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Investigación y Educación en Enfermería

Print version ISSN 0120-5307

Invest. educ. enferm vol.31 no.2 Medellín May/Aug. 2013

 

ARTÍCULO ORIGINAL / ORIGINAL ARTICLE/ ARTIGO ORIGINAL

 

Violence and discrimination against nursing students in a Colombian public university

 

 

Violência e discriminação contra estudantes de enfermagem numa universidade pública colombiana

 

 

Carmen Leonor Moreno-Cubillos1; Luz Elena Sepúlveda-Gallego2

 

1MD, Especialist. Professor, Universidad de Caldas, Colombia. email: carmen.moreno@ucaldas.edu.co.

2MD, Ph.D. candidate, Professor, Universidad de Caldas, Colombia. email: lesga@une.net.co.

 

Receipt date: November 27, 2012. Approval date: May 8, 2013.

 

Subventions: none.

Conflicts of interest: none.

How to cite this article: Moreno-Cubillos CL, Sepúlveda-Gallego LE. Violence and discrimination against nursing students in a Colombian public university. Invest Educ Enferm. 2013;31(2): 226-233.

 


ABSTRACT

Objective. To measure the frequency of acts of gender discrimination and violence against nursing students in a Colombian public university. Methodology. A cross-sectional descriptive study with a representative sample of 81 students in the nursing program was conducted during the first half of 2011. The information was taken through a self-filled survey, inquiring about the history of violence and discrimination during college life, taken place on campus and at practice sites. Results. Seventy percent of the students were subjected to one of 17 types of violent or discriminatory acts investigated during their university life in the university facilities or in practice sites. The most frequent events reported by students were: abuse of authority (43%), taunts, gestures and obscene compliments (32%), psychological aggression (27%); verbal aggression (19%); and discrimination due to physical appearance (12%). Conclusion. A high proportion of nursing students participating in the study were subjected to acts of violence and discrimination. It is necessary for the university to generate welfare strategies to change attitudes related to these actions.

Key words: sexism; social discrimination; violence; students, nursing.


RESUMO

Objetivo. Estimar a frequência dos atos de discriminação e violência de gênero que se apresentam contra estudantes de enfermagem numa universidade pública colombiana. Metodologia. No primeiro semestre de 2011 se realizou um estudo descritivo de corte com uma mostra representativa de 81 estudantes do programa de Enfermagem. A informação se tomou mediante enquete auto-diligenciada que perguntava sobre antecedentes de atos de violência e discriminação durante a vida universitária, sucedidos no campus universitário e nos lugares de prática. Resultados. 70% dos estudantes foram objeto de algum dos 17 tipos de atos violentos ou discriminatórios pesquisados, durante sua vida universitária nas instalações da Universidade ou nos lugares de prática. Os eventos mais frequentemente referidos pelos estudantes foram: abuso de autoridade (43%), enganos por meio de burlas, gestos e piropos obscenos (32%), agressão psicológica (27%); agressão verbal (19%); e discriminação por aspecto físico (12%). Conclusão. Uma alta proporção dos estudantes de enfermagem participante no estudo foi objeto de atos de violência e discriminação. Faz-se necessário que a Universidade gere estratégias de bem-estar para modificar as atitudes relacionadas com atos de discriminação e violência.

Palavras chaves: sexismo; discriminação social; violência; estudantes de enfermagem.


 

 

INTRODUCTION

Florence Nightingale, known as 'the lady with the lamp' not only became the symbol of nurses for her performance during the Crimean War, but because of her knowledge, revolutionized the education given in schools in England, introduced important concepts in medical education and public health, and promoted secular education in nursing schools. Most significantly for all these activities was, to challenge British society stereotypes; first, by acquiring knowledge through her liberal father after rejecting an arranged marriage and becoming a nurse against her family's will, eventually confronting the public health system to defend her ideas.1

Today, the status of nursing personnel still continues to create difficulties for their professional practice because the relationship between the abuse on these professionals and the degree of stress or exhaustion they present, as well as their performance at work and their absenteeism,2-6 has often been documented; on the other hand, nurses, along with other health personnel, rank first in what is now called occupational violence and has been generating increased hospital costs, requiring security personnel at the care sites,7 given that they also run a higher risk of being subjected to violent events, -lethal or not-.8 Also, nursing students still face social and educational stereotypes, by which they undergo different acts of aggression during their training. One is acceptance of bullying as part of the culture in the workplace regarding a profession that has traditionally involved women and has been linked to care and service, where aggression comes not only from their superiors but also from patients; the latter case involving the acceptance of this behavior as part of the healing process as the patient is considered in a state of vulnerability.9

In this regard, in 2004 Celik and Bairaktar surveyed 225 nursing students in Turkey and found that 100% reported having suffered verbal abuse, 83.1% academic abuse, 53.3% sexual abuse, and 5.7% physical abuse.10 These behaviors generate a high likelihood of developing depressive symptoms. Moreover, as found Cortés' literature review on depression, the risk factors for depression are combined in most nursing students: being female, under 25 years of age, being single, reported child sexual abuse, performing occupations that generate stress and doing night shifts; other frequent life stressors are, single motherhood, being head of household, double work shifts, and pregnancy.11

Also in 2004, at the university object of this study, a descriptive research on sexual violence among students from 10 academic programs was conducted, finding that the nursing program ranked second in frequency for these kinds of events,12 given that the sample obtained at that time was not randomly selected, it was considered of interest, to further study this research with the students from the nursing program with a representative sample that would adequately generalize the results. In this sense, this study sought to measure the frequency of acts of discrimination and gender violence against nursing students at a public university in Colombia.

