Using Locus of Control to Empower Student Nurses to be Professional

Using Locus of Control to to be Professional

M. Susan Dawson, RN, MA, MSN

The author examines locus of control as a factor

in some educational problems. Characteristics

and implications of internal and external locus of

control are identified; and strategies are presented

to promote assertiveness, accountability, and

independence in students who previously avoided

risking-taking behaviors.

Empower Student Nurses

M. Susan Dawson, RN, MA, MSN, is Assistant Professor, Nursing Faculty, St. Louis Community College AT Meramec, Sf. Louis, MO.

Locus of control as a factor in the education of nursing students is the focus of this article. The social learning theory of locus of control is directed toward application to education. The types of locus of control-internal and external-are discussed. Implications for nursing faculty are explored with two developmental models identified. Behaviors of internal and external locus of control people are investigated. Recommendations for nursing faculty behavior to facilitate empowerment are discussed in relation to locus of control issues of student nurses.

Basic nursing education provides challenges for students and faculty. Beginning students start the process of fitting their own personal identities into the complex world of nursing practice. Many factors influence the assimilation of students into the professional role. Understanding the variables of students’ responses can provide insight into the teachinghearning milieu. One important variable is locus of control.

Locus of control is a social learning theory referring specifically to belief about a person’s source of control over events. Many people believe that they have control over things that happen to them (internal control). Others believe that other outside forces-for example luck, fate, or other powerful people-control what hap- pens to them (external control) (Rotter, 1966). Rotter con- tends that internally controlled people achieve more, are more motivated, and are more resistant to manipulation than externally controlled people. Externally controlled people are more fatalistic and respond by conforming to external manipulation. According to Rotter, no differences exist in intelligence or ability between internally controlled and externally controlled people.

Locus of control has been considered a factor in health behaviors (Kist-Kline & Lipnickey, 1989, Redeker, 1989), psychological adjustment to stress (Fogas, et al, 1992, Jennings, 1990), and pathological behavior (Bhatia and G o b , 1978). Since reactions and behaviors are critical in

10 Nursing Forum Volume 29, No. 4, October-December, 1994

nursing education, a student‘s locus of control could ulti- mately affect success in nursing education and practice. Exploring the reactions and behaviors of both internally controlled (IC) people and externally controlled (EC) people is worthwhile for nursing faculty to motivate students to succeed.

Internally Controlled Students

Joe (1971) differentiated IC people from EC by specific characteristics. According to Joe, IC people scored high on dominance, tolerance, good impression, sociability, intellectual efficiency, achievement, and feeling of well- being. IC people describe themselves as assertive, achieving, powerful, independent, effective, and indus- trious. Those with internal control tend to control their impulses better, are more willing to work on personality problems, make attempts to seek information, and show overt strivings for achievement. They also avoid failure because they interpret it as reflective of an inability to deal effectively with the situation. The tendency to be more cautious in risk-taking situations, according to Joe is characteristic of IC individuals.

Another perspective of internally controlled students was expressed by Bellack (1975). His evaluation included self-reinforcement, which views locus of control as both a cognitive and a motivational variable. According to Bellack, IC people prefer self -control. This tendency includes self-reinforcement, particularly positive self - reinforcement. The effect of positive self-reinforcement on behavior explains many of the characteristics attributed to the IC people by Joe (1971).

Empowering (giving control, authority, and ability to) nursing students is a fundamental task of nursing faculty (Gibson, 1991). Empowerment is associated with the concepts of coping skills, support, participation, efficacy, competence, self-sufficiency, and self-esteem, according to Gibson. Empowerment entails faculty fostering development of internal locus of control (McGraw, 1992).

The implications of having IC students in a nursing program are many. The IC student appears to have great advantage during this process of becoming a profes-

sional nurse. In terms of trust and ability to risk new uses of self, IC students exhibit more of these traits. A person who is internally controlled and able to self-reinforce in a positive way seems destined for autonomy and a true sense of self-efficacy. Personal choice and responsibility for one’s self are the rudiments of the empowerment process (Gibson, 1991). The IC student possesses those multiple characteristics previously listed that pre- dispose them to empowerment. One-to-one interper- sonal interactions between faculty and students are well received and interpreted positively by the student who has IC traits.

Empowering (giving control, authority, and

ability to) nursing students is a

fundamental task of nursing faculty.

