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Nurse Education Today 33 (2013) 13371341

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Nurse Education Today


journal homepage: www.elsevier.com/nedt

Organisational culture and learning: A case study


Elaine Bell
Women and Children's Health Network, Adelaide, South Australia, Australia

a r t i c l e i n f o s u m m a r y

Article history: Objectives: To explore the impact organisational cultures have on the learning experience of student nurses
Accepted 19 February 2013 and identify the inuencing factors.
Methods: A case study approach was used. The single case being a Defence School of Health Care Studies
Keywords: (DSHCS) and the multiple units of analysis: student nurses, the lecturers and Student Standing Orders. An
Learning
in depth three dimensional picture was achieved using multiple data collection methods: interview, survey,
Student
observation and document analysis.
Nurses
Culture
Findings: The ndings suggest that the DSHCS is perceived to be a sub-culture within a dominant civilian
learning culture. Generally, the students and staff believed that the DSHCS is an excellent learning environ-
ment and that the defence students overall are high achievers. The common themes that appeared from
the data were image, ethos, environment, discipline, support, welfare and a civilian versus military way of
thinking.
Conclusion: The learning experience of defence student nurses is very positive and enhanced by the positive
learning culture of the civilian Higher Educational Institution. The factors inuencing a positive learning
experience that can be impacted by the overarching culture are discipline, image, ethos of adult learning,
support and welfare.
2013 Elsevier Ltd. All rights reserved.

Introduction nurse or soldier. Single service military command would explain


that the role of soldier takes precedence over that of nurse. However,
The Defence School of Health Care Studies (DSHCS) sits within a the nurse is recruited for her/his nursing qualications which are
large civilian institution and the education offered is fully integrated governed by a regulator body the Nursing and Midwifery Council
within the civilian curriculum. Military student nurses are taught (NMC, 2004). It is worthwhile considering the mission of DMETA,
with and learn alongside their civilian colleagues facilitated by both which is to develop defence medical education, training and re-
military and civilian nurse lecturers. Having spent ve years as a mil- search with its academic and clinical partners (DMETA, 2006), this
itary nurse lecturer in this environment it became apparent that there supports the Defence Medical Services (DMS) mission to provide mil-
were a number of differences between the military and civilian stu- itary medical personnel who are correctly trained and current in their
dents. The military nursing students appeared to be excelling above specialties to enable them to fulll any operational requirement
the civilian students in the overall statistics and the reason for this (MOD, 2007). To achieve this mission, a complete restructure of the
had not been explored. This unique situation was the catalyst for this military defence medical services occurred to allow consultants, spe-
study and is particularly noteworthy given the increasing number of cialists, nurses, technicians and other medical professionals to work
United Kingdom (UK) defence training establishments who are devel- within the National Health Service (NHS) alongside NHS colleagues,
oping partnerships with civilian organisations (Edmonds, 1999). usually in Ministry of Defence (MoD) Hospital Units (MDHU s).
The aim of the study was to explore the perceived organisational The organisational culture in the defence forces is characterised by
culture within the DSHCS and evaluate how this may impact on the tradition, morals, norms and a set of social patterns which is communicat-
learning experiences of military student nurses. ed through stories, rituals and symbols (Taylor and Rosenbach, 2005).
These characteristics are overarched by three concepts: expertise,
corporateness and social responsibility (Huntingdon, 1978). The authori-
Literature Review
sation of soldiers to use deadly force in ways that the rest of society
cannot, suggests a very different role and organisational culture within
There is a potential role conict for military nurses, the role of
the defence forces from that of the rest of society (Hartle, 1989). The
carer versus that of combatant, that is, is their primary role that of
cultural characteristics of the defence forces include readiness, speed, re-
liability, self-sufciency, versatility and an ability to improvise (Janowitz,
72 King William Road, North Adelaide South Australia 5255, Australia. Tel.: +61
81618728. 1968). The soldier has a component of an heroic posture in his profes-
E-mail address: elaine1bell@googlemail.com. sional self image for he must be prepared to face danger (Field, 1968).