 

METHODOLOGY

This article presents the results of a research project titled: 'Discrimination and violence against women in the Faculty of Health Sciences of a Colombian university', which was a cross-sectional descriptive research and had as target population the university community (faculty, students, and administrators) from the Faculty of Health Sciences of a Colombian university, and as unit of study the members of that community. The project was approved by the Faculty's Bioethics Committee. The required information was obtained from primary sources from a survey filled out by each of the individuals in the sample, after signing informed consent and receiving delivery of the definitions of the events to be investigated.

The study was conducted with a representative and random sample of the population comprised of 1806 students, 265 professors, and 31 administrative staff, the calculation resulted in a sample of 372 individuals based on an estimate of 50% for the ratio, a maximum 5% tolerable error, and an estimated loss of 25% of those selected. Students were stratified by academic program and the sample for the nursing program was 81 students.

The variables used for the study were demographic; those related to discriminatory or violent acts, which were adapted from the instrument used by research at Universidad de Antioquia on gender violence,13 breaking down the different types of discriminations; and those referring to the aggressor. Those related to this aspect were: abuse of authority, harassment at work, sanction or punishment; discrimination based on physical appearance, gender, sexual orientation, religion, origin and socio-economic level; exclusion; aggression, physical, psychological and verbal; blackmail; threats or intimidation; jokes, compliments, or obscene gestures; sexual harassment and rape. The variables that characterized the aggressor were: sex, rank, and if the complaint report of the event was made or not - in the latter case, descriptions of the reasons were elicited via open questions. The history of discriminatory or violent acts throughout university life was investigated, both on campus and in practice sites. The information was processed in SPSS version 15. The values used to determine statistically significant differences was the chi square, with p values lower than 0.05; Fischer's exact test was also used.

 

RESULTS

Responses were obtained from 81 students of which 72.8% were females, 75.3% were in the age range between 20 and 29 years, the mean age was 21.1 years and standard deviation was 2.8 years; 48.1% came from Manizales, the other 13.9% from another capital city and 38% from non-capital cities. Some 2.5% of the students were recognized as Afro-Colombian, 2.5% as belonging to indigenous communities, and 95% as mestizo. 91.3% reported belonging to socioeconomic levels one to three and the remaining 8.7% to level four, 72.5% reported belonging to the Catholic religion, 7.5% to another religion, and 20% to no religion. According to sexual preference, 90% of students claimed to be heterosexual, 6.3% homosexual, and 3.7% bisexual. As for the time spent at the university, 72.2% of students had three years or less of college life.

A total of 70.4% of the students reported having experienced at least one of the events investigated during their university stage. Table 1 presents the frequencies found for each event, as well as sex and rank of the aggressor. It can be seen that the most frequently reported events were abuse of authority (43.2%), taunts, compliments or gestures (32.1%), psychological aggression (27.2%), and verbal aggression (18.5%). In most of the events, the frequency of the female sex offender is higher; however, the male sex was predominant in sanction or punishment (60%), physical aggression (100%), blackmail (100%), taunts, compliments or obscene gestures (73.1%), and sexual harassment (100%). In most events, professors had the role of aggressors and, with higher frequencies than other ranks in abuse of authority (82.9%), workplace harassment (80%), sanction or punishment (90%), discrimination due to gender (75%), origin-based discrimination (66.7%), exclusion (70%), psychological aggression (81.8%), verbal aggression (53.3%), blackmail (10.00%), and threats or intimidation (100%). This study did not register any cases of rape.

Abuse of authority was more frequent as students spent more time at the university; thus, the frequency of students with one year or less of permanence was 16.7%; for students with two to three years, it was the 35.6%; for students with four to five years, it was 76.2%, and for students with six years or more it was 100%. The previous relationship was statistically significant (X2=15.02, p=0.002).

Statistically significant differences were found when sexual orientation was related to discrimination because of sexual orientation, given the frequency among heterosexuals was null, it occurred in two of the five homosexual subjects and in two of the three bisexual subjects (X2=40.7, p<0.001). When student gender was related to the exclusion phenomenon, statistical significance was found more frequently among male students (27.3%) compared to women (6.8%), by a disparity of 5.6 (X2= 6.22, p= 0.021). The analysis of the phenomena of exclusion found that two individuals of African descent, one of the two natives, and one of every ten Mestizo were subjected to it (X2 with Yates' correction = 17.57, p<0.001). The most common reasons for not reporting were fear of reprisals (30.2%), lack of objectivity from the disciplinary bodies (25.6%), did not consider it necessary (23.3%), and lack of knowledge of the procedure to report (13.9%).

 

DISCUSSION

Colombian legislation defines abuse of authority as the abuse of functions of public servants or the use of their Office for their own benefit.14 It is stated in the act against workplace harassment (Act 1010 of January 23, 2006), but this definition can be applied to civil servants and to any structure where there is a hierarchy of power that can be used against those who are in the lower ranks; for the present case, it would be professors over students. The results of this research show that, as would be expected, longer exposure or permanence in the university results in more frequent events. Additionally, the increased frequency of female offenders could be attributed to the fact that the majority of nursing teachers, especially in the last three years of a five-year program, are women. It is also worth noting that in practice sites students are also subject to the power structure of each institution.

Abuse of authority was the most frequent event reported in this study. Thomas and Burk, based on the conception of Meissner according to which, in vertical violence teachers exercise their authority by abusing students, found in their study that the most common forms of abuse of authority were: feeling ignored, blamed unfairly, humiliated publicly or that their assessments of patients were not taken into account. These authors recommend that both hospitals and educational institutions should endeavor to eradicate this type of violence.15

The events that ranked second in this study were the taunts, gestures, and obscene remarks that, mostly, were perpetrated by other male students. These attitudes are part of what has been studied as 'bullying' or school harassment but that we also see reflected in the university and it has also been regarded as one of the elements of sexual harassment. Although this has often been documented in the nursing staff, the frequency found in this study is 2.5%, which is considerably less than the 37.1% reported by Celik and Celik.16 This low frequency is because in this study some behaviors that are part of the behavior covered by the workplace harassment act were separated, as are jokes, obscene gestures and remarks, blackmail and threats. If all were added, the frequency would amount to 40.8%.

Psychological aggression or bullying, as called by Leymann in 1980,17 was the third event found in this study, with a frequency of 27.2%. These values are lower than initially reported by Yildirim in the 2007 study with nurses in Turkey, which reported 86.5%,18 but higher than the 21% found in the 2009 study.19 The value is also much lower than the 70% found among nurses in the United States,20 where half of the attacks were caused by colleagues, a finding similar to that by Rowe and Sherlock.21 This type of aggression, more subtle than verbal aggression, was committed mostly by male professors, which in the case of the nursing program are concentrated mostly in the area of basic sciences common to the Faculty of Health Sciences, where the subjects have a high rate of failure and repeats.

Verbal aggression was ranked fourth in this work with a frequency of 18.5%; this is below the 80.3% reported in Turkey22 or the 38.9% in Thailand,23 but with the concern that about half the cases are caused by professors. The high frequency found in the study may be related to changes in the language of adolescents and young adults, which has finally become the accepted form of communication between them in order to be accepted by the group. Although it is significant in the long term for those subjected to it, the event is even more serious when caused by professors because it affects not only the teaching-learning process, but, for example, it perpetuates this aggressive behavior in future professionals.

In this study we found all kinds of discrimination, especially regarding physical appearance and origin, which, as described by Junious et al.,24 are stress factors not detected in quantitative studies, but which have great impact on ethnic minority students that represent 26% of the students in the US. Latinos make up 15% of the US population, but only 1.5% of registered nurses belong to this group and to reach some level of recognition they must be persistent, or in the words of these students 'be hardheaded' in their aims in view of the discrimination they face.25

It is also noteworthy that, although nursing as part of the health sciences calls for a significant degree of tolerance, this does not seem to be the case regarding sexual diversity, and as in the rest of our society, are resistant to those with a different sexual orientation other than heterosexual.

Equally significant is the fact of exclusion referred to male students who make up a quarter of the students in the program, possibly related to the perception of nursing being a female profession, where stereotypes and prejudices make male students to be seen as gay or as not having the qualifications to work in this profession; therefore, suffering gender discrimination especially from female professors.26,27

The values also reveal association between exclusion and being afro-descendant or from indigenous communities. Because of this type of violence, students have to deal with insensitivity and discrimination, and have feelings of loneliness and lack of understanding from their peers or support from the professors.28

As in most cases of discrimination and non-physical violence, not reporting the facts suggests under recording. The recorded reasons for not reporting the events have to do with their situation of inferiority as students, within the university hierarchy, especially when this complaint is against a professor who can use his/her position to harm a student, either personally or through other faculty staff; also, because students feel helpless in against the university structure and do not know the procedures or the existence of a disciplinary code that covers professors.

We can conclude that the conditions of violence and discrimination shown against nursing students are present in the university studied, considering that a high proportion of them reported having been subjected to acts of violence and discrimination during their stay in college. Despite legislative advances in the area of protection for women, non-discrimination and punishment for sexual harassment, they have failed to eradicate the phenomenon. More strategies are, therefore, required to improve the conditions of the student population, as well as to modify the attitudes of teachers in the field of discrimination and violence. In this sense, it is necessary for the university subject of this study to implement welfare strategies to change attitudes related to such behavior promoting a healthy coexistence among the various university establishments.

 

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