University of Southern California Dissertations and Theses

Higher Education And Nursing Perceptions Affecting Student Learning And Development In The Clinical Environment

(USC Thesis Other)

Higher Education And Nursing Perceptions Affecting Student Learning And Development In The Clinical Environment

PDF

Download

Open document

Flip pages

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content INFORMATION TO USERS This material was produced from a microfilm copy of the original document. While the most advanced technological means to photograph and reproduce this document have been used, the quality is heavily dependent upon the quality of the original submitted. The following explanation of techniques is provided to help you understand markings or patterns which may appear on this reproduction. 1. The sign or "target" for pages apparently lacking from the document photographed is "Missing Page(s)". If if was possible to obtain the missing page{s) or section, they are spliced into the film along with adjacent pages. This may have necessitated cutting thru an image and duplicating adjacent pages to insure you complete continuity. 2. When an image on the film is obliterated with a large round black mark, it is an indication that the photographer suspected that the copy may have moved during exposure and thus cause a blurred image. You will find a good image of the page in the adjacent frame. 3. When a map, drawing or chart, etc., was part of the material being photographed the photographer followed a definite method in "sectioning" the material. It is customary to begin photoing at the upper left hand corner of a large sheet and to continue photoing from left to right in equal sections with a small overlap. If necessary, sectioning is continued again - beginning below the first row and continuing on until complete. 4. The majority of users indicate that the textual content is of greatest value, however, a somewhat higher quality reproduction could be made from "photographs" if essential to the understanding of the dissertation. Silver prints of "photographs" may be ordered at additional charge by writing the Order Department, giving the catalog number, title, author and specific pages you wish reproduced. 5. PLEASE NOTE: Some pages may have indistinct print. Filmed as received. Xerox University Microfilms 300 North Zeeb Road Ann Arbor, Michigan 46106 I I 74-26,018 CHRISTIAN, Marilyn Jean, 1933- HIGHER EDUCATION AND NURSING PERCEPTIONS AFFECTING STUDENT LEARNING AND DEVELOPMENT IN THE CLINICAL ENVIRONMENT. University of Southern California, Ph.D., 1974 Education, administration University Microfilms, A XEROX Company, Ann Arbor, Michigan © Copyright by Marilyn Jean Christian 1974 THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED. HIGHER EDUCATION AND NURSING PERCEPTIONS AFFECTING STUDENT LEARNING AND DEVELOPMENT IN THE CLINICAL ENVIRONMENT A Dissertation Presented to the Faculty of the School of Education University of Southern California In Partial Fulfillment of the Requirements for the Degree Doctor of Education by Marilyn Jean Christian June 1974 This dissertation, written under the direction of the Chairman of the candidate’s Guidance Committee and approved by all members of the Committee, has been presented to and accepted by the Faculty of the School of Education in partial fulfillm ent of the requirements fo r the degree of Doctor of Education. D a te......... ............................... Guidance Committee ACKNOWLEDGMENTS The quest for learning and for providing deep meaning to my educational journey thus far in life has been enriching, humbling, and an ennobling adventure. It would be difficult to name individually all to whom I would wish to thank personally for their part in making this experience possible. Students and patients have provided the greatest meaning for my efforts. These, with colleagues in my pro fessional and student life, have given me a bit of them selves as we have shared in learning together. Much of my learning I owe to those whose names appear among the nota bles in education, nursing and other of the allied health sciences. Others just as great in my personal value, have come from all walks of life. Each have left their stamp on my personal being for which I shall ever be grateful. The following individuals have made outstandingly unique contributions and have opened special educational vistas to me: MY PARENTS, who nurtured my early inquisitiveness, fostered the necessary assurance of personal worth before God for my own uniqueness and place in life as well as always providing far more than life1s necessities by love, encouragement, and a healthy "family pride." ii MARY WELCH, a Nebraska librarian who showed me at the age of three the beginning wonders of a public library and patiently allowed me to go beyond the children's section to any area that beckoned me to look and finally read. DAVID NELSON, my fifth grade teacher in Massachusetts, who opened the window of art in form and beauty to my learning arena. ALFRED WALTERS, a distinguished professor of music who first in Massachusetts and again later in life helped me to learn that musical love and amateur talent was a joy to be treasured, to foster and grow. EVELYN LINDBERG, a Texas high school teacher who made poetry and literary masterpieces sparkle like jewels leading me to the beauty of words and giv ing me a sense of continued craving in life's search for these hidden treasures. EDYTH T. JAMES MORTON, a Maryland professor of physi ology and nursing educational administrator, who opened to me the rhythmic beauty of scientific study in human physiology and later during her last years of administration shared the best of her years of learning with me in introducing me to teaching and educational leadership. Her contin ued interest and enthusiasm with constructive crit icism shall always be treasured. DR. HELEN L. MORTON, a physician, scholar, and deep personal friend who not only shared with me the deeper pathophysiological meanings in medical mat ters but encouraged my scholarly pursuits through hours of patient interaction with me in my learn ing endeavors. DR. EARL V. PULLIAS, a scholar and teacher superior to any others I have encountered. A University of Southern California Christian gentleman, a trusted friend who shall ever be remembered for stimulating excellence with gentle understanding in learning the deeper things of life. MY COMMITTEE OF STUDIES, Dr. Leslie Wilbur, Chairman; Dr. Robert Ferris, and Dr. Leo Richards for their iii guidance and encouragement in my studies and in this research project. Thank you seems such a small statement for each of the above. It is sincere and but a token of a deep felt appreciation to all those who have helped to make this step complete. iv TABLE OF CONTENTS Page ACKNOWLEDGMENTS ...................................... ii LIST OF TABLES.........................................vii Chapter I INTRODUCTION AND PROBLEM ....................... 1 Introduction The Problem Background of the Problem Setting of the Problem Hypotheses Definitions of Terms Basic Assumptions Delimitations Organization of the Remainder of the Study II REVIEW OF RELATED LITERATURE ................ 15 Studies of College Environment and Student Learning Theoretical Framework Studies of Learning Environment Studies of Nursing and Other Health Related Professions Learning Environment Summary of the Literature III THE INSTRUMENT AND METHODOLOGY..................40 Development of the Research Instrument Construction of the Instrument Validation of the Instrument The Population Sample Collection of the Research Data Method of Analysis IV ANALYSIS OF THE DATA co V Chapter Page Comparisons of the Valences of Vector A: Achieving Competence Comparisons of the Valences of Vector B: Managing Emotions Comparisons of the Valences of Vector C: Becoming Autonomous Comparisons of Valences of Vector D: Establishing Identity Comparisons of Valences of Vector E: Freeing Interpersonal Relationships Comparisons of Valences of Vector: F Clarifying Purposes Comparisons of Valences of Vector: G Developing Integrity Grouped Data by Vectors V SUMMARY OF THE FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS...........................133 Summary of the Investigation Summary of the Findings as Related to the Stated Hypotheses Conclusions Discussion of the Findings Recommendations BIBLIOGRAPHY .......................................... 142 APPENDICES.............................................. 159 vi LIST OF TABLES Table Page 1. VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 3: TEACHING IS CONSISTENT WITH CLINICAL PRACTICE .............................. 55 2. VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 9: NURSING SERVICE LEADERS DO NOT GIVE STUDENT JOB RECOGNITION MORE OFTEN THAN DO FACULTY........................... 57 3. VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 14: STUDENTS ARE NOT MORE INTER ESTED IN CARING FOR PATIENTS WITH RARE VS. COMMON ILLNESSES .......................... 58 4. VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 24: EMPHASIS ON TEACHING IS RELATED TO CURRENT NEEDS OF PATIENTS .......... 60 5. VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 26: IMMEDIATELY FOLLOWING GRADU ATION STUDENTS ARE COMPETENT IN ONE OR MORE AREAS OF NURSING C A R E .....................62 6. VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 32: FACULTY ARE LESS COMPETENT IN CLINICAL PRACTICE THAN ARE THE NURSING SERVICE LEADERS ON THE TEACHING UNIT................................... 63 7. VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 46: FACULTY ARE MOST HELPFUL IN ASSISTING STUDENT LEARNING IN THE CLINICAL SETTING .............................. 65 8. VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 5: STUDENTS SEE NURSING LEADERS USING APPROPRIATE FORMS OF COURAGE AND AGGRESSION IN PATIENT CARE .....................67 9. VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 11: STUDENTS LEARN TO USE COURAGE AND AGGRESSION TO MAKE CHANGE IN PATIENT CARE ...........................68 vii Table Page 10. VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 33: IF A STUDENT CRIED AT THE TIME OF A PATIENT'S DEATH, NURSES IN AUTHORITY WOULD NOT THINK THE STUDENT WAS "UNPROFESSIONAL" ........................ 70 11. VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 35: PERSONAL HOSTILITIES ARE NOT USUALLY CONCEALED IN THE CLINICAL SETTING........................................71 12. VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 39: IN CLINICAL PRACTICE STU DENTS LEARN APPROPRIATE USE AND POWER OF PERSONAL EMOTIONS ........................ 73 13. VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 41: MOST STUDENTS ARE HAPPY IN CLINICAL LEARNING ............................ 74 14. VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 42: STUDENTS ARE ASSISTED TO GROW IN TRUSTING THE EMOTIONAL CON DUCT CONDUCIVE TO PATIENT CARE AND PERSONAL BETTERMENT .......................... 76 15. VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 10: STUDENTS SEEK CONSULTATION ON CLINICAL PROBLEMS FROM WHOMEVER IS CLOSEST IN AN EMERGENCY, OTHERWISE FROM FACULTY................................. 77 16. VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 15: STUDENTS WILL NOT SEEK CONSULTATION FROM ANOTHER STUDENT VS. FACULTY OR NURSING SERVICE LEADERS........................................79 17. VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 20: STUDENTS USUALLY SHOULD BE TRUSTED TO DO WHAT THEY HAVE BEEN TAUGHT WITHOUT ADDITIONAL DIRECT SUPERVISION................................... 81 viii Table Page 18. VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 22: NURSES IN AUTHORITY DO NOT TEND TO RESTRICT STUDENT AUTOMONY IN CLINICAL C A R E ................................. 82 19. VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 28: NURSES IN AUTHORITY TEND TO ASSIST STUDENTS IN DECISION MAKING RELATED TO PATIENT C A R E .......................84 20. VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 30: WELL REASONED STUDENT NURS ING ACTIONS WOULD USUALLY BE ACCEPTED EVEN IF CONTRARY TO THE IDEAS OF THE NURSE IN AUTHORITY.............................85 21. VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 48: STANDARDS OF PRACTICE ALLOW FOR INDEPENDENT STUDENT DECISION MAKING.......... ............................. 87 22. VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 12: NURSING SERVICE LEADERS AND FACULTY DEMONSTRATE RECOGNITION OF INDIVIDUAL STUDENT NEEDS AND QUALITIES................... 88 23. VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 18: STUDENTS FEEL IT IS BEST IF THEY ARE HEARD AND SEEN ON THE CLINICAL UNIT............................................90 24. VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 36: STUDENTS DEMONSTRATE AN APPROPRIATE BALANCE OF FEMININE- MASCULINE PERSONALITY IN MANNERS, HABITS AND HOBBIES.............................91 25. VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 37: STUDENTS SELF ESTEEM VARIES AS HE/SHE PRACTICES CLINICALLY REGARD LESS OF VERBAL INPUT FROM OTHERS............... 93 ix Table Pa9e 26. VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 38: STUDENTS PAY LITTLE ATTEN TION AS TO HOW WELL THEY DO IN CLINI CAL PRACTIVE VS. OTHERS IN THEIR CLASS..........................................94 27. VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 45: WHAT STUDENTS WEAR AND HOW THEY ACT IN THE CLINICAL SETTING IS NOT AS IMPORTANT AS THE QUALITY OF CARE THEY G I V E ............................... 96 28. VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 49: STUDENTS ARE ENCOURAGED TO RECOGNIZE STRONG AND WEAK POINTS IN SELF WHICH AFFECT PATIENT AND FAMILY C A R E ................... 97 29. VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 1: FACULTY AND NURSING SERVICE LEADERS DO NOT TRY TO MANIPULATE STU DENTS INTO DOING WHAT SEEMS TO BE NEEDED ON THE U N I T ...........................99 30. VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 6: STUDENTS DEMONSTRATE RECOG NITION OF NEEDS AND VALUES OF NURSING SERVICE LEADERS AND FACULTY .................. 100 31. VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 17: INTERACTION BETWEEN STUDENTS AND NURSING SERVICE LEADERS REFLECTS OPENNESS AND T R U S T ...........................102 32. VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 19: NURSING SERVICE LEADERS DO NOT TEND TO DOWNGRADE FACULTY................. 103 33. VALENCE TO VECTOR E, RESPONSE TO TEST ITEM 23: COMMUNICATION WITH OTHERS ON THE UNIT IS A PROBLEM TO MOST STUDENTS..................................... 105 x Table Page 34. VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 25: FACULTY DO NOT TEND TO DOWN GRADE NURSING SERVICE LEADERS ............. 106 35. VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 29: NURSING SERVICE LEADERS AND FACULTY SEEM TO WORK WELL TOGETHER TOWARD IMPROVING PATIENT CARE AND STU DENT LEARNING............................... 107 36. VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 2: BALANCED LIVING IS GENERALLY POSSIBLE FOR STUDENTS UNDER THE PRES SURES OF ACADEMIC AND CLINICAL LIFE . . . .109 37. VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 21: FACULTY HELP STUDENTS INDIVIDUALIZE AND CRYSTALLIZE PER SONAL LIFE GOALS............................. Ill 38. VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 27: LEADERS IN NURSING SERVICE HELP STUDENTS INDIVIDUALIZE AND CRYSTALLIZE PERSONAL LIFE GOALS ............ 112 39. VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 31: GOALS OF CLINICAL PRACTICE SEEM CLEAR TO STUDENTS.......................113 40. VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 40: NURSING OFFERS A GOOD OPPORTUNITY TO GET AHEAD IN LIFE............. 115 41. VALENCE OF VECTORS F, RESPONSE TO TEST ITEM 43: BACCALAUREATE STUDENTS DO NOT THINK THEY SHOULD BECOME SUPER VISORS OR ADMINISTRATORS.................... 116 42. VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 47: GOALS OF CLINICAL PRACTICE USUALLY SEEM RELATED TO CURRENT STU DENT NEEDS................................... 118 xi Table Page 43. VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 4: STUDENTS HAVE AS MUCH OPPOR TUNITY AS THEY WOULD LIKE TO EXPLORE MORAL VALUES RELATED TO NURSING WITH THEIR NURSING LEADERS.........................119 44. VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 7: STUDENTS OFTEN DISCUSS THEIR PERSONAL DEVELOPING BELIEFS AND VALUES WITH NURSING LEADERS ................. 121 45. VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 8: STUDENT DEDICATION TO DUTY AND STANDING FOR MORAL PRINCIPLE IS JUST AS PREVALENT TODAY AS WAS TRUE 10 TO 12 YEARS AGO ...................122 46. VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 13: STUDENTS ARE URGED TO FUNCTION CLINICALLY CONSISTENT WITH THEIR INTERNAL OR MORAL BELIEFS.............. 124 47. VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 16: CLINICAL EXPERIENCE DOES NOT CAUSE CONFUSION IN THE STUDENT'S ABILITTO DEVELOP BEHAVIOR CONSISTENT WITH PERSONAL LIFE VALUES.....................125 48. VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 34: IF POLICIES INTERFERE WITH LEARNING, STUDENTS DO NOT FOLLOW THE POLICY WITHOUT VERBALIZATION ............... 126 49. VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 44: STUDENTS DEMONSTRATE THEIR OWN PERSONAL VALUES AND INTEGRITY AS THEY GIVE PATIENT C A R E .......................128 50. LINEAR CORRELATION AMONG THE VECTORS B THROUGH G WITH A, ACHIEVING COMPETENCE, FOR STUDENTS, NURSING SERVICE LEADERS AND FACULTY WITH LEVEL OF CONFIDENCE .... 130 xii Table Page 51. ANALYSIS OF VECTORS BY CHI SQUARES COMPARING STUDENT GROUPS TO NURSING SERVICE LEADERS AND FACULTY SHOWING LEVELS OF CONFIDENCE FOR EACH................ 132 xiii CHAPTER I INTRODUCTION AND PROBLEM Introduction Our only exact data as to the physical world are our sensible perceptions. We must not slip into the fallacy of assuming that we are com paring a given world with given perceptions of it. The physical world is, in some general sense of the term, a deduced concept. Our problem is, in fact, to fit the world to our perceptions, and not our perceptions to the world.(Whitehead, 1967, p. 165) Research on student development in college has rapidly increased over the past decade. Students have been flooded with questionnaires, personality inventories, and various measures of intellectual achievement and apti tudes. Most of these have been exploratory in nature with few theories framed. Empirical evidence is abundant verifying the posi tion that students are influenced by social encounters in the college or university environment. The focus of these studies has been in the following three primary areas: quantitative dimensions of the students, faculty, hours of study, and other objectives areas (Richards, L. P. Rand, and L. M. Rand, 1967; Rock, Centra, and Linn, 1969); de- 2 scriptive profiles of college life (Austin, 1968; Rock, Centra, and Linn, 1969; Thistlethwaite, 1959); and envi ronmental studies with emphasis upon the personal encoun- tern with teachers, peers, administrators or others (Pace, 1969; Stern, 1970). Using this last approach Stern (1960, 1964, 1970) has taken the position that certain college characteristics such as teachers, peers and others in the learning environment parallel specific student personality characteristics. He uses Henry Murray's dual concept of environmental press and personal needs and conceptualizes press as a stimulus forming an individual need pattern for each student. Further, he points out that student peers, faculty or others in the student learning environment are conceptualized as influences upon students' need patterns. Studies using different criterion variables have been successful in generating a theoretical and conceptual framework for investigating the influence of the learning environment upon the college student's development. Some of the indices of influence used include academic achieve ment (Thistlethwaite, 1959), occupational preparation (Beardslee, and O'Dowd, 1962), value orientation (Trent, 1969), number of students planning to pursue a higher de gree (Thistlethwaite, 1962a), and maturational changes of students (Katz, 1962, 1968). A review of learning environmental studies demon- 3 strates a gap in the study of the unique and important clinical learning environment for students of nursing in higher education. This study was undertaken to test a specific theory of college student development in the clinical setting. An attempt was made by such testing to find evidence which might suggest guidelines to improve the clinical learning environment. Chickering's theory of development of college stu dents was used as the theoretical basis of departure for this study (Chickering, 1969). He has postulated that en vironmental conditions at some institutions do foster or inhibit change along seven major vectors of student devel opment and that systematic modification can increase the frequency of value development. The seven major develop mental vectors he identifies for the young adult are: "achieving competence, managing emotions, becoming au tonomous, freeing interpersonal relationships, clarifying purpose, establishing identity, and developing integrity." Each of these developmental vectors he further divides into major components or areas of definition. The primary focus of this study applied Chicker- ing’s developmental theory in evaluating the clinical learning environment for students in a selected baccalau reate and master degree program of nursing. The three groups of individuals which were considered to exercise 4 primary influence in the clinical learning environment for these students were the students themselves, the faculty, and the medical center staff nurses. These interactors within the clinical setting were included in the study. (See Appendix I for letter from Chickering for permission to adapt and test his theories in this study.) The Problem The purpose of this study was to ascertain whether or not significant perceptual differences existed toward the clinical learning environment on the part of students, faculty and medical center staff nurses in the baccalau reate and graduate student programs of nursing at Loma Linda University. The study was based on Chickering's theory of college student development (Chickering, 1969) and Dalme's 1971 doctoral dissertation at the University of Colorado (Dalme, 1971). Background of the Problem The clinical learning environment for students of nursing has been beset by problems of rapid expansion and changes in the expectations of nurses in the health care delivery system. The emerging new roles of the clinical nurse specialists, the nurse scientist, the physician asso 5 ciate, and the physician assistant alter demonstrably the traditional role of the professional nurse of today (Ab- dellah, 1970). The past two decades have witnessed the change of governance of schools of nursing as schools have moved from less than 10 percent college based programs and more than 90 percent hospital governed programs to today's new patterns, which display rapid increases in community col lege programs and moderate increases in baccalaureate pro grams in nursing. Thirty nine percent of all U.S. schools of nursing are still hospital based. The 61 percent that are collegiate schools of nursing enroll 66 percent of the total undergraduate students leading to state board re quirements for a registered nurse (National League for Nursing, 1973). With the rise of collegiate nursing the disparity between the university with its academic freedom, indepen dent decision-making systems and the hospital with its "bureaucracy and hierarchical rigidity" points to the di verse worlds of nursing service and nursing education (Brown, 1970). Newsome's (1964) statement that "theory has no direct reference and no formal implication for prac tice" has been reinforced into a reality in many if not most clinical learning environments. Perhaps Burns (1962) is correct as he states that what we do know is that "the 6 connection between philosophy and educational practice cannot be explained or formalized" in terms of logical or material implication. The student of nursing seems to be caught in an extremely polarized learning environment. The student spends the largest number of hours of planned learning within the clinical setting attempting to learn and devel op a professional identity. The student hears theory in the classroom and often sees different practice in the clinical setting. The writer was unable to identify any appropriate evaluation tools to test the climate for learning within the clinical setting. This study has been an attempt to identify the specific perceptions leading to the problems as stated above. Much has been written in nursing literature de scribing the feelings of dissatisfaction of students, fac ulty and clinical nursing staff with the growing complexi ty in the hospital setting. Some researchers have identi fied areas of conflict within specified members of the nursing team. Becker, Greer, Hughes and Strauss (1961) describe a set of "rites of passage" doctors and nurses in training experience producing conflict in learning to be come a professional. Krause (1971) identifies the image presented to students of nursing by other nurses as well as the actualities of work as major sources of problems in 7 professional development. Bromphy (1971) deplores the lack of research studies specifically focusing upon the self concept and role perception among nurses. Her study showed a "significant negative relationship between ideal self-concept - ideal role-perception congruence and the length of nursing experience." Dalme (1971) came close to the heart of the learn ing environment problem area for nurses as she studied the students' perception of certain environmental influences in the development of professional identity. This study was done using Erikson's (1955, 1959, 1970) theory of identity development with a thoroughly tested and seeming ly well-validated questionnaire for data collection. Dalme's study produced the beginning structure of a research instrument for evaluating the clinical learning environment for nurses. The study did suggest need for some revision of the instrument. The writer felt that it would be of value to study and possibly utilize Dalme's instrument as a basic testing tool with modifications needed to correct recognized weak nesses in the tool. Further to expand the instrument to include the evaluation of the effect of both faculty and staff nurses upon the learning environment which was not included in Dalme's study. (See Appendix I for letter of permission to use Dalme's tool.) 8 Setting of the Problem Loma Linda University is a private, Seventh-day Adventist, coeducational institution in inland Southern California. It is located sixty miles east of Los Angeles in the San Bernardino, Redlands, Riverside area. The in stitution has an approximate annual enrollment of 3,000 full-time students representing many nations of the world. Having sprung from medical origins in 1905, the University still has a strong emphasis in medical related schools as well as the College of Arts and Sciences and the School of Education. The School of Nursing had its origin in the earli est organized instrucution given at the University, the first students having enrolled in 1905 in Loma Linda. The University also operates a complex medical center (515 beds) which provides the primary clinical facilities for the School of Nursing as well as for students of the other health disciplines. In 1974, within a mile of the medical center, ground is to be broken for a 55 0 bed veterans hospital to be operated under the joint governance of the University and the Veteran's Administration. With this imminent doubling of clinical facility size as well as the recog nized need for change in the organization of nursing the 9 School of Nursing received federal funding for a five-year project by the Department of Health Education and Welfare under grant #5-D 10-NU-0353-05 for a high priority need in improving the learning environment for nursing education. As director of the project this writer worked in an administrative-team leader manner to produce a climate for working together toward the goal of improving patient care through improving the learning environment. This study represented one of the final steps of the project in determining within the clinical setting if significant perceived differences existed on the part of faculty, staff and students of nursing which affect student learn ing and development. Hypotheses The primary hypothesis tested in this investiga tion was that significant identifiable mean differences exist in the way the clinical learning environment is per ceived by the students, faculty, and medical center staff nurses in the sample population. Additional hypotheses tested in this study were as follows: 1. Chickering's (1969) theoretical postulates of col lege student development can be measured in rela- 10 tionship to the professional development of stu dents in nursing. 2. Using Chickering's (1969) vector model, an instru ment can be constructed to measure perceptions of student development along the following seven major vectors: a. achieving competence b. managing emotions c. becoming autonomous d. establishing identity e. freeing interpersonal relationships f. clarifying purposes g. developing integrity 3. A positve score along Chickering's vectors corre lates with perceived professional development in each vector area. 4. A composite score of all of the vector areas im plies meaning to the overall perception a compe tent professional nurse as seen by self, nursing service leaders or faculty. 5. Students, faculty, and medical center nursing staff demonstrate a variance in their components score profile. 11 Definitions of Terms For the purpose of this study, the following defi nitions will be used: Clinical learning environment: the Loma Linda University Medical Center where students, faculty and nursing service personnel interact with patients and other health care professionals in the delivery of health care. Perception: an adaptive, cognitive act, always rooted in the intentional life of the person, in his mo tives and aims vis-a-vis the environment (Klein, 1970, p. 4); thus the way a person receives his environment deter mines the effect it has upon him. Professional development: growth in the perform ance of nursing practice as a whole person including per sonal needs, goals, achievements and success of the indi vidual (Bridgman, 1953, p. 176; Goble, 1970, pp. 10-21). Professional identity: a state of unity or sameness with the professional group in values, norms, standards and behaviors. Operational unity and sameness are manifested in attitudes which reflect plans to work as a nurse and support the nursing profession, and in general having a favorable image of nursing. Conversely, disunity or lack of sameness is the negative com ponent of professional identity and is exemplified by attitudinal responses indicating no desire to continue to work or improve the nursing profession, and in general, expressing attitudes that reflect dissatisfaction with nursing. (Dalme, 1971, p. 48) 12 Valence: a quantified measurement of the per ceived influence of the clinical learning environment as measured on the vector scale used in this study. Basic Assumptions This study was made with the following basic as sumptions : 1. Chickering's theory of college student development can be applied to the development of students in collegiate programs of nursing. 2. The perceptions obtained of the studied groups accurately reflected the experience within the clinical learning environment. 