0260-6917/$ see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.nedt.2013.02.009
1338 E. Bell / Nurse Education Today 33 (2013) 13371341

The extent to which employees accept the organisational culture reward which is broadly political, so the culture within a HEI can be
will signicantly affect the climate, and if people do not feel part of considered as the pursuit of tting culture to the needs of its mem-
the organisation and do not share the dominant attitudes and beliefs bers and tting the needs of the members to the needs of its culture
it is likely to result in negative emotions and conict (Mullins, 1994). (Bruner, 1996). This is interesting when considering the potentially
This is extremely relevant when exploring the impact organisational differing needs within a military culture and that of a civilian HEI
culture may have on the learning experience within a defence school and the impacts of this on the learning experience of the students
that sits within a large civilian university. Organisational culture can within these.
be dened as: Learners should be active participants in a programme of study,
the learning experience being meaningful and having a critical focus
the collection of traditions, values, policies, beliefs, and attitudes (Grundy, 1987). Learning is dened as:
that constitute a pervasive context for everything we do and think
in an organisation The combination of processes whereby the human person (knowl-
(McLean and Marshall, 1993, p. 1). edge, skills, attitudes, emotions, values, beliefs and the senses) en-
ters a social situation and constructs an experience which is then
Phrased more simply it is how things are done around here transformed through cognitive, emotional and practical processes,
(Mullins, 1994). Organisational culture provides a consistent outlook and integrated into the persons biography
and maintenance of values to support decision-making, co-ordination (Jarvis and Parker, 2007, p. 2).
and control; however, this consistency may result in many attitudes
and beliefs becoming permanent and unchallenged, making them high- Learning to live in a new culture involves subtle changes to expec-
ly resistant to change (Peters and Waterman, 2004). These values and tations, loss of identity, familiarity and social events that once provid-
beliefs are mostly passed on from previous generations (Schein, ed encouragement, direction and to meaning to life (Brislin et al.,
2004). Members of an organisational culture engage in rituals, pass 1975). External factors such as goals and resources, and internal fac-
along myths and stories and use jargon to communicate the tors such as perceptions and expectations need to be considered
organisational culture (Baker, 1980; Deal and Kennedy, 1982), and (Triandis, 1975). Assessment is seen to be a strong motivator for
this concept is particularly strong within the defence forces (Taylor study (Quinn, 2000). The focus on assessment can foster a strategic
and Rosenbach, 2005). learning strategy when the student is only concerned with passing
Ethos can be dened as the underlying attitude towards the world the course rather than the learning experience itself (Biggs, 2000).
and how this is reected in the tone, character and quality of life Learning does not take place in a vacuum (Fenwick and Tennant,
(Geertz, 1993). Within the defence forces this can be illustrated 2004). Each learner brings their own experiences, socio-economic
through the salute, uniform, insignia of rank, promotion and com- background and beliefs which inuence how they learn. Yet, there
mand and supports the ceremony and etiquette. This symbolism is little known about the inuence a military culture can have on
within the military is often perceived as tradition, and tradition can how students learn when placed in a dominant civilian environment.
be seen to dene identities, power relations and social interactions
within organisational cultures (Boyer, 1990). Tradition can be seen
as the basis of truth and cohesion, through rational processes which Methods