Externally Controlled Students

Joe (1971) distinguished externally controlled (EC) individuals from internally controlled persons by testing for specific characteristics. EC people were identified as having severe levels of anxiety, feelings of powerlessness, frustration, and a propensity toward aggression and hostility. EC people were delineated by suspiciousness, mistrust, dogmatism, low insight, authoritarianism and low need for social approval. People who are externally controlled tend to show less interest in achievement because they feel little control over r e w d s and punishment (Joe, 1971).

Bellack (1975) expressed the tendency of EC people to depend completely on external input. This pattern of EC people reveals deficiency in the use of self-reinforcement. If EC people do self-reinforce, it is likely to be of a negative nature. (For example, they display this type of self talk: ”Great. At least you didn’t mess things up this time like you usually do”). The behavioral effects of this ten-

Nursing Forum Volume 29, No. 4, October-December, 1994 11

~~

Using Locus of Control to Empower Student Nurses to be Professional

dency are particularly important regarding new or changing situations (Oberle, 1991).

Situation changes reflect the process of nursing education. During nursing education, students find themselves giving injections, asking personal questions of their clients, and evaluating care given. These can all be fright- ening new experiences in terms of proficiency and the life-threatening nature of mistakes. EC people have diffi- culty establishing trust, especially with authority figures, such as nursing faculty. So rather than looking to a clinical instructor for guidance, the EC student perceives the instructor as a threat to success and self-esteem.

~~ ~ ~ ~

Facilitating empowerment of nursing

students is allowing students to become

what they are capable of becoming.

Feelings of powerlessness common to EC students place them at a disadvantage in the process of achieving empowerment (Strassberg, 1973). EC students tend to subordinate development of autonomy to external approval. The extreme of this characteristic of external control is learned helplessness (Arkelian, 1981). Neaves (1989) relates that “in spite of efforts (of nursing faculty) to promote professionalism. . . lack of assertiveness, low self-confidence, dependent behavior, and low sense of accountability persistently characterizes the practice of many nurses” (p. 12). The traditional image of the doctor-nurse game-an EC nurse dominated by the desire to gain approval from the authoritarian doctor, or at least to avoid rejection and anger from this powerful other-is the result of EC students not being empowered Weaves, 1989). Nursing educators display forethought in using locus of control as a tool to idenbfy personality types to teach and empower nursing students effectively, particularly EC students.

Locus of Control and the Nursing Education Process

Facilitating empowerment of nursing students is allowing students to become what they are capable of becoming (McGraw, 1992). ”The influence of internal versus external locus of control is very important in developing. . . the professional nurse” (Strasen, 1992, p. 32). Joe (1971) suggests that the locus of control variable plays a major role in the learning process by influencing individual strategies for problem solving and risk taking.

Although locus of control is consided a stable personality factor, the potential always exists for changing a person’s locus orientation by intmducing new experiences (Arkelian, 1981). Changing locus of control from external to internal may be affected by manipulating behaviors (Oberle, 1991).

Nursing faculty members can utilize several means for encouraging externally controlled students to develop internally controlled values. To truly empower nursing students to independent functioning, educators can specifically encourage activities that stimulate exchange of ideas, analysis of problems, and respectful teamwork.

Having students sit in a circle and brainstorm ideas for specific case studies is one strategy to accomplish mutual respect. All student ideas and contributions are accepted, while the faculty member clarifies most eff ec- tive approaches. By opening up the discussion about a specific patient with a specific set of problems in a cli- mate where there is collegiality, all students feel their contributions are significant. By guiding and asking questions, the faculty member encourages nursing students to think their own ideas through, rather than labeling them “right or wrong.”

Nursing instructors can allow students to set their own goals, pursue their own interests within curriculum guidelines, and promote collegiality with other students and faculty in order to influence locus of control from external to internal (Linares, 1989). Allowing many pos- sible approaches to a problem empowers students more effectively than insisting on a faculty member’s one ”right” way. The learning environment should value each individual, as well as create encouragement, moti- vation, and colleagueship (Carlson-Catalano, 1992).