3. The methods used for data gathering were appropri ate to the study. Delimitations The delimitations of the study were seen to be these: 1. The population sample for this study was limited to a single institution. Newcomb (1943, p. 3) defended the approach: 13 The limitations of studying a single community are obvious. But it is patent that, for most individ uals, whatever changes are in prospect must be mediated through the immediate social surroundings. Since values come to be values largely through the mediation of the groups with which an individual has direct contact, one cannot sensibly study individual's values apart from groups. A national social science research project also supported this rationale: Peer groups and peer cultures should not be stud ied except within an institutional setting, that is, as part of a system of interactions which the college comprises. (Social Science Research Coun cil, 1960, p. 46) 2. Professional nursing education takes place in a complex setting of interrelationships with multi ple persons and groups. This study was limited to the perceptions of selected students, medical cen ter nursing staff and faculty. Patients, visi tors, physicians, other paramedical, and auxiliary personnel have not been included. 3. Only students in the baccalaureate and graduate programs of nursing were included. 4. The time for data gathering was limited to one academic quarter. 14 Organization of the Remainder of the Study The following organization was adopted to form a logical order for this study: Chapter II presents a review of literature related to studies of conceptual theories or frameworks for inves tigating the influence by the environment of higher educa tion upon students. Special emphasis was given to studies in nursing and other health-related disciplines related to this research topic. Chapter III describes the methodology of the study including the research design and statistical analysis, the research sample, the instrumentation, the data collec tion, the methodological assumptions, and limitations. Chapter IV presents the data and its analysis fol lowing Chickering's developmental vectors with a discus sion of the results. Chapter V presents a summary of the findings, con clusions and recommendations based on the findings with suggestions for further study. CHAPTER II REVIEW OF RELATED LITERATURE The formal study of higher education in North America began with the founding of Harvard in 1636. The purposes of Harvard centered on maintaining the old cul ture brought from England into the middle of a new wilder ness. Concern over environmental influences in education was present as Mitchell (1663) wrote in those beginning years: We in this country, being far removed from the more cultivated parts of the world, had need to use utmost care and diligence to keep up learning and help to education among us, lest degenerarcy, bar barism, ignorance and irreligion do by degrees break in upon us [p. 31]. The education of the day was combined with a deep concern for the moral and religious development of the students, and out of this concern grew many rules that stood in loco parentis. Thus an original purpose of Ameri can higher education was "personal development" through acculturation to the classic and to moral principles (Handlin, and Handlin, 1970). The definition of personal development in higher education has changed in many ways over the past decades 15 16 according to the recent report of the Carnegie Commission on Higher Education (Kerr, 1973). "In loco parentis rules were gradually relaxed, as students took over more control of their own collegiate lives." [p. 60] Personal devel opment broadened in scope and meaning on the campus but has continued to be a theme and a recognized part of learning in higher education in the United States. "Per sonal development can be translated into the education of the individual student and the provision of an environment for developmental growth." [p. 63] Because of the increasingly large amount of writ ing that is available on the subject of the student and his relationship to the educational environment, special emphasis was placed on literature that most closely re lated to this study. The organization of this chapter will (1) investigate selected studies related to the in fluence of the college or university environment on stu dent learning, (2) discuss some of the theoretical or con ceptual framework used for investigating the learning en vironment for students in higher education, and (3) review learning environmental studies in nursing and certain other health related professions. 17 Studies of College Environment and Student Learning A model for needed changes in the strategies and contents of educational research has been presented by Shulman (1966). This model he formed from three specific educational systems in which students function namely "his primary environment, the instructional environment, and the eventual transfer environments." When there is con gruence among the elements of these environments, the edu cational process functions effectively. Breakdown in the process occurs when the elements are discontinuous. It is suggested that one of the most critical areas for educa tional research is study of environmental differences in higher education. Walberg (1970) in search for a model for research in teaching stated that much of the reliable variance in student performance is attributable to the aptitude of the learner and the environment of learning, leaving only a small part accounted for by instructional variables. Many studies have been done searching for means of identifying environmental influences on learning. Helm- stadter (1970, pp. 34, 35), believes that such studies need to begin by analysis of "power and authority involve ment" at the administrative level. Teachers are cited 18 (Stolurow, 1971), as the primary variable within the learning environment which might be meaningfully improved. Redesigning our campuses would make a major gain in im proving the learning environment by encouraging creativity via creative environs according to the work done by Bess (1969). Feldman and Newcomb (1969, pp. 120-121), have ex plained the complexity of learning environmental studies when they wrote of the overwhelming differences of student bodies, including students' needs, images of college life, abilities, aspirations and socio-economic backgrounds, combined with selection variables such as recruitment and admission policies of different institutions and all in fluence the learning environment that is established. Such diversity makes a universal description of "The Amer ican College" impossible. Some investigators have sug gested that pairing student characteristics with institu tional characteristics would maximize the particular po tentialities of both (Stern, 1960). All variable factors identifiable within the learning environment need to be taken into account in or der to make optimal use of physical and human resources in learning and teaching (Randhawa, 1973). Again the total environmental approach is urged by Brunswik (1957), but recognizing the wide range and relative inaccessibility of 19 many conditions affecting learning he was led to the con clusion that relations between persons and environments are "probabilistic rather than nomothetic." He called for extensive intro-individual studies in order to establish what little order there might be in an otherwise chaotic universe for study. Pace and Stern (1958) worked together in the statement of a need for the development of and beginning criteria for measuring the psychological characteristics of college environments. Based on the College Character istics Index (CCI), Stern (1963), identified six environ mental factors from responses of 1,076 students at 23 in stitutions. The six factors were intellectual orienta tion, social effectiveness, play, friendliness, constraint, and dominance— submission. These factors were used to identify student relationships between colleges and stu dents . In 1962, Pace developed the College and University Environment Scales (CUES), an adaptation of the CCI. In 19 69 the CUES was revised to its present second edition (Pace, 1969). These scales generalized on various studies of attitudes and group behavior. The 160 item test was to scale students1 conceptions of the "prevailing atmosphere or climate of the campus" into seven scored areas: prac ticality, community, awareness, propriety, scholarship, 20 campus morale, quality of teaching, and faculty— student relationships. Pace (1966) generalized on various studies and group behavior: ...Attitudes of individuals tend to reflect the most common beliefs of the members of the groups they belong to, the greater the clarity of the groups situation, the more will the individual be directed to the group goal-related task; pres sures toward uniformity are stronger in a cohesive group; the more cohesive a group is, the more dif ficult it is for the group to adapt to changes in external conditions [p. 91]. In an attempt to increase fundamental knowledge about the psychological characteristics of college envi ronments, those characteristics were related to student attributes and to criteria of institutional excellence. This was done by Stern (1966) at Syracuse University in volving a sample of students attending colleges of varied sizes. Two tests were administered, the Activities Index (AI) (Sterns, 1958), a personality measure and the College Characteristics Index (CCI). The data indicated that in coming freshman generally share stereotyped expectations of college life that combine some of the most characteris tic of the elite liberal arts colleges with the community spirit, efficiency, and social orderliness of the church- related schools, causing a subsequent frustration and dis illusionment on the part of the students. 21 Stern (1970, 1971) has continued with his learning environmental studies. A recent report of 49 campuses with the hypothesis that "the type and frequency of prob lems reported might bear a significant relationship to the intellectual climate of the campuses" measured by the same instruments as listed above in the 1966 study, AI and CCI, revealed that "each campus presents a unique environment with distinctive constituents." The study yielded no guidelines widely applicable for improvement of the learn ing environment (Stern, 1971). Austin (1965a) reported results of a study involv ing 246 colleges and 30,000 students. His test of 250 items showed that student behavior and college image are related to the personal characteristics of the student. He also noted that measures of college environment should be based upon distinct campus events or student behavior to define a campus environment. Numerous additional data gathering instruments have been developed to gain insight into learning environ mental characteristics (Harnett, 1974; Miller, 1968; Plough and Dressel, 1973) showing similar problems. The multiple areas or complexity of the learning environment in higher education calls for greater specificity and less global attempts to evaluate the multiple factors involved. Recent studies have placed added emphasis upon the 22 need for studying the student in the learning environment (Bushnell, and Zagaris, 1972; Bilorusky, 1969; Grafton, 1968; Lyon 1971; Walbert, 1969). Tyler (1970) emphasized that attention needs to be less global and stresses the need for study of the individual student as he states that one important condition of learning is a meaningful envi ronment, "opportunity to practice in appropriate situa tions that are meaningful to the student." Lyon (1971) tested selected students in the School of Education at the University of Massachusetts using the Rokeach Measure of Dogmatism (Rokeach, 1960). The students tested were in volved in an environment emphasizing a "humanistic experi ence" and demonstrated that either the experience was mak ing individuals more flexible and less dogmatic or that the school was attracting that kind of students. Major student presses within the environment of learning were studies by Cope and Hewitt (1971). They concluded that two of these were social and academic and were found to be the major factors which led students to withdraw from the environment. Two statements of possible solutions to meeting individual learning needs are as follows: Today there is still a considerable flexibili ty within higher education. We still expect that college means a different experience for different students. But, steadily, the flexibility, differ 23 entiation, and individual responsiveness are slip ping away. Only a determined effort can reverse this trend.(Newman, 1971, p. 27) The current search for new educational funnels must be reversed into the search for the institu tional inverse; educational webs which heighten the opportunity for each one to transform each moment of his living into one of learning, sharing, and caring.(Illich, 1971, pp. ix, x) Studies just preceding, during and following the university campus upheavals and unrest of the late 1960's and early 1970's point repeatedly to data giving evidence of student— faculty— administration communication gaps (Cox, 1968; Robertson, and Steele, 1971; Tussman, 1969; Wilms, 1973). Silberman (1973) is hopeful, more hopeful than in his earlier work (1970), that there is a change to more concern with individualized learning. "These two changes, in atmosphere and learning style, go hand in hand," a focus on the learner accurs only if the environ ment is included in that focus (pp. xvi, xvii). Simmons (1968) in a study to identify the traits that distinguish academically successful college women from those of average attainment, measured the scores and scales recorded by 286 women in the college of agricul ture, education, and liberal arts and sciences at the Uni versity of Illinois, Urbana. The components measured were: grade point average, achievement level, self con cept, environment, motivation, attitude, and faculty stu- 24 dent relations. "Environmental factors appeared to have the greatest influence on academic achievement." If the college climate is viewed as intellectually stimulating and congruent with personal goals, then it is more likely that effort will be expended to achieve academic success. Eble (1972, p. 146), discusses his study of vari ous institutions of higher learning and states that dis tance in perceptions of student and faculty was usually present. He concludes that faculty seemed to "overesti mate what students knew or should know" and that students tended to "underestimate what professors were interested in." Communication and student— faculty interaction Eble felt needed to be encouraged. Bonham (1972) and Corwin (1974) stated that from their studies of the environment in higher education there was role conflict of students and faculty but that there was reason to believe that a new spirit of openness and trust was becoming evident on many campuses. Hawkins (1973, p. 8) says there is very little formal research to assist faculty in understanding or control of educationally significant learning. He parallels "present day education al practice with 19th century medicine when most advances were made by thoughtful practitioners and when such novel ties as the germ theory had not yet reached beyond the laboratorys." 25 Nolle (1973) reports that investigators of the student— teacher influence process must face the fact that much literature has been "too simplistic to provide inter pretations which can go substantially beyond the initial biases of the investigator." Educators are still con fronted with the tremendous task of generating testable theories (Stinchcombe, 1968) whose confirmation implies rejection of plausible competitors. To achieve this end, they need to consider testable theories which can incor porate many variables and many complex relationships at several points in time (Blalock, 1969, and Boudon, 1970) and which can withstand repeated testings on comparable data sets. These theories seem to be in short supply. There is need for "replicated complexity" rather than "truncated simplicty" if we are to understand the stu dent— teacher influence process. Theoretical Framework Studies of Learning Environment Research addressing development in higher educa tion has increased dramatically during the last ten years. Jacob's (1957) survey which found minimal impact on col lege values, right or wrong, was a major stimulus. "Few theories have been framed, few hypotheses" (Chickering, 26 1969, p. 4). Thus, though much useful knowledge has been generated, it has remained largely in unintegrated form. Chickering expressed the need for some synthesis, for some systematic framework to order this growing field. Gibbon (1897), presented a threefold theory of existence which might have proved helpful to early profes sors in understanding the student as a person. He states these as values of existance in the division of the "mind, body, and estate" as: 1. First requisite of happiness is a clear con science, unsullied by the reproach or remem brance of an unworthy action...love of study, a passion which derives fresh vigour from enjoyment, supplies each day, each hour, with a perpetual source of independent and rational pleasure.... 2. The madness of superflous health I have never known, but my tender constitution has been fortified by time.... 3. Merits of society and situation in annual and adequate supply [pp. 344, 345]. Toynbee (1971) at the age of 82, summed up part of his wisdom of life stressing the fostering of individuali ty as follows: There is a great variety of natural gifts among human beings, and all these different kinds of gifts are valuable, indeed indispensable, for human welfare. But these human gifts are only potentialities to begin with. They do not become effective realities unless they are stimulated and trained and given opportunities for being used. 1 27 and this is really what we mean by education in the widest sense [pp. 85, 86]. To Lewin (1936), behavior is the result of two interdependent vectors— person and environment— operating in a dynamic field of "life space." Construct of developmental tasks has existed for almost thirty years, but received probably its greatest impetus from the work of Havighurst (1951) in the early 1950's. Havighurst (1953) defines a developmental task as one: ...which arises at or about a certain period in the life of an individual, successful achieve ment of which leads to his happiness and to suc cess with later tasks, while failure leads to un happiness in the individual, disapproval by the society, and difficulty with later tasks [p. 2]. He describes the period of 18 to 30 years of age as one of storm and stress because individuals must move from an age-graded to a social status-graded society. His list of developmental task expectations for this age group center about selecting a mate, creating a home life and omits any reference to education. He does suggest that the developmental task mastery is the purpose of education. Erikson's Identity Theory (Erikson 1955, 1959, 1963, 1968, 1970) states that identity is the self identi fication that one develops from the "soil of social organ- 28 ization (Erikson, 1960, p. 282)." He has hypothesized a continuous thread of life which takes the form of one's identity, beginning at birth and ending with death. Iden tity of the individual emerges from all human interac tions, shifting to accommodate the multiplicity of human roles that one assumes during a lifetime. Erikson (1968) postulates that there are eight identifiable stages of man's identity from birth to death. These stages of de velopment can be briefly described as: (1) trust, (2) au tonomy, (3) initiative, (4) industry, (5) identity, (6) intimacy, (7) generativity, and (8) integrity [pp. 135- 141]. Ralston and Thomas (1974) did a study "to inves tigate the relevancy of Havighurst and Erikson's con structs to the concerns of todays college students." The study was done at the University of Cincinnati in 1969 using 300 subjects, juniors, seniors, and beginning grad uate students with an open-ended sentence completion test ing tool. The results of this study showed overlap of developmental areas of early adulthood and adolescense and found the two new areas, school success and financial con cerns, as not having been identified in the works of Havighurst and Erikson. Katz and his associates (1968, p. 418), concluded from their four-year study of more than three thousand 29 students between the ages of 17 and 2 2 years on the Berke ley and Stanford campuses, that individuals reacted in a variety of ways to the college experience. However, be cause the college environment was too structured, the great majority of students failed to achieve an autonomous identity. In a recent study Katz (1973, p. 12 8) again states that "because there is little attention from adults, the student feels...his self esteem plunge." This change occurs late in adolescence when the "personality is very labile, when impulses can easily become disarrayed, and when the sense of reality can be vague and even bizarre." Sanford (1962, 1966, 1967a, 1967b) postualtes edu cational planning of the total personality as well.as by social theory. He believes that education should concen trate on developing the individual student rather than on imparting knowledge and skills. Such a theory of personal ity Sanford (1967) argues is a theory of in terms of which it is possible to state specific goals for the individual, describe the interrelations of his various psychological processes, and understand the ways in which he changes under the impact of environmental influences Ip. xv]. Gibb's (1972) study identified trust, openness, realization and interdependence as the developmental framework needed for innovation in higher education. Tay lor (1973, p. 99) using his multiple talent totem pole 30 model concluded that the measure of performance of an educational sys tem should primarily be concerned with the degree to which students are effectively and fully func tioning. .. how well they are developing and how well their inner resources are activated and are functiong naturally and fully. Corey and Herrick (1962) summarize adolescent, age 12 to 18, developmental tasks and relate them to education as follows: (1) they are necessary learning, (2) they must be learned within restricted time periods, (3) they are interdependent, (4) they involve varied types of learning, (5) they define the concerns of children. Originally an attempt to analyze existing American educational practices in terms of a thought paradigm O'Neill and Demos (1971) altered their original purposes to include a detailed analyses of communist "brain wash ing" only. This proved to be a horrendous task but pre sented many considerations related to the learning envi ronment. They concluded that "brain washing is primarily a moral project. Its fundamental aim is to alter the will through the instrumentality of values." [pp. 2, 6], Such learning is highly environmental related with control of the environment necessary and reflects the opposite type of attempts made by most studies already referred to which 31 frees the individual to be self directed and the estab lishment of personal identity is sought. Struner (1973) holds that identity can be created with things and ideas but especially with the exploritory process which enliven them. He theorizes that the learn ing environment is "orchestrated by their inhabitant pro duced experiences and structures which are self generat ing. " Chickering (1973) states that "Self development is the emerging goal of education...opportunities which en able continued self-expansion and self development." [p. 72]. This study is based on Chickerings (1969) develop mental theory for education. New forms and practices in education recognize four major principles upon which "man's fate and the fate of education are inextricably linked," (Chickering, 1972) they are: 1. Education effectively integrated into the individual total life experience. 2. Most effective learning occurs when related to significant personal plans and aspirations. 3. Sound learning and development require direct and indirect, vicarious, active and reflective experiences. 4. Personal requirement will vary in the above. [pp. 13-29]. 32 Studies of Nursing and Other Health Related Professions Learning Environment Historically/ the systematic study of work, which has consistently included the professions, had its roots in the way an individual related to an ongoing social structure in which he participated. Becker and Casper (1956) discuss the elements of identification with an oc cupation stressing that the occupational identity is evolved from the process of an individual learning who he is, and how he should behave in relation to the norms of the group to which he belongs. Achieving professional identity has been the pri mary focus of several studies. Menges (1974) after point ing out that few programs of professional education have a clear underlying theory; explicit communicable objectives or follow up validity studies says that "little opportuni ty is available to students to control their own develop ment..." [p. 38]. He feels that much in professional edu cation demonstrates manipulative programs screening stu dent admissions to find those most like present practi tioners rather than searching for means to improve the professional practice creatively through admissions. Borgen and Weiss (1968) found empirical validation 33 for the Minnesota Job Description Questionnaire (MJDQ) which yields an occupational reinforcer pattern depicting relative magnitudes of 21 reinforcers for each of the 81 occupations surveyed. More reinforcers were found to be available to higher level occupations, including most professional occupations, and those reinforcers were pri marily intrinsic. As a part of a larger study of careers in the men tal health field being made at the University of Chicago, Spray (1968) found that the knowledge of the work environ ment was the best predictor of professional level of func tion and was a prerequisite to understanding the influence of idealogical adherence and professional training. Following a series of workshops held to study stu dent attitudes to professionalism Abercrombie and Terry (1973) reported that they found students "did not want to become like the professionals they knew." The students spoke of their own fear of "loss of identity, stating 'you don't know where yourself is anymore'." [p. 473]. Recent studies in nursing professionalism (Cahil, 1973; Jones, 1971a, 1971b; Spingarn, 1974) reveal similar problems of identity crises. A psychiatrist (Jones, 1971a; 1971b) points out that the adjustment needed for the nurse in both "professional and complete way of life" is associ ated with a high degree of stress as found in an Oxford 34 hospital school of nursing during a 1970 study there: A nurse expressed the feeling that you have to be self contained, emotionally intact person... you cannot allow the patient to see you have prob lems and conflicts of your own. To learn this control, the nurse has to learn to switch off or on emotionally on or out of the learning environ ment. ... In teaching and practice there may be positive discouragement of initiative and encour agement of conformity [1970a, pp. 30, 31]. Recently two important related studies were com pleted involving nursing student identity and profession alization as related to environments (Dalme, 1971; Johnson 1971). The central hypotheses tested by Dalme (1971) was that "there is a correlation between nursing students' perceptions of selected environmental influences and the professional identity nursing students develop." [p. 16]. Data was obtained from 250 nursing students representing 66 percent of the total nursing students enrolled in four baccalaureate degree programs in one midwestern state. The testing tool was constructed by Dalme using Erikson's (1968) theoretical proposition that there is a relation ship between environmental influences and the identity one developes. Likert-type scales of 21 items each were de veloped to measure students' perceptions of peers, faculty, and staff nurses' influence upon nursing students in the clinical educational environment. The findings of Dalme's study found Erikson's theory of identity helpful for frame 35 work use but the qualitative nature of his constructs could not be precisely captured in an operational defini tion that allowed quantitative measure of them. The study omitted other nursing related interactors in the students' clinical learning environment as beyond the purpose of the study. The research did indicate that all perception scales were statistically significant (p>.01) correlated with the professional identity scale. This study also was instrumental in providing a basis for restructure of a testing tool and further assessment of nursing learning environment. Johnson's (1971) study was purposed to determine whether the six dimensions, general esteem, academic en thusiasm, extrinsic motivation, breadth of interest, in trinsic motivation, and encapsulated training could be shown to differ among baccalaureate degree nursing pro grams, as well as between students and faculty members. The study utilized responses from 1,789 faculty members and 5,267 members of the 1969 senior class of a stratified national sample of 212 nursing schools. The study was supported and was sent out by questionnaire by the Nation al Commission for the study of Nursing and Nursing Educa tion Lysaught, 1970, p. 105). Non response present a seri ous problem with over 50 percent student attrition to the mailed questionnaire. The instrument used was a "slightly 36 modified version" of the Medical School Environment Inven tory (MSEI), (Hutchins, 1962: Hutchins, and Nonneman, 1966) . The MSEI had been shown to distinguish between graduates who were oriented toward education and research vs. clinical practice of medicine. The MSEI after minor changes in wording was renamed the Nursing School Environ ment Iventory (MSEI). Both instruments consisted of 169 items each contributing to one of the six factors named above. The NSEI was assumed to have similar validity for nursing schools as it had to medical schools. Johnson (1971) stated: while data of this study demonstrated significant trends toward discernable differences between en vironments of the three types of nursing schools, they also yielded evidence for substantial simi larity between the environments of many of the same schools [p. 131]. Professional identity as related to role develop ment and/or conflict are areas in which considerable study has been done in nursing. Because of their significance to this study selected major studies are here referred to. Kramer (1970) demonstrated nursing role changes and depri vation found in 220 collegiate graduate nurses working in 37 medical center hospitals. Report of a five year study (Kramer, McDonnell, and Reed, 1972) investigated the conflicts and adaptation of 37 collegiate nurses who are socialized into the professional work system but employed by the "bureaucratic work system." This study emphasized role configuration and perceived op portunity to enact bureaucratic-professional role concepts. The study began in 1967 with a sample of 220 generic bac calaureate nurses from 37 medical centers throughout the United States. Responses of the nurses during the personal interview produced an awareness of the breadth and harshness of the nurses1 feelings toward nursing, toward their jobs, and toward their lack of opportunity to enact the nurse role as they learned it in school and hve continued to idealize it [p. 21]. Corwin (1960, 1961), and Corwin and Taves (1963) have produced the Bureaucratic Role Conception (BRC) scale which has been used to assess reported loyalty to the work system as reflected in practices of conformance to bureau cratic operation and loyalty to the organization. This test also measures the loyalty, to tenets of the profes sional system as it has been adapted to test Professional Role Conception (PRC) by Kramer, et. al. (1972). Lefcourt (1970) compared ratings of adequacy in the role of the student nurse by supervisors and students (N=23) themselves. Contrary to prediction it was found that adequacy in laboratory tasks was inversely related to nurse-role adequacy as judged by supervisors and students. 