have survived conict and debate, within a wider context (Brown,
1995). There are two distinctive types of military cohesion, rstly, A case study approach was used to explore the inuence a military
task which is collective commitment to a common goal and, secondly, culture may have on how students learn when placed in a dominant
social which is deemed to be the emotional bonds and personal rela- civilian environment. The single case being the DSHCS and the multi-
tionships within the group (Bondy, 2004). The inuence of the task at ple units of analysis were the military student nurses, the lecturers
hand may impact on the perceived culture of military student nurses and Student Standing Orders. The data was collected primarily using
depending on where they see their primary role, whether it be a de- semi structured interviews using a sample of six third year military
fence or a nursing role. The social aspect will be impacted by the emo- student nurses, supported by questionnaires completed by nine
tional bonds and personal relationships they may develop with those nurse lecturers within the DSHCS and triangulated using the docu-
beyond the defence force organisational culture. ment analysis of the Student Standing Orders (SSO). The interviews
Most organisations have more than one set of beliefs inuencing were conducted at a time and location that was mutually convenient
the behaviour of their members and often results in the development for the participant and the researcher and lasted approximately
of sub-cultures (Morgan, 1986). Factors that can impact on interper- 30 min. The interviews were audio recorded with the consent of the
sonal relations between sub-cultures include goals, resources, per- participant and then transcribed verbatim by the researcher. The in-
ceptions, expectations and role. Within this an individual may terviews were transcribed with precision, but did not include excla-
expect respect due to age, profession or status which is fully acknowl- mations, laughter, stalling, silences, pauses or hesitations as it was
edged within their own cultural environment (Triandis, 1975). Yet, the content not the structure that was analysed (Mellon, 1990). Orig-
this may not be acknowledged beyond their cultural group and so is inal copies of the transcripts have been kept for archiving to adhere to
of particular interest when considering military rank and its meaning the Data Protection Act 1998 (Robson, 2002). Copies of these were
outside of a military context. In contrast to this, if an individual con- made to assist the in depth analysis of the data, which were destroyed
forms to the expected behaviour and expectation of a sub-culture, once analysis was complete. Following transcription each participant
he is afforded legitimacy and acceptance by that group (Rollinson, was given the opportunity to review their own data to ensure
2002). Each group therefore needs to understand the differing man- that transcription was accurate to promote the validity of the data
agement styles, status, reward and evaluation systems of the other collected (Lincoln and Guba, 1985).
(Datta, 1991). This may be achieved through effective training and Consideration was given to include civilian students within the
education. sample groups to provide a comparative element. However, due to
Education provides skills, ways of thinking, feeling and speaking time and resource constraints it was decided to focus this study on
(Bruner, 1996). The aim is for learners to acquire knowledge and de- military students with a recommendation that further research be
velop judgement, to become self reliant, to create new knowledge untaken focusing on civilian perspectives within this environment.
and to work well together (Garton and Pratt, 1989). This does not Data was analysed using a Constant Comparative method (Erlandson
stand alone but exists within a culture of power, distinction and et al., 1993).
E. Bell / Nurse Education Today 33 (2013) 13371341 1339

