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Organisational culture and learning: A case study

Elaine Bell
Women and Children's Health Network, Adelaide, South Australia, Australia
s u m m a r y a r t i c l e i n f o
Article history:
Accepted 19 February 2013
Keywords:
Learning
Student
Nurses
Culture
Objectives: To explore the impact organisational cultures have on the learning experience of student nurses
and identify the inuencing factors.
Methods: A case study approach was used. The single case being a Defence School of Health Care Studies
(DSHCS) and the multiple units of analysis: student nurses, the lecturers and Student Standing Orders. An
in depth three dimensional picture was achieved using multiple data collection methods: interview, survey,
observation and document analysis.
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
The Defence School of Health Care Studies (DSHCS) sits within a
large civilian institution and the education offered is fully integrated
within the civilian curriculum. Military student nurses are taught
with and learn alongside their civilian colleagues facilitated by both
military and civilian nurse lecturers. Having spent ve years as a mil-
itary nurse lecturer in this environment it became apparent that there
were a number of differences between the military and civilian stu-
dents. The military nursing students appeared to be excelling above
the civilian students in the overall statistics and the reason for this
had not been explored. This unique situation was the catalyst for this
study and is particularly noteworthy given the increasing number of
United Kingdom(UK) defence training establishments who are devel-
oping partnerships with civilian organisations (Edmonds, 1999).
The aim of the study was to explore the perceived organisational
culture within the DSHCS and evaluate how this may impact on the
learning experiences of military student nurses.
Literature Review
There is a potential role conict for military nurses, the role of
carer versus that of combatant, that is, is their primary role that of
nurse or soldier. Single service military command would explain
that the role of soldier takes precedence over that of nurse. However,
the nurse is recruited for her/his nursing qualications which are
governed by a regulator body the Nursing and Midwifery Council
(NMC, 2004). It is worthwhile considering the mission of DMETA,
which is to develop defence medical education, training and re-
search with its academic and clinical partners (DMETA, 2006), this
supports the Defence Medical Services (DMS) mission to provide mil-
itary medical personnel who are correctly trained and current in their
specialties to enable them to fulll any operational requirement
(MOD, 2007). To achieve this mission, a complete restructure of the
military defence medical services occurred to allow consultants, spe-
cialists, nurses, technicians and other medical professionals to work
within the National Health Service (NHS) alongside NHS colleagues,
usually in Ministry of Defence (MoD) Hospital Units (MDHU s).
The organisational culture in the defence forces is characterised by
tradition, morals, norms anda set of social patterns whichis communicat-
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-
sation of soldiers to use deadly force in ways that the rest of society
cannot, suggests a very different role and organisational culture within
the defence forces from that of the rest of society (Hartle, 1989). The
cultural characteristics of the defence forces include readiness, speed, re-
liability, self-sufciency, versatility and an ability to improvise (Janowitz,
1968). The soldier has a component of an heroic posture in his profes-
sional self image for he must be prepared to face danger (Field, 1968).
Nurse Education Today 33 (2013) 13371341
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E-mail address: elaine1bell@googlemail.com.
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http://dx.doi.org/10.1016/j.nedt.2013.02.009
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The extent to which employees accept the organisational culture
will signicantly affect the climate, and if people do not feel part of
the organisation and do not share the dominant attitudes and beliefs
it is likely to result in negative emotions and conict (Mullins, 1994).
This is extremely relevant when exploring the impact organisational
culture may have on the learning experience within a defence school
that sits within a large civilian university. Organisational culture can
be dened as:
the collection of traditions, values, policies, beliefs, and attitudes
that constitute a pervasive context for everything we do and think
in an organisation
(McLean and Marshall, 1993, p. 1).
Phrased more simply it is how things are done around here
(Mullins, 1994). Organisational culture provides a consistent outlook
and maintenance of values to support decision-making, co-ordination
and control; however, this consistency may result in many attitudes
and beliefs becoming permanent and unchallenged, making themhigh-
ly resistant to change (Peters and Waterman, 2004). These values and
beliefs are mostly passed on from previous generations (Schein,
2004). Members of an organisational culture engage in rituals, pass
along myths and stories and use jargon to communicate the
organisational culture (Baker, 1980; Deal and Kennedy, 1982), and
this concept is particularly strong within the defence forces (Taylor
and Rosenbach, 2005).