38 The professional role an individual comes to hold arises primarily out of his personality and environment interaction. Such a role which the individual comes to hold may influence his perception of people he meets, moulding his view of society and affecting his personality for life (Alutto, 1971; Banton, 1968; Bates, 1970; Branch, 1972; Kiker, 1973). Guttchen (1966) raises the age old question as to how philosophy guides practice. Other writers (Alexander, 1972; Aydelotte, 1972; Pickard, 1974; Pierik, 1973; Sachs, 1974; Walker, 1971) seem confident that the strength of future professional education remains in the degree in which education and practice in the clinical setting can lock their goals on improving the learning environment and patient care by educators and service personnel working together. Haggerty (1973) perhaps best sums up the need for change in the medical environment when he states that the argument should no longer be "whether" the institution of higher education needs improvement in the delivery of care to the community, "but how to most effectively do its job." He believes that the academia must be more involved with both education of students and service to patients [p. 132]. 39 Summary of the Literature The majority of the studies that now are numerous in the field of educational environment in higher education conclusively agree that the environment is a highly impor tant area of the educational system. Studies show that the learning environment can be studied from many approaches and that changes can be made which will influence the de velopment of the individual student within his environment. Theories of college student development are being postu lated but relatively few have been tested on a longitudinal and replication study base. Theories of college student development are just beginning to be applied to the educa tion of nursing and other health related disciplines. It is postualted that education and practice in the real world must be brought together. The realm of interactions of students, faculty and clinical nursing leaders needs yet to be investigated in terms of sound theoretical frame works . CHAPTER III THE INSTRUMENT AND METHODOLOGY This chapter presents a description of how the re search instrument was developed, validation of the instru ment including use and reconstruction of the pretest, the population sample, the collection of the research data and finally the method of analysis. Development of the Research Instrument The primary hypothesis in this study was that sig nificant identifiable mean differences exist in the way the clinical learning environment is perceived by the students, faculty and medical center staff nurses in the sample popu lation. Additional hypotheses were tested using Chicker- ing's (1969) theoretical postulates of college student development measured in relation to the professional de velopment of students in nursing. From these hypotheses two central variables were identified; clinical environ mental influences on (1) student personal development and (2) student professional developmental competency. The empirical indicators of perceived student learning and de velopment in the clinical environment were (1) the students 40 41 themselves, (2) the nursing service leaders, and (3) the nursing faculty. Since no previous scales were found which would obtain specific data needed for measuring the stated hypotheses, a new instrument was prepared. The test items were written to provide a basis for scoring along Chickering's seven major developmental vec tors. Each of these vectors were defined to include the original concept of individual development as defined by Chickering but were restated to adapt to the individual student development of nurses as could be tested in the clinical learning environment. Permission was granted by Chickering for this usage. See letters in Appendix I. The vector definitions as adapted to nursing student develop ment were as follows: A. ACHIEVING COMPETENCE: 1. professional competency in patient assessment includes all phases of patient care; 2. skill in physical and manual aspects of patient care; 3. acquiring satisfaction with ones own ability to render patient care well. B. MANAGING EMOTIONS: 1. learning how to use the parameters of love, respect, courage, aggression and sexual expres sion with mental control in respect to the fol lowing interactive behavior: a. that which is conducive to patient well being; 42 b. that which produces meaningful interaction with all persons closely associated with the student related patients within the health care setting; c. that which demonstrates appropriate rela tions with other individuals not related to patient care. 2. trusting emotional conduct through intelligent behavior. C. BECOMING AUTONOMOUS: 1. independent decision making in nursing assess ment when appropriate; 2. utilizes consultants as need indicates; 3. carries nursing role without continual need for reassurance and/or approval. D. ESTABLISHING IDENTITY: 1. recognition of self with human needs, both strong and weak, and how this understanding of self affects self, patients, and others in ones environment; 2. the ability to sense the helpful or destructive forces through which ones being resonates to others; 3. developing appropriate individual manners of dress as well as professional and social man ifestations of feminine-masculine personality balance; 4. establishing a life pattern for personal and professional growth. E. FREEING INTERPERSONAL RELATIONSHIPS: 1. demonstrates an open attitude toward acceptance of, or tolerance for patients and others who have varied backgrounds, habits, values, and appearances; 2. shows sensitivity to the values gained through interpersonal exchange of ideas and people; 43 3. develops appropriate trusting relationships with others which if necessary can exist through periods of separation and noncommunica tion; 4. decreases necessity to coerce or manipulate patients, colleagues, or others. F. CLARIFYING PURPOSES: 1. formulates personal and professional life plans and practices that integrates life's experi ences increasing both their direction and mean ing; 2. demonstrates personal understanding of life's value in maintaining wholeness requiring a bal ance among his intellectual, emotional, physi cal and spiritual parts thus releasing the needed energy for coordinated purposeful action. G. DEVELOPING INTEGRITY: 1. forming a professional and personal set of val ues consistent with outward behavior arising from internal beliefs and convictions; 2. develops personal and professional standards by which one appraises himself and in terms of which self esteem varies. There are four main types of attitude scales (1) summate and rating (Likert Scales), .(2) equal appearing intervals (Thurston Scales), (3) cumulative scales (Gultman Scales), and (4) semantic differential scdles (Ary, Jacobs, and Razavieh, 1972, pp. 179, 180). The Likert-type summat- ed rating scale was chosen for this study. Kerlinger (1974) recommends this type of scale for measuring atti tudes as was done in this study. 44 ...attitude values, all of which are considered of approximately equal 'attitude value,' and to each of which subjects respond with degrees of agree ment or disagreement (intensity). The scores of the items are summed, or summed and averaged, to yield an attitude score. As in all attitude scales, the purpose of the summated rating scale is to place an individual somewhere on an agree ment continuum of the attitude in question [p. 496]. The Likert-type summated rating scale allows sub jects to respond to a series of items written in a single— stimulus form indicating their degree of agreement or dis agreement, on a five-point rating scale (Oppenheim, 1966, pp. 133-142). This study was constructed using a five- point scale indicating the individual's opinion of the item from strongly agree, agree, undecided, disagree, to strong ly disagree. The use of the five intervals as a standard was discussed by Day (1940, p. 400), in review of attitudinal research. He stated that 77 percent of attitude scales were of this type. Response items may vary from one to ten, but most researchers favor an uneven number in order to have a neutral point which also tends to delimit the error of central tendency. Construction of the Instrument Using Chickering's (197 0) seven developmental vectors as a guide, items were developed to measure each 45 vector area. These items were constructed by adapting ap propriate items from Dalme's (1971) instrument for measur ing nursing students' perception of selected environmental influences and their development of professional identity (see Appendix X for letters of permission for uses in adapt ation of items from this questionnaire.) Prior to doing this study the researcher considered the strong possibility of using all or most of Dalme's (1971) questionnaire with an additional section or subtest to meet the hypotheses proposed by this study. As the instrument was developed, it was found that relatively few of Dalme's items fit Chickering's theoretical framework. The writer next moved to previous unpublished studies which had been done under the Loma Linda University School of Nursing five-year pro ject on Learning Improvement, funded by the Department of Health Education and Welfare under Grant #5-D 10-NU-0353-05 referred to in Chapter I. In this HEW project a longitudi nal study had been conducted with this writer as project director, which demonstrated satisfactions and dissatisfac tions of nurses including students in the Loma Linda Uni versity Medical Center. These statements of satisfaction and dissatisfaction provided a major source of material for constructing test items into developmental vector categories. Guilford's (1965) criteria for constructing a 46 Likert-type scale was used. He suggests the following basic items: 1. Collect a large number of favorable and un favorable statements regarding the attitude object. 2. Select from these approximately equal number of favorable and unfavorable statements. 3. Administer these items to a number of indi viduals, asking them to indicate their opinions regarding each statement by determining whether they strongly agree, agree, are undecided, dis agree, or strongly disagree with each statement. 4. Compute the score of each individual.... 5. Carry out an item analysis to select those items that yield the best discrimination. Through item analysis one finds the correla tion between the subjects' total scores and their response to each item. Ninety one items were constructed which as judged by the researcher provided 13 items for each of the seven vectors to be scaled. Validation of the Instrument Wolins and Dickinson (1973) point out that psycho logical literature is rich with studies demonstrating that "collecting responses to affective stimuli using a large number of ordered categories is not effective when compared with using some smaller number;" [p. 712] . Thus a 20 point scale is no better and maybe worse in terms of reliability 47 and validity, than say, a five-point scale as was used in this study. Content validity according to Kerlinger (1974, pp. 458, 459) consists essentially in judgment. Alone or with others one judges the representiveness of the items in terms of the property being measured. Usually other "com petent" judges should judge the content of the items with the universe cleax’ly defined and with specific directions for making their judgments. A jury of 12 was selected to assist in increasing the test content validity. Four members of the jury were familiar with nursing but were not nurses themselves. These included a physician, a sociologist, a psychologist and a social science researcher. The other eight members of the jury were nursing administrators equally divided between education and clinical practice. Each jury member was given a letter of instruction (see Appendix II) and a set of seven envelopes one for each developmental vector with the vector title and complete definition as earlier described in this chapter, typed on each of the envelopes. They were also given each of the 91 items which had been numbered randomly and cut for sorting as in a Q sort. This then consisted of what Kerlinger (1974, p. 588) calls a structured Q sort with a built in theory as the basis of the sort, that is, the jurors were to sort the 91 items 48 into the vectors as based on Chickering's developmental theory. Analysis of the jurors responses was made to select those items with which there was a greater than 50 percent agreement with the categorization of the item into one of the seven selected developmental vectors. This yielded a testing instrument with 64 items or 70 percent of the orig inal 91 prepared items. Although the instrument now had an unequal number of items for each vector it was decided to use all 64 items on the pilot or pretest and then proceed to select those items yielding the best discrimination. On February 25, with written instructions, the pilot test was administered as shown in Appendix II. The test was administered by a Loma Linda University research staff member previously instructed by this investigator. The sample for the pilot test was similar to the group to be tested for this study. The pilot group consisted of 43 second year students in the Associate Degree Nursing Pro gram of Loma Linda University who were receiving their clinical experience in the White Memorial Hospital in Los Angeles, 15 nursing service staff leaders in that hospital, and the four faculty who were teaching the students in the pilot group. A computerized item analysis was done on the pilot test. Selection was then made of items showing the strong 49 est degree of discrimination and the test was revised as shown in Appendix II. The final test was made of 4 9 items with seven items for each of the seven vectors tested. On this test 27 items were stated positively and 22 negatively. All items were mixed randomly for both vector and positive versus negative relationship. The Population Sample Included in this study was a total of 342 partici pants. All were either full time enrolled students, facul ty or nursing service personnel at Loma Linda University. The students and faculty were from the School of Nursing at Loma Linda University and the nursing service personnel were staff leaders, (team leaders, head nurses or super visors for clinical units) in the Medical Center of Loma Linda University. The sample was further divided into the following subgroups. 1. Students: 247 baccalaureate and graduate students 84 sophomores 63 juniors 76 seniors 24 full time graduate nursing students working toward masters degrees 2. Nursing Service Leaders: 59 full time employees having direct contact with the above students in the clinical learning environment. 3. Faculty: 36 teaching in the clinical learning environment. 50 Collection of the Research Data All data was gathered during the week of March 11, 1974, Questionnaires were administered by a nursing re search project staff member with the cooperation of the faculty and nursing administration. The baccalaureate students were tested either by total class groups or sec tions with the instructions attached to the test as shown in Appendix II. Graduate students, nursing service leaders and faculty had the test delivered and collected by the project staff member. Most individuals were interested and cooperative in completing the test with the exception of a few instances where the clinical setting nurses felt pressed with patient responsibilities and relief was not always possible during the day of the test administration. A small number of fac ulty and graduate students declined to participate on the basis of their lack of "adequate" involvement within the University Medical Center. In each of these instances with faculty and graduate students, their major clinical in- volvement was in other community health agencies such as public health department or mental health agencies. Method of Analysis The data was compiled with the assistance of some 51 of the Loma Linda University statisticians and the scienti fic computation facility. Computer analysis was done when ever possible. The data was grouped by the sample sub groups as shown on the preceding page. At the time when the questionnaire was constructed (see Appendix II), nurs ing service leaders and faculty were subdivided into three subgroups each. At the time of analysis because of the low numbers in the subgroups and the lack of significant dif ference in response, these parameters were reduced leaving the students divided by class, faculty, arid nursing service leaders as independent groups but without subgroups there in. First an item analysis was done by identified groups (see Appendix III). Then a matrix was designed to render an analysis of valence of vectors by items and groups which was next divided into the tables by items (see Tables 1 to 49 as shown in Chapter III, and Appendix IV). Mean scores were determined from interval responses on each of the 4 9 items. Values from one to five were ar bitrarily chosen for each of the intervals, with a mean score of one meaning strongly agree, three a neutral or undecided position and five a position of strongly dis agree. All test items were stated in the positive in Chapter IV as the negative items, 22 in number, had to be reversed for statistical analysis and meaningful compari 52 sons. A matrix was designed to indicate analysis by vec tor and linear correlation, and another for vectors and chi squares described in Chapter IV. These statistical methods were used to analyze the data for possible relationships between vectors and items studied. CHAPTER IV ANALYSIS OF THE DATA The major purpose of this research study was to test Chickering's theoretical postulates of college stu dent development. The primary hypothesis tested was that: significant identifiable mean differences exist in the way the clinical learning environment is perceived by the stu dents, faculty and medical center staff nurses in the sam ple population. The organization of this chapter centered about the hypotheses for the study. The testing tool was con structed to measure perceptions of college student devel opment along the seven major vectors. The data has been presented as identified by the research instrument in the following order: (a) achieving competence, (b) managing emotions, (c) becoming autonomous, (d) establishing iden tity, (e) freeing interpersonal relationships, (f) clari fying purposes, and (g) developing integrity. The valence or quantified measurement of the per ceived influence of the clinical learning environment was measured on the vector scale for each item of the seven vectors and was reported by each of the seven items within 53 54 each vector. Mean scores for the 342 subjects in the study were determined from the interval response on each of the 49 items in the testing instrument. Values from one to five were arbitrarily chosen for each of the inter vals in each test item, with a mean score of one meaning total agreement, three a neutral position and five a posi tion of positive disagreement. The statistical procedure of chi-square, test of independence was used to determine significant differences at either the 5 or 1 percent level of confidence among the vector groups and shall be report ed following the analysis of items by vector. Comparisons of the Valences of Vector A: Achieving Competence A high degree of intergroup agreement existed among the students, nursing service leaders and faculty on, the consistanay of classroom and formal teaching with that which can and should be practiced in the clinical setting (Table 1). The difference in mean scores indicated a range of 0.8. Students and faculty demonstrated a greater than 60 percent agreement with the item. Nursing service leaders showed a bimodal dispersion of response with 27.1 percent 55 TABLE 1 VALANCE OF VECTOR A, RESPONSE TO TEST ITEM 3: TEACHING IS CONSISTENT WITH CLINICAL PRACTICE Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.4 10.7 Junior 63 2.5 11.1 +- Senior 76 2.8 6.6 Graduate 24 2.5 4.2 All Students 247 2.6 8.9 Nursing Service Leaders 59 3.0 27.1 Faculty 36 2.2 8.3 ■ir TOTAL 342 2.6 11.0 56 undecided. A decided positive indication existed that teaching is relative to current clinical practice but nursing service leaders were not so certain that this was so. The total subject group support the concept that, nursing service leaders did not tend to give recognition to a gob well done by students more often than did the nursing faculty (Table 2). The difference in the means showed a range of 1.0. More than 80 percent of the graduate students and 70 per cent of the faculty agreed with the statement with the undergraduate students which showed just over 50 percent in the direction of agreement. Faculty and nursing ser vice leaders respectively held a 25 and 37.3 percent un decided response. Responses to this item showed definite evidence that students do not gain positive support in achieving competence for a job well done by nursing ser vice leaders over nursing faculty. The item does not test whether students receive recognition of competence at all. Four of the group analyzed, juniors, seniors, fac ulty, and total students, presented a bimodal spread re sponse when asked if, students are more interested in nursing patients with rare and exotice problems than those with more common illnesses (Table 3). The difference in mean scores indicated a range of 57 TABLE 2 VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 9: NURSING SERVICE LEADERS DO NOT GIVE STUDENT JOB RECOGNITION MORE OFTEN THAN DO FACULTY Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.5 17.9 Junior 63 2.7 19.0 +- Senior 76 2.8 11. 8 ■4“ Graduate 24 2.0 8.3 + - All Students 247 2.6 15.4 Nursing Service Leaders 59 3.0 37.3 -4 — )■ Faculty 36 2.1 25.0 TOTAL 342 2.5 19.2 58 TABLE 3 VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 14: STUDENTS ARE NOT MORE INTERESTED IN CARING FOR PATIENTS WITH RARE VS. COMMON ILLNESSES Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.5 7.1 -e Junior 63 3.0 11.1 * < —> • Senior 76 3.0 1.3 Graduate 24 2.8 4.2 All Students 247 2.8 6.1 Nursing Service Leaders 59 3.6 10.2 Faculty 36 3.1 5.6 TOTAL 342 3.0 '6.5 59 0.8. Sophomores and graduate students felt they were not significantly responsive to the more exotic case but nurs ing service leaders responded with greater than 60 percent perceiving that students were more interested in caring for such a patient. The responses to this item show that students and faculty basically were not sure if caring for patients with rare and exotic diseases were important for satisfaction in achieving competence in nursing. Nursing service leaders were fairly certain that the exotic or rare nature of illness did influence student interest in rendering patient care. Over 80 percent of the faculty felt that, the em phasis on philosophy and/ov soientifie method seems re lated to the veal "here and now" needs of patients (Table 4) . The difference in means showed a range of 1.4. Graduate students, with over 70 percent also agrees with the statement. Just over one half of the sophomores and juniors agree and 10 to 20 percent of them were undecided. Seniors and nursing service leaders showed over a 50 per cent disagreement with the statement with slightly over 10 percent undecided. There was a definite lack of congru ence over the relatedness of clinic teaching to current clinical practice. Strong disagreement exists by most respondents to 60 TABLE 4 VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 24: EMPHASIS ON TEACHING IS RELATED TO CURRENT NEEDS OF PATIENTS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.9 13.1 <- Junior 63 2.7 11.1 - t - Senior 76 3.2 10.5 ->■ Graduate 24 2.3 4.2 All Students 247 2.9 10.9 « - Nursing Service Leaders 59 3.5 13. 6 Faculty 36 2.1 2.8 -4 ~ TOTAL 342 2.8 9.5 61 the issue stating, that immediately following graduation most baccalaureate students are safe and have become pro fessionally competent in one or more areas of nursing care (Table 5). The mean difference in scores showed a range of only 0.5. Seniors and faculty members disagree most with more than 80 percent of both responding negatively. Soph omores and nursing service leaders seem to express great er confidence in new graduate professional competence, slightly more than 50 percent still disagree, but this same group presents a 21.6 percent overall mean in the un decided category. A decidedly negative view was taken to this issue by most of the respondents which would strongly indicate a lack of perception of achieving competence in one or more areas of nursing at the time of graduation. No significant difference existed in the positive direction of valence for the subject's perception of the statement concerning, faculty who teach on the clinical units are less competent in nursing care than are the nursing service leaders on the unit (Table 6). The difference in mean scores showed a range of 1.1. Just over one half of the sophomores, juniors, se niors and graduate students all agreed to the statement with an average of 21.9 percent undecided. Stronger per ceptions were recorded by faculty, over 60 percent, and by 62 TABLE 5 VALENCE OP VECTOR A, RESPONSE TO TEST ITEM 26: IMMEDIATELY FOLLOWING GRADUATION STUDENTS ARE COMPETENT IN ONE OR MORE AREAS OF NURSING CARE Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.5 26.2 Junior 63 3.7 11.1 -> Senior 76 4.0 2.6 Graduate 24 3.7 12.5 All Students 247 3.7 13.8 - > • Nursing Service Leaders 59 3.8 17.0 - > Faculty 36 3.9 2.8 TOTAL 342 3.8 12.3 63 TABLE 6 VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 32: FACULTY ARE LESS COMPETENT IN CLINICAL PRACTICE THAN ARE THE NURSING SERVICE LEADERS ON THE TEACHING UNIT Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.7 23. 8 Junior 63 2.7 22.2 *<- Senior 76 2.7 19.7 Graduate 24 2.8 20.8 All Students 247 2.7 21.9 Nursing Service Leaders 59 1.7 11.9 Faculty 36 2.4 16.7 - t - TOTAL 342 2.5 19.6 64 nursing service leaders with over 80 percent agreed on faculty incompentency compared to their service faculty colleagues. Respondents did not generally perceive nurs ing faculty as having greater clinical competency than nursing service leaders. Students should seek help toward competency from service leaders more than from faculty ac cording to this item response. A high degree of favorable agreement was perceived by most subjects as they viewed the, nursing faculty being most helpful in assisting student learning in the clinical setting (Table 7). The difference in the means scores showed a range of only 0.5. Over 60 percent of all subjects agreed to this statement with the exception of nursing service lead ers with slightly over 50 percent who agreed but nearly one-fourth or 23.7 percent undecided. Faculty were sig nificantly helpful in assisting students to achieve pro fessional competency according to this vector item. Comparisons of the Valences of Vector B; Managing Emotions Bimodal expressions of perceive managing of emo tions were demonstrated in the handling of courage and ag- 65 TABLE 7 VALENCE OF VECTOR A, RESPONSE TO TEST ITEM 46: FACULTY ARE MOST HELPFUL IN ASSISTING STUDENT LEARNING IN THE CLINICAL SETTING Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.1 13.1 Junior 63 2.2 12.7 ■<- Senior 76 2.5 19.7 Graduate 24 2.0 8.3 All Students 247 2.3 14.6 *+“ Nursing Service Leaders 59 2.5 23.7 <- Faculty 36 2.0 8.3 TOTAL .............. 342 2.2 14.3 66 gression on the clinical unit. These responses were to the item stating that, in the clinical setting students see nursing leaders (service and faculty) using appropri ate forms of courage and aggression to achieve meaningful ends for the improvement of patient care (Table 8). The difference in the mean scores indicated a 0.7 range. Sophomores showed slightly more than 50 percent agreement and nursing service agreed by 60 percent. A high degree of spread was noted throughout the sample pop ulation. The response to this item indicated that assis tance to students' ability in managing emotions via role modeling of nursing leaders was not significant. A significant amount of indicisiveness was felt by the sample with 22 percent overall undecided on the issue of whether, students learn to use courage and aggression to make changes in patient care (Table 9). The difference in mean scores showed a range of only 0.3. Over 50 percent of the sophomores, juniors, se niors and nursing service leaders agreed to the statement. Faculty showed a bimodal spread of response with 33.3 per cent undecided. Managing emotions does not seem to be significantly assisted by students demonstrating how to use courage and aggression to achieve change in patient care in the clinical setting. A significant agreement in direction of valence 67 TABLE 8 VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 5: STUDENTS SEE NURSING LEADERS USING APPROPRIATE FORMS OF COURAGE AND AGGRESSION IN PATIENT CARE Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.8 17. 9 - f - Junior 63 2.9 23.8 <—* Senior 76 3.2 13.2 Graduate 24 3.2 4.2 All Students 247 3.0 16.6 <—h Nursing Service Leaders 59 2.3 25.4 + Faculty 36 3.0 30.6 TOTAL 342 2.9 18.8 68 TABLE 9 VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 11: STUDENTS LEARN TO USE COURAGE AND AGGRESSION TO MAKE CHANGE IN PATIENT CARE Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.7 25. 0 +- Junior 63 2.8 12.7 Senior 76 2.7 18.4 +- Graduate 24 2.7 29.2 All Students 247 2.7 20.2 Nursing Service Leaders 59 2.6 15. 3 Faculty 36 2.9 33. 