Using Nostalgia to Increase Motivation and Counteract Threats

by Andrew Watkins, Pharm.D., PGY1 Pharmacy Practice Resident, St. Dominic Memorial Hospital

Nostalgia, “a sentimental longing or wistful affection for the past,” has become a topic of active research in recent years.¹ It is a unique emotion that is anchored in social interactions and past experiences that invoke both positive feelings of support but also feelings of longing. Despite its bittersweet nature, it tends to be a positive emotion that people of all ages and cultures experience. Evidence now suggestions that nostalgia has a role as a psychological balancer, maintaining homeostasis and comforting people in times of stress or adversity. Nostalgia can be prompted by a number of stimuli such as smells, tastes, or visual information. In addition to these stimuli, nostalgia can also be prompted by feelings of loneliness, angst, or unrest. It is in these situations that nostalgia works to counteract these negative experiences and rebalance one’s emotional state. For example, it is not uncommon during times of stress or hardship to reminisce or nostalgize about good times experienced in the past. While these feelings are bittersweet and emphasize the dichotomy between the past and present, they promote positive emotions that can act as a buffer to help one progress through current situations.

One of the fascinating things about nostalgia is that the event being remembered need not be positive for the nostalgic feelings to be positive. There are many times when remembering a “bad” or negative past event or time period can still invoke positive feelings. One example, many people reminiscing about early times in a relationship or creating a business when there were hardships or financial struggles. The experience was probably not enjoyable at the time, but reminiscing about it will likely invoke positive feelings of happiness and pride in your ability to navigate those difficult times and grow. The role of nostalgia as a tool in education is relatively unexplored. As educational environments often elicit feelings of stress or anxiety, the use of nostalgia to mitigate these feelings is a very intriguing area of research.

When pursuing goals, people typically appraise tasks as threats or challenges. Threats are seen as negative experiences in which one may experience loss or may not be able to meet demands. On the other hand, challenges are seen as positive experiences that provide opportunities for growth. Threat appraisals in an educational context have been associated with procrastination, higher anxiety, lower performance, and decreased intrinsic motivation.^2-5 These effects are very detrimental because a decrease in intrinsic motivation arguably has the greatest negative effect on performance.⁶ If using the homeostatic model of nostalgia, one might expect a negative stimulus to prompt nostalgic feelings, which then help offset the negative stimulus. Numerous studies have found this to be the case; threats against self-esteem, meaning in life, and social connectedness have all been found to be reversed by nostalgia.^7-10 As an example, one of these studies involved researchers prompting one group of participants to think of a nostalgic experience. In a questionnaire given after this experience, these participants reported stronger feelings of support and self-regard than those who were not prompted to think of a nostalgic experience. Using this homeostatic model in the context of threat/challenge appraisals, one could hypothesize that the negative stimulus of a threat appraisal would stimulate nostalgia, which would counteract the negative feelings and increase intrinsic motivation. Challenge appraisals, because of their positive connotations, would theoretically not prompt nostalgic feelings. Knowing this, a group of researchers recently set out to explore whether nostalgia could restore the intrinsic motivation prompted by threat appraisals.¹¹

In their study, the authors deployed a number of specifically timed questionnaires to students (n = 382, age 18 to 27 years) who attended at a university in Northeastern United States. The experiment began with a baseline nostalgia inventory (T0 nostalgia) that where participants indicated how nostalgic they felt in the preceding days. The scores from this questionnaire were averaged to create a nostalgia index score. Two months later (around the middle of the semester), participants answered questionnaires to assess their threat and challenge appraisals (T1 threat and T1 challenge). The scores were averaged to give each participant both a threat and a challenge index score. Lastly, the participants were asked one month later (toward the end of the semester) to answer the same nostalgia inventory (T2 nostalgia) as well as an intrinsic motivation scale (T2 intrinsic motivation). The relationships among these variables were then analyzed.