Table 1
Interview questions (military students).

Tell me about your time in the DSHCS

If you could change one thing what would it be? Achievement


What does organisational culture mean to you?
How would you describe the organisational culture within the DSHCS?
Does it differ from the organisational culture of your previous unit? Please explain.
What motivates you to learn?
How is your motivation inuenced by the course? Support &
What are your expectations for the rest of the course? Welfare Environment
Military
Vs
Purposive sampling was used and the inclusion criteria for the Civilian
sample group were rstly, that they must be in their third year of stu-
dent nurse training and secondly, that they must have previous expe-
rience of working within a military unit prior to commencing their
training. Ethical approval was gained from the university research
Ethos and Discipline
ethics committee and all elements of the case study proposal and
Image
data collection methods were supported. The military nursing stu-
dents were interviewed using a semi structured approach and denot-
ed 25% of the chosen population. The interview questions can be
found in Table 1. The questionnaire consisted of eight open ended Fig. 1. Themes from data collection.
questions which were linked to the student's interview questions to
support the triangulation of data. The questions can be found in
Table 2. All participants reviewed the transcriptions and interpreta- Bill felt that a student being exposed to the military culture is a
tions of the interviews and agreed that they were a true reection. positive factor as we are a military organisation. Bill's statement
All names used in this paper are pseudonyms to protect the identities strongly supports the perception that the military is different from
of the participants. any civilian organisation. There was a feeling of strong commitment
to learning from the military lecturers, particularly illustrated by
Results and Discussion Roberta, who said that 99% of lecturers are committed to the stu-
dents. So it could be reasonably concluded that although a perception
The central theme was a strong distinction between the civilian of differing cultures exists an overarching culture of learning was
and military cultures and the impact this had on the learning experi- dominant. The presence of a degree of fragmentation in the perceived
ence. A number of strong themes emerged from the data: denition culture and the potential that an underlying military sub-culture
of culture in regard to a military versus a civilian culture, achievement, exists could impact on the internal sense of community, but not neces-
image, environment, discipline, ethos, support and welfare, which can sarily learning (Becher and Trowler, 2001).
be seen in Fig. 1.
Achievement
Dening Organisational Culture
Assessment is seen as a strong motivator and inuential factor
The participants dened organisational culture by using varying when considering achievement (Quinn, 2000). This was alluded to
discourse, for example, one of the students dened it as something in the student interviews and staff questionnaires, but more emphasis
that means something to us, we join the military and have a camara- was made to the sense of achievement and very little reference was
derie that no one understands outside of the military. Another stu- made to assessments. Mark said I want to qualify and deploy opera-
dent said it is like a big family, the military. The comment by the tionally and work as hard as possible to get the best experience so I
rst student is extremely interesting in that she believes no one out- can be a better nurse and work to the highest standard possible
side the military context will understand the culture and this is very with the people I am there to do the job for. There was a strong
much in line with the theory of Balkanization, in that people belong sense of a deep approach to learning, for example, Colin, who said
exclusively to a group where others are not accepted (Hargreaves, Being here is part of the journey of becoming a qualied nurse and
1999). This is reinforced by the second student who referred to the every day is a learning experience I can only describe it as a journey
military rather than the wider HEI when dening organisational cul- of learning. Although, there were indications of strategic learning
ture. The defence forces do not support a them and us culture, but and mention of assessments such as Jackie, who said If you have an
do fully embrace the concept of military ethos and the need to assignment due in you tend to work together or help each other it
achieve their mission to train medical personnel who can operate leads to a good learning environment for the military students and
within a military operational environment. Alan explained that The whole point of this is to qualify and it's a
target and something I am looking forward to. Achievement did sup-
Table 2 port the emergent theme of discipline.
Questionnaire questions (military lecturers).
Discipline
What does organisational culture mean to you?

Please describe your perception of the organisational culture within the DSHCS?
Discipline can be dened as instructing a person to follow a particu-
List all the factors that you believe shape the organisational culture within the
DSHCS, please make a list of positive and negative. lar code of conduct and adhere to a certain order, essentially, methods of
Does the organisational culture within the DSHCS differ from your previous unit? modeling character and teaching self control and acceptable behaviour
Please explain. (Papalia et al., 2006). This certain order can be closely related to the
If you could change one thing about the DSHCS what would it be and why? roles, rules and responsibilities that exist within an organisation and
What do you think motivates military student nurses to learn?
can be strongly linked to its culture (Mintzberg, 1971). The structure
1340 E. Bell / Nurse Education Today 33 (2013) 13371341