3 TOTAL 342 2.7 22.0 69 was seen in the response to the statement, if a student cried when a -patient died nurses in authority would not think the student "unprofessional" (Table 10). The difference in mean scores showed a range of 0.6. All subjects agreed from 60 to 90 percent with a mean of less than 10 percent undecided. According to these responses, crying at the time of a student's patient death was generally considered within the realm of manag ing emotions on an appropriate professional level. Students and nursing service leaders showed sig nificant difference in response to the item, personal hos tilities are not usually concealed in the clinical setting (Table 11). The difference in mean scores showed a range of 0.6. Over 50 percent sophomores, 60 percent juniors and seniors, and 70 percent graduate students perceived hos tilities were concealed. The variance in response between students and their faculty or service leaders indicated lack of recognition among these groups as to how emotions in the form of personal hostilities should have been han dled within the clinical setting. Faculty and service leaders showed about one-fourth undecided with more fac ulty agreeing than disagreeing and nursing service leaders responding bimodally. A strong degree of agreement existed, over 70 per- 70 TABLE 10 VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 33: IF A STUDENT CRIED AT THE TIME OF A PATIENT'S DEATH, NURSES IN AUTHORITY WOULD NOT THINK THE STUDENT WAS "UNPROFESSIONAL" Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.2 13.1 Junior 63 2.1 7.9 Senior 76 2.2 5.3 Graduate 24 2.1 4.2 All Students 247 2.2 8.5 Nursing Service Leaders 59 1.6 3.4 - t - Faculty 36 o • CM 11.1 TOTAL 342 2.1 7.6 71 TABLE 11 VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 35: PERSONAL HOSTILITIES ARE NOT USUALLY CONCEALED IN THE CLINICAL SETTING Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.4 22.6 - > Junior 63 3.4 12.7 - * Senior 76 3.4 5.3 Graduate 24 3.5 8.3 All Students 247 3.4 13.4 -> Nursing Service Leaders 59 2.9 23.7 Faculty 36 2.9 27.8 TOTAL 342 3.3 16.3 72 cent, in all groups to the statement, during clinical practice students learn appropriate use and power of per sonal emotions in patient care (Table 12). The difference in means showed a range of only 0.3. Mean scores of undecided were 15.4 with the highest level of indecision, 32.2 percent, among nursing service leaders. The means suggest a strongly perceived indica tion that students learn management of emotions in patient care. Only the faculty group with over 80 percent strongly perceived, most students are happy in their clin ical learning (Table 13). The difference in means indicated a range of 0.7. Juniors and seniors showed a bimodal response. Graduate students showed slightly more than 40 percent in agreement with 37.5 percent in agreement with 37.5 percent undecided. With a mean of over 21 percent undecided for the population tested and with the bimodal spread in the junior and se nior group, the total response tends to lack significant evidence that happiness was present in the clinical learn ing environment on the part of most students. Emotional management was not strongly supported by this item re sponse. A significant degree of agreement among all groups existed on the statement, within the clinical environment 73 TABLE 12 VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 39: IN CLINICAL PRACTICE STUDENTS LEARN APPROPRIATE USE AND POWER OF PERSONAL EMOTIONS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.2 11.9 Junior 63 2.2 15.9 Senior 76 2.2 9.2 Graduate 24 2.4 12.5 All Students 247 2.2 12.1 <- Nursing Service Leaders 59 2.4 32.2 - t - Faculty 36 2.1 13.9 TOTAL 342 2.2 15.4 74 TABLE 13 VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 41: MOST STUDENTS ARE HAPPY IN CLINICAL LEARNING ► .. Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.5 13.1 Junior 63 2.8 20.6 Senior 76 3.1 15.8 Graduate 24 2.7 37.5 <- All Students 247 2.8 18.2 Nursing Service Leaders 59 2.6 27.1 Faculty 36 2.4 16.7 TOTAL 342 2.7 21.3 75 students are assisted to grow in trusting their emotional conduct conducive to patient care and personal betterment (Table 14). The difference in means showed a range of only 0.4. Seniors and graduate students showed the highest degree of indecision, 25-33 percent respectively, but still indicated more than 50 percent agreement with the statement. Sophomores and faculty indicated greater than 70 percent agreement. This item added a significant de gree of supporting evidence that students were assisted in the development of emotional management within the clini cal learning environment. Comparisons of the Valences of Vector C: Becoming Autonomous Over 80 percent of the total study population agreed that, students usually seek consultation on clini cal problems in nursing from whomever is closest in an emergency but otherwise usually will try to find assis tance from a faculty member (Table 15). As might be expected with such a high degree of agreement a low of 4.8 percent of undecided was recorded. This probably indicated that faculty were being utilized 76 TABLE 14 VALENCE OF VECTOR B, RESPONSE TO TEST ITEM 42: STUDENTS ARE ASSISTED TO GROW IN TRUSTING THE EMOTIONAL CONDUCT CONDUCIVE TO PATIENT CARE AND PERSONAL BETTERMENT Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.3 14.3 « - Junior 63 2.4 17.5 +- Senior 76 2.5 25.0 +- Graduate 24 2.5 33.3 <- All Students 247 2.4 20.2 <- Nursing Service Leaders 59 2.5 20.3 Faculty 36 2.1 16.7 TOTAL 342 2.4 21.0 77 TABLE 15 VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 10: STUDENTS SEEK CONSULTATION ON CLINICAL PROBLEMS FROM WHOMEVER IS CLOSEST IN AN EMERGENCY OTHERWISE FROM FACULTY Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.0 2.4 - t - Junior 63 2.1 7.9 <- Senior 76 2.1 2.6 - e Graduate 24 2.1 8.3 i ^- All Students 247 2.0 4.5 ■4- Nursing Service Leaders 59 2.4 5.1 Faculty 36 2.0 2.8 TOTAL 342 2.1 4.8 78 when needed but did not interfere with the student's au tonomy for self direction or use of resources close at hand. Variability of perceptions were obvious in the re sponse to the statement, students will not usually seek consultation or help from another student rather than con fronting their instructor or nursing service leader (Table 16) . The difference in mean showed a range of 0.7. Sophomores, more than 60 percent; nursing service leaders and faculty, slightly more than 50 percent; agreed with the statement with better than 30 percent of the faculty being undecided. The strength of the total student re sponse tended to be bimodal reflecting the bimodal valence of juniors and graduate students and a greater than 50 percent disagreement of the senior group. With diversi fied spread and the relatively low population mean of 14.1 percent undecided, this item tended to reflect confusion or hesitancy in deciding where students received the greatest help in coping with problems in the clinical learning environment. A significant diversified response between stu dents and nursing leaders was apparent in the perceptions indicated on the item, students should be trusted to do what they have been taught without direct supervision in 79 TABLE 16 VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 15: STUDENTS WILL NOT SEEK CONSULTATION FROM ANOTHER STUDENT VS. FACULTY OR NURSING SERVICE LEADERS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.5 7.1 Junior 63 2.9 12.7 * ■ Senior 76 3.2 10.5 ->• Graduate 24 3.0 12.5 <r-b All Students 247 2.9 10.1 - e —> ■ Nursing Service Leaders 59 2.7 15.3 <- Faculty 36 2.7 15.3 <- TOTAL 342 2.8 14.1 80 most situations of clinical practice (Table 17). The difference in mean showed a range of 0.9. Students reflected an opposite valence on this item from nursing leaders. Fifty to 60 percent of each student group agreed with the statement. The same 50 to 60 per cent of faculty and nursing service leaders disagreed. This item probably indicated that students perceived a needed degree of clinical autonomy significantly higher than do their leaders. This could lead to confusion in behavior and learning in the clinical environment. A relatively high degree of indecision, 19.5 per cent existed among the population groups in response to the statement that, nurses in authority do not tend to restrict student autonomy even within the collaborative medical team approach to care (Table 18). The difference in mean showed a range of 0.9. The disagreement was found with a greater than 60 percent re sponse in the junior and senior group. Nursing service leaders showed a greater than 60 percent agreement to the statement, and the sophomores and faculty showed a bi modal spread. This item again suggested confusion in the degree of autonomy allowed, fostered, or understood by the nurses in the clinical environment. Over 90 percent of the nursing service leaders agreed that, nurses in authority tend to assist students 81 TABLE 17 VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 20: STUDENTS USUALLY SHOULD BE TRUSTED TO DO WHAT THEY HAVE BEEN TAUGHT WITHOUT ADDITIONAL DIRECT SUPERVISION Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.7 6.0 <- Junior 63 2.5 9.5 -tr Senior 76 2.6 10.5 ■<- Graduate 24 2.7 25.0 *- All Students 247 2.6 10.1 <- Nursing Service Leaders 59 3.4 15.3 Faculty 36 3.4 2.8 TOTAL 342 2.8 11. 3 82 TABLE 18 VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 22: NURSES IN AUTHORITY DO NOT TEND TO RESTRICT STUDENT AUTONOMY IN CLINICAL CARE Group Number of Subjects Mean Undecided Direction of Valence Sophomore 84 3.0 19.0 Junior 63 3.2 23.8 - > ■ Senior 76 3.3 13.2 Graduate 24 3.1 25.0 All Students 247 3.2 19.0 Nursing Service Leaders 59 2.4 17.0 Faculty 36 2.9 19.4 TOTAL 342 3.0 19.5 83 to make appropriate independent decisions in patient care (Table 19). The difference in mean showed a range of 1.1. Students are not so sure about this. Over 60 percent of the graduate students disagreed, seniors presented a bi modal valence spread and sophomores and juniors agreed just over 50 percent. Faculty tends to respond more like the sophomores and juniors with just over 50 percent agreed to the issue. Although there is not a high degree of overall difference in response the item did infer lack of perceived congruity among the groups. This could in hibit smooth student growth toward autonomy because of ambiguity within the population. Sophomores, nursing service leaders, and faculty showed a greater than 20 percent undecided perception of the statement that, a welt reasoned student nursing action would usually be accepted by nurses in authority even if it was contrary to the ideas of the nurse in authority (Table 20). The difference in mean showed a range of 0.8. Sophomores indicated a bimodal response; juniors, seniors, graduate students and faculty reported slightly more than a 50 to 60 percent disagreement while nursing service leaders tended to agree, but not to the 50 percent level. Ambiguity was present as to the degree of autonomy allowed 84 TABLE 19 VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 28: NURSES IN AUTHORITY TEND TO ASSIST STUDENTS IN DECISION MAKING RELATED TO PATIENT CARE - Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.8 31.0 -fr- Junior 63 2.8 14.3 <- Senior 76 2.9 10.5 Graduate 24 3.4 12.5 -> All Students 247 2.9 13.0 - f - Nursing Service Leaders 59 2.3 8.5 +• Faculty 36 2.8 16.7 TOTAL 342 ' 2.8 15.2 85 TABLE 2 0 VALENCE OP VECTOR C, RESPONSE TO TEST ITEM 30: WELL REASONED STUDENT NURSING ACTIONS WOULD USUALLY BE ACCEPTED EVEN IF CONTRARY TO THE IDEAS OF THE NURSE IN AUTHORITY Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.4 29.8 ■ < —> Junior 63 3.3 15.9 Senior 76 3.5 11.8 Graduate 24 3.4 8.3 - > - All Students 247 3.4 18.6 - > * Nursing Service Leaders 59 2.7 27.1 «- Faculty 36 3.5 22.2 TOTAL 342 3.3 19.1 86 or fostered in student nursing decision making even when made on a well reasoned basis. A strong total population bimodal spread with a high degree of undecided response, 21.5 percent, was indi cated on the item, the policies or standards of nursing practice allow for independent decision making for stu dents as well as staff (Table 21). The difference in means showed a 0.2 range. Only nursing service leaders did not present the bimodal re sponse seen in each of the other groups. Over 50 percent of the service leaders agreed with the statement but slightly over 25 percent were undecided. The means indi cated ambiguity and suggest difficulty in developing stu dent autonomy. Comparisons of Valences of Vector D: Establishing Identity A positive valence is indicated by most respon dents to the statement, nursing service leaders and fac ulty demonstrate recognition of students as individuals with unique personal needs and qualities (Table 22). The difference in means show a range of 0.9. Ju niors showed a bimodal spread in response with all other student groups agreeing to the statement between 50 and 87 TABLE 21 VALENCE OF VECTOR C, RESPONSE TO TEST ITEM 48: STANDARDS OF PRACTICE ALLOW FOR INDEPENDENT STUDENT DECISION MAKING Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.9 23.8 Junior 63 3.0 20.6 < - - * ■ Senior 76 3.0 15.8 Graduate 24 2.9 25. 0 - f r ~ * All Students 247 3.0 20.6 ■ < - > ■ Nursing Service Leaders 59 2.7 25.4 < - Faculty 36 3.1 19.4 TOTAL 342 2.9 21.5 88 TABLE 22 VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 12: NURSING SERVICE LEADERS AND FACULTY DEMONSTRATE RECOGNITION OF INDIVIDUAL STUDENT NEEDS AND QUALITIES Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.7 17.9 Junior 63 3.1 14. 3 Senior 76 2.9 10.5 Graduate 24 2.8 8.3 ■<r All Students 247 2.9 13.8 -4~ Nursing Service Leaders 59 2.3 17.0 Faculty 36 2.2 11.1 TOTAL 342 2.7 13.3 89 60 percent. Nursing service leaders and faculty responded most strongly with both groups agreeing beyond 80 percent in the positive. Nursing leaders supported student iden tity in their perception to a more significant degree than students recognized by the behavior of the leadership group. Faculty, by over 60 percent, nursing service lead ers and graduate students by over 50 percent agreed that, it is best if students are both heard as well as seen on the alinieal unit (Table 23). The difference in range of means was 0.5. Sopho more, junior and senior students were not so sure of the statement presenting a bimodal response and indicating that it was often best if they were "seen but not heard" on the unit. With the above findings and low mean group undecided, there was significant lack of awareness of suggested poor response to individual student voiced ideas on the clinical unit. This could lead to decreased rec ognition of student identity without intention on the part of their nursing leaders. All groups indicated a strongly positive valence to the statement, nursing students' mannerss personal hobbies tend to demonstrate an appropriate balance of feminine-masculine personality (Table 24). The mean range of difference was only 0.4. Sixty 90 TABLE 23 VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 18: STUDENTS FEEL IT IS BEST IF THEY ARE HEARD AND SEEN ON THE CLINICAL UNIT Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.7 9.5 Junior 63 2.8 7.9 Senior 76 3.0 6.6 - t —> - Graduate 24 2.9 8.3 * < “ All Students 247 2.8 8.1 -fr- Nursing Service Leaders 59 2.5 22.0 Faculty 36 2.6 11.1 TOTAL 342 2.8 10.5 91 TABLE 24 VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 36: STUDENTS DEMONSTRATE AN APPROPRIATE BALANCE OF FEMININE- MASCULINE PERSONALITY IN MANNERS, HABITS AND HOBBIES Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.4 ' 21.4 Junior 63 2.2 12.7 +- Senior 76 2.3 17.1 <- Graduate 24 2.4 25.0 « - All Students 247 2.3 18.2 «- Nursing Service Leaders 59 2.6 35.6 <- Faculty 36 2.4 25.0 TOTAL 342 2.4 22.1 92 to 90 percent of the total responses were in agreement with the statement. Graduate students, faculty and nurs ing service leaders indicated 25 to 35 percent undecided. Feminine-masculine personal identity was significantly identified within the clinical learning environment. All students by over 50 percent agreed with the statement that, regardless of what others on the unit may say3 the student’s self esteem will vary as he/she prac tices within the clinical setting regardless of the verbal input from others (Table 25). The range of total mean difference was 0.8. Fac ulty disagreed with the statement by over a 60 percent re sponse while nursing service showed a bimodal response spread. Lack of congruence in perception of personal identity establishment was indicated between students and their nursing leaders. All groups indicated a negative valence in re sponse to the statement, students here pay attention as to how well they do in clinical practice relative to others in their class (Table 26). The total range of mean difference was 0.6. Ju niors, seniors, graduate students and faculty showed a 80 to 90 percent disagreement with the statement. With the above response and only 11 percent undecided, a signifi cant degree of student identity was evidenced by individ- 93 TABLE 25 VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 37: STUDENTS SELF ESTEEM VARIES AS HE/SHE PRACTICES CLINICALLY REGARDLESS OF VERBAL INPUT FROM OTHERS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.8 6. 0 Junior 63 2.8 3.2 Senior 76 2.7 5.3 ■ f ' Graduate 24 2.7 8.3 <- All Students 247 2.8 5.3 <- Nursing Service Leaders 59 3.0 22.0 Faculty 36 3.5 16.7 - > TOTAL 342 2.9 9.5 94 TABLE 26 VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 38: STUDENTS PAY LITTLE ATTENTION AS TO HOW WELL THEY DO IN CLINICAL PRACTICE VS. OTHERS IN THEIR CLASS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.5 11.9 Junior 63 4.1 3.2 Senior 76 4.0 1.3 -> Graduate 24 3.6 16.7 -* All Students 247 3.8 6.9 Nursing Service Leaders 59 3.6 23.7 - > Faculty 36 4.0 13.9 TOTAL 342 3.8 11.0 95 ual student difference attended to within the clinical setting. All respondent groups with the exception of fac ulty disagreed with the statement, what students wear and how they aot in the clinical setting is not as important as the quality of care they may render to patients (Table 27) . The mean range of difference was 0.9. Sophomore, senior, and nursing service leaders indicated a 70 to 8 0 percent, juniors over 60 percent, and graduate students over 50 percent disagreement. Faculty indicated a bimodal response. This significant response disagreement would indicate that perceived identity of apparel and behavior was as important as the care rendered by students in the clinical setting. Seventy to 90 percent of the respondents agreed that, the student is encouraged to recognize strong and weak points in his/her own self which affect patients and their families (Table 28). The mean range of difference was 0.4. This re sponse with only 6 percent undecided presented strong evi dence of perceived recognition of individual student's personal affect on their patients and families. 96 TABLE 27 VALENCE OP VECTOR D, RESPONSE TO TEST ITEM 45: WHAT STUDENTS WEAR AND HOW THEY ACT IN THE CLINICAL SETTING IS NOT AS IMPORTANT AS THE QUALITY OF CARE THEY GIVE Group Number of Subj ects Mean Percent Undecided Direction of Valence Sophomore 84 3.9 6.0 ->- Junior 63 3.6 9.5 Senior 76 3.5 3.9 - > - Graduate 24 3.5 4.2 -* All Students 247 3.6 6.1 Nursing Service Leaders 59 3.6 13.6 Faculty 36 3.0 16.7 TOTAL 347 3.5 8.6 97 TABLE 28 VALENCE OF VECTOR D, RESPONSE TO TEST ITEM 49: STUDENTS ARE ENCOURAGED TO RECOGNIZE STRONG AND WEAK POINTS IN SELF WHICH AFFECT PATIENT AND FAMILY CARE Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 1.9 9.5 Junior 63 2.1 4.8 <- Senior 76 2.1 3.9 <- Graduate 24 1.9 0.0 - f - All Students 247 2.0 5.7 +- Nursing Service Leaders 59 2.2 15.3 Faculty 36 1.8 2.8 TOTAL 342 2.0 6.0 98 Comparisons of Valences of Vector E: Freeing Interpersonal Relationships All groups studied, except for the senior group, agreed that, faculty and nursing service leaders do not often try to manipulate students into doing what seems needed on the unit (Table 29). The mean scores showed a range of 0.5. Fifty to 60 percent of each group scored left of the undecided point. Fifty percent of the seniors disagreed and per ceived that students were manipulated. With the senior group exception, open student— leadership relations were present as indicated by this item. All groups agreed that, students demonstrate rec ognition of the personal needs and values of nursing ser vice leaders and faculty (Table 30). The total mean range of difference was only 0.3. Four of the six groups studied had indicated a greater than 20 percent undecided with the highest negative re sponding groups being nursing service leaders with 30.5 percent and faculty with 41.7 percent. Although students did not express such a high rate of indecisiveness, stu dent- leadership relationships would be questioned by the total response of this population. 99 TABLE 29 VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 1: FACULTY AND NURSING SERVICE LEADERS DO NOT TRY TO MANIPULATE STUDENTS INTO DOING WHAT SEEMS TO BE NEEDED ON THE UNIT Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.5 10.7 <- Junior 63 2.8 4.8 <- Senior 76 3.3 10.5 Graduate 24 2.4 16.7 All Students 247 28 9.7 Nursing Service Leaders 59 2.3 13.6 4 - Faculty 36 2.5 16.7 TOTAL 342 2.7 11. 8 100 TABLE 30 VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 6: STUDENTS DEMONSTRATE RECOGNITION OF NEEDS AND VALUES OF NURSING SERVICE LEADERS AND FACULTY Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.5 23.8 Junior 63 2.6 25.4 - f - Senior 76 2.7 18.4 Graduate 24 2.4 16.7 - t - All Students 247 2.6 21.9 > - f - Nursing Students Leaders 59 2.7 30.5 - f - Faculty 36 2.7 41.7 - f - TOTAL 342 2.6 25.5 101 Significant inter-group differences of perception occurred on the statement, interaction between nursing students and nursing service leaders is one of an open and trusting quality (Table 31). The difference in the means showed a range of 1.0. Sophomores and seniors indicated a bimodal response with slightly more than 20 percent undecided. Juniors, seniors and faculty agreed with the statement. Nursing service leaders disagreed. This item throughout showed a marked degree of indecisiveness throughout the respondents with greater than 35 percent in the faculty and graduate stu dent groups. Freedom of interpersonal relationships on an open trusting nature would be highly questionable intoto. Significant inter-group agreement existed that, nursing service leaders do not tend to downgrade nursing educators (Table 32). The means showed a 0.6 difference in range. Soph omores, nursing service leaders and faculty showed a 60 to 70 percent agreement with the item. The total student group accounted for 28.3 percent undecided indicating that interpersonal relationships in this area may not be well known. Graduate students had the strongest identified perception with over 60 percent agreeing that, communica tion with others on the unit is not a problem to most stu- 102 TABLE 31 VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 17: INTERACTION BETWEEN STUDENTS AND NURSING SERVICE LEADERS REFLECTS OPENNESS AND TRUST Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.1 22.6 Junior 63 3.3 17.5 - > Senior 76 3.5 22.4 Graduate 24 3.3 37.5 All Students 247 3.3 22.7 -+■ Nursing Service Leaders 59 2.5 32.2 Faculty 36 3-.1 36.1 TOTAL . . . . . 342 3.2 27.3 103 TABLE 32 VALENCE OF VECTOR #, RESPONSE TO TEST ITEM 19r NURSING SERVICE LEADERS DO NOT TEND TO DOWNGRADE FACULTY Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.3 32.1 +- Junior 63 2.5 28.6 ■ < “ Senior 76 2.6 18.4 4r Graduate 24 2.3 45.8 All Students 247 2.5 28.3 ■ < * * Nursing Service Leaders 59 2.0 8.5 - f - Faculty 36 2.5 13.9 TOTAL 342 2.4 25.0 104 dents (Table 33). The mean difference in range was only 0.4. Junior and student groups presented a bimodal spread in response indicating that although other groups agreed that the problem was not major, communication problems were exis- tant in the clinical environment. There was not total agreement as to the existence of the problem on clinical units. Significant inter-group agreement existed on the item that, nursing educators do not tend to downgrade nursing leaders (Table 34). Differences in mean scores indicated a range of only 0.2. All student groups agreed with a 70 to 80 per cent response. Nursing service leaders and faculty con curred with just over 50 percent. Nursing service leaders present 27.1 percent undecided. Interpersonal relation ships seemed to be more trusting with less indecision from educators to service leaders than conversely as indicated by data on Tables 32 and 34. A bimodal response for junior, senior and graduate groups was present on the statement, nursing service and education leaders seem to work together well in assisting each other toward the improvement of patient care and stu dent learning (Table 35). Differences in mean scores indicated a range of 105 TABLE 33 VALENCE TO VECTOR E, RESPONSE TO TEST ITEM 23: COMMUNICATION WITH OTHERS ON THE UNIT IS A PROBLEM TO MOST STUDENTS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.7 10.7 ■4- Junior 63 3.0 7.9 -4 — > Senior 76 2.9 9.2 *4 — b Graduate 24 2.6 4.2 •4r All Students 247 2.8 8.9 4- Nursing Service Leaders 59 2.7 17.0 4- Faculty 36 2.8 16.7 -4 - TOTAL 342 2.8 10.7 106 TABLE 34 VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 25: FACULTY DO NOT TEND TO DOWNGRADE NURSING SERVICE LEADERS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.2 11.9 Junior 63 2.3 14.3 -f- Senior 76 2.4 15.8 +- Graduate 24 2.2 20.8 +- All Students 247 2.3 14.6 +- Nursing Service Leaders 59 2.4 27.1 -tr Faculty 36 2.3 0.0 4 - TOTAL 342 2.3 14.9 107 TABLE 3 5 VALENCE OF VECTOR E, RESPONSE TO TEST ITEM 29: NURSING SERVICE LEADERS AND FACULTY SEEM TO WORK WELL TOGETHER TOWARD IMPROVING PATIENT CARE AND STUDENT LEARNING Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.5 21.4 - 4 - Junior 63 2.8 23.8 - 4 ~ > Senior 76 2.9 25.0 <—> Graduate 24 2.9 33.3 ■ 4 —> All Students 247 2.7 24.3 - f - Nursing Service Leaders 59 2.4 20.3 - 4 - Faculty 36 2.8 19.4 - 4 - TOTAL 342 2.3 23.4 108 0.5. An overall inter-group indication of indecision ex ceeded 20 percent except for the faculty mean of 19.4. Such a high rate of undecided and the bimodal spread prob ably indicated possible problems in knowing if the leaders work together or showed a lack of positive evidence of co operative efforts. Comparisons of Valences of Vector F: Clarifying Purposes A significant difference of valence was indicated between student and leader (faculty and service) response to the item, balanced, living is generally -possible for students of nursing under the pressures of academic and clinical life (Table 36). Differences in mean scores indicated a range of 1.3. Students responded from over 50 to slightly over 70 percent in disagreement. Faculty and nursing service leaders indicated agreement from over 50 to over 60 per cent. Purposes or achievement of a balanced way of pro fessional life were in apparent conflict between students and their nursing leaders. Only faculty with over an 80 percent response of agreement perceived that, faculty help student individual- 109 TABLE 36 VALENCE OF VECTOR F, RESPONSE TO TEST 2: BALANCED LIVING IS GENERALLY POSSIBLE FOR STUDENTS UNDER THE PRESSURES OF ACADEMIC AND CLINICAL LIFE Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.2 8.3 Junior 63 3.9 3.2 Senior 76 3.6 9.2 Graduate 24 3.2 0.0 - ) • All Students 247 3. 5 6.5 Nursing Service Leaders 59 2.6 10.2 Faculty 36 2.6 13.9 TOTAL 342 3.2 7.3 110 ize and crystallize their ■personal life goals (Table 37). The mean difference in range was 1.1. Seniors with slightly over 50 percent disagreed with the statement with the rest of the valences bimodal in spread. All groups with a bimodal group response had a greater than 20 percent in the undecided category with nursing service leaders indicating over a 40 percent neutral response. Ambiguity existed in the use of faculty assisting students to clarify purposes of life goals. Responses to the statement, leaders in nursing service help students crystallize their personal life goals were all negative or bimodal (Table 38). The mean difference in range was 0.5. Fifty to slightly over 60 percent of the juniors and seniors re sponded negatively. All other groups presented a bimodal distribution with as high as 42.4 percent undecided. As in Table 37, ambiguity exists in the use of nursing lead ers for assistance in clarifying life goals. To 50 to 60 percent of the sophomore and junior groups, the goals of clinical practice seem clear to the students (Table 39). Differences in mean scores indicated a range of 0.9. Senior and graduate student and faculty groups in dicated a bimodal response. Nursing service leaders by over 50 percent disagreed with the statement. Ambiguity Ill TABLE 37 VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 21: FACULTY HELP STUDENTS INDIVIDUALIZE AND CRYSTALLIZE PERSONAL LIFE GOALS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.9 25.0 ■ < ' " ) ■ Junior 63 3.2 20.6 - t - - * Senior 76 3.3 14.5 Graduate 24 2.9 33.3 All Students 247 3.1 20.6 Nursing Service Leaders 59 2.8 40.7 Faculty 36 2.2 11.1 TOTAL 342 2.9 23.7 112 TABLE 38 VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 27: LEADERS IN NURSING SERVICE HELP STUDENTS INDIVIDUALIZE AND CRYSTALLIZE PERSONAL LIFE GOALS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.3 29.8 Junior 63 3.4 17.5 - * ■ Senior 76 3.6 19.7 - ) > Graduate 24 3.6 37.5 All Students 247 3.4 24.3 - * Nursing Service Leaders 59 3.1 42.4 +->■ Faculty 36 3.1 33.3 —h TOTAL 342 3.4 29.2 . . 113 TABLE 39 VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 31: GOALS OF CLINICAL PRACTICE SEEM CLEAR TO STUDENTS Groups Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.6 11.9 Junior 63 2.7 22.2 Senior 76 3.1 13.2 - f —> - Graduate 24 3.1 16.7 All Students 247 2.8 15.4 Nursing Service Leaders 59 3.5 22.0 - + ■ Faculty 36 3.1 19.4 TOTAL 342 3.0 17.3 114 in clarity of purpose was clearly present on an inter group basis. From 50 to 80 percent of all of the groups stud ied, with the exception of juniors, agreed that, nursing offers a very good opportunity to get ahead in life (Table 40) . The mean difference in range was 1.2. Over 60 percent of the junior group disagreed. There was a rela tively high response in the undecided category with the highest of 27.8 percent in the faculty group. Although the majority agreed with the statement, there was some lack of clarity or unifying purpose which may account for the perceptions indicated. A significant inter-group negative valence oc curred in the response of all groups to the item stating, baccalaureate nursing students do not think they should become leaders in nursing with appropriate roles in super vision or other levels of administration (Table 41). The differences in mean scores indicated a range of 0.5. Sophomore, graduate student and nursing service leaders indicated the strongest disagreement, but it seemed evident that most respondents had clearly perceived student purposes which did not include top levels of leadership in supervision and administration. Over 50 percent of the senior group did not per- 115 TABLE 40 VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 40: NURSING OFFERS A GOOD OPPORTUNITY TO GET AHEAD IN LIFE Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.2 22.B - t - Junior 63 3.4 12.7 -> Senior 76 2.2 18.4 - f - Graduate 24 2.4 25.0 All Students 247 2.2 24.3 <- Nursing Service Leaders 59 2.4 20.3 Faculty 36 2.7 27.8 ■4r TOTAL 342 2.5 21.6 116 TABLE 41 VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 43: BACCALAUREAT STUDENTS DO NOT THINK THEY SHOULD BECOME SUPERVISORS OR ADMINISTRATORS Group Number of Subject Mean Percent Undecided Direction of Valence Sophomore 84 3.6 16.7 - > Junior 63 3.3 20. 