UNIDIRECTIONAL TIME MANAGEMENT IN NURSING STUDENTS: A GROUNDED THEORY STUDY

UNIDIRECTIONAL TIME MANAGEMENT IN NURSING STUDENTS: A GROUNDED THEORY STUDY Tayebeh Mirzaei 1, Ali Ravari 1, Fatemeh Oskouie 2, Forough Rafii 2 1 School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Kerman (IRAN) 2 Center for Nursing Care Research, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran (IRAN) mirzaei_t@yahoo.com, t.mirzaei@rums.ac.ir Abstract Motivational experts have touted time-management skills as a central predictor of success in many fields and scholarly research backs these claims. This study aimed to investigate how nursing students manage their time through the circumstances and obstacles brought about by their academic field. The study was conducted using grounded theory method. Twenty-one nursing students were recruited by purposeful and theoretical sampling. Data was collected by semi-structured interviews and analyzed using the method suggested by Corbin and Strauss. "Unidirectional time management" emerged as the core category. The sub-categories included accepting nursing, escaping ambiguity, assessing prevalent conditions and expectation, stress and dissatisfaction related to passing time, and effort for reducing stress and increasing satisfaction. In order to overcome their stress, students allotted most of their time to academic tasks. The findings of this study indicate the need for creating conditions for these students in order to have time for extra-curricular activities and responsibilities associated with their age rage. Keywords: grounded theory, Iran, nursing student, stress, time management. 1 INTRODUCTION Time management is a major factor that affects nursing students' views, their use of the time available to them and how they adjust themselves to do their academic responsibilities (Bonhomme 2007). Time management for students can be defined as: clusters of behavioral skills that are important in the organization of study and course load (Sansgiry et al. 2006). This is a process that is constantly changing and must be well under the control of each individual (Hackworth 2007). Time management if often known as a product of organizing skills, but the same processes may not be applicable for everyone in the same way (Macan et al. 2010). Therefore, what works for a particular person might not work for others (Sarp et al. 2005). It has been suggested that the temporal perception of each individual may be influenced by culture and personality (Nonis et al. 2005). Also, the time availability of each individual for attending to time requirements varies based on the abilities and capability limitations attached to each person (Nandhakumar and Jones 2001). 1.1 Background There is currently no confirmation regarding the exact number of hours that are needed to produce competent and capable nurses (Lipscomb and Snelling 2010).This is due to the fact that the healthcare sector needs to reduce costs, but at the same time improve quality in order to serve the ever-more demanding patients. Thus due to changing healthcare policies, the lack of staff, and economic constraints, nurses need to take on new roles (Holmstro m and Larsson 2005). Iranian undergraduate nursing students like other students in western countries must be prepared for nursing care of patients to promote their wellbeing, and working as an educator, a manager, researcher, or consultant (Iran High Council planning regulations of Medical Sciences 2005). so, nursing students face with huge academic workloads upon entering this field (Seyedfatemi et al. 2007). They feel overwhelmed because of the pressure related to these academic duties, their non-academic and daily works, and time constraints. this make student s perception of the extensive knowledge base required and an inadequate time to develop it (Misra and McKean 2000). In addition, during their education in high school, Iranian students are completely supported by their families and usually do not have nonacademic responsibilities. However, upon entering university, they confront with new non-academic responsibilities which require time management. Proceedings of EDULEARN12 Conference. 2nd-4th July 2012, Barcelona, Spain. 5836 ISBN: 978-84-695-3491-5

