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Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
Nurse Education Today (2004) 24, 160–168
Nurse Education Today intl.elsevierhealth.com/journals/nedt
Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland Eija Heikkinena,*, Arja Isolab,1 a
Department of Research and Development, Kajaani Polytechnic, P.O. Box 52, Ketunpolku 3, 87100 Kajaani, Finland b Department of Nursing and Health Administration, University Hospital of Oulu, University of Oulu, P.O. Box 5300, 90014 Linnanmaa, Finland Accepted 19 November 2003
KEYWORDS
Summary The aim of this paper is to describe the different definitions of envy in a nurse education environment. Answers are sought to questions concerning student nurses’ experiences and perceptions of envy and their ways of coping with envy in one polytechnic of health and welfare in Finland. Conclusions are presented to illuminate the concept of envy based on student nurses’ perceptions in one polytechnic, where 64 (N ¼ 100) student nurses were recruited from among the available (attending classes) students in 1998. The research material was collected using an instrument of 15 open-ended questions. The phenomenographic approach was used to analyze the data. According to this paper, envy appears different, depending on whether students are talking about their personal feelings of envy or envy shown by others. Furthermore, envy is described differently at the general level and in health care. Student nurses described their own envy as mild nuances of feelings, while envy at the general level was described as consisting of aggressive feelings. The most general way of coping with envy is rationalization. These findings can be used to help student nurses identify envy as a concept and also to recognize emotions as part of personal knowledge. c 2003 Elsevier Ltd. All rights reserved.
Nursing; Envy; Phenomenographic
Introduction
Knowledge about the definitions of envy in a nurse education environment and the role of envy in the processes of learning, motivation to study and *
Corresponding author. Present address: Kuurnantie 78, 87200 Kajaani, Finland. Tel.: +358-8-61899206; fax : +358-8-61899640. E-mail addresses: [email protected] (E. Heikkinen), [email protected] (A. Isola). 1 Tel.: +358-8-5534437.
collaboration between student nurses is scant. Is envy an emotion that student nurses learn during their education? In Finland, nurse education has been given in polytechnics since 1991. Student nurses’ professional development takes place in the practical context of collaboration between student nurses, lecturers and health care staff (Campbell et al., 1994; Toit Dlitt et Phil, 1995). Dilemmas of nursing philosophy involve ontological and epistemological questions about caring and manifest in the nursing theory. Caring practices
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Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
and educational knowledge are based on these dilemmas (Meleis, 1997). The main ontological dilemma in nursing care is the question of love (Fitzegerald and Van Hooft, 2000) and the need to take care of people (Carper, 1997) in their own cultural and sociological environment (Appleton, 1990; Leininger, 1994; Price and Cortis, 2000). Loving is understood as the willingness and commitment of the nurse to want the good of the patient/client rather than her/himself, without reciprocity (Fitzegerald and Van Hooft, 2000). Caring is understood as a complex of emotions, collaboration, moral responsibility, respect and empathy (Morse, 1990; Appleton, 1990). Student nurses’ individual position, earlier personal and caring experiences and knowledge of human beings, illness, health and emotions are involved in the totality of knowing (Yegdich, 1999). Student nurses must use all of their abilities, knowledge and skills to take care of patients (Carper, 1997), to apply humanistic values and also to recognize their own limits and responsibility (Meleis, 1997; Carper, 1997). These shared characteristics give them certain distinctiveness and make them different from other students (Price and Cortis, 2000). Student nurses’ epistemological dilemmas concern empirics, ethics, personal and aesthetic knowing. Empirics as the science of nursing is based on the assumption that what is known is accessible through the senses, i.e. seeing, touching and hearing. Ethics focuses on the moral component of knowing, the norms and ethical codes of nursing, what are good and right, and what is responsible. Personal knowing concerns the inner experiences of becoming a whole, aware self. Aesthetic knowing refers to the comprehension of meaning as a singular, particular, subjective expression called art/act. It allows one to move beyond the limits and circumstances of a moment (Carper, 1997; Chinn and Kramer, 1995). It is important to understand that knowledge of the ontological and epistemological dilemmas of nursing does not directly increase ethical actions or collaboration between staff and students in nursing care (Birkelund, 2000). One of the commonly used methods to improve student nurses’ epistemological learning is reflection. This means that student nurses think critically about incidences and their actions in response to them (Schon, 1983; Burnard, 1995; Glen et al., 1995) and try to connect their actions to certain theoretical dimensions (Atkins and Murphy, 1993; Smith, 1998). According to previous papers (Gavanagh, 1991; Heikkinen et al., 2003), there are some problems in open discussion. Half of Finnish nursing students in one polytechnic thought that a good
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nurse should not feel envy (Heikkinen et al., 2003). There is also a fear of including envy among the characteristics of a nurse (Heikkinen et al., 1998). On the other hand, the feeling of envy and especially the negative consequences of envy are difficult to explore because they are subconscious (Foster, 1972; Alberoni, 1993; Klein, 1994). On the other hand, the philosophy concerning ontological dilemmas, holistic caring and good caring (Tuomi, 1997) may involve problems to discuss of envy openly. If the educational environment is studentoriented (Halldorsdottir, 1990; Hughes, 1993), it helps student nurses to become patient-oriented (Rolfe, 1994) and improves their motivation to study (Simonson, 1996; Spouse, 1998).
