suggestions on how the rotation could be
changed to optimize their maternity clinical experiences. Another item asks
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
questionnaire elicits data on personal characteristics of the student--age, marital
status, number of children and whether they participated in the birth of these
children, race, religion, employment status, and other college degrees.
Each of the items in the questionnaire was tallied on an individual basis to
obtain a frequency distribution of responses. Item #11 was grouped into
categories; a subscale score for each category was obtained. The categories
are general physical assessment (items 1-6), maternity physical assessment
(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
these categories is as follows: 0-18 for performing general physical assessment,
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
the maternity patient.
Responses to the open-ended questions were examined for themes. The
frequency of occurrence of each theme was reported. The instrument was
30
reviewed by two experts who are nursing educators in maternity nursing to
establish content validity. A pilot test was completed on seven male nursing
students enrolled in a baccalaureate nursing program in the Inland Northwest.
Some minor revisions in wording were made based on the responses from the
pilot study.
Data Collection Procedures
This study was implemented in the winter of 1995. A letter of information
(Appendix C) describing the study was given to each eligible student.
Participation in the study was voluntary. Participating institutions were asked to
distribute the questionnaire to the male students enrolled in their nursing
program. A pre-addressed stamped envelope was attached to each
questionnaire. A follow-up postcard was sent to the instructor two weeks after
the questionnaire was mailed.
Protection of Human Rights
Prior to initiation of this study, approval for the study was obtained from the
researcher's thesis committee at the Nursing Department of Gonzaga University.
Approval for implementation of the study was also obtained from the appropriate
personnel in the colleges where the instrument was distributed.
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
files accessible only by a password known to the researcher. Data gathered
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.
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.
Descriptive statistics (i.e., frequency distributions) were used to analyze survey
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
physical assessment, maternity physical assessment, general patient care,
maternity patient care, and teaching. Frequency distributions, means, and
standard deviations were then completed on these categories. Relationships
between age, marital status, and the number of children of the male student and
perceptions of their maternity clinical nursing rotation were explored. Individual
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-
such as perceived positive versus negative experiences for the student-for
items #8, 9, and 10. Item #18 regarding suggestions on how this rotation could
be changed to optimize the clinical experience was categorized into 12 themes.
For item #22, frequency distributions were used to compare the differences
in the mean scores (0 - 3) of the possible support sources-i.e., other nursing
students, staff on the maternity unit, maternity patients, patients' family
members, instructors, and physicians. The higher the score, the more
supportive each of these groups was perceived.
The background information was used to describe the characteristics of the
sample population and to compare the comfort level of members of different
groups with providing nursing care to the maternity patient. The students were
32
grouped according to marital status, age, children or no children, employment in
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
statistic, and Pearson's r were used to look at relationships between these
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-
squared is a nonparametric test used to assess whether a relationship exists
between two nominal-level variables. Pearson's r is the most widely used
correlation coefficient and designates the direction and magnitude of a
relationship between two variables that are measured on at least an interval
scale (Polii & Hungler, 1991).
33
CHAPTER IV
STUDY FINDINGS
The purpose of this study was to explore Associate Degree maie nursing
students' perceptions of their clinical experiences on the maternity unit.
Relationships between selected demographic and curriculum characteristics and
these perceptions were also explored.
The director of the nursing program or the maternity-unit coordinator of
various community colleges distributed the researcher-designed questionnaire to
male students who were currently involved with or had completed their maternity
nursing clinical rotation. A total of 118 questionnaires were mailed. Fifty-five
questionnaires were returned (response rate = 46.6%); 52 of these
questionnaires were usable. The subjects were from colleges in eastern
Washington (n = 7), central Washington (n = 15), western Washington (n = 25),
northern Idaho (n = 4), and eastern Montana (n = 4).
Characteristics of the Sample
The 52 students who participated in this study represent a convenience
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
was employed (n = 38, or 73.1% ) in a health-related facility (n = 24, or 46.2%),
and in the second year of the nursing program (n = 38, or 73.1%). Twenty-four
34
(46.2% ) had previously completed an associate (n = 13, or 25%), bachelor's (n =
10, or 19.2%), or master's (n = 1, or 1.9%) degree. Table 1 presents the
demographic characteristics of the study sample.
Table 1
Characteristics of the Sample
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
Age of Oldest Child
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
35
Table 1 (Continued)
Present at Birth of Child
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
Employment in Health-Related Field
No 14 26.9
Yes 24 46.2
Year in Nursing Program
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
To further describe the characteristics of the sample, item #6 on the tool
inquired about the length of their maternity clinical rotation. Twenty-three
(44.2%) of the subjects indicated that their maternity clinical rotation was under
five weeks, 23 (44.2%) indicated between 6 to 10 weeks, and 6 (11.5%)
indicated between 11 to 18 weeks. The second part of item #6 asked if the
36
rotation included all areas of maternity nursing--i.e., mother-baby, labor and
delivery. Forty-three (82.7%) indicated their maternity clinical rotation included
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
and delivery were as follows: 27 (52%) indicated 1 to 2 weeks, 10 (19.3%)
indicated 3 to 4 weeks, 5 (9.6%) indicated 5 to 6 weeks. Nine (17.3% ) indicated
they did not spend any time in labor and delivery. W eeks in the mother-baby
unit were as follows: 18 (34.6%) indicated 1 to 2 weeks, 15 (28.8% ) indicated 3
to 4 weeks, 16 (30.8%) indicated 5 to 6 weeks, and 3 (5.7%) indicated 8 to 9
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
following qualities: knowledge of obstetrics, calmness, caring, communication
skills, and clinical skills. The subjects were to rate themselves from 0 (not at all
like me) to 3 (a lot like me). Thirty-three (63.5%) thought knowledge of
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
this quality was 2.02 (SD = .7).
The quality of calmness was rated as follows: 36 (69.2% ) indicated a lot
like me, 11 (21.2%) indicated somewhat like me, 5 (9.6% ) indicated a little like
me (mean = 2.60, SD = .66). The quality of caring was rated as follows: 46
(88.5%) indicated a lot like me, and 6 (11.5%) indicated somewhat like me
(mean = 2.89, SD = .32). Communication skills were rated as follows: 36
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
presents these statistics.
Table 2
Qualities of the Subject
Qualitv A Lot Somewhat A Little Not