Using time more effectively help nursing students to achieve a better balance between work and personal lives (Arnold and Pulich 2004) to be more successful in their examinations (Prichard et al. 2006) and be prepared for clinical setting (Heslop et al. 2001). Despite the widespread use of the concept time management, little scientific research has concentrated on the way in which individuals manage time and on the processes involved (Claessens et al. 2007). In some studies time management has been recognized as the center of success (George et al. 2008, Jeffreys 2007) and qualitative studies among successful and unsuccessful students have been proposed in order to distinguish the significance of this phenomena(ali and Naylor 2010). Little is known about the factors involved in time management behaviors of nursing students in Iran and most empirical evidences is associated with western cultures. considering the cultural and personal aspects of time management, the need for such a study in a country like Iran, located in south western Asia and the Middle East is felt. Using grounded theory approach, this study aims at contributing to the growing literature regarding the time management process. 2 METHOD 2.1 Design This study was a part of a doctoral dissertation. This grounded theory study aims to explore and describe the process of time management in Iranian nursing students. Grounded theory focuses on the identification, description and explanation of interactional processes among individuals or groups within a given social context (Corbin and Strauss 2008) rendering this method useful for the topic under question. 2.2 Participants Twenty-one undergraduate nursing students were recruited by purposeful and theoretical sampling. Their age ranged between 19 and 23. 2.3 Ethical considerations Approval for the study was obtained from the ethics committee of the Tehran University of Medical Sciences (TUMS). All participants gave informed consent. The participants were assured anonymity, and allowed to stop the interview at any time they wished and refuse to answer questions. 2.4 Data collection The data were collected by using semi-structured interviews. The mean duration of interviews was 58 minutes. The interviews started with broad questions in order to encourage the participants to speak freely and to recount their personal experiences regarding time management. As the interview progressed, questions became more specific allowing a deeper investigation of issues raised by the participants in earlier interviews. The interviews were tape recorded. 2.5 Data analysis The tape-recorded interviews were transcribed and analyzed verbatim. by the first author. The transcripts of the interviews were read again and again, and codes were allocated to recurrent themes. More interviews were conducted in order to obtain further explanation or clarification regarding certain statements. When category saturation occurred, interviews were ended. The constant comparative method suggested by Corbin and Strauss (2008) were used to code the data. MAXQDA 7 software was utilized for data management. An empirically grounded set of insights was developed by using the guidelines of Corbin and Strauss (2008) in order to examine the behavior of nursing students in managing their time. Data analysis was carried out in four phases. In the first phase the data was analyzed in search for concepts, and codes were derived from the interview data and theory categories and their properties were identified. Then the analysis was elaborated through relating concepts to each other, crosscutting, and comparing incident against incident for similarities and differences, and theoretical sampling. In the next phase the data was analyzed for context and sets of conditions that give rise to time management problems were identified. In the third phase 5837

strategies used by nursing students to handle the circumstances or difficulties they confronted in educational setting were identified. The fourth and final phase was then focused at detecting core categories. Credibility was enhanced via validation of the emerging codes and categories in subsequent interviews and debriefing with the supervisors. Faculty members in turn checked the codes and the emergent categories. The core categories were verified by supervisors who studied the transcripts. Prolonged engagement, member checking, peer checking, and maximum variation of sampling was used to support the confirmability of the findings (Strauss and Corbin 1998). In addition, several nursing students who did not participate in the interviews reviewed the results and confirmed their fitness. 3 RESULTS Findings revealed that accepting the field orientates students. The students were in the first place concerned with continuing their education in nursing and their second priority was either to become competent nurses or to make their parents proud. Due to the large volume of academic duties in addition to other extracurricular chores and responsibilities, the participants were not satisfied with how they spent their time, felt like they did not have enough time to attend to their studies, and thus, were stressed. In order to reduce stress and be more satisfied with their time, the participants tried to pass more time for their academic tasks and spend less time on other chores and integrate other vital responsibilities alongside their academic work. Unidirectional time management were the core category of this study. 3.1 Accepting nursing Students who unidirectional spent their time in nursing were those who had accepted their field. The first participant (sixth term student) stated: Now that you ve come into this field, you should become a role model in what you do. 3.2 Escaping ambiguity 3.2.1 Continuing education in nursing Dispositions towards progress and interest in specialized work caused the main goal of the participants to be continuing their education in the field of nursing. In this regard the first participant (sixth term student) stated: Last year I had a lot on my mind and didn t consider continuing graduate studies, but this year I ve decided to enroll in the master s entrance exam and have bought the references I need to study 3.2.2 Becoming a competent nurse Becoming a competent nurse was the objective of some students. This was due to the commitment they felt towards caring for patients. The seventeenth participant (fifth term student) stated: If one day I have to take care of a patient, I should know how to do my job well. I think now is the best time for me to study and progress. 3.2.3 Attaining the approval of the family Another goal of the students was the approval of their families. The second participant (eighth term student) remarked: Since my father really wants me to excel, I ve studied to make him happy. Upon clearing up their ambiguity and becoming orientated, students start to assess their circumstances. 3.3 Assessing prevalent conditions and expectations 3.3.1 Great loads of academic duties All the participants complained about the high load of academic work. The twenty first participant (sixth term student) said: Now we have exams, homework, classes, and are doing our internships all at the 5838