Review of the literature on envy Envy can be defined as a feeling of displeasure and ill will at the superiority of another person in happiness, success, reputation, or the possession of anything desirable and a tendency to regard with discontent another’s possession of some superior advantage which one would like to have for oneself (Simpson and Weiner, 1989). The concept of envy is defined in philosophical (Gillman, 1996), psychological (Freud, 1982; Klein, 1994; Berke, 1991; Gillman, 1996), sociological (Foster, 1972; Alberoni, 1993; Scheler, 1961) and nursing science (Maijala et al., 2000; Heikkinen et al., 1998, 2003) literature. Many philosophers find envy a painful element of anger, malevolence and grief (Gillman, 1996). According to Scheler (1961), resentment develops through a revenge – malice – envy – malevolence and disparagement stimulus. Envy elaborates resentment when the revengeful and malicious feelings are subdued. Jealousy is often confused with envy and approached in almost identical words (Gillman, 1996). Jealousy is a fear of losing something that belongs to one, while envy is a desire to have something that one has never possessed (Foster, 1972). According to Klein (1994) and Alberoni (1993), human self-esteem affects the experience of envy. If a person has good self-esteem, he/she is able to value him/herself and to respect his/her own feelings and opinions. A person with poor selfesteem is in constant need of other people’s attention in order to manage with his/her life. Envy is present when someone compares him/ herself to another and wants to get some of the same things that the other possesses (Freud, 1982). Envy is said to be strongest in relation to an equal (Klein, 1994; Alberoni, 1993). On the other hand, envy can be defined through cultural forms and symbolic
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behaviour and also characterized in terms of social functions. Envy is said to be inherent in every human being and present to a greater or lesser extent in every society (Foster, 1972; Alberoni, 1993). Maijala et al. (2000) showed, by analysing psychiatric nurses’ discussion, that envy was defined as a “lacking” and the object of envy as something good possessed by someone else. Heikkinen et al. (1998, 2003) defines envy through the relations prevailing between students nurses and health care staff. Objects of envy are shown, and managers and lecturers influence the feelings of envy and also the methods of coping with envy.
Aims of the paper The aim of this paper is to describe different definitions of envy in a nurse education environment. Answers were sought to the following questions: 1. What are student nurses’ experiences and perceptions of envy like? 2. What methods are used by student nurses to cope with envy?
Methods The informants consisted of 64 (N ¼ 100, response percentage 64%) student nurses recruited from among the available student nurses (attending classes) who had been studying in the same group for one to three years in one polytechnic of health and welfare in Finland in 1998. It was emphasized to all student nurses that their participation was voluntary, their anonymity would be guaranteed, and all information would be considered confidential. The data were collected with an instrument consisting of 15 open-ended questions. The questionnaire had been designed on the basis of two earlier statements concerning the nursing environment (Heikkinen et al., 1998) and the nurse education environment (Heikkinen et al., 2003). The structural validity of the statements concerning envy was studied with the help of factor analysis. The explanatory proportions (42.1–62.1%) show that the instrument actually measured the object of study (Floyd and Fowler, 1989). Internal validity was measured in such a way that the themes of the questionnaire were based on earlier statements (Heikkinen et al., 1998, 2003) concerning nurse students’ sense of self and objects of envy, the influence of lecturers on envy and the ways of coping with envy. (Burns and Grove, 1999). The questionnaire included questions concerning envy as a concept: “What does envy
E. Heikkinen, A. Isola
mean in your opinion?” There were questions concerning the student nurses’ own and their fellow students’ envy: “How does a student nurse behave or act if she/he feels envy?” “What kind of differences have you noticed in the treatment of male and female students?” “In what situations do you feel envy at school?” How do you behave or act when you feel envy?” There were question concerning the health care environment: “What kind of actions increase envy in the health care environment?” In every question were asked examples of envy. One question was left open-end, and the respondents were instructed to write whatever they wanted to say about envy. This increased internal validity (Burns and Grove, 1999). In this study, a phenomenographic approach was used to analyse the data. The student nurses’ answers included private and personal information about envy, and the descriptions were considered valid (Uljens, 1989; Burns and Grove, 1999) When saturation was reached, data collection was discontinued (Polit and Hungler, 1999). This method was assumed to give the best possible wide, new definitions of the concept of envy. Student nurses are able to describe their own experiences and perceptions of envy, but it is impossible to describe envy as reality (cf. phenomenology). In the phenomenographic approach, the central concept of study is the idea that defines the relations between individuals and the surrounding world. The “what” viewpoint approaches the specific subject of thinking, while the “what kind of” viewpoint refers to the process. Actually, these points of view cannot be distinguished from each other because functioning (the “what kind of” viewpoint) always leads to a product (the “what” viewpoint ) (Uljens, 1989; Gr€ ohn, 1992). This paper clarifies conceptually student nurses’ envy; in other words, it represents a second-degree point of view. The first-degree point of view would involve the question: “What kind of phenomenon is envy in reality?” The informants were not met (the process of analysis took two years), and it is hence impossible to identify any behaviours, feelings or modes of non-verbal communication (Uljens, 1989; Burns and Grove, 1999; Bailey, 1997). The analysis was started by writing down the answers (41 pages) and reading them through. Every answer was analysed for internal connections by formulating descriptive categories, i.e. significance classes. The descriptive categories thus obtained were examined as the results of the paper in a wider context. This is called the conceptualisation conseptualizing of ideas. Similar contents were also found in questions classified under other headings. These contents were added to the chosen themes of
Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
the paper (Uljens, 1989; Bailey, 1997). At the next stage, different categories were distinguished in the horizontal and vertical directions. The horizontal system was used to separate categories that differed by content from each other. In the vertical dimension, the categories were qualitatively distinguished from each other to see, for example, whether a given concept was more important or more general than another. For this paper, the replies in the different categories were counted to show how common the different descriptions were among these students (Uljens, 1989). The reliability of this paper depends on the material and the meanings of the categories. The validity of the material depends on the informants’ tendency to answer the questions as the researcher expects them to answer. The researcher must also realise that her ideas influence the interpretation (Uljens, 1989; Hinds et al., 1990; Appleton, 1995). In this paper, the data analysis shows the genuineness of the categories and significances with consistency. Reliability would have been better if the meanings of the categories had been discussed with the student nurses after the categorization of the themes. This was impossible, because the informants were no longer available to discuss of themes in that polytechnic. According to this approach, the researchers’ categorization is also a finding (Uljens, 1989). The situations and students were unique. Another study could reveal more envy in a nurse education environment (Burns and Grove, 1999). The present findings were produced by these 64 student nurses in one polytechnic of health and welfare in Finland. But the findings highlight some essential points of the concept of envy, which can be extrapolated to discussions in some other nurse education environments.