6 Senior 76 3.3 6.6 ~b Graduate 247 3.4 16.7 -y All Students 247 3.4 14.6 ~y Nursing Service Leaders 59 3.7 15.3 -y Faculty 36 3.2 22.2 -y TOTAL 342 3.5 16.1 117 ceive that, the goals of clinical practice are related to current student needs (Table 42). The mean difference in range of response was 0.8. Sophomore, junior, graduate students, and faculty agreed that the goals are relevant. Nursing service leaders, graduate students, juniors and sophomores indicated a 22 to 27 percent undecided. This item would add evidence to ambiguity of purpose for clinical practice in some groups. Comparisons of Valences of Vector G: Devc > ping Integrity No significant valence directional difference oc curred in response to the statement, students have as much opportunity as they would li'k.e to explore moral values re lated to nursing with nursing leaders (Table 43). Differences in mean scores indicate a range of only 0.3. All groups indicated disagreement with the statement. Sophomore, junior and senior groups indicated a disagreement to just over 50 percent. Eighty percent of the graduates disagreed. Although both nursing service leaders and faculty also disagreed, they both indicated greater than 40 percent in the neutral position. This item probably indicated that in more cases than not re- 118 TABLE 42 VALENCE OF VECTOR F, RESPONSE TO TEST ITEM 47: GOALS OF CLINICAL PRACTICE USUALLY SEEM RELATED TO CURRENT STUDENT NEEDS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.7 23.8 ■Jr Junior 63 2.5 22.2 - f - Senior 76 3.3 10.5 -b Graduate 24 2.8 25.0 <- All Students 247 2.8 19.4 Nursing Service Leaders 59 2.9 27.1 Faculty 36 2.7 11.1 - f - TOTAL 342 2.8 19.9 119 TABLE 43 VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 4: STUDENTS HAVE AS MUCH OPPORTUNITY AS THEY WOULD LIKE TO EXPLOR MORAL VALUES RELATED TO NURSING WITH THEIR NURSING LEADERS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.4 25.0 - * ■ Junior 63 3.5 34.9 - > Senior 76 3.4 23.7 - > Graduate 24 3.7 12.5 All Students 247 3.4 25.9 Nursing Service Leaders 59 3.3 47.5 - > Faculty 36 3.6 41.7 -b TOTAL 342 3.5 30.2 120 spondents perceived student's need or desire for discus sion of moral issues. A wide variation of valence spread was noted in response to the statement, students often discuss their personal developing system of beliefs and values with fac ulty or nursing service leaders (Table 44). The mean difference in range of response was 0.9. Sophomore, graduate and nursing service leader groups in dicated a bimodal spread. Junior and faculty groups indi cated agreement to 50 and 60 percent respectively. Sixty percent of the seniors disagreed with the statement. In developing personal integrity there was considerable ambi guity in perceptions of student assistance which might be had from discussing beliefs and values with nursing lead ers . A significant positive valence is indicated for the item, dedication to duty and standing for moral prin ciple is just as prevalent in individual students of nurs ing today as was true ten to twenty years ago (Table 45). The differences in mean scores indicated a range of 0.5, All groups indicated a positive majority re sponse indicating integrity as here perceived has not changed for twenty years. Positive valence, 50 to 60 percent, were indi cated by all groups except for the graduate students where 121 TABLE 4 4 VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 7: STUDENTS OFTEN DISCUSS THEIR PERSONAL DEVELOPING BELIEFS AND VALUES WITH NURSING LEADERS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 3.0 6.0 ■ < —b Junior 63 2.8 9.5 Senior 76 3.3 6.6 Graduate 24 2.9 20.8 All Students 247 3.0 8.5 Nursing Service Leaders 59 2.8 25.4 Faculty 36 2.4 5.6 TOTAL 342 2.9 11.8 122 TABLE 45 VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 8: STUDENT DEDICATION TO DUTY AND STANDING FOR MORAL PRINCIPLE IS JUST AS PREVALENT TODAY AS WAS TRUE 10 TO 20 YEARS AGO Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.6 15.5 -<— Junior 63 2.3 14.3 «- Senior 76 2.7 19.7 - f - Graduate 24 2.7 29.2 All Students 247 2.6 17. 8 -<r Nursing Service Leaders 59 2.7 15. 3 - t - Faculty 36 2.2 16.7 TOTAL 342 2.5 18.4 123 a bimodal valence was shown to the statement, students are urged to function in -patient care consistantly with their internal or moral beliefs in clinical practice (Table 46). The mean difference in range of scores was only 0.2. Graduate students, nursing service and faculty indi cated a neutral position on the issue from 22 to 30 per cent of their responses. The relative high percent re sponse of undecided on the part of the leaders to the undergraduate student groups probably indicated questions on student perceptions in this area related to the devel opment of student integrity. A high degree of positive response was indicated by all groups to the statement, response to clinical ex perience does not cause confusion in the students ability to develop behavior consistant with internal personal life values (Table 47). The difference in means showed a range of 0.6. The responses ranged from 50 to 8 0 percent in agreement with the statement. No evidence was found in this item indicating inter-group incongruity. Only faculty and nursing service leaders and grad uate students indicated a 50 percent or greater agreement with the statement, if policies seem to interfere with learning3 students do not tend to follow the policy with out verbalization (Table 48). 124 TABLE 4 6 VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 13: STUDENTS ARE URGED TO FUNCTION CLINICALLY CONSISTENT WITH THEIR INTERNAL OR MORAL BELIEFS Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.5 19.0 Junior 63 2.7 12.7 Senior 76 2.6 11. 8 Graduate 24 2.6 29.2 All Students 247 2.6 16.2 - f - Nursing Service Leaders 59 2.7 30.5 Faculty 36 2.5 22.2 TOTAL 342 2.6 20.2 125 TABLE 47 VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 16: CLINICAL EXPERIENCE DOES NOT CAUSE CONFUSION IN THE STUDENTS ABILITY TO DEVELOP BEHAVIOR CONSISTENT WITH PERSONAL LIFE VALUES Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 1.9 8.3 Junior 63 2.5 12.7 Senior 76 2.3 15.8 Graduate 24 2.4 8.3 • £ - All Students 247 2.2 11.7 Nursing Service Leaders 59 2.5 30.5 ■ < “ Faculty 36 2.2 13.9 TOTAL 342 2.3 14.5 126 TABLE 4 8 VALENCE OF VECTOR Gf RESPONSE TO TEST ITEM 34: IF POLICIES INTERFERE WITH LEARNING STUDENTS DO NOT FOLLOW THE POLICY WITHOUT VERBALIZATION Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.9 14. 3 Junior 63 2.9 14. 3 Senior 76 3.1 10.5 Graduate 24 2.8 16. 7 All Students 247 3.0 13.4 - t —h Nursing Service Leaders 59 2.8 28.8 <- Faculty 36 2.7 25.0 TOTAL 342 2.9 17.6 127 The difference in means showed a range of 0.4. All undergraduate student groups presented a bimodal va lence with less than 15 percent in the undecided area. Lack of unified perceptions probably indicated communica tion problems concerning policy principles but such a wide spread valence of students from faculty could interfere with the development of student integrity in this area. Significant, highly positive, 80 to 90 percent, valences were indicated by all groups to the statement, students demonstrate their own personat values and Integ rity as they participate in patient care (Table 49). The differences in mean scores indicated a range of only 0.2. This item was perceived as very strong and shows a strong relationship to developing personal integ rity within the clinical learning environment. Grouped Data by Vectors It was hypothesized that a positive score along the vectors correlates with perceived professional devel opment in each vector area. This hypothesis was tested by running intercorrelations among scales obtained from the 342 subjects data cards. Vector A, achieving competence, was selected as that vector which most closely measured perceived professional development. A linear correlation 128 TABLE 4 9 VALENCE OF VECTOR G, RESPONSE TO TEST ITEM 44: STUDENTS DEMONSTRATE THEIR OWN PERSONAL VALUES AND INTEGRITY AS THEY GIVE PATIENT CARE Group Number of Subjects Mean Percent Undecided Direction of Valence Sophomore 84 2.0 9.5 Junior 63 2.0 7.9 ■<r Senior 76 2.1 3.9 +■ Graduate 24 1.9 4.2 -f- All Students 247 2.0 6.9 Nursing Service Leaders 59 2.0 8.5 Faculty 36 1.9 8.3 TOTAL 342 2.0 7.0 129 was then run comparing vectors B through G with vector A held constant. The results of this analysis are presented in Table 50. It was clearly understood that the results of the above linear correlation did not necessarily indicate a cause and effect relationship. The table was but a mea sure of the extent of relationship between the variables in the sample studied. In making the above analysis via computer the correlation coefficient, degree of freedom, and t ratio was computed. Using Guilford's (1965, pp. 580, 581) tables of coefficients of correlation and t ra tio significance was determined at the .05 and .01 level. Vector E, freeing interpersonal relationships in dicated nonsignificant inter-group differences with stu dents, nursing service leaders and faculty. Vector F, clarifying purposes, was nonsignificant in the nursing service leader and faculty group. Nonsignificant differ ences of perception of all vectors were identified in the entire faculty group. The hypothesis was supported by the correlations of vectors B, C, F, and G with vector A at the 0.5 or 0.1 level of significance in the student and nursing service groups. The statistical procedure of chi square was used to determine significant differences at either the 5 or 1 130 TABLE 50 LINEAR CORRELATION AMONG THE VECTORS B THROUGH G WITH A, ACHIEVING COMPETENCE, FOR STUDENTS, NURSING SERVICE LEADERS AND FACULTY WITH LEVEL OF CONFIDENCE Vector Variables Students Nursing Service Leaders Faculty B. Managing eimotions .01 .05 NS C. Becoming autonomous .01 .05 NS D. Establishing identity .05 NS NS E. Freeing inter personal rela tions NS NS NS F. Clarifying purposes . 01 .01 NS G. Developing integrity .01 .05 NS 131 percent level of confidence among members of the various groups by vectors. From the 342 subjects data cards the computer printout indicated the data matrix and the ex pected value matrix with the desired chi square. For the basis of this study the parameters were collapsed using the strongly agree, and agree (1.0-2.4) as group one; un decided (2.6-3.4) as group two; and disagree, strongly disagree (3.5-5.0) as group three (Table 51). For the total frequencies reported by vector and compared to the groups as in this table, 44 of the re sponse categories were nonsignificant with 26 significant at the .05 or .01 level. Through inferential statistics therefore 26 or 59.1 percent of the vector categories to groups studied have a significant relationship above that which would arise by chance. Vectors A and F have the most significant relationship to the groups compared. TABLE 51 ANALYSIS OF VECTORS BY CHI SQUARES COMPARING STUDENT GROUPS TO NURSING SERVICE LEADERS AND FACULTY SHOWING LEVELS OF CONFIDENCE FOR EACH Groups VECTORS A B C D E F G Sophomores to Nursing Service Leaders .01 NS NS NS NS NS NS Juniors to Nursing Service Leaders NS NS .05 .05 . 01 NS NS Seniors to Nursing Service Leaders NS .01 .01 NS .01 .01 NS Graduates to Nursing Service Leaders .01 .01 .05 NS NS NS NS All Students to Nursing Service Leaders .05 .01 .01 NS NS NS NS Sophomores to Faculty NS NS NS NS .05 NS NS Juniors to Faculty .05 .05 NS NS .05 .05 NS Seniors to Faculty .01 NS NS NS NS .01 NS Graduates to Faculty NS NS NS NS NS . 01 NS All Students to Faculty .05 .05 NS NS NS .01 . 05 LO w CHAPTER V SUMMARY OF THE FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS This chapter is divided into five sections. The first summarizes the investigation, the second is a sum mary of the findings as related to the hypotheses, the third states the basic conclusions, the fourth is a dis cussion of the findings, and finally the fifth presents the recommendations. Summary of the Investigation The purpose of this study was to ascertain whether or not significant perceptual differences existed toward the clinical learning environment on the part of students, faculty and nursing service staff leaders. The investigation sample of 342 subjects was taken from the sophomore, junior, senior and graduate students, nursing faculty and nursing service staff associated with baccalaureate and graduate student programs of nursing at Loma Linda University. The study was based on Chicker- ing's (1969) theory of college student development with adaptation to professional nursing students within the 133 134 clinical learning environment. In order to identify perceptions affecting nursing student learning development of a new testing instrument was prepared and validated by jury Q sort and pretest pri or to the administering of the 49 item Likert scaled ques tionnaire. Respondents answered on a five point scale from strongly agree to strongly disagree. The 49 items were phrased in positive and negative random statements with seven items testing each of the seven developmental vectors as adapted from Chickering's postulates, Dalme1s (1971) questionnaire on professional identity, and a pre vious longitudinal HEW supported five year study on im proving the learning environment for students at Loma Linda University. After the questionnaire was administered the data were compiled and with the assistance of some of the Loma Linda University statisticians and the scientific computa tion facility, computer analysis was done. First an item analysis was run, then matrices were designed to render an item analysis, vector analyses and linear correlation with regression analysis and chi square to test for vector level of significance at the 5 and 1 percent levels of confidence. All data were placed in chart form (Tables 1 to 51) and an item summary was compiled (see Appendix III) . 135 Summary of the Findings as Related to the Stated Hypotheses The primary hypothesis tested was that significant identifiable mean differences existed in the way the clin ical learning environment is perceived by the students, faculty and medical center staff nurses in the sample pop ulation. Using a valence directional variation from the mean of a greater than 50 percent variation as a criteria for significant difference in perception, 25 of the 49 items or 51 percent of the items showed a significant dif ference in perception by one or more groups. This hypoth esis was supported by further findings which shall be sum marized in this chapter and were reported in detail in Chapter IV. Additional hypotheses tested were as follows: 1. Chickering's theoretical postulates of college student development can be measured in relation ship to the professional development of students in nursing. An instrument was developed which supported this hypothesis as a measuring tool. 2. Using Chickering's vector model, an instrument can be constructed to measure perceptions of student development along the seven major vectors identi fied. Although this was a difficult task and has 136 not been validated adequately for standardization, the instrument was vector balanced, i.e., equal number of items for testing each vector, and the results supported this hypothesis. 3. A positive score along Chickering's vectors corre lated with perceived professional development in each vector. It was planned to use more of Dal- me's instrument as a comparative test for profes sional development. Upon study, it was found helpful but could not be used as originally planned. Table 50 indicates an attempt to test this hypothesis by using vector A, achieving com petency, as the professional development vector and correlating vectors B through G as a test. The hypothesis held to a significant level with students and nursing service leaders but there was no significant difference between the tested vec tors for the faculty group. 4. A composite score of all of the vectors relates to the overall perception the professional nurse has of herself. The mean score for all vectors and all items within the vectors was 2.63. This hy pothesis was not adequately tested. This score may relate to the perception that the professional nurse has of herself but would be better tested by 137 correlating this test with some personality tests. 5. Students, faculty, and medical center nursing staff demonstrate a different composite score pro file. Significant profile differences were noted in this study indicating strong support of the hy pothesis. Nursing service leaders throughout the study indicated a relatively high degree of un certainty in response. Senior students tended to indicate the strongest perceptions with the junior group indicating the next overall strong percep tions. No single student group seemed to be most like faculty or nursing service leaders. By item, 16 statements or 32.6 percent of the to tal sample showed an identical composite score profile in direction but not valence of vector. On 9 items, 18.4 percent, students showed a direct opposite response than either nursing service leaders or faculty. The total stu dent group showed agreement with nursing service but not with the faculty on four items. The total students indi cated agreement with faculty but not with service leaders on 10 items. Conclusions The findings of this study seem to justify the 138 following conclusions: 1. Perceptions influencing the clinical learning en vironment differ as perceived by students, fac ulty and nursing service leaders. 2. Students indicate stronger perceptions regarding their learning environment than do their nursing leaders. 3. Student groups have dissimilar composite vector profiles within their own total student group. 4. Student vector profiles are dissimilar from their nursing leaders. 5. Nursing service leaders have a high degree of in decision of the perceptions of students clinical learning developmental directions. 6. Faculty and nursing service leaders often do not perceive the clinical learning environment poten tial or problems as do their student associates. 7. Communication in terms of student goals, values, purposes, parameters of clinical function and in terpersonal feelings need to be clarified among the students, faculty and nursing service leaders. 8. Students seek a greater degree of autonomy in de cision making and clinical function than they per ceive is fostered by nursing leaders. 139 Discussion of the Findings Several distinguishing characteristics or traits seem to run throughout this study. One primary character istic is the fundamental need for the development of the whole person and not just a professional entity. In the clinical arena it is easy for teachers to give lip service to this need but quite another matter to identify develop mental needs of the individual and then strive to specific ally meet these needs. Well developed theories of college student development should form a basic part of curriculum development for the professional nursing student. As teachers or nursing service leaders, we think we know what students need and how they perceive their learning environment to be. Repeatedly this study has shown that the opposite is so. Chickering has indicated the importance for stu dents becoming autonomous as a phase of student development. It is more than interesting to note that when students per ceive they need assistance in learning faculty perceive they are or can be independent. When students perceive that they can function in areas they have been taught, their leaders feel they desire supervision. Repeatedly communication problems seem to be present. Leaders perceive, students do not wish to discuss their personal developing 140 system of beliefs and values and the students perceive the reverse. This investigation also implies that there is a relatively high degree of agreement of statements relating to vector E, freeing interpersonal relations, and yet the students are not free as indicated by other incongruency in items which could be facilitated by more open communica tion on issues of student concern. This study implies strong indications of developing personal integrity. Clarifying purposes is the one total vector which implies the greatest need for further clarifi cation and cooperative effort for improving the clinical learning environment. Recommendations Recommendations based upon this study are as fol lows : 1. There is a definite need for replication, refine ment and longitudinal studies in this area of learning environment in the clinical setting. General college environmental scales do not fit the unique needs of the clinical setting. Dalme's study provided a data base but study must include all primary interactors in the clinical learning environment and not just student opinions. Personality studies would be helpful if run concur rently with a replicate or refinement of this study. This would help in validating the testing tool by determining what personality factors are being measured rather than the intended educational de velopment factors. There is overlap in the present vectors as used in the test in this study. Work needs to be done to develop more test items which give a higher degree of discrimination for each vector. Attention should be given to improving communica tion of clinical learning goals and clinical prac tice parameters to increase understanding and agreement for goal directed activities in nursing education. Finally it is recommended that this study be used as a basis for further intensive analysis and im provement of the clinical learning environment in other institutions of higher learning. It'has implications which might well be applied to health related disciplines other than nursing in the study of the clinical learning environment. B I B L I O G R A P H Y 142 BIBLIOGRAPHY Abercrombie, M. L. J., and Terry, P. M. Students' atti- tudes to professionalism. Universities Quarterly; Higher Education and Society^ 1973, 27, 4 65-474. Alexander, M. M. Combining teaching with clinical practice. Supervisor Nurse, 1972, 3(6), 13-17. Allport, G. W. Pattern and Growth in Personality. New York; Holt, 1961. Alutto, J. A., Hrebiniak, L. G., and Alonso, R. C. A study of differential socialization for members of one professional occupation. Journal of Health and Social Behavior, 1971, 12(2), l40-l47. Ary, D., Jacobs, L. C., and Razavieh, A. Introduction to Research In Education. San Francisco: Holt, Rine hart, and Winston, 1972. Austin, A. W. Recent studies of college environment. Paper presented at the American Personnel and Gui dance Association, Minneapolis, April 1965. (a). _. The inventory of college activities: assessing the college environment through observable events. Paper presented at the American Psychological Asso ciation, Chicago, June 1965. (b) . _. The College Environment. Washington, D. C.: The American Council on Education, 1968. Aydelotte, M. K. Nursing education and practice: putting it all together. Journal of Nursing Education, 1972; 11(4), 21-27. Banton, M. Roles: An Introduction to the Study of Social Relations. London: Tavistock, 1968. Barzun, J., and Graff, H. F. The Modern Researcher. New York: Harcourt, Brace, and World, 1962. Bates, M. Doctor and nurse: changing roles and relations. New England Journal of Medicine, 1970, 283, 129-134. 143 144 Beardslee, D. , and O'Dowd, D. Students and the occupation al world. In N. Sanford (Ed.), The American Col lege. New York: Wiley, 1962. Becker, H. S., and Carper, J. The elements of identifica tion with an occupation. American Sociological Review, 1956, 21, 341-348. Becker, H. S., Geer, B., Hughes, E. C., and Strauss, A. Boys in White: Student Culture in Medical School. Chicago: University of Chicago Press, 1961. Becker, H. S., Geer, B., and Hughes, E. C. Making the Grade: The Academic Side of College Life. New York: Wiley, 1968. Berelson, B., and Steiner, G. A. Human Behavior: An In ventory of Scientific Findings. New York: Har- court, Brace, and World, 1964. Bess, J. I. Campus cues to educative behaviors. Part of a symposium on student initiation of curricular change at the meeting of the American Personnel and Guidance Association, Las Vegas, March 31, 1969. Bilorusky, J. A. Participatory education: involved stu dents take the initiative. Paper presented at the American College Personnel Association Convention, Las Vegas, March 31, 1969. Blalock, H. M., Jr. Theory Construction: From Verbal to Mathematical Formulations. Englewood Cliffs, Ni J.: Prentice-Hall, 1969. Bonham, G. W. Inside the Academe: Culture in Crisis. New Rochell, N. Y.: Change, 1972. Borg, W. R., and Gall, M. D. Educational Research: An Introduction. New York: McKay, 1971. Borgen, R. H., and Weiss, D. J. Supervisor perceptions of occupational environments and ROE's classification of occupation. Paper presented at the American Psychological Association Convention, San Francis co, August 30 to September 3, 1968. Boudon, R. A. Report to the Meeting on Longitudinal Studies Concerning Educational and Occupational Op portunities . Paris: Organization for Economic Co operation and Development, 1970. 145 Branch, R. G., and Platt, L. A. The effects of early clinical experience upon dental students: a study of professional role adoption. Paper presented at the annual meeting of the Southern Sociological Society, New Orleans, April 5-8, 1972. Bridgman, M. Collegiate Education for Nursing. New York: Russell Sage, 1953. Bromphy, E. B. Relationships among self-role congruence and nursing experience. Nursing Research, 1971, 20, 447-450. Brown, B. The possible dream. Nursing Outlook, 1970, 19, 36-39. Brunswik, E. Scope and aspects of the cognitive problem. In J. Gruber, R. Jessor, and K. Hammond (Eds.), Cognition: The Colorado Symposium. Cambridge, Mass.: Harvard University Press, 1957. Burns, H. W. Logic of the educational implication. Educa tional Theory, 1962, 12, 63. Buros, 0. C. (Ed.) Mental Measurements Yearbook. (7th ed.) Highland Park, N. J.: Gryphon, 1972. Bushnell, D. S., and Zagaris, I. Report from Project Focus: Strategies for Change. Washington, D. C.: American Association of Junior Colleges, 1972. Cahil, I. D. The faculty subculture in the university. Nursing Forum, 1973, 12, 220-259. Chickering, A. W. Education and Identity. San Francisco: Jossey-Bass, 1969. _. Social change, human development and higher education. In E. J. McGrath (Ed.), Prospect for Renewal. San Francisco: Jossey-Bass"^ 1972. _. College advising for the 1970's. In J. Katz (Ed.), Service for Students: New Directions for Higher Education. San Francisco: Jossey-Bass, 19V 3 “ Coe, R. E. Sociology of Medicine. New York: McGraw Hill, 1970. 146 Cope, R. G., and Hewitt, R. G. Types of college dropouts: an environmental press approach. College Student Journal, 1971, 5(2), 46-51. Corey, S. M., and Herrick, V. The developmental tasks of children and young people. In W. Bailer (Ed.), Readings in the Psychology of Human Growth and De- velopment. New York: Holt, Rinehart, and Winston, 1962. Corwin, R. G. Role Conception and Mobility Aspirations: Study in the Formation of Nursing Identities. (Doctoral dissertation, University of Minnesota) Ann Arbor, Mich.: University Microfilms, 1960, No. 60-3505. ________ . Professional employee: study in conflict in nursing roles. American Journal of Sociology, 1961, 66-604-615. ________ . Education in Crisis: A Sociological Analysis of Schools and Universities in Transition. New York; Wiley, 1974. Corwin, R. G., and Tavees, M. J. Nursing and other health professions. In H. E. Freeman, S. Levine, and L. G. Reader (Eds.), Handbook of Medical Sociology. Engelwood Cliffs, N. J.: Prentice-Hall, 1963. Cox, A. Commission Report. Crisis at Columbia. New York: Random House, 1968~ Dalme, F. C. A Study of the Relationship of Nursing Stu dents' Perception of Selected Environmental Influ ences and the Students1 Development of Professional Identity. (Doctoral dissertation, University of Colorado) Ann Arbor, Mich.: University Microfilms, 1971, No. 72-3641. Day, D. Methods in attitude research. American Sociologi cal Review, 1940, 5, 395-410. Dixon, W. J. (Ed.) BMP Miomedical Computer Programs. Los Angeles: University of California Press, 1970. Dressel, P. L., and Lehmann, I. J. The impact of higher education on student values and critical thinking abilities. Educational Record, 1965, 46(3), 248- 258. 147 Eble, K. E. Professors as Teachers. San Francisco: Jossey-Bass, 1972. Erikson, E. H. Childhood and Society. New York: Norton, 1950. ________ . Growth and crisis of the "healthy personality." In C. Kluckhohn, and H. A. Murray (Eds.), Personal ity in Nature, Society, and Culture. New York: Knopf, 1955. ________ . Childhood and Society. (2nd ed.) New York: Norton, 1963. Identity: Youth and Crisis. New York: Norton, 1968. ________ . Autobiographic notes on the identity crisis. Daedalus, 1970, 49, 730-759. Eron, L. D. The effects of nursing education on attitudes. Nursing Research, 1955, 4, 24-27. Feldman, K. A., and Newcomb, T. M. The Impact of College on Students, Vol. 1. San FrancTsco: Jossey-Bass, 1969. Fox, D. J., and Diamond, L. K. Satisfying and stressful situations in nursing education. In D. J. Fox, and R. L. Kelly (Eds.), The Research Process in Nursing. New York: App1eton-Ceritury-Crofts, T967. Gibb, J. R. Trust and role freedom: a tori innovation in educational community. Journal of Research and Development in Education^ 1972, 5 (3), 76-85. Gibbon, E. The Autobiographies of Edward Gibbon. (2nd ed.) In J. Murray (Ed.) London: Clowes and Sons, 1897. Goble, Frank G. The Third Force: The Psychology of Abraham Maslow. New York: Grossman, 1970. Goslin, D. A. Introduction, In D. A. Goslin (Ed.), Hand book of Socialization Theory and Research. Chicago: Rand-McNally, 1969. Grafton, C. L. A Latitudinal Study of Attitudes Comparing Certain Student Groups on Issues Related to Univer sity Life. (Doctoral dissertation, University of Southern California) Ann Arbor, Mich.: University Filmed as received without page(s) 1H8 UNIVERSITY MICROFILMS. 14 9 Helmstadter, G. C. Research Concepts in Human Behavior: Education, Psychology, Sociology, . New York: Meredith, 1970. Hutchins, E. B. The Measurement of Student Environment and its Relation to Career Choice in Medicine. (Mimeo graphed) , The Association of American Medical Col leges, 1962. Hutchins, E. B., and Nonneman, A. J. Construct validity of an environmental assessment technique for medical schools. Technical Report No. 1661. Evanston: Office of Basic Research, Division of Education, American Association of Medical Colleges, 1966. Illich, I. Deschooling Society. In R. N. Anshen (Ed.) Vol. 44, World Perspectives. New York: Harper and Row, 1971. Insel, S. A., Ingmire, A. E., Robinson, B., and Arnold, E. Communication and relationship styles among nurse leaders. Proceedings of the Annual Convention of the American Psychological Association, 1972, 7, 449-450"” (Summary) . Issac, S., and Michael, W. B. Handbook in Research and Evaluation. San Diego: Knapp, 1971. Jacob, P. E. Changing Values in College. New York: Harper, 1957. Johnson, W. R. The Measurement and Evaluation of Student and Faculty Perceptions of Nursing Education Envi ronments . (Doctoral dissertation University of Rochester) Ann Arbor, Mich.: University Micro films, 1971, No. 71-1444. Jones, W. L. P. Roles in nursing 1: the student. Nurs ing Times, 1971, 67, 30-31. (a) Roles in nursing 2: why do they put up with it? Nursing Times, 1971, 67, 88. (b). Katz, J. Personality and interpersonal relations in the college classroom. In N. Sanford (Ed.), The Ameri can College. New York: Wiley, 1962. 150 ________ . A new conception of service: principles and strategies. In J. Katz (Ed.), Services for Stua dents: New Directions for Higher Education. San Francisco: Jossey-Bass, 1973. Katz, J., and Associates. No Time for Youth. San Francis co: Jossey-Bass, 1968. Kerlinger, F. N. Foundations of Behavioral Research. (2nd ed.) San Francisco: Holt, Rinehart, and Winston, 1973. Kerr, C. (Chm.) The Purposes and the Performance of Higher Education In the United States: Approaching the Year 2000~ A report and recommendations by the Carnegie Commission on Higher Education. San Fran cisco: McGraw-Hill, 1973. Kiker, M. Characteristics of the effective teacher. Nurs ing Outlook, 1973, 21, 721-733. Klein, G. S. Perception, Motives, and Personality. New York: Knopf, 1970. Kohn, P. M. Relationships between expectations of teachers and performance of students (Pygmalion in the class room) . Journal of School Health, 1973, 43, 498-503. Kramer, M. Role conceptions of baccalaureate nurses and success in hospital nursing. Nursing Research, 1970, 19, 428-439. Kramer, M., McDonnell, G., and Reed, L. Self-actualization and role adaptation of baccalaureate degree nurses. Nursing Research, 1972, 21, 111-123. Krause, E. A. The Sociology of Occupations. Boston: Little-Brown, 1971. Lefcourt, H. M., and Steffy, R. A. One man's adequacy is another man's failure. Psychological Reports, 1970, 26, 689-690. Lewin, K. Principles of Topological Psychology. New York: McGraw-Hill, 1936. Lysaught, J. P. An Abstract for Action: National Commis sion for the Study of Nursing and Nursing Education. San Francisco: McGraw-Hill, 1970. 