Ethos can be dened as the underlying attitude towards the world
and how this is reected in the tone, character and quality of life
(Geertz, 1993). Within the defence forces this can be illustrated
through the salute, uniform, insignia of rank, promotion and com-
mand and supports the ceremony and etiquette. This symbolism
within the military is often perceived as tradition, and tradition can
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
have survived conict and debate, within a wider context (Brown,
1995). There are two distinctive types of military cohesion, rstly,
task which is collective commitment to a common goal and, secondly,
social which is deemed to be the emotional bonds and personal rela-
tionships within the group (Bondy, 2004). The inuence of the task at
hand may impact on the perceived culture of military student nurses
depending on where they see their primary role, whether it be a de-
fence or a nursing role. The social aspect will be impacted by the emo-
tional bonds and personal relationships they may develop with those
beyond the defence force organisational culture.
Most organisations have more than one set of beliefs inuencing
the behaviour of their members and often results in the development
of sub-cultures (Morgan, 1986). Factors that can impact on interper-
sonal relations between sub-cultures include goals, resources, per-
ceptions, expectations and role. Within this an individual may
expect respect due to age, profession or status which is fully acknowl-
edged within their own cultural environment (Triandis, 1975). Yet,
this may not be acknowledged beyond their cultural group and so is
of particular interest when considering military rank and its meaning
outside of a military context. In contrast to this, if an individual con-
forms to the expected behaviour and expectation of a sub-culture,
he is afforded legitimacy and acceptance by that group (Rollinson,
2002). Each group therefore needs to understand the differing man-
agement styles, status, reward and evaluation systems of the other
(Datta, 1991). This may be achieved through effective training and
education.
Education provides skills, ways of thinking, feeling and speaking
(Bruner, 1996). The aim is for learners to acquire knowledge and de-
velop judgement, to become self reliant, to create new knowledge
and to work well together (Garton and Pratt, 1989). This does not
stand alone but exists within a culture of power, distinction and
reward which is broadly political, so the culture within a HEI can be
considered as the pursuit of tting culture to the needs of its mem-
bers and tting the needs of the members to the needs of its culture
(Bruner, 1996). This is interesting when considering the potentially
differing needs within a military culture and that of a civilian HEI
and the impacts of this on the learning experience of the students
within these.
Learners should be active participants in a programme of study,
the learning experience being meaningful and having a critical focus
(Grundy, 1987). Learning is dened as:
The combination of processes whereby the human person (knowl-
edge, skills, attitudes, emotions, values, beliefs and the senses) en-
ters a social situation and constructs an experience which is then
transformed through cognitive, emotional and practical processes,
and integrated into the persons biography
(Jarvis and Parker, 2007, p. 2).
Learning to live in a new culture involves subtle changes to expec-
tations, loss of identity, familiarity and social events that once provid-
ed encouragement, direction and to meaning to life (Brislin et al.,
1975). External factors such as goals and resources, and internal fac-
tors such as perceptions and expectations need to be considered
(Triandis, 1975). Assessment is seen to be a strong motivator for
study (Quinn, 2000). The focus on assessment can foster a strategic
learning strategy when the student is only concerned with passing
the course rather than the learning experience itself (Biggs, 2000).
Learning does not take place in a vacuum (Fenwick and Tennant,
2004). Each learner brings their own experiences, socio-economic
background and beliefs which inuence how they learn. Yet, there
is little known about the inuence a military culture can have on
how students learn when placed in a dominant civilian environment.