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After that the things that were related to the education environment and increased the feelings of envy were classified into the following horizontal categories: contents of studying, lecturers’ actions, and students’ mutual relations. Student nurses described the things that increased their feelings of envy as follows: The importance of exams. . . and when we see everybody’s tests marks and can place ourselves below, at or above the average. The male student gets more attention, and he is asked about his feelings and experiences more often than female students.
These categories and the student nurses’ opinions related to the education environment as a factor increasing feelings of envy are shown in Table 1. We differentiated four horizontal categories of levels of envy and three categories of envy as a concept. The differences in envy can be concretised with the help of the following Fig. 1, where envy at an general level, envy of other students, student nurses’ own envy and envy in health care are shown. This figure also includes the key concept of coping with envy, although these findings are explained in the next chapter. Envy was defined as student nurses’ own envy concerning fellow students as follows: It feels sad. Hanging over me.
Student nurses described envy shown by their fellow students as follows: A human being feels hatred, embitterment and inferiority compared to a fellow student if he/she has or gets better things than me. A fellow student uses verbal and social abuse.
Findings Student nurses’ experiences and perceptions of the concept envy Student nurses’ experiences about being as a student were classified into the following horizontal categories: contents of studying, teaching arrangements and social relations. They described their studying in the educational environment as follows: . . .The long days are strenuous both physically and psychologically. . . . . .but there are also many good things. I can compare with this institution with the previous one I attended.
Student nurses described envy at a general level and its relations to the educational environment as follows: People are envious of others’ success or some other matter that they don’t have themselves, for example, money or physical properties. . . A person may feel hatred, bitterness and inferiority towards others who are better than he or she. It may encourage one to try to get better test marks.
The following categories of envy in health care were formulated: envy does not belong to health care, it is connected to womanhood, is part of humanity or is manifested between groups, or may remain hidden. Student nurses described envy in health care as follows:
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Table 1
Characteristics of educational environments and things that increase envy.
Categories of educational environments
Categories of factors that increase envy
Examples of description
Contents of studying: Theoretical (12) Stressful (15)
Contents of studying (8) Desire to be perfect (4) Group examinations – good success without studying (2) Importance of examinations (1) Boasting about one’s success (2)
The importance of examinations. . . and when we see each other’s marks and can place ourselves either below, at or above the average
Lecturers’ actions (46) (unfair evaluation, changing times of returning papers, changing rules, favourite students, arrangements involving superiority, mandatory lectures, registration of absences, compensation tasks) Long days Too many students in the same group
The students are not equal to the teachers.
Positive (23) Interesting (12) Uninteresting (1) Teaching arrangements
Social interaction
Relations between others (9) Relations between students, between students and lecturers between other groups between male and female:
. . .long days are physically strenuous. . .
Quarrels in group for not lending lecture notes.
Students in the technical department get paid. . . Males are treated better (47) Males are treated worse (13) Females are treated better (3)
The male student gets more attention, he is asked about his feelings and experiences. . .
(The number of descriptions is given in brackets).
Envy does not belong to health care because envy among the staff may lower the standard of patient care – the main thing is not the patient but the nurses’ competition with each other. Perhaps envy is quite common within health care because it is such a female-dominated profession.
Nursing students’ coping with envy We established six main categories of student nurses’ ways of coping with envy and also five individual differences that related to the educational environment. Student nurses’ ways of coping with envy consisted of the following horizontal categories: rationalisation, outbursts of feeling, silence, humour, transfer and no envy at all. They described their ways of coping with envy as follows: I try to act so that no one will notice my envy. I think, in other words, I ask myself what is the reason to be envious Small jokes of exam results.