151 Lyon, J. C. Learning to Feel - Feeling to Learn: Humanis tic Education for the Whole Man. C. R. Rogers, and W. R. Coulson (Eds.). Columbus, Ohio: Merrill, 1971. Marks, E. Individual differences in perceptions of the college environment. Journal of Educational Psy chology , 1970, 61, 270-279. Mayhew, L. B. Institutional factors and the learning envi ronment. In L. E. Dennis, and J. F. Kauffman (Eds.), The College and the Student. Washington, D. C.: American Council on Education, 1966. McConnell, T. R., and Heist, P. The diverse college stu dent population. In N. Sanford (Ed.), The American College. New York: Wiley, 1962. Menges, R. J. Professional education: changing the locus of control. Education Forum, 1974, 38, 231-235. Miller, j. V. Student Behavior and Climate. Ann Arbor, Mich.: Michigan University Counseling and Person nel Services Information Center, 1968. Mitchell, J. A model for the maintaining of students and fellows of choice abilities at the college in Cam bridge, probably in 16 63, Publications of the Colonial Society of Massachusetts, 1935, 31, 311. Cited by L. Cremm, American Education: the Colon ial Experience, 1607-1783. New York: Harper and Row, 1970. Muessig, R. H. Youth Education, Problems, Perspectives, Promises'! Association for Supervision and Curricu- lum Development. Washington, D. C.: National. Education Association, 1968. National League for Nursing. Minutes of the Business Meet ings of the Council of Baccalaureate and Higher Degree Programs, (Mimeographed), Minneapolis, Minn., May 8, 1973. Nelson, E. N. P. Persistence of attitudes of college stu dents fourteen years later. Psychological Mono graphs , 1954, No. 343. Newcomb, T. M. Personality and Social Change. New York: Dryden, 1943. 152 ________ . The Acquaintance Process. New York: Holt, Rinehart, and Winston, 1961. ________ . Research on student characteristics: current approaches. In L. Dennis, and J. Kauffman (Eds.), The College and the Students. Washington, D. C.: American Council on Education, 1966. ________ . Attitude development as a function of reference groups; the Bennington study. In E. E. Maccoby, T. M. Newcomb, and E. L. Hartley (Eds.), Readings in Social Psychology. New York: Holt, 1968. Newcomb, T. M., Koenig, K., Flacks, R., and Warwick, D. P. Persistence and Change: Bennington College and Its Students After Twenty-five Years. New York: Wiley, 1967. Newman, F. (Chm. Task Force). Report on Higher Education. (Dept. HEW, Supt. of Doc. Cat. No. HE 5.250:50065) Washington, D. C.: U. S. Government Printing Office, 1971. Newsome, G. L. In what sense is theory a guide to practice in education. Educational Theory, 1964, 14, 37. Nolle, D. B. Alternative path analytic models of student- teacher influence: the implication of different strokes for different folks. Sociology of Educa tion, 1973, 46, 417-426. O'Neill, W. F., and Demos, G. D. Education Under Duress: Behavior Modification Through Thought Reform. Los Angeles: LDI Books, 1971. Oppenheim, A. N. Questionnaire Design and Attitude Measure ment. New York: Basic Books, 1966. Pace, C. R. Perspectives on the student and his college. In L. E. Dennic, and J. F. Kauffman (Eds.), The College and the Student. Washington, D. C.: American Council on Education, 1966. ________ . College and University Environment Scales, Technical jManual. (2nd ed.) Berkeley, Educational Testing Service, 1969. 153 Pace, C Pavalko Perry, : Perry, 1 Pickard Pierik, Plant, I Plant, V Plough, Ralston, . R., and Stern, G. G. An approach to the measure ment of psychological characteristics of college environments. Journal of Educational Psychology, 1958, 49, 269-277. , R. M. Sociology of Occupations and Professions. Itasca, 111.: Peacock, 1971. R. R. Institutional research: vital third force in higher education. Journal of Higher Education, 1972, 43, 737-753. V. G. Forms of Intellectual and Ethical Development in the College Years. New York: Holt, Rinehart, and Winston, 1970. , C. G. Family nurse practitioners: preliminary answers and new issues. Annals of Internal Medi cine, 1974, 80, 267-268. M. M. Joint appointments: collaboration for better patient care. Nursing Outlook, 1973, 21, 576-579. 7. T. Changes in ethnocentrism during college. Journal of Educational Psychology, 1958, 49, 112- 165. Longitudinal changes in tolerance and authori- "tarianism for subjects differing in amount of col lege education over four years. Genetic Psychology Monographs, 1965, 72, 247-287. 7. T., and Telford, C. W. Changes in personality for groups completing different amounts of college over two years. Genetic Psychology Monographs, 1966, 74, 3-36. T. P., and Dressell, P. L. Assessing academic press. Improving College and University Teaching, 1973, 21, 93-97. N. C., and Thomas, G. P. Developmental tasks of early adulthood, Improving College and University Teaching, 1974, 22(1), 21-22. Randhawa, B. S., and Fu, L. L. W. Assessment and effect of some classroom environment variables. Review of Educational Research, 1973, 43, 303-321. 154 Rector, W. H., and Shaw, M. C. Dimensions of the learning environment: the school opinion survey. Western Regional Center of the Interprofessional Research Commission on Pupil Personnel Services Monograph, Chico State College, Ca., 1967. Richards, J. M., Jr,, Rand, L. P., and Rand, L. M. Region al differences in junior colleges. Personnel and Guidance Journal, 1967, 6, 987-992. Robertson, D., and Steele, M. The Halls of Yearning: An Indictment of Formal Education, a Manifesto of Student Liberation. New York: Canfield-Colophon, 1971. Rock, D. A., Centra, J. A., and Linn, R. L. The identifi cation and evaluation of college effects of student achievement. Research Bulletin. Princeton, N. J.: Educational Testing Service, 1969. Rokeach, M. Dogmatism scale, form E. The Open and Closed Mind. New York Basic Books, 1960. ________. Beliefs, Attitudes, and Values. San Francisco: Jossey-Bass, 1969. Sachs, D. M., and Shapiro, S. H. Comments on Teaching psy choanalytic psychotherapy in a residency training proqram. Psychoanalytic Quarterly, 1974, 4 3, 51- 76. Sanford, N. (Ed.) The American College. New York: Wiley, 1962. ________ . Self and Society: Social Change and Individual Development. New York: Atherton Press, 1966. ________ . Education for Individual Development: New Di mensions in Higher Education. ( dHEW Report No. 31) Washington, D. C.: U. S. Government Printing Office, 1967. (a). ________ . Where Colleges Fail. San Francisco: Jossey- Bass, 1967 oiiege . (b). Shostrom, E. L. EITS Manual for the Personal Orientation Inventory! San Diego: Educational and Industrial Testing Service, 1966. 155 Shulman, L. S. Reconstruction in educational research. Paper presented at the conference on Social Change and the Role of Behavioral Scientists, Atlanta, Ga,, May 4-6, 1966. Silberman, C. E. Crisis in the Classroom. New York: Random House, 1970. ________ . (Ed.). The Open Classroom Reader. New York: Random House, 1973. Simmons, W. D. Superior Women College Students: A Study of Their Self Concepts and Academic Motivation. Final Report. (DHEW) Washington, D. C.: Office of Education, Bureau of Research, 1968. Social Science Research Council. The American College and Student Personality. New York: Social Scxence Research Councxl, 1960. Spingarn, N. D. Biggest of the health professions, nursing is beset with paradoxes. Chronicle of Higher Edu cation, 1974, 8(18), 1, 8. Spray, S. L. Institutional constraints on professionalism, the case of the mental health professions. Paper presented at the National Seminar on Adult Research, Chicago, February 11-13, 1968. Stern, G. G. The Activities Index: Preliminary Manual. Syracuse, N. Y.: Syracuse University Psychological Research Center, 1958. ________ . Congruence and dissonance in the ecology of college students. Student Medicine, 1960, 8, 304- 340. ________ . Environments for learning. In N. Sanford (Ed.), The American College. New York: Wiley, 1962. ________ . Characteristics of the intellectual climate in college environments. Harvard Educational Review, 1963, 33, 5-41. ________ . Student ecology and the college environment. Research in Higher Education. New York: College Entrance Examination Board,1964. 156 Studies of College Environments. Syracuse: University of Syracuse Press, 1966. ________ . People in Context: Measuring Person-Environment Congruence in Education and Industry. New York: Wiley, 1970. ________ . Campus environments and reported problems. In M. Keeton (Ed.), Shared Authority on Campus, Wash ington, D. C.: American Association for Higher Education, 1971. Stinchcombe, A. Constructing Social Theories. New York: Harcourt, Brace, and World, 1968. Stolurow, L. M. Learning environments-or-rooms for thought. How Teachers Make a Difference (DHEW, Stock No. 1780-0813). Washington, D. C.: U. S. Government Printing Office, 1971. Struner, W. F. The college environment. In D. W. Vermilye (Ed.), The Future in the Making. San Francisco: Jossey-Bass, 197 3. Taylor, C. W. Devleoping effectively functioning people - the accountable goal of multiple talent teaching. Education, 1973, 94, 99-111. Thistlethwaite, D. L. College press and student achieve ment. Journal of Educational Psychology, 1959, 50, 183-191. Rival hypotheses for explaining the effects of different learning environments. Journal of Educa tional Psychology, 1962, 53, 310-315. (b). Thurstone, L. L. The theory of attitude measurement. Psy chological Review, 1929, 26, 249-269. Thurstone, L. L., and Chave, E. J. The Measurement of At- titudes.. Chicago: University of Chicago Press, 1929. Tittle, C. R., and Hill, R. J. Attitude measurement and prediction of behavior: an evaluation of condi tions and measurement techniques. Sociometry, 1967, 30, 199-213. 157 Toynbee, A. J. Surviving the Future. New York: Oxford University Press, 1971. Trent, J. W. , and Medsker, L‘ . L. Beyond High School: A Study of 10,000 High School Graduates. San Fran cisco: Jossey-Bass, 1968. Tussman, J. Experiment at Berkeley. New York: Oxford University Press, 1969. Tyler, R. W. Academic excellence and equal opportunity. In F. Harcleroad (Ed.), Issues of the Seventies. San Francisco: Jossey-Bass, 1970. U. S. Department of Labor. Occupational Outlook Handbook, 1972-73 Edition. Bulletin 1700. Washington, D. C.: Government Printing Office, 1973. Vispo, R. H. On human maturity. Perspectives in Biology and Medicine. 1966, 9(4). Walberg, H. J. Social environment as a mediator of class room learning. Journal of Educational Psychology, 1969, 60, 443-448. A model for research on instruction. School Review, 1970, 78, 185-200. (a). ________ . Professional role discontinuities in educational careers. Review of Educational Research, 1970, 40, 409-420. (FT Walker, L. O. Toward a clearer understanding of the con cept of nursing theory. Nursing Research, 1971, 20, 428-435. Webster's New Collegiate Dictionary. Springfield, Mass.: G and C Merriam, 1973. Whitehead, A. N. The Aims of Education and Other Essays. New York: Free Press, 1967. Wilms, B. All quiet on the berkeley front. College Man agement , 1973, 8, 12-15, 25. Wilson, V. An analysis of feminity in nursing. American Behavioral Scientist, 1971, 15, 213-220. 158 Wolins, L., and Dickinson, T. L. Transformations to im prove reliability and/or validity for affective scales. Educational and Psychological Measurement, 1973, 33, 711-713. APPENDICES 159 APPENDIX I LETTERS OF P E R M ISSIO N FOR USE OF MATERIAL to and from Arthur W. Chickering, Ph.D. and Prances C. Dalme, Ph.D. 160 LOMA LINDA UNIVERSITY SCHOOL OF NURSING OmdOPTHS D UN Arthur W. Chlckering, Ph.D Tice—president for Academic Affairs Empire State College Saratoga Springs, New York 12866 Dear Dr. Chlckering: Sometime in November of 1973, I talked with you by phone concerning my Interest in the theory of college student development as postulated in your book, Education and Identity. As I stated, under a HEW five-year project grant #5-D 10-NU-0353-05, we have been giving high priority to improving the learning environment for nursing education at Loma Linda University. Various problems have been worked with under the project grant. One area of extreme complexity and critical need is in the heart of nursing education, the clinical learning environment. It is this specific area which I have selected to concentrate my doctoral dis sertation efforts under the direction of the Department of Higher Edu cation, School of Education at the University of Southern California. I would appreciate official permission to use the college student devel opmental theory you have postulated as I might best apply this in one medical center as the basis for further clinical application and re testing as may seem appropriate. For your information, I am enclosing a copy of the definitions of areas of student development as I have adapted them for clinical application. I have tried to maintain your intent but make direct reference to de velopments as could be evaluated only within the clinical learning en vironment versus the university environment as a whole. If there are suggestions or areas of conflict you perceive in the definitions as here stated, please feel free to tell me. I am also enclosing for your general information, my original disser tation proposal as was accepted by my Doctoral Committee of Studies. At this point I have developed test items for each developmental area. These have now been returned from the twelve judges used to increase validity of the test by agreement with the item to developmental area defined. Following analysis of the decisions of the judges, the pilot test is being constructed with hope that it will be administered and revised yet this month. Campuses at Lbm a Linda and La Sierra LOMA LINDA, CALIFORNIA 92334 February 20, 1974 161 I vould be happy to share the results of this study with you If you wish. Thank you for greatly assisting in the stimulation and synthesis of my Interest In college student development in the direction of student Iden tity. I am eager to carry this area of research beyond the scope of my doctoral study at a later time. Slneeralv vours. Harilyn J. Christian Dean MJC:hm Enclosures E A P IB E B S T A T E C O D U L E C E n i'a i i : ijk iv i:i: s it y o r m v y o k k SARATOGA SPRINGS Kijw y o k k I3SG0 March 8, 1974 Ms. Marilyn Christian Loma Linda University School of Nursing Loma Linda, California 92354 Dear Ms. Christian: Herewith official permission to make use of the developmental theory set forth in Education and Identity, and any other ideas there that are of use to you. I have not yet had a chance to go over your proposal and react to it but I hope to be able to do so within tho next few weeks. Right now I’m very much snowed under but I did want to let you know that you should feel free to go ahead. I look forward to hearing more about your work as time goes on. Good luck. Sincerely yours, Arthur W. Chickering . . Vice President for Academic Affairs LOMA L IN D A U N I V E R S I T Y 164 LOMA L1KOA, CALIFORNIA 9 2 3 3 4 SCHOOL O F NURSING O F T td OF THE DEAN August 3, 1973 Frances C. Dalme, Fh.D 6 Jamestown Court Little Rock, AR 72205 Dear Doctor Dalme: The phone conversation I had with you last evening was a real pleasure. 1 appreciated your openness and willingness to share with me your own materials from your doctoral dissertation done at the University of Colorado in 1971. As I stated, my own proposed dissertation deals with a study on the evaluation of the clinical learning environment for baccalaureate and graduate students in nursing. I do plan to deal with input from stu dents, faculty and nursing staff in assessing the strengths or weaknesses In the clinical setting as perceived by the groups identified above. I would like to study your evaluation tools with the hope of adapting and expanding these tools to meet the purposes of my study and at the same time not lose the value of the rigorous reliability studies which you gave to your testing devices. If this is possible in meeting my goals I could see how it might add strength to both of our studies by further validating your testing tools in additional settings with the added dimensions as 1 perceived them. Please be assured that full credit would be given to you for any of the tools which 1 might wish to use in some manner in my study. I would appreciate a letter of permission to use your tools and study as the needs in my own dissertation might indicate with my reassurance to not destroy the integral content of your tools taking them out of the con text for which they were derived. Again, as I stated to you on the telephone, 1 could perceive after com pleting the dissertation that it would be an exciting thing to consider the possibility of a joint publication of a testing tool which might be used for evaluating clinical learning environments for nursing. It seems to me that this area is so neglected and yet so important in the funda mental learning processes of students in nursing. Campuses at Loma Linda and La Sierra 165 I would appreciate your response to this letter being sent to my home where I am spending more time than in my office at this particular time. My home address is as follows: 1177 Hummingbird Lane, Corona, CA 91720. Thank you again for your cordiality and helpfulness as I try to carry your study a few steps forward. Very sincerely yours, Marilyn J. Christian, Dean HJC:hm % 166 U n i v e r s i t y o f A r k a n s a s S C H O O L O F N U R S IN G L IT T L E . R O C K 7 2 2 0 1 O F F IC E O F T H E DEAN August 10, 1973 4 3 0 1 W E S T MARKHAM AREA C O D E 3 0 1 0 3 4 . 3 0 0 0 E X t: 2 3 4 Ms. Marilyn J. Christian, Dean School of Nursing Loma Linda University Loma Linda, California 92354 Dear Marilyn: Thank you so much for your letter of August 3, 1973 confirming our telephone conversation of the previous evening. I am most excited that you are planning to study the instrument, used for my dissertation, in the hope it will meet the purposes of your own study. I feel certain you will need to expand and perhaps improve the instrument before it can be satisfactory for your use. You have my full permission to use the instrument and my study In any way that can be helpful in facilitating your dissertation. I believe your study has great potential for advancing my work in addition to making a contribution to the nursing literature. Please keep me informed of your progress and if 1 can help in any way, just let me know Best wishes to you for a successful study Sincerely, Frances C. Dalme, R.N., Ph.D. Associate Dean for Graduate Programs FCD:sb APPENDIX DEVELOPMENT AND USE OF THE INSTRUMENT The following includes: 1. Instructions and materials to the Jury as was distributed. The 91 items following the "In structions to the Juror" were numbered and cut for Q sort as described under Chapter III. 2. Pilot Test letter of instructions and instrument as administered. 3. Research Test instructions and questionnaire as administered. 167 LOMA L IN D A U N I V E R S I T Y SCHOOL O F NURSING LO M A LIN D A, CA LIFO R N IA 92334 OFFICE O F T H E DEAN January 31, 1974 LETTER TO THE JUROR Dear Colleague: You are being asked to serve as a member of a twelve—person Jury to assist me In the construction of a testing tool which we hope will eventually lead to the Improvement of student learning and patient care by nurses at Loma Linda University. This is a small part of the five-year learning improvement project HEW 5-D-10—NU—0353-05 and will also be of primary assistance to me in my dissertation requirement for doctoral study at the University of Southern California. Please be assured that I recognize this is requesting your assis tance on a task on top of your full and often overloaded schedule. Completion of this task should take you not more than 30-45 minutes. Your willingness to participate is greatly appreciated. If, for any reason, this cannot be completed within the next seven days, please call me at Extension 2118 so that other arrangements might be made. Thank you for your cooperation and help. I will be pleased to share the major results of this study with you if you desire. Pnril ■ ( al 1 w v OtirS p Marilyn J. Christian, Dean. MJC:hm Enclosures % Campuses at Loma Linda and La Sierra 168 169 INSTRUCTIONS TO THE JUROR 1. Background; The attached list of statements arise out of a theory of college development as purposed by Dr. Arthur W. Chickering in his book, Education and Identity. San Fran cisco: Jossey-Bass, Inc., 1969. Chickering postulates that environmental conditions in colleges and universities do foster or inhibit in seven major areas of student de velopment. The degree to which the student develops in each of these areas has a direct relationship to the value he attaches to his college experience in meeting his per sonal life goals. Accepting Chickering's theory of college student development, the writer attempted to redefine the Chicker ing developmental areas into terms which could be assessed in the clinical environment of nursing. The following definitions are an attempt to meet this goal. Next, items were developed which can be categorized under each of the seven developmental areas. 2. Directions: As a member of the twelve-person jury you are asked to sort the separate statements you are here given, into one of the seven identified areas of student develop ment. The statements may be positive, negative, or neu tral. Some statements seem clearly to be phases of devel opment while others may only relate to development by their seemingly indirect relationship to the clinical learning environment. Each statement has been phrased to "fit" best into one area even though there is possibility of overlap into more than one developmental area. Please read the definitions on each of the en closed envelopes carefully. Then proceed to sort the statements which in your judgment best "fits" or effects a defined area of student development. Please end your sorting process with not less than ten items for each de fined area of development. Some areas may have more than ten items but never less. Sorting and resorting will no doubt be required to achieve what you feel is the best "fit." 170 The numbers shown on each item and on the envelope are for tabulation and control purposes only. You will not be identified in the study. Order of selection is not being utilized only agreement in categorization. Please work alone. Your first judgment is generally best. When sorting is complete, please place the items in one of the seven envelopes which corresponds with its best "fit." When your sorting task is complete, please call Mrs. Monica Dulan at Extension 2061 or Mrs. Mathisen at Extension 2118 and they will pick up the brown packet of envelopes and instructions. Thank you again for your important help to me on this project. ITEMS FOR JUROR SORT Faculty and nursing service leaders often try to manipulate students into doing what seems to be needed on the unit. Students seem to prefer observing ■ rather than being Involved in direct clinical care. Nursing leaders frequently learn together with students. Most students feel they are learning to give better nursing care than that ' which is being given now by present staff nurses. 5. Balanced living is generally not possible for students of nursing under the pressures of academic and clinical life. 6. Many students remain in nursing lnsplte of dissatisfaction with their professional life goals. 7. Classroom or formal teaching for patient care, is consistant with that which can and should be practiced in the clinical setting. 8. Working w IiSl the nursing team a student usually feels acceptance and warmth. Students would like to have more opportunity to explore moral values related to nursing with their nursing leaders. 172 13. In the clinical setting students see positive examples of the use of courage and aggression to ac hieve meaningful ends In team endeavors to Improve patient care. Students are usually aware of the reactions their presence produces In patients and colleagues. 14. Students demonstrate recognition of the Individual needs and values of nursing service leaders and faculty. Nursing leaders tend to demonstrate a 15. Students seldom discuss their non-threatening attitude toward personal developing system of students. “ beliefs and values with faculty or nursing service leaders. It is usually considered Inappropriate 16. In the clinical area It Is Important for students to demonstrate love in for the nurse to "look busy", patient care. 17. Dedication to duty and standing for moral principle Is just as prevalent in Individual students of nursing today as was true ten to twenty years ago. 173 21. Nursing service leaders and faculty demonstrate recognition of students as individuals with unique personal needs and qualities. 18. Leaders In nursing service tend to give recognition to a job well done by students more often than do the nursing faculty. 22. Students are urged to behave consistently with their internal or moral beliefs in clinical practice. 19. Students usually seek consultation 23. Nursing leaders in education and on clinical problems in nursing from service really try to catch whomever is closest in an emergency students mnlHng a mistake, but otherwise usually will try to . find assistance from a faculty member or a nursing service leader. 20. Students learn to use courage and 24. Students are more interested in aggression to make change in patient nursing patients with rare and care. exotic problems than those with more common illnesses. Students seem to be caught between theory and practice or what "ought to be" and what "can be" in the clinical setting. Students will usually seek con sultation or help from another student rather than confronting their instructor or nursing service leader. Clinical experience causes confusion in the students ability to develop behavior consistant with internal personal life values. Interaction between nursing students and nursing service leaders is of an open and trusting quality. 174 29. Students feel it is best if they are "seen but not heard" on the clinical unit. 30. Professional skills are not stressed enough in the bacca laureate program of nursing. 31. Students are being educated with a reasonable balance of nursing principles geared to meeting patients need today and in the future. 32. The nursing service leaders tend to downgrade the nursing educators. Students should be trusted to do vhat they have been taught without direct supervision In most situations of clinical practice. Nurse faculty help students crystal lize their life goals. NurBes in authority tend to restrict student autonomy even within the colloboratlve medical team approach to care. 37. There is a lot of emphasis on philosophy and/or scientific method which seems unrelated to the real "here and now" needs of patients. 38. The nursing educators tend to downgrade nursing service leaders. 39. Immediately following graduation most baccalaureate students are safe but have not become pro fessionally competent in one or • more areas' of nursing care. * Communication with others on the 40. Leaders in nursing service help unit is not a problem to most students. students crystallize their life goals. 41. Nurses In authority tend to assist students to make appropriate In dependent decisions in patient, care. 42. Most nurses are more concerned with following the rules and regulations than seeking ways to improve patient care. 43. The assignments for clinical care seem usually to be developed by the faculty without adequate Input. 44. Nursing service and education leaders seem to work together well in assisting each other toward the improvement of patient care and student learning. 176 45. The majority of the nursing service leaders are more professionally competent than are the faculty re sponsible.for teaching on that unit. 46. A well reasoned student nursing action would usually be accepted by nurses in authority even if it was contrary to the ideas of the nurse in authority. 47. When students have ideas they would like to try which would seem to enhance learning or patient care they seek means of implementing the idea through clinical or school channels. 48. It is usually easy to get a student group decision here without much discussion. 49. The goals of clinical practice seem unclear to many students. 177 S3. If policies seem to Interfere with learning students follow the policy without saying anything. 50. The nursing faculty are good about 54. Personal hostilities are usually assigning students to the kinds of concealed in the clinical setting, patients that allow lots of inde pendent judgments. 51. Most nursing faculty who teach on the clinical units are more competent in nursing care than are the nursing service leaders on that unit. 55. Nursing students manners, personal habits and hobbles tend to demon strate an appropriate blend of feminine-masculine personality. 52. If a student cried when a patient 56. Students self esteem will vary died nurses in authority would think as he/she practices within the the student "unprofessional". clinical setting regardless of the verbal input from others. 65. Clinical nursing In this Institution provides a satisfying student experience. 66. The curriculum Is clearly planned and Implemented successfully to help foster personal growth In the whole person or In the major areas of life. 67. The goals of clinical practice are developed with student input demon strated by Individualization as is reasonably possible. 68. Most students agree that It's better to just do as you're asked without asking questions. 178 69. Baccalaureate nurses feel that leadership Is a synonym for administration. 70. What students wear and how they act In the clinical setting is as im portant as the care they may render to patients. 71. The nursing faculty are most helpful In assisting student learning in the clinical setting. 72. Most faculty are happy and en thusiastic in teaching clinical care to students. 57. Students here pay little attention to how well they do relative to others In their class. 58. During clinical practice students learn appropriate use and power of personal emotions in patient care. 59. Nursing offers a very good opportunity to get ahead in life. 179 . 61. Within the clinical environment students are assisted to grow in trusting their emotional conduct conducive to patient care and personal betterment. 62. Students are pretty good In their ability to evaluate their own clinical and overall personal growth and accomplishments. 63. Baccalaureate nursing students think they should become leaders in nursing with appropriate roles in team leadership, supervision or other levels of administration. « 60. Most of the students are happy in their clinical learning. 64. Students demonstrate personal values and integrity as they participate in patient care. ) 73. The goals of clinical practice often seem unrelated to current student needs. 74. Patients have little to give In assisting students In determining life values. 75. Baccalaureate students are leaders upon graduation. 180 77. The nursing service leaders are most helpful in assisting student learning In the clinical setting. 78. Professional nursing is recognized as a dreary life long learning pro cess by most students. 79. Most of the students here are genuinely Interested In studying and learning to Improve the health care delivery system. 76. Faculty really push student capabilities to the limit. 80. Nursing service leaders really push student capabilities to the limit. 81. The policies or standards of nursing practice allow for independent decision making for students as well aa staff. 82. Upon graduation students feel they can readily achieve personal recog nition for their strengths in clinical care and personal worth to the institution. 83. Faculty encourage students to express their views about nursing related social problems. 84. Faculty or nursing service leaders usually watch students too closely. 181 85. The policies or standards of nursing practice inhibit the student of nursing from practicing that which she knows to be for the best good of the patient. 86. Most nursing service leaders are happy in their job setting here. 87. Students here feel they can't do anything to improve the patient care system within the institution. 88. Most nursing students feel they do not have enough practical experience. 89. The policies of the medical center or school assist students In learning. 182 90. The student is encouraged to recog nize strong and weak points in his/ her own self which affect patients and their families. 