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Nursing and gerontology: A study of professionalism

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Nursing and gerontology: A study of professionalism

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Content NURSING AND GERONTOLOGY:
A STUDY OF PROFESSIONALISM
by
Dagney May Cooke
A Thesis Presented to the
FACULTY OF THE LEONARD DAVIS SCHOOL OF GERONTOLOGY
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE IN GERONTOLOGY
September 1977
UMI Number: EP58854
All rights reserved
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Disssrtation Ajcntsmng
UMI EP58854
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
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789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, Ml 48106- 1346
UNIVERSITY OF SOUTHERN CALIFORNIA
LEONARD DAVIS SCHOOL OF GERONTOLOGY
UNIVERSITY PARK
LOS ANGELES, CALIFORNIA 90007
C 7 7 Z
TfvU w/vùùtm by
Dagney May Cooke
undeA tk(L duizcM on o i h e r CommJJXzz,
and appAovzd by aJUi rmmbeAS, ho6 bzzn pAz-
^ZYitzd to and acazptzd by th z Vzan Tho, Lzana/id
VaoÂJi Sckoot 0 ^ GoJiontoZogy, tn poAttaZ {^uZitttmznt
o i th z AtqLiOiQ,m2.nt6, ioA th z. degA.ee
MASTER OF SCIENCE IN GERONTOLOGY
Vote, 2-5:/f7 7
THESIS COMMITTEE
ChaZnman
ACKNOWLEDGMENTS
The guidance, criticism and support of my chairman^ ;
Professor William C, Albert, and my committee member, \
Professor Robert Wiswell, are gratefully acknowledged. In
addition, appreciation is due Dan Tiberi for his special |
assistance during the course of this study, |
I am indebted to the respondents from the nursing 1
I
schools for their cooperation and assistance throughout !
the data gathering phase of the study.
I would also like to express my thanks to the National^
Retired Teachers Association and the American Association '
of Retired Persons for the funding of this project.
Finally, I would like to thank my husband for his
encouragement and steadfast faith in my endeavors.
11
TABLE OF CONTENTS
ACKNOWLEDGMENTS ..................................... ii
LIST OF T A B L E S ........... v
CHAPTER
I STATEMENT OF THE PROBLEM....................1
Introduction ........... 1
Background ............................ 2
Purpose of the S t u d y ...................3
Research Problem . 4
II PROFESSIONALISM .......................... 7
Introduction .......................... 7
Defining Profession ......... 8
Criteria of a Profession............. 13
Process of Professionalization . . . 30
Conclusion....................... .. . 37
III THE PROFESSIONAL STATUS OF NURSING:
A REVIEW OF RELATED LITERATURE ......... 40
Introduction . 40
Status of Nursing.......................40
Comparison of Nursing to Criteria . .47
Summary and Conclusions.... ........... 76
IV NURSING AND GERONTOLOGY.................. 79
Introduction........... 79
Trends and Interest in Geron
tological N u r s i n g ..................79
Need for Gerontological Nursing . . . 96
Summary and Conclusions 9 8
V THE PROFESSIONAL STATUS OF GERONTOLOGY 100
Introduction . ..................... 100
Trends of Gerontology .............. 101
Documentation of Needs 10 4
Professional Criteria .............. 109
Conclusion....................... . 126
1 1 1 I
t
I
CHAPTER
I
VI METHODOLOGY............... , . , , , , 129
Introduction 129
Procedures 130
Selection of Colleges and
Universities for Study , , , , 136
Description of Survey
Questionnaires , . 137
Treatment of the Data . . . . , ,141
VII RESULTS
Introduction
Discussion ,
Licensure
Summary . .
142 I
142 I
171
189 I
195 !
VIII CONCLUSIONS AND RECOMMENDATIONS , , ,197
Introduction 197
Conclusions 198
Recommendations ,,,,,,,,, 202
BIBLIOGRAPHY ....................... 206
APPENDICES
A Outline of Areas to be Covered , , , 217
B Sample of Nursing Schools . , . . , 219
C Information Collection Form « * . , 222
D Interview Data Collection Form , , ,2 27
E Data From Test-Retest for
Reliability - Question #5 . , , , , 232
F Data From Test-Retest for
Reliability - Question #6 . , , , , 234
G Data From Test-Retest for
Reliability t - . Question #12 , . . . ,2 36
LIST OF TABLES
TABLE Page
1 Description of Institutions ............ 143
2 Percentage of Course Categories and
Percentage of Gerontological Content
in C o u r s e s............. ............ . 147
3 Percentage of Gerontological Agencies
Utilized by Nursing Schools........... . 151
4 Percentage of Continuing Education |
Course Categories . . . 153 j
I
5 Percentage of Respondents Responses to |
Importance of Gerontological Courses I
to Curriculum and Gerontological Issues '
to Professional Issues 154 ;
6 Percentage of Journals in Libraries . . 157
7 Percentage of Topical Area Category of I
Courses to be Implemented............16 0 I
8 Percentage of Faculty with Geron- '
tological Training ..................... 161
9 Percentage of Faculty with Geron
tological Training Compared to Mean I
number of Gerontological Courses . . . 165
10 Gerontological Association Membership
Compared to Mean Number of Geron
tological Courses .................166
11 Importance Gerontological Courses/
Curriculum, Issues/Profession Compared
to Mean Number of Gerontological Courses 167
12 Chi-Square Values Between Variables . . 16 8
13 Number of Gerontological Courses
Compared to Number Dissertations/ !
Theses................................... 169
V
CHAPTER I
STATEMENT OF THE PROBLEM
' Introduction
This report is based on an exploratory study of educa^
' tional statuses and trends in eight disciplines. Adult
Education, Counselor Education, Dentistry, Law, Medicine,
Nursing, Public Administration, and Social Work in their
relation to gerontology. Course curricula, attitudes to
ward the relevance of gerontology for each discipline and
I prospects for the future development of courses in aging
within each discipline were examined. Licensing and/or
credentialing procedures for the disciplines with such
procedures were also explored, A better understanding of
how gerontological content is integrated into educational
curricula, and how and if licensing bodies are testing for
this knowledge, are two goals of this exploration.
The project was conducted by faculty and staff from
the Leonard Davis School of Gerontology and the Andrus
Gerontology Center and 11 Leonard Davis School students.
i Eleven students participated in this project to meet the
requirements for a master's thesis, one student used the
I project for graduate research credit, and one student used
; the project for undergraduate research credit. An outcome
of this project will be a report detailing the individual
I
disciplines, synthesizing the overall findings and making
inferences about the preparation in professional and tech
nical schools studied and possible unmet needs in the area
I of aging.
I
Each discipline was investigated by one or more of
the 11 students. Nursing, one of the eight areas within
the project, was selected for research by the author of
this report. As the growing population of older people are
requiring increased health services, there will be an in
creased demand for nursing care services. It is important,
therefore, to explore the trends and interest in geron
tological nursing, and the educational preparation received
: by nurses in this field.
Background
The culmination of this project was initiated by the
concern of the students in the Leonard Davis School of
Gerontology regarding the future development of the field
of gerontology and its professional status. These students,
in the first class at the School in September of 1975, were
interested in such questions as: How would their training
I be accepted by other professionals and would they be con- |
sidered professionals? i
Responding to this concern, the faculty and admini- ;
i stration of the Leonard Davis School identified several !
I :
I disciplines which were linked to gerontological issues and ;
had potential for or were actually serving the elderly,
j They submitted a research proposal entitled, "Analysis of
; Professional Education in the State of California for Ser
vices to the Retired and Aged," to explore relationships
' between these disciplines and gerontology. The National
; Retired Teachers Association/American Association of Re
tired Persons funded the grant. The students selected the
discipline which interested them and began research in that
discipline. The criteria employed to choose the eight dis-
^ciplines were: (1) the discipline related to gerontology
; and actively or potentially served older persons; (2) stu-
I dents participating in the study were interested in examin-
'ing the discipline.
Purpose of the Study
The immediate goals of the study were to determine ex
isting course offerings (both courses in aging and courses
with aging content), field experience and student research
; that included gerontological content. Other variables
! taken into account were: The attitudes of faculty and
staff within these disciplines toward the inclusion of
j aging content in their curricula; the quantity and extent
I to which the licensing and/or credentialing boards screen
' their candidates for expertise in aging. This project is
i the initial step in a long range goal to improve the qual-
i
j ity of services offered to the retired and aged by upgrad-
I
I ing professional and technical education, relevant licens
ing procedures, and the accountability of educators in the
I
j fields of Adult Education, Counselor Education, Dentistry,
I Law, Medicine, Nursing, Public Administration, and Social
I
I Work.
i I
Research Problem |
The researchers identified several variables to be in-;
i
vestigated, devised instruments to quantify each variable, ;
i
, and made assumptions on the relationships between these
I
I
variables. Some of the variables taken into consideration '
, I
, were; (1) the number of students in the departments/divi- :
Isions/schools ; (2) the numbers and types of degrees within
^each department/division/school; (3) the number of faculty j
in the department/division/school; (4) the number of doc-
^ torates held by faculty teaching courses with gerontologi- '
cal content; (5) the number of faculty belonging to the Ger-
'ontological Society and the Western Gerontological Society;
j (6) attitudes of faculty and administration responding to- ^
, i
ward the importance of gerontology; and, (7) the number
of journals related to gerontology which are subscribed to
'by each department or school's library.
I Two separate questionnaires were devised to collect
I
I the data on these variables. One was constructed for the
I
i researchers to record pertinent information by examining
each school's catalogue and bulletins. The second ques
tionnaire was developed to record information which was not
available in the catalogue or needed clarification. This
instrument was sent to the educational institution and
followed up with a phone or person-to-person interview with
the dean/chairperson or his/her representative.
The researchers realized that in an exploratory study
of this nature, cause and effect relationships could not
always be established. But some associations between vari
ables could be analyzed after the data was collected.
One assumption investigated was the percentage of
faculty having specialized gerontological training, and
whether this training was reflected in the institution's
course offerings. It may be assumed that a higher percent
age of faculty having specialized training would indicate a
higher number of courses with aging content being offered.
Comparison of faculty holding membership in the Gerontol
ogical Societies was also made to the number of courses
offered.
Another consideration examined was the respondents'
attitudes toward the importance of gerontological curricula
5i
! and issues, and whether the more importance attached would
I '
' show a higher number of courses with gerontological con- |
tent. The number of gerontological courses offered by in- .
' stitutions were correlated to the number of disserations
and theses written in the area of aging. It can be assumed I
' I
that the more courses offered, the more research in the
I area of aging would be undertaken.
1
; Courses containing gerontological content were ex-
I
, amined to determine the actual percentage of content within '
,those courses. In the same manner, field work agencies !
! utilized for experience to work with the older adults, werei
’investigated as to the type of agency and the percentage of ;
utilization by the institutions. Correlations were made
between titles or topics of age related courses in basic |
education, continuing education, and projected course j
offerings.
CHAPTER II
PROFESSIONALISM
1 Introduction
i Examining the concept of professionalism is difficult
because the term is used to define a variety of traits,
characteristics, and ideals of occupational status. Re
viewing the sociological literature on professionalism re
veals the amorphous, and oftentimes ambiguous explanations
which have developed in attempts to delineate the limits of
professional standing. It is the intent of this paper to
canvas the extant literature on professionalism and formu
late a reasonable clarification of the major constituents
of professional standing, as well as the processes that can
transform an occupation into a profession. Three specific
questions are answered in attempting to provide a succinct
picture of the nature of professionalism,
1. What is a valid definition of a profession?
2. What are the requisite criteria needed for
achieving professional status?
I 3. What are the processes intrinsic to
I the development of a profession?
I
Defining Profession
I
I The problem of developing a specific definition of
I profession is complex because of the term's generalized
! utilization. Barber (1965) states that there is no abso
lute difference between professional and other types of
I occupational behavior, but only relative differences with
i
' respect to certain attributes common to all occupational
behavior. There are different degrees of professionalism
I
and not all professions display the same characteristics. |
In fact, some business organizations may encompass criteria
I
of professionalism without ever achieving professional !
status. Therefore, while precise verbal definition about !
I !
the term profession persists, we should think of occupa
tions as falling somewhere along a continuum of profes-
I
sionalism, the continuum being made up of common défini- i
tional traits (Goode, 1960a). j
A profession is usually defined as an occupation which
requires training in the liberal arts or the sciences and i
graduate study in a particular field. Manual labor is not
' considered to be one of the areas of professionalism. At
, the professional level of employment, individuals often are,
assigned a large amount of responsibility based solely on
their past experiences within the setting and direct client
! contact is most extensive. Professional status is not
i
! gained by claiming it, but must be created as a result of
behavior. A professional works in an occupation that
I primarily serves people by contributing to and enhancing
i their potentials as humans. Profit motives are secondary
to the concern for people (Stone & Shertzer, 1969).
! Cogan (195 5) states that there is an almost insur-
i mountable controversy in trying to define profession. He
I !
examines the development of a definition of professions at ,
I
three different levels: (1) historical and lexicological, !
I (2) persuasive, and (3) operational. In the historical j
I
■ and lexicological interpretation, a profession is a voca
tion whose practice is founded upon the understanding of
I
a theoretical structure of some department of learning or |
j
I science, and upon the abilities accompanying such an under
standing. This understanding and these abilities are
I
applied to the vital practical affairs of man. The prac- ;
tices of the profession are modified by knowledge of a |
I
generalized nature and by the accumulated wisdom and ex- î
t
perience of mankind, which serve to correct the errors of
specialism. The profession, serving the vital needs of
man, considers its first ethical imperative to be altruis
tic service to the client (Cogan, 1953) . The persuasive
j I
definition of profession has justified the existence of ;
professional occupations in society. These justifications
: keep the profession desirable by directing societal atti- j
I tudes to the value of the services the profession offers. |
! ■
j Operational definitions are designed to furnish the basis
! upon which individuals and associations may make specific !
S
; decisions as to the behavioral concommitants of a profes-
I
sion. They are guidelines for the practitioner in his day^j
I to-day work, and are the rules for professional conduct. !
I They mediate the practitioner's relation to the client, to !
I I
his colleagues, to the public, and to the professional |
' association. They set forth the specific criteria of
, general and specific education for the professional, the
: requirements for admission to practice, and the standards
for competent service. Cogan summarizes his discussion of
the definitional aspect of profession by stating that the
! promulgation of a satisfactory definition has progressed
: little beyond the six elements proposed by Abraham Flexner
(1915): (1) intellectual operations coupled with Targe
individual responsibility; (2) raw materials drawn from
science and learning; (_3) practical application; (4) educa
tionally communicable techniques; (5) a tendency towards
self-orientation; and, (6) an increasing altruistic moti-
I
i vation.
Cogan (19 53) also states that an important, though
implicit, criterion of professions is revealed through the
study of dictionary definitions. The first point to be
10
I noted is that the professions are described as dealing with |
* the practical affairs of men. Also, the profession is
'traditionally applied specifically to the three learned i
I !
! professions of divinity, law, and medicine. Cogan con- }
'eludes from an analysis of dictionary definitions that it j
I
may be observed that the traditional professions mediate ;
I '
jman's relation to God, man's relation to man and state, |
■ . I
: and man's relation to his biological environment. Smith j
(1958) discusses the diversity of professions and infers |
I
that they are complex social institutions which select I
' _ I
people of varied skills, often from several social strata,
'and organize them into different levels of operation and
diverse interest groups. j
Some authors have tried to define profession in a con- ’
i
' cise and explicit manner. Greenwood (1957) adapts Hall's j
I
'(1949) definition and sees a profession as an organized |
I group which is constantly interacting with the society that j
forms its matrix, which performs its social functions |
I
through a network of formal and informal relationships, and'
which creates its own subculture requiring adjustments to
it as a prerequisite for career success. Any occupation
wishing to exercise professional authority must find a
technical basis for it, assert an exclusive jurisdiction, '
I
i and convince the public that its services are uniquely
trustworthy, and while there is a general tendency for
11.
I occupations to seek professional status, remarkably few of
! the thousands of occupations in modern society attain it
(Wilensky, 1964). Hughes (1963) states that a profession
I
I delivers esoteric services — advice or action — to indi-
I
' vidual organizations, or government; to whole classes of
people ; or to the public at large. The action may be
; manual, but the service still includes advice. The person
1 for or upon whom the esoteric service is performed, or the
I
‘ one who is thought to have the right or duty to act for
' him/her, is advised that the professional's action is
, necessary. Professionalism might be defined as a process
by which an organized occupation, usually, but not always,
by virtue of making a claim to a specific estoteric compe
tence and a concern for the quality of its work, controls
' training for and access to it, and controls the rights of
■ determining and evaluating the way the work is performed
(Vollmer & Mills, 1966).
It is clear that the concept of professionalism does
not lend itself to precise definition; however, certain |
occupational attributes are generally characteristic of ^
professional status. The next section will examine in
I I
( detail those criteria, revealed in a review of sociological
literature, which have been consistently ascribed to the '
I
established professions. !
12
I Criteria of a Profession i
I ,
Defining specific criteria of professional status is !
also a precarious task. Different authors list varying
i ;
'numbers of attributes which they consider essential to the i
establishment of a profession, but it is evident that some
long standing professions do not comply with all of these |
: I
I requisites. Also, many occupations do possess some elements
I ■ i
I of professionalism without having professional status. This
1 section will closely examine seven attributes which most
I authors generally regard as constituents of professional
status. These criteria are as follows : body of knowledge; |
' • I
university education; professional ideology; professional !
associations; codes of ethics; self-regulation ; and, public
sanction. !
I Body of Knowledge i
!
! All mature professions rest on a common body of know
ledge that can be utilized flexibly by practitioners in
various types of interventive activities (National Associa- '
tion of Social Workers, 1964). Others supporting the need
for a body of knowledge are Engel (1970); Halmos (19 70);
Schott (1976); Lewis and Maude (1952); Wickenden (1950);
Boehm (1959); Turner and Hodge (1970); Harries-Jenkins
(19 70); Schein (1972); Pavalko (1971); Bearing (1972); and, ,
1 !
'Stone and Shertzer (19 69). The nature of this knowledge,
whether substantive or theoretical, on which advice and
13
I action are based is not always clear; it is often cl mixture
; of several kinds of practical and theoretical knowledge.
But, it is part of a professional complex, and the profes-
!sional claim, that the practice should rest upon some
branches of knowledge to which the professionals are privy
by virtue of long study and initiation and apprenticeship
■under masters already members of the profession (Hughes,
I1963). Greenwood (1957) states that the characteristic
skills of a profession are derived from a source of know
ledge which has been systematically organized into a body
of theory. This body is made up of abstract propositions
which describe in general terms the focus of the profes
sion's interest. Preparing for professional status is, j
therefore, an intellectual, as well as a practical experi
ence .
Wilensky (196 4) refers to a technical base on which I
professional knowledge is supported. He differentiates '
I
"technical" from "scientific" in that both scientific and |
non-scientific systems of thought can serve as a technical '
base for professionalism, but the success of the claim is j
greatest where the society evidences strong, widespread
consensus regarding the knowledge or doctrine to be applied,
Goode (1961) reports that a prolonged specialized
training in a body of knowledge is paramount to the success-:
ful development of a profession. The principles of this
14 I
I knowledge must be applicable to concrete problems. Pro-
i
fessionals must not only use, but help create this know- ;
' ledge; the profession itself must be the final arbiter as |
I
' to what is valid knowledge. Therefore, the profession i
I
I controls access to knowledge and hence, access to the pro-:
fession. Society should believe that the knowledge can
{ actually solve existing problems and should also accept as
, proper that these problems be given over to some occupa- !
tional group for effective solution (Goode, 1960b). |
i
University Education '
Education clearly emerges as an important factor in
determining whether or not a discipline is a profession |
(Lewis & Maude, 1952; Wickenden, 19 50; Harries-Jenkins,
19 70; Stone & Shertzer, 1969). The problem is that every-|
i one has a different idea as to how much education really ;
is necessary. Moore (19 70) regards it as extremely im- |
I
probable that technically trained individuals with less
: than a bachelor of arts or science degree could manage to
attain the relatively higher positions on any scale of pro
fessionalism. Goode's (1957) criterion of lengthy training
in a body of specialized abstract knowledge infers formal
education at the graduate level. The training involves in-
I quiry into an abstract body of knowledge, not the acquisi- ^
tion of technical skills. Jackson (1970) believes the ex
istence of professionalism itself depends on the notion of
15
I the university as the institution of the in te1le c tu à1. j
; Furthermore, he sees the rise of the professions as posi- |
! i
; tively correlated with the rise of the universities. |
} Traditionally, professions have been affiliated with |
I I
I organized educational institutions, and this has developed |
I
into the concept of professional schools within the uni- I
I
versity. Barber (1965) cites four major roles of the uni- i
I I
I versity professional school. They are as follows; |
I
I 1. Transmission to its students of the generalized
and systematic knowledge that is the basis for
professional performance; |
2. Creation of new and better knowledge on which
professional practice can be based;
3. Ethical training of students, explicit (codes)
and implicit (behavioral aspects);
4. Improvement of existing codes.
Barber concludes that the better the university profes
sional school, the more likely it is to use resources from
the other professional schools in the university and from
all the other departments of basic knowledge insofar as
they are relevant. The university professional schools are
the leading, though not the sole, innovators and systema-
tizers of ideas for their professions. The emerging or
marginal professions seek to locate in universities,
Harries-Jenkins (1970) infers that professional educa-
16 :
I tion is dependent upon training and knowledge required out-,
side the employment setting while generalists receive their
i occupational preparation from within the employing organi- j
!
j zation. Carr-Saunders and Wilson (196 4) state that a |
sound general education in theoretical and practical know
ledge and then specialized education in the specific dis-
i cipiine, as in the professions, increases efficiency.
I Professional Ideology |
Every profession has a professional ideology, which is
; !
' the basis for offering the best possible service in the ;
I
' public interest (Ritzer, 1973; Boehm, 1959; Harries-
: Jenkins, 19 70; Pavalko, 19 71; Bearing, 19 72; Stone & I
i
Shertzer, 1969). Elliot (1972) states that a professional |
ideal has three important aspects: ^
^ 1. The notion of service; '
i
2. An emphasis on professional '
judgment based upon pro- i
fessional knowledge; j
3. Belief in professional free
dom and autonomy in the work i
situation. (p. 23) ;
The service ideal may be defined as the norm that the '
; technical solutions which the professional arrives at
1
should be based on the client's needs, not necessarily the
!
I best material interest or needs of the professional himself
i
■ or those of society. Further specifications of the service
ideal is inherent in its four subdimensions:
17 !
I 1. The practitioner decides upon the
client's needs, and the occupation
: will be classified as less pro-
' fessional if the client imposes
his own judgment.
2. The society actually believes
that the profession not only
accepts these ideals, but also
follows them to some extent.
3. The profession demands real sacri-
\ fice from its practitioners as an
' ideal, and occasionally, in fact.
4. The professional community sets
up a system of rewards such that
"virtue pays off. "(Goode, 1960b,
p. 23)
!
i Wilensky (19 64) reports that the success of the claim to
‘ professional status is governed also by the degree to which
the practitioners conform to a set of moral norms that
characterize the established professions. These norms
I
' dictate not only that the practitioner do technically,
. high-quality work, but that he adhere to a service ideal-
devotion to the client's interest more than personal or
commercial profit should guide decisions when the two are
in conflict. In short, a major determinant of professional
status is the degree of adherence to the service ideal and
its supportive norms of professional conduct.
Beatman (19 56) feels that basic to professional
; maturity are the knowledge essential to practice and the
' appropriate use of that knowledge. He goes on to say that.
1 8
I the hope of every profession is to
have its practitioners embody the best
of its knowledge, experience, skill, and
ethics; that they will practice with
dignity, confidence and success; and
j that the nature and contribution of the
: practitioner that its perpetuation and
I continuing progress are assured, (p. 383)
The nature of professional practice is such that the
' practitioner must make many unique and special decisions on:
; the singularity of any particular client-practitioner
; transaction (Ritzer, 1973). Quality of service rendered
! is of deepest concern to the client. He places his health
and his fortune in the hands of his professional advisor, j
and he entrusts him with confidences of an intimate and !
personal kind. He is interested in the moral quality of |
service (Carr-Saunders & Wilson, 1964). Therefore, this '
. problem is particularly complicated by the fact that the ,
professional service is said to require not only special
I
! skills from the practitioner, but also a particular kind i
of relationship between the professional and the client i
(Ritzer, 1973). Lewis and Maude (1952) state that the re
lationship of the client and the practitioner is the basis
of professional morality. This relationship is between
; individuals and it is fiduciary. The practitioner gives
i
the best possible advice, which the client is not competent
to criticize, and the practitioner acts according to his ,
client's needs. Schein (1972) stresses this point even
1 9
further saying the very essence of professionalism is the ;
I
delivery of a service in response to the need of a client.
There must also be a clear identification as to exactly !
i
whose needs are being met. Moore (19 70) maintains that an ■
important professional qualification is commitment to a |
particular calling. It is this commitment that lends j
! credence and stability to the profession's code of ethics. |
I
1 The profession and all its requirements are treated as a !
lasting set of norms and behavioral expectations. The j
' professional accepts these standards, identifies with his |
’ colleagues and sees the profession as a whole entity.
These standards should come across in the professional's
dealings with his clients. I
! Professional Associations ^
Professional associations are necessary for the de-
i velopment and continued growth of a profession (Goode,
1960; Wickenden, 1950; Boehm, 1959 ; Harries-Jenkins, 1970; i
Schein, 1972; Stone & Shertzer, 1969). The professional '
organization provides a framework and sanctions for this
complex of obligation and responsibility delegated to the '
established profession. In essence, it is disciplinary in
all its functions, especially the educational. It is con-
[ cerned with keeping its members accountable to the implied ,
‘ contract with society. The organization also insures the
provision of the best possible advice and service within
20
j existing knowledge, while protecting the public from the
I unqualified practitioner. The professional orgAniza,tion
' is the profession's ultimate measure of professional in-
I
; dependence. It is the association that defines the educa
tional requirements, entry standards, and code of ethics
I of the profession (Lewis & Maude, 1952) , Greenwood (1957)
I
! proposes that professional associations exert control oyer
I the profession's training centers and granting or denying !
I accreditation by one of the associations within a profes- j
,sion is the prime way the caliber of curriculum and in- |
struction and the location of professional schools is regu-j
lated. :
I
Carr-Saunders and Wilson (1964) propose that generally !
i
speaking, each profession is organized on a craft basis, :
I and though within a profession it is usual to find a number|
: of independent associations, relations between them are j
,generally friendly and there is a clear tendency towards a ^
' j
dominating association or a closely cooperating group. j
Part of the constitution of a profession is the spontaneous !
I
'coming together of the practitioners in associations. The ,
reasons for associations are protection and the desire to
I hallmark the competent and to foster the study of the tech
nique and give this technique such an importance that
! boundaries are clearly defined and stable.
Ritzer (1973) lists three characteristics of profes-
21
I sions which are basic to the justification for professional
I control over members. They are as follows:
I 1. Assumed power of ethical codes.
I 2. The consequences of control over
' recruitment and certification.
3. The professional review boards and
I their assumed control over practitioners,
I Code of Ethics
I-----------------
: Professional ethics arise from the codes of the most
: ancient professions: the Hippocratic oath; the inviolabil
ity of the confessional; and the devotion of the lawyer to
his client's interest (Lewis & Maude, 19 52) . The codes of
ethics of specific disciplines are an integral component in
.the establishment of a profession (Goode, 1960a; Harries-
'Jenkins, 1970 ; Schein, 1972 ; Pavalko, 1971; Bearing, 19 72 ;
ÎStone & Shertzer, 1969). Ethical conduct, proposed or
values in the codes of ethics of the human services, per
tain to four major aspects- of professional relationships
(Levy, 19 74):
1. The practitioner, where codes insure
competence, integrity, independence,
impartiality and propriety.
2. The client, involving values of devotion,
loyalty, objectivity, honesty, candor,
confidentiality, autonomy, respect.
.22
punctuality, exeditiousness, and
; personal attention.
I
; 3. The professional colleagues, re-
j garding etiquette, fairness, and
I professional orientation.
4. The society, insuring care in the
use of personal status, care of
I one's personal associations, regard
i
for others, justice, obligation to
be concerned about social problems,
and social orientation.
; Codes of ethics are at once the highest and the lowest
istandards of practice expected of the practitioner; the
, awesome statement of rigid requirements ; and the promo
tional material issued primarily for public relations pur
poses. They embody the gradually evolved essence of moral
expectations, as well as the arbitrarily prepared shortcut
•to professional prestige and status. At the same time,
! they are handy guidelines for the legal enforcement of
ethical conduct (Levy, 1974).
Greenwood (1957) states that the profession's ethical
code is part formal and part informal. The formal is the
.written code to which the professional usually swears
i
'when being admitted to practice. The informal is the un
written code, which nonetheless carries the weight of
23
' formal prescriptions. As a written document, the code of |
' ethics serves as a guideline of expected levels of service,I
; ;
j Not only does it describe expected levels of quality and •
1 competency, it also may remind members to refrain from
' 1
! commercialism (direct competition with colleagues), as well|
; as state the professional's responsibility to the interests|
: of society (Marshall, 19 39). Contained within the code is |
; a strong altruistic commitment to the betterment of the i
larger society through the use of the professional's |
I
specialized abilities (Cogan, 1953), i
i
SeIf-régulâtion
Self-regulation refers to the monitoring of profes- |
sional behavior by colleagues. In other words, the peer
group holds its members accountable and will invoke dis- ;
I
ciplinary action when deviation from acceptable standards i
I has occurred (Posz, 1973), This type of monitoring system '
is distinguished from one in which the principle monitoring !
.tasks fall on a hierarchial organization, the consumer of '
I I
the service, or an external governmental regulatory agency, ,
'Under true professionalism, monitoring and corrective action
is performed by the peer group. In theory, the professional
group itself is held accountable for the actions of its
members (Wichenden, 19 50; Lewis & Maude, 1952; Harries- .
^ Jenkins, 1970 ; Schein, 1972 ; Pavalko, 1971; Bearing, 1972;
Stone & Shertzer, 19 69), One aspect of self-regulation is
24 !
' the level of autonomy attained by the profession, ;
I Ritzer (1973) states that the professional organfza- |
' tion rather than the society or the client defines the |
I nature of the expected service and the manner of its trans-j
mittal because the profession claims to be the only legiti-^
mate arbiter of improper performance. In practice, auton- j
I omy exists when the leaders of a profession define or |
i
I regulate the nature of the service offered in two ways : !
; ’ 1
(1) control over recruitment and certification of members ; !
: I
and, (2) setting standards of adequate practice (Ritzer#
i 1973). In discussing the idea of recruiting, Caplow (1954)!
states that in the independent professions the entire re- |
cruiting process, from the initial choice of candidates for|
training to the bestowal of honors at retirement, is under |
the close control of the professional group. Although the |
i
' right to practice is generally conferred by a governmental |
board, this agency normally represents the profession and |
has usually been kept free from political interference,
Goode (19 50b) states that professional autonomy means
having one's behavior judged by colleague peers, not out
siders. He adds that this is a derivative trait and is
based on both the mastery of a field of knowledge and com
mitment to the service ideal. This mastery of the profes
sional person, because of his specialized training and the
complicated nature of the problems being dealt with, has
25
the authority to dictate what a client should do. The
rationale behind this authority is that the client lacks
the needed theoretical background to diagnose his need or
I prescribe any of the possible cures. This authority does
^ not carry over to any other professions. One only has
authority when one has knowledge of a certain specific
area(Greenwood, 1957).
An effective method of self-regulation is through.the
; creation of what Goode (.1961) calls the community profes-
i sional. Although the profession cannot produce the next
I
j generation biologically, it can do so socially, A profes
sion should and can control the selective process of its
professional trainees. After these trainees are selected
they are sent through the profession's adult socialization
process. The profession is determining who will be market
ing the services of the profession and, to an extent, the
way in which those services are marketed. The profession
can better preserve its standards in this way.
Public Sanctioning and Licensing
Greenwood (1957) discusses the importance of commun
ity sanction in the achievement of professional status.
Other authors recognized this contention (Goode, 1960a;
Engel, 1970 ; Schott, 1976 ; Lewis & Maude, 1952;
Winchenden, 1950 ; Turner & Hodges, 1970 ; Schein, 1972 ;
Bearing, 1972; Stone & Shertzer, 1969). Public sanction
26
I- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
refers to the community's formal and informal acceptance
of a discipline's ability to best deliver necessary ser
vices in its area of expertise. A profession may gain
sanction from the community by formal or informal means.
Formal approval constitutes reinforcement of professional
standards by police power. By formally sanctioning a pro
fession, the community gives a profession a monopoly on
performing a certain service. The profession employs its
association to convince the community that it will greatly
benefit from the monopoly. Professions must be convincing
on three factors :
1. Specialized education is necessary to
perform the specific skill.
2. Those who have completed this education
have capability to deliver service
superior to those who have not.
3. The target population of service is of
sufficient significance in the community
to warrant the superior performance.
Greenwood notes that formal aspects of
public sanctions take the form of approv
ing of professional-client confidentiality
and acceptance of a system of licensure.
Licensure is the process by which per
mission to practice a profession is granted
27
j o n c e t h e r e q u i r e m e n t s o f t h e l e g a l i t y
I a r e r e c o g n i z e d .
j The degree to which a profession is subject to state
supervision depends upon the external constitution or legal.
.status it has in society (Carr-Saunders & Wilson, 1964).
Licensing systems for screening applicants assures legal
status. Thereby, the professional controls admission into
the field (Greenwood, 1975).
Operational Definitions
I
From the preceding literature review and for the pur
pose of this study, operational definitions of the seven
criteria required for professional standing have been de
veloped. They are as follows:
1. Body of Knowledge - an identifiable and
distinct set of theories, methodologies,
and principles which form the technical
base for professional practice.
2. University Education - the formal process
within an educational institution in which
the professional body of knowledge is trans
mitted, usually at the graduate level.
3. Professional Ideology - the notion of
service that is the basis for the pro
fession's commitment to the field and
which establishes the practitioner as
2 8
the most appropriate individual to
offer this particular type of service
because of his training and knowledge
of the discipline,
4. Professional Association - established
organizations of professionals that set
criteria for membership in the field,
keep members accountable for their
actions, insure the provision of the
best possible services, exert control
over the profession's training centers,
and keep abreast of the current legislative
and political activity affecting the field,
5. Code of Ethics - written and formalized
standards of professional conduct that
establish the commitment of the pro
fessional AS well as insuring the com
petence of the practitioner and the
quality of his services,
6. Self-regulation - the professional
mechanism which maintains the ability
of the discipline to autonomously govern
and regulate its members, establish stand
ards of service, enforce the code of
ethics, assume responsibility for any
29
disciplinary action and be publicly
accountable for the actions of its
1 constituency.
7. Public Sanction - the formal and in
formal approval which a community
grants a discipline acknowledging the
profession's ability to best deliver
offered services and to be self-regulat-
I ing.
I
' Conclusion
This discussion has delineated the criteria that have
been found to be relatively universal in regard to profes
sional characteristics. It should be noted that in addi
tion to our defined criteria, the concept of autonomy is
‘ also associated with professional standing. The authors
of this study feel there are inherent problems in defining
and measuring this concept. Therefore, we have integrated
, the notion of autonomy in the examination of self-regula
tion, and will utilize these seven criteria in analyzing
the professional status of our individual discipline.
Process of Professionalization
While there are definite criteria requirements for
eligibility to professional status, the process by which an
occupation achieves this distinction is varied in the de-
3 0
I velopment of each specific discipline. Certain steps are
i
I common for professionalization in general, but the sequence
j of events and the intensity of their implementation dif
fers. This section will examine the processes that precede
professional standing.
Professions with a more substantial and more theoreti
cal body of knowledge behind them are better able to con
vince society of the need for their particular services and^
i perhaps to persuade society of their right to take respons-
1 ibility for them. Reference must be made to a theoretical
; body of knowledge for decisions made by the practitioners
of the profession. The professional's responsibility for
interpreting the body of knowledge and for considering,
even deciding, the client's needs and solutions to them is
; an important aspect of the autonomous development of the
individual profession. One way in which a profession may
first develop as a separate occupational group is when some
individuals recognize a social need and become committed
' to providing for it. These initial pioneers, entering the
field from a variety of routes, will be united by this
common concern. The development of a new occupational
group may open up new career possibilities for others in
i
relatively marginal or terminal career positions. As time
goes by and the process of professionalization continues,
qualifications will be laid down for entering to the occu-
31
' pation and entry routes institutionalized. An occupation
with pretentions to professional status cannot afford to
I
serve as a refuge for the unqualified (Elliot, 19 72),
The emerging profession claims to be offering a unique
service not available elsewhere. It does not rely on open .
competition with those occupations closest to its field,
but is likely to proclaim openly that its rivals are either
improperly trained or illegal competitors. The economic
success of a new profession is based on the normative
acceptance it achieves --- or how much right to a legally ,
, enforceable monopoly it can successfully claim. Profes-
■ sional services usually cannot be adequately evaluated by
laymen. Professionals admit that they need their client's
cooperation for a good performance; for survival, they also
need their client’s faith (Goode, 1960a).
Those taking the lead in striving for the advancement
, of professionalism within the occupational group and in
claiming public recognition of its new status become the
elite of that profession. They implement the following
procedures according to Barber (1965):
1. Acknowledge the inadequacies of their
group but compare them to ones that
formerly existed in established pro
fessions -- express hope for progress.
2. Construct and publish a code of ethics.
32
3. Establish a professional association
which will perform the following
functions ;
a. self control;
b . socialization;
c. education;
d . communication with public ;
e . defense of professional interest
against infringement by the public
or other occupational groups.
4. Leaders establish measures and titles
of more or less professional behavior,
hoping, of course, to use such prestigious
titles as "fellow" as an incentive for the
less professional to become more so.
5. Seek licensure from the state.
6. Seek to strengthen university professional
schools.
7. Information program for the general public.
8. Conflict resolution — with those in the
group who are less qualified and with
other professionals who may be charging
them with encroachment.
As previously stated, there are differences of opinion
about the subsequent processes of professionalization.
33
! Wilensky (1964) enumerates five procedural elements of
professionalization. They are as follows ;
1. Start doing full time the thing
that needs doing.
2. Establish a training school within
a unviersity.
3. Combine to form a professional
association with:
a. further self-conscious de
finition of core tasks ;
b. the contest between the home-
guard who learned the hard way
and are committed to the local
establishment, on the one hand;
and the newcomers who took the
prescribed courses and are com
mitted to practicing the work
wherever it takes them;
c. the hard competition with
neighboring occupations,
4. Political agitation to win support of
law for the protection of the job terri
tory and its sustaining code of ethics:
a. licensing;
b. certification.
34
5. Establishment of rules to eliminate the
unqualified and unscrupulous, and rules
to protect clients and emphasize the ser
vice ideal in a formal code of ethics.
Caplow (1954) lists the following processes as in
herent to the achievement of professional status:
1. Establishment of a professional associa
tion with definite membership criteria
designed to exclude the unqualified;
2. Change of occupational name, which
serves the multiple function of re
ducing identification with the previous
occupational status asserting a tech
nological monopoly.
3. Development and promulgation of a
code of ethics which asserts the social
utility of the occupation, sets up public
welfare rationale, and develops rules
which serve as a further criteria to
eliminate the unqualified and unscrupulous ;
this imposes a real and permanent limita
tion on internal competition.
4. Prolonged political agitation, whose
object is to obtain the support of the
public power for the maintenance of the
35
new occupational barriers, and also
development of training facilities
directly or indirectly controlled by
the professional society, particularly
with respect to admission and to final
qualification; the establishment through
legal action of certain privileges of
confidence and inviolability, the elab
oration of rules of decorum found in the
code, and the establishment — after
conflict — of working relations with
related professional groups.
Goode (1961) lists seven steps of professionalization
which occur simultaneously ;
1. Formulating a code of ethics,
2. Founding of a professional association,
3. Promulgating favorable legislation.
4. Establishing curricula for professional
training (preferably in a university),
5. Making appeals to foundations for funds
with which to develop new professional
knowledge.
6. Writing articles to explain the unique
contribution of the occupation.
36
7. Making protests against inaccurate
stereotypes of the occupation.
i
1 Conclusion
It is evident, from the preceding analysis, that pro
fessionalism is not an easily defined characteristic.
■ While one can observe a well-established profession, such
' as law or medicine, and describe its component and deriva-
: tive traits, it is much more difficult to specifically de-
I lineate those elements which are mandatorily required for
achievement of professional status. Varying professions
' may or may not possess all the aforementioned criteria,
and the degree to which a criterion is integrated into a
profession also differs. Therefore, it must be concluded
that professionalism is a continuum of occupational status,
with no definite demarcation between the profession and
the non-profession. While some occupations are distinc
tively recognized in the professional and non-professional
loci, others seem to arbitrarily fall between the two
, classifications.
Generally, there are seven criteria that are fre
quently observed in professions. They are :
1. A specific body of knowledge.
2. Training and education within
a university.
3. A professional ideology.
37
4. An organized professional association.
5. A professional code of ethics.
6. Self-regulation through occupational
authority and autonomy.
7. Public approval, sanction, and
licensure.
These seven criteria are often used as indicators of pro
fessional standing, but are not always present in all pro
fessions .
The evolutional process which ultimately confers pro
fessional status is also not a specific, well-defined para
digm. Some events that usually occur are :
1. recognition of need;
2. recruitment of full-time workers
to meet the need;
3. establishment of a body of know
ledge that is transmittable through
a university;
4. organizing a professional associa
tion with the development of a code
of ethics and a professional ideology ;
5. winning legal sanction through licensing
and certification.
In conclusion, it must be mentioned that these pro
cesses often occur simultaneously rather than in a pre-
3 8
scribed sequence. Nevertheless, a general paradigm does
exist. This paradigm implicates a basic framework of
events that occur in the evolution of a profession. The
evaluation of our specific discipline will utilize the
seven criteria in analyzing the professional statuses of
nursing and gerontology.
39
CHAPTER III
THE PROFESSIONAL STATUS OF NURSING
A REVIEW OF RELATED LITERATURE
Introduction
The previous chapter presented a review of the socio
logical literature on professionalism. From the review of
the literature, seven widely accepted criteria were estab
lished to evaluate the professional status of the eight
disciplines included in this study, A review of the liter
ature directly related to the field of nursing provides
further support for the validity of these established
‘criteria. This chapter will provide an examination of the
pertinent literature relevant to the status of nursing as
a profession, and a specific analysis of the discipline of
: nursing utilizing the seven criteria.
Status of Nursing
The professionalization of nursing has been discussed
! in nursing literature by many authors. E,L, Brown (1948),
Griffin and Griffin (19 7 3) , and Guinee (19 70) quoted
40.J
I Flexner's criteria as evidence that nursing had evolved to ]
' i
professional status. E.L. Brown (19 4 8) reported that j
I
Dr. Abraham Flexner formulated the criteria in 1915 and
I
i applied the characteristics of various professions includ- i
I
; ing nursing. The six criteria for a profession as set down
by Dr. Flexner are: (1) professions involve intellectual
I operations and a large degree of individual responsibility;
' I
1 (2) they are learned in nature ; (3) they are practical, not
I I
, merely academic and theoretical; (4) they communicate !
I
' through a highly specialized educational discipline ; I
(5) they are self-organized; (6) they are responsive to i
public interest; and, they tend to become concerned with j
the achievement of social ends. Dr. Flexner found that j
nursing did not conform in all respects to his idea of a
profession, but that it met some of the criteria. However,;
E.L. Brown (1948) in her report on "Nursing for the Future",
I !
wrote that nursing had moved far enough in the direction of|
meeting Flexner's criteria so that it could be considered
' a profession, or at least an evolving profession. But she
I
was concerned that all schools and all nurses in practice
did not meet the tests of professionalism. Echoing
Flexner's requirements for intellectual operations and
communication through a specialized educational discipline,
‘ I
' she recommended that the term professional be applied to i
schools affiliated with institutions of higher learning.
41
I and to the nurses who had graduated from those professionalj
schools. I
Bixler and Bixler (1959) enlarged on the criteria pre-
I
sented by Flexner by recognizing the expansion of nursing
I
curriculums, the improvement of faculty standards, and the
: marked progress made in utilizing the scientific method in
I studying problems of nursing. Hanton (19 74) added other
' criteria to the acknowledge criteria. He listed a con-
I
tinuing professional education in addition to the basic {
■ professional education, self-discipline, mental rather than'
manual work, the provision of services for social welfare,
, and self-employment. He was concerned that nurses had an |
identity problem and needed to think out what professional-I
ism was and how it related to nursing. Griffin and Griffini
i (1973 )were also concerned with professionalism, but in the!
context of the definition of the professional nurse as op- '
' posed to the technical nurse. While Flexner had stressed '
that a profession should be practical, not just academic j
'
' and theoretical, nurses, acknowledging nursing's practical
and service orientation, were emphasizing education and a
theoretical base for practice to meet the criteria for
professionalism.
Nursing literature generally reflects the belief that :
nursing is a profession. A few writers (Bloom, 1963;
Strauss, 1969) agreed that the discipline of nursing had
42
I achieved professional status, but with qualification.
! Bloom stated that nursing thought of itself as a professioni
and its right to do so was accepted. However, he thought
i
I that though nursing was more qualified in its orientation !
I
toward service, it was less qualified in its requirement
' for prolonged specialized training in a body of abstract
I 1
I knowledge than the professions of medicine, law, and the I
! ministry. Strauss (1969) asserted that nurses had success-;
I
; fully laid claim to the professional title before most !
other groups appeared on the medical scene, and even before |
medicine had cleaned house under Flexner's examining eye.
He was concerned, however, with the unequal status of
nurses compared to physicians, and attributed this to
nurses' acceptance of their subordination to physcians.
i Others (Etzioni, 1969; Glaser, 1966 ; Katz, 1969 ;
jSimpson & Simpson, 1969) saw the discipline of nursing
'limited or lacking in certain of the requirments considered
essential for a profession, and concluded that nursing had
; not achieved professionalism or was termed a semi-profes
sion. Coinciding with Flexner's criterion of a large
degree of individual responsibility and intellectual opera
tion, the lack of autonomy, in the sense of nurses' depend
ence and subordination to the physician, was pointed out as
! the reason nursing could not be considered to be a profes
sion (Etzioni, 1969 ; Glaser, 1966; Katz, 1969 ; Simpson &
43
I Simpson, 1969). Etzioni (1969) saw doctors making deci-
' sions and nurses involved in application of knowledge with
the result that nurses were not directly related to pro- j
I fessional decisions of life and death. Both Etzioni (1969)|
' and Glaser (1966) thought that hospital nursing offered
little chance to develop autonomy because of supervision by
I doctors and other nurses, and because of the obligation to '
j obey medical orders for the patients' welfare. Katz (1969);
; concluded that nurses wanted professional dignity and
i
' autonomy, but physicians wanted dependable, servile nurses.j
Since physicians had the upper hand, antagonism between I
doctors and nurses has developed. Simpson and Simpson |
(1969) state the lack of autonomy is due to the prevalence |
of women in the semi-professions. Closely related to
! autonomy is the idea of status of nursing. The preceding
writers brought out the point that the discipline is made ■
; up of women primarily, and that typical professions are
I
! male-oriented.
' Another requirement for a profession found to be
limited was a body of professional nursing knowledge
(Glaser, 1969; Katz, 1969). Glaser (1969) wrote that
! clinical nursing literature written by nursing authors was
; far greater in number than any foreign country, but it was
I
not advanced or cumulative enough to serve as the founda
tion for a profession. Katz (1969) contended that there
44
I had not been a development of a clear cut body of profes-
; sional nursing knowledge, nor had nurses been accepted by
I other professionals and groups as the guardians of the
I existing knowledge.
Writers outside of the profession of nursing have
focused on the area of autonomy and a body of knowledge as
being deficient. Several of the writers (Etzioni, 1969;
I Glaser, 1966; Katz, 1969) indicate that physicians are |
I autonomous and that nurses are not, and that there is
I antagonism between the two groups. Both nurses and physi
cians refute this claim. Nurses point out that they no
longer blindly carry out doctor's orders and that their |
vigilance often saves lives (.Dickinson, 1966) . Bixler and |
Bixler (19 59) point out that nursing functions autonomously :
I
in formulation of professional policy and in control of j
‘professional activity through its organizations and accred- |
itation and licensing programs, |
Nurses and doctors are not continually at odds with
one another. In 1859, Dr. Lemuel Shattuck (Jones, 1966)
stated that bad nursing often defeats the best medical ,
advice, and good nursing often does more to cure disease.
I
In the prevention of disease and in the promotion of health,
nursing is of equal and even greater importance. The
I
; American Medical Association in 19 70 took a position in
support of the expanding role of the nurse in providing
45
' patient care (Kelly, 1975). The statement was made that an;
identical act or procedure might be the practice of medi- |
I
cine when carried out by a physician, and the practice of
; I
i nursing when carried out by the nurse. Kelly (19 75) quoted'
1 :
i a Health, Education, and Welfare report published in 1971
' which looked at the ever widening area of independent nurs-
I ing practice. The report stated that independent nursing
I practice was due to the nurses' assumption of certain |
I !
1 activities and the relaxation or removal of those under
; medical direction, and that there was a continual realign-
i i
ment taking place between the functions of the professional!
; i
nurse and the physician.
^ * I
Preceding writers (Glaser, 1966; Katz, 1960) deline- j
ated an insufficient body of professional nursing knowledgej
as the argument against nursing having achieved profes-
, sional status. Kelly (1975) points out that the knowledge ^
(
base in nursing has increased significantly with nurses
formulating theory, publishing articles, and engaging in
research. The criterion of a body of knowledge will be
explored in more detail in the next section.
In summary, writers of nursing literature generally
conclude that the discipline of nursing has met the cri
teria for a profession, established by Flexner and enlarged*
I
.on by others, and that it has attained professional status.
The need for clarification of the terms professional nurse
46
I and technical nurse was expressed, however, and a , concern
I
was shown that professional nurses be educated at insti
tutions of higher learning to meet the test of professional-
i ism. Writers, outside of the discipline of nursing,
acknowledged nursing's commitment to service, and some were|
, sympathetic to nursing's claim to professional status. j
i However, they pointed out that nursing had not met certain |
I I
j criteria, particularly in the areas of an advanced, cumula-|
; tive body of knowledge and autonomy, in the sense of not |
j
having an equal and responsible role when compared to >
I
physicians. Therefore, they concluded that nursing had '
!
not attained the status of a profession or could be classed
as a semi-profession, I
I
A general overview of the pertinent literature rele- |
vant to the status of nursing as a profession has been pre-*
jsented. In the next section, the discipline of nursing I
will be examined against each of the seven criteria util-
I
ized in this study and regarded to be constituents of pro
fessional status. An historical overview will be employed
to look at the discipline of nursing in relationship to the
criteria.
Comparison of Nursing to Criteria
Seven criteria were delineated in the previous chapter
'that have been found to be relatively universal in regard
to professional characteristics. These seven criteria are
4 7 I
as follows: Body of knowledge, university education, pro
fessional ideology, professional associations, codes of
' ethics, self-regulation, and public sanction.
I Body of Knowledge
! A body of knowledge is defined as an identifiable and
distinct set of theories, methodologies, and principles
J which form the technical base for professional practice.
I
I Literature for nursing education was published as early
: as 1852 when Florence Nightingale's book. Notes on Nursing
; provided the impetus for the emerging principles of nursingI
(Popiel, 1966). McKenna (1960) stated that the existence |
, of a body of a professions' own literature is one of the
marks of a profession. The discipline becomes more self- ■
sufficient, and the literature beomces more comprehensive
; j
' and inclusive. Requirements pertinent to the field and the j
I
demand of those in practice cause it to come into being. j
i
Publications are in textbook, source book, and periodical I
form. !
Books became a necessity when instructions for nurses ;
became organized and when the first schools, modeled on the
Nightingale plan, were started. Notes on Nursing, What It
Is and What It is Not by Florence Nightingale was pub
lished in 1859, and became the textbook for nurses at
I I
schools of nursing in England and America (Griffin & j
Griffin, 1973; Popiel, 1966). The first manual of nursing :
48
I in the United States was published in 1879 by the Connecti-
I cut Training School, and was entitled. The New Haven Manual
I of Nursing (Griffin & Griffin, 1973). In 1885, the Text-
j book of Nursing by Clara Weeks Shaw, a nurse, was published
and is believed to be the first nursing text in America.
Other texts followed with subject matter devoted to materia
! medica, bacteriology, nursing ethics, and nursing prin-
I
i ciples and practice (Griffin & Griffin, 1973).
! Books on clinical subjects written specifically for
; nurses began to appear before World War I. They were often j
written by doctors, sometimes in collaboration with a
nurse. After World War I, there was a more dynamic ap
proach to nursing texts as represented by an early book, |
Principles and Practice of Nursing by Bertha Harmer pub-
^ ------------------------------------------------------------------------------------------------------------------- j
'lished in 1923 (Griffin & Griffin, 1973). I
I
The official publications of the professional nursing |
organizations in the United States are. The American |
Journal of Nursing, Nursing Outlook, and Nursing Research j
I
, (Griffin & Griffin, 1973). The American Journal of
Nursing first appeared in 1900, and its aim was to be a
journal managed, edited, and owned by the women of the
I i
■ profession (McKenna, 1960) . Journal content is classified
under three major headings : (1) material which promotes |
: ' I
: the program of the American Nurses' Association; (2) clini
cal material of interest to the general practitioner and
49
! the clinical specialist; and, (3) information about pro-
jgrams of government, voluntary agencies, and international
I affairs which influence employment of nurses and the de-
Ivelopment of the profession (McKenna, 1960).
Nursing Outlook is the official organ for the National
,League of Nursing. It is designed to assist nurses and
others in fostering the development and improvement of
nursing services and nursing education (McKenna, 1960). It
was first published in 1953, but was the outgrowth of the
Public Health Nurse, published in 1918, and the Visiting
I Nurses * Quarterly published from 1909 until 1919 (Griffin &
Griffin, 1973).
Nursing Research publishes research studies, projects,
and other activities which investigate, interpret, and
apply findings. The first issue was published in 1952,
,and its purpose is to inform members of the results of
scientific study in nursing, and to stimulate research in
nursing (Griffin & Griffin, 1973 ; McKenna, 1960 ). Griffin
& Griffin, speaking of Nursing Research, stated that the
profession had reached a point of maturity with self
instituted evaluation and research sufficient in breadth
and depth to justify publication of a magazine limited to
research.
International publications are represented by the
International Nursing Review, established in 1930 as the
50
I official journal of the International Council of Nurses, ^
and the International Nursing Index first published in |
I 19 66 (McKenna, 1960) . Other journals are devoted to spe- :
! cific clinical interest, such as the Journal of Psychiatric'
I
; Nursing ; functional orientation, as the Journal of Nursing
; Education, and others with a religious affiliation as The
! Catholic Nurse and News for Nurses. Those of a broad
j appeal to nurses employed in a variety of positions are
Nursing Form and R.N. (Griffin & Griffin, 197 3),
Today, new nursing knowledge is accumulating rapidly
; due to extensive research, rapid advances in scientific
knowledge, and development of nursing care techniques.
The sharing of nurses' findings has resulted in a prolifer
ation of nursing literature in the form of books, periodi-
! cals and pamphlets, and specialized publications. These
publications are of a widely diverse nature rather than
; the texts and reference books related to clinical nursing
in former years (Kelly, 1975).
Nurses have been aware of the need for research since
: the 1930's, knowing that a body of theory serves as a base
for the profession's focus of interest, and that theory
construction by systematic research is normally not found
in non-professional occupations. As they gained more ad^
Ivanced preparation in the social, physical, and biological
sciences, they began to direct and carry out research them^
selves (Kelly, 1975).
51
' Kelly (19 75) states that a need to develop a knowledge
I
I and research into nursing practice has been repeatedly em-
jphasized in national reports and articles. In addition to
I reports published in Nursing Research, others are published
by the American Nurses* Foundation and the Health Profes
sions Education Exchange of Research. The Division of Re-
,search and Statistics is the research arm of the American
Nurses* Association, and it began sponsoring national con
ferences for nurse researchers in 1965. Financial support
for research and its dissemination was accomplished by the
, creation of the American Nurses * Foundation in 1955.
Greenwood (1972) points out that in the evolution of
professions, the researcher-theoretician emerges who en
gages in scientific investigation and theoretical systema
tization. Thus, as Kelly (197 5) has found, as more nurses
hold doctoral degrees, more have assumed research positions
in universities, health institutions, and medical centers.
Therefore, a body of knowledge has been established
beginning with manuals and books on principles of nursing
published in the middle and late 1800*s. Texts and period^
icals published by and for nurses continue to grow in
numbers, and content has enlarged from a clinical focus to
an extremely diverse nature. Nurses have long been aware
of the necessity for research and theory construction. The
discipline is engaged in research and the official nursing
52
! organizations emphasize the need for research and give
!
' assistance and support to it.
I
I University Education
A university education is the formal process within an
education institution in which the professional body of
'knowledge is transmitted. University education for nurses
has been a long slow process, but the need for education
of nurses was recognized. Development of formal education
. began more than one hundred years ago (Griffin & Griffin,
! 1973) .
The Deaconess School in Kaiserwerth established in
■ 1836 was the first school offering an educational program
to prepare nurse practitioners. In 1860, the St. Thomas
Hospital School in London was started by Miss Nightingale.
Modern practices were implemented in the school, and theory
and clinical practices were integrated (Jones, 1966).
Early ^schools in America were patterned after those in
England and showed the influence of Miss Nightingale. In
1873, three schools appeared almost simultaneously inde
pendent of hospitals. These schools were the New England
Hospital for Women and Children, Bellevue Hospital School
of Nursing, and the Connecticut School, Schools developed
rapidly, and due to lack of endowment and a source of near
free labor, were absorbed by the hospitals. Other schools
were organized, however, using Florence Nightingale's
53
I principal idea of a school independent of the hospital
I which precluded cheap labor (Griffin & Griffin, 1973;
j Jones, 1966) .
I University Programs. A course of study was started
for nurses at Teachers' College, Columbia University, and
Adelaide Nutting became the first professor of nursing in
the world in 19 07 when she was appointed to the faculty
(Griffin & Griffin, 19 73; Jones, 1966). The first collegi-
,ate program for nurses was established by the University of
' Minnesota in 19 09 , ' and preceded junior college programs
1 which began in the 1930's. By 1950 there were 195 collegi
ate programs (Kelly, 1975).
• Early leaders in nursing envisioned preparation for
professional nursing taking place in colleges and universi-
; ties, and early in the twentieth century, this belief was
supported by leading nursing educators and physicians
(Guinee, 1970). Comprehensive studies and reports were
made advocating affiliation with colleges and universities.
The Goldmark Report published in 1926 reported on the re
commendations of the Committee on Nursing and Nursing Edu
cation in the United States. A strengthening of ties be
tween the Association of Schools of Nursing and universi
ties was recommended (Jones, 1966). A comprehensive study
of nursing education, directed by E.L. Brown (19 48), ad
vised increased association with institutions of higher
54 ;
education, and recommended that the term, professional, be
applied to these schools, and to the nurses who had gradu
ated from them. A report, "Toward Quality in Nursing,"
published in 196 3 by a consultant group to the Surgeon
General of the Public Health Service, stated that bacca
laureate programs should prepare nurses for leadership
positions (Jones, 1966; Kelly, 1975). In 1965, the
American Nurses' Association issued a position paper on
"Education for Nursing"(Jones, 1966; Kelly, 1975) in which
! it took the position that education of nurses should take
,place in institutions of higher learning. It further re
commended that the professional level should be obtained
in baccalaureate degree programs, and the technical level
in associate degree programs.
Closely related to studies of nursing education was
the support of the federal government (Kelly, 1975) . The
Nurse Training Act, passed by Congress in 1964, provided
traineeships for professional nurses among other grants and
financial aids. This financial aid continued until 1974,
Graduate Education. Graduate education can be traced
back to the first decades of the twentieth century, and the
first programs concentrated on public health nursing, and
preparation for supervision and teaching (Kelly, 19 75), The
purpose of master's degree education today is to prepare
professional nursing leaders in the areas of clinical
55
'specialities, administration, and teaching (Kelly, 1975).
i Support for doctoral programs for nurses began in
I 1955 when the National League of Nursing started a pre-
I
doctoral and post-doctoral nursing research fellowship pro-
I
gram. The program was designed to assist nurses to qualify
for doctoral study in a discipline outside of nursing. In
196 3 the Department of Health, Education, and Welfare
initiated the Nurse Scientist Graduate Training Grants Pro-,
gram (Kelly, 1975). This federally funded program directed
‘ that the doctoral program should be pursued in an estab-
,lished discipline such as the biological or behavioral
sciences, with or without a minor in nursing,
Kelly (1975) reports that nurses have ranged in many
directions, and have degrees in many areas. In 1973, eight
, universities offered doctoral degrees by the educational
unit in nursing, and 12 other schools had registered nurses
enrolled as doctoral candidates. In 19 73 there were 1,019
nurses with doctoral degrees in the world, 964 of whom were
in the United States. There seems to be agreement now that
the profession should support a diversity of programs be
cause the role of nursing in society is not fixed, and also
that research training should be strengthened.
Continuing education fpr nurses began in the early
1900's with hospitals and nursing alumnae associations
offering post-graduate courses, and universities and col-
56
'leges offering courses in supervision. Some colleges
established institution funded continuing education pro-
I grams after funds for short-term courses, provided by the
Nurse Training Act in 1964, dwindled (Kelly, 1975).
The movement toward the preparation of nurses in in
stitutions of higher learning has been slow and has taken
varied forms. Nurses are earning advanced degrees and
the trend toward higher education, since World War II, is
significant (Guinee, 1970). The official voice for nurses,
! the American Nurses* Association, has taken the stand that
j education of nurses should take place in institutions of
higher learning and that the professional level should be
obtained in baccalaureate degree programs. Ambiguity ex
ists since both graduates of baccalaureate degree programs
and associate degree programs are entitled to apply for
registered nurse licensure. This tends to cloud the issue
of a university education as a criterion for professional
status. However, the trend and support of leaders in the
field is toward university education for professional educa
tion in nursing.
Professional Ideology
The criterion of professional ideology is explained
as the notion of service that is the basis for the profes
sion's commitment to the field, and which establishes the
practitioner as the most appropriate individual to offer
57
this particular type of service because of his training
and knowledge of the discipline. In addition to service,
there are aspects of professional judgment based upon pro
fessional knowledge, and professional freedom and autonomy
in the work situation.
The evolution of nursing service has been uneven in
the world, and history tells us little of how the service
was performed or what methods were used until the pre-
Nightingale period. Nursing of the sick dates back to
primitive times when women were designated to care for the
ill. During early civilization, the Egyptians, Hebrews,
Greeks, Romans, and Indians provided nursing care to their
populations. During this era, the nurse was mentioned as
the most appropriate person to give nursing services.
India was the first country to record the use of nurses in
the care of the sick. They were employed in hospitals,
and the requirements for them were similar to those of
practical nurses of today (Popiel, 1966).
Nursing began as an organized service in the early
Christian era (Popiel, 1966). The early Christian church
served the poor, the travelers, the orphans and the sick
(Griffin & Griffin, 1973). Deaconesses, who were lay
women appointed by bishops, cared for the sick in hospi
tals and visited the sick much as visiting nurses today.
Gradually religious orders assumed the activities of the
5 8
I deaconesses (Popiel, 1966) . The middle ages ssw the de^-^
!
■ finite organization of the nursing orders with nursing
sisters beginning as probationers and advancing to higher
levels. Guided by the church, the nursing service evolved
from organization to institution, Seoulat" orders developed
and attracted those who were committed to cate for the
sick, but without the demand of complete jreligiQus devo^
tion (Griffin & Griffin, 1973),
It was only during the period of the reformation that
nursing sank to its lowest level. Service to the sick was
no longer given by committed, care-trained persons. The
new Protestant church did not feel the same responsibility
to the sick as did the Catholic church. Deprived of the
dignity of the church, nursing lost its social standing
(Griffin & Griffin, 1973),
It was during the Nightingale era that the service of
nursing began to ascend the latter of respectability. Miss
Nightingale and her nurses were totally committed to the
care of the sick during the Crimean War in the years 1864-
1856 (Popiel, 1966) . Griffin and Griffin (1973) state that
before Miss Nightingale's time there was no such thing as
professional nursing, but at the time of her death, nursing
was a profession. She placed nursing on a foundation of an
organization, and with high educational principles and
ethics, gave it an impetus under which it is still progrès
sing.
59
The stimulus of war was necessary to produce a demand
t #
for modern nursing service. The nurse, by virtue of educa
tion and training, was designated as the appropriate person
to render this service. When the Civil War started. Miss
Nightingale was asked for advice by the Sanitary Commission
of the United States. This experience, and in the light
of what Miss Nightingale had previously accomplished,
pointed up the desperate need for organized schools of
: nursing. In 189 8 when the Spanish-American War broke out,
■Congress authorized employment of nurses under contract.
,By this time, schools of nursing had been training nurses
for about twenty years. The status of nursing was advanced
when the Army Nurse Corps was created by law in 19 01
(Griffin & Griffin, 1973).
World War I saw 400 nurses in the Army Nurse Corps
aided by reserves from the American Red Cross Nursing Ser
vice. In 1916 the United States Naval Reserve for nurses
was created, and in 19 20 Army Nurses received military
rank. Both the Army and Navy established their own schools
of nursing which were later dissolved (Griffin & Griffin,
19 73). In the years between World War I and World War II,
nursing became a more comprehensive service. An equal em
phasis was placed on the maintenance of health as was car
ing for the ill. Agencies other than hospitals, such as
schools and industry, developed the need for nurses with
60
I
I advanced preparation (Griffin & Griffin, 19 73), As medi- j
. cine became more complex, nurses began performing many of
t '
: the duties formerly reserved for physicians, plus the
I
I addition of new nursing services (Popiel, 1966), j
I
! During World War II, 75,000 nurses served in 52 areas
throughout the world. The Cadet Nurse Corps, formed by
I act of Congress in 1942, provided additional nurses for the'
I Armed Forces (Popiel, 1966) . Following the war in 1947, a
1
! permanent nurse corps for the Army, Navy, and Air Force was
established by law, thus eliminated the need for the Red
,Cross reserve service (Griffin & Griffin, 1973). The pass-|
! age of the Hill-Burton Act in 1946 and the Medicare bill in■
195 8 increased the demand for nursing services in hospitalsJ
health centers and nursing homes (Popiel, 1966), '
; . i
Nursing functions today are complex requiring judgment,;
: skill and technical expertise based upon knowledge in the
nursing field and others, such as psychology, sociology, i
and health and welfare. The nurse functions as part of the !
medical team and supervises the practical nurse and others.
There is a continuous growth in specialization with nurses
giving service in an ever-widening range of agencies and
environments. The nurse health practitioner engages in in-
'dependent decision making and collaborates with other
health care professionals (Griffin & Griffin, 1973). Ducas
(196 2) points out that nurse specialists (e.g., nurse mid-
61 .
wife) may function under the supervision of the physician,
but not always with the physical presence of the doctor.
The nurse anesthetist gives the anesthesia of the doctor's
choice, but is held legally responsible. It has been
pointed out previously that nurses no longer blindly follow
doctor's orders, and that her knowledge and skill saves
lives. Nurses are assuming certain activities no longer
under medical direction and there is a continual realign^
ment taking place between the functions of the nurse and
the physician.
: There can be no argument that the discipline of nurs
ing with its long history of service to the sick and the
well has met the service ideal. Nor is there little doubt
that the nurse is the most appropriate individual to offer
nursing services. History also demonstrates that profes
sional knowledge is the basis of nursing decisions requir
ing judgment and skill. Present day educational require
ments and licensing procedures give further credence to
the emphasis placed on professional judgment based upon
professional knowledge. In addition, the nurse is enjoined
by the code of ethics to maintain competence in nursing
practice, accepting responsibility for individual judgments
and actions. Nurses carry out medical orders, and in that
sense autonomy and freedom may be questioned. But, the
code of ethics directs the nurse to safeguard the patient
62
' when his safety and care are affected. The nurse, there
fore, has the freedom to question or refuse to carry out
orders which would be harmful to the patient. The nurse
exerts autonomy in providing nursing services, and in
supervising others in giving services. Furthermore,
nursing functions autonomously in formulation of profes
sional policy, and in the control of professional policy
and activities.
Profession a1 As soci at ion s
Professional associations are those established organ
izations that set criteria for membership in the field,
keep members accountable for their actions, insure the pro
vision of the best possible services, exert control over
the profession's training centers and keep abreast of
current legislative and political activity affecting the
field. In the first part of the twentieth century, nurses
began to think of nursing organizations to help them to ob
tain legal standards of education and practices to protect
those receiving nursing care and to those giving nursing
care. National nursing organizations were formed, and
nurse registration and practice acts were advocated (Popiel,
1966). The three established nursing organizations of note
are the American Nurses Association, The National League
for Nursing and the International Council of Nurses, In
addition, there are many specialty organizations for nurses
63
' which meet their special needs and interests.
The American Nurses Association was founded in 1896
I
as the Nurses Associated Alumnae of the United States and
Canada. It changed its name in 1911 when Canada withdrew
to form its own society (De Young, 1966; Griffin & Griffin,
1973). Even at this early date of its organization, the
purposes of this association met the criterion broadly for
a professional association. The purposes were, to estab
lish and to maintain a code of ethics, to elevate the
standards of nursing education, and to promote the useful-
, ness and honor, the financial and other interests of the
nursing profession (Griffin & Griffin, 1973). The present
bylaws state the purpose of the organization is to foster
high standards of nursing practice, promote the profes
sional and educational advancement of nurses and to pro
mote the welfare of nurses to the end that all people may
have better nursing care (Kelly, 1975).
The Association has worked to develop uniform stand
ards of education and practice, and uniform licensing laws
in the states, and formulated a code of ethics within which
is the inherent concept of accountability (Kelly, 1975).
Membership is restricted to those holding licensure as a
registered nurse in at least one state (Griffin & Griffin,
1973). Through its official publication. The American
Journal of Nursing, it keeps members abreast of programs of
64
' the Association, clinical material of interest, and inform
ation about programs of government, voluntary agencies, and
international affairs which influence employment and the
development of the profession (McKenna, 1960).
The American Nurses' Association is the professional
association for registered nurses, for as Merton (1958)
states, a professional organization is an organization of
practitioners who judge one another as professional com
petent and who have banded together to perform social
functions which they cannot perform in their separate
capacities as individuals.
The National League for Nursing was founded in 1952,
but was an outgrowth of the American Society of Superinten
dents of Training Schools for Nurses which was organized
in 189 3. Its major purpose is to promote the improvement
of nursing service and nursing education so that nursing
needs of society might be met (De Young, 1966). Individ
ual membership is open to anyone interested in promoting
improved nursing service and education, and agency member
ship is open to organizations providing nursing services
(Kelly, 1975).
The League offers a variety of services in accredita
tion, consultation, evaluation and testing, research and
studies, and information services (Kelly, 1975). One of
the main functions is the accrediting services for the
65
‘ various educational programs in nursing. Since the incep
tion of the accrediting service in 1949, it has been a
s stimulant to the improvement of nursing education. While
the accreditation is voluntary, and it does not jeopardize
a school's state accredited status, it does signify a
nursing education program of high quality in all respects.
The testing service is also on a voluntary basis, but
every state uses the State Board Test Pool Examination for
professional nurse licensure (Kelly, 1975). Through its
accreditation and evaluation and testing programs, the
: League exerts control over the profession's training
centers.
The International Council of Nurses founded in 1899,
is a federation of national nursing organizations with the
American Nurses' Association representing the United States
(E.L. Brown, 1970). Its primary objective is to raise the
standards of professional education and practice, and to
' promote the development of the nurse as a human being and
as a citizen (De Young, 19 66) . It has sought common de
nominators in education and practice, and has developed an
International Code of Ethics (Kelly, 1975). Specialty
organizations haveincreased in number within the last ten
years. Such organizations as the American Association of
Nurse Anesthetists and the like, meet the specialized needs
of nurses and assist in disseminating information to
nurses.
6 6
In essence, therefore, nursing associations have de-
! veloped standards of education and practice for quality
i service. Through the development of licensing laws and a
' code of ethics, members are held accountable for their
actions. Control is exerted over training centers by the
associations. Information of a political and professional
nature flows from the associations to the membership.
Hence, nursing associations well fulfill the criterion of
professional associations for professional status.
■ Code of Ethics
Written and formalized standards of professional con
duct denotes a code of ethics. It establishes the commit
ment of the professional as well as insuring the competence
of the practitioner and the quality of his services. In
terest in a code of ethics for the nursing profession can
be traced back to 1896 when the American Nurses' Associa
tion was founded (Guinee, 19 70). A code was formulated by
the Association's Committee on Ethical Standards in 1926.
The code expressed the ideals of the profession, served as
a guide to its members in their activities, and helped
members arrive at sound conclusions. It was concerned with
the nurse's relation to the patient, to the nursing profes
sion and the medical and other professions. Professional
skill, knowledge, and loyalty was recognized (Guinee,
1970).
67
In 1950 a code for professional nurses was adopted by
the American Nurses' Association. It was revised in 1960
and again in 196 8. Ten statements serve as guidelines for
ethical nursing practice and conduct (Guinee, 1970).
The Code for Professional Nurses
1. The nurse provides services with respect
for the dignity of man, unrestricted by
considerations of nationality, race, creed,
color, or status.
2. The nurse safeguards the individual's right
to privacy by judiciously protecting in
formation of a confidential nature, sharing
only that information relevant to his cate,
3. The nurse maintains individual competence
in nursing practice, recognizing and accept
ing responsibility for individual actions
and judgments.
4. The nurse acts to safeguard the patient
when his care and safety are affected by
incompetent, unethical, or illegal conduct
of any person.
5. The nurse uses individual cqmpetence as a
criterion in accepting delegated responsi
bilities and assigning nursing activities
to others.
68
6. The nurse participates in research
activities when assured that the
rights of individual subjects are
protected.
7. The nurse participates in the efforts
of the profession to define and upgrade
standards of nursing education and
practice.
8. The nurse, acting through the professional
organization participates in establishing
and maintaining conditions of employment
conducive to high-quality nursing care.
9. The nurse works with members of health
professions and other citizens in promoting
efforts to meet health needs of the public.
10. The nurse refuses to give or imply endorse
ment to advertising, promotion, or sales
for commercial products, services, or
enterprises.
Guinee (19 70) and Kelly (1975) contend that a code of
ethics is not a Golden Rule to remain in effect forever.
To be useful and realistic, the code must be sensitive to
changes in society and keep step with trends and develop
ments .
Kelly (1975) states that the concept of accountability
69
'is related to professional ethics, and that the nurse is
I accountable to the public for the quality of nursing care
I rendered to the public. She further contends that although
; accountability is a legal fact because of the licensure
process to protect the public, the law guarantees minimum
safe practice, not quality of performance. Thus, the code
is necessary to insure quality care. Nurses are also
accountable to the group with whom they are professionally
associated, such as the employing agency and the physician.
In addition to the code of the American Nurses'Associa
tion, there is an International Code of Nursing Ethics
adopted in 1953. Prior to this the Nightingale Pledge was
prepared under the direction of Lystra Gretter and a group
of nurses. It was patterned after the Hippocratic Oath
and is still in use at some graduation exercises (Guinee,
1970; Kelly, 1975).
The discipline of nursing has a written and formalized
code of ethics which shows the concern of the discipline
for the competence of the nurse and the quality of the
nursing service. The Code for Professional Nurses meets
the criterion for professional status.
Self-regulation
Self-regulation refers to the professional mechanism
which maintains the ability of the discipline to govern and
regulate its members, establish standards of service, en-
70
: force the code of ethics, assume responsibility for any
I disciplinary action and be publicly accountable for the
i
I actions of its constituency. Nursing functions autono
mously in formulation of professional policy and in control
of professional policy and in control of professional
activity through its organizations and licensing and
accreditation programs (Bixler & Bixler, 1959).
The American Nurses' Association developed uniform
licensing laws in the states, and today all professional
nurses in every state have to be registered (Kelly, 1975).
; Nurse practice acts were based on a model suggested by the
American Nurses Association in 1955, and was used by most
states until 1974. In the 1970's some states began to
formulate their own practice acts when laws were changed
to incorporate the broadened definition of nursing (Kelly,
1975) . North Carolina was the first state to have a nurse
practice act, and passed a law in 1903 to license nurses.
By 1952 all states and territories had a nurse practice
act (De Young, 1966; Dickinson, 1966; McKenna, 1960).
Licensure is the legal basis of nursing practice with
the single common purpose of protecting the public (Kelly,
1975; McKenna, 1960). Licensure is defined as the process
by which and agency of government grants permission to per
sons to engage in a given profession or occupation by cer
tifying that those licensed have attained the minimal de-
71
' gree of competency necessary to ensure that the public
: health, safety, and welfare will be reasonably well pro-
I
I
j tected (Kelly, 19 75). The State Board of Nurses serves as
the examining group for licensure, traditionally made up
of nurses appointed by the Governor from a list of names
submitted by the state's Nurses Associations. In recent
years other non-nurses have been legally required as board
members. The State Board Test Pool Examination developed
. by the National League for Nursing in 1944 is used by all
I states, and determines safe and effective practice at a
; minimal level. Requirements for licensure include comple
tion of an educational program in a state accredited school
of nursing, and passing the State Board Test Pool Examina
tion for Professional Nurses. Revocation of a license
could occur when certain acts or impaired ability on the
part of the nurse might directly endanger the public.
Other reasons include fraud or deceit in procuring a
■license, conviction of a crime, unprofessional conduct, or
' immoral acts. However, relatively few nurses have had
licenses revoked or suspended. Nursing associations and
state boards emphasize the responsibility of professional
nurses in reporting negligent practice (Kelly, 1975) .
The National League for Nurses accredits nursing pro
grams in addition to the State Boards of Nurses accredita
tion. The League's accreditation is voluntary, but because
72
' its criteria are nationally determined, accreditation by
' this body signifies a nursing education program of high
I
j quality in all respects -- admission and achievement
standards, curriculum, faculty preparation, library, labor
atory and other facilities. The accreditation service had .
its inception in 194 9 and has been a stimulant to the im
provement of nursing education (Kelly, 1975).
High standards of nursing practice are fostered by
the American Nurses' Association. Divisions on Nursing
practice have been established, and standards of practice
for each division have been developed (Burnside, 1976).
Clinical competence of nurses in specialty groups are ad
vanced through the establishment of certification programs
for nurse practitioners (Dolan, 1968).
Therefore, the discipline of nursing as a peer group,
monitors the behavior of nurses, and holds the members
accountable for their actions. SeIf-regulation is main-
;tained through the mechanism of the professional nursing
associations and the state boards of nursing.
Public Sanction
Public sanction is interpreted as meaning the formal
and informal approval which a community grants a discipline,
acknowledging the profession's ability to best deliver
offered services and to be self-regulating. Greenwood
(1972) states that the community approves the profession's
7 3
' authority within certain spheres by conferring upon it
powers and privileges. Among its powers is the control by
!
I the profession over its training centers achieved by one
of the associations exercising an accreditation process.
By granting or withholding accreditation, a profession can
regulate the number and location of schools as well as con
tent of curriculum and quality of instruction. The National
League for Nursing, as explained earlier, is the official
'association which accredits the various programs of nursing,
! and as Kelly (1975) indicates, accreditation approval sig-
; nifies a nursing education program of high quality in all
respects. In this way the profession convinces the com
munity that no one should wear a professional title who has
not had it conferred by an accredited school.
Secondly, Greenwood (1972) says, the profession per
suades the community to institute a licensing system to
screen those qualified to practice the professional skill,
and which will grant a professional title. State govern
ments, through their state boards of nursing, as the ex
amining body, license nurses, and upon passing the examina
tion, the nurse is entitled to use the designation of
Registered Nurse (Kelly, 1975). Police power, the commun
ity's formal approval, enforces the licensing system, and
those practicing the skill of nursing without a license
would be liable to punishment (Greenwood, 1972). The
74
i nurses* code of ethics directs the nurse to safeguard the
I
j patient when his care and safety are affected by incompe-
I tent, unethical, or illegal conduct of any person (Guinee,
■ 1970) .
I
The community grants approval also by acknowledging
the professional privilege of confidentiality (Greenwood,
1970). The nurses’ professional code of ethics directs
nurses to safeguard the individual's right to privacy by
j protecting information of a confidential nature sharing
I only that information relevant to his care (Guinee, 1970).
i The relative immunity from community judgment on technical
■ matters is another of the professional privileges (Green
wood, 19 72) . Standards for performance in the discipline
of nursing are reached within the discipline itself, and
through the nursing organizations (Kelly, 1975).
The discipline of nursing has been granted approval by
the community by acknowledging nursing's power to accredit
institutions of learning through its organizations and
state accrediting boards. The community has instituted a
licensing system for screening nursing applicants, thus,
assuring legal status and the granting of a professional
title. The discipline's privilege of confidentiality has
been assented to by the community, and nursing has been
accorded immunity from judgment on technical matters. The
community has accepted that nursing is best able to deliver
7 5
nursing service and that the discipline is able to be self
regulating.
Summary and Conclusions
This chapter reviewed pertinent literature relevant to
the status of the discipline of nursing as a profession.
'In addition, the discipline of nursing was examined against
_each of the seven criteria utilized in this study and con
sidered to be constituents of a profession. An historical
overview was applied to look at the discpline of nursing
in relationship to the criteria.
' A general overview of the literature showed a dispar
ity between writers from the discipline of nursing and
those outside of the field of nursing. Writers of nursing
literature generally concluded that nursing had met the
criteria established by Flexner, and enlarged upon and
added to by others within the discipline, and had attained
professional status. Nurses found the terms professional
and technical nurse ambiguous, and expressed the need for
clarification in relation to the status of nursing as a
profession. Writers outside of the field of nursing
claimed that the discipline had not met certain criteria
necessary for full professional status. Frequently men^
tioned were the criteria for an advanced and cumulative
body of knowledge, and autonomy in the sense that nurses
were subordinate and dependent upon physicians in carrying
76
' out medical orders. These writers concluded that nursing
I had not reached professional status or should be classed
I as a semi-profession.
! In looking at the discipline of nursing on a profes
sional continuum, certain strong areas emerge which meet
the selected criteria utilized in this study. Nursing ex
hibits strength in a professional ideology, professional
associations, a written code of ethics, self-regulation,
and public sanction.
' There has been some argument as to nursing have a
i distinct and cumulative body of knowledge to serve as a
base for the technical aspect of nursing. Nurses them-
,selves have recognized the need for research and theory
building, and the associations have emphasized and sup
ported research. New nursing knowledge has accumulated
'rapidly and there has been a proliferation of nursing liter
ature in recent years. The criteria for a university edu
cation as a requirement for professional status, has
created controversy for those within and those outside of
the discipline. Although the American Nurses Association
has taken the position that the professional level of
nursing should be obtained in baccalaureate degree pro
grams, individual members of the discipline are not all
convinced of this and the controversy has not been re
solved. Others look at the varied programs which graduate
11 \
'nurses, all of whom are eligible to take the examination
for registered nurse licensure, and are dubious that nurs-
I
j ing satisfies this criteria. Finally, some authors ques-
' tion nursing's claim to professional status on the basis
of autonomy in nursing's relation to medicine. Nurses'
traditional role in following medical orders was shown to
place nurses in a subordinate role. Writers of nursing
literature have pointed out the ever-widening areas of in
dependent nursing practice, and the continual realignment
■ taking place between the functions of the nurse and the
,physician. The concept of autonomy in this study was in
cluded as part of self-regulation. The nursing discipline
functions autonomously in formulation of policy, in control
of policy, through its organizations, and in licensing and
accreditation programs.
Given the seven relatively universally accepted cri
teria as constituents for professional status, and utilized
'in this study, it can be concluded that the discipline of
nursing has shown strength in meeting the majority of those
criteria, and is working to fulfill the few criteria in
question. Therefore, the discipline of nursing is con
sidered to be evolving toward full professional status.
78
CHAPTER IV
NURSING AND GERONTOLOGY
Introduction
The preceding chapter has established that the dis-
i cipline of nursing has been traditionally involved in the
service to the sick and to the well of all age groups.
Nursing specialization has developed both in certain of
the life stages on the developmental continuum, and in
clinical areas. The four time honored specialties in
nursing are pediatrics, maternity, medical-surgical, and
psychiatric nursing (Ducas, 1962). It will be the purpose
of this chapter to review, the trends and interest in geron
tological nursing, and to examine the need for gerontol
ogical nursing.
Trends and Interest in Gerontological Nursing
Geriatric nursing in the United States has evolved
slowly and gradually (Burnside, 1976). M.I. Brown (1971)
states that nursing of the elderly was developed early in
the history of the United States as a family art. Prior to
79
' the middle of the century, nurses applied general prin-
'ciples of nursing to the aged and adapted their care to
,the needs of individuals. When the Social Security Act
was enacted in 1935, money became available to the aged
poor, provided the recipients did not live in institutions,
!
Retired and widowed nurses converted their homes into
boarding houses to accommodate these aged people. These
nurses became the first geriatric nurses in the country
and their homes were the forerunners of present day nursing
homes (Davis, 1968).
I The care of the aged had a low priority during World
War II. There was a slight improvement in the care of the
aged who lived in nursing homes after the war due to each
state establishing minimal standards and licensure of
homes. Nurses who had been managing their own small homes
and caring for the patients alone now became administrators
of larger facilities (Davis, 1968).
More nurses began to identify with geriatric nursing
and were interested in improving their practice. However,
continuing education for geriatric nurse practitioners was
unavailable. In the 19 40's, nursing literature barely
mentioned the older person. There were no textbooks on
geriatric nursing, and research in geriatric nursing was
non-existent. Coupled with the lack of information avail
able to these early practitioners was a sense of isolation
80
' and lack of prestige in the eyes of physicians, other
j nurses and the general public (Davis, 1968).
Opportunities for nurses to give nursing care to the
! elderly expanded. Nurses began functioning in varied
' capacities in extended care facilities, nursing homes,
convalescent homes, senior centers and residential insti-
I
I tutions (Davis, 1968). More nurses were becoming informed
' about the aging process, and becoming skilled in the many
i aspects of nursing of the aged (Davis, 19 68; Knowles,
■ 1965) . The knowledge base for geriatric nursing began to
expand, and some research on nursing needs of older indi
viduals was undertaken (M.I. Brown, 1971; Knowles, 1965).
At this point, it is appropriate to attempt to dis
tinguish between gerontological nursing and geriatric
nursing since both terms appear in the literature, Hodkin-|
son (1966) defines geriatric nursing as entirely a matter !
of looking after elderly patients from the age of about j
, sixty years onward. M.I. Brown (1971) states that geron- |
' I
tological nursing, as is commonly known in this country, '
refers to nursing that maintains and augments the healthy ,
life among persons who are experiencing primarily aging
.changes as opposed to disease processes. Gerontological
nursing draws on the scientific base of knowledge from
■ gerontology and on the health promotional aspects of
nursing. In contrast, geriatric nursing is more often
81
' concerned with the care of the sick, infirm, and disabled
whose health states are greatly influenced by pathological
I
I processes. M.I. Brown (1971) , however, does not propose a
separation of nursing of the aged into gerontological and
geriatric nursing. Rather, she sees geriatric nursing in
a broader context of an interactional process carried on
between the nurse and the aging patient by which the
patient is assisted in solving problems of health, personal
; care, and disability due to aging and related pathology.
I She sees the nursing process carried on with the nursing
I team, the medical care team, the family circle and other
groups. She states the problem solving process is the same
with patients of all ages, but geriatric nursing is unique
in considering the nature of disease common to the aged
group, the physiologic, sociologic, and psychologic changes
; that occur because of the aging process and the increasing
probability of death. The American Nurses' Association's
Geriatric Nursing Division in 19 74 proposed a change in
name to the Division on Gerontological Nursing (Davis,
197 5). A resolution stated that the term geriatrics means
the study of diseases of old age; gerontology is the study
of aging. Aging is not a disease, but a normal life pro
cess ; the function of the nurse is to assist the individual
to reach and maintain optimum function throughout the pro
cess of aging ; carrying out medical treatment regime is
82
I only one of the seven functions defined by the American
I Nurses' Association (Davis, 1975 X The name of the Divi
sion of Geriatric Nursing was changed to the Division on
' Gerontological Nursing by the official vote at the American
Nurses' Association's convention in 1976 (Name of Division,
no author, 197 6).
The term geriatric nursing was used in earlier writ
ings, and seemed to denote a concern for the care of the
; elderly sick and disabled. Gerontological nursing is a
I more encompassing term in which nursing looks at the
healthy aspect of the elderly individual, with the know
ledge that age changes are not disease processes. Some
writers use the two terms interchangeably, but the trend
is toward use of the term "gerontological nursing."
A steady increase in numbers of publications dealing
with gerontological nursing was reported by Basson (1967).
Between the years of 1955-1965 there were over 500 journal
articles and 80 books published. The greatest number of
' publications were in the health, disease and care cate
gories, with about one-third in the health services cate
gory. Later publications of this ten-year span were con
cerned with psychological aspects of geriatric nursing
with a decrease of those dealing with direct nursing care
or the social variables of patients' needs or care. Atten-;
tion given to nursing education for geriatric care were few
8 3
'in number, and during this ten year period, there was a
paucity of theoretical development (Basson, 1967). A tabu-
! lation of geriatric articles from the Cumulative Index to
Nursing Literature by Burnside (1976), showed a steady in
crease in numbers of publications from 19 56 when 32 arti
cles were published until 196 7 when 110 articles were pub
lished. An irregular pattern in the number of geriatric
articles appeared between 19 6 8 and 19 7 4 with a high of 105
articles in 1971 and a low of 50 articles in 1974.
i
As more nurses began working with the elderly, litera-,
I
; ture reflected the concern with the qualities and skills
that a geriatric nurse should possess. Keith (19 75) and
Laurice (1966) stated that the geriatric nurse must be a
very special type of nurse. The qualities a geriatirc
nurse should have according to Keith are: (1) maturity
which denotes emotional stability and understanding;
(2) empathy to understanding the loneliness and problems of
older people ; (3) a sincere love for people for the older
person is quick to recognize insincerity; (4) emotional
objectivity to reduce personal reaction to death ; (5) un
derstanding of nursing techniques involved in diseases and
the general care of the geriatric patient. Newton and
Anderson (196 6) add the qualities of a sense of humor,
tolerance, patience, tact, flexibility, optimism and the
ability to understand the need for privacy and personal
84
: independence of the older person. Burnside (1976) said
; that empathy and sensitivity are crucial components in
' care of the elderly. She reasoned that there is a slower
I pace and a different attitude needed for the nurse who
I works with the elderly, and that all nurses are not pre
pared for this type of nursing. Laurice (1965) also con-
: tended that not every good nurse is qualified to care for
I the aged, and advised nurses to examine their viewpoint on
1 aging, the aged person, and death.
Hodkinson (1966) pointed out that nursing the elderly
requires the nurse to possess knowledge and special skills
'because of the multiple pathologies especially common in
the elderly. The nurse must demonstrate responsibility
for the care of the chronically ill patient, for it is the
nurse rather than the doctor who bears responsibility for
the day-to-day care. The knowlege and skill required by
nurses caring for aged persons, as seen by Anderson (1971)
is the ability of nurses to recognize, nuture, respect,
and challenge the ability of the aged person to cope with
problems, to reason and decide for himself, and to act
appropriately. Anderson (1971) said nurses* knowledge of
: some of the characteristics common to aging should be re
flected in the plan of nursing care, and that there was a
I
i greater need for continuous planned care for older persons
than for younger ones. Kaplan (1974) took the position
85
I that the registered nurse who has been trained in the
I general hospital with the emphasis on short term care
! would not be equipped to cope with the demands of long-term
I care patients. He predicted that nurses without special |
training would have difficulty in dealing with the intensi-;
fied family involvement, and growing attachment or dis
enchantment with long-term care patients. In addition,
the knowledge that a higher percent of long-term care
I patients, compared to short-term hospital patients, would
i not become well would have to be dealt with by the nurse,
I Nursing educators were the first to recognize the
possibility of improving geriatric nursing practice by
providing increased opportunities for students of nursing
to learn gerontological and geriatric nursing (M.I. Brown,
1971; Davis, 1968). In 1959 St. Anselm's College in New
Hampshire realized that gerontology and geriatric nursing
were expanding fields of health and developed a short
course for senior students in gerontology (Routhier &
deLourdes, 1959). However, teachers of practical nursing
programs were the first to introduce geriatric nursing into
their nursing cUrriculums recognizing that the licensed
practical nurses would be employed to care for the aged in
nursing homes. Programs in collegiate schools preparing
students for registered nurse practice, on the other hand,
had little content in geriatric nursing (M.I. Brown, 1971).
.8 . 6 :
'Moses and Lake (1968) surveyed the extent of geriatric
• nursing content in baccalaureate, nursing curriculums and
I found that geriatric nursing received little attention in
the schools of nursing. They recommended inclusion of
gerontological aspects for the basic education program,
extension courses and workshops for practitioners, and
masters' degree programs to prepare clinical specialists
and nurse educators. Raheja and Beniger (1976) also re
commended that material on aging be presented in geriatric
i
curriculums and continuing education in gerontology should
; be encouraged. They added that use of nursing homes and
extended care facilities for clinical practice should be
,increased, and that gerontological nursing groups should
be initiated in the State Nurses' Associations. A plea to
include gerontology as a mandatory subject in the nursing
■ school curriculum was made by Wister in 19 76 at the Phila
delphia Geriatric Center Conference. Two hundred nurses
'and representatives from geriatric agencies from five
eastern states and the District of Columbia heard authori
ties discuss features of nursing for the elderly. Brody
'called on all professional schools to give the same
attention to aging in their curriculums as that given to
other phases of the life cycle, while Fada termed geron
tological nursing to be the most creative and demanding
specialty of the nursing profession.
. 8 . 7 .
Although educational opportunities for nurses to
learn about the aged have been limited, many schools in
I recent years, have tried to offer gerontological courses
at both the graduate and undergraduate level. Burnside
(1976) cites masters' degree programs in gerontological
nursing programs at Duke University and the University of
Arizona. Geriatric nurse practitioner programs are of
fered at the University of Colorado, Denver; and Texas
Women's University. The School of Nursing at the Uni
versity of California, San Francisco, will study the ex-
, panded role of the nurse in rehabilitative nursing. Also,
from California, recent reports indicate that the Uni
versity of California, Los Angeles, has started a new
program in Gerontological Nursing to prepare clinical
specialists in nursing care of the aging (New Nursing
Program, 1976, no author), and the Department of Nursing,
California State University at Long Beach, will start a
masters' degree level geriatric nurse practitioner in
Spring 1977 (The Department of Nursing, 1977).
Closely allied to education and practice is the recog
nition that many students and practitioners continue to
reflect negative attitudes about the aged, and regard
nursing care of the aged ill as low status employment.
Students' initial involvement with the aged ill sometimes
are unpleasant, traumatic experiences which account for
8 8
! negative attitudes (Burnside, 1976 ; Davis, 1968). Burnside
(1976) states that it is generally agreed that the student
I
I nurse should be exposed to the alert elderly person before
dealing with the aged person with complex nursing problems.
De Lora and Moses (1969) , in a study of specialty prefer-
,ences, found that few baccalaureate students stated a pre
ference for geriatric nursing. Baccalaureate nurses were
found to have a less positive attitude toward the aged than
did licensed practical nurses (Gillis, 1973). Huskin (1970)
'pointed out that geriatric nursing had little appeal to
Î young promising persons even though they were committed to
nursing as a profession.
I Burnside (1976) spoke of the negativistic attitude in
the profession. Lack of interest in the aged person and
the shortage of nurses may have caused the problem of
,poorly qualified nurses caring for the aged. Those nurses
working in nursing homes and geriatric units stated they
were being regarded as second-class nurses, Huskin (1970)
said that registered nurses who worked in gerontological
settings often commented upon the low status of the spe
ciality, and the difficulty they met in attempting to re
cruit nurses in this area. E.L. Brown (1970) deplored that
the nursing profession had shown little interest in the
aged and in long-term care, and stated that there was no
other field in the health services where nursing leadership
89
was so much needed as in the care of the aged.
This lack of status in the eyes of physicians, nurses,
, and the general public, and a sense of alienation caused
, early practitioners in geriatric nursing to appeal to the
American Nurses' Association (Davis, 1968), In response
to the appeal, a Conference Group on Geriatric Nursing
Practice was initiated by the Association in 19 62, and in
19 66 the Division of Geriatric Nursing Practice was estab
lished (M.I. Brown, 1971; Davis, 1968). Starting in 1968
: the Division began developing standards for geriatric
, nursing with the premise that knowledge and theories of the
aging process must be inherent in the standards if their
application was to improve the cate of the aged. The Divi
sion of Geriatric Nursing Practice also published a pamph
let entitled "Guidelines for Short-Term Continuing Educa
tion Programs Preparing the Geriatric Nurse Practitioner,”
The Division advocated a theoretical background in aging
to dispel attitudes of stereotypes about aging and to
stimulate nurses' interest in working in nursing homes
(Standards for Geriatric Nursing, 19 70).