The most general way of student nurses to cope with envy was to rationalise the reasons that caused envy. They thought about the reasons why the other student was better or concentrated on the positive aspects of their own lives. It was possible for a person to talk about envy to him/herself, to a friend or to the target of the envy when a rational strategy of coping with envy was used. Most of outbursts of feeling described were negative. In this paper, the individual differences between nursing students’ ways of coping with envy were also analysed. The experiences of being a student nurse in the educational environment were formulated into five categories, characterised as theoretical, stressful, positive, interesting and uninteresting. The objects of envy were categorised into study success, lecturers’ actions, skills and matters that were not envied. The coping with envy was manifested as rationalisation, outbursts of the feeling, silence, humour, transfer and no envy. All the other answers were categorised as indicating envy that is not relevant to health care, is connected with womanhood, is part of humanity,
Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
Figure 1
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Differences in the definitions of envy by student nurses. (The number of descriptions is given in brackets).
is manifested between groups or remains hidden. On the basis of these answers, 56 experiences were identified. According to the present findings, nine student nurses considered their studying uninteresting and 12 found it stressful (N ¼ 64). Such feelings may be due to quarrels within the group. Negative influences of envy on the student nurses’ motivation to study were found among the three students who denied the existence of envy. It may be that these students’ nurses are not sensitive to others’ emotions in patient care. Wenzlaff (2000) found that unwanted thoughts are difficult to suppress, and suppressing may lead to anxiety, despondency and hopelessness. Student nurses’ individual experiences of studying and the manifestations envy as well as the conclusions are shown in Table 2.
Discussion The findings of this paper shed new light on the essence of envy in a nurse education environment and the connection between envy and student nurses’ motivation to study. It seemed that edu-
cational achievement is the main thing envied, but half of the informants pointed out that this motivates them to study harder for the exams. It may be that formal achievements, such as success in exams, is too highly appreciated in nurse education because there were only a few references to such nursing skills as empathy, collaboration or practical skills. Most of student nurses thought that male students were treated better than female students. The present findings agree with Cummings (1995), who showed that lecturers had favourite students and also treated male students better than female students. The important finding was that student nurses’ experiences of envy appear different, depending on whether they talk about their personal feelings of envy or envy shown by others. Furthermore, envy is described differently at the general level and in health care. When the student nurses described their own feelings of envy, envy was characterised in terms of mild nuances, such as being in a bad mood or coping with envy by rationalisation. When the student nurses described the envy of their fellow students, they used such words as undermine others’ position and consolidate one’s own position. Envy at a general level was described as
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Table 2 Nurse students’ individual experiences of studying and their connections with envy. Findings of this paper
Object of envy Educational achievement Lecturers’ action No object of envy Skills Coping with envy Rationalization Outbursts of feeling Silence Humour Transference Denial Presence of envy in nursing education Not part of health care Connected with womanhood Part of humanity Non-existent Conclusions
Student nurses’ experiences of studying, statistical presentation of opinions Positive (16)
Theoretical, interesting (19)
Uninteresting (9)
Stressful (12)
12 4 2
15 5 1
3 3 2
8 2 3 1
8 3 1 3 3
16 5
4 3 1
9 2 1
1
2
2
2 2 3 1
1
4 4 5 Only group to cope with envy by humour
6 4 3 1
5
The object of Use most envy is least commonly rationalization to closely connected with studying cope with envy
Most deny envy (altogether no object of envy (3) and denial (2))
(The number of descriptions is given in column).
consisting of aggressive feelings and actions. It seemed that the general level of envy was attributed the strongest emotion and that one’s personal feelings of envy were difficult to discuss. Kelly et al. (2000) also found that, when discussing the feelings of dying patients, nurses were unable to approach the idea of death. Instead, they said that “everything is normal” or “it belongs to the ward’s routines”. Furthermore, Yegdich (1999) says that a human must convert his/her experiences into human descriptions of human phenomena. Thus, the existence of envy can be understood by analysing individual experiences of envy and describing envy as a human phenomenon. According to the present findings, the positive influence of envy on the student nurses’ motivation to study was recognised. Envy motivated them to work hard for better grades and to analyse their own weakness and strengths. Reflection may improve collaboration between student nurses if they discuss envy together. These conclusions are similar to those of Smith (1998), who pointed out that reflection helps student nurses to learn about them and to act professionally. The positive influences of envy on social development have been reported by Foster (1972), Scheler, Nietzsche and Hartmann (Gillman, 1996).
Conclusions The main conclusion of this study was that the concept of envy appeared different, depending on whether the student nurses talked about their personal feelings of envy or envy shown by others. Furthermore, envy was described differently at the general level and in health care. These discrepancies could be related to ontological and epistemological dilemmas in health care. Because caring is understood as collaboration, moral responsibility, respect and empathy, student nurses’ individual positions and emotions are involved in the totality of knowing. Hence, descriptions of the strength of personal feelings of envy are inconsistent with ontological dilemmas. Personal knowledge is a standing relative to another and one’s own self (Carper, 1997). For these reasons, clarifying envy as a concept will help nurse students and lecturers understand each other in personal, social and environmental contexts. These findings can be used in nursing education to identify envy as a concept and also to recognize emotions as part of personal knowledge. Emotions are part of education and therefore important to share with other. According to the findings, envy is
Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
considered also to involve mild nuances of emotions that are not usually attributed to envy. One future challenge is to clarify lecturers’ experiences of envy in the nursing environment. The results of previous studies of envy (Heikkinen et al., 1998; Heikkinen et al., 2003) will also be incorporated into the model of envy in nursing education and practice environments.
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Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland Eija Heikkinena,*, Arja Isolab,1 a
Department of Research and Development, Kajaani Polytechnic, P.O. Box 52, Ketunpolku 3, 87100 Kajaani, Finland b Department of Nursing and Health Administration, University Hospital of Oulu, University of Oulu, P.O. Box 5300, 90014 Linnanmaa, Finland Accepted 19 November 2003
KEYWORDS
Summary The aim of this paper is to describe the different definitions of envy in a nurse education environment. Answers are sought to questions concerning student nurses’ experiences and perceptions of envy and their ways of coping with envy in one polytechnic of health and welfare in Finland. Conclusions are presented to illuminate the concept of envy based on student nurses’ perceptions in one polytechnic, where 64 (N ¼ 100) student nurses were recruited from among the available (attending classes) students in 1998. The research material was collected using an instrument of 15 open-ended questions. The phenomenographic approach was used to analyze the data. According to this paper, envy appears different, depending on whether students are talking about their personal feelings of envy or envy shown by others. Furthermore, envy is described differently at the general level and in health care. Student nurses described their own envy as mild nuances of feelings, while envy at the general level was described as consisting of aggressive feelings. The most general way of coping with envy is rationalization. These findings can be used to help student nurses identify envy as a concept and also to recognize emotions as part of personal knowledge. c 2003 Elsevier Ltd. All rights reserved.
Nursing; Envy; Phenomenographic
Introduction
Knowledge about the definitions of envy in a nurse education environment and the role of envy in the processes of learning, motivation to study and *
Corresponding author. Present address: Kuurnantie 78, 87200 Kajaani, Finland. Tel.: +358-8-61899206; fax : +358-8-61899640. E-mail addresses: [email protected] (E. Heikkinen), [email protected] (A. Isola). 1 Tel.: +358-8-5534437.
collaboration between student nurses is scant. Is envy an emotion that student nurses learn during their education? In Finland, nurse education has been given in polytechnics since 1991. Student nurses’ professional development takes place in the practical context of collaboration between student nurses, lecturers and health care staff (Campbell et al., 1994; Toit Dlitt et Phil, 1995). Dilemmas of nursing philosophy involve ontological and epistemological questions about caring and manifest in the nursing theory. Caring practices
0260-6917/$ - see front matter c 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2003.11.004
Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
and educational knowledge are based on these dilemmas (Meleis, 1997). The main ontological dilemma in nursing care is the question of love (Fitzegerald and Van Hooft, 2000) and the need to take care of people (Carper, 1997) in their own cultural and sociological environment (Appleton, 1990; Leininger, 1994; Price and Cortis, 2000). Loving is understood as the willingness and commitment of the nurse to want the good of the patient/client rather than her/himself, without reciprocity (Fitzegerald and Van Hooft, 2000). Caring is understood as a complex of emotions, collaboration, moral responsibility, respect and empathy (Morse, 1990; Appleton, 1990). Student nurses’ individual position, earlier personal and caring experiences and knowledge of human beings, illness, health and emotions are involved in the totality of knowing (Yegdich, 1999). Student nurses must use all of their abilities, knowledge and skills to take care of patients (Carper, 1997), to apply humanistic values and also to recognize their own limits and responsibility (Meleis, 1997; Carper, 1997). These shared characteristics give them certain distinctiveness and make them different from other students (Price and Cortis, 2000). Student nurses’ epistemological dilemmas concern empirics, ethics, personal and aesthetic knowing. Empirics as the science of nursing is based on the assumption that what is known is accessible through the senses, i.e. seeing, touching and hearing. Ethics focuses on the moral component of knowing, the norms and ethical codes of nursing, what are good and right, and what is responsible. Personal knowing concerns the inner experiences of becoming a whole, aware self. Aesthetic knowing refers to the comprehension of meaning as a singular, particular, subjective expression called art/act. It allows one to move beyond the limits and circumstances of a moment (Carper, 1997; Chinn and Kramer, 1995). It is important to understand that knowledge of the ontological and epistemological dilemmas of nursing does not directly increase ethical actions or collaboration between staff and students in nursing care (Birkelund, 2000). One of the commonly used methods to improve student nurses’ epistemological learning is reflection. This means that student nurses think critically about incidences and their actions in response to them (Schon, 1983; Burnard, 1995; Glen et al., 1995) and try to connect their actions to certain theoretical dimensions (Atkins and Murphy, 1993; Smith, 1998). According to previous papers (Gavanagh, 1991; Heikkinen et al., 2003), there are some problems in open discussion. Half of Finnish nursing students in one polytechnic thought that a good
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nurse should not feel envy (Heikkinen et al., 2003). There is also a fear of including envy among the characteristics of a nurse (Heikkinen et al., 1998). On the other hand, the feeling of envy and especially the negative consequences of envy are difficult to explore because they are subconscious (Foster, 1972; Alberoni, 1993; Klein, 1994). On the other hand, the philosophy concerning ontological dilemmas, holistic caring and good caring (Tuomi, 1997) may involve problems to discuss of envy openly. If the educational environment is studentoriented (Halldorsdottir, 1990; Hughes, 1993), it helps student nurses to become patient-oriented (Rolfe, 1994) and improves their motivation to study (Simonson, 1996; Spouse, 1998).
Review of the literature on envy Envy can be defined as a feeling of displeasure and ill will at the superiority of another person in happiness, success, reputation, or the possession of anything desirable and a tendency to regard with discontent another’s possession of some superior advantage which one would like to have for oneself (Simpson and Weiner, 1989). The concept of envy is defined in philosophical (Gillman, 1996), psychological (Freud, 1982; Klein, 1994; Berke, 1991; Gillman, 1996), sociological (Foster, 1972; Alberoni, 1993; Scheler, 1961) and nursing science (Maijala et al., 2000; Heikkinen et al., 1998, 2003) literature. Many philosophers find envy a painful element of anger, malevolence and grief (Gillman, 1996). According to Scheler (1961), resentment develops through a revenge – malice – envy – malevolence and disparagement stimulus. Envy elaborates resentment when the revengeful and malicious feelings are subdued. Jealousy is often confused with envy and approached in almost identical words (Gillman, 1996). Jealousy is a fear of losing something that belongs to one, while envy is a desire to have something that one has never possessed (Foster, 1972). According to Klein (1994) and Alberoni (1993), human self-esteem affects the experience of envy. If a person has good self-esteem, he/she is able to value him/herself and to respect his/her own feelings and opinions. A person with poor selfesteem is in constant need of other people’s attention in order to manage with his/her life. Envy is present when someone compares him/ herself to another and wants to get some of the same things that the other possesses (Freud, 1982). Envy is said to be strongest in relation to an equal (Klein, 1994; Alberoni, 1993). On the other hand, envy can be defined through cultural forms and symbolic
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behaviour and also characterized in terms of social functions. Envy is said to be inherent in every human being and present to a greater or lesser extent in every society (Foster, 1972; Alberoni, 1993). Maijala et al. (2000) showed, by analysing psychiatric nurses’ discussion, that envy was defined as a “lacking” and the object of envy as something good possessed by someone else. Heikkinen et al. (1998, 2003) defines envy through the relations prevailing between students nurses and health care staff. Objects of envy are shown, and managers and lecturers influence the feelings of envy and also the methods of coping with envy.
Aims of the paper The aim of this paper is to describe different definitions of envy in a nurse education environment. Answers were sought to the following questions: 1. What are student nurses’ experiences and perceptions of envy like? 2. What methods are used by student nurses to cope with envy?
Methods The informants consisted of 64 (N ¼ 100, response percentage 64%) student nurses recruited from among the available student nurses (attending classes) who had been studying in the same group for one to three years in one polytechnic of health and welfare in Finland in 1998. It was emphasized to all student nurses that their participation was voluntary, their anonymity would be guaranteed, and all information would be considered confidential. The data were collected with an instrument consisting of 15 open-ended questions. The questionnaire had been designed on the basis of two earlier statements concerning the nursing environment (Heikkinen et al., 1998) and the nurse education environment (Heikkinen et al., 2003). The structural validity of the statements concerning envy was studied with the help of factor analysis. The explanatory proportions (42.1–62.1%) show that the instrument actually measured the object of study (Floyd and Fowler, 1989). Internal validity was measured in such a way that the themes of the questionnaire were based on earlier statements (Heikkinen et al., 1998, 2003) concerning nurse students’ sense of self and objects of envy, the influence of lecturers on envy and the ways of coping with envy. (Burns and Grove, 1999). The questionnaire included questions concerning envy as a concept: “What does envy
E. Heikkinen, A. Isola
mean in your opinion?” There were questions concerning the student nurses’ own and their fellow students’ envy: “How does a student nurse behave or act if she/he feels envy?” “What kind of differences have you noticed in the treatment of male and female students?” “In what situations do you feel envy at school?” How do you behave or act when you feel envy?” There were question concerning the health care environment: “What kind of actions increase envy in the health care environment?” In every question were asked examples of envy. One question was left open-end, and the respondents were instructed to write whatever they wanted to say about envy. This increased internal validity (Burns and Grove, 1999). In this study, a phenomenographic approach was used to analyse the data. The student nurses’ answers included private and personal information about envy, and the descriptions were considered valid (Uljens, 1989; Burns and Grove, 1999) When saturation was reached, data collection was discontinued (Polit and Hungler, 1999). This method was assumed to give the best possible wide, new definitions of the concept of envy. Student nurses are able to describe their own experiences and perceptions of envy, but it is impossible to describe envy as reality (cf. phenomenology). In the phenomenographic approach, the central concept of study is the idea that defines the relations between individuals and the surrounding world. The “what” viewpoint approaches the specific subject of thinking, while the “what kind of” viewpoint refers to the process. Actually, these points of view cannot be distinguished from each other because functioning (the “what kind of” viewpoint) always leads to a product (the “what” viewpoint ) (Uljens, 1989; Gr€ ohn, 1992). This paper clarifies conceptually student nurses’ envy; in other words, it represents a second-degree point of view. The first-degree point of view would involve the question: “What kind of phenomenon is envy in reality?” The informants were not met (the process of analysis took two years), and it is hence impossible to identify any behaviours, feelings or modes of non-verbal communication (Uljens, 1989; Burns and Grove, 1999; Bailey, 1997). The analysis was started by writing down the answers (41 pages) and reading them through. Every answer was analysed for internal connections by formulating descriptive categories, i.e. significance classes. The descriptive categories thus obtained were examined as the results of the paper in a wider context. This is called the conceptualisation conseptualizing of ideas. Similar contents were also found in questions classified under other headings. These contents were added to the chosen themes of
Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
the paper (Uljens, 1989; Bailey, 1997). At the next stage, different categories were distinguished in the horizontal and vertical directions. The horizontal system was used to separate categories that differed by content from each other. In the vertical dimension, the categories were qualitatively distinguished from each other to see, for example, whether a given concept was more important or more general than another. For this paper, the replies in the different categories were counted to show how common the different descriptions were among these students (Uljens, 1989). The reliability of this paper depends on the material and the meanings of the categories. The validity of the material depends on the informants’ tendency to answer the questions as the researcher expects them to answer. The researcher must also realise that her ideas influence the interpretation (Uljens, 1989; Hinds et al., 1990; Appleton, 1995). In this paper, the data analysis shows the genuineness of the categories and significances with consistency. Reliability would have been better if the meanings of the categories had been discussed with the student nurses after the categorization of the themes. This was impossible, because the informants were no longer available to discuss of themes in that polytechnic. According to this approach, the researchers’ categorization is also a finding (Uljens, 1989). The situations and students were unique. Another study could reveal more envy in a nurse education environment (Burns and Grove, 1999). The present findings were produced by these 64 student nurses in one polytechnic of health and welfare in Finland. But the findings highlight some essential points of the concept of envy, which can be extrapolated to discussions in some other nurse education environments.
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After that the things that were related to the education environment and increased the feelings of envy were classified into the following horizontal categories: contents of studying, lecturers’ actions, and students’ mutual relations. Student nurses described the things that increased their feelings of envy as follows: The importance of exams. . . and when we see everybody’s tests marks and can place ourselves below, at or above the average. The male student gets more attention, and he is asked about his feelings and experiences more often than female students.
These categories and the student nurses’ opinions related to the education environment as a factor increasing feelings of envy are shown in Table 1. We differentiated four horizontal categories of levels of envy and three categories of envy as a concept. The differences in envy can be concretised with the help of the following Fig. 1, where envy at an general level, envy of other students, student nurses’ own envy and envy in health care are shown. This figure also includes the key concept of coping with envy, although these findings are explained in the next chapter. Envy was defined as student nurses’ own envy concerning fellow students as follows: It feels sad. Hanging over me.
Student nurses described envy shown by their fellow students as follows: A human being feels hatred, embitterment and inferiority compared to a fellow student if he/she has or gets better things than me. A fellow student uses verbal and social abuse.
Findings Student nurses’ experiences and perceptions of the concept envy Student nurses’ experiences about being as a student were classified into the following horizontal categories: contents of studying, teaching arrangements and social relations. They described their studying in the educational environment as follows: . . .The long days are strenuous both physically and psychologically. . . . . .but there are also many good things. I can compare with this institution with the previous one I attended.
Student nurses described envy at a general level and its relations to the educational environment as follows: People are envious of others’ success or some other matter that they don’t have themselves, for example, money or physical properties. . . A person may feel hatred, bitterness and inferiority towards others who are better than he or she. It may encourage one to try to get better test marks.
The following categories of envy in health care were formulated: envy does not belong to health care, it is connected to womanhood, is part of humanity or is manifested between groups, or may remain hidden. Student nurses described envy in health care as follows:
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Table 1
Characteristics of educational environments and things that increase envy.
Categories of educational environments
Categories of factors that increase envy
Examples of description
Contents of studying: Theoretical (12) Stressful (15)
Contents of studying (8) Desire to be perfect (4) Group examinations – good success without studying (2) Importance of examinations (1) Boasting about one’s success (2)
The importance of examinations. . . and when we see each other’s marks and can place ourselves either below, at or above the average
Lecturers’ actions (46) (unfair evaluation, changing times of returning papers, changing rules, favourite students, arrangements involving superiority, mandatory lectures, registration of absences, compensation tasks) Long days Too many students in the same group
The students are not equal to the teachers.
Positive (23) Interesting (12) Uninteresting (1) Teaching arrangements
Social interaction
Relations between others (9) Relations between students, between students and lecturers between other groups between male and female:
. . .long days are physically strenuous. . .
Quarrels in group for not lending lecture notes.
Students in the technical department get paid. . . Males are treated better (47) Males are treated worse (13) Females are treated better (3)
The male student gets more attention, he is asked about his feelings and experiences. . .
(The number of descriptions is given in brackets).
Envy does not belong to health care because envy among the staff may lower the standard of patient care – the main thing is not the patient but the nurses’ competition with each other. Perhaps envy is quite common within health care because it is such a female-dominated profession.
Nursing students’ coping with envy We established six main categories of student nurses’ ways of coping with envy and also five individual differences that related to the educational environment. Student nurses’ ways of coping with envy consisted of the following horizontal categories: rationalisation, outbursts of feeling, silence, humour, transfer and no envy at all. They described their ways of coping with envy as follows: I try to act so that no one will notice my envy. I think, in other words, I ask myself what is the reason to be envious Small jokes of exam results.