91. Student individual personal and professional growth life patterns are highly concentrated upon during the time of their clinical experience. LOMA LINDA UNIVERSITY 18 3 LOMA LINDA, CALIFORNIA 92)34 SCHOOL OF NURSING O F F K I OF THE DEAN February, 1974 PILOT TEST INSTRUCTIONS AND INSTRUMENT Dear Student, Nursing Leader or Faculty Member: You have been selected to participate In this study which will provide data to better understand factors affecting student learning in the clinical setting. Students, nursing staff and faculty are participating in this study. Your honest opinions are needed to give a realistic picture of the situation. As an individual you will not be identified in any ray in the study. Thank you for your willingness to assist in this study for Loma Linda University Nursing. This test is but one part of our constant endeavor to improve patient care and student learning through understanding and increased communication. Since this is the first time this test has been administered, we would appreciate after your response to the item that you note the items which seemed unclear. Your suggestions for improvement would be appreciated. Nursing Practice Project Staff Campuses at L om a L inda and L a S ien a 184 SA A U D SD 10. Students demonstrate recognition of the Individual needs and values of nursing service leaders and faculty. SA A U D SD 11. Students seldom discuss their personal developing system of beliefs and values with faculty or nursing service leaders. SA A U D SD 12. Dedication to duty 3nd standing for moral principle is just as prevalent in individual students of nursing today as was true ten to twenty years ago. SA A U D SD 13. Leaders in nursing service tend to give recognition to a job well done by students more often than do the nursing faculty. SA A U D SD 14. Students usually seek consultation on clinical problems in nursing from whomever is closest in an emergency but otherwise usually will try to find assistance from a faculty member or a nursing service leader. SA A 0 D SD IS. Students learn to use courage and aggression to make change in patient care. SA A U D SD 16. Nursing service leaders and faculty demonstrate recognition of students as individuals with unique personal needs and qualities. SA A U D SD 17. Students are urged to behave consistantly with their internal or moral beliefs in clinical practice. SA A U D SD 18. Students are more interested in nursing patients with rare and exotic problems than those with more common illnesses. SA A U D SD 19. Students will usually seek consultation or help from another student rather than confronting their instructor or nursing service leader. SA A U D SD 20. Clinical experience causes confusion in the students ability to develop behavior consistant with internal personal life values. SA A U D SD 21. Interaction between nursing students and nursing service leaders is of an open and trusting quality. SA A U D SD 22. Students feel it is best if they are "seen but not heard" on the clinical unit. SA A U D SD 23. Professional skills are not stressed enough In the baccalureate program of nursing. SA A U D SD 24. Students are being educated with a reasonable balance of nursing principles geared to meeting patients need today and in the future. SA A U D SD 25. The nursing service leaders tend to downgrade the nursing educators. PILOT TEST AS ADMINISTERED 185 SA A SA A SA A SA A SA A SA A SA A SA A SA A LQMA LINDA UNIVERSITY SCHOOL OF NURSING Perceptions Of Student Learning And Development In The Clinical Environment I. IDENTIFICATION:( CHECK THE APPROPRIATE BLANK) 1. Student:____ (A) Sophomore ___(B) Jr. (C) Sr. __(D) Graduate___ 2. Nursing Service Leader: (Years since graduation from basic program) (A) Less than 10____ (B) 10 - 19____ (C) 20 or more___ 3. Nursing faculty:____ (Years since graduation from basic program) (A) Less than 10____ (B) 10 - 19____ (C) 20 or more___ II..DIRECTIONS: In each of the following items please circle the response which best reflects your preception of the statement. Respond as you personally feel not as you judge others might feel. Please circle each item as SA: strongly agree; A:aRree; U:undecided; D:dlsagree or SD:strongly disagree. J D SD 1. Faculty and nursing service leaders often try to manipulate students into doing what seems to be needed on the unit. J D SD 2. Balanced living is generally not possible- for students of nursing under the pressures of academic and clinical life. J D SD 3. Classroom or formal teaching for patient care is consistant with that which can and should be practiced in the clinical setting. J D SD 4. Working with the nursing team a student usually feels acceptance and warmth. I D SD 5. Students would like to have more opportunity to explore moral values related to nursing with their nursing leaders. I D SD 6. Students are usually aware of the reactions their presence produces in patients and colleagues. I D SD 7. Nursing leaders tend to demonstrate a non threatening attitude toward students. I F D SD 8. It is usually considered inappropriate for students to demonstrate love in patient care. I D SD 9. In the clinical setting students see positive examples of the use of courage and aggression to achieve meaningful ends in team endeavors to Improve patient care. -1- 3 186 SA A SA A SA A SA A SA A SA A SA A SA A SA A SA A SA A SA A SA A SA A SA A SA A SA A D D SD 26. Students should be trusted to do what they have been taught without direct supervision In most situations of clinical practice. U D SD 27. Nurse faculty help students crystallize their life goals. U D SD 28. Nurses In authority tend to restrict student autonomy even within the collaborative medical team approach to care. 0 D SD 29. Communication with others on the unit Is not a problem to most students. 0 D SD 30. There Is a lot of emphasis on philosophy and/or scientific method which seems unrelated to the real "here and now" needs of patients. 0 D SD 31. The nursing educators tend to downgrade nursing service leaders. J D SD 32. Immediately following graduation most baccalaureate students are safe but have not become professionally competent in one or more areas of nursing care. J D SD 33. Leaders in nursing service help students ; crystallize their life goals. J D SD 34. Nurses in authority tend to assist students to make appropriate independent decisions in patient care. J D SD 35. Nursing service and education leaders seem to work together well in assisting each other toward the improvement of patient care and student learning. J D SD 36. The majority of the nursing service leaders are more professionally competent than are the faculty responsible for teaching on that unit. 1 D SD 37. A well reasoned student nursing action would usually be accepted by nurses in authority even if it was contrary to the ideas of the nurse in authority. I D SD 38. The goals of clinical practice seem unclear to many students. f D SD 39. The nursing faculty are good about assigning students to the kinds of patients that allow lots of independent judgements. I D SD 40. Most nursing faculty who teach on the clinical units are more competent in nursing care than are the nursing service leaders on that unit. f D SD 41. If a student cried when a patient died*nurses in authority would think the student "unprofessional". D SD 42. If policies seem to interfere with learning students follow the policy without saying anything. 187 SA A U D SO 43. Personal hostilities are usually concealed In the clinical setting. SA A O D SD 44. Nursing students manners, personal habits and hobbles tend to demonstrate an appropriate blend of feminine-masculine personality. SA A U D SD 45. Students self esteem will vary as he/she practices within the clinical setting regardless of the verbal input from others. SA A U D SD 46. Students here pay little attention to how veil they do relative to others In their class. SA A U D SD 47. During clinical practice students learn appropriate use and power of personal emotions in patient care. SA A U D SD 48. Nursing offers a very good opportunity to get ahead In life. SA A U D SD 49. Most of the students are happy in their clinical learning. SA A U D SD 50. Vi thin the clinical environment students are assisted to grow in trusting their emotional conduct conducive to patient care and personal betterment. SA A D D SD 51. Baccalaureate nursing students think they should become leaders in nursing with appropriate roles in team leadership,supervision or other levels of administration. SA A D D SD 52. Students demonstrate personal values and integrity as they participate in patient care. SA A U D SD 53. The curriculum is clearly planned and implemented sucessfully to help foster personal growth in the whole person or in the major areas of life. SA A U D SD 54. Baccalaureate nurses feel that leadership is a synonym for adminis tration. SA A U D SD 55. What students wear and how they act in the clinical setting is as important as the care they may render to patients. SA A U D SD 56. The nursing faculty are most helpful in assisting student learn ing in the clinical setting. SA A U D SD 57. The goals of clinical practice often seem unrelated to current student needs. SA A U D SD 58. Patients have little to give in assisting students in determining life values. SA A U D SD 59. The nursing service leaders are most helpful in assisting student learning in the clinical setting. SA A U D SD 60 Professional nursing is recognized as a dreary life long learning process by most students. 188 5 SA A SA A SA A SA A J D SD 61. The policies or standards of nursing practice allow for Independent decision making for students as well as staff. j D SD 62. Most nursing students feel they do not have enough practical experience. J D SD 63. The student is encouraged to recognize strong and weak points in his/her own self which affect patients and their families. I D SD 64. Student individual personal and professional growth life patterns are highly concentrated upon during the time of their clinical experience. 189 LOMA LINDA UNIVERSITY LOHA LINDA. CALIFORNIA 9 2 ) 5 4 SCHOOL OF NURSING March, 1974 Dear Student, Nursing Leader or Faculty Member: You have been selected to participate In this study vhlch will provide data to better understand factors affecting student learning In the clinical setting. Students, nursing staff and faculty are participating in this study. Your honest opinions are needed to give a realistic picture of the situation. As an individual you will not be identified in anyway in the study. Thank you for your willingness to assist in this study from Loma Linda University Nursing. This test is but one part of our constant endeavor to improve patient care and student learning through understanding and increased communication. The test is being given during the week just prior to the School Spring vacation. We are very hopeful for 100% return. Please complete your copy as soon as possible and return the completed copy to Mrs. Mathisen, SN Room 103 by Thursday, March 14. Tests administered within the medical center will be collected at announced locations. From previous experience we have found that it takes the average person 20-30 minutes for completion time of this test. Nursing Practice Project Staff I 190 Hote: This is the primary research questionnaire used. Statements that appear hereofy the negative have had the responses reversed in order to determine the mean,' but appear here as presented to the respondents. Perceptions Of Student Learning And Development In The Clinical Environment OF THE LOMA LINDA UNIVERSITY MEDICAL CENTER I. IDENTIFICATION: ( CHECK THE APPROPRIATE BLANKS ) 1. Student:____(A) Sophomore__(B) Jr. (C) Sr. (D) Graduate^ 2. Nursing Service Leader:___ (Years since graduation from basic program) (A) Less than 10 (B) 10 - 19___ (C) 20 or more___ 3. Nursing Faculty:___ (Years since graduation from basic program) (A) Less than 10 (B) 10 - 19 (C) 20 or more II. DIRECTIONS: In each of the following items please circle the response which best reflects your preception of the statement. Respond as you personally feel not as you judge others might feel. Please circle each item as SA: strongly agree; A: agree; U: undecided; D: disagree or SD: strongly disagree. Please do not mark between categories of agreement. SA A U D SD 1. Faculty and nursing service leaders often try to manipulate students into doing what seems to be needed oh the unit, SA A U D SD 2. Balanced living is generally not possible for students of nursing under the pressures of academic and clinical life. SA A U D SD 3. Classroom or formal teaching for patient care is consistant with that which can and should be practiced in the clinical setting. SA A U D SD 4. Students would like to have more opportunity to explore moral values related to nursing with nursing leaders. SA A U D SD 5. In the clinical setting students see nursing leaders using appropriate forms of courage and aggression to achieve meaningful ends for the improvement of patient care, SA A U D SD 6. Students demonstrate recognition of the personal needs and values of nursing service leaders and faculty. SA A U D SD 7. Students'seldom discuss their personal developing system of beliefs and values'with faculty or nursing service leaders. 191 SA A U D SD 8. Dedication to duty and standing for moral principle is just as prevalent in individual students of nursing today as was true ten to twenty years ago. SA A D D SD 9. Leaders in nursing service tend to give recognition to a job well done by students more often than do the nursing faculty. SA A U D SD 10. Students usually seek consultation on clinical problems in nursing from whomever is closest in an emergency but otherwise usually will try to find assistance from a faculty member. SA A U D SD 11. Students learn to use courage and aggression to make change in patient care. SA A U D SD 12. Nursing service leaders and faculty demonstrate recognition of students as individuals with unique personal needs and qualities. SA A U D SD 13. Students are urged to function in patient care consistantly with their internal or moral beliefs in clinical practice. SA A D D SD 14. Students are more interested in nursing patients with rare and exotic problems than those with more common illnesses. SA A U D SD 15. Students will usually seek consultation or help from another student rather than confronting their instructor or nursing service leader. SA A U D SD 16. Clinical experience causes confusion in the students ability to develop behavior consistant with internal personal life values. SA A D D SD 17. Interaction between nursing students and nursing service leaders is one of an open and trusting quality. SA A U D SD 18. Students feel it is best if they are "seen but not heard" on the clinical unit. SA A U D SD 19. The nursing service leaders tend to downgrade the nursing educators. SA A U D SD 20. Students should be trusted to do what they have been taught without direct supervision in most situations of clinical practice. SA A TJ D SD 21. Nurse faculty Help students individualize and crystallize their personal life goals. SA A U D SD 22. Nurses in authority tend to restrict student autonomy even within the collaborative medical team approach to care. SA A U D SD 23. Communication with others on the unit is not a problem to most students. 3 192 SA A U D SD 24. There is a lot o£ emphasis on philosophy and/or scientific method which seems unrelated to the real "here and now" needs of patients. SA A D D SD 25. The nursing educators tend to downgrade nursing service leaders. SA A U D SD 2 Immediately following graduation most baccalaureate students are safe but have not become professionally competent in one or more areas of nursing care. SA A U D SD 27. Leaders in nursing service help students crystallize their personal life goals. SA A U D SD 28. Nurses in authority tend to assist students to make appropriate independent decisions in patient care. SA A U D SD 29. Nursing service and education leaders seem to work together well in assisting each other toward the improvement of patient care and student learning. SA A U D SD 30. A well reasoned student nursing action wouldl usually be accepted by nurses in authority even if it -was contrary to the Ideas of the nurse in authority. SA A U D SD 31. The goals of clinical practice seem unclear to many students. SA A D D SD 32. Most nursing faculty who teach on the clinical units are more competent In nursing care than are the nursing service leaders on the unit. SA A U D SD 33. If a student cried when a patient died nurses in authority would think the student "unprofessional". SA A D D SD 34. If policies seem to interfere with learning students tend to follow the policy without saying anything. SA A U D SD 35. Personal hostilities are usually concealed fim the clinical setting. SA A D D SD 36. Nursing students manners, personal habits raod hobbies tend to demonstrate an appropriate balance of feminine-masculine personality. SA A U D SD 37. Regardless of what others on the unit may say, the studentls self esteem will vary as he/she practices within the clinical setting regardless of the verbal input from others. SA A D D SD 38. Students here pay little attention to how mil they do In clinical practice relative to others in their class. SA A U D SD 39. During clinical practice students learn appropriate use and power of personal emotions in patient care- SA A U D SD 40. Nursing offers a very good opportunity to gett ahead in life. 4. 193 SA A D D SD 41. Most of the students are happy In their clinical learning. SA A II D SD 42. Within the clinical environment students are assisted to grow in trusting their emotional conduct conducive to patient care and personal betterment. SA A U D SD 43. Baccalaureate nursing students think they should become leaders in nursing with appropriate roles in supervision or other levels of administration. SA A D D SD 44. Students demonstrate their own personal values and integrity as they participate in patient care. SA A D D SD 45. What students wear and how they act in the clinical setting is as Important as the quality of cate they may render to patients. SA A U D SD 46. The nursing faculty are most helpful in assisting student learning in the clinical setting. SA A U D SD 47. The goals of clinical practice often seem unrelated to current student needs. SA A D D SD 48. The policies or standards of nursing practice allow for Independent decision making for students as well as staff. SA A U D SD 49. The student is encouraged to recognize strong and weak points in his/her own self which affect patients and their families. THANK YOU FOR YOUR COOPERATION APPENDIX III TABULATED SUMMARY OF ALL ITEM DATA 194 195 APPENDIX III TABULATED SUMMARY OF ALL ITEM DATA By Groups and Sub Groups Soph. Jrs. Srs. Grad. Total Nsg. Service Leaders Faculty Item 1 SA 12 5 4 3 24 15 6 A 39 30 21 13 103 24 16 U 9 3 8 4 24 8 6 D 24 24 37 3 87 12 6 SD _0 _2 _6 _1 9 _0 _2 84 63 76 . 24 247 59 36 Item 2 SA 6 3 6 1 16 5 3 A 28 9 14 10 61 33 19 U 7 2 7 0 16 6 5 D 31 28 24 9 92 12 8 SD 12 21 2j5 _4 62 3 1 84 63 76 24 247 59 36 Item 3 SA 7 3 2 2 14 1 8 A 52 39 44 15 150 21 19 U 9 7 5 1 22 16 3 D 14 14 20 4 52 19 5 SD _2 _0 _5 _2 9 2 _1 84 63 76 24 247 59 36 Item 4 SA 2 0 0 0 2 0 0 A 15 7 17 4 43 6 2 U 21 22 18 3 64 28 15 D 38 31 36 12 117 24 16 SD _8 _3 JL _5 21 _1 _3 84 63 76 24 247 59 36 196 Nsg. Total Service Faculty Leaders Grad Soph Srs Jrs Item 5 SA 14 11 39 15 102 41 80 17 41 15 19 28 10 29 25 15 20 12 SD 36 59 247 24 84 76 63 Item 6 SA 15 15 140 54 45 29 18 10 41 14 18 16 48 20 13 35 16 11 SD 36 59 247 24 76 63 Item 7 12 97 21 99 18 SA 24 25 15 15 20 10 35 32 39 31 20 SD 36 247 59 24 76 84 63 Item 8 29 115 44 52 11 36 13 22 SA 24 29 23 15 17 10 36 12 SD 247 59 36 24 76 63 Item 9 22 126 38 49 SA 19 16 22 18 14 35 50 15 12 27 12 15 19 SD 247 76 63 36 59 24 197 Nsg. Grad. Total Service Faculty Leaders Srs Soph Jrs Item 10 12 54 10 42 13 63 SA 27 173 11 20 36 14 11 SD 36 247 59 24 76 63 84 Item 11 SA 11 12 10 35 120 50 65 11 31 40 21 21 14 21 12 20 SD 36 59 247 24 76 63 84 Item 12 SA 24 36 10 122 34 65 19 14 39 24 45 15 14 21 24 SD 36 247 59 24 63 Item 13 15 132 40 54 SA 21 25 18 11 39 32 52 16 13 18 19 SD 36 247 59 24 76 63 84 Item 14 21 113 15 83 15 13 40 SA 16 13 33 27 16 35 32 22 22 SD 36 247 59 24 63 84 198 Soph. Jrs. Srs. Grad. Total Nsg. Service Leaders Faculty Item 15 SA 12 4 3 0 19 1 1 A 40 25 24 11 100 33 17 U 6 8 8 3 25 9 11 D 25 23 34 8 90 14 7 SD JL _3 _7 _2 13 _2 _0 84 63 76 24 247 59 36 Item 16 SA 19 7 11 5 42 3 5 A 53 34 40 11 138 30 23 U 7 8 12 2 29 18 5 D 5 14 13 6 38 7 3 SD _0 _0 _0 _0 0 JL _0 84 63 76 24 247 59 36 Item 17 SA 2 0 0 1 3 3 0 A 24 18 16 4 62 29 10 U 19 11 17 9 56 19 13 D 37 30 30 7 104 8 11 SD _2 __4 13 _3 22 _0 2 84 63 76 24 247 59 36 Item 18 SA 14 10 5 1 30 7 1 A 32 24 32 12 120 28 22 U 8 5 5 2 20 13 4 D 25 18 29 7 79 11 8 SD _5 _6 _5 _2 18 _0 _1 84 63 76 24 247 59 36 Item 19 SA 8 7 5 5 25 17 2 A 45 28 38 7 118 30 22 U 27 18 14 11 70 5 5 D 3 10 19 1 33 7 5 SD _1 _0 _0 . _0 1 _0 _2 84 63 76 24 247 59 36 199 Soph. Srs. Srs. Grad. Total Nsg. Service Leaders Faculty Item 20 SA 9 8 8 2 27 0 0 A 40 33 35 10 118 15 13 U 5 6 8 6 25 9 1 D 26 15 25 6 72 32 17 SD JL _1 _0 _0 5 _3 _5 84 63 76 24 247 59 36 Item 21 SA 5 2 3 1 11 0 2 A 31 18 20 8 77 23 28 U 21 13 11 6 51 24 4 D 23 24 33 9 89 10 2 SD _4 _6 _9 _0 19 _2 _0 84 63 76 24 247 59 36 Item 22 SA 1 1 2 0 4 2 0 A 33 16 20 8 77 38 17 U 16 15 10 6 47 10 7 D 30 26 38 9 103 9 12 SD _4 _5 _6 _1 16 _0 _0 84 63 76 24 247 59 36 Item 23 SA 2 5 5 1 13 2 0 A 48 26 33 15 122 31 19 U 9 5 7 1 22 10 6 D 20 24 29 6 79 15 11 SD _5 3 _2 _1 11 1 _0 84 63 76 24 247 59 36 Item 24 SA 3 2 3 5 13 0 5 A 40 35 25 12 112 15 26 U 11 7 8 1 27 8 1 D 25 18 32 6 81 26 4 SD _5 _1 _8 _0 14 10 _0 84 63 76 24 247 59 36 200 Soph. Jrs. Srs. Grad. Total Nsg. Service Leaders Faculty Item 25 SA 10 3 4 4 21 3 7 A 55 43 48 13 159 34 21 U 10 9 12 5 36 16 0 D 9 8 10 2 29 6 7 SD _0 _0 _2 _0 2 _0 1 84 63 76 24 247 59 36 Item 26 SA 2 1 1 1 5 1 0 A 10 8 7 3 28 5 3 U 22 7 2 3 34 10 1 D 40 37 49 11 137 34 29 SD 10 10 17 _6 43 _9 _3 84 63 76 24 247 59 36 Item 2 7 SA 1 15 0 2 1 0 0 A 19 11 8 9 44 13 11 U 25 34 15 9 60 25 12 D 34 3 48 4 125 20 12 SD _5 _0 _5 _0 17 _1 _1 84 63 76 24 247 59 36 Item 28 SA 0 0 1 0 1 1 0 A 44 35 37 6 122 47 17 U 12 9 8 3 32 5 2 D 26 18 29 13 86 6 15 SD _2 1 _1 _2 6 _0 2 84 63 76 24 247 59 36 Item 29 SA 2 1 2 1 6 3 1 A 52 30 31 7 120 35 18 U 18 15 19 8 60 12 7 D 11 16 21 8 56 9 8 SD _1 _1 _3 _0 __5 _0 _2 84 63 76 24 247 59 36 201 Soph. Jrs. Srs. Grad. Total Nsg. Service Leaders Faculty Item 30 SA 0 0 1 1 2 2 1 A 18 18 18 6 60 26 5 U 25 10 9 2 46 16 8 D 30 32 35 12 109 15 18 SD 11 _3 13 _3 30 _0 4 84 63 76 24 247 59 36 Item 31 SA 2 1 0 1 4 1 0 A 51 2 30 8 121 10 14 U 10 14 10 4 38 13 7 D 18 16 32 9 75 30 13 SD _3 _0 __4 2 9 _5 2 84 63 76 24 247 59 36 Item 32 SA 8 2 6 0 16 22 1 A 34 32 33 12 111 30 25 U 20 14 15 5 54 7 6 D 21 12 20 6 59 0 4 SD _1 _3 2 JL __7 _0 _0 84 63 76 24 247 59 36 Item 33 SA 17 12 18 3 50 28 6 A 47 38 40 18 143 28 24 U 11 5 4 1 21 2 4 D 6 7 11 1 25 1 2 SD _3 _1 _3 _1 8 _0 _0 84 63 76 24 247 59 36 Item 34 SA 7 5 1 1 14 2 2 A 30 24 29 11 94 24 16 U 12 9 8 4 33 17 9 D 32 23 34 7 96 15 9 SD _3 2 _4 JL 10 J^ _0 84 63 76 24 247 59 36 202 Soph. Srs. Srs. Grad. Total Nsg. Service Leaders Faculty Item 35 SA 2 1 0 0 3 0 0 A 15 14 24 5 58 25 15 U 19 8 4 2 33 14 10 D 46 36 32 17 141 20 10 SD _2 _4 _6 _0 12 _0 _1 84 63 76 24 247 59 36 Item 36 SA 4 2 5 2 13 1 0 A 54 49 50 13 166 30 25 U 18 8 13 6 45 21 9 D 6 2 7 2 17 7 2 SD _2 _2 _1 _1 __6 _0 _0 844 63 76 24 247 59 36 Item 37 SA 8 2 7 2 19 0 1 A 39 37 39 11 126 24 5 U 5 2 4 2 13 13 6 D 29 13 19 9 70 18 21 SD _3 _9 _7 0 19 __4 __3 84 63 76 24 247 59 36 Item 38 SA 1 1 2 1 5 0 0 A 20 6 9 2 37 6 1 U 10 2 1 4 17 14 5 D 39 28 35 16 118 34 20 SD 14 26_ 29 _1 70 _5 10 84 63 76 24 247 59 36 Item 39 SA 4 5 6 1 16 2 2 A 63 44 56 16 179 34 28 U 10 10 7 3 30 19 5 D 7 4 5 4 20 3 1 SD __0 0 2 _0 __2 JL _0 84 63 76 24 247 59 36 ■ ■ ' ■ -■■■■■ ..m • 203 Soph. Jrs. Srs. Grad. Total Nsg. Service Leaders Faculty Item 40 SA 10 8 12 2 32 6 1 A 51 31 43 14 139 32 18 U 19 21 14 6 60 12 10 D 3 3 5 1 12 7 5 SD _1 J) _2 _1 4 _2 _2 84 63 76 24 247 59 36 Item 41 SA 3 2 0 0 5 2 0 A 54 29 32 11 126 31 26 U 12 13 12 9 46 16 6 D 12 16 25 4 57 9 3 SD 3 3 7 0 13 1 1 84 63 76 24 247 59 36 Item 4 2 SA 3 1 2 0 6 2 3 A 61 44 43 14 162 36 26 U 12 11 19 8 50 12 6 D 8 7 11 2 28 9 1 SD _0 _0 _1 _0 1 _0 _0 84 63 76 24 247 59 36 Item 4 3 SA 1 2 3 0 6 7 0 A 14 13 22 3 52 9 10 U 14 13 5 4 36 38 8 D 46 33 42 14 135 5 17 SD _9 2 _4 _3 18 _0 JL 84 63 76 24 247 59 36 Item 44 SA 12 8 6 5 31 5 5 A 63 49 59 17 188 48 28 U 8 5 3 1 17 5 3 D 1 1 7 1 17 5 3 SD _0 _0 _1 _0 1 _0 _0 84 63 76 24 247 59 36 204 Soph. Jrs. Srs. Grad. Total Nsg. Service Leaders Faculty Item 45 SA 0 0 5 2 7 2 1 A 9 15 14 5 43 7 14 U 5 6 3 1 15 8 6 D 58 32 46 11 147 37 14 SD 12 10 _8 _5 35 _5 _1 84 63 76 24 247 59 36 Item 46 SA 15 6 4 5 30 3 4 A 51 44 44 15 154 31 27 U 11 8 15 2 36 14 3 D 5 5 10 2 22 11 2 SD _2 0 3 0 5 0 0 — 1 1 1 ..... — — " ■ ■ ' 84 63 76 24 247 59 36 Item 47 SA 5 2 3 1 11 1 1 A 38 36 24 10 108 23 19 U 20 14 8 6 48 16 4 D 18 11 32 7 68 18 12 SD _3 _0 _9 _0 12 _1 __0 84 63 76 24 247 59 36 Item 48 SA 0 0 0 0 0 2 1 A 37 26 32 10 105 29 13 U 20 13 12 6 51 15 7 D 25 23 30 8 86 12 12 SD _2 _1 _2 _0 5 JL 3 84 63 76 24 247 59 36 Item 49 SA 16 11 6 3 36 5 8 A 57 42 63 20 182 41 26 U 8 3 3 0 14 9 ■ 1 D 3 7 4 1 15 4 1 SD _0 __0 _0 _0 0 _0 _0 84 63 76 24 247 59 36 APPENDIX IV TABULATED SUMMARY OF ALL ITEMS BY VECTOR 205 TABLE 1«~ Summary of valences for vector As achieving competence 'Test item 3 Test item 9 Test item 4 Test item 24 Test item 26 Test item .._32 Test 4 item GROUPS N X a. ■ D b 1 9 0 X a D b u r X 3 D b U c X a D h U r X » D ■ h u r X a D b u c X a D h u c Sophomores 84 2.,4 4- 40? 7 2.5 4- 17.9 2.5 4- 7,3. 2.9 13.1 3.5 -h 26.2 2.7 V- 23,8 2.1 4- 13,1 Junior 63 2.5 4- li.i 2.7 4- 19.0 3.0 4-*- 1121 2.7 +■ 11.1 3.7 - > 11.1 2.7 4* 22.2 2.2 4 12.7 Senior 76 2.8 4 * 2.8 «- U.8 3.0 4-V 1-3 3.2 ■ + 10.5 4.0 - + ■ .2.6 2.7 4- L9.7 2-? i 4* 19.7 Graduate 24 3-5 4- 4.2 2.0 + 9-3 2.8 + 4.2 2.3 +■ 4.2 3.7 + 12.5 2.8 4- 20.8 2.0 4* .8.? All student 247 2.6 4 - -9*9 2.6 4- 15.4 2.8 6.1 2.9 + ■ 10.9 3.7 •¥ 13.8 2.7 4" 21.9 2.3 4- 14.6 Nursing service leaders 59 3.0 27.1 3.0 4-*- 37.3 3.6 - * ■ 10.2 3.5 ■+ 13.6 3.8 17.0 1,7 4* LI.9 2.5 4* 23.7 Faculty 36 2.2 4- CO CO # 2.1 ■4- - 25.0 3.1 -4-+ 5.6 2.1 + ■ 2.8 3.9 2.8 2.4 4 - L6.7 2.0 4~ 1 ’ 1 t ! CO Mean totals -.2,6 11.0 2.?, CM * —s -h S 4-? 2.8 ,9.5 3.8 12.3 2.5 L9.6 2.2 14.3 X - Mean of responses D - Direction of valence b U - Percent of responses in undecided category c 206 TABLE 2, — Summary of valences for vector B : managing emotions ■Test it« 5 m Test item 11 Test item 33 Test item 35 Test item 39 Test item 41 Test item 42 GROUPS N x ' . a . . : . D b ■ y C X n D h U p X a , . D h U r . X a D h U i' X » D u X D b u c . X a D b u r Sophomores 84 2.8 4* 17.9 2.7 25.0 2.2 4- 13.1 3.4 ■+ . 22.6 2.2 11.9 2.5 13.1 2.3 +■ 14.3 Junior 63 2.9 23.8 2.3 +■ 12.7 2.1 4~ 7.9 3.4 12.7 2.2 • * - 15.9 2.8 20.6 2.4 17.5 Senior 76 ‘ 3.2 4-* 13.2 2.7 - t - 18.4 2.2 +■ 5.: 3.4 - * ■ 5.3 2.2 4* 9.2 3.1 15.8 2.5 +■ 25.0 Graduate 24 3.2 4-V 4.2 2.7 - t - 29.2 2.1 4- 4.; 3.5 ■+ 8.3 2.4 4- 12.5 2.7 4* 37.5 2.5 + ■ 33.3 All student 247 3.0 < * - * - 16.6 2.7 20.2 2.2 4 - 8.f 3.4 ■ + 13.4 2.2 4 * 12.1 2.8 4- 18.2 2.4 4 - 20.2 Nursing service leaders 59 2.3 4- 25.4 2.6 < ■ 15.3 1.6 • 4 “ 3.i 2.9 23.7 2.4 4- 32.2 2.6 4 - » 27.1 2.5 4 - 20.3 Faculty 36 3.0 4-4« 30.6 2.9 - * - * ■ 33.3 2.0 4 - 11.1 2.9 27.8 2.1 4- 13.9 2.4 4- 16.7 2.1 4 - 16.7 Mean totals 2.9 18.8 2.7 22.0 2.1 7.( 3.3 16.3 2.2 15.4 2.7 21.3 2.4 21.0 X - Mean of responses a D - Direction of valence b U - Percent of responses in undecided category c 207 TABLE 3*” Summary of valences for vector C : becoming autonomous •Test item 10 Test item 15 Test item 20 Test item 22 Test item 28 Test item 30 Test item 48 GROUPS N X' A<- D b ‘ 9 q X .. a D h u r X q D h u c X f l D h U r X Jl . D ' h U r X { I D b u c X a D h U c Sophomores 84 2.0 4 2.4 2.5 7.1 2.7 4 6.0 3.0 +-* 19.0 2.8 , 4 31.0 3.4 - + - » ■ 29.8 2.9 +-*■ 23.8 Junior 63 2.1 4 7.9 2.9 ++ L2.7 2.5 4 9.5 3.2 + 23.8 2.8 4 14.3 3.3 4 15.9 3.0 «-► 20.6 Senior 76 2.1 4 2.6 3.2 L0.5 2.6 4 .10.5 3.3 4 13.2 2.9 4 4 10.5 3.5 4 11.8 3.0 «-+ - 15.8 Graduate 24 2.1 ■f 8.3 3.0 12.5 2.7 4 25.0 3.1 4 4 25.0 3.4 4 12.5 3.4 4 8.3 2.9 4 4 25.0 All student 247 2.0 4 4.5 2.9 -*-*■ 10.1 2.6 4 10.1 3.2 4 4 19.0 2.9 4 13.0 3.4 4 18.6 3.0 4 4 20.6 Nursing service leaders 59 2.4 + 5.1 2.7 +■ L5.3 3.4 4 15.3 2.4 4 17.0 2.3 4 8.5 2.7 4 27.1 2.7 4 25.4 Faculty 36 2.0 + 2.8 2,7. +■ 30.6 3.4 4 2.8 2.9' 4 4 19.4 2.8; 4 16.7 3.5. 4 22.2 3.1: 4 4 19.4 Mean ■ totals 2.1 4.8 2.8 L4.1 2.8 11.3 3.0 19.5 2.8 15.2 3.3 19.1 2.9 21.5 X - Mean of responses a D - Direction of valence b U - Percent of responses in undecided category c to O oo TABLE 4.— Summary of valences for vector D : establishing Identity 'Test item 12 . Test item 18 Test item 36 Test item 37 Test item 38 Test item 45 Tes^ item GROUPS N X --V D b ’ V c X » D h u f i « * X D h u c X a D h u r X A D 'h u n X a D b p c X a D b U c . Sonhomores 84 2-7 4- 2.7 +-V 9.5 2.4 4- 21.4 2.8 4 - 6,0 3.5 4- n.9 3.9 4- 6.0 1.9 4 - ,?-,5 Junior 63 3.1 4 - 4 - 14.3 2.8 « - * ■ .7.9 2.2 12.7 2.8 4* 3.2 4.1 • + • - 3.2 3.6 4- 9.5 2.1 4 - '4.8 Senior 76 2.9 4- 10.5 3.0 6.6 2.3 + - 17.1 2.7 4- 5.3 4.0 4 1.3 3.5 4 3.9 2.1 4- 3.9 Graduate 24 2.8 4- 8.3 2.9 4- 8.3 2.4 + • 25.0 2.7 4 8.3 3.6 4- 16.7 3.5 4- 4.2 1.9 4- 0.0 All student 247 2.9 4- 13.8 2.8 4- .8.1 2.3 ■ « - 18.2 2.8 4 * 5.3 3.8 4- 6.9 3.6 4 6.1 2.0 4- 5.7 Nursing service leaders 59 2.3 4- 17.0 2.5 4- 22.0 2.6 4* 35.6 3.0 4-4- 22.0 3.6 4- 23.7 3.6 4- L3.6 2.2 4- .15.3 Faculty 36 2.2 4- 11.1 2.(7 4* Ll.l 2.4 4- 25.0 3.5 4- 16.7. 4.0 4- 13.9 3.0 -H 4- 16.7 1.8 4* 2.8 Mean totals - 2.7 13.3 2.8 L0.5 2.4 22.1 2.9 9.5- 3.8 11.0 3.5 8.6. 2.0 .6.0 X - Mean of responses a D - Direction of valence b U - Percent of responses in undecided category c 209 TABLE 6?” Summary of valences for vector F : clarifying purposes ■Test item Test item Test item Test item Test item Test item Test item GROUPS Sophomores ISul Junior X U . Senior 10.5 Graduate 25.0 247 All student 19.4 Nursing service leaders 27.1 2 M UL1 Faculty ZLA Mean totals 1A X “ Mean of responses a D - Direction of valence b U - Percent of responses in undecided category c 210 » TABLE 5."~ Summary of valences for vector Sj freeing Interpersonal relationships • •Test Item 1 . Test item 6 Test item L7 Test item .9 Test item 23 Test item 25 Test item • 29 GROUPS N X a. ■ _ D b ' V c X a D h U < * X - E l D h U c X . a D h u r X fl D h U n X f t D b u c X a D b U r Sophomores 84 2*5 4* 1 9 , * 2 2.5 4 * 23.8 3.1 22.6 2.3 32.1 2.7 4- 10.7 2.2 ‘ 4* 11.9 2.5 4- 21.4 Junior 63 2.8 4 * 4.8 2.6 4- 25.4 3.3 17.5 2,5 • * - 28.6 3.0 4-4 7.9 2.3 4- 14.3 2.8 4— 4 23.8 Senior 76 3.3 -4 10.5 2.7 4 * 18.4 3.5 «-+• 22.4 2.6 18.4 2.9 4 -4 9.2 2.4 4- 15.8 2.9 4-4 25.0 Graduate 24 2.4 4 * 16.7 2.4 4* 16.7 3.3 37.5 2.3 b 45.8 2.6 4 * 4.2 2.2 4- 20.8 2.9 4—4 33.3 All student 247 2.8 ■ + ’ . 9.7 2.6 4- 21.9 3.3 - * ■ 22.7 2.5 b 28.3 2.8 4~ 8.9 2.3 4- 14.6 2.7 4* 24.3 Nursing service leaders 59 2.3 4* 13.6 2.7 4* 30.5 2.5 «- 32.2 2.0 b 8.5 2.7 4- 17.0 2.4 4 27.1 2.4 4- 20.3 Faculty 36 2.5 4* 16.7 2.7 4- 41.7 3,1 - * ■ 36.1 2.5 b 13.9 2.8 n- 16.7 2.3 4- 0 . 0 2.8 4r 19.4 Kean totals 2.7 1 1 . 8 2.6 25.5 3.2 27.3 2.4 25.0 2.8 10.7 2.3 14.9 2.3 23.4 X - Kean of responses i t D - Direction of valence b U - Percent of responses In undecided category c 211 TABLE 7.— Summary of valences for vector G: developing Integrity ■Test item lest item Test item Test item Test item Test item Test item GROUPS Sophomores Junior J 1 2 J L Senior - * ■ Graduate All student 1 L £ XLJ. Nursing service leaders 2JL Faculty Mean totals LSL X - Mean of responses a D - Direction of valence • b * U - Percent of responses in undecided category c 212