Methods
A case study approach was used to explore the inuence a military
culture may have on how students learn when placed in a dominant
civilian environment. The single case being the DSHCS and the multi-
ple units of analysis were the military student nurses, the lecturers
and Student Standing Orders. The data was collected primarily using
semi structured interviews using a sample of six third year military
student nurses, supported by questionnaires completed by nine
nurse lecturers within the DSHCS and triangulated using the docu-
ment analysis of the Student Standing Orders (SSO). The interviews
were conducted at a time and location that was mutually convenient
for the participant and the researcher and lasted approximately
30 min. The interviews were audio recorded with the consent of the
participant and then transcribed verbatim by the researcher. The in-
terviews were transcribed with precision, but did not include excla-
mations, laughter, stalling, silences, pauses or hesitations as it was
the content not the structure that was analysed (Mellon, 1990). Orig-
inal copies of the transcripts have been kept for archiving to adhere to
the Data Protection Act 1998 (Robson, 2002). Copies of these were
made to assist the in depth analysis of the data, which were destroyed
once analysis was complete. Following transcription each participant
was given the opportunity to review their own data to ensure
that transcription was accurate to promote the validity of the data
collected (Lincoln and Guba, 1985).
Consideration was given to include civilian students within the
sample groups to provide a comparative element. However, due to
time and resource constraints it was decided to focus this study on
military students with a recommendation that further research be
untaken focusing on civilian perspectives within this environment.
Data was analysed using a Constant Comparative method (Erlandson
et al., 1993).
1338 E. Bell / Nurse Education Today 33 (2013) 13371341
Purposive sampling was used and the inclusion criteria for the
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
ethics committee and all elements of the case study proposal and
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
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-
tions of the interviews and agreed that they were a true reection.
All names used in this paper are pseudonyms to protect the identities
of the participants.
Results and Discussion
The central theme was a strong distinction between the civilian
and military cultures and the impact this had on the learning experi-
ence. A number of strong themes emerged from the data: denition
of culture in regard to a military versus a civilian culture, achievement,
image, environment, discipline, ethos, support and welfare, which can
be seen in Fig. 1.
Dening Organisational Culture
The participants dened organisational culture by using varying
discourse, for example, one of the students dened it as something
that means something to us, we join the military and have a camara-
derie that no one understands outside of the military. Another stu-
dent said it is like a big family, the military. The comment by the
rst student is extremely interesting in that she believes no one out-
side the military context will understand the culture and this is very
much in line with the theory of Balkanization, in that people belong
exclusively to a group where others are not accepted (Hargreaves,
1999). This is reinforced by the second student who referred to the
military rather than the wider HEI when dening organisational cul-
ture. The defence forces do not support a them and us culture, but
do fully embrace the concept of military ethos and the need to
achieve their mission to train medical personnel who can operate
within a military operational environment.
Bill felt that a student being exposed to the military culture is a
positive factor as we are a military organisation. Bill's statement
strongly supports the perception that the military is different from
any civilian organisation. There was a feeling of strong commitment
to learning from the military lecturers, particularly illustrated by
Roberta, who said that 99% of lecturers are committed to the stu-
dents. So it could be reasonably concluded that although a perception
of differing cultures exists an overarching culture of learning was
dominant. The presence of a degree of fragmentation in the perceived
culture and the potential that an underlying military sub-culture
exists could impact on the internal sense of community, but not neces-
sarily learning (Becher and Trowler, 2001).
Achievement
Assessment is seen as a strong motivator and inuential factor
when considering achievement (Quinn, 2000). This was alluded to
in the student interviews and staff questionnaires, but more emphasis
was made to the sense of achievement and very little reference was
made to assessments. Mark said I want to qualify and deploy opera-
tionally and work as hard as possible to get the best experience so I
can be a better nurse and work to the highest standard possible
with the people I am there to do the job for. There was a strong
sense of a deep approach to learning, for example, Colin, who said
Being here is part of the journey of becoming a qualied nurse and
every day is a learning experience I can only describe it as a journey
of learning. Although, there were indications of strategic learning
and mention of assessments such as Jackie, who said If you have an
assignment due in you tend to work together or help each other it
leads to a good learning environment for the military students and
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-
port the emergent theme of discipline.