The most general way of student nurses to cope with envy was to rationalise the reasons that caused envy. They thought about the reasons why the other student was better or concentrated on the positive aspects of their own lives. It was possible for a person to talk about envy to him/herself, to a friend or to the target of the envy when a rational strategy of coping with envy was used. Most of outbursts of feeling described were negative. In this paper, the individual differences between nursing students’ ways of coping with envy were also analysed. The experiences of being a student nurse in the educational environment were formulated into five categories, characterised as theoretical, stressful, positive, interesting and uninteresting. The objects of envy were categorised into study success, lecturers’ actions, skills and matters that were not envied. The coping with envy was manifested as rationalisation, outbursts of the feeling, silence, humour, transfer and no envy. All the other answers were categorised as indicating envy that is not relevant to health care, is connected with womanhood, is part of humanity,
Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
Figure 1
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Differences in the definitions of envy by student nurses. (The number of descriptions is given in brackets).
is manifested between groups or remains hidden. On the basis of these answers, 56 experiences were identified. According to the present findings, nine student nurses considered their studying uninteresting and 12 found it stressful (N ¼ 64). Such feelings may be due to quarrels within the group. Negative influences of envy on the student nurses’ motivation to study were found among the three students who denied the existence of envy. It may be that these students’ nurses are not sensitive to others’ emotions in patient care. Wenzlaff (2000) found that unwanted thoughts are difficult to suppress, and suppressing may lead to anxiety, despondency and hopelessness. Student nurses’ individual experiences of studying and the manifestations envy as well as the conclusions are shown in Table 2.
Discussion The findings of this paper shed new light on the essence of envy in a nurse education environment and the connection between envy and student nurses’ motivation to study. It seemed that edu-
cational achievement is the main thing envied, but half of the informants pointed out that this motivates them to study harder for the exams. It may be that formal achievements, such as success in exams, is too highly appreciated in nurse education because there were only a few references to such nursing skills as empathy, collaboration or practical skills. Most of student nurses thought that male students were treated better than female students. The present findings agree with Cummings (1995), who showed that lecturers had favourite students and also treated male students better than female students. The important finding was that student nurses’ experiences of envy appear different, depending on whether they talk about their personal feelings of envy or envy shown by others. Furthermore, envy is described differently at the general level and in health care. When the student nurses described their own feelings of envy, envy was characterised in terms of mild nuances, such as being in a bad mood or coping with envy by rationalisation. When the student nurses described the envy of their fellow students, they used such words as undermine others’ position and consolidate one’s own position. Envy at a general level was described as
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Table 2 Nurse students’ individual experiences of studying and their connections with envy. Findings of this paper
Object of envy Educational achievement Lecturers’ action No object of envy Skills Coping with envy Rationalization Outbursts of feeling Silence Humour Transference Denial Presence of envy in nursing education Not part of health care Connected with womanhood Part of humanity Non-existent Conclusions
Student nurses’ experiences of studying, statistical presentation of opinions Positive (16)
Theoretical, interesting (19)
Uninteresting (9)
Stressful (12)
12 4 2
15 5 1
3 3 2
8 2 3 1
8 3 1 3 3
16 5
4 3 1
9 2 1
1
2
2
2 2 3 1
1
4 4 5 Only group to cope with envy by humour
6 4 3 1
5
The object of Use most envy is least commonly rationalization to closely connected with studying cope with envy
Most deny envy (altogether no object of envy (3) and denial (2))
(The number of descriptions is given in column).
consisting of aggressive feelings and actions. It seemed that the general level of envy was attributed the strongest emotion and that one’s personal feelings of envy were difficult to discuss. Kelly et al. (2000) also found that, when discussing the feelings of dying patients, nurses were unable to approach the idea of death. Instead, they said that “everything is normal” or “it belongs to the ward’s routines”. Furthermore, Yegdich (1999) says that a human must convert his/her experiences into human descriptions of human phenomena. Thus, the existence of envy can be understood by analysing individual experiences of envy and describing envy as a human phenomenon. According to the present findings, the positive influence of envy on the student nurses’ motivation to study was recognised. Envy motivated them to work hard for better grades and to analyse their own weakness and strengths. Reflection may improve collaboration between student nurses if they discuss envy together. These conclusions are similar to those of Smith (1998), who pointed out that reflection helps student nurses to learn about them and to act professionally. The positive influences of envy on social development have been reported by Foster (1972), Scheler, Nietzsche and Hartmann (Gillman, 1996).
Conclusions The main conclusion of this study was that the concept of envy appeared different, depending on whether the student nurses talked about their personal feelings of envy or envy shown by others. Furthermore, envy was described differently at the general level and in health care. These discrepancies could be related to ontological and epistemological dilemmas in health care. Because caring is understood as collaboration, moral responsibility, respect and empathy, student nurses’ individual positions and emotions are involved in the totality of knowing. Hence, descriptions of the strength of personal feelings of envy are inconsistent with ontological dilemmas. Personal knowledge is a standing relative to another and one’s own self (Carper, 1997). For these reasons, clarifying envy as a concept will help nurse students and lecturers understand each other in personal, social and environmental contexts. These findings can be used in nursing education to identify envy as a concept and also to recognize emotions as part of personal knowledge. Emotions are part of education and therefore important to share with other. According to the findings, envy is
Student nurses’ experiences and perceptions of envy in one nurse education environment in Finland
considered also to involve mild nuances of emotions that are not usually attributed to envy. One future challenge is to clarify lecturers’ experiences of envy in the nursing environment. The results of previous studies of envy (Heikkinen et al., 1998; Heikkinen et al., 2003) will also be incorporated into the model of envy in nursing education and practice environments.
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