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Student’s self esteem at threat
ways to enhance nursing and medical students self esteem

By Saira AmirAli Khimani

On the first day I was so anxious about giving the wrong information to the patient. I remember one of the patients asked me what my diagnosis is. ‘I said 'I do not know', she said 'you do not know? How can you look after me if you do not know what my diagnosis is?' and there I lost my self esteem.

This type of incidences is unforgettable in a medical and nursing student’s academic life. Such moments spoils self-esteem and self image of students. Chronic low self-esteem is an important concept to measure as it has been linked with depression and with suicide attempts in adolescents. (Begley & White 2003). Studies have shown outrageous results of chronic self esteem. In a follow-up study of 101 US medical schools, 15 students were reported to have committed suicide between August 1989 and May 1994 (Dyrbye, Thomas, & Shanafelt 2005). Therefore positive self esteem of oneself is a universal need for every human being and is an essential component in restoring and maintaining mental and physical health.

Individuals who feel good about themselves are confident, take pride in their work, and demonstrate respect and concern for patients and colleagues. Studies have highlighted that a students may develop a stronger sense of professional self-concept as the transition from student to nurse progresses. Final year students express a higher professional self-concept than their second year counterparts (Arthur & Thorne as cited in Arayathanitkul, et al 2002).

It has been suggested that the roots for building high self-esteem may lie in the educational process. However this educational process always comes up with many challenges that are the major causes of negative self concept of a student. A recent study of nursing student experiences of clinical practice identified that clinical experience is one of the most anxiety producing components of the nursing program (Sharif & Masoumi 2005). Furthermore lack of clinical experience, unfamiliar areas, difficult patients, fear of making mistakes and being evaluated by faculty were expressed by the students as anxiety-producing situations in their initial clinical experiences. In addition, adjustment to the school environment, exposure to human death and suffering, educational debt, ethical conflicts and personal life events are reported causes of low self esteem among medical students. Hence both nursing and medical students equally feel threat to their self esteem after entering into this challenging professional education.

Initial clinical experiences and other causes reported to decrease the self concept may lead to serious consequences such as substance abuse, impaired academic performance, academic dishonesty and frustrations. One student shared that “when I came home, I started to shout on my sister she has done nothing actually on that day patient had shouted on me in front of other patients just only because I had not administered her painkiller as I am not allowed thus it was the wrong reaction (frustrations) on the wrong person.”

As Richard Bach stated “Sooner or later, those who win are those who think they can”. There are many strategies discussed in literature to cope with low self esteem and the challenges of academic life. Among these strategies seeking social support, managing daily life effectively and engaging in s recreational activities are most commonly use by the students. Likewise there are different approaches for enhancing positive self esteem among nursing and medical students.
These are as follows
Cognitive Approach: This approach emphasize on developing positive mental attitudes, helping students to think about their feelings, and adopt healthier ways of interpreting or relating to the events that occur in their lives. Certain strategies such as reflection writing, sharing clinical experiences and case scenarios help the student to reflect and analyze their perceptions in order to reduce their clinical fear.

Behavioral approach: This approach endeavors to develop specific functional behaviors in students so that they can display behaviors that command greater respect from others and self-esteem in themselves. Such behaviors may relate to voice control, posture, eye contact, or expression of feelings. As Eramus truly said “Fortune favors the bold”.

Experiential approach: Robert browning truly states “Praise is the best diet for all of us, after all”. Building on this concept this approach provides positive experiences for students to build up feelings of self-respect and self-esteem. Most of the activities rely on external sources of feedback and reinforcement. Positive and immediate feedback by incharge nurse or clinical faculty for caring a sick patient is an example of experiential approach.

Environmental approach: This approach is a more holistic approach that structures the environment and the activities students engage in to develop particular attitudes and skills that lead to high self-esteem. This approach generally talks about providing safe, nurturing and professional environment where a learner can learn by role modeling and independently. These approaches contribute greatly in building a high self esteem of students.

Along with these strategies faculty of the institution also plays a major role in building self concept and self esteem of undergraduate medical and nursing students. First the school can improve evaluation system from grading (A-F) to pass/fail and adding extracurricular activities in the curriculum. Moreover allowing students to contribute in curriculum development can enhance their self concept and self esteem. Secondly teach students to use adaptive coping mechanisms for example acceptance, planning and positive reinterpretation, and self-distraction as a part of their formal curriculum.

In a nut shell a student may develop a stronger sense of professional self-concept as the transition from student to a certified professional. Throughout the course of studies, students face academic and personal life stressors that hinders in developing positive self regard for themselves. Thus to combat with the lower self perception and self concept a student should be equip themselves from problem solving abilities, recreational activities and supportive colleagues. Institutions should also look into updating the curriculum, evaluation system and assisting students who are not able to cope with the demands of this challenging professional education.