within the DSHCS is hierarchical embracing rank as its building blocks These results would suggest that the ethos within the DSHCS is
and this was evident among the military lecturing staff for example, very much related to image and the desire to wear uniform but
Harry said They [DSHCS students] are not allowed as much autonomy with a reluctance to do so due to the environment within which
to guide their personal learning as civilian students. This is also learning was occurring.
established clearly in the SSO which outline to the military students
what rules and regulations must be followed. Each student is required Environment
to read these and sign to say that they have fully understood them on
the beginning of their training. They are fully accessible to them at The military students clearly appreciated the need to be within the
any time. This is in line with any other military unit where the docu- civilian learning organisation in order to achieve their goals but felt
ment is usually called Unit Standing Orders. that external factors, specically, military resources could improve
Discipline is a major factor when determining military strength, ef- their environmental living and increase the promotion of a military
ciency and professional knowledge (Bondy, 2004). However, these ethos (Triandis, 1975). The wider student experience can have a sig-
orders seem to have developed a perception among some of the mili- nicant impact on the learning event and living in halls of residence
tary students of being treated like children. A number of students can provide support but also problems in the maintenance of friend-
mentioned this perception in their interviews for example, Zoe said ships (Mackie, 1998). Learning to live in a new society involves subtle
we are treated like children even though we are Phase II trainees, changes to expectations, loss of identity, familiarity and social events
and a lecturer, Bill, commented that occasionally you hear that that once provided encouragement, direction and added meaning to
student's are afraid to come up the corridor, and a number of the stu- life (Brislin et al., 1975). Some felt that the lack of this would disad-
dents explained that the corridor in which the military lecturers sit vantage those military students who joined directly and had no pre-
has various names, for example, the corridor of power and the vious military experience, feeling that these individuals would
ivory tower. struggle once qualied and posted to their rst military unit. Never-
When interviewed the students provided some interesting in- theless, they did appreciate that military events organised by the
sights into their perception of the discipline within the DSHCS, Colin DSHCS were helping to overcome this, namely, early morning physi-
said that Everyone needs a leader and to be told you need to be cal exercise, military evenings and military exercises.
here at this time and there at that time if you don't have discipline
and a leader then it all falls apart. Yet, Zoe who transferred to Support and Welfare
nurse training after being a medic in the Army felt that military nurs-
ing students were sometimes belittled and made to feel like a private Social responsibility is seen as one of the overarching concepts that
soldier but we have earned our rank and the right to be here. Colin, dene a military culture (Huntingdon, 1978). The commitment to a
who was a transfer from the Army but a more junior rank to Zoe, said common goal encompassing emotional bonds and personal relation-
They [DSHCS] treat us like children a little bit but some of the senior ships within the group is also an important concept related to ethos
ones [military students] don't like being talked down to. There was a (Bondy, 2004). This is addressed within the DSHCS by the Divisional
clear focus by some on recognition for prior achievement in the pur- Support Ofcers (DSO) who have overall responsibility for the military
suit for ongoing achievement within the professional training. It students' welfare throughout their training. This includes accommo-
appeared that could have been inuenced by the ethos within the dation issues, support during disciplinary action, medical needs and
DSHCS. emotional support for any personal issues they may experience.
Military students are paid a salary throughout their training and
Ethos and Image provided with accommodation and extra money to pay for food and
this appears to be a strong inuencing factor in their welfare and sup-
When considering the role of achievement and discipline within port needs. This was highlighted by Mark, who said I chose the mil-
the context of organisational culture and learning, rituals were itary and it is an added bonus to get paid, I couldn't go through
found to be particularly strong within the military (Taylor and student loans and everything like that.
Rosenbach, 2005). A military culture embraces the salute, uniform, There was a strong link between the support provided by the
rank and command, supporting the ceremonies and etiquette found DSHCS and also the discipline as Zoe explained [DHSCS] staff moti-
within it (Geertz, 1993). One of the student's, Elliott, remarked in vate me because they encourage you and tell you you are doing really
uniform I believe that it helps re-establish that we are part of the mil- well, but they give you a kick when you need it. The SSO also provide
itary. Interestingly, one of the lecturers, Tracy, responded I don't
think we need to wear uniform to have credibility as military staff,
it changes the dynamics of the classroom. Yet, when asked if stu-
Military
dents should wear uniform while at the university all the students environment
interviewed responded no. For example, Zoe, said No, I think it is Civilian
too much of a risk it only takes for something to happen to one per- Influence Image
son. Zoe went on to explain that due to the university being in a
large multi cultural city the wearing of uniform would put them at
greater risk of attack or abuse. This is supported by the recent events
High Ethos of
in Peterborough where military personnel were banned from wearing Learning adult
Achievers
uniform in public as a result of verbal abuse (Dawar, 2008). Whereas, learning
all would be happy to wear uniform if the DSHCS was part of a mili-
tary barracks. The military student nurses had been used to living
on a military barracks behind the wire and were now experiencing Military
Discipline
more open living arrangements. The students commented on the lack rules
of the presence of senior military staff in uniform which previously Salary and
had made them feel more secure and supported but also instilled a Support

strong military ethos throughout. Des Browne, the defence Secretary


said that he felt it's a great shame that some individuals in this com-
munity don't respect our forces (Dawar, 2008). Fig. 2. Summary of overall concepts identied within the DSHCS impacting on learning.
E. Bell / Nurse Education Today 33 (2013) 13371341 1341

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