Like Me Like Me Like Me Like Me Mean
n % n % n % n % (0 to 3 Scale)
Knowledge of
Obstetrics 10 19.2 33 63.5 8 15.4 1 1.9 2.02
Calmness 36 69.2 11 21.2 5 9.6 2.60
Caring 46 88.5 6 11.5 2.89
Communication
Skills 36 69.2 15 28.8 1 1.9 2.67
Clinical Skills 23 44.2 27 51.9 2 3.8 2.39
Major Findings
After completing these summary statistics, analyses next turned to
answering each of the study's research questions.
Male Students' Description of Their Maternity Clinical Rotation
Research question one asked how male nursing students describe their
maternity clinical rotation. Content analysis was used to analyze the responses
to open-ended items #8, 9 , 1 0 , 1 7 , 23, 24, and 25 of the questionnaire.
Frequency distributions and descriptive statistics were used for analyzing the
forced-choice parts of items #16,17, and 22 through 25.
38
Item #8 asked the student to describe what the ciinical rotation was like for
him. Seven themes were identified from the responses: 1) positive/enjoyable,
2) positive/great, 3) positive/insightful, 4) negative/stressful, 5) other negative,
6) mixed stressful/interesting, and 7) mixed, okay but . . . . Comments reflective
of these themes are found in Table 3.
Table 3
What the Clinical Rotation Was Like
Theme Frequency Sample Comment

n %
Positive/Enjoyable 14 26.9 "Very positive. I enjoyed the experience and all

of my patients were open to the idea of a male
nurse."
Positive/Great 5 9.6 "Great-challenging."
Positive/Insightful 7 13.5 "A positive learning experience, one in which I

gained skill and confidence."
Negative/Stressful 2 3.8 "Different, not knowing what to expect,

somewhat stressful."
Mixed Stressful/ 12 23.1 "Very educational, stressful."

Interesting
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
of their rotation. Eight themes were identified; these were: 1) intimate
assessment/care, 2) lack of acceptance as a nurse, 3) uncomfortable/lack of
39
personal experience, 4) other/school-related issues, 5) no difficulties
experienced, 6) other, 7) lack of motivation/not worthwhile, and 8) their own
perceptions of how difficult it was going to be. Comments reflective of these
themes are presented in Table 4.
Table 4
The Most Difficult Aspect

n %
Intimate Assessment/ 12 23.1 "Episiotomy and breast care."

Care
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."
Uncomfortable/Lack of 7 13.5 "It is rather difficult for a male to teach about

Personal Experience postpartum checks, bonding, breast feeding, and
other mother-specific roles."
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."
No Difficulties 1 1.9 "None"
Lack of Motivation/Not 2 3.8 "Staying motivated to study an area of nursing in

Worthwhile which I know I shall never work."
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."
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
the most rewarding aspect. One student (1.9%) experienced a negative
maternity clinical rotation without any rewarding aspects. Parent-infant
interaction (n = 4, or 7.7%), coaching during labor (n = 3, or 5.8%), patient
teaching (n = 2, or 3.8%), the NICU experience (n = 2, or 3.8%), and the follow
through care from labor, delivery to postpartum (n = 3, or 5.8%) were other
rewarding aspects listed in the subjects' maternity clinical rotation. Table 5
presents comments reflective of these themes.
Table 5
The Most Rewarding Aspect
Theme Frequency Sample Comments

n %
Birth Experience 19 36.5 "Watching/participating in 3 births-incredible/

exciting."
Bonding 4 7.7 "To see the mother-baby-family bonding that

can occur."
Coaching 3 5.8 "Helping a baby being bom. Coaching the

patient."
Teaching 2 3.8 "Patient teaching."
Identify as Nurse 7 13.5 "Recognition as a contributing team member in

a somewhat closed circle of caregivers."
Care of Newborn 8 15.4 "Getting to work with the newborn babies.

(I love babies!)"
Whole Rotation 1 1.9 "Urology rotation and this maternity rotation."
Negative Experience 1 1.9 "Seeing the clock hit 5 p.m. on my last day."
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."
Other 1 1.9 "A smooth day."
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
by the subjects included: 3 (5.8%) in mother-baby unit, 1 (1.9%) in the clinic, 2
(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
a male nursing student. Five (9.6%) of the subjects indicated frustration
because they were not accepted as a nurse. Comments reflective of these
themes are presented in Table 6.
42
Table 6
Thoughts and Feelings about Refusal bv Maternity Patient

n %
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."
Other 1 1.9 "It was a most rewarding feeling. For that

moment I felt what blacks and women have felt
for years!! All men should have that experience
. . . maybe the world would be a better place."
Item #22 on the tool asked subjects to indicate on a scale from 0 (not at all
supportive) to 3 (most supportive) how supportive the following people were
during their maternity rotation: nursing students, staff, maternity patients,
patients' families, instructors, and physicians. The subjects reported the most
support from their instructors (40, or 76.9%) and other nursing students (39, or
75%). Eleven (21.2%) of the subjects rated the instructor as somewhat
supportive. Other nursing students were rated as follows: somewhat supportive
(n = 8, or 15.4%), a little supportive (n = 3, or 5.8%), and not at all supportive
(n = 1, or 1.9%). The staff was rated by 25 (48.1 %) of the subjects as most
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
were rated as follows: most supportive (22, or 42.3%), somewhat supportive
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
members as not supportive. Finally, support from physicians were rated as
either somewhat or most supportive by 34 (65.4%) of the subjects. Eight
(15.4% ) of the subjects rated the physician as not supportive. Table 7
summarizes these support ratings and presents the mean support ratings for
these different groups.
Table 7
Support on Maternity Unit
Source Not at All A Little Somewhat Most Average

