Qualitative Study on Student Nurses’ Experiences on Absenteeism

INTRODUCTION

Indian Nursing Council is a statutory body which prescribes the syllabus and regulations for various nursing programmes and these will be implemented by schools and colleges of Nursing and health care institutions through Board and affiliated universities.² The monitoring and control of nursing student’s attendance as per the syllabus is within the control of nursing institutions and each student is expected to fulfill the academic requirements and get 80% of theory and 100% of practical attendance in each subject in order to get eligibility to appear for the final examination. But in spite of having good academic monitoring such as mentoring, parent teacher meet and counseling facilities within the institution, few students become absent. 

Absenteeism can be defined as persistent, habitual, and unexplained absence from school (Brooks, 1997, as cited in Bond, 2004).³ Students absenteeism is a major concern for lecturers at institutions of higher learning. Absences create a dead, tiresome, unpleasant classroom environment that makes students who come to class uncomfortable and the lecturer irritable. It is also an alarming problem for administrators, teachers, parents and society. This can have an effort on the progress of all the students attending the class. The families of habitual absenteeism can also suffer with poverty and unemployment.⁴ If the student is trained properly, he or she become a good citizen in the society especially in health care team.

A study was conducted to assess the causes of student absenteeism in selected universities of South Africa. For the study using mixed methodology and survey research design, data was collected from 1026 students. The results revealed that, student absenteeism in the universities were due to lack of subject interest, poor teaching strategies by lectures, unfavorable learning environment, too much socialization, part time jobs and poor relationship with the lectures.¹

Hence the researcher felt to undertake a study on experiences of nursing students on absenteeism at selected colleges of Kolar with an objective to find out the root causes of absenteeism and its remedies among nursing students. 

MATERIALS AND METHODS

The Research design used for the study was Phenomenological research design. First an ethical permission was obtained from Institutional ethical committee and then a written permission was obtained from the head of Nursing Institutions, Kolar. For the study around 15 nursing students who were irregular for classes and clinical, having below 60% of attendance and 60% of cumulative requirements not completed, studying in 2nd, 3rd and 4th year GNM and B.Sc(N) programme, available at the time of data collection and willing to participate in the study were included. Through purposive sampling technique two focus groups were made (separately for each college). After obtaining formal permission from study participants, using in-depth interview method, data was collected from all students. First sociodemographic data was collected followed by questions related to absenteeism and its remedies were elicited using six open ended questionnaires. During data collection the researcher facilitated the group and her assistants, who were also nursing faculties, attended all focus group discussion and helped researcher by taking notes as they verbalized and the same time recording also was done using a tape recorder.

DATA ANALYSIS

Data analysis was, by debriefing after each focus group discussion and by listening to the tape and verifying the data. The content was verified while reading line by line and paragraph by paragraph, looking for significant statements and codes according to the topics addressed.

The researcher used three levels of coding. In level one coding, researcher examined the data line by line and making codes which were taken from the language of the subjects who attended the focus group. In level two coding, comparing of coded data with other data and creation of categories were done. In level three coding, the categories that seem to cluster together were formed as themes. Then the documents were submitted to two assessors for validation. This action provided an opportunity to determine the reliability of the coding.

RESULTS

I. Description of Socio-demographic data of nursing students 

With regard to socio-demographic data, majority (82%) of nursing students were males and 18% of them were females, most (62%) of them were between 19 to 20 years of age group, 72% of them were studying B.Sc (N), 28% of them were studying in GNM programme, in that 54% of them were in 2nd year, 40% of them were in 3rd year and 6% of them were in 4th year. Among 15 members, 70% of them were selected nursing by force, 80% of them scored above 60% of marks in PUC and 98% of them were passed PUC with first attempt.

II. Causes of absenteeism:

From focus group discussion study analysis, five themes were emerged. These were embarrassment, dependency, too much work load, good relationship and lack of freedom.

Theme - I: Embarrassment

This theme emerged from all focus group that almost all male nursing students expressed that they were embarrassed throughout the OBG postings and which made them to be absent.

One student stated that:

“When we go to the patient for giving care or doing some procedure, they tell us don’t come here”.

Another student added to this:

In postnatal ward one or the other patient will be feeding the child, we cannot do any procedure when we go near patient they show the faces and when we stand away from the patient, our teacher comes and scolds at us for simply standing without doing work.