The American Nurses' Association continued to promote
improvement in geriatric nursing practice in other ways.
A certification program to recognize geriatric nursing
practitioners of superior performance was developed
(M.I. Brown, 1971), and the first certification examination
9 0
for geriatric nurses was given in 19 74 (ANA Gives Certifi
cation Examination, 1974). Certification is based upon
I
, the applicant's knowledge of the aging process, and com
petence of geriatric nursing practice based on this know
ledge (M.I. Brown, 1971). The certification process con
sists of an examination, vouchers, and an evaluation of
experience and original work with application made directly
to the American Nurses' Association Certification Unit
(American Nurses' Association Certifies 63, 1976). As
noted earlier in this chapter, the name of the Division on
, Geriatric Nursing Practice, whose certification board is
' responsible for certifying candidates, was changed to the
’ Division on Gerontological Nursing (Name of Division, 1976).
The Association also started conferences on care of the
aged. A series of forty conferences for registered nurses
working in nursing homes were structured to deepen the
participants awareness of the physiological, psychological
and social factors affecting care of the aged (ANA Begins
Conferences, 1973).
In addition to working toward improvement of geriatric
nursing practice, the American Nurses' Association publicly
supported legislation that provided health care to the aged
(M.I. Brown, 1971). In 1958, the delegates of the American
Nurses' Association adopted a résolution that the Associa
tion supported the principle of extending and improving
91'
' contributory social insurance to include health benefits
I for recipients of old-age, survivors, and disability in-
I
i surance, and that nursing services be included as a benefit
of any health insurance program (The 195 8 Convention,
195 8). This action occurred at the time the American
Medical Association and the American Hospital Association
were opposed to a bill introduced by Representative Forrand
to make hospital insurance benefits available for the aged
through Social Security (Hospital Insurance Benefits, 1958).
I
'In 1960, the American Nurses' Association reaffirmed the
I 1958 stand to extend the Social Security system to include
health insurance coverage for the aged, retired, and dis-
,abled in whatever program would be adopted (The 1960 ANA
Convention, 1960). The passage of the Medicare Act --
health insurance for the aged provided under Title 18 of
the Social Security Act of 1965, has not deterred the
American Nurses' Association from emphasizing the need for
a comprehensive national health insurance program. The
Association's Committee on Skilled Nursing Care recommended
to the Senate Sub-committee on Long-Term Care that a plan
for national health insurance should be developed for all
citizens, and that a distinction be made between health
care and medical care (ANA and Senate Sub-committee, 19 75).
The president of the American Nurses' Association appeared
before the Democratic Platform Committee and the Republican
92
I Party Platform Sub-committee and recommended a national
I health insurance program to improve the care of the
elderly. She also urged the development of alternatives
I to hospitalization and nursing home care such as day care
and home care for the older adult (ANA President Testified,
1976).
The American Nurses' Association has been active in
voicing concerns and in offering recommendations to govern
mental bodies in reference to the aged, and those who care
' for the aged persons. In 19 72, representatives from the
, Association appeared before the Senate Sub-committee on
Aging and took the stand that it was important to consider
the quality of existence in the years prior to death. The
recommendation was made that the aging process must be ex
plored and understood so that the goal of improving the
; quality of life of the aged might become a reality (Older
Americans Act, 1972). A major paper entitled, "Nursing in
Long-Term Care Toward Quality Care for the Aging, was pro
duced by the American Nurses' Association's Committee on
; Skilled Nursing Care. This paper was incorporated into a
'special Senate report, and it made five recommendations to
the Sub-committee on Long-Term Care of the Special Commit
tee on Aging. These recommendations were :
1. The elderly should have the right to
high quality care in their choice of
93 :
setting, and there should be a de
velopment of a national policy on
care of the aging.
2. Development of a plan for national
health insurance plan for all citizens^
with a clear distinction between health
care and medical care.
3. Availability of a wide range of health
and supportive services to all elderly
persons, including nursing home care,
home care, and out-of-home care.
4. Deletion of the term ’ ’skilled nursing"
from federal standards since it is not
measurable, nor defined in relation to
patient needs.
5. Develop and strengthen the educational
programs of registered nurses at all
levels to remedy specific deficiencies
in the area of gerontological nursing,
in addition, a background in the basic
care of the aging should be required
of all professionals and workers involved
in long-term health care.
The Association's report as well as the Senate report
pointed out that of the 815,000 nurses practicing in the
94
'United States, only 65,235 could be found in the nation's
'2 3,000 nursing homes. The reasons given in the report for
I the small number of nurses working in nursing homes in^
eluded the poor image of nursing homes, poor working condi
tions, and low job satisfaction. Coinciding with these
reasons, there was the failure of schools of nursing and
federal government programs to stress geriatrics in nurse
training programs, and the general dissatisfaction with the
■ role of nurses in the nursing home settings CANA and Senate
Sub-committee, 19 75).
Thus, the American Nurses' Association, the official
organization for registered nurses, has recognized and sup
ported the need to improve nursing cate of the elderly, as
well as the need to include gerontological content in edu
cational programs for nurses. Nurse practitioners caring
for the elderly have consistently worked to improve within
their specialty, and struggled to elevate their status.
Educators, too, have made efforts to increase students' ex
posure to gerontological nursing. However, many student
nurses and graduate registered nurses have not looked upon
gerontological nursing as a desirable or needed specialty.
In the preceding section, the evolution of gerontological
nursing, and the interest and trends in that field was pre
sented. The following section will investigate the need
for gerontological nursing.
95
Need for Gerontological Nursing
' Increasing number of persons are living to 65 years
I of age and older, and people are living more often into
the oldest ages. This steady increas of numbers is sig
nificant because of the fact that long-term illness and
disability constitute the bulk of health problems of adults
in their later years (Working with Older People, 19 74).
Loether (197 5) states that 86 percent of Americans aged 65
I or older are afflicted with one or more chronic diseases
I compared to 72 percent of those between 45 and 64 years of
I age. In addition, older persons are more likely to suffer
’from a multiplicity of ailments. Consequently, there is a
great need for therapeutic and preventive health services.
Acute illness and accidents are also numerous. In 1969,
95 out of every 100 persons, 65 and over suffered from
acute illness or accident. Mental illness in the elderly
population accounted for 30 percent of the total population
of patients in public mental hospitals in 1968.
The elderly have more admissions to hospitals and stay
,longer. They have a higher utilization rate and are prime
! users of nursing homes, long-term care facilities, and of
home health services in the future (Working with Older
People, 1974). Wister (1976) stated there were 1.2 million
long-term beds in this country, exceeding the number of
beds in acute care general hospitals. Trager (19 72) noted
96
! that 5.75 percent of the elderly population was homebound.
' I
I
! An increased use of medical services and of drugs can be i
; expected. Medicare, Medicaid and other health plans are i
j I
I easing financial barriers to health care, and there will bel
I I
I an increased demand for services from physicians, nurses,
and others (Working with Older People, 1974). Wister (1976)
' reported that old people now constitute 80 percent of those
. served by the nursing profession in the United States.
I The American Nurses' Association made the statement |
I I
i that it recognizes the necessity of expanding the practice 1
of nurses in geriatrics if the availability, accessibility,:
and quality of health care services to the aging are to be |
increased and improved. The Association also stated that |
the skills inherent in both nursing and medicine should be
i
' used more efficiently to meet health care needs of the
aging due to intensified awareness of the health needs of
aging persons, rapid advances in technology and specializa-:
I
tion, and an increase in consumer demands (Guidelines for j
Short Term, 197 4). i
Therefore, there is an increasing number of aged per-
sons with their concomitant illnesses and disabilities.
There is a high utilization of health care and medical
facilities, and an increased use of health and medical
services by the elderly. The existence of health plans and
insurance ease the financial barriers to health care. Be-
97
' cause of these reasons, it is apparent that the demand and
! the need for gerontological nursing exists and will con-
I tinue to increase. Not only will practitioners, possessing
the knowledge of gerontological concepts, be required, but
there will be an increased need for educators to impart
gerontological knowledge and skills to both nursing prac-
tioners and to nursing students.
Summary and Conclusions
Gerontological nursing has evolved slowly, but in
I
j recent* years interest and involvement in the field has
I
' accelerated. Gerontological nursing practice is develop
ing , but concern has been, and is being, voiced by educa
tors and others at the limited amount of content in the
professional school's curriculums. Publications are on the
increase, and along with a small amount of research, a body
of knowledge is being formulated. A recurrent theme in the
literature has been the lack of interest and negative atti
tudes shown by registered nurses and student nurses toward
the nursing care of the elderly. The American Nurses'
Association develops and supports programs in gerontolog
ical nursing service and education. It is active in pro
moting legislation and in working with government bodies to
enhance the quality of life for elderly persons, and to pre
sent and define the role of gerontological nursing.
It can be concluded that nurses, as individuals, and
98 '
i the discipline in general, show a concern for the problems
of the aged, and are beginning to perceive the importance
,of gerontological concepts in nursing practice and nursing
education. As individuals, and through their professional
organizations, they are working to bring about changes
which will improve the quality of services and programs for
an elderly population.
99
CHAPTER V
THE PROFESSIONAL STATUS OF GERONTOLOGY
Introduction
According to the operational definitions within the
, context of this study, a discipline meets professional
standing if it meets with established criteria. These are;
(1) body of knowledge; (2) university education; (3) pro
fessional ideology; (4) professional association ; (5) code
of ethics; (6) self-regulation; and, (7) public sanction.
Ostensibly, medicine, nursing, and social work can be con
sidered professions, whereas, public administration, coun
selor education, and adult education indicate that they
are moving toward professional standing. Since increasing
demographics and longevity have made the elderly a signifi
cant and recognizable aggregate in our society, it is ques
tionable whether or not these disciplines can adequately
meet the needs of the aged. The field of gerontology could
address itself to these needs and has the ability to imple
ment and provide for a uniform system of research, educa-
100
tion, and service delivery.
The following chapter will examine the historical
trends in the field of gerontology, will support the need
for gerontology, and will examine whether or not geron
tology meets professional status according to the desig
nated criteria.
Trends of Gerontology
Gerontology, according to Breen (1970), is a field of
discipline which is no longer than three decades old. It
has taken at least this period of time for gerontology to
be thought of as "a systematic examination of data and
logical sets of conclusions concerning the aging process"
(p. 5). Gerontology has been defined in a variety of ways
and involves a variety of disciplines. Clark Tibbitts
(1960) has helped popularize the term "social gerontology."
Social gerontology focuses upon two points of view: one
view is concerned with the scientific and psychological
forces upon the organism and the other is concerned with
how the environment and organizational structure of culture
influences the individual. Breen (1970) identifies five
separate stages in the development of gerontology as a dis
cipline. These include : the philosophical stage, bio
logical stage, psychological stage, social stage, and polit-
.ical stage.
Philsophical concern in aging dates back to Aristotle’s
101
time. Lengthy dialogues of Aristotle, Cicero, and Homer j
reflect upon the interest and concern of growing old.
Cicero’s "De Senectute" (106-43 B.C.) addresses the prob
lems of old age and expresses that it is a time of joy
rather than a time of despair. I
The biologic interest in aging dates back to the |
I 1800’s. Birren (1970) credits Quetelet as the first geron- |
; f
:tologist. However, it was not until the late 1930’s that
an avid interest in aging began. During the 1930’s the j
'number of individuals age 65 increased 35 percent as con- |
trasted with an increase in the general population of 7.2 ;
percent (Birren, 1970). In 19 39 a group of British scien
tists became interested in age related changes in cells,
organs, and tissues, and decided to form an International
Club for Research on Aging (Tibbitts, 196 0). The publiea- '
tion of Cowdry’s Problems of Aging in 1939 and the estab
lishment of the Gerontological Society in 1945, illustrates i
I ‘
the growing interest in the biological aspects of aging '
Kleemeir, Havighurst & Tibbitts, 1967).
Psychological interest in the elderly evolved with the
development of institutional facilities. Long-term care
facilities and interest in "senility" promoted the awareness
of the mental health needs of the elderly. The first
i 1
marked contribution was Stanley Hall's book on Senescence, |
^ !
published in 1923 (Kleemeir et al., 1967). The first i
i
I
I
1
10 2
I systematic attempt to investigate the psychological aspects
■ of aging, however, occurred when the Stanford Later Matur-
I
I ity Research Project conducted a study (Tibbitts, 1960),
Social interest in the aging began when increasing
numbers of aged affected various aspects of society,
I
Issues such as housing, economics, and health became press
ing social concerns. The establishment of the Journal of
Gerontology in 1946 ennumerated problems of aging in the
social science areas. The National Conference on Aging,
' furthermore, was organized in 19 50 and was devoted to so*-
; cial economic and related aspects of aging.
The political stage of gerontology developed in the
mid-thirties. While primarily an economic issue, the So
cial Security Act of 19 35 was also indicative of political
interest in aging. A year before, Simmons published a
work entitled. The Role of the Aged in Primitive Society
' and provided a basis for comparing the elderly in agricul
tural and industrial societies. In 194 8 a report on Social
Adjustment in Old Age indicated that sociologic interest
in aging was beginning to carry itself through the develop
mental stages of life. The 1950's furthermore, revealed a
proliferation of publications and continued research. At
this time eight sections of the first National Conference
on Aging was organized and the Inter-University Training
Institute in Social Gerontology was conceptualized and sup-
103
; ported (Tibbitts, 1960).
In 1965 the first White House Conference on Aging and
the passage of the Older Americans Act provided for the
I Administration on Aging and the Social Security Amendments.I
; In addition, the establishment of the National Retired ,
Teacher's Association, American Association of Retired Per-'
, sons, the National Council on Aging, the Senate Sub-commit-'
tee on Aging, National Center on Black Aging, and the
; National Institute on Aging, are indicative of the growing
; interest and stature of the field of gerontology.
Documentation of Needs
The need to address the aged and their problems is
becoming more apparent. Kleemeir (1965) states that to
day's belated attention now given to the problems of aging
and the aged is a product of different perspectives of view
ing the elderly, rather than the significant increase in
the elderly population. Due to changing perspectives and
, demographical statistics, the fact remains that there is a
need for specialized training in working with older adults.
Krauss (1963) and Kleemeir (1965) further substantiate this
need. Krauss states that it is obviously becoming more
evident that meeting the needs of the aged require a spec-
cialized body of knowledge in modern society. Kleemeier
adds that there is both a need in society and science for a!
major visible investment of effort directed toward the ■
104
■ solution or alleviation of the problems of aging. Certain
I
I problems, areas, methods, techniques, knowledge, profes-
i
I
; sional personnel, and institutions should clearly be seen
i as having an intimate, predominate, or exclusive concern
for aging with different disciplines contributing to a
central area of concern.
The need for special training in the area of aging was
identified by the White House Conference on Aging in 1961.
I A committee concerned with the role and training of pro-
^ fesional personnel designated four occupational groups
; which they felt needed gerontological training. These in-
' elude: (1) Medical Services; (2) Social Work; (3) Educa
tional, Religious, and Recreational Services ; and, (4) En
vironmental Planning and Administration. In addition,
Clark Tibbitts (196 7) describes the following four cate
gories of personnel needed to work with the aged :
(1) direct providers of services; (2) planners, administra-
' tors and program directors; (3) researchers ; and (4)
teachers.
Present economic, housing, health, and legislative
trends further support the requirement for gerontological
training. The spread of technology and an industrial
economy have presented unforeseen problems for the elderly.
Retirement income for a person over 6 5 is provided by the
Social Security Act, The original intent of Social Secur-
105
' ity was to help the elderly meet the risks of old age and
unemployment (United States Department of Health, Education
and Welfare, 1973). Until recently, coverage excluded
' governmental, agricultural, domestic, casual and non-profit
employees, and the self-employed. In the 19 70's, however,
coverage has been broadened so that 90 percent of the popu
lation 65 and over is eligible for Social Security benefits
(Fitzpatrick, 1975). Thus, Social Security is presently
, the major source of retirement income. The 1968 study in
dicates that over 60 percent of aged units received no
other periodic retirement benefits (Koladrubetyz, quoted
by Fitzpatrick). Private pensions were received by only
12 percent of the aged and these generally were people who
received higher Social Security benefits, as well (Fitz
patrick, 1975). Although Social Security benefits have
increased within recent years so has the cost of living and
it is doubtful that the elderly can meet rising food costs,
taxes, and medical expenses.
The enactment of the Supplementary Security Income
Program has provided additional monies on the basis of
"need" rather than right. Presently, maximum Supplementary
Security Income payments in the State of California are
$259 for an individual and $488 for a couple. Payments
vary, however, according to living arrangements and dis
abilities. In addition, not all eligible people get the
106
' maximum payment amounts if they have other income. Conse
quently, a substantial gap between minimum benefits and the
i
I
i living costs of the elderly exists.
In 19 74, the median income for all American families
was $12,836, while the median income for families 65 or
orlder was $7,29 8 (Current Population Reports: Special
Studies, May 1976). Realistically, approximately 50 per
cent of the elderly are poor and have incomes less than
’ $3,000 (United States Congress House Select Committee on
I
' Aging, March 19 76) . Low income makes home ownership and
; maintenance of homes difficult. As costs for repairs,
utilities, and property taxes rise, the elderly find them
selves with a lack of resources. It was projected that by
1976 about 8.3 million elderly people would be living in
3.7 million sub-standard housing units (United States
Congress House Select Committee on Aging, March 19 76).
The steady increase in the elderly population affects
health trends. The elderly utilize health services more
frequently since the rate of hospitalization and length of
hospital stay both increase with age. One out of every
four persons is likely to be hospitalized within a given
period, and approximately 71 percent of persons 6 5 or older
visit a physician at least once a year (Loether, 1975).
Twenty-eight percent of the $80 billion spent nationally
for personal health care in 197 3 was for older persons who
107
I constitute only 10 percent of the population. The per
I capita health costs for an older person is $1,0 52 as com-
I
I pared to $385 per capita for younger adults (United States
Department of Housing Education and Welfare, 19 75), Medi
care insurance helps pay for hospital stays and certain
post-hospital care of people 6 5 and over. As of January 1,
1977, the elderly are responsible for $124 deductible and
are covered for 60 days. For a hospital stay over 60 days
the patient will pay $31 a day for services. What this
'means is that the elderly will be responsible for paying
, 28 percent of doctor bills and related medical expenses and
the government will pay the balance (Medicare Increase,
January 1977). This does not include, however, medical
costs of the elderly not covered by Medicare or Medi-Cal.
Legislative trends also indicate that an interest in
the elderly is ever-growing. Governmental bodies such as
the Veterans Administration and the National Institute of
Child Health and Human Development, the Administration on
Aging, United States Senate Special Committee on Aging,
Social Security Administration, and Area Agencies on Aging,
are indicative of the interest in the elderly.
Gerontology, hence, can provide a distinctive educa-
!tional and research-oriented discipline which deals speci
fically with the phenomenon of aging. Social, economic,
and legislative trends document the needs for specialized
108
I training in working with the aged and promotes the status
!
I of gerontology towards professionalism.
I Professional Criteria
; Body of Knowledge : Gerontology
To state that gerontology does not have an identifi-
' able body of knowledge would be erroneous. Kleemier,
Havighurst, and Tibbitts (19 6 7) note "the body of special
ized knowledge is there and is accumulating." (p. 39) The
task is to put it into a coherent framework rather than
, parcel the knowledge to other disciplines. The issue,
' hence, is not that social gerontology fails to meet the
criterion of a recognizable body of knowlege. The issue
is whether it should be given serious consideration as a
separate discipline.
Traditionally, gerontology is a multidisciplinary
, field, thereby borrowing knowledge from the sciences and
social sciences. As previously mentioned, the historical
' development indicates the accumulation of theories, know-
I
ledge, and research. Breen (1970), Birren (1970), and
Tibbitts (1960) have documented the accumulation of know
ledge in the fields of philosophy, biology, sociology,
physiology, and politics.
University interest in gerontology dates back to the
1950's when several universities initiated gerontological
programs. Cornell University developed programs in educa- 1
10 9
!tion, industry, and business; the University of Chicago was
I
I an innovator in pre-retirement programs ; and, Duke Uni-
I versity brought various departments in the university to-
!
Igether to examine problems of the aged. In addition, the
University of California developed a research program, the
University of Iowa developed a Gerontology Institute, and
the University of Michigan started its Institute of Geron
tology. Each of the schools have done much to increase
I knowledge in the gerontological field.
Recently, the University of Southern California has
j set precedent by establishing a separate School of Geron
tology. The Leonard Davis School of Gerontology is dedi
cated to developing and identifying a distinct set of
theories, methodologies, and principles which form the
technical base of professional practice. It offers courses
which concentrate on biological theories, developmental
processes, and psycho-social needs, as they relate to the
aging individual.
The creation of governmental bodies such as the Admin
istration on Aging, the United States Senate Sub-committee
on Aging (19 59), followed by the Senate Special Committee
on Aging, the National Council on Aging (1960) , the Admini
stration on Aging (1965), the National Institute on Aging,
: and the National Institute on Child Health and Human De
velopment, have added several dimensions to the current
110
; body of knowledge. They are subsidizing research, publish-
; ing relevant literature, and have become strong adovcates
I in the field. In addition, the proliferation of publica
tions and governmental grants are also indications of an
ever-growing body of knowledge that pertains specifically
to gerontology.
Professional Education
At present, there are no specific courses required to
be considered a "gerontologist." In the field of Adult
I
: Education, for example, many teachers are considered geron-
' tologists having had no formalized training in the area of
aging. Although the recent Ryan Act (1970) has made re
quirements for receiving a credential much mor stringent
in California, educators of adults are still not required
to take courses which deal specifically with the aging in
dividual.
Nevertheless, there is a growing consensus that a
'university education is necessary in the field of geron
tology. The Gerontological Society, in 1956, sponsored a
conference to consider the problems of training in the
social science aspects of gerontology (Shock, 1957). As a
result, the Inter-University Training Institution in Social
Gerontology was established (Breen, 1970). Shock felt con
cerned that professional workers had not receive adequate
exposure to the aspects of aging. In 19 57 he stated, "there
111
is a definite need for the organization of course material
on our knowledge about aging for presentation to under
graduate and graduate students. More systematic instruction
is imperative if we are to attract potential, competent re
search and professional workers into this field." (p. 175) ,
I
There are several points of view on whether or not
gerontology should eventually become a self-standing dis
cipline or whether it should be incorporated into tradi
tional fields of study. Breen (1970) questions whether one
'can have a separate scholarly discipline in gerontology and
,train specialists in the field. Some educators argue that
training should be at a generalist level in gerontology
with scholarly training and specialization in traditional
fields such as biology or sociology (Breen, 1970), Kuhlen,
Kreps, Kushner, Osterbind and Webber (1967) emphatically
states that specialization is possible and should be re
quired within social gerontology. In 195 7 Kleemeir took
the position that gerontology could be considered a dis
tinctive area of teaching and research. As a separate
entity, he said, it could be contained within the univer
sity with its own administrative authority, faculty, and
academic rights and responsibilities.
Within the last two decades, gerontology has become a
recognized course of study in university education. A
national survey in 19 61 by the University of Michigan on
112 !
I educational activities showed that progress was being made
1
! in the field. From 1958 to 1961, 112 institutions and 116
I
I departments reported on 2 21 research projects in gerontol
ogy, and 137 theses and dissertations were written « The
dissertations were produced in the fields of sociology,
psychology, and human development, and the greatest number
of master's degrees were in the field of social work, A
survey in 19 6 4 conducted by the Gerontological Society,
; identified 159 institutions giving some training in geron-
!tology (Breen, 1970). Of the total number of institutions,
i80 were academic, 40 were medical or professional, and the
rest were agencies. Research programs in gerontology had
199 students enrolled or had completed a program, while
1,0 89 students were in the applied programs. Recommenda
tions were made to increase funding for research and train
ing, and to develop facilities and resources. It was sug
gested that interdisciplinary mechanisms and inter^uniyers-
ity cooperation should be undertaken. Breen (1970) con
cluded that this report held great promise for the future
of gerontology.
In 1967, Donahue identified a number of progra,ms,
* centers, and institutes of gerontology in university set
tings which were multidisciplinary in nature and, in addi
tion to research programs, offered graduate training. Ex
amples given were as follows: Duke Center for Aging Re-
113
' search and Human Development; University of Chicago Program
of Adult Development and Aging; and. University of Southern
I California Rossmoor-Cortise Institute for Study of Retire-
' ment and Aging, and the University of Michigan-Wayne State
Institute of Gerontology.
More recently the expansion of gerontology has spread
to colleges and universities throughout the country. In
19 76 the Association for Gerontology in Higher Education
compiled a directory designed to inform educators, pro
fessionals, and students of gerontology related courses,
I degree programs, research programs, educational services,
and training programs. The study indicates that there are
approximately 1,275 institutions in the United States which
offer gerontology courses. In California alone 104 insti
tutions offer gerontology courses. These institutions may
be community colleges, vocational and technical institutes,
colleges, universities, professional schools, or non-degree
granting institutions (United States Department of Health,
Education, and Welfare, Office of Human Development, Admin
istration on Aging, Fall 1976).
The interest in gerontology is exemplified through the
proliferation of training schools in various institutions.
More colleges and universities are recognizing the future
importance of gerontology. At the same time, however, there
appears to be disagreement as to whether gerontology should
114
! becomes a self-standing discipline. Presently, the major
ity of schools are incorporating gerontology into tradi-
' tional fields of study. Until this issue becomes resolved
I individual institutions will have to decide if a separate
: and distinct school for gerontology is necessary. Thus,
one must conclude that the educational requirements for
I
I gerontology are presently in the state of development
! making a definite step toward professional standing.
Professional Ideology
A professional ideology should center around three
I important aspects : the notion of service, an emphasis on
professional judgment based upon knowledge, and belief in
professional freedom and autonomy (Elliot, 1973). Pre
sently, a formalized written ideology for gerontology does
'not exist. There are indications, however, that the need
I and potential for establishing such an ideology is growing.
' As mentioned previously, housing, health, economic,
and demographic trends support the need for special train
ing in the gerontological field. In the past, governmental
organizations and private organizations have recognized the
responsibility for providing services to the elderly in
these areas, however, as Kleemeir and Birren (196 7) note,
"...while this movement is discernible in many places and
I
agencies, its essential gerontological character tends to
be obscured, becoming identified with the fostering agency.
115
I or in the case of instruction and research programs, with
traditional scientific disciplines," (p. 6) There is a
; need, thus, for "a major, visible and unambiguous invest
ment of effort directed toward the solution o r alleviation
of the problems of aging," (p, 6) Gerontology, as s l self
standing discipline would have a predominant and exclusive
concern with the aged, thereby affirming the ideological
interest in service,
I The study of gerontology has been present as a re-
I search effort for several decades. The need for developing
I gerontology as a separate discipline in the area of
academia, however, has been a recent development. In 1967
gerontology had cursory programs throughout the country.
In 19 75 the University of Southern California established
the Leonard Davis School of Gerontology and set precedent
by establishing a training and research center for the aged
which was housed in a separate school of gerontology. Since
July 19 76 a national directory published by the Association
of Gerontology for Higher Education, listed 1,275 educa
tional programs that dealt with the aged (Watkins, 1977),
Thus, as Weg states, "The study of aging has come of age."
(Weg, as quoted by Watkins, 197 7.)
Since gerontology is so new, the need for qualified
practitioners have been unmet. One can expect that very
few specialists have had gerontological training. Due to
116
' this phenomenon, an emphasis on professional judgment and
the freedom and autonomy to make choices are ideals which
I have not yet been tested and/or attained. The field, as
it exists in academia today, is newborn and those special
ists trained in gerontology are few in number. The in
dications and potential for growth in the field, however,
will eventually lead to more trained specialists who will
be responsible for making sound, professional and autono-
' mous judgments.
I
I
; Professional Associations
In order for gerontology to be considered a profession,
I organizations which set criteria for membership in the
; field must be established. There are presently three
organizations which deal specifically with gerontology.
The Gerontological Society is the organization most com
monly associated with the field. It is the authoritative
voice as author and critic in the formulation of national
policy and reflects upon the status of gerontology in
modern society (Freeman, 19 71). Jerome Kaplan (19 70)
states that the formation of the Gerontological Society in
, 19 45 marks the most significant contribution on a national
scope. The Society is devoted to research on aging and
encompasses training and evaluation of services for older
people. Research is conducted in biology, clinical medi
cine, psychology, social sciences, and social welfare.
117
The Society publishes two journals; the Journal of
Gerontology and the Gerontologist. The Journal of Geron-
tology publishes quarterly reports of original research in
I
: the affiliated fields mentioned above. The Gerontologist
is also published quarterly and carries articles of general
interest in the areas of medical care, recreation, housing,
social welfare, employment and any other area which is re
lated to aging.
The Western Gerontological Society and Association for
' Gerontology in Higher Education are two organizations which
, have primarily an educational focus. The primary goals of
the Western Gerontological Society is to work for the well
being of all older residents of Western states by promoting,
communication, fostering better understanding of gerontol
ogy, stimulating research, and by encouraging professional
preparation for gerontological research*
Currently, neither the Gerontological Society or
Western Gerontological Society have professional require
ments for admission. The Gerontological Society requires
that one complete an application and have two standing
; members sign the form, while the Western Gerontological
Society invites any individual or organization with an in
terest in aging to become a member. Both these societies
represent rudiments of a professional association. How
ever, if the societies are to exist as such, they must be-
118
! come increasingly regulative and set definite standards of
I admission.
I
I In addition to the three organizations previously men
tioned, there are other organizations which have vested in
terests in aging. The American Association of Retired Per
sons, American Association of Homes for the Aging, American
Nursing Home Association, and the National Council on Aging
, are greatly involved with the elderly. The American Asso-
' ciation of Retired Persons was founded by Dr. Ethel Percy
'Andrus in 19 58 and is dedicated to research, counseling and
( correspondence. The organization, furthermore, is volun
tary, non-profit, and non-partisan. The American Associa
tion of Homes for the Aging was founded in 1961 and is
dedicated to improving programs and standards of institu
tions serving older people. The American Nursing Home
Association sponsors educational meetings and seminars ; and,
the National Council on Aging is the leading national vol^
untary agency which provides professional services for
hose concerned with the elderly.
Code of Ethics
Many persons are working within the framework of geron
tology. Up to this point, all have primary allegiance to
their own discipline. If the field of gerontology con
tinues to move along on the continuum of professional
status, and if professionalization is to occur, the neces-
119
' sity of the formulation of a standardized cose of ethics
is apparent. Cox (1976) notes that a lack of formalized
I
I standards of professional conduct severely limits the pro
fessional status of gerontology. Cox believes that the
lack of ethical codes is difficult due to the diversity of
skills, training, and tasks of membership.
The diversity of skills and training is primarily due
. to the nature of gerontology. Gerontology is of a multi
disciplinary nature; that is, a combination of specialized
' fields, and therefore fosters and produces generalists in
I this area. Many people who enter the field are already
working in specialized areas and their gerontological in
terest, therefore, becomes a part of their professional
responsibilities. In addition, the fact that gerontolog
ical associations have an extremely broad-based membership
hinders a stringent code of ethics from developing.
The need for ethical standards is quite apparent. The
: fact that human beings are involved in research and prac
tice mandates that ethical standards be considered. Accord
ing to Eisdorfer and Wilkie (1970) when one utilizes human
subjects in research, three basic elements of technical
practice are involved. These include: consent, confidence
and standard or accepted procedure.
Regulations of standards encompassing gerontology has
not yet come about. Guinee (1970) feels that standards
__12.0
'may only develop when people begin to pay for professional
services. Since there appears to be some question as to
'whether or not gerontology can best provide for the needs
of the elderly, professional services have not yet been
recognized. Thus, people are not paying gerontologists for
services, but are paying those professionals who have
I vested interests within the field. Time and public recog-
■ nition of gerontology as the provider of needs and ser-
'vices for the elderly will support and initiate the forma-
!tion of a code of ethics.
j In looking at an established code of ethics, such as
that of nursing which is presented in Chapter III, there
are certain basic elements which could apply to gerontol
ogy : the idea of services unrestricted by reason of
nationality, race, creed, color, or status; safeguarding
the individual's right to privacy; safeguarding the in
dividual from incompetent or illegal conduct of any person;
'participation in research activities when the rights of
the individual are protected; working with members of other
professions to meet the needs of the public.
Gerontology has not yet reached the point where other .
of the elements apply, but would need to work toward estab
lishment of: maintaining individual competence in practice
for individual actions and in delegating responsibilities ; ;
define and upgrade standards of practice and education;
121
; through professional organizations, establish ^nd maintain
I conditions of employment for high-quality service; re-
I fusai to endorse advertisements or promotion of commercial
I products, services or enterprises. Thus, established pro
fessional codes of ethics can be used as guides if geron
tology is to formulate its own code.
SeIf-regulation
Self-regulation has been operationally defined as the
professional mechanism which maintains the ability of the
discipline to autonomously govern and regulate its membersf
' establish standards of service, enforce the code of ethics,
assume responsibility for disciplinary action, and be
publicly accountable for the actions of its constituency.
At this point in time, there is no mechanism which con
trols self-regulation in the field of gerontology. Since
admission to the Gerontological Society and Western Geron
tological Society is virtually open to all, regulation of
their members is non-existent. For example, many of the
people who work in the field are professionals or semi-pro
fessionals in some other field such as teaching, nursing,
social work, counseling, and so forth. As stated pre
viously, their primary allegiance, thus, may not be
directed towards gerontology. The diversity of educational
background and of services performed is likely to make it
difficult for those in gerontology to meet a standard of
122
' self-regulation which would qualify them as professionals.
I It is possible, as suggested by Finn and Carmichael (1974) ,
j that there will be a division in the field which will be
I broken down as follows : a) a broad group of paraprofes-
sionals of different degrees of skill who work daily with
the aged; b) an intermediate level of semi-professionals ;
and, c) an apex of highly trained academic and scientific
personnel for research and training. Future events will
show whether or not these highly differentiated groups will
' be able to unify to the extent necessary to advance geron- ■
i tology to the level of a profession.
Public Sanction
Since there is no legislation which regulates the
practice of gerontology by means of licensure or certifica
tion , formal approval by the community does not exist.
Nevertheless, an increase in publications, professional
organizations, governmental programs and community ser
vices, indicates informal sanction by the public and a
growing awareness and interest in aging.
Mass media and publications help project an image in
the public eye. Several newspapers, magazines, and journals
are currently disseminating information about the elderly.
The Los Angeles Times, for example, has run a series of
articles on nursing homes, retirement, attitudes and stereo
types toward the aged. Social Security benefits and legis-
123 :
' lation for the elderly, and so forth. Magazines which have
recently published articles dealing with the aged are as
I follows : Saturday Evening Post, Psychology Today, New West,
; Ladies Home Journal, and McCall's. Subjects discussed
dealt with sex after sixty, stress and aging, death and :
I
dying, time and leisure, and housing. Professional
journals also help to relate facts and knowledge on aging.
Examples of these include : Aging, Age and Aging, Long-term
I Care, Educational Gerontology, Journal of Gerontology,
I Experimental Aging, and Research and Current Literature qn '
I Aging.
There are also a number of national and scientific
professional organizations which include an interest in the
aged. The American Public Welfare Association, for ex
ample, has a section devoted primarily to the problems of
I the aged. The National Council for Homemaker Services, the
American Medical Association, Group Advancement of
; Psychiatry and the Adult Education Association also have
divisions working with the aged. In addition, the Division
of Later Maturity, established by the American Psycho
logical Association, the American Sociological Society, and
the American Hospital Association, and the American Geri
atrics Society, all deal with age related issues.
As mentioned previously, governmental interest in the
aged stems back to the 1930's. The Veterans Administration.
12 4.
I on Aging, Commission on Aging, Senate Sub-committee on
I Aging, the Social Security Administration, and Area
I Agencies on Aging help boost the image of the elderly. In
■ addition, the increase in community services for the eld
erly illustrate the increasing importance of gerontological
issues. The following represent a sampling of services
provided in the Los Angeles area: advocacy; counseling and
social services ; health care services ; home services ; in
formation and referral services; legal services ; nutrition
■ services ; outreach; recreation ; and, transportation are
; offered by several agencies. These agencies include : Re
tired Senior Volunteer Program; Los Angeles City Parks and
Recreation ; Senior Citizens Centers ; Los Angeles City
Office on Aging, and so forth.
As evidenced by the increase in public services, aging
is a provocative and pressing issue in our society. How
ever, whether the field of gerontology warrants public
recognition as the provider of services remains an issue
of debate. At present, the term "gerontology" and "geron
tologist" have no specific meaning to the general public.
Measures must be taken to define gerontological terms so
that the public will support the field, as society's advo
cates for the elderly.
12 5
* Conclusion
i
\ It must be concluded that gerontology is currently
I
j recognized as a field of specialty with major educational
and career emphasis still resting within the established
professions. That there is a need for gerontological
training is unquestionable, but whether or not the public
sanctions gerontology as the discipline which best pro
vides for the needs of the elderly remains a controversial
issue. Kleemier, Havighurst and Tibbitts (1967) all agree
' that gerontology as a separate discipline requires pro-
I fessional education and that it can provide specialized
training and skills needed to work with the elderly. In
order to ensure more specialized personnel and quality pro
grams, the following recommendations have been made:
I. Training schools which place an emphasis on
; f
^ gerontology as a self-standing discipline
must be established. Lenzer (1966) suggests
four propositions which will help more uni
versities integrate gerontology within their
system. They are as follows :
1. The establishment of interdisciplinary
research centers at major universities
across the country.
2. Involve distinguished senior scientists
and teachers not currently engaged in
the field.
' 126
3. Imbed aging into the curricula of
university schools and departments;
make curriculum material available
at the least possible cost and in
convenience to such schools; and,
with a minimum amount of disruption of
the existing institutional program.
4. Establish and increase contact with existing
professional associations which help set
standards for members of the profession.
II. If gerontology is to take the route of profes
sionalization, immediate and long range goals
need to be established. These are:
1. Definition of the role and services to
be provided by gerontologistits.
2. Establish an organization with membership
requirements based upon certain minimums
of specialized education and training in
gerontology or establish a core of members
having specialized training within the
framework of existing gerontolpgic^l
societies.
3. Establish committees within the professional
organization to formulate standards of edu
cation and practice with a means of evalua
tion of the standards.
127
4. Evolvement of a code of ethics to
ensure accountability and ;t;esponSi
bil ity for actions of gerontologists.
5. Formulation of a certification pro
cedure to screen for gerontological
knowledge as a basis for practice;
this procedure to be devised by the
organization to protect and maintain
autonomy. Certification can eventually
take the form of governmental licensing
to ensure legal protection and enforce
ment, and to meet the criteria of public
sanction.
Gerontology, thus, lacks some of the designated
criteria needed to be considered a profession. Neverthe
less, a growing public awareness, an increasing number of
elderly persons, and pressing needs indicate that geron
tology has a proclivity towards increasing structure,
standardization, and regulation of the field.
12 8 J
CHAPTER VI
METHODOLOGY
Introduction
As evidenced by the extensive literature review re
search on professions in general, the nursing profession
in particular, and nursings' relationship and responsibil
ity to the field of gerontology, certain issues have been
raised which call for further examination. Chief among
these are the educational aspects in the training of pro
fessionals in the various disciplines, and the licensing
or credentialing mechanisms required for practice by some
of the disciplines. Hence, a major portion of this study
deals with these issues.
In addition to the literature review, the research
design includes an assessment of gerontological content of
curriculums in courses of study leading to a degree in the
following disciplines at accredited colleges and univer
sities in California : adult education, counselor educa
tion, dentistry, law, medicine, nursing, public administra-
129
1 tion, and social work. Other variables taken into account
I
I were : the attitudes of faculty and staff within these
I disciplines toward the inclusion of aging content in their
curricula, and the extent to which licensing or credential
ing boards screen their candidates for knowledge of aspects
of aging. This chapter discusses the methods and procedure:
utilized in collecting the data. Due to the nature of the
survey design, no research hypothesis was formulated by the,
total group involved in the study. Some members of in-
' dividual disciplines (e.g., nursing) developed and tested
1 research hypotheses for their own needs. It is hoped that
future studies in this area will formulate research
hypotheses from the conclusions of this study. For pre
sentation of the material, this chapter has been divided
into four sections : (1) procedures; (2) selection of col
leges and universities for study ; (3) description of survey
questionnaires; and, (4) treatment of the data.
Procedures
The initial step of the researchers was to form groups
to study the eight disciplines in the State of California,
The criteria employed to select the eight disciplines were:
i the discipline related to gerontology and actively or
potentially served older persons ; students participating in
the study were interested in examining a particular dis
cipline. The number of researchers for each discipline are ;
130
i as follows: adult education, two; counselor education,
1 three; dentistry, one ; law, initially three, later reduced
t
i to two, then reduced to one, and finally reduced to none;
medicine, two; nursing, initially two, reduced to and end
ing with one ; public administration, one ; social work,
I
initially three, then reduced to and ending with two. With
two exceptions, the members of the groups used this survey
as a master's project, and each group produced a thesis
' according to their discipline.
' Once the groups were selected, a list of seven steps
,was developed for the researchers to follow Csee Appendix
A). The first of these steps was an extensive review of
the literature on professionalism. This included a generic
review of professions that included: definitions ; cri
teria; development of professions ; responsibilities within
professions, between professions, and to the public at
large. The next step was a similar review of the litera
ture by the groups of their respective disciplines relating
'their disciplines to the previous section. This included a
; history of the discipline and the processes leading to the
development, establishment, and activities of the disci
pline as a profession. The third step was an examination
of the relationship of the individual discipline to the
field of gerontology. The fourth step was a study of the
field of gerontology on the continuum of professional
131
' ■ status that included the material on professions, and an
; examination of gerontology as a developing profession. The
I
j literature reviews on professionalism and gerontology on
' the continuum of professional status were researched by
all members, and later were incorporated into each thesis.
The literature reviews of the respective disciplines and
the discipline's relationship to the field of gerontology
were researched by individual groups and were included in
each group's thesis according to discipline.
The fifth step, consisting of a study of the educa-
, tional institutions and their curricular offerings in
gerontology in each discipline, was then undertaken. In
order to accomplish this, the library and interview ques
tionnaires were developed. Researchers had, by this time,
acquired the 19 76-1977 course catalogues of the schools
being surveyed for each discipline. If the number of
schools was too large to survey, sampling procedures were
incorporated prior to this step. Information from these
catalogues were transcribed to the library questionnaire
by the researchers. A letter explaining the study and a
copy of the interview questionnaire were sent to the deans
or chairpersons of the schools. The letter indicated that
the researchers would contact the dean or a representative
of the dean for either a personal or telephone interview in
order to complete the interview questionnaire. In the
132
' event the letter and questionnaire had been forwarded by
the dean to a faculty member or administrator, an appoint- ■
]
j ment was made with that person. If the letter and ques-
[ tionnaire had not been forwarded, duplicate copies were
forwarded for review by the respondent. Before either the
personal or telephone interviews took place, sessions were
held by the researchers with supporting faculty on inter
viewing techniques. Role playing was used to demonstrate
both the personal and interview techniques.
' A personal interview was made if the school partici-
; pating in the survey was located within a 100-mile radius
of the University of Southern California. Exceptions to
this guideline were made at the discretion of the individ
ual researchers. During the interview, the researcher
transcribed the respondent's answers onto the interview
questionnaire form. The answers were repeated by the
interviewer to the respondent to assure that the correct
answer had been recorded. The telephone interview was used
when the school being surveyed was located beyond the 100-
mile radius, or if a personal interview could not be ob
tained. The protocol for the telephone interview was the
same as that for the personal interview. In some in
stances, the interview questionnaire was completed and re
turned by mail before attempts to make appointments were
made. In other cases, respondents would not submit to in-
133
I terviews, but did complete and return the form.
! Next, a study of credentialing boards, their proce-
j dures, and expectations as related to gerontology was
i undertaken for each discipline. This included information
on the amount of knowledge of gerontological concepts ex
pected of those taking licensing or credentialing examina
tions in order to obtain the appropriate license or accred
itation for each of the eight disciplines. The last of the
seven steps was concerned with conclusions and possible
steps and proposals for gerontology in the future of the
■ surveyed disciplines.
' Procedure for Nursing
A copy of the Interview Data Collection Form, along
with the introductory letter, was sent to the dean or
; chairperson of each of the 19 accredited nursing schools in
California offering a program leading to a baccalaureate
degree or higher. In ten cases the form was forwarded to
' another faculty member. In two cases, the form was com
pleted and returned (California State University, Chico;
San Francisco State University). Of the remaining 17
schools, personal interviews were conducted at six of the
schools; Azusa Pacifica College ; Biola College ; California
State University, Long Beach ; California State University,
Los Angeles ; Loma Linda University ; and the University of
California, Los Angeles. Eleven interviews were conducted
134
with representatives from the schools by telephone. The
representative from one school (Mount St. Mary's College)
although within the prescribed area, preferred a telephone
interview. One school (University of San Francisco) re- :
turned the questionnaire and was followed up with a tele
phone interview for additional information. Telephone
interviews were conducted with faculty representatives from
the following schools : California State College, Bakers
field; California State Universities of Fresno, Hayward,
and Sacramento; Humboldt State University ; Mount St. Mary's,
College ; Point Loma College ; San Diego State University ;
San Francisco State University; San Jose State University ;
and, the University of California, San Francisco.
The California Board of Registered Nursing is the
official body responsible for the licensing ôf registered
nurses in the State of California. A staff member of the
Board office was contacted by telephone, and inquiry made
as to whether gerontological content was included in the
examination required for the licensure of registered
nurses. As a result of the telephone contact, the staff
member sent a booklet outlining laws related to nursing
education, licensure, and practice, and a memorandum re
garding continuing education for relicensure. This mater
ial was incorporated into the appropriate section of this
study.
135
! Selection of Colleges and
I Universities for Study
: Accredited California institutions of higher education
offering courses of study leading to degrees in the eight
disciplines served as the population for this survey. All
of the departments of the eight disciplines were surveyed
unless special conditions applied. For example, if the
,total number of schools was too great to be sampled, sampl
ing techniques were instituted. Therefore, specific sam-
jpling procedures varied by discipline, and are defined by
t
each group surveying their respective disciplines. The
dean of the school, department chairman, or program director
'served as the initial contact for the study. In the event
this person was unavailable, subsequent contacts were made
with a representative of that person.
Selection of Nursing Schools
There are 8 4 schools of nursing accredited by the
,Board of Registered Nurses in California which offer pre-
service 'programs in professional nursing. Of the 84
schools, 19 colleges or universities offer the baccalaure-
I ate degree or higher in nursing, 60 community colleges
offer the associate degree, and five hospital schools offer
the diploma in nursing. The study of the field of nursing
was limited to the 19 schools offering the baccalaureate
degree programs because the American Nurses' Association
136
* recommends the baccalaureate degree for professional stand
ing . It was further felt that it would not be possible to
, thoroughly examine all 84 nursing programs (see Appendix B
for a list of schools).
Interviews were obtained from representatives from all
of the 19 schools. Of the 19 persons interviewed, eight
were deans or chairpersons, and 11 were appointed faculty
representatives. Of the 11 representatives, at least
seven had some involvement or interest in the field of
: gerontology.
Description of Survey Questionnaires
As a result of extensive literature reviews on pro-
: fessions in general and the eight disciplines included in
the survey, two questionnaires were developed by a student-
facuity group to obtain factual and attitudinal information
■ from the schools granting degrees in the eight disciplines
used in this study. The library questionnaire, the "In
formation Collection Form," was completed by the research
ers using 197 6-1977 course catalogues from the department
of the college or university being surveyed (see Appendix C
for library questionnaire). There were several reasons for
the researcher completing the library questionnaire :
(1) to familiarize the researcher with the school and de
partment being surveyed; (2) to enable the researcher to
137
' approach the interview with a knowledge of the school and
department so that rapport and cooperation with the re-
i spondent was established; and, (3) to lessen the length
and time involved in completing the interview question
naire, the "Interview Data Collection Form" (see Appendix D
I
for interview questionnaire).
The primary goal of the survey is to assess the avail-
' ability of gerontological material and gerontological ex-
i posure students receive in the schools offering degrees in
I
! the eight mentioned disciplines. The questionnaires were
; t
\ developed in order to gather information in the following
areas: degrees offered, courses with gerontological con
tent, field practicums, student population, faculty popula
tion, continuing education, instructor membership in geron
tological societies, dissertations and theses written in
the field of aging, age related journals subscribed to by
the school library, plans for future gerontology courses,
training of instructors in gerontology, and attitudinal
questions about the importance of gerontology to the
school.
The Information Collection Form. Information was ex
tracted from the 1976-1977 course catalogues by the re
searchers and transcribed to this form. The variables in
the questionnaire are : types of degrees/certificates
, offered by the department, courses in the departmental
138
' curriculums indicated in the course catalogue that contain
I content related to gerontology, requirement by the depart-
t
I ment of a field practicum/internship/traineeship, student
population of the institution, faculty population of the
department, number of faculty holding doctorates within
I
the department, researcher's rating of the incorporation
of gerontology within the departmental curriculum, con
tinuing education offerings by the department, and con
tinuing education courses with gerontological content.
! The Interview Data Collection Form. The interview
, questionnaire was developed to collect information not
readily available in the course catalogues. An interview
with the dean or chairperson or an appointed representative
was the basis for completing the form. The variables in
cluded in the questionnaire are; number of students en-
' rolled in the department, courses offered within the de
partmental curricula that contain gerontological content,
. instructors' membership in either the Gerontological
Society or the Western Gerontological Society, number of
agencies used for field practicums, number of students in
field practicums, agencies that provide students with the
opportunity to work with or on behalf of older adults,
number of doctoral dissertations and master's theses re
lated to aging and completed since 19 71, aging journals
subscribed to by the school library, future plans for
139
I gerontological courses, percentage of department faculty
! who teach aging related courses having had gerontological
I
I training, and three attitudinal questions about the im-
I
: portance of gerontology to the department curriculum, the
discipline, and to the future of the discipline. ,
In order to determine the realiability or dependabil
ity of the three attitudinal questions (#5, 6, 12) on the
interview questionnaire, a stability or test-retest inter
pretation of reliability was tested in the following
manner. The three attitudinal questions were reproduced
, on a single sheet of paper and were administered to fifteen
graduate students from a University of Southern California,
Leonard Davis School of Gerontology research design class.
The subjects were given no more information other than to
answer the three questions in relation to their own dis-
, cipline. A week later, a retest of the same three ques
tions were administered to the same subjects. The data
: was used to determine the reliability of the three attitud
inal questions.
The Spearman rank-order coefficient of correlation was
used to determine the relationship between answers on the
test.and retest to the same questions. The null hypothesis
is that no relationship exists between the answers given on
the test and retest. At the .01 level of signifiance the
I
critical value is 0.715. If the computed statistic is
140
' greater than this value, the null hypothesis is rejected
! and reliability of the questions is demonstrated. On the
I other hand, if the computed statistic is less than 0.715,
the null hypothesis is accepted and the reliability of the ,
three attitudinal questions is not demonstrated. For all
I
three questions, a positive correlation was shown to exist
(the data is available in Appendices E, F and G).
Treatment of the Data
As a group we attempted to quantify the amount of
I
. gerontological subject matter of courses leading to de-
' grees in the eight disciplines, and other related material.
The purpose of the data analysis was to assess any associa-
: tions among the variables of the questionnaires. The data
was treated with descriptive statistics and presented in
raw numbers, ratios, percentages, frequencies, and tables
or measures that were appropriate to examine the possible
associations between variables; within each discipline,
and between the eight disciplines.
141
CHAPTER VII
RESULTS
Introduction
This chapter will deal with the result of this study,
I Data from the Information Collection Form and the Interview
Collection Form will be presented in narrative and table
forms. Eight tables will describe one or more of the vari
ables as set forth in the Methodology chapter. A sub
section will present the results of the testing of five
formulated hypotheses in the format of tables and statis
tical analyses. Data in all of the tables will be pre
sented in the form of percentages, numbers, and mean
numbers. The final section will discuss data collected
; concerning the licensing procedure for registered nurses
in the State of California. The data was collected by in
terview and review of pertinent literature, and will be
presented in narrative form.
A description of the 19 institutions included in the
sample for this study are presented in Table 1, Abbrevia-
142
Table 1
Description of Institutions
Name
Student
Popula
tion
Nursing
Popula
tion
Number
Faculty
Nursing
Degrees
Offered
Azusa Pacifica College 1,440 94 7 B.S.
Biola College 2,349 161 11 B.S.
CSC, Bakersfield 2,050 103 13 B.S.
CSU, Chico 13,500 255 31 B.S., M.S.
CSU, Fresno 15,000 290 30 B.S., M.S.
CSU, Hayward 8,800 600 17 B.S.
CSU, Long Beach 31,000 600 28 B.S., M.S.
CSU, Los Angeles 24,486 1 ,000 32 B.S., M.S.
CSU, Sacramento 20,000 133 17 B.S.
Humboldt SU 7,000 190 11 B.S.
Loma Linda U 4,700 467 61 B.S., M.S.
Mount St. Mary’s C 700 145 20 B.S.
Point Loma C 1,800 220 8 B.S.
San Diego SU 30,000 200 29 B.S.
San Francisco SU 20,000 362 22 B.S.
San Jose SU 30,000 292 25 B.S., M.S.
UC, Los Angeles 35,000 400 58 B.S., M.S.
US, San Francisco 3,000 624 120 B.S., M.S.
D.N.S.
UC, San Francisco 6,000 565 42 B.S.
14 3
' tions used in Table 1 are as follows. C-College; CSC-
: California State College; CSU-California State University;
I
I SU-State University; UC-University of California ; and U-
■ University. The term, nursing schools, will be used
throughout the chapter in referring to departments, divi
sions, or schools of nursing.
The total student population of the universities and
colleges in which the departments/divisions/schools of
nursing are located range from 700 to 35,000. The total
of nursing students enrolled in the 19 schools of nursing
; is 6,701, and the population in individual institutions
ranges from 94 to 1,000. Departments/division/schools of
nursing with a population below 200 represents 31.6 per
cent ; between 200-300 is 26,3 percent ; between 300-400 is
15.8 percent; and above 500 population is 26.3 percent.
Nursing school faculty totals 5 82. Percentage of
nursing school faculty to total nursing student population
averages nine percent. Percentage of faculty to student
population in private and state nursing schools also aver
age nine percent each. The total number of faculty holding
doctorate degrees is 83 or 14.3 percent of the total
faculty. The two institutions with the greatest number of
faculty holding doctorates are the University of California,
Los Angeles with 14 (24.1 percent), and the University of
California, San Francisco with 39 (32.5 percent). The four
144
institutions which do not have faculty holding doctorates
are: Azusa Pacifica College, Humboldt State University,
Point Loma College, and San Diego State University.
I Faculty holding doctorates range from one to seven in the
remainder of the institutions.
All of the institutions offer the Bachelor of Science
degree in Nursing, eight (42.1 percent) offer the Master
of Science or Master of Nursing degree, and one (5.3 per
cent) offers the Doctor of Nursing Science degree. In
addition to the academic degrees, there are programs lead-
: ing to certification or credentialing in various areas.
The title of these programs are : Public Health Nurse
Certificate; School Nurse Credential; Nurse Practitioner,
Adult Health; Nurse Practitioner, Maturity; Nurse Practi
tioner, Pediatrics ; Pediatric Nurse Associate; Family
Counseling Credential; Interdisciplinary Gerontology Cer
tificate; and the Teaching Credential.
All of the schools offer programs which allow gradu
ates to apply for the California Public Health Nurse Cer
tificate. Six (31.6 percent) offer the School Nurse Cre
dential program, and four (21.1 percent) offer the re
mainder of the programs.
A total of 87 courses containing gerontological con
tent are offered by the 19 schools of nursing. Of the 87
courses, 52 (59.8 percent) are required, 16 (18.4 percent)
145
' are overview courses, 17 (19.5 percent) are graduate
' courses, and two did not fall into any of the categories.
: The eight schools with a graduate program offer a total of
37 courses, 17 (45.9 percent) are graduate and 20 (54.1
percent) are undergraduate courses. Undergraduate courses
!
offered by all of the schools total 70. Of these 70
courses, 50 (71.4 percent) are offered by schools with an
undergraduate program only, and 20 (28.6 percent) are
offered by schools with a graduate program as well.
! A compilation of titles of the 87 courses resulted in
, four general categories. Table 2 presents the categories
and titles, the percentage of courses falling within each
category and the corresponding percentage of gerontological
content within the courses of each category.
The schools with the greatest number of courses in
the categories of gerontology and development are:
California State University, Long Beach (38 percent); Uni
versity of California, San Francisco (33.3 percent); Cali
fornia State College, Bakers field (13.3 percent) ; and
California State University, Fresno (13.3 percent). Of the
' total 87 courses containing gerontological content, the
schools reporting the greatest number of courses are :
University of California, San Francisco (11.5 percent);
California State University, Sacramento (9.2 percent); Loma
Linda University (9.2 percent); Azusa Pacific College (6.9
146
Table 2
Percentage of Course Categories and Percentage
of Gerontological Content in Courses
Percentage
Percentage Gerontological
Category____ . _____________________ Courses_____ Content_____
Gerontology 17.2 66.4
Adulthood and Aging
Care of the Aged and Promotion of
Their Self-esteem
Clinical Gerontological Nursing
Geriatric Nursing
Health Care of the Aging
Health Problems of the Aging
Legislation and Political Aspects
of Aging in Long-Term Health Care
Nursing and the Aged
Nursing Evaluation of the Aged
Hospitalized Client
Nursing, Gerontological
Political Sociology of Aging
Restorative Nursing with the
Aged Hospitalized Client
Topics in Nursing -- Geriatric
Development 9.2 66.9
Clinical Studies Throughout
the Life Cycle
Human Development
Human Life Cycle
Human Life Span
Theoretical Framework for Develop
mental Problems of Middle and
Later Years
147
Table 2 (Cont'd.)
Percentage
Percentage Gerontological
Category______________________ Courses________ Content
Clinical 42.5 22.7
Adult and Ambulatory Nursing
Clinical Nursing
Community Health Nursing
Family Health Nursing
Health Care Problems of
Minority Group Members
Medical-Surgical Nursing
Nursing in Long-term Illness
Nursing Process and Practice
Psychiatric and Mental
Health Nursing
Public Health Nursing
Theory 21.8 13.2
Foundations of Nursing
Introduction to Nursing
Man and Adaptation
Man and Health
Nursing Concepts
Nursing Science
Nursing Theory
Theoretical Foundations
Theoretical Frameworks
Overview of Health Professions
Miscellaneous 9,2 19.1
Critique of Studies
Death and Dying
Holistic Nursing
Human Sexuality
Issues and Trends in Nursing
Leadership in Nursing
Politics of Planning in
Human Services
Special Studies
14 8
I percent); and San Francisco State University (6.9 percent).
None of the eight schools with graduate programs offer
I
a dual degree or a minor in gerontology at the graduate
I level. However, seven of the schools, with the exception
‘ of California State University, Chico, offer a program with
an emphasis in gerontology.
All of the 19 schools report that a field practicum is
a requirement in the nursing programs. Information was
available from 18 of the 19 schools on the total number of
' agencies utilized (California State University, Chicago
, excepted). The 18 schools utilize 740 agencies. Seventeen;
of the 19 schools (California State Universities, Chico
and Los Angeles, excepted) report a total of 4,579 students
placed in these agencies. All 19 schools report a total of
211 agencies utilized to provide students with the oppor
tunity to work with or on behalf of older adults. Seven-
i teen of the 19 schools (California State University, Los
Angeles and University of California, Los Angeles excepted)
report a total of 2,918 students placed in these agencies.
Of the schools reporting, the percentage of students re
ceiving experience in gerontological agencies is 63.7 per
cent of the total number of students. Ten of the 19
schools place the same number of students in gerontological
agencies as are placed in general agencies. These schools
are: Azusa Pacifica College; California State College,
149
I Bakersfield; California State University, Fresno; Cali-
I fornia State University, Hayward; California State Univer-
I
I sity, Sacramento; Mount St. Mary's College; Point Loma
' College ; San Diego State University ; San Jose State Uni
versity ; and the University of San Francisco. ,
I
Seventeen of the 19 schools listed 159 names of
agencies in which students are placed to gain experience
in working with an on behalf of the older adult. The
i names of the agencies were compiled and grouped into six
I categories. The categories with the names of the agencies,
I and the percentage of utilization are presented in Table 3.
Divisions of continuing education in the nursing
schools, or representatives from the nursing school to the ,
university division of continuing education, are present
in 10 of the 19 schools. Eight schools do not have con
tinuing education programs, and information was not avail
able from one school. Of the ten schools which do have
programs, four are schools with a graduate program, and six
are schools with the baccalaureate program only. Eight of
the ten schools offer a total of 2 3 courses which contain
aging or gerontological content. The schools with the per-
! centage of courses are: California State University,
Sacramento (30.4 percent); University of California, San
: Francisco (17.4 percent); California State University,
Hayward (13 percent); Humboldt State University (8.7 per-
150
Table 3
Percentage of Gerontological Agencies
Utilized by Nursing Schools
Percent
Agencies________________________ Uti lized
Convalescent Centers 20.1
Homes for Aged
Nursing Homes
Health Clinics 17.6
Departments of Public Health
Health Centers
Out-patient Clinics
Senior Citizen Clinics
Home Health Agencies 10.0
Visiting Nurse Associations
Hospitals 29.6
General Hospitals
Hospital Educational Development Systems
Medical Centers
Psychiatric Hospitals
Rehabilitation Hospitals
Veterans Administration Hospitals
Senior Citizen Centers 21.4
Adaptation Groups
Adult Protective Service
Community Centers
Day Care Centers
Nutrition Centers
Recreation Centers
Resource Centers
Physicians' (Geriatrician) Offices 1.3
151
cent); San Diego State University (8.7 percent); University
I of California, Los Angeles (8.7 percent); California State
i
I University, Fresno (4.4 percent); and, the University of
San Francisco (4.4 percent).
The 2 3 continuing education course titles were com-
' piled and grouped into three categories. Table 4 presents
the categories with the titles of the courses, and the per
centage of courses within each category.
In response to the question, "How important would you
rate courses with aging content in relation to your total
' department/school curriculum?" five schools reported very
important, two said not very important and none said of no
importance. The question of how important would you rate
aging issues in comparison with all other issues your pro
fession is concerned with resulted in seven schools report
ing very important, nine reporting important, two reporting
somewhat important and one reporting not very important.
5
[
! Table 5 presents the percentage of respondents' responses
to the importance of gerontological courses to the total
curriculum, and the importance of gerontological issues to
total professional issues.
The schools reporting that courses with gerontological
content are very important in relation to total curriculum
are: Azusa Pacifica College; California State College,
Bakersfield; California State University, Fresno ; San Diego
152
Table 4
i
I
I Percentage of Continuing Education
! Course Categories
Percent
Category_______________________________________ Courses
Aging 52.2
Adulthood and Aging
Bio-psycho-social Aspects of Aging (2)
Bio-psycho-social-spiritual Aspects
of Aging
Geriatric Advocacy -- Who Speaks for
the Elderly?
Health Professions and the Dying Patient
Mental Health and Aging
Perspectives on Dying
Positive Aspects of the Aging Process
Senior Citizens
Social Policy of Aging
Nursing Care 30.4
Community Health Nursing
Geriatric Nursing
Management of the Oncology Patient
Medical-surgical Nursing
Newer Aspects of Cardio-vascular Disease
Process of Aging -- Implications for
Nursing Care
Restorative Nursing Care of the Elderly
and Long-term Care Patient
Miscellaneous 17.4
Foundations of Nursing Theory
Human Sexuality
Leadership in Nursing
Overview of the Health Professions
153
Table 5
Percentage of Respondents' Responses to
Importance of Gerontological Courses to
Curriculum and Gerontological
Issues to Professional Issues
! Importance
Percent
Percent Gerontol’
Ge ron tologic a1 ogical
Courses/
Curriculum
j Very Important
Important
■ Somewhat Important
Not very Important
Of no Importance
26.3
26.3
36.8
10.5
0
36.8
47.4
10 .5
5.3
0
15 4 :
i State University; and, San Jose State University. The
I schools reporting an important relationship are : Califor-
I
I nia State University, Chico; California State University,
I
Hayward, Humboldt State University; Mount St. Mary's
College ; and the University of San Francisco. The schools
reporting a somewhat important relationship are: Cali-^
fornia State Universities of Long Beach, Los Angeles, and
Sacramento ; Loma Linda University; and the Universities of
California at Los Angeles and San Francisco. The schools
; reporting a not very important relationship are : Biola
; College and San Francisco State University.
In regard to the importance of gerontological issues
in comparison with all other issues to the profession, the
schools reporting it to be very important are : Azusa
Pacifica College; California State College, Bakersfield ;
California State University, Long Beach ; Loma Linda Uni
versity ; Point Loma College; San Diego and San Jose State
Universities. The schools reporting important are : Biola
College; California State Universities of Chico, Fresno,
Hayward, Los Angeles, and Sacramento; Humboldt State Uni
versity of San Francisco. The schools reporting somewhat
important are : the Universities of California at Los
Angeles and San Francisco. The school reporting not very
important is San Francisco State University.
Doctoral dissertations related to aging and completed
155
' since 1971, total four. The four dissertations were all
I completed at the School of Nursing, University of Califor-
I
I nia, San Francisco, the only school to offer a doctoral
degree in nursing. A total of nine master's theses re- |
lated to aging were completed since 19 71 at five of the
I eight schools which have a graduate program. Four of these
theses were completed at Loma Linda University, two at San
Jose State University, and one each at California State
I Universities of Chico and Fresno, and the University of
I
; California, Los Angeles.
I In response to the question concerning aging related
journals subscribed to by the departmental/school library,
all of the schools except two (Mount St. Mary's College
and Point Loma College) report their general school library
subscribes to journals. Table 6 lists the titles of the
journals subscribed to by the institutions, and the cor
responding percentage of subscription of each journal.
The institution with the greatest number of journals
is the University of California, Los Angeles with 21 (18.3
percent). San Diego State University and the University
; of California, San Francisco, follow with 10 (8.7 percent).
Loma Linda University and San Francisco State University
have eight (7 percent); California State College, Bakers-
t
field and California State Universities of Los Angeles and
San Jose have 6 (5.2 percent); California State University,
156'
Table 6
I Percentage of Journals in Libraries
' Journal________ Percent
Aging 13,9
Aging and Development 5,2
' American Geriatric Society Journal 7,8
Current Literature on Aging 2,6
Developments in Aging , 9
Educational Gerontology 4,3
Experimental Aging Research 2,6
' Geriatrics 11,3
Human Development 8,7
Industrial Gerontology ,9
Journal of Gerontology 11,3
Journal of Gerontological Nursing 7,8
The Gerontologist 11,3
, Other 11,3
Age and Aging
Aging, New York
Aging, Washington
Forum Gerontology
Geriatric Nursing
Gerontologica
Gerontologica Clinica
Gerontologica Clinica, Kiev
Gerontology and Geriatrics
Gerontologist, Switzerland
Gerontologist, Washington
International Journal of Aging and
Human Development
151 .
' Long Beach has 5 (4.3 percent); Biola College and Califor
nia State Universities of Chico and Fresno have 4 (3.5 per-
I
i cent); California State University, Sacramento has 3 (2.6
I percent); and Azusa Pacifica College has one (.86 percent),
Nine of the institutions subscribe to the Journal of Geron
tological Nursing. These institutions are; Azusa Pacifica
College; Biola College ; California State College, Bakers
field; California State Universities of Hayward, Sacra
mento, and San Diego; Loma Linda University; University of
California, San Francisco; and the University of San
I Francisco.
Fourteen of the 18 schools responding (77.8 percent)
; plan to implement aging related courses into their cur
ricula within the next two years. None of the schools will
implement courses within three to five years, and four
schools do not plan to implement aging related courses.
California State University, Chico did not respond to the
question. The four schools which do not plan to institute
courses and represent 22.2 percent of the total are: Biola
College; California State Universities of Fresno and Hay
ward; and. Mount St. Mary's College. Two reasons were
given by the four schools which do not plan to implement
courses: Lack of time in the student program or no room
for more courses (Biola College and Mount St. Mary's
College), and the presence of age related courses in the
.15 8
I curricula at the present time (California State Universi-
' ties of Fresno and Hayward).
I Twenty-five topical areas were identified in which
. aging related courses are to be implemented by the 14
schools. These topical areas were grouped into six cate
gories. The categories with the specific areas for each,
and the percentage of each category are presented in
Table 7.
Point Loma College and San Francisco State University
; listed four topica areas each, in which aging related
; courses are to be implemented within the next two years.
The remaining 12 of the 14 schools, listed from one to two
areas each.
The percentage of faculty, who teach aging related
courses, having specific gerontological training is pre
sented in Table 8.
Three schools report their faculty have between 15-
25 percent of specific gerontological training: Califor-
' nia State Universities of Hayward, Long Beach, and Sacra
mento. Six schools report less than 5 percent of their
faculty have gerontological training : California State
Universities of Chico and Fresno; Mount St. Mary's College ;
Point Loma College; San Diego State University ; and the
University of California, Los Angeles. The remaining ten
schools report that 5-15 percent of their faculty have
159
Table 7
Percentage of Topical Area Category
of Courses to be Implemented,
Category____________________________ Percent
All areas of integrated programs 4
Aging theories 8
Implications of Theories of Aging
for Nursing Practice
Life Theories
Assessment of the Aged 20
Physical Assessment of the
Aged Patient
Health Assessment of the
Aged Patient
Bio-psycho-social 28
Behavioral Response to Cognitive
and Sensory Disturbances
Interests of the Aged
Physiology of Aging
Psycho-social Aspects of Aging
Remotivation
Resocialization
Geriatric/Gerontological Nurse Practitioner 20
Nursing Care 20
Nursing in the Community
Planning the Care of the Aged
Preparation for Home Care, Nursing,
Home, and Retirement
Practicum in Aging
Special Areas of Nursing Interest
160
Table 8
Percentage of Faculty with
Gerontological Training
Percent of Training Percent of Faculty
15-25 15.8
5-15 52.6
0-5 31.6
161:
specific gerontological training.
In response to the question, "Do you feel that faculty
who teach your aging related courses should have specific
gerontological training?" 18 of the 19 schools said yes.
No answer was given by California State University, Chico.
All 19 schools responded that the content of gerontology
has very important or important implications for the future
of the discipline. Eleven schools (57.9 percent) state
I that it has very important implications, and eight schools
' (42.1 percent) state that it has important implications,
i The question concerning membership in the Gerontolog
ical Societies by instructors teaching gerontological
courses resulted in; one school reporting instructors be
longing to the Gerontological Society, two to the Western
Gerontological Society, five to both of these societies,
and four schools responding "don't know." No answer was
reported by California State University, Chico. The eight
schools reporting that instructors hold membership in the
Gerontological Societies, represent 44.4 percent of the 18
'schools responding to this question. The schools reporting
instructors' membership in the Societies are as follows :
Gerontological Society : Loma Linda University; Western
.Gerontological Society: California State University,
Sacramento and the University of San Francisco. Both of
Societies: California State Universities of Hayward, Long
162
Beach, and San Diego; San Francisco State University; and,
I the University of California, San Francisco.
I The findings from the "Information Collection Form"
: and the "Interview Collection Form" have been presented.
I
! As a result of the findings, certain questions were raised
concerning the effect certain of the variables would have
on other of the variables. It was felt that there might
be a relationship between the number of courses with
; gerontological content, and some of the variables. From
; this assumption, the following five hypotheses were postu-
i lated for testing:
1. The number of faculty having had gerontological
training has no relationship to the number of
courses with gerontological content offered.
2. The number of faculty belonging to geron
tological societies has no relationship to
the number of gerontological courses offered.
3. The amount of importance attached to geron
tological courses in relationship to total
curricula has no relationship to number of
gerontological courses offered.
4. The amount of importance attached to total
professional concern of gerontological
issues has no relationship to the number
of gerontological courses offered.
163
' 5. The number of gerontological courses
!
offered has no relationship to the number
of dissertations and theses written in
the area of aging.
The data relevant to each of the hypotheses are pre
sented in Tables 9 through 13. Table 9 (hypothesis 1)
compares the percentage of faculty having gerontological
training with the mean number of gerontological courses.
Table 10 (hypothesis 2) compares faculty belonging to
Gerontological Associations to the mean number of geron-
! tological courses. Table 11 (hypotheses 3 and 4) compares
the importance attached to gerontological courses in re
lationship to total curriculum with the mean number of
gerontological courses, and the importance attached to
total professional concern of gerontological issues with
■ the mean number of courses. Table 12 (hypothesis 5) com
pares the number of gerontological courses offered with the
number of dissertations and theses written in the area of
aging.