Supportive Supportive Supportive Supportive Rating
n % n % n % n % M SD
Instructor 11 21.2 40 76.9 M = 2.784

SD = .415
Other Nursing Students 1 1.9 3 5.8 8 15.4 39 75.0 M = 2.667

SD = .683
Staff 1 1.9 8 15.4 17 32.7 25 48.1 M = 2.294

SD = .807
Maternity Patient 2 3.8 6 11.5 20 38.5 22 42.3 M = 2.240

SD = .822
Family Members 5 9.6 9 17.3 19 36.5 18 34.6 M = 1.980

SD = .969
Physician 8 15.4 6 11.5 16 30.8 18 34.6 M = 1.917

SD = 1.088
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
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
were treated differently, the following themes were identified: 1) treated
negatively by staff, 2) treated apprehensively by the patient, 3) permission asked
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
them comfortable. Comments reflective of these themes are presented in Table
8.
Table 8
Being Treated Differently

n %
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
Patient preference for a 11.9 "By the nurses--no. By family/patients--yes.

male nurse Ironically, some female patients preferred a male
. . . postpartum."
Patient refusal for male 3 5.8 'Patient refusal.'

nurses
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."
Treated with curiosity 1 1.9 'Not hostile, more as a curiosity.'
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
support from students/staff/patients, 3) physical strength, 4) more respect by
physicians, 5) more disadvantages related to stereotyping, 6) males offering
added dimension to nursing, 7) patient preference for male nurses in general,
and 8) other advantages. Table 9 presents sample comments that illustrate
these themes.
46
Table 9
Perceived Gender-Related Advantages

n %
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."
Physical Strength 4 7.7 "Physical strength."
More Respect by Physicians 2 3.8 "Some doctors seem to talk to me different,

seems to be more interaction."
Disadvantages/Stereotyping 6 11.5 "We as males have more disadvantages related

to other female nurses afraid to give up what
has been a fairly closed field."
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."
Other 3 5.8 "I feel disadvantaged not having ability to

experience any of the things that occur with
pregnancy or childbirth."
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
following ratings were given: very worthwhile (n = 23, or 44.2%), worthwhile
(n = 17, or 32.7%), somewhat worthwhile (n = 11, or 21.2%), and not worthwhile
(n = 1, or 1.9%). The mean rating assigned to the experience was 2.19
(SD = .84). The following themes were identified in the comments: 1) positive,
but no comments regarding value; 2) positive and considering a career in
47
maternity nursing; 3) positive, but not certain of usefulness or value; 4) positive,
gained understanding and holistic care, valuable; 5) neutral, learned something;
6) negative, no value; and 7) negative, related to setting. Comments reflective
of these themes are presented in Table 10.
Table 10
Evaluation of the Maternity Rotation

n %
Positive/no comments 4 7.7 "Would have liked more experience. I learned

regarding value a lotjust hope most of it stays with me as I
won't be practicing in this area."
Positive/would consider a 4 7.7 "Made me consider OB as a specialty for

career myself."
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."
Positive/ gained 19 36.5 "To provide holistic care, it is best to be

understanding/ holistic exposed to all aspects of life. After all,
carel valuable approximately 50% of the population is female."
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."
Negative related to 4 7.7 "Again, it needs to be longer to be productive

setting and meaningful. I would have liked several
weeks there as opposed to the few days
received."
48
Comfort Level Providing Care to Maternity Clients
Research question two asked about male nursing students' comfort level
with providing care to maternity clients. To answer this question, frequency
distributions, means, and standard deviations were completed on items # 1 1 ,1 4 ,
and 15 on the research tool.
Item #11 asked the subjects how uncomfortable it was for them to provide
nursing care to maternity patients by a rating of 0 (no problem) to 3 (a great deal
of a problem). Clinical skills were grouped according to categories and included
general assessment (6 skills), maternity assessment (5 skills), general patient
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
care category, and 27 for the educational category.
The general assessment category scores ranged from 0 to 6 out of a
possible score of 18 with a mean rating of .91 (SD = 1.47). The maternity
assessment category scores ranged from 0 to 15 out of a possible score of 15
and had a mean rating of 4.15 (SD = 4.41). General patient care category
scores ranged from 0 to 4 out of a possible score of 18 and received a mean
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
(SD = 4.38). The educational category scores ranged from 0 to 23 out of a
possible score of 27 and had a mean rating of 3.36 (SD = 6.76).
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
49
specific aspects of care was considered: head to toe assessment, therapeutic
communication, assistance with personal care, and education. The rating for
this section was a 0 (more difficult) to 2 (not as difficult) scale.
In the first part, the subject compared his comfort level with providing care
to a maternity patient to his comfort level providing care to a male patient.
Twenty-two (42.3% ) of the subjects indicated that a head to toe assessment was
more difficult on a maternity patient than a male patient; 30 (57.7%) thought an
assessment was the same on both types of patients. Therapeutic
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
subjects indicated that communication was not as difficult with a maternity as
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
toe assessment: more difficult (n = 6, or 11.5%), the same (n = 41, or 78.8%),
and not as difficult (n = 5, or 9.6%). Ratings for therapeutic communication
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,
or 15.4%), the same (n = 37, or 71.2%), and not as difficult (n = 7, or 13.5%).
50
The following ratings were obtained for education: more difficult (n = 5, or
9.6%), the same (n = 39, or 75%), and not as difficult (n = 8, or 15.4%).
Item #15 on the tool asked the subjects how helpful would it have been for
a female to accompany them for the following activities: examination of
breasts/nipples, examination of episiotomy/pad, education on breast feeding,
education on wiping perineal area front to back, education on lochia flow,
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
was examination of the episiotomy/pad (n = 18, or 34.6%); this was followed by
assisting with breast feeding (n = 17, or 32.7%), educating on breast feeding
(n = 16, or 30.8%), and examination of breasts/nipples (n = 16, or 30.8%). Table
11 details the responses to this item.
Table 11
How Helpful Would It Have Been For a Female to Accompany You?
Activity Very Helpful Somewhat A Little Not at Ail

n % n % n % n % n %
Assist Mother with Breast 17 32.7 14 26.9 6 11.5 4 7.7 10

Feeding
Exam of Breasts/Nipples 16 30.8 13 25.0 8 15.4 5 9.6 10
Exam of Episiotomy/Pad 18 34.6 12 23.1 3 5.8 6 11.5 13
51
Table 11 (Continued)
Education on breast 16 30.8 12 23.1 4 7.7 6 11.5 13 25.0

feeding
Catheterization 8 15.4 16 30.8 10 19.2 4 7.7 12 23.1
Education on lochia flow 9 17.3 9 17.3 8 15.4 5 9.6 21 40.4
Education on Perineal 8 15.4 11 21.2 3 5.8 5 9.6 25 48.1

Care
Attitudes Toward Maternity Nursing in General
Research question three asked about male nursing students' attitudes
toward maternity nursing in general. To answer this research question,
frequency distributions and descriptive statistics were completed on items #1, 2,
3, 4, 19, and 20 of the questionnaire. Content analysis was carried out on the
responses to item #13.
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
responses were obtained: agree (n = 7, or 13.5%), unsure (n = 1, or 1.9%), and
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
(n = 6, or 11.5%), unsure (n = 1, or 1.9%), and disagree (n = 45, or 86.5%). Item
#3 asked whether the students thought they should be supervised by a female
nurse or instructor during the physical examination of a maternity patient.
Responses to this item were: agree (n = 21, or 40.4% ), unsure (n = 6, or
11.5%), and disagree (n = 25, or 48.1 %).
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
(n = 41, or 78.8%), unsure (n = 4, or 7.7%), and disagree (n = 7, or 13.5%).
Item #13 on the tool asked the subjects what they considered the most
important quality in providing maternity nursing care. Through the process of
content analysis, the following themes were identified: 1) knowledge of
obstetrics, 2) competence, 3) caring, 4) teaching, 5) calmness, 6) communication
skills, 7) safety, 8) professionalism, 9) empathy, 10) establishment of trust, and
11) honesty. Comments reflective of these themes are presented in Table 12.
Table 12
Most Important Quality in Providing Nursing Care

n %
Knowledge of Obstetrics 5 9.6 "Knowledge and accurate comprehensive

care."
Competence 5 9.6 "Competence with knowledge and skills."
Caring 8 15.4 "Caring and being able to show the

maternity patient you care for her and her
baby genuinely."
Teaching 6 11.5 "Teaching-these clients are in and out in a

few days. I feel educating patients while
they are still in the 'taking in' phase presents
quite a challenge."
Calmness 4 7.7 "Calm, prompt response to patient needs."
Communication Skills 5 9.6 "Listening and reacting consistently to

verbal and non-verbal communication."
Safety 1 1.9 "Safety for mom and baby."
53
Professionalism 3 5.8 "Same as any aspect of nursing--

professionalism."
Empathy 6 11.5 'Empathy.
Establishment of Trust 2 3.8 "Establishing trust-treating everyone as a

unique individual."
Honesty 1.9 Honesty, careful gentleness, manners:
Factors Associated With Positive Versus Negative Experiences
Research question four explored factors that were associated with a male
student's maternity nursing experience being regarded as positive versus
negative. To answer this research question, frequency distributions, means, and
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
#23, 24, and 25.
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."
Subjects were then grouped according to demographic characteristics,
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
54
treated differently because of gender, whether they thought they had advantages
related to gender, and their overall rating of thieir maternity clinical rotation.
Analyses with Pearson's r, independent t-tests, and Chi-squared statistics failed
to reveal significant relationships.
Suggestions to Optimize Maternity Clinical Experience
Research question five asked subjects for suggestions to optimize their
maternity ciinicai experience. Content analysis was completed on the narrative
responses to item #18 on the tool. The following themes were identified: 1) no
changes, 2) optional rotation, 3) offer choices, 4) survey patients in advance
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
nurses/professionals, 9) make experience shorter, 10) make experience longer,
11) school related suggestions, and 12) other. Comments reflective of these
statements can be found in Table 13.
Table 13
Suggestions to Optimize Clinical Experience

n %
No Changes 10 19.2 "I don't think anything could be changed--but I

also had a very supportive ciinicai group as
well as a supportive instructor."
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."
55
Survey Patients 3 5.i "Perhaps a questionnaire for clients expected

to be present during clinical times about their
choices, to determine availability and
matching with male nurses."
Follow Other Nurses 3.8 "Less hands on, more observation with
explanations by nurse or instructor."
Provide More Support 3 5.8 "Have female help more often."
Buddy with Student 2 3.8 "Buddy system with another student-male or

female."
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."
Shorter Experience 1 1.9 "Reduce amount of time, percentage of total

AA degree. Entirely too much time devoted to
a portion of nursing that is such a small % of
total nurses in real world."
Longer Experience 5 9.6 "Make it longer in order to get a better

knowledge base of the various areas."
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."
Other 2 3.8 "Keep the patient in the hospital longer-

impossible."
Career in Maternity Nursing
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
pursue a career in maternity nursing. Twenty students (38.5%) said "yes"; 21
(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.
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
considering a career in maternity nursing after graduation. The following
responses were obtained: yes (n = 3, or 5.8%), unsure (n = 11, or 21.2%), and
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
newborn nursery to 5.33 for midwife. A summary of these ratings is presented in
Table 14.
Table 14
Career in Maternity Nursing
Areas of Interest Interest Score

M SD
Newborn Nursery 2.60 1.96
NICU 2.91 2.17
Labor and Delivery 2.89 2.03
Postpartum 4.56 1.59
Mother-Baby Unit 4.67 1.41
OB-Gyn Nurse Practitioner 4.67 2.29
Midwife 5.33 2.06
57
CHAPTER V
DISCUSSION AND CONCLUSIONS
The purpose of this study was to explore male nursing students'
perceptions of their clinical maternity nursing experiences. More specifically,
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
sample, thus, is similar to those documented in other studies (Auster, 1979;
Becker & Sands, 1988; Bush, 1976; Faught, 1989; Garvin, 1976; Johnson etal.,
1984; Mannino, 1963; Robinson, 1973; Schoenmaker& Radosevich, 1976;
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
in a health-related facility. Most were in the second year of their nursing
program. Almost half had other degrees.
Summary of Findings
In general, the male nursing students in this study responded favorably to
their maternity nursing clinical rotation. Most of the subjects rated the maternity
clinical rotation as either worthwhile or very worthwhile. Only one student
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
58
documented by Fogg (1961). In Fogg's study, 30 male nursing students were
questioned about their experiences in obstetric nursing. The men considered
the experience valuable and thought that it gave them a better understanding of
total patient care.
The statement in this present study's tool about whether male nursing
students should be supervised by a female nurse or instructor during the
physical examination of a maternity patient created perplexing statistics: 40.4%
(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
required to be supervised-must be equal." Another student admitted, "It may be
necessary in today's legal world."
Most of the subjects thought that all nursing students, men and women,
should be required to have the same maternity nursing clinical experience. One
student stated," A nurse is a nurse." Another student made the following
comment: "There is enough discrimination against male nurses. W e don't need
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 encouraged to pursue a career in maternity nursing or if male nurses
should be excluded from maternity nursing. The subjects were uncertain about
encouraging male nurses to pursue a career in maternity nursing with 38.5%
(n = 20) saying" yes," 21.2% (n = 11) saying "no," and 40.4% (n = 21) being
unsure. Subjects provided a variety of comments to this question. For example,
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?"
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:
"That is discrimination and it is also an insult to the profession of nursing."
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
consistent with those documented by Rogness (1976). In Rogness' study 15
male nursing students were administered an open-ended questionnaire; the
students reported facing isolation and loneliness, lack of adequate role models,
and having to deal with other peoples' ignorance and stereotypes.
The subjects were asked to rate themselves on the following qualities:
knowledge of obstetrics, calmness, caring, communication skills, and clinical
skills. Forty-three (82.7%) indicated that knowledge of obstetrics was either
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
exhibited a higher degree of qualities such as empathy, tenderness, nurturance
than other servicemen.
One question on the tool asked the subjects to consider the most important
quality in providing maternity nursing care. Through content analysis, eleven
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
60
competence or communication skills were the most important qualities. Four
(7.7%) thought calmness was the most important quality, three (5.8%) thought
professionalism, two (3.8%) thought establishment of trust, and one (1.9%)
thought either honesty or safety.
Half of the male nursing students in this study described their maternity
clinical rotation positively. Fourteen (26.9%) reported the rotation as stressful.
Nine (17.3% ) commented negatively about their ciinicai experience. One
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
all of my patients were open to the idea of a male nurse."
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
subjects (13.5% ) reported being uncomfortable because of lack of personal
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."
61
Nineteen (36.5%) subjects thought the birth experience was the most
rewarding aspect of their rotation. Other rewarding experiences included: care
of the newborn, "being identified as a nurse," the parent-infant interaction,
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
overwhelmed when I watched the birth. It was awesome." Another student
stated, "Successful teaching in correct breast feeding technique.. . it was
rewarding to be accepted by patients regardless of my gender. Tips on breast
feeding were eagerly put into practice by 'first time' mothers."
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
institution. Twenty-one subjects (40.4% ) indicated that an obstetric patient had
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
have any students present, regardless of gender because this is an extremely
personal time. Most (78.9%) of the subjects thought a patient had a right to
refuse care by a male nursing student.
The subjects generally indicated that most individuals were supportive of
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
62
of each other." Nursing staff were rated most supportive by 48.1 % of the
subjects. One student remarked, "Staff varied greatly in attitude of male
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
according to your attitude. My patients had no problem speaking openly to me."
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
favored the idea of male maternity nurses.
The families of maternity patients and physicians were rated as most
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."
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
contact with these individuals.
To further describe their maternity clinical rotation, the questionnaire asked
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
perception that nursing is a female profession.
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
thought they had advantages because of their gender. A diversity of themes
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
factors identified in Cyr's study included increased recognition associated with
minority status, career opportunities, job challenges and security, being able to
help others, and the ability to bring a different perspective to nursing.
64
As mentioned previously, most of the students rated the overall maternity
rotation as either worthwhile (32.7%) or very worthwhile (44.2% ) and most
(76.9% ) of the male students approved of their maternity clinical rotation. Of
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
patient. One student rated a score of 15 out of 15 on the maternity assessment
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
all of the skills listed.
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
performing an assessment on both types of patients; 22 (42.3%) indicated an
assessment was more difficult on a maternity patient. Therapeutic
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
more enigmatic; 46.2% (n = 24) rated providing personal care to a maternity
patient as more difficult than it is to a male patient; 48.1 % (n = 25) rated
providing personal care the same on a maternity patient as a male patient. Most
(78.8% ) of the subjects indicated providing education was equally comfortable
for both types of patients. Of the four areas, personal care would
understandably cause the most difficulty for the male students because of the
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
maternity patients to provide a lot of their own personal care.
The second part of the same question asked the students to compare
comfort in providing nursing care to a maternity patient to comfort providing care
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:
assessment (78.8%), communication (80.8%), personal care (71.2%), and
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
of breasts/nipples, examination of episiotomy/pad, education on breast feeding,
education on wiping perineal area front to back, education on lochia flow,
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
female accompany them for examination of breasts/nipples (55.8%), examination
of episiotomy/pad (57.7%), and assistance with breast feeding (59.6%).
Assistance/accompaniment for education of breast feeding (53.1%),
catheterization (46.2%), education on perineal care (36.5%) and lochia flow
(34.6%) were indicated as helpful or very helpful by almost half of the subjects.
It is interesting to note that from 10 (19.2%) to 25 (48.1 %) 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
students are not necessarily accompanied by a male during personal care of
male patients-would it be considered gender bias if a female nurse
accompanied a male nursing student for personal care of the maternity patient?
66
Analyses failed to demonstrate significant relationships between
demographic characteristics and responses to the questionnaire associated with
male students' perception of their maternity nursing experience as positive
versus negative. One explanation for this might be related to the complexity of
human beings. Each human is essentially unique with respect to personality,
social environment, mental capacities, values, and lifestyle. This makes
research concerning relationships between personal attributes and human
behaviors and attitudes difficult because many factors have confusing
interrelationships (Polit & Hungler, 1991).
As mentioned previously, the subjects rated themselves on the following
qualities: knowledge of obstetrics, calmness, caring, communication skills, and
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"
ratings by communication skills (69.2%), calmness (69.2%), knowledge of
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
profession, therefore, might, logically, perceive themselves as caring.
The subjects did not identify any one common theme when asked about
suggestions to optimize their maternity clinical rotation. Subjects were more
likely to indicate no changes than to make any one particular suggestion.
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
continue to be a minority in maternity nursing. These findings are consistent
with other studies that have indicated that male nurses generally avoid
67
specialties such as obstetrics (Bush, 1976; Greenberg & Levine, 1971; Williams,
1973).
Limitations of the Study
Factors that may impose limitations on both the accuracy and
generalizability of this study's findings need to be acknowledged. Male nursing
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
employment in a health-related field. Also, the types of programs they are in
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.
A second limitation of this study is the research to o l-a questionnaire
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,
question relevancy, and ease of response; minor revisions in wording were
made following the pilot test. The questionnaire contained both open-ended and
close-ended questions to minimize the superficiality of close-ended questions
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.
An additional limitation to this study is that the interval between the
maternity clinical rotation and the subjects' completion of the questionnaire
68
varied from school to school. It is possible that the interval between course
completion and response to the questionnaire affected the students' responses
on the tool. A lapse in time between the experience and the data collection
affects a person's ability to recall information accurately and may lead to
exaggeration of both the positive and negative aspects of the experience.
A final possible limitation to this study is one shared by all research
involving humans--i.e., the complexity of the human being. Each human being is
unique with respect to personality, social environment, mental capacities,
values, and lifestyle. This makes research concerning human behaviors and
attitudes confounding (Polit & Hungler, 1991). Therefore, it is more problematic
to control the research situation in studies focusing on human behavior. In this
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
be other variables that contributed to these students' attitudes related to their
maternity clinical rotation that were not measured in this study.
Implications of Findings
Regardless of the limitations of this study, it produced findings that give
insight into male ADN students' attitudes toward the maternity clinical rotation.
From this study, it was found that most maie students consider the maternity
clinical experience to be of value for their professional and personal growth.
With an understanding of pregnancy in context of the family unit, holistic nursing
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
function in an obstetric situation in another unit.
69
Nurse educators should treat all of the students as equals. Men in nursing
want to be considered as a nurse. Educators should not perpetuate the attitude
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
role models to new fathers.
Research in nursing must continue to explore the attitudes of male nursing
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'
learning. Nurse researchers should also explore patient satisfaction in maternity
with nursing care provided by a male nurse. This present study considered only
male nursing students. Female nursing students might respond similarly to their
maternity clinical rotation. It is suggested that this study be replicated using a
sample of female student nurses in order to compare and contrast their
responses with those of the male students.
Conclusion
Male nurses have usually been associated with certain areas of health
care-psychiatry, anesthesia, urology, and administration. In addition, they have
sometimes been denied the opportunity to practice in certain clinical areas such
70
as maternity nursing. Male nurses can make unique contributions to areas that
are traditionally associated with female nurses. A successful nurse of either
gender must develop an attitude of professional competence, mature
understanding, and self-understanding.
Nurse educators are responsible for providing male students with learning
experiences that are equal in quality to those provided female students.
Educators have a responsibility to see that each student, regardless of gender,
receives the complete content and clinical experiences the course was designed
to provide. In addition, educators can have a tremendous influence on students;
a trusting relationship--as well as mutual respect--must be established. The
educator acts not only as a role model, but also as a support person and the
professionalism that is incorporated throughout nursing curricula must be
continually emphasized. Finally, patients' safety and rights to privacy and
dignity must be respected. Male students are just as capable as female students
of respecting these rights.
The main goal of nursing is to provide quality nursing care. A professional
nurse--male or fem ale-can effectively care for all patients while maintaining
patients' dignity.
71
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76
APPENDIX A
Letter of Approval
My name is Linda Gambill and I am currently a graduate student in nursing
at Gonzaga University, Spokane, Washington. For my thesis research, 1am
conducting a study about male students' perceptions of their maternity clinical
nursing experience. These students must be in the process of or have
completed their maternity clinical rotation. The study will take approximately 20
minutes of the students' time to complete. The survey includes questions to be
answered on a Likert scale regarding students' comfort level in providing
physical care to a maternity patient and the support they received from the
instructor, staff, other nursing students, and maternity patients. There are also
some open-ended questions regarding their maternity clinical experiences.
Finally, a section is included concerning personal characteristics of the student.
A copy of the questionnaire is attached for your review.
I am requesting your permission to allow your male nursing students to
participate in this study by signing this document. The individual responses on
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
of giving quality nursing care.
Your return of the questionnaires by February 6,1995, would be
appreciated. Results of this study will be available upon request by contacting
me at (509) 533-7304 (office).

/________
Linda Gambill, RNC, BSN Coordinator/Instructor's Signature/Date

Number of Male Respondents___________
77
APPENDIX B
MALE STUDENTS MATERNITY CLINICAL ROTATION
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. ( ) ( ) ( )
2. Male nursing students should have the option of only giving

nursing care to the newborn rather thanthe maternity patient. ( ) ( ) ( )
3. Male nursing students should be supervised by a female nurse

or instructor during the physical examination of a maternity
patient. ( ) ( ) ( )
4. All nursing students, men and women, should be required to have

the same maternity nursing clinical experience. ( ) ( ) ( )
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:
6. A. How long was your maternity clinical rotation as a student?

(1) Under 5 weeks ____ (2) 6 -10 weeks ____(3) 11 -1 8 weeks
B. Did the rotation include all areas of maternity nursing Yes No

(mother-baby, labor and delivery)? (1) (0)
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.
8. What was your clinical rotation like for you?
9. What was the most difficult aspect for you in this rotation?
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
(11) Assess and rate episiotomy pain
(12) Perform an enema/suppository

(13) Perform an injection
(14) Give bed pan
(15) Assist to commode/bathroom
(16) Perform a bed bath
(17) Assist to the shower
(18) Perform a catheterization
(19) Help with breast feeding

(20) Perform a sitz bath
(21) Apply ice to breasts
(22) Apply ice to perineal area
(23) Remove staples from a cesarean delivery
(24) Perform a perineal irrigation

(25) Remove and apply a perineal pad
79
(26) Educate patient on perineal care ( ) ( ) ( ) ( ) ( )

(27) Educate about breast feeding ( ) ( ) ( ) ( ) ( )
(28) Educate about lochia flow ( ) ( ) ( ) ( ) ( )
(29) Educate about involution of the uterus ( ) ( ) ( ) ( ) ( )
(30) Educate about bladder distention ( ) ( ) ( ) ( ) ( )
(31) Educate on contraceptives ( ) ( ) ( ) ( ) ( )
(32) Educate about constipation ( ) ( ) ( ) ( ) ( )
(33) Educate on use of manual or electric
breast pump ( ) ( ) ( ) ( ) ( )
(34) Educate on maternity brassiere for support ( ) ( ) ( ) ( ) ( )
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:
Not as difficult The Same More Difficult

(2) (1) (0)
(1) Head to toe physical assessment (
(2) Therapeutic communication
(3) Assist with personal care
(4) Education
B. On a maternity patient vs. another female patient:
(1) Head to toe physical assessment ( )

(2) Therapeutic communication ( )
(3) Assist with personal care ( )
(4) Education ( )
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)
(1) Examination of breasts/nipples ( ) ( ) ( ) ( ) (

(2) Examination of episiotomy/pad ( ) ( ) ( ) ( ) (
(3) Education on breast feeding ( ) ( ) ( ) ( ) (
(4) Education on wiping perineal area front to back ( ) ( ) ( ) ( ) (
(5) Education on lochia flow ( ) ( ) ( ) ( ) (
(6) Assist new mother with breast feeding ( ) ( ) ( ) ( ) (
(7) Catheterization ( ) ( ) ( ) ( ) (
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)
If yes, in what clinical setting?.
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?
Please respond to the following: Yes Unsure No

(2) (1) (0)
19. Should male nurses be encouraged to pursue a career
in maternity nursing? ( ) ( ) ( )
Comments:
81
20. Should male nurses be excluded from maternity nursing? ( ) ( ) ( )

Comments:
21. Are you considering a career as a nurse in maternity nursing

when you graduate? ( ) ( ) ( )
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.
Labor and Delivery _____ Postpartum _____

Mother-Baby Unit _____ Newborn Nursery _____
Midwife _____ Neonatal intensive care unit _____
OB-Gyn Nurse Practitioner_____
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)
Other nursing students ( ) ( ) ( ) ( )