The results suggest that perceived threats may promote nostalgia. Threat appraisals were negatively associated with intrinsic motivation and positively associated with the T2 nostalgia score, even when controlling for baseline T0 nostalgia in a regression analysis. Moreover, the authors found that T2 nostalgia was positively associated with intrinsic motivation. These results align with the idea that threat appraisals decrease intrinsic motivation but also increase nostalgia. This nostalgia then acts to balance the negative effects by increasing intrinsic motivation. Next, the authors found that challenge appraisals were associated with higher intrinsic motivation. Challenge appraisals were also associated with higher T2 nostalgia, but this relationship was no longer significant when T0 baseline nostalgia was taken into account. This implies that challenge appraisals do not predict a change in nostalgia over time like threat appraisals do. This nostalgia indirectly increases intrinsic motivation in response to threat appraisals but are unaffected by challenge appraisals.

This evidence opens the door for future research into nostalgia as a tool to overcome a variety of perceived threats in educational settings. I personally think that nostalgia is a promising tool to help students experiencing stress or feelings of being overwhelmed. I could see it playing a role in individual student counseling sessions, which could involve the educator prompting the student to reflect on past experiences and how he or she handled those situations. These sessions could also be as simple as a student just talking through a past experience(s) while the educator listens, prompting internal feelings of reassurance and promoting the student’s self-esteem.

One could also imagine brief nostalgic writing assignments, perhaps weekly, during a course. An instructor could ask students to briefly write about a time in their past when certain feelings or events happened (e.g. time of difficulty, a prideful experience) and how the situation was resolved or handled. The writing prompts could change each week to avoid assignment burnout. These types of brief written assignments would give students the opportunities to express themselves and would force them to reflect on past events. Or perhaps simply making brief cultural references to the past (i.e. music, TV shows) during class sessions could subconsciously promote nostalgic feelings in students, which might promote positive feelings and improve intrinsic motivation. Nostalgia appears to be a promising tool. We need more research in order to optimize its use in education.

References

1. Pearsall J, Hanks P. New Oxford Dictionary of English. 1^st ed. Oxford (UK): Oxford University Press;1998.
2. McGregor HA, Elliot AJ. Achievement goals as predictors of achievement-relevant processes prior to task engagement. J Educ Psychol. 2002;94(2):381-95.
3. Putwain D, Remedios R. The scare tactic: do fear appeals predict motivation and exam scores? School Psychol Quart. 2014;29(4):503-16.
4. Putwain D, Symes W. Perceived fear appeals and examination performance: facilitating or debilitating outcomes? Learn Individ Differ. 2011;21(2):227-32.
5. Putwain D, Symes W. Teachers' use of fear appeals in the mathematics classroom: worrying or motivating students? Br J Educ Psychol. 2011 Sep;81(Pt 3):456-74.
6. Cerasoli CP, Nicklin JM, Ford MT. Intrinsic motivation and extrinsic incentives jointly predict performance: a 40 year meta-analysis. Psychol Bull. 2014;140(4):980–1008.
7. Sedikides C, Wildschut T, Routledge C et al. To nostalgize: mixing memory with affect and desire. Adv Exp Soc Psychol. 2015;51:189–273.
8. Wildschut T, Sedikides C, Arndt J et al. Nostalgia: content, triggers, functions. J Pers Soc Psychol. 2006;91(5):975–93.
9. Routledge C, Wildschut T, Sedikides C et al. The power of the past: nostalgia as a meaning-making resource. Memory. 2012;20(5):452–60.
10. Zhou X, Sedikides C, Routledge C et al. Counteracting loneliness: on the restorative function of nostalgia. Psychol Sci. 2008;19(10):1023-9.
11. Bialobrzeska O, Elliot AJ, Wildschut T et al (2019). Nostalgia counteracts the negative relation between threat appraisals and intrinsic motivation in an educational context. Learn Individ Differ. 2019;69:219–24.

Bridging the Gap: From the Classroom to Practice

Cody Taylor, PharmD, PGY2 Critical Care Pharmacy Practice Resident, University of Mississippi Medical Center

It’s 06:00 and a nervous pharmacy student anxiously waits to begin his first Advanced Pharmacy Practice Experience (APPE) in the cardiac intensive care unit. He takes a moment to look around the unit hoping to calm his nerves but to no avail. The scene unfolding before him consists of nurses running from room to room, a patient in critical condition, and medical residents asking for drugs he only vaguely remembers from his second year in pharmacy school. It’s day 1 of his final year of pharmacy school and he already feels defeated. This is my story and one that is similar to that of many pharmacy students across the nation.

APPEs are designed to provide students with daily opportunities to assess and monitor patients, interact with other healthcare professionals, improve literature evaluation, and enhance many other skills including giving presentations and educating patients.  These experiences often provoke stress and anxiety for students. For me, it was a combination of my first experience with critically ill patients, a lack of knowledge regarding critical care practice, the pressure to remember everything from the previous three years of pharmacy school, navigating an unfamiliar electronic medical record, and learning to cope with difficult situations.

Student pharmacists are expected to master various core competencies during their final year of APPEs. While each college of pharmacy has their own set of competency statements, they generally revolve around: developing and applying foundational knowledge, promoting safe and evidence-based patient care, contributing to interprofessional teams, and engaging in professional development. Some colleges of pharmacy have begun assessing their students’ preparedness to meet these competencies. Student pharmacists have reported less preparedness in areas such as recommending medications and doses, evaluating laboratory test results, assessing medication appropriateness, and discussing pharmacotherapy recommendations during interprofessional team rounds.¹  Preceptors have also weighed in.  Students do not seem to be able to integrate foundational knowledge from all academic disciplines when discussing a patient problem.  Moreover, students have difficulty performing pharmaceutical calculations and critiquing primary and tertiary literature.² These topics are discussed throughout the pharmacy curriculum, but many factors can influence why pharmacy students may feel unprepared and anxious. In addition to the fact that these topics were often covered in class two or three years ago, some students are innately prone, based on their personality and previous experiences, to anxiety, fear, or low self-esteem.

So, what can we do to help prepare pharmacy students to transition from the classroom to clinical practice? The Accreditation Council for Pharmacy Education (ACPE) accreditation standards now require colleges to assess student readiness to enter APPEs.³ Since the release of these standards, colleges/schools of pharmacy have increasingly implemented objective structured clinical examinations (OSCEs), simulations, and authentic patient cases in their curriculum.

Tchen and colleagues at the University of British Columbia took a different approach to prepare their students for APPEs.⁴ They received feedback from both students and preceptors that students were not adequately ready for their inpatient APPEs. To address this problem, they developed a series of online, self-paced modules.  They used focus groups consisting of preceptors, faculty, pharmacy residents, and recent alumni to develop these modules. Modules focused on common terminology, processes, and procedures in the inpatient setting; how to effectively use a patient’s chart to identify pertinent information; and how to perform a patient workup and assessment. Post-module survey results indicated just under 70% of students felt the modules improved their performance during their inpatient APPEs. However, only 25% of students believed it helped reduce their anxiety. This is not surprising as many people experience anxiety when experiencing new, unfamiliar circumstances and this feeling likely cannot be completely mitigated through didactic instruction. Preceptors also perceived a benefit to the modules, stating that there was more time to focus on student-centered learning versus orienting the student to the practice environment.

This is an interesting approach to increasing APPE readiness among pharmacy students. Gathering feedback from faculty, preceptors, and alumni to create these modules enabled a multidimensional approach to fill the gaps between the classroom and practice. Allowing students to progress through the modules at their own pace is also helpful as this allows each student to review the material at a time when they are most motivated to learn and immediately before starting the rotation.  This is a great example of “just in time” learning.

It is difficult to change curriculums based on one college of pharmacy’s experience, but I believe Tchen and his colleagues at the University of British Columbia describe an effective way to increase pharmacy students’ readiness for their APPEs.

References:

1. Scott DM, Friesner DL, Miller DR. Pharmacy students’ perceptions of their preparedness to provide pharmaceutical care. American Journal of Pharmaceutical Education.74(1) Article 8.
2. Lundquist LM, Hogan S. Evaluating preceptors’ perceptions of student preparedness for advanced pharmacy practice experiences. Journal of Pharmacy Teaching. 14(1);19-32.
3. Accreditation Council for Pharmacy Education. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree (Standards 2016). 2015.
4. Tchen P, Leung L, Simpson F, et. al. Bridging the gap: An evaluation of self-paced online transition modules for advanced pharmacy practice experience students. Currents in Pharmacy Teaching and Learning 2018; 10:1375-1383.