same time. In addition to all this, we have to present our work to the management course, read journals, translate, type, and get ready to give a decent presentation. 3.3.2 Non-academic responsibilities When an individual enters university, it is expected to become more active member of society, get prepared for marriage, and so on. This was evident from the responses of participants. The sixth participant (second term student) said: My family expects me to be more social. In our family, we usually get married at a young age. One of my apprehensions is how to get married, and to whom; someone who can tolerate the conditions of nursing. How am I going to live with the work load that I have? Sometimes I come to the conclusion that nursing students shouldn t get married at all, unless they don t want to continue their studies. The non-academic burdens of students who lived in the dormitory were more evident. The second participant (eighth term student) remarked: There are a lot of chores aside from my personal affairs. Washing clothes, cooking, grocery shopping; these all take time. 3.3.3 Understanding the priority of schoolwork in order to reach goals The participating students felt that in order to reach their academic goals, they must pay less attention to non-academic tasks and others expectations from them. The thirteenth participant (sixth term student) stated: I have two exams coming up and have three days to get ready for them. Meanwhile, we will have our annual traditional family gathering the Yalda Night (The longest night of the year, that is, on the eve of the Winter Solstice around December 20) ceremony I ve been yearning for all year. But I can t attend the gathering. I m so disappointed that I don t have enough time for it. After the students realized the priority of spending time for their academic duties and the high volume of these duties, they felt unsatisfied and stressed to pass their time. 3.4 Feeling stress and dissatisfaction for passing time 3.4.1 The feeling of not having enough time for academic duties The participants felt that the time they had been not enough for completing the academic load with which they were faced. The second participant (eight term student) commented: Every human being needs entertainment alongside academic work. Right now, I don t even have half an hour for that. I think if I went out, I d substantially fall behind. 3.4.2 The feeling that one s efforts are not enough Due to idealism, the students felt as though their efforts were not enough. The eighteenth participant (fourth term student) mentioned: I ve been studying for four terms and there is not a single course I think I know well! The volume of the studies is so high; I can t get around learning anything profoundly. 3.4.3 The feeling of falling behind compared to others The competition that the students felt between them caused them to have constant stress about falling behind their peers. In this respect the sixth participant (second term student) stated: I ve decided to sleep less in order to make better use of my time. I have to sacrifice my afternoon siesta in particular because I m worried I ll fall behind other students. The feelings of stress and dissatisfaction which drove participants to attempt to overcome these issues was the core of this study. 3.5 Efforts for reducing stress and increasing satisfaction 3.5.1 Making time for academic duties Since the dense schedule of courses and internships occupied most of their workdays, the participants looked for other times in which they could study. Therefore they reduced their sleep, relaxation, and holidays in order to make time for their studies. For them, there was not a big difference between workdays and holidays. Concerning this issue, the twenty first participant (sixth term student) said: I plan out my weekends in a way as to spend them studying. 5839

3.5.2 Spending less time for other duties The participants tried to reduce extra-curricular duties in numerous ways in order to attain more time for attending to their academic responsibilities. The first participant (sixth term student) stated: I tried to plan my meals so as to not coincide with the other students. For example we had to cook dinner on Thursdays; although I was very hungry I d say that I wasn t in order not to spend too much time. I d hurry back and quickly make scrambled eggs so I could get to my studies. Omitting entertainment was one of the most popular ways that the participants used for dealing with the crisis of not having enough time. For example the second participant (eighth term student) commented: Often my friends go out for the weekend to parks and religious shrines. But unfortunately I ve had to cross out these activities for myself. 3.5.3 Integrating other tasks alongside academic duties Some participants tried to address other tasks alongside their academic duties. In this respect the twenty first participant (sixth term student) said: In the previous 5 terms, although it has hard, I tried to go to English classes alongside my studies. I d go to university from early in the morning until five in the afternoon. After five, I d head out to English classes until 8pm. Can you believe it? At the end of the day I d feel like my brain was boiling! I d do it because I was interested. But this term, because of the load of my academic work, I wasn t able to enroll in the English class. In the sixth term, although the abovementioned student was very interested in English classes, she decided to discontinue her classes due to the priority of her academic work. 4 DISCUSSION The distinct finding of this study is that accepting their field was the most decisive parameter in shaping how nursing students spend their time. Due to the large number of applicants for the limited number of university places in Iran, applicants for all fields have to take part in the competitive National Higher Education Entrance Exam (NHEEE). All students participating in the exam are ranked and those with better rankings have a higher chance in gaining entry to the field and the University of their Choice. Currently it is generally accepted that higher ranking students occupy and fill the more prestigious programs, such as medicine, dentistry or pharmacology. Whilst, the lower ranking students must choose between the remaining less desired fields such as nursing; most often without any particular inspiration or interest (Tabari Khomeiran and Deans 2007). Thus for most students, nursing was not their first field of choice when entering university. Besides, some of them did not have a good understanding of nursing as a profession (Nikbakht Nasrabadi et al. 2004). Based on our study, nursing students had spent a lot of time for the university entrance exam and since nursing was not their first choice, they were not satisfied with their entrance exam results and felt unsatisfied upon entering university. From what our study results, it was clear that after entering the field of nursing, students had come to the conclusion that they might as well accept their field and progress in it. Hence, after the students came to accept the field of nursing, they ended their ambiguity, became orientated, and their time management and goals took effect. The students were in the first place concerned with continuing their education in nursing and their second priority was either to become competent nurses or to make their parents proud. On one hand, students were faced with great loads of academic work associated with their field of study. On the other hand, because of the change in their lifestyles after entering university they were faced with additional loads of non-academic responsibilities; for example moving into the dormitory, getting prepared for marriage, or an increased need for independence. Other studies have also indicated that nursing students strongly felt the burdens and strains of their field of study on themselves, their private lives and ultimately their time(norman et al. 2005, Magnussen and Amundson 2003). Jordanian nursing students indicated that finding time to study was their highest concern (Abu-Moghli et al. 2005).Meanwhile Unlike middle-school, the personal inclinations of university students are considered warranted (Eilam and Aharon 2003, Ravari et al. 2008). In the end, the students came to the conclusion that in order to reach their goals they must spend more time on their academic duties as opposed to other tasks. With the goals that the participants had set for them, their stress regarding their academic responsibilities increased and they felt that they did not have enough time for these responsibilities. 5840