Comments:
Staff on the maternity unit ( ) ( ) ( ) ( )

Comments:
Maternity Patients ( ) ( ) ( ) ( )
Comments:
Patients' husband, mother, ( ) ( ) ( ) ( )

significant other, etc.
Comments:
Instructor ( ) ( ) ( ) ( )
Comments:
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?
(1) Yes ___ (0) No

Explain:
25. How would you rate your maternity rotation overall? Please circle.
Very Worthwhile Worthwhile Somewhat Worthwhile Not Worthwhile

(3) (2) (1) (0)
Please explain your answer.
83
BACKGROUND INFORMATION
A. Marital Status: Single___ Married___ Divorced___ Separated___
B. How many children do you have? _________
C. What are the ages of your children? __________________
D. Were you present at the birth of your children? (1)Yes (0) No
E. How would you describe yourself:
(1) Caucasian (4) Spanish-American

(2) Asian (5) Native American
(3) Afro-American (6) Other (Please specify) ___
F. What is your religion?_________________
G. Are you employed now?

(1)Yes ___ (0) No If yes, what do you do? _______
H. What is your age? _ _ _ _ _
J. What quarter/semester are you in the nursing program ?_______ _
K. Do you have any other college degrees?
(1) Yes (0) No, W hat_____________
THANK YOU FOR YOUR PARTICIPATION IN THIS STUDY.
84
APPENDIX C
Letter of Information and Informed Consent
My name is Linda Gambill and I am currently a graduate student in nursing
at Gonzaga University. For my thesis, I am conducting a study that examines
male students' perceptions of their maternity clinical nursing experience. You
are being invited to participate in this study because you are a male student who
is in the process of completing or has recently completed your maternity nursing
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
professionals capable of giving quality care.
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
considering a career in maternity nursing after graduation.
Your participation in the study is voluntary. Your decision to participate or
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
you will be willing to participate.
Your individual responses on the questionnaire will be kept confidential.
Data obtained from this study will be shared with my thesis committee. Results
85
of this study will be available upon request by contacting me at (509) 533-7304
(office). Completion of the questionnaire implies consent.
Linda Gambill, RNC, BSN
Graduate Student
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
choose this specialty less frequently.
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
questionnaire was used to collect the data.
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
patients. There were no significant relationships between demographic characteristics and
siudents' perceptions of their maternity experience. Analyses of suggestions to optimize their
rotation did not reveal any one common theme.
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.
Approved for publication:
'kw uuxcL
Committee Chairpei
By V v ^ ^ a o u
Dean of Graduate School

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A Bell & Howell Information Company

NURSING CLINICAL EXPERIENCE

SUBMITTED TO THE FACULTY OF THE

DEPARTMENT OF NURSING AND THE GRADUATE SCHOOL

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE DEGREE OF

MASTER OF SCIENCE IN NURSING

UMI Microform 1374555

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300 North Zeeb Road

Ail Rights Reserved

Dale Abendroth Lenski, MN, RN

Barbara E. Morrison, MN, ARNP

In Western culture, nursing is considered a feminine career. However, men

This study investigated 52 Associate Degree male nursing students'

perceptions of their clinical experience on the maternity unit, their degree of

improving the obstetrical rotation. A researcher-designed questionnaire was

used to collect the data.

In general, the students responded favorably to their maternity rotation.

moderately comfortable with providing care to maternity patients. There were no

significant relationships between demographic characteristics and students'

perceptions of their maternity experience. Analyses of suggestions to optimize

their rotation did not reveal any one common theme.

Research must continue to explore the attitudes of male nursing students

nurses and optimize learning.

There are a number of people I would like to acknowledge who have

significantly influenced the writing of this thesis. I am indebted to Dr. Susan

Norwood, my Thesis Committee Chairperson, for her continued support and

Morrison, Thesis Committee Members, for their assistance in completing this

thesis. Finally, I am indebted to Jill W. Smith, my friend and typist.

CHAPTER I. INTRODUCTION .......................................................................... 1

The Research Problem .......................................................................... 1

Purpose Statement .......................................................................... 6

Research Questions .......................................................................... 6

CHAPTER II. REVIEW OF L IT E R A T U R E ........................................................ 7

History of Men in Nursing ............................................................... 7

Characteristics of the Men Who Are in Nursing ................................ 10

Attitudes Toward Men in Nursing........................................................... 17

Men in Maternity Nursing ....................................................................... 21

CHAPTER III. RESEARCH METHODOLOGY ........................................... 27

Setting for the Study ......................................................................... 27

Sample and Sampling Procedure ......................................................... 27

Data Collection Procedures ............................................................. 30

Protection of Human Rights ............................................................. 30

Data Analyses ......................................................................................... 31

CHAPTER IV. STUDY F IN D IN G S .................................................................... 33

Characteristics of the Sample ........................................................... 33

Major Findings .................................................................................... 37

Limitations of the Study ...................................................................... 67

Implications of Findings ....................................................................... 68

A Letter of Approval ........................................................................ 76

C Letter of Information and Informed Consent............................ 84

1. Characteristics of the Sample ................................................................ 34

2. Qualities of the Subject ......................................................................... 37

3. W hat the Clinical Rotation W as L ik e ......................................................... 38

4. The Most Difficult Aspect ....................................................................... 39

5. The Most Rewarding Aspect ..................................................................... 40

6. Thoughts and Feelings about Refusal by Maternity Patient .............. 42

7. Support on Maternity Unit ....................................................................... 43

8. Being Treated Differently ....................................................................... 44