Colucciello (1990) identifies a developmental model from Kelman (1961) as an effective means of professional development for nurses. As illustrated in Table 1, change in the locus of control can be evidenced by the student nurse’s development from external control (compliance and identification) to internal control (internalization) in relation to nursing functions. Being able to identify student behaviors as compliant or identifying will enable nursing faculty members to understand the externally controlled student. The EC student wants to meet the instructor’s expectation for external response. The only way this student knows if the behavior or thought processes are acceptable for nursing is by faculty (external) reassurance. This EC student is likely to select those behaviors that have been approved, and not indepen-

dently adopt other acceptable behaviors. For example, a student nurse gets medications ready on time, and is commended by the instructor. Next time, the student gets the medications ready on time, but lets an IV run dry or misses a treatment. The control is external from the instructor, not from the student. The internally controlled student recognizes that all medications and treat- ments need to be on time because that is part of professional responsibility. The internally controlled student has a role expectation that includes personal responsibility for timing. The knowledge of these differences can be used by nursing instructors to direct learning activities that encourage internalization of values rather than compliance to individual instructor’s authority.

Table 1. Locus of Control Developmental Model

External Locus of Internal Locus of Control Control

Compliance Internalization

Hopes for favorable Accepts norms and standards reactions of student nurse role on rational

grounds

Instrumental thinking tions

Behaves in expected way in order to obtain positive responses from faculty

Nursing student role expecta- are congruent with own value system

Identification

Selective adoption of nursing behavior

Perceived as acceptable because they are associated with student nurse role

(1961), (pp. 57-58).

The internally controlled student has a role

expectation that includes personal

responsibility for timing.

Eyers, Loustau, and Ersek (1992) present another significant model useful to educators in nursing. These authors applied the concepts of ”Women’s Ways of Knowing” (Belenky, et al, 1986) to nursing students. Because most nursing students are women, the concepts can be applied, The nursing students’ perspectives and cognitive development interface with the transitions needed for socialization into the nursing profession. The model categorizes phases of learning by descriptive characteristics. The concepts are easily adapted to student nurses’ ways of knowing as they progress through the education process in terms of locus of control changes. Each concept represents a stage that students can pass through to achieve constructed knowing. Each way of knowing is summarized and related to locus of control changes with suggestions for teaching methods, as follows:


Using Locus of Control to Empower Student Nurses to be Professional

Silence. Externally controlled students are unable to trust; nursing faculty are seen as all powerful. Students’ fear of expressing opinions is based upon fear of faculty disapproval. Students require such methods as group discussion to realize that individual opinions and con- cerns are valued.

Received knowing. Externally controlled students interpret information literally. They always seeks one right answer. EC students feel that being told is the source of information. The receiving, retaining, and returning words of authority reinforces external control. Students at this stage benefit from planning patient care independently before clinicals so that knowledge is perceived as coming from within the student.

They understand that knowledge is

tentative, and are able to integrate

internally and externally gained

knowledge.

Subjective knowledge. Students still believe there are ”right” answers, but are beginning to realize that truth is now within themselves. They value their own voices and experiences in relation to nursing activities. These students see that all opinions are equally valid. However, voiced opinions can sever connectedness with other students and with faculty. Authority is mistrusted because of belief in external control. Collegial activities with faculty, such as attending workshops or seminars with faculty members, can encourage internal control within those relationships.

Procedural knowing. Students are nursing procedure focused. How decisions are made is more important than what is decided. Truth can be shared between faculty and students because students begin to develop

trust in their own control. Knowledge validating activities, such as student created class presentations, help the growth process for this nursing student who is in transitional locus of control.

Separate knowing. In spite of all activities, students remain detached, critical, adversarial, and suspicious. External control is very prevalent and transition to internal locus of control may or may not occur, regardless of learning activities.

Connected knowing. Students operate in relationshp with other students and faculty reciprocally; they believe in connectedness even in disagreement. Students in this stage use procedures for evaluating others’ knowledge, and enjoy collaborative learning. These students are beginning to use relationships for a transitional stage of locus of control. Group activities in nursing lab can facilitate the important bonding needed by these nursing students.

Constructed knowing. These nursing students listen to their own voices as well as others and integrate separate and connected approaches to interaction. They are not afraid to be analytical as well as connected. These students respect their own opinions and others’ opinions. They understand that knowledge is tentative, and are able to integrate internally and externally gained knowledge. A historical sense of self is developed by these students. Internal control has enabled understanding that comes from considering teaching and learning in context.

Being familiar with these ways of knowing, as well as with the suggested activities, can facilitate the faculty’s ability to influence locus of control changes in student nurses. The nursing faculty can accomplish positive changes in locus of control by:

Seeing the role of faculty members as facditators of learning experiences rather than as fountains of indisputable information;

directed behaviors rather than material to be mem- orized and given back verbatim;

Respecting student development and input by dis- playing a collegial attitude and trusting student

Presenting problems to be solved by student-


power to reason and problem solve, rather than by strict supervision that encourages powerlessness;

Questioning to encourage creative and critical thinking rather than leduring to assure coverage of content.

Conclusion

Distinguishing between internal and external locus of control in nursing students is a useful tool in solving nursing education problems. By understanding the characteristics of locus of control and using suggested models, nursing faculties can facditate internal control behaviors in students. These behaviors lead to empowerment in students and later in practicing nurses.

Locus of control is a means, not an end in itself. The development of nursing as a profession depends upon caring faculty interested in positive change during the education process. Students require a large measure of understanding and effective teaching/learning experiences to cultivate internal locus of control and empowerment in practice.

Nursing faculty members can be role models by con- tributing knowledge and skills without taking offense or acting defensive about students' questions. In a truly scholarly, empowering atmosphere, nursing faculty can provide the environment necessary for internal locus of control development.

In an academic environment that truly influences student nurses' locus of control, the faculty must change its attitude from, "I have what you want, and I dare you to get it," to a more vulnerable "Let me share ways of knowing and learning with you." Self -examination of each faculty member's own locus of control and need for power will facilitate attitude changes toward students that result in true collegiality. The result of this change of approach can be profoundly influential toward student change in locus of control. Not all students can or will respond to empowerment attitudes and behaviors on the part of faculty. But developing internal locus of control in at least the professional arena wiU contribute dramatically to the professional status student nurses strive to achieve.

References

Arkelian, M. (1981). An assessment and nursing application of the concept of locus of control. Annals of Nursing Science, 16,25-42. Aspen Systems Corporation.

Bellack, A. (1975). Self-evaluation, self-reinforcement, and locus of control. Journal of Research in Personality, 9,158-167.

Bhatia, K. and Golin, S. (1978). Role of locus of control in frustration- produced aggression. lournal of Consulting and Clinical Psychology,

Carlson-Catalano, J. (1992). Empowering nurses for professional practice. Nursing Outlook, 40,139-142.

Colucciello, M. (1990). Socialization into nursing: a developmental approach. Nursing Connections, 3(2), 17-27.

Eyres, S., Loustau, A., and Ersek, M. (1992). Ways of knowing among beginning nursing students. ]oumal ofNursing Education, 31,175-180.

Fogas, B., Wolchik, S., Braver, S, Freedom, D. and Bay, C. (1992). Locus of control as a mediator of negative divorce-dated events and adjustment problems in c h i l h . Ameriuzn Journal of Ortkchiaty, 62,589-597.

Gibson, C. (1991). A concept analysis of empowerment. Journal of Advanced Nursing, 16,354 -361.

Jennings, B. (1990). Stress, locus of control, social support, and psychological symptoms among head nurses. Research in Nursing and Health, 23,393-401.

Joe, V. (1971). Review of the internal-external control construction as a personality variable. Psychological Reports, 28,619-640.

Kelman, J. (1961). Processes of opinion change. Public Opinion Quarterly,

Kist-Kline, G. and Lipnickey, S. (1989). Health locus of control implications for the health professional. Health Values, 13(5), 38-47.

Linares, A. (1989). A comparative study of learning characteristics of RN and generic students. Journal ofNursing Education, 28,354-360.

McGraw, J. (1992). The road to empowement. Nursing Administration Quarterly, 26(3), 16-19.

Neaves,J. (1989). The relationship of locus of control to decision making in student nurses. Journal of Nursing Education, 28(1), 12-17.

Oberle, K. (1991). A decade of research in locus of control What have we learned? lournal of Advanced Nursing, 16,800-806.

Redeker, N. (1989). HdthbeLiefs, health locus of control, and the frequency of practice of breast self-examination in women. JOG", 1,45-51.

Rotter, J. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs: General and Applied, 80(609), 1-28.

Strasen, L. (1 992). Imge of Professional Nursing. Philadelphia: Lippincott. Strassberg. D. (1973). Relationships among locus of control, anxiety,

and valued-goal expectations. Journal of Consulting and Clinical

46,364-365.

25,57-58.

P S Y C ~ O ~ O ~ Y , 41(2), 319-320.


Documents

Using Locus of Control to Empower Student Nurses to be Professional