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Lisa McKendrick Calder, BScN, MN, RN
Associate Professor, Faculty of Nursing, MacEwan University
Ph.D. (Nursing) Student
Twitter: @LisaMC27716654
Orchid ID https://orcid.org/

0000-0002-3261-7174

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Higher Education: Higher levels of psychological distress and poor mental health then age-matched comparisons (Hernández-Torrano et al., 2020)

Alberta Context: 90% of post-secondary students felt overwhelmed, 64% had overwhelming anxiety, 42% felt depressed and found it difficult to function, 13% had seriously considered suicide and 2% had attempted suicide (Alberta Government, 2017)

Saskatchewan Context: 21% disclosed a diagnosis of    anxiety on the entrance to the program and 23% by the
the fourth year of this demanding degree (Brown et al.,  2020)

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How do (diverse) nursing students with anxiety experience peer relations throughout the undergraduate BScN educational program?

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Anxiety is a common experience of post-secondary students, with a higher prevalence among nursing students than in other disciplines (Mills et al., 2020; Wedgeworth, 2016).

Anxiety can range from being a helpful stimulus to an overwhelming factor impacting daily life. With nursing students, anxiety can result in lower grades, and impairment in self-esteem, and in some cases, it can affect their progression in the program (Wedgeworth, 2016).

Suresh et al. (2021) and Eisenberg et al. (2007) found that while a significant percentage of higher education screened positive for depression and anxiety, a much smaller percentage utilized formal support services. Peer support and other informal support mechanisms were being utilized instead (Hefner et al., 2009; Suresh et al., 2021).

Literature I am just beginning to explore is that which provides evidence of differences in the experience of anxiety in different populations. This is at a cursory stage for me and will be the focus of an integrative literature review course I am undertaking this spring but preliminary findings from what I have seen:
1) significant differences in the experience of anxiety in different populations but very little literature is available on the experience itself. Most literature to date focused on prevalence in different populations and thus focuses more quantitatively than qualitatively.
2) Populations, where there is a high variance in experience, seem to also be associated with groups who face social stigmatization and microaggressions (Nadal, Griffin, 2019).
3) Help-seeking behaviours are different amongst different populations.

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Lindsay and Schwind (2016) identifies this question as paramount to narrative inquiry.

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Students

Educators

Institutions

Nursing Practice

What I am Most Interested In:
The subjective experience of navigating the BScN program for individual participants.

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Due to the nature of the research question, a qualitative approach is required. Phenomenology was a good fit as it examines the lived experience of participants, however, so much of what I am interested in better understanding is the personal context of what informs the subjective experience. The narrative inquiry methodology will offer the opportunity to explore and describe this richly.

Narrative Inquiry

Deep excavation of participant's subjective understandings or viewpoints of experience (Clandinin, 2013; Duffy, 2012; McMahon & McGannon, 2015)

Not about telling a story- but instead is about inquiring deeper to look at social, cultural and institutional narratives and the things that shape the participant’s subjective experience (Clandinin, Rosiek, 2007)

Occurs in three-dimensional space- temporality, sociality, and place (Clandinin, 2013)

Do not necessarily focus on “big” problems but on everyday experiences (Clandinin et al., 2018; Clandinin, 2013)

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Look at research puzzles.

Inquirers need to think narratively and relationally (Clandinin et al., 2018)

Inquirers walk alongside the participant (Clandinin, 2013; Lavoie, 2021)

Value experience and collaboration with participants

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“A good story gives you the chance to better understand someone else’s life. It can help you find common ground.” ~Barack Obama

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“A good story gives you the chance to better understand someone else’s life. It can help you find common ground.” ~Barack Obama

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Twitter Feed: https://twitter.com/barackobama/status/1164192919047299072

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Purposive sampling

Small size- anticipate 5-8 at maximum

Seeking voices from diverse backgrounds including as plausible- Indigenous students, male nursing students, international students, English as second language learners, "mature" students

Saturation is not attainable (Kim, 2016) and is not my goal

Empowering the voice of these individuals who may not get as represented in research, and who may have a very different experience with nursing education as well as with mental health and wellness than the vast majority of existing literature.

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Primarily interviews but may also include:

Documents, historical text, photographs, artistic elements like songs and poems (Duffy, 2012)

Participant observation fieldwork, artifacts, and visuals (Kim, 2016)

Interviews: semi-structured or unstructured and usually a series of engagements not a single engagement.

As an inquirer it is important to allow the participant to tell their own story without interruption (Kim, 2016).

I may use a journal prompt to have the participant share their story prior to our first interview.

Ongoing collaboration with participants. Participants are co-inquirers and validation is important.

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Duffy (2012) identified 3 main steps:

1. Identify the method of analysis

2. Analyze the data from that vantage point and criteria of interest

3. Retell the story from the perspective of that method of analysis

The vantage point I am most interested in would be a critical social lens at this stage but may find others speaking within the data.

Important to validate the story with the participant (who is considered a co-creator) and I would like the participants to be involved fully right up to and including knowledge dissemination.

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The reflexivity of the researcher (Lavoie, 2021) is important in narrative inquiry.

The degree of inclusion of participants and validation of re-storying (Duffy, 2012) needs to be reported and need to be clear- whose story is it?

Transparency of process (Duffy, 2012) in the dissemination in particular is important.

Relational Ethics is paramount (Clandinin et al., 2018)

Avoid further stigmatizing (Mollard et al., 2020; Rance et al., 2017)

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The utility of narrative inquiry depends upon its authenticity, adequacy, plausibility, and engagement of the audience to think deeply (Clandinin & Connelly, 2000)

Non-transferable and relies on providing stimulating questions and curiosities to engage the audience

I will be exploring the opportunity to utilize an arts-based approach to dissemination such as photovoice or digital storytelling.

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The rising prevalence of anxiety in the university environment globally is having a profound impact on students, educators, and institutions alike. Anxiety can result in lower grades, and impairment in self-esteem, and in some cases, it can affect their progression in their educational program (Wedgeworth, 2016). Higher education settings are seeing significant investment into student mental well-being efforts and support services.  However, not all students with threats to their mental wellness such as depression and anxiety access these services and many rely on informal support such as peer support (Suresh et al., 2021). There is a dearth of available information on the experience of anxiety in students who are more vulnerable to mental health challenges. This narrative inquiry study will engage diverse participants who live with anxiety and are navigating an undergraduate Bachelor of Science in Nursing degree. The aim is to excavate and re-story their experiences to provide a rich description of the contextual factors that inform their personal experiences with anxiety, focusing on how they experience peer relationships they develop within this educational program and how these may or may not be the informal support services they turn to. Participants will be purposely selected to represent a broad array of experiences and participants will be engaged in multiple phases of data collection including several interviews, potentially sharing of journal entries, artistic artifacts, and participant observation. The knowledge created will be rich stories of 5-8 participants told from the vantage point of the participant, engaging them right through the dissemination point of this narrative inquiry.  Along with stories for translation, all dissemination and story will be accompanied by reflective questions inviting the audience to think deeply and reflect.

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Brown, J., McDonald, M., Besse, C., Manson, P., McDonald, R., Rohatinsky, N., & Singh, M. (2020). Anxiety, mental illness, learning disabilities, and learning accommodation use: A cross-sectional study. Journal of Professional Nursing, 36(6), 579–586. https://doi.org/10.1016/j.profnurs.2020.08.007

Clandinin, D. J., Caine, V., & Lessard, S. (2018). The relational ethics of narrative inquiry. Routledge, Taylor & Francis Group.

Clandinin, D. J. (2013). Engaging in narrative inquiry. Left Coast Press, Inc.

Clandinin, D. J., & Connelly, M. (2000). Narrative inquiry : experience and story in qualitative research. Jossey-Bass.

Clandinin, D.J., Rosiek, J. (2007). Mapping a landscape of narrative inquiry: Borderland spaces and tensions. In

Clandinin, D.J.. Handbook of narrative inquiry:

Mapping a methodology (pp.35-75). Thousand Oaks, CA: Sage.

Duffy, M. (2012) Narrative Inquiry: The Method. In Munhall, P.L. Nursing research a qualitative perspective. (Fifth Edition) Jones & Bartlett Learning (pp.421-439)

Eisenberg D, Golberstein E, Gollust SE. (2007). Help-seeking and access to mental health care in a university student population. Medical Care, 45(7):594–601.

Hefner J, Eisenberg D. (2009). Social support and mental health among college students, American Journal of Orthopsychiatry, 79(4):491–9

Hernández-Torrano, D., Ibrayeva, L., Sparks, J., et al. (2020). Mental Health and Well-Being of University Students: A Bibliometric Mapping of the Literature. Frontiers in

Psychology,11:1226.

Kim, J.H. (2016). Understanding Narrative Inquiry: The Crafting and Analysis of Stories as Research. SAGE Publications, Inc.

https://doi.org/10.4135/9781071802861

Lavoie, M. (2021). Walking Alongside: Relational Research Spaces in Visual Narrative Inquiry. International Journal of Qualitative Methods, 20.

https://doi.org/10.1177/16094069211053107

Lindsay, G. M., & Schwind, J. K. (2016). Narrative Inquiry: Experience matters. Canadian Journal of Nursing Research, 48(1), 14–20.

https://doi.org/10.1177/0844562116652230

McMahon, J., & McGannon, K. R. (2016). Whose Stories Matter? Re-Vising, Reflecting and Re-Discovering a Researcher’s Embodied Experience as a Narrative

Inquirer. Sport, Education and Society, 21(1), 6–113.https://doi-org/10.1080/13573322.2015.1076779

Mills, S., Krouse, A. M., Rossi-Schwartz, R., & Klein, J. M. (2017). Curriculum Revision: Student Stress and Lessons Learned. Journal of Nursing Education, 56(6), 337–342. https://doi.org/10.3928/01484834-20170518-04

Mollard, E., Hatton-Bowers, H., & Tippens, J. (2020). Finding Strength in Vulnerability: Ethical Approaches when Conducting Research with Vulnerable

Populations. Journal of Midwifery & Women’s Health, 65(6), 802–807. https://doi.org/10.1111/jmwh.13151

Nadal, K. L., & Griffin, K. E. (2012). The psychology of hate: How heterosexist biases and subtle discrimination influence the bullying and victimization of lesbian, gay, bisexual, and transgender youth. In M. A. Paludi (Ed.), The psychology of love., Vols. 1-4. (pp. 131–147). Praeger/ABC-CLIO.

Rance, J., Gray, R., & Hopwood, M. (2017). “Why Am I the Way I Am?” Narrative Work in the Context of Stigmatized Identities. Qualitative Health Research,

27(14), 2222–2232. https://doi.org/10.1177/1049732317728915

Suresh, R., Karkossa, Z., Richard, J., & Karia, M. (2021). Program evaluation of a student-led peer support service at a Canadian university. International Journal of Mental Health Systems, 15(1), 1–11. https://doi.org/10.1186/s13033-021-00479-7

Wedgeworth, M. (2016). Anxiety and education: an examination of anxiety across a nursing program. Journal of Nursing Education Practice, 6(10), 23.

https://doi.org/10.5430/jnep.v6n10p23