Chung- Ang University, Red Cross College of Nursing, South Korea
Received date: 24/08/2016; Accepted date: 31/08/2016; Published date: 10/09/2016
Background: Since nurses work with humans, nursing education helps them understand humans and acquire relative knowledge in order to identify and solve problems.
Method: A focus group interview was conducted with 10 participants who attended a chorus activity.
Result: The analysis revealed five themes. “Cooperation and interaction” showed highly positive results and revealed that music helped each participant develop respect and understand for others. “Confidence and sense of accomplishment” helped participants improve school credits, work performance, and attitudes. Regarding “natural communication with the leader,” participants considered it a good opportunity to develop a close association with their professor. “Emotional stability” was experienced by getting along with friends, seniors, and juniors during the chorus activity. Finally, “Adaptation to nursing” was identified as an essential factor for a nurse.
Conclusion: These findings indicate that music helps nursing students gain stability during university life, decreases stress, and improves self-regard, communication, cooperation, and confidence.
Music effect; Chorus activity; Nursing student; Focus group.
• Nurses need to possess an understanding of humans to enable them to work with patients.
• Music helps one to understand others and fosters cooperation.
• This study examined the effect of a chorus activity on nursing students, using a focus group interview.
Although the field of nursing is based on concepts of volunteering and sacrifices, it requires high medical skill and ethical thinking that is rooted in scientific knowledge, as well as decision-making skills. In order to produce nurses with high intellectual level and skill, it is necessary to attempt to change the nursing education curriculum and environment . Nursing education is a very important process because it produces nurses who care for humans, beings with a comprehensive mind structure. Therefore, nursing education should help nurses understand humans and acquire relative knowledge to enable them to identify and solve problems. Therefore, as an expert nursing professional, it is essential for nurses to possess an extensive understanding of human behavior as well as gain comprehensive knowledge, attitudes, and abilities through relationships and communication .
Nursing colleges attempt to improve their students’ theoretical knowledge and learning achievements by providing comprehensive knowledge, ability, and work ethics, but teachers and students feel pressurized to adapt to a new education system. Owing to the unsatisfactory learning achievement, as well as the resource problems in the practical field, nursing students’ lack of knowledge and abilities leads to a high turnover rate and inability to perform the roles of a nurse. If they are not adequately prepared for a nurse’s work, such students find it difficult to adapt to hospitals and feel victimized due to the resultant stress. Moreover, a lack of confidence causes anxiety, which in turn leads to negative interactions with others .
The most important factor in the nursing field is not only to develop the knowledge and ability to effectively complete a given task, but also to create human resources that reflect a mature personality, that is, someone who has a positive attitude, is generous and open-minded, and can cooperate with others. It also includes someone who has the ability to react, and exhibits active thought, a critical attitude, and creative thinking . Nurses with a mature personality provide a comfortable and stable environment, use lots of their potential ability with positive thinking, such that they can adapt to the society and help overcome difficult tasks. Therefore, it is important to offer an optimal educational environment in the nursing college curriculum, in addition to an opportunity to develop the essential characteristics mentioned above.
In order to cater to these needs, nursing colleges currently attempt to develop and offer elective and compulsory in the regular curriculum to bring out diversity and creative thinking. However, the opportunities are still insufficient. The nursing college curriculum and education environment require a paradigm shift. Since nursing is a study aimed at human beings, it is especially necessary to develop not only intellectual and scientific abilities, but also to foster cultural and artistic abilities through the humanities. This, in turn, will help improve nursing students’ self-confidence and other abilities that enable nurses to fulfill a flexible role in any given situation.
A previous study suggests the necessity of music education in the nursing college and nursing curriculum, as a curriculum activity to help solve the problems encountered by nurses. A broad definition of music suggests that it applies to the human culture and virtues, and conveys knowledge . Activities that can effectively improve positive thinking and psychological stability are vital for nursing professionals, as they enable them to solve the problems they encounter during nursing education. To improve the psychological sense of stability, music therapy is utilized as a useful intervention strategy to address feelings, perception, and human emotions .
In addition, musical experience helps relax the body, mitigates negative reactions such as depression and anxiety, and restricts aggressive behavior while interacting with the nursing environment [6-10]. When applied into the nursing curriculum, it improves nursing students’ ability to understand patients, and decreases the burden of practice by improving confidence. Music education through a chorus activity helps develop emotional stability, and fosters positive thinking . Such chorus activities will help students who deal with complex human being, and facilitate the process of building a mature personality as a nurse who meets societal demands.
Thus, the present study provided nursing students an opportunity to participate in a music activity within the nursing educational environment, and examined their experience with the same. The positive results of this study will guide the development of an improved nursing curriculum. The purpose of the study was to examine the positive effects of an individual’s participation in musical activities, through a focus group interview, focusing on nursing students’ experiences during the various steps of a regular chorus activity. It also aimed to form the foundation for developing effective strategies for nursing through music activities. Thus, the following research questions were explored:
1.Does the chorus activity have a positive effect on nursing students?