Their feeling of as though they were falling behind their peers and their idealism intensified their stress. For reduce stress in the end nursing students must be made choices. Regarding choices made between two options researchers suggest that people consider what they will gain when choosing to work either on task A or task B, and whichever task has higher utility will be chosen(könig and Kleinmann 2007). In our study, In order to overcome stress, the participating students all attempted to reduce the volume of other tasks while focusing primarily on their academic duties. Unlike our study in one study of a group of at-risk African American college students, what this group had in common was that they typically held priorities that placed other activities (e.g., socialization, work, family, extracurricular organizations) higher than academics, and so they had used disproportionately more time for leisure activities rather than academic activities(bonhomme 2007). For our participants, their grades were very important. Therefore they chose to study for the exam instead of attend the family gathering they had anticipated for an entire year. However some of other researchers have also shown that there is a meaningful relationship between time management, behavior, and stress (Kearns and Gardiner 2007, Pulford and Sohal 2006, Macan et al. 1990). But There are also discrepancies in studies which appear to show that instead of the actual use of time management behaviors, perceptions of structure and purpose in time use might be useful in diminishing worries (Kelly 2003). Our participants continued the unidirectional behavior they had practiced during high school and at the time of getting ready for the university entrance examination. Thus they tried to spend more time on academic responsibilities and to reduce stress by establishing this balance. The more stress participants felt towards their academic tasks, the more time they needed to spend for establishing balance. The time management strategies mentioned in the study is a foundation with which these students created this equilibrium. Time management behavior of students is affected by their understanding of what causes stress. The participants of this study, based on their goals and valuations, perceived the stress of academic duties to be higher than other stresses and had come to the conclusion that they must spend more time on academic tasks. So, although a balance had been established between the amount of stress and the efforts for reducing that stress, the time spent for academic duties was out of proportion compared to the time spent for other duties. This misbalance had affected the personal lives of the participating students. 5 CONCLUSION This study as a part of more extensive research (PhD dissertation identified the methods used by nursing students in Iran for planning and prioritizing their academic and nonacademic activities) described how the experience of nursing students contextualized and influenced their time management practices. Nursing students attempted to understand, reconcile, and live within the possibly conflicting contexts of academics and non-academics. Based on the findings of this study, the time management of students was concentrated on personal motivations. Those students who had accepted the nursing field, based on the goals that they had, gave high importance to their academic duties. With the circumstances that they had created and were upon them, these students were forced to relinquish many of their desires in order to reach their goals. In other words, they were confronted with an internal struggle to choose between academic duties and other tasks. In the end, due to their perceived goals, the participants preferred to spend the majority of their time for their academic duties. Since in order to overcome the stress imposed by academic responsibilities the participants spent far less time on other needs and duties than is normally needed for healthy growth and development of individuals in this age range, they were constantly faced with an internal struggle and feeling of loss. The findings of this study show the necessity of investigating the time needed for reaching the goals of the nursing education program, and also the need to harmonize the goals of the academic studies of the nursing field with the length of its period. The curriculum for a bachelor s degree in nursing should be modified appropriate to the age, and the social and spiritual needs of the students; as well as the particular conditions of their culture and environment. It is suggested that in future studies, time management behavior is investigated among other students and contexts. 5841

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