Discipline
Discipline can be dened as instructing a person to follow a particu-
lar code of conduct and adhere to a certainorder, essentially, methods of
modeling character and teaching self control and acceptable behaviour
(Papalia et al., 2006). This certain order can be closely related to the
roles, rules and responsibilities that exist within an organisation and
can be strongly linked to its culture (Mintzberg, 1971). The structure
Table 1
Interview questions (military students).
Tell me about your time in the DSHCS
If you could change one thing what would it be?
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?
What are your expectations for the rest of the course?
Table 2
Questionnaire questions (military lecturers).
What does organisational culture mean to you?
Please describe your perception of the organisational culture within the DSHCS?
List all the factors that you believe shape the organisational culture within the
DSHCS, please make a list of positive and negative.
Does the organisational culture within the DSHCS differ from your previous unit?
Please explain.
If you could change one thing about the DSHCS what would it be and why?
What do you think motivates military student nurses to learn?
Military
Vs
Civilian
Achievement
Environment
Discipline
Ethos and
Image
Support &
Welfare
Fig. 1. Themes from data collection.
1339 E. Bell / Nurse Education Today 33 (2013) 13371341
within the DSHCS is hierarchical embracing rank as its building blocks
and this was evident among the military lecturing staff for example,
Harry said They [DSHCS students] are not allowed as much autonomy
to guide their personal learning as civilian students. This is also
established clearly in the SSO which outline to the military students
what rules and regulations must be followed. Each student is required
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
any time. This is in line with any other military unit where the docu-
ment is usually called Unit Standing Orders.
Discipline is a major factor when determining military strength, ef-
ciency and professional knowledge (Bondy, 2004). However, these
orders seem to have developed a perception among some of the mili-
tary students of being treated like children. A number of students
mentioned this perception in their interviews for example, Zoe said
we are treated like children even though we are Phase II trainees,
and a lecturer, Bill, commented that occasionally you hear that
student's are afraid to come up the corridor, and a number of the stu-
dents explained that the corridor in which the military lecturers sit
has various names, for example, the corridor of power and the
ivory tower.
When interviewed the students provided some interesting in-
sights into their perception of the discipline within the DSHCS, Colin
said that Everyone needs a leader and to be told you need to be
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
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
soldier but we have earned our rank and the right to be here. Colin,
who was a transfer from the Army but a more junior rank to Zoe, said
They [DSHCS] treat us like children a little bit but some of the senior
ones [military students] don't like being talked down to. There was a
clear focus by some on recognition for prior achievement in the pur-
suit for ongoing achievement within the professional training. It
appeared that could have been inuenced by the ethos within the
DSHCS.
Ethos and Image
When considering the role of achievement and discipline within
the context of organisational culture and learning, rituals were
found to be particularly strong within the military (Taylor and
Rosenbach, 2005). A military culture embraces the salute, uniform,
rank and command, supporting the ceremonies and etiquette found
within it (Geertz, 1993). One of the student's, Elliott, remarked in
uniform I believe that it helps re-establish that we are part of the mil-
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-
dents should wear uniform while at the university all the students
interviewed responded no. For example, Zoe, said No, I think it is
too much of a risk it only takes for something to happen to one per-
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
in Peterborough where military personnel were banned fromwearing
uniform in public as a result of verbal abuse (Dawar, 2008). Whereas,
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
more open living arrangements. The students commented on the lack
of the presence of senior military staff in uniform which previously
had made them feel more secure and supported but also instilled a
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).
These results would suggest that the ethos within the DSHCS is
very much related to image and the desire to wear uniform but
with a reluctance to do so due to the environment within which
learning was occurring.
Environment
The military students clearly appreciated the need to be within the
civilian learning organisation in order to achieve their goals but felt
that external factors, specically, military resources could improve
their environmental living and increase the promotion of a military
ethos (Triandis, 1975). The wider student experience can have a sig-
nicant impact on the learning event and living in halls of residence
can provide support but also problems in the maintenance of friend-
ships (Mackie, 1998). Learning to live in a new society involves subtle
changes to expectations, loss of identity, familiarity and social events
that once provided encouragement, direction and added meaning to
life (Brislin et al., 1975). Some felt that the lack of this would disad-
vantage those military students who joined directly and had no pre-
vious military experience, feeling that these individuals would
struggle once qualied and posted to their rst military unit. Never-
theless, they did appreciate that military events organised by the
DSHCS were helping to overcome this, namely, early morning physi-
cal exercise, military evenings and military exercises.