Chi square analysis indicates no significant relation-
, ship exists between faculty having had gerontological train
ing and the number of gerontological courses offered (see
Table 13). The figures in Table 9 show that the highest
mean number of courses correspond to faculty having 5-15
percent of training (the majority at 53 percent). The next
164
Table 9
Percentage of Faculty with Gerontological
Training Compared to Mean Number of
Gerontological Courses
Percent X
Training Courses
0-5 3.67
5-15 5.10
15+ 4.67
16 5.
Table 10
Gerontological Association Membership
Compared to Mean Number of
Gerontological Courses
X
Association Courses
Western Gerontological 5.71
Gerontological 5.20
Both 5.20
166
Table 11
Importance Gerontological Courses/
Curriculum, Issues/Profession
Compared to Mean Number of
Gerontological Courses
Importance
No or not very
Somewhat
Important or very
Courses/
Curriculum
X
Courses
6.00
’6.00
3.55
Issues/
Profession
X
Courses
6.00
8.00
4.06
16 7
Table 12
Number of Gerontological Courses
Compared to Number Disserations/Theses
Courses Disse rtations/The ses
37 13
168
Table 13
Chi-Square Values Between Variables
2
Variables X
' Gerontological training 0.24 5.99
Gerontological Association Membership .03 1.60
Importance Gerontological Courses/
Curriculum .77 1.60
Importance Gerontological Issues/
Profession 1.29 1.60
169
' highest level of mean courses corresponds to faculty having
I
I 15 percent of training (16 percent of faculty) . The lowest
I number of mean number of courses correspond to faculty hay-
• ing 0-5 percent of training (32 percent of faculty).
No significant relationship was found between faculty
, holding membership in gerontological associations and mean |
number of courses when the hypothesis was subjected to chi-
square analysis. See Table 13 for level of significance,
I The relationship between mean number of courses and
' respondents* attitudes regarding importance of gerontologi-:
i cal courses to curriculum and gerontological issues to pro
fessional issues was not significant when subjected to chi-
square analysis (see Table 13). The figures in Table 11
indicate that the highest mean number of courses correspond
to the attitudes of no or not very and somewaht importance
of gerontological courses to curriculum. The lowest mean
number of courses correspond to the attitudes of important
or very important. In regard to attitudes of importance of
gerontological issues to total professional issues, the
highest mean number of courses correspond to the attitude
of somewhat important. The lowest mean number correspond
to important or very important.
Hypotheses 1-4 (data in Table 9-11) were tested with
chi-square analysis. The variables listed in these tables
and the results of the analysis are presented in Table 13,
170
No significant relationship at the .05 level was ob-
j tained between the variables listed in Table 13 and the
I mean number of gerontological courses. The null hypotheses
: stating there was no relationship between the variables and
mean number of courses were, therefore, accepted.
The Pearson r correlation was used to correlate the
number of gerontological courses with the number of dis
sertations and theses written in the field of aging (see
Table 12). A correlation of .795 was found to be signifi-
I cant at the .05 level at 7 degrees of freedom* Therefore,
I the hypothesis which postulated that the number of geron
tological courses aoffered had no relationship to the number
of didsertations and theses written in the area of aging
was rejected. A discussion of the results of the testing
of the hypotheses will be included in the discussion of the
results of the study which follows,
Discussion
Institutions within which nursing departments/divi^
,sions/schools are housed very widely as to total student
population. Student nurse population averages slightly
higher (32 percent) in nursing departments with a popula
tion below 200, with 27 percent each in departments between
200-300 and above 500, and a somewhat lower percentage (16
percent) in departments between 300-500. The 32 percent
represents the majority of nursing programs offering the
171
' baccalaureate degree only. The number of faculty members
I vary and do not show an incremental increase with in-
icreased numbers of nursing students. Doctoral degrees held
; by the total faculty represents 14 percent of the total
faculty. The low percentage of doctoral degrees can be
, attributed to the fact that the California Board of Regis
tered Nurses' accreditation of nursing schools is based
upon faculty having a master's degree or higher. Also,
doctoral degrees, as a terminal professional degree in
'nursing are limited to a few institutions, suggesting that
, nurses holding doctoral degrees may have earned them in
fields other than nursing. The highest percentage of
faculty holding doctorates are located at the two Univers
ities of California where doctoral degrees are more of a
university requirement than a professional one. It should
be noted that the four schools which do not have faculty
holding doctoral degrees do not offer a graduate program.
There is no difference in the percentage of faculty popula
tion (9 percent) to student population in private schools
of nursing compared to public schools. The implication is
.that the criterion employed for faculty-student ratio rests'
I
on an adequate number of qualified faculty (required by
Board of Registered Nurses) rather than doctorate level
faculty.
Slightly less than one-half of the schools offer a
172 .
master's degree as well as a bachelor's degree in nursing,
'and it is anticipated the percentage will increase as the
demand for faculty in nursing schools increases. The Uni-
I versity of California, San Francisco, the only school of
fering the professional degree of Doctor of Nursing Science,
as would be expected, has the highest number of faculty,
and the highest percentage of doctoral degrees held by a
, faculty. Attention is brought to the fact that this Uni-
! versity consists of four professional schools, one of which
' is the School of Nursing. This type of organization un-
i doubtedly accounts for the higher percentage of faculty
, with advanced degrees, the degrees offered, and the many
and varied course offerings, among which are a high per
centage of gerontological courses.
Of the programs leading to certification and creden-
tialing, a higher percentage of schools offer the school
nurse credentialing program than all of the rest of the
programs combined. These programs include: Nurse Prac-
tioner programs for maturity and adult health, with a pos
sibility of some aging content; one program in an inter
disciplinary gerontology certificate; several pediatric
programs ; one family counseling, and one teaching creden-
tialing program. The implication is that a higher percent
age of these programs give emphasis to the earlier half of
the life span than the latter half.
173
' The data indicates that all of the 19 schools of nurs
ing offer courses containing aging or gerontological con-
; tent. A total of 87 courses has been identified with the
majority (60 percent) being required courses, and a far
lesser percentage being classified as overview (18 percent),
and graduate (20 percent). However, schools with graduate
programs comprise only 42 percent of the sample which could
account for the lower percentage of graduate courses. When
looking at the undergraduate course offerings, 71 percent
are offered by schools with the baccalaureate program only,
and 2 9 percent are offered by schools with a graduate pro
gram as well. Therefore, the schools with graduate pro
grams offer a total lower percentage of courses than do the
schools with undergraduate programs only. Perhaps a better
criterion would be to examine the amount of gerontological
content within courses offered rather than the number of
courses with some content. It will be noted in Table 2,
page 146, that the courses in the categories of gerontology
and development contain the highest percentage of geron
tological content. Ten of the 15 schools offering courses
in these two categories are schools with graduate programs
reflecting a higher specialization in these areas.
The data in Table 2 describing the course categories,
shows that the highest percentage (43 percent) of courses
'are offered in the category of clinical nursing. Nursing
174
‘ theory follows with 22 percent, then gerontology with 17
* percent, with the lowest percentage attributed to develop-
■ mental and miscellaneous courses (9 percent), However,
when the percentage of gerontological content within the
' courses is noted, a disparity between number of courses
containing gerontological content, and the percentage of
gerontological content within courses results. The cate
gory of clinical with 43 percent of the courses shows that
actual gerontological content is about one-half or 23 per
cent. In like manner, theory courses represent 2 2 percent
with 13 percent of gerontological content. In contrast,
gerontological and developmental courses with a relatively
low percentage of courses, represent 6 6 percent of geron-
. tological content each, and miscellaneous courses with a
,low percentage have 19 percent of content. The indication
is that courses labeled aging, geriatric or gerontological,
and developmental contain the highest percentage of geron-
tolocial content. The clinical and theory courses which
appear to cover gerontological aspects, actually have a low
percentage of content. Although courses of a clinical
nature have been included in the gerontology category, the
I actual title of aging or gerontology seems to insure a high
percentage of gerontological content. Courses listed in
the miscellaneous category, although general in nature,
bear a relationship to the latter part of the life span.
175
' and have a higher percentage of gerontological content,
! The same general pattern emerges when requited courses
!
I are looked at in relation to the categories in Table 2,
I
I Required courses represent 49 percent of the clinical cate--
gory, 2 7 percent of theory, 9 percent of development, and
7 percent each of gerontological and miscellaneous cate
gories. There are only four required courses in the geron
tology category, all of which are undergraduate courses*
■ All of the graduate courses in this category are electives,
! The low percentage of required courses in the developmental
I category might be attributed to prerequisite developmental '
courses being taken prior to admission to the nursing pro
gram. Such courses may or may not include content on the
latter part of the life span. Overview courses too follow
the same pattern as do the required courses in the percent
age of courses falling into the respective categories.
Field practicums are a requirement in all of the
schools' curricula, and may be coordinated with specific
academic courses. The 740 agencies utilized by the schools
are an indication of the variety of the agencies used, and
,the varied experience students will attain, Nursing stu
dents have contact with all age groups in the clinical por
tion of their program. The question is how much contact is
made with the older adult, and what is the type of experi
ence obtained? The data in this study does not coyer the
176
amount of time spent working with the older adult, but the
data presented in Table 3, page 150, on the types of geron
tological agencies and the percentage of utilization, gives
an insight into the type of experience obtained. It can
be noted that the highest percentage of utilization takes .
place in hospitals. The assumption can be made that the
primary focus of hospitals would be acute care nursing,
and that the patient population would consist of a wide
range of age groups. Of course, it can also be assumed
that some hospitals, such as the Veterans hospitals, with
a high percentage of older patients would provide some ex
perience in working with older age groups, for those
shcools utilizing this type of hospital.
The next most utilized gerontological agencies are the
senior citizen centers and convalescent centers. These two
groups of agencies together cons is ti tute just over 40 per
cent of the total agencies with a majority of the popula
tion being in the older age areas. Senior citizen centers
(21 percent) offer the opportunity for student nurses to
work with active, more healthy older persons, while the
convalescent centers (20 percent) provide experience in
working with the chronically ill patient. Health clinics
and home health agencies with a combined total of 38 per
cent do not offer contact specifically with the older adult.
However, agencies, such as the Visiting Nurses* Association,
17 7
' have a high population of the older, chronically ill
!
! patient. It is significant that the categories of agencies
' of Health Clinics, Home Health Agencies, Senior Citizen
Centers and Geriatrician's Offices representing 50 percent
of the total are community rather than hospital b^sed.
This appears to indicate an awareness and desire of nursing,
school faculty to expose students to experience beyond that
of institutional care, although this may not always be
gerontological care. With a utilization of 211 gerontolog
ical agencies by nursing schools, and 64 percent of the
' nursing students receiving experience in these agencies, it
' may appear that students are receiving adequate opportun
ities to work with the older adult. It should be pointed
out that each individual student may receive experience in
only one of these agencies, which may or may not provide
sufficient opportunity to work with older persons, The
quality of the students' experience in the agencies is un
known, nor does the data supply information about the
agencies supervisors' and instructors' knowledge of aging
; and gerontological issues. These concerns are of impor
tance if the student's exposure to aging issues is primar
ily through the field practicum. Because of the mandate
of the Board of Registered Nursing in 19 76 to include
geriatric nursing in the schools' curriculum^, it is rea
sonable to assume agencies with a high population of older
178
' persons will be utilized. It is of interest to speculate
if the geriatric nursing courses will be so titled, or if
I this theory portion will be combined with other areas of
nursing in a single course. It has been established pre
viously that when aging, geriatrics, or gerontology are
used in the title of a course, there is a higher percentage
of gerontological content in that course.
Turning to continuing education courses, the data
shows that eight schools offer a total of 2 3 courses con
taining aging or gerontological content. The compilation
of course titles into categories as shown in Table 4, page
152, points out that 52 percent are within the aging cate-
; gory. This category reflects a broad range of titles, not
specifically nursing care in nature. In comparison the
nursing care category amounts to 30 percent. The differ
ence in percentage may be the result of nurses in geriatric
nursing practice asking for courses which will give them a
greater breadth of knowledge of the aging population with
the many ramifications for the individual and society.
Nursing educators too may see a need in the nursing prac
tice community in offering a higher percentage of courses
in the aging category. The number of continuing education
; courses containing gerontological content is low, and it
can be assumed the number of courses offered need to be in
creased. This assumption is based upon the increased need
179
I for gerontological nurses in the future as outlined in
i Chapter IV, the requirement of an examination to test an
j applicant's knowledge of the aging process to become certi
fied as a gerontological nurse practitioner, and the man
datory continuing education requirement for relicensure
which will go into effect July 1, 197 8 in the State of
California. A wide range of courses to meet the require
ment for relicensure are acceptable, as long as they are
approved by the Board of Registered Nurses, thus leaving
the field open to the inclusion of gerontological courses.
I The majority of the respondents (5 2 percent) stated
that courses with gerontological content are important or
very important in relation to the total curriculm as shown
in Table 5, page 153, Those replying somewhat important
amounted to 3 7 percent, and 11 percent said not very im
portant. However, when the mean number of courses were
compared to the respondents' attitude of course importance
: to curriculum (Table 11, page 166), the lowest mean number
of courses (3.55) corresponds to the answers of important
or very important. On the other hand, a higher mean number
of courses (6 each) corresponds to the answers of somewhat
or not very important. This disparity is pointed out when
the hypothesis postulating relationships of attitudes and
number of gerontological courses in relationship to total
curricula, was tested with chi-square analysis (Table 13,
180
I page 16 8). No significant correlation was found between
the mean number of courses offered and the respondents*
attitudes of importance of gerontological courses to the
' total curriculum. The reason that over 50 percent of the
respondents considered aging courses important when com-
I
pared to total curriculum, could be due to a lack of know
ledge on their part on the amount of gerontological content
within courses. It was assumed that more content was in
cluded, especially in the integrated course curriculums,
than actually occurred.
The same general picture emerged when respondents *
attitudes of importance of gerontological issues to total
professional issues were compared as shown in Table 5,
page 153. The highest percentage (84 percent) stated that
gerontological issues are important or very important in
comparison with all other issues in the profession. A much
lower percentage (11 percent) said somewhat important, and
5 percent said not very important. In comparing the re
spondents ' attitudes of importance to the mean number of
courses offered (Table 11, page 166), the lowest mean
number of courses (4,06) corresponds to the answers of im
portant or very important. In contrast, a higher mean level
of courses (8) corresponds to somewhat important, and 6 to
no or not very important. No significant correlation was
found between the mean number of courses and the respon-
181 :
' dents' attitudes of importance of gerontological issues to
I total professional concerns (Table 13, page 168), Note
should be taken of 84 percent of the respondents regarding
gerontological issues important to the profession in
comparison to the 52 percent regarding gerontological
courses important to the curriculums. This may be indica
tive of nurses acknowledging the importance of aging issues
to nursing, but look to the national nursing bodies and
organizations for guidance and direction before any local
^ implementation takes place.
: A significant correlation occurred when numbers of
courses were compared to dissertations and theses completed
in the area of aging (Table 12, page 167). The numbers of
dissertations and theses written in areas other than aging
is not known, but 13 writtten in the area of aging in the
past five years is a low figure. Given the respondents'
attitudes that gerontological issues are of importance in
comparison with other issues of the profession, and that
the content of. gerontology has very important implications
for the future of the discipline, an expansion of knowledge
and research in the field of aging must be undertaken.
This suggests an increase of courses and faculty in the
present graduate programs, and the establishment of gradu
ate programs in those schools which do not have them.
Journals of gerontological, aging, or developmental
182
■ interest are found in the institutions' libraries rather
I than within the dpeartments or divisions of nursing.
Therefore, the journals subscribed to would have interest
to other divisions and schools within the colleges and
universities, and a relationship between journals and the
variables included in this study could not be made. Of
the journals subscribed to, the highest percentage of sub
scriptions were to Aging, Geriatrics, Journal of Geron
tology and the Gerontologist, as shown in Table 6, page
' 156. It was found that the Journal of Gerontological
: Nursing, a relatively recent publication, was subscribed
to by nine of the libraries a No relationship was seen be
tween subscription to the journal and numbers of geron
tological courses, attitudes toward the importance of
gerontological courses compared to the total curriculum,
or faculty holding membership in gerontological societies.
It was found, however, that with one exception, faculty had
five percent or more of specific gerontological training in
those institutions subscribing to the Journal of Geron
tological Nursing. The inference is that faculty with
training are cognizant of gerontological journals directed
specifically to nursing issues, and have recommended this
journals be included in school libraries.
Significantly, 78 percent of the schools intend to
implement aging related courses within the next two years.
183
; This high percentage seems to dispute the 52 percent of the
respondents who felt that gerontological courses compared
1 importantly with the rest of the curriculum. An interpre
tation can be made that as a result of the requirement by
the State Board of Registered Nurses that geriatric nursing^
be included in the curriculums, there is the recognition by
the schools that more specific content on aging needs to be
^ included. But, it should be noted that all of the respon-
: dents stated that gerontological content has important or
very important implications for the future of the nursing
i discipline, indicating a sense of responsibility to put
into effect the means to meet this challenge. It should
also be remembered that the Board of Registered Nurses,
who define courses for curriculum, is made up primarily of
registered nurses, who reflect the ideals and goals of the
: nursing community.
The topical areas of the courses intended to be imple
mented, listed in Table 7, page 159, show a trend toward
specificity in courses. The lowest percentage is quoted
for integrated curricular courses and theory courses, in
which aging content would be included. Biological-psycho-
' logical-social courses with 2 8 percent represents the
highest percentage, followed by courses for gerontological
nurse practitioner, and nursing care courses with 20 per
cent each. Topical areas of courses to be implemented
184
I parallels course categories of continuing education courses,
I but are in contrast to the courses offered in basic cur-
I
I riculums now. Basic curriculums contain the greatest
number of courses dealing with clinical and theoretical
areas, with the lowest number in the specific gerontologi
cal and developmental areas. The areas in which the
courses are to be implemented reflect an awareness that
nurses who will work with the aged need to have knowledge
' ■ beyond stricly nursing care procedures. Some schools will
■ be starting graduate programs where there is usually
. greater flexibility in the type of course offerings. Re
alistically, the courses to be implemented in all probabil
ity will be included in graduate and continuing education
programs. It is felt that the courses in the Biological-
psychological-social * category would be of benefit to under
graduate nursing students, and an attempt be made to in
clude such courses in the basic curriculums.
Faculty having specialized gerontological training are
reported by 13 of the 19 schools. As shown in Table 8,
page 160, the majority of faculty (53 percent) have between
' 5-15 percent of training, followed by 32 percent with from
0-5 percent, with s low of 16 percent having 15-25 percent
of training. The hypothesis postulating a relationship be
tween faculty having had gerontological training, and the
number of gerontological courses to be offered, was tested
185
; with chi-square analysis (see Tables 9 and 13, pages 164
' and 168). The correlation between the percentage of
faculty with training and the mean number of courses was
found to be not significant, when subjected to chi-square
analysis. However, although the difference is small, it
was found that institutions, where the percentage of
faculty had the least amount of training, offered the low
est mean number of courses. The highest mean number of
• courses are offered by institutions where the faculty have
I between 5-15 percent of training. The majority of faculty
having training falls within the 5-15 percent range which
accounts for the higher number of course offerings for
• this group. Faculty having 15-25 percent of training
accounts for the next highest mean number of courses of
fered, In comparing the latter two groups, it was found
that only 16 percent of the faculty with the most training
offer an almost equal number of courses that 50 percent of
the faculty with 5-15 percent offer., The indication is
; that a lesser number of faculty with extensive training can
provide as many courses as a large number with less train
ing, The implication is important in this era of rising
costs in higher education. The assumption has already been
made that there will be an increased need for nursing
schools to offer specialized gerontological courses for
nurses. Although approximately two-thirds of the schools
186
' report that at least five percent of their faculty have
gerontological training, the overall amount of training is
I low.
This area of specialized gerontological training takes
on added meaning because all of the respondents state that
faculty who teach aging related courses should have geron
tological training. This implies that not only will
faculty presently engaged in teaching current and future
courses need training, but employment of new faculty will
' be based upon their having had training in the field of
I gerontology. Specialized education takes place at the
I post-graduate and graduate level. Post-graduate courses
offered by the schools at this point are limited in number.
Although seven of the eight graduate schools offer an em-
■ phasis in gerontology, the fact that only 13 disserations
and theses have been completed in the area of aging in the
past five years indicates limited interest or limited
course offerings.
Gerontological Society membership of faculty was re
ported by eight of the schools. Five schools report
faculty membership in both the Gerontological Society and
the Western Gerontological Society, two in the Western
alone, and one in the Gerontological Society alone. It was
found that all of the schools reporting faculty membership
in the societies, also reported faculty having specialized
187
gerontological training. Conversely, the schools reporting
faculty having training, did not equate with the numbers
holding membership in the societies. Mean numbers of
courses were compared to the society membership as shown
in Table 10, page 165. Chi-square analysis was used to
I
test the hypothesis. Table 13, page 168, showed there was
no significance in the correlation between courses and
membership in societies. Neither was there any distinguish
able range between membership in each of the societies
listed above. Mebership seems to depend upon individual
faculty interest rather than amount of specialized geron
tological training.
The results of the data from the "Information Collec
tion Form" and the "Interview Collection Form" have been
presented with an interpretation and discussion of the re
sults. In addition, five hypotheses were postulated and
tested. The hypotheses examined relationships between
number of courses and the variables of attitudes of geron
tological courses to curriculum and gerontological issues
to professional issues, gerontological training, membership
in gerontological associations, and the number of disserta
tions and theses written in the area of aging. The results
were presented in the Results and Discussion sections. The
following section of this chapter will deal with the licen-,
sure procedure for registered nurses in the State of Cali
fornia.
188
! Licensure
I
i The Board of Registered Nursing is the designated
1
I board which deals with matters of nursing education and
nursing registration in the State of California operating
within the Department of Consumer Affairs (Buggy, 1976),
The composition of the Board consists of nine members, six
of whom are licensed registered nurses, two represent the
public at large, and one is a licensed physician. Three
of the nurses are required to be engaged in direct patient
! care with at least five continuous years of experience, two
; nurses must be active as educators or administrators, and
one nurse must be the administrator of a nursing service
with at least five continuous years of nursing service
(Buggy, 1976). Among the varied responsibilities, the
three that apply to this study are: examination for licen
sure, disciplinary procedures, and accreditation of
schools.
Examination for Licensure
A license as a registered nurse is issued only by ex
amination. The exception to this rule pertains to nurses
,already licensed in other states or territories. The board
then determines if the requirements for licensing or regis
tration are equal or higher than those in California, and
if the nurse meets this and other requirements, will issue
the license or registration (Buggy, 19 76),
18.9
The procedure for the examination for licensure as a
registered nurse follows that required by contractual
agreement with the National League for Nursing for the use
of the State Board Test Pool Examination (Buggy, 1976,
Kelly, 1975) . The applicants who take the examination are
advised that they cannot disclose the contents of the ‘
written examination questions except to a member of the
Board. No one but the Board is authorized to solicit,
accept, or compile information of the content of the
written examination questions (Buggy, 1976).
An applicant, to be eligible to take the examination,
must have successfully completed the courses prescribed by
the Board from an accredited school of nursing (Buggy,
1976). The Duffy Bill or California Assembly Bill 3857,
as of July 1975, allows non-graduates of a school of nurs
ing to take the examination if they satisfy the minimum
requirements as outlined by the Board (Bozcas, 1977). This
Bill has caused certain of the schools of nursing to re
arrange courses so that those required are completed usu
ally prior to the senior year.
The examination consists of tests in the areas of
medical-surgical nursing, obstetrical nursing, nursing of
children, and psychiatric nursing (Bozcas, 1977). Geriat-
, ric nursing is not included as a separate entity. Kelly '
(19 75), however, states that each test in the State Board
190
' Test Pool Examination is integrated, and includes questions
I from many areas, such as from the natural and social sci
ences, relating to the clinical areas being tested, Al-
I though information was not made available, it is con
ceivable that content of a geriatric or gerontological
focus could be included in the tests in the areas of medi
cal-surgical nursing, and psychiatric nursing.
Relicensure for registration is biennial by submission
I of an application and payment of the registration fee. Be-
f ginning July 1, 197 8, mandatory continuing education goes
t
into effect, and the licensee will need to submit proof to
' the Board of successful completion of thