Anxiety and Peer Support of Diverse Nursing Students: A Narrative Inquiry Approach by https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu A Project Created for University of Saskatchewan EADM 842 Submitted to Amanda Stalwick April 12, 2022 en-us 2022-04-09 15:15:17 UTC 2022-04-13 18:31:49 UTC hello@padlet.com https://padlet-uploads.storage.googleapis.com/1662592048/85e819a9a6d83c85ec9c045baf22ce81/Lisa_Photo.jpg Anxiety and Higher Education lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2139989306
  • 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)

    • ]]>     2022-04-12 00:18:02 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2139989306     lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2139996232 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
    ]]>     2022-04-12 00:23:37 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2139996232     Research Puzzle lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140007718 How do (diverse) nursing students with anxiety experience peer relations throughout the undergraduate BScN educational program?]]> 2022-04-12 00:32:23 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140007718 To Whom Does this Matter? And Why? lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140017337
  • Students
  • Educators
  • Institutions
  • Nursing Practice

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

    ]]>     2022-04-12 00:39:49 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140017337     “A good story gives you the chance to better understand someone else’s life. It can help you find common ground.” ~Barack Obama lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140023507 Twitter Feed: https://twitter.com/barackobama/status/1164192919047299072]]> 2022-04-12 00:44:38 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140023507 Choosing the Methodology lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140024399 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)


    ]]>     2022-04-12 00:45:17 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140024399     Participant Selection lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140024950 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.


    ]]>     2022-04-12 00:45:43 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140024950     Data Collection lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140025169
  • 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. 

    • ]]>     2022-04-12 00:45:52 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140025169     Data Analysis lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140025312
  • 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.

    ]]>     2022-04-12 00:45:59 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140025312     Knowledge Translation lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140025490
  • 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.

    • ]]>     2022-04-12 00:46:09 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140025490     References. lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140026745 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






    ]]>     2022-04-12 00:47:02 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140026745     Background Literature lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140028725 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.







    ]]>     2022-04-12 00:48:40 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2140028725     Seeing Myself as a Narrative Inquirer lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2141035232
  • 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

    • ]]>     2022-04-12 15:37:42 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2141035232     Ethical Considerations lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2141056368
  • 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)


    • ]]>     2022-04-12 15:51:24 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2141056368     Questions and Thank You! lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2141066948 2022-04-12 15:58:04 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2141066948 Summary and Abstract lisamckendrickcalder https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2141099640 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. ]]> 2022-04-12 16:20:36 UTC https://padlet.com/lisamckendrickcalder/hmwmr5gqocc9gwnu/wish/2141099640