One more student said:

One day I went to do bed making in OBG ward, suddenly patient got up and said don’t come here, go out! This made me not to go for clinical postings.

Theme-II: Dependency

Most (80) % of the students expressed that, they are dependent on their parents or warden to plan their day to day activities failing in which they become absent.

One student stated that:

“When my father is at home he makes me to get up early from bed and send me to the college and when my father is not there, my mother won’t make me to get up because she doesn’t like that I have joined nursing hence I become absent”.

Another student added to this; 

“When I was studying in PUC and stayed in the hostel, we require to follow very strict time to get up from bed, go to the college and study time after coming here such rules are not there. Hence I don’t know the time I will sleep and become absent.”

One more student added to this; 

“One day my teacher counseled me for becoming regularly absent, then I decided to maintain regularity, after a week while coming to college my friends called me to go out, I went with them then I continued to become absent”.

Theme-III: Too much work load  

Cumulative record requirement was another issue expressed by students

One student said that:

“We were placed in a partial block. We required to fulfill our syllabus requirement like care plans, case studies and procedure demonstration as per our cumulative record in the clinical and also assignments in the class hours. Complete 8 hours we are packed (morning clinicals and afternoon classes) without a single hour to relax. Hence we are not able to cope with that, hence we become absent.

Another student added that

“Because of over work in the clinicals, I become tired then I am unable to attend afternoon Classes.”

Theme-IV: Good relationship

Most (76.06%) of the students expressed that, teachers and parents should maintain good relationship with them and understand their feelings.

One student said that:

“My parents do not understand my feelings and they always force me to do all the activities. I am not able to share my feelings with them, because they are busy with their own work and they are not interested to listen to my words”.

Another student added to this; 

“Teacher should be strict, but they also should maintain friendly nature to understand our problems and also they should be polite and approachable for all the students.”

One more student said that:  

“My parents have not given freedom for me to choose the profession as I like, they pushed me in to this profession, because of lack of interest, I am skipping the classes”.

Theme-V: Lack of freedom

Most (82.86%) of the students expressed that, restrictions are more in the profession and only 27.14% of them expressed that this rules are important to maintain professional dignity

One student stated that:

Once you enter in to this profession you will lose all your freedom and will suffer a lot, like you should not put nail polish, you should not wear pants, you should not leave the hairs freely. This suppresses our personal interest.

Another student added to this:  

“My college is like a jail, which builds up on rules and regulations”

III. Preventive remedies 

With regard to preventive remedies, Majority (56.6%) of students expressed that teachers and parents working together can prevent absenteeism.

One student said that; 

“Student must involve themselves in the studies by reading the books and clarifying the doubts”

Another student added to this: 

“Student must be up-to-date in their studies and do not keep any work pending, it will increase the tendency to escape from the situation”

RECOMMENDATIONS 

Students: 

• Study systematically and regularly. 
• Make a point to read the lessons beforehand. 
• Keep a dictionary with you while reading. 
• Develop self-confidence-it means faith in your own strength and faith in your studies. 
• Have an intense desire to excel the studies. 
• Study in groups with peers. 
• Draw a time table from time.⁵

Nurse educators:

• Plan full block Classes or Clinicals 
• Conduct counseling for students and parents regularly
•  Maintain good student and teacher relationship
• Have a good time plan in the hostel and college 
• Identify the absentees immediately and bring to the notice of principal and parents 
• Plan test and assignments as per curriculum requirement without over loading the students

DISCUSSION

The findings of the present study revealed that indiscipline, dependency, lot of expectation from teachers and parents among students, lack of co-operation and co-ordination between parents and institution, misunderstanding between parents, lack of knowledge among parents in handling adolescent children, lack of timely guidance by the teachers in the clinical and theory classes became the root causes of absenteeism among nursing students. This was supported by the study conducted by Loraine D. Cook and Austine Ezenne.⁶

CONCLUSION

Absenteeism from clinical areas and classes among nursing students is a significant problem. From the findings of the study five themes were emerged such as Embarrassment, Dependency, Too much work load, Good relationship and Lack of freedom. So the nurse educator should deal with such type of problems in order to make students to complete their education programme and to become a competent and dedicated nurse to the society.