2.Which strategy of a chorus activity can be useful to nursing majors?
3.What are the effective methods to improve the implementation of a chorus activity and musical thinking in the nursing curriculum?
This qualitative study employed a focus group interview to discuss and describe nursing students’ experience with a music activity. The study addressed the question, “what is the meaning and value of nursing students’ experience of a chorus activity?”
A focus group interview is one of the most used research methods to develop and evaluate health and medical relationship programs because it facilitates free discussions and group interactions by forming a structured group of people who have a common interest. A focus group interview can draw out the intensive experiences, thoughts, opinions, and insights of participants about a topic, and provides detailed information regarding their opinions.
Unlike individual in-depth interviews, a focus group interview readily creates a situation that fosters interactions between the group participants, such that the researcher can easily explore what he/she wishes to study. Moreover, the researcher can accurately understand the contents and motivations of the participants’ experiences .
Participants included nursing students from colleges located in Seoul, who spontaneously participated in a regular chorus activity. They were active participants and submitted the application form chorus by themselves before attending. Additionally, they had experience of chorus practice and of participating in a subscription concert. To recruit participants, those who participated in the chorus activity were notified about the aim of the study through emails or the Social Network Service (SNS), and those willing to participate in the present study were selected. Subsequently, out of those who consented to participate, 10 were selected for the focus group interview.
According to Morgan,  a few participants barely suitable for a study may not yield intensive information about the empirical subject so as to generalize the findings. Additionally, he suggested that 6–10 participants were adequate for a focus group interview, as it is difficult to continue a discussion with less than 6 participants, and difficult to control it with more than 10 participants. Therefore, 10 participants were selected in the present study, to ensure an optimal number of research participants.
The data was collected through a focus group interview that was conducted on April 20, 2015. The participants were explained the purpose and process of the study during the first 10 minutes. They were then provided 5 minutes to gather their thoughts, after which the discussion commenced. The focus group interview lasted for 1 hour and 30 minutes. The researcher led the interview, and it was recorded using a cell phone and a recorder. The interview was conducted in a seminar room to ensure that the interview could be conducted comfortably, and the interviewer could understand their thoughts, behaviors, and emotions. The researcher developed a draft of the interview questions, which were reviewed by an expert, to ensure the validity and practicality of the questions. The interview continued until no new content was generated through the discussions. He also maintained a record of additional information such as nonverbal behavior or expressions, and emotional expressions, which were used while analyzing the data.
In order to accurately draw the characteristics and thoughts of the group, the researcher began the interview with a general topic. Though the opinion of the participants is important, there was a time limitation. Thus, if the group digressed from the main subject of discussion, the researcher naturally controlled it and summarized the discussion.
The interview questions focused on the participants’ experience rather than their general opinion. The interview commenced with an introduction, and included main, reverse, and final questions. It gradually proceeded from general to specific topics relevant to the purpose of the study.
The main interview question was an open-ended one, “what is your general experience of the chorus activity?”, gradually moving to more specific ones such as “what is the most favorite aspect of the chorus activity?”, “what difficulty did you face during the chorus activity?”, “which aspect of the chorus activity is good for nursing?”, and “Do you think it necessary to have music and chorus activities in the nursing curriculum?”
This study was approved by the research ethics committee of the institution. Before conducting the focus group interview, the participants were explained the purpose and process of the study in detail, and all the results were processed anonymously, to ensure privacy. After explaining the participants’ right to withdraw participation during the study, they signed a written consent form to participate in the study.
The recorded data was first transcribed and the empirical content and meaning of the data significant for the study were drawn out by reading the transcripts repeatedly. Subsequently, meaningful statements and phrases related to the topic of study were identified. Based on his understanding, the researcher then classified such statements into general and abstract statements. The abstract statements were then compared and analyzed, and classified into categories. Finally, based on the systemized topic and categories, common themes were identified from the statements.
Validity and reliability
To ensure the validity of the results, the researcher attempted to meet the standards of credibility, audibility, fittingness, and conformability used in the evaluation of qualitative research. For credibility, the researcher chose participants who had abundant experience of participating in the chorus activity, and during the interview, he used open-ended questions to tap information on various experiences and insights. The researcher transcribed the interview and analyzed it qualitatively.
Analysis of the focus group interview with 10 participants revealed the following five themes: “cooperation and interaction,” “confidence and sense of accomplishment,” “natural communication with the leader,” “emotional stability,” “adaptation to nursing.” The themes and participants’ verbatim statements on each theme have been presented below.
Theme 1 Cooperation and interaction
All participants viewed the chorus activity as a chance to experience cooperation in different forms. Through harmony of sound and balance of music, they explained that they learnt to adapt to human relationships, understand others’ opinions and circumstances, and have an opportunity to interact with other. Participants considered cooperation and interaction as the foundation of a continuous relationship and connection. Thus, cooperation and interaction through the chorus activity showed a high positive result. Additionally, the harmony of music helped each participant develop respect and understand for others. The participants opined that this activity offered an opportunity to develop a continuous relationship between seniors and juniors, and between companions.
“It was good chance to communicate with friends, seniors because I do not like to relate with someone before attending chorus activity.” (Participant 1)
“It was method to communicate with someone who I do not hang out with. The chorus activity which makes me easy to connect others is the most memorable activity that I have done in my university life.” (Participant 3)
“I can make friends with other classes and especially I can get along with students with intimacy. It is common that do not know each other even at the same school for several years. So it was good to know each other through chorus activity.” (Participant 5)
“Everyone tries to sang harmony to one song and finally knows how to do make the harmony together. In the busy daily life, it was precious time because we all make effort to go to the same positive goal.” (Participant 6)
Theme 2 Confidence and sense of accomplishment
Most of the participants reported that repeated chorus practice, accomplishment of a new song, and confidently performing the resulting song led to a sense of accomplishment. They emphasized that learning music theory for the first time, understanding sound and rhythm, and creating a harmony with others were key factors that developed self-confidence. They also experienced a feeling of accomplishment when they achieved a goal. Furthermore, they recognized that the chorus activity not only provided them confidence and a sense of accomplishment, but also motivated them to find meaning and purpose in university life, which in turn helped improve school credits and employment opportunities, and aided the review of their life values and attitudes.
“I was happy because I had mastered difficult song and confident by practicing song … When I completed effortneeded song, I felt a lot of happiness and accomplishment.” (Participant 3)
“I thought that the pleasure and sense of accomplishment when I finish concert at the first time will helps me to solve problems with confidence.” (Participant 4)
“I become to have my own experience of club or volunteer activities when I get a job in the hospital. I can tell someone that I have priceless memory and university life.” (Participant 8)
“It was boring and busy life before I participated in chorus activity. I can study hard and get high credit because of this activity.” (Participant 9)
“When I sang, I was one part of group. And I feel accomplishment even though the song didn't have good harmony.” (Participant 10)
Theme 3 Natural communication with the leader
At first, all the participants felt uncomfortable in participating in the chorus activity with their professor or teacher. However, over repeated sessions, they viewed it as a good opportunity to learn from their teachers. Thus, if the leader or conductor was their professor, it provided the students opportunities to develop a close connection through regular meetings.
“I become familiar to professor. It was special chance to choose and participate in chorus activity.” (Participant 3)
“Thanks to passion of professor, I can take participate in chorus activity and it make me overcome difficulty so that I can finish concert.” (Participant 9)
“It was happy to intimacy with professor and can meet her outside of class. I would not feel embarrass when I go clinic through this activity.” (Participant 8)
Theme 4 Emotional stability
Participants realized that they were happy to get along with friends, seniors, and juniors during the chorus activity. During the meaninglessness and stress of practical exercises, they recognized that their moments with music provided them comfort and stability, which improved their overall school life.
“In boring school life with practical exercise and class, chorus activity is my healing point. Sound music, especially singing the various genre such as traditional song, hymn and pop song was good for my mental health and joy of my life … It was special experience to develop my perspective.” (Participant 2)
“There was a gap between my imagination and reality because I always study in the school. Now I feel I am really university student and … boring university life becomes exciting.” (Participant 3)
“Even practice was joyful and it was like a gift set of university life that one can enjoy including after party, volunteer activity, MT.” (Participant 5)
“I have employment and national exam ahead so I had a lot of anxiety, unstable mind, stress. Thanks to chorus activity, I can have stable mind and escape from depress." (Participant 7)
“I feel belongs and my life becomes more fun. Because of getting a job, my confidence went lower and lower. Thanks to chorus activity, I can get along with others and recover confidence.” (Participant 10)
“Chorus will give lots of power to live in the future. It is unforgettable memory, great time to have precious memory. It will be my best memory of university life.” (Participant 11)
Theme 5 Adapting to nursing
Participants recognized their responsibility to practice and participate in the chorus activity. They also realized that being in harmony with the group was one of the essential characteristics of a nurse, because he/she had to deal with their duties at the hospital. As members of the chorus, they tried to participate and made an effort to get along and manage each other, as is also required for nursing.
“It is useful in the practical field because I learned how to harmonize with others through the chorus activity.” (Participant 1)
“I expect that chorus activity will be a good experience to balance with medical team in the clinic.” (Participant 2)
“Through the chorus activity, I experienced harmony. I think this experience will help me to adapt nursing task which needs to cooperate with each other for efficiency.” (Participant 5)
“By doing practice, as song made beautiful harmony, I could feel cooperation and importance of harmony …” (Participant 6)
“Everyone enjoys and helps to learn and sing so that I can learn teamwork and duty as one of the team, how to harmonize with others. I cooperate with someone and complete something.” (Participant 8)
“These days, people try to appeal themselves but through the chorus activity I learn how to harmonized with others … Playing is not individual work but team works. I learn how to listen, concentrate on others.” (Participant 9)
“To care for someone, the most important factor is considerate mind. In this sense, the chorus activity gives considerate and peaceful mind to me.” (Participant 11)
Nursing involves caring for patients who exhibit comprehensive thought, behavior, and multi-cultural diversity. In order to cater to the problems of patients who have diverse values and beliefs, nurses require sufficient knowledge, skills, and integrated information .
Nursing entails catering to the diversity in the patients. However, caring for human beings has some challenges. In this process, humans have to cooperate and communicate in order to understand others’ perspectives.
In the present study, parts of the chorus activities, such as cooperating to divide, harmonizing sound, and making identical music, required the participants to cooperate, communicate, and interact with others. This also aided the students to think about the same in their social life or other aspects of daily life. Several nursing studies have revealed that cooperation and interaction are the most important aspects of nursing. Through cooperation, nurses can achieve the philosophy of care, and therefore, its importance is continuously emphasized .
Nurses are required to develop knowledge, manage patients, and can manage the medical machine for new technology to care patient. Further, self-confidence and sense of accomplishment are essential qualities in a nurse. In order to seek solutions for patients with new symptoms and tackle their endlessly changing conditions, nurses need to develop abilities such as confidence, problem-solving, and critical and creative thinking. Further, achievement through confidence further motivates nurses to generate positive outputs .
The findings of the present study indicate that students can develop confidence through the chorus activity, and a sense of accomplishment when they overcome obstacles. Another study revealed that confidence and sense of accomplishment were essential for nursing students,  which are reinforced through music. This supports the findings of the present study.
Even though most tutors in the present nursing college tried to improve nursing students’ practical ability to care for patients’ heath in the clinic, majority of the students sought a job in the field they majored in. With an increase in the demand for nursing, students have to face many uncertainties. Many students choose nursing because of their grades or parents expectations, rather than their own preference or awareness of what nursing is or if they have the ability to be a nurse. Therefore, students need a leader who can be a mentor, with whom they can communicate, listen to practical stories, and seek guidance. However, often there is a gap between the nursing students and their professors, seniors, or companions. Problem solving is difficult in an uncomfortable relationship. The chorus activity is an ideal context for students to communicate, acquire information, and consult their adviser . Nursing is an art and a science. Caring for patients from different cultural backgrounds means that special care is provided based on scientific and theoretical knowledge. Nursing is an integrated task. To solve problems and achieve goals, nurses need to invest their heart and soul. Additionally, stable thinking is necessary to create positive and pleasurable situation and maintain a stable mental state. Indeed, as suggested in previous studies, those who offer nursing services need to have a stable state of mind, effectively control stress, and have a high emotional quotient . However these mental and psychology factors need to be dealt in the process of nursing education. As revealed in the present study, music sensibility and action provides relief and helps individuals control their emotions by expending passion and pleasure in a stable way .
These results indicate that it would be beneficial to reinforce the effect of music, as well as interest in music through the nursing curriculum and to appropriately utilize nursing students’ music ability. In order to practice integrated nursing with complicated patients, it is important to offer students an opportunity to experience the effect of music theory, which in turn will help to develop nursing theory that can be applied in the practical nursing service field.
These results explain the role of a nurse as an expert. Therefore, nursing professionals should develop creativity, understand a situation, and discover their intellectual and theoretical attitudes. Diversity offers an opportunity to be creative. Therefore, the present nursing curriculum attempts to offer integrated knowledge and experience.
This study has some limitations because it employed a small sample and only one group, which may have limited the identification of concepts. Therefore, further study is needed to verify these findings.
This study aimed to understand the positive experiences of nursing students and to generate base data to be used to improve the nursing curriculum and the life in nursing college. These findings indicate that music helps nursing students gain stability during university life; decreases stress; and improves self-regard, communication, cooperation, and confidence. Therefore, it is necessary to include it as a part of the nursing course.
To develop their intellectual ability and personality as a part of their nursing education, nursing students need opportunities to experience diverse cultures and activities. Indeed, the educational system needs to support the development of the overall abilities of nursing professionals. This study suggests that the effect of music, through the chorus activity, is necessary to improve the integrated abilities of nursing students.
The authors have no conflicts of interest to declare.
Funding statement: This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors.
The study was conducted after receiving approval from the institutional review board (1041078-201503-HR-050-01).
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