The feelings of guilt and shame experienced by Nursing and Midwifery students☆
Introduction
Feelings of guilt and shame play an important role in social relationships, and in the health care field, interpersonal relations are a very important part of care and treatment. Health team members should be aware of feelings of guilt and shame, but despite their potential importance, these emotions have received little attention in nursing literature. From this perspective, examining nursing and midwifery students' feelings of guilt and shame contributes to students' recognition of these feelings. Furthermore, assessing students' feelings of guilt and shame might be a useful mechanism for enhancing the understanding of these feelings, providing individualised solutions to students' problems, and preparing them for the nursing profession.
Webster's dictionary (2011) gives simple definitions of shame and guilt. Shame is defined as ‘an emotional attitude excited by realisation of a shortcoming or impropriety’, whilst guilt is ‘the state of having committed an offence’ (Parker, 2011).
Guilt and shame are moral emotions distinguished by negatively valenced self-evaluation. The focus of the emotion distinguishes guilt from shame. Shame concerns one's entire self, whereas guilt concerns only a specific action (Robinaugh and McNally, 2010). Classical psychoanalytical theory suggests that guilt serves to enable the ego to balance the conflicts between the id and the superego and is considered a response to the mistake made (Deniz, 2006, Kalyoncu et al., 2002, Karataş, 2008).
Feelings of guilt and shame are not separated by clear-cut boundaries; however, guilt is defined as ‘a distressful situation arising from an awareness accompanied by the actual violation of social rules and values or the design of such action’, and shame is defined as ‘the distressful situation arising from a person's realisation of a basic incompetence’. In summary, guilt is the emotion of internal sanction; shame, the emotion of social sanction (Kalyoncu et al., 2002, Karataş, 2008, Teroni and Deonna, 2008, Tracy and Robins, 2006).
‘Health-care system’ is a term used to describe a system that offers care and medical treatment, rehabilitation, and health support services to society as a whole. Today, the health problems of societies are variable depending upon political, social, economic, environmental, and cultural factors, and they usually have a complex structure. In order to solve this complexity, every health-related discipline should be allowed to provide health-care services in a cooperative and organised manner with its field-specific knowledge and skills. Only in this way can the individual and society attain a healthy, productive, and meaningful way of life (Uygur et al., 2008). Within this context, nurses and midwives undertake crucial roles and responsibilities in the health-care team; therefore, they should be afforded the same importance as the doctors in the health-care team.
On the other hand, student nurses and midwives need to be socialised into their profession in order to undertake crucial roles in the health-care system. The question of how a nurse or midwife becomes socialised into their profession is critically important. Various definitions of socialisation exist. Cohen views professional socialisation as ‘The complex process by which a person acquires the knowledge, skills, and sense of occupational identity that are characteristic of a member of that profession. It involves the internalisation of the values and norms of the group into the person's own behaviour and self-conception. In the process a person gives up the societal and media stereotypes prevalent in our culture and adopts those held by members of that profession (Brennan and McSherry, 2007). In 1981, Cohen recognised the importance of values as a central concept within the socialisation process. In 1977, Lacey emphasised that not only are an individual's personality and qualities important, but also that past experiences influence the socialisation process (Brennan and McSherry, 2007, Howkins and Ewens, 1999, Mackintosh, 2006). Feelings of guilt and shame are influenced by an individual's values, and past experiences. Resolving the feelings of guilt and shame can be an effective part of inculcating socialisation into the profession.
Guilt and shame can fulfil adaptive purposes in specific situations. Shame, for example, reminds the individual of the standards of propriety and behaviours necessary to remain a part of the social group, and guilt serves as a check on interpersonally harmful impulses. When guilt or shame is chronically used to organise and interpret experience, they can become an affective style which might lead to different forms of psychopathology. Guilt and shame can, therefore, also be viewed as traits or affective styles that actively guide a person's processing of information, self-evaluation, and self-regulatory behaviour across time and situations (Ferguson and Crowley, 1997). In other words, shame and guilt represent the work of natural selection to mitigate the power of negative emotions. When individuals experience shame and guilt, they are motivated to take corrective action to affirm cultural codes. Thus, for humans to be moral, they must have the capacity to experience shame and guilt and use this emotion to offer apologies and adjust behaviours so as to conform to norms, ideologies, and values. Unless individuals can experience shame and guilt, they will become sociopaths, and the moral order will break down (Stets and Turner, 2007). However, the feelings of guilt and shame control people; render them inefficient in school, in the social environment, and at work; and are affected by many factors (Carducci, 2000, Gilbert, 2000).
It has been assumed that guilt and shame might affect the abilities of nursing and midwifery students when fulfilling their roles assertively and with professional autonomy during the interdisciplinary care and treatment process (Dahlqvist et al., 2008, Fagerberg and Norberg, 2009, Luhanga et al., 2008). Bond (2009) examines shame in its many manifestations: the power to shame inherent in the clinical context; the consequences of shame on students' ability to learn; and the knowledge, skills, and attitudes needed by nurse educators to heal and prevent shaming in clinical nursing education. Bond (2009) concludes that shame and its effect on clinical nursing education must be taken into account by nurse educators. Therefore, feelings like guilt and shame should be identified during the education of nursing and midwifery students and such problems should be addressed and resolved.
Section snippets
Purpose and Research Questions
The present study was conducted with a cross-sectional design for the purpose of examining the feelings of guilt and shame in student nurses and midwives with respect to personal characteristics. The research questions are as follows:
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What are midwifery and nursing students' guilt and shame mean scores?
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Are the midwifery and nursing students' guilt and shame levels affected by their personal characteristics (gender, age, type of school, year at school, income status, and educational background of
Findings
The findings of this investigation on the levels of guilt and shame are dealt with under two titles in this section: ‘Personal characteristics of the students’ and ‘The guilt–shame scores and their association with personal characteristics’.
Discussion
In most empirical studies, both shame and guilt have been positively related to psychopathology and interpersonal difficulties (Rüsch et al., 2007). However, the effect of shame and guilt amongst populations of nursing and midwifery students has not been covered in the literature. Nursing and midwifery are professions that require interpersonal communication, and members of these professions are required to have effective communication with the individuals in their care, their families, and
Conclusion and Recommendations
Nurses and midwives should be aware of feelings of guilt and shame, both their own and their clients'. For example, feelings of guilt and shame are very important in sexual health. Nurses and midwives are effective promoters of sexual health. The World Health Organisation's definition of sexual health emphasises freedom from fear, shame, guilt, etc. (WHO, 1986). Therefore, both the nurse and client are free of guilt and shame in order to promote sexual health. As another example, health-care
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This study was presented as a poster in the 9th National Nursing Students Congress “With International Participation” held in Muğla, Fethiye on 01–03 April, 2010.
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Student in second year.
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