Support and Welfare
Social responsibility is seen as one of the overarching concepts that
dene a military culture (Huntingdon, 1978). The commitment to a
common goal encompassing emotional bonds and personal relation-
ships within the group is also an important concept related to ethos
(Bondy, 2004). This is addressed within the DSHCS by the Divisional
Support Ofcers (DSO) who have overall responsibility for the military
students' welfare throughout their training. This includes accommo-
dation issues, support during disciplinary action, medical needs and
emotional support for any personal issues they may experience.
Military students are paid a salary throughout their training and
provided with accommodation and extra money to pay for food and
this appears to be a strong inuencing factor in their welfare and sup-
port needs. This was highlighted by Mark, who said I chose the mil-
itary and it is an added bonus to get paid, I couldn't go through
student loans and everything like that.
There was a strong link between the support provided by the
DSHCS and also the discipline as Zoe explained [DHSCS] staff moti-
vate me because they encourage you and tell you you are doing really
well, but they give you a kick when you need it. The SSO also provide
High
Achievers
Salary and
Support
Ethos of
adult
learning
Military
environment
Learning
Civilian
Influence
Image
Discipline
Military
rules
Fig. 2. Summary of overall concepts identied within the DSHCS impacting on learning.
1340 E. Bell / Nurse Education Today 33 (2013) 13371341
a very good basis in ensuring that all the students are fully aware of
what is expected from them throughout their training. The hierarchi-
cal nature of the military can be perceived as purely disciplinarily;
however, this is also very much part of the support structure, and
Elliot highlighted this by stating things like head of school commen-
dations, midyear appraisal and annual reports let you know how you
are doing and where you need to focus to succeed. Any merit is
recognised which helps to motivate you, something the civilian stu-
dents do not get.
The wider student experience can have a signicant impact on the
students' success (Mackie, 1998) and social support is vital to the ad-
justment needed to embrace university life (Ozga and Sukhnandan,
1998). In addition to this there will be subtle changes needed in re-
sponse to changing expectations, loss of identity, social events and
peers (Brislin et al., 1975).
Conclusion
There is little known about the inuence a military culture
can have on how students learn when placed in a dominant civilian
environment. This study provides a snapshot in time to work towards
a better understanding of how organisational culture may impact
on individual learners who bring their own experiences, socio-
economic background and beliefs.
The ndings suggest that the DSHCS is perceived to be a military
sub-culture which sits within a dominant civilian learning culture.
Most participants felt that a military environment, clear achievement,
support and welfare and an ethos of adult learning had a positive in-
uence on the learning experience. Whereas, the civilian context,
image, discipline and military rules could impact less favorably on
the learning experience. How these concepts work together and in
conict is illustrated in Fig. 2.
Throughout the data there are signicant links between discipline,
support, welfare and ethos with a common theme of achievement. It
appears that achievement is a high priority for the military students
who took part in this study. This case study has demonstrated that
the learning experience of military student nurses appears to be
very positive and is enhanced by the positive learning culture of the
civilian Higher Educational Institution. The military sub-culture
however, appears to create a unique learning environment that is
inuenced by a number of strong themes, these can be seen in
Fig. 3. It has provided the basis for further research to prove or other-
wise that organisation culture does impact on the learning experience
of nursing students. It is recommended that a larger study be under-
taken involving civilian nursing students to explore the themes iden-
tied in more depth.
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CIVILIAN
Support
MILITARY
Environment
Ethos
Welfare
Image
Discipline Achievement
LEARNING
Fig. 3. The culture of the DSHCS.
1341 E. Bell / Nurse Education Today 33 (2013) 13371341

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