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Administrative Considerations In The Utilization Of Paraprofessionals In The Teaching-Learning Process

PDF

Selection Procedures And Criteria Of Admissibility For The Associate Degree Nursing Programs In The California Community Colleges

PDF

An Analysis Of The Freshman Biological Curriculum In The State Colleges Of California

PDF

The Design And Utilization Of Nonprofit Foundations Affiliated With California Public Community Colleges

PDF

Critical Teaching Behaviors Effecting Attitude Development In Physical Education

PDF

The Relationship Between Student Characteristics And Work Rate And Between Work Rate And Performance In Programmed Instruction With Two Different Subject Matter Fields

PDF

A Comparison Of Graduates Of Work-Study And Traditional Programs Designedfor Those Formerly Labeled Educable Mentally Retarded (Emr)

PDF

The External Degree: Nontraditional Implications For The California State University And Colleges

PDF

An Analysis Of Critical Issues In Higher Education In Denmark

PDF

Awareness And Knowledge Of California State University And College Personnel In Relation To Planning, Programming, Budgeting Systems

PDF

Are Community College Students With Majors Congruent With The Holland Vocational Inventory Typologies More Persistent In Their Pursuit Of Educational Goals?

PDF

Meaning In A Dance Form

PDF

The Development Of Higher Education In An Emergent Country: Malawi, Africa, 1960-1967

PDF

The Community College Concept And The Developing World: A Planning Strategy With A Focus On Asia

PDF

An Analysis Of Characteristics Of Community College Student Volunteers Insocial Services

PDF

Guidelines For Student Personnel Services In Vietnamese Higher Education

PDF

Perceptions Of Effectiveness Of Administration Based On Faculty Participation In The Decision Making Process Of Junior Colleges

PDF

Pupil Yield--The Relationships Between Selected Housing Unit And Housing Occupant Factors And The Number Of School Age Children

PDF

An Experimental Analysis Of The Relationship Between The Reliability Of Amultiple-Choice Examination And Various Test-Scoring Procedures

PDF

An Investigation Of Graduate Student Perceptions Of Campus Environment

Asset Metadata

Creator Christian, Marilyn Jean (author)

Core Title Higher Education And Nursing Perceptions Affecting Student Learning And Development In The Clinical Environment

Degree Doctor of Philosophy

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag education, administration,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Wilbur, Leslie (committee chair), Ferris, Robert E. (committee member), Richards, Leo (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-720571

Unique identifier UC11356465

Identifier 7426018.pdf (filename),usctheses-c18-720571 (legacy record id)

Legacy Identifier 7426018.pdf

Dmrecord 720571

Document Type Dissertation

Rights Christian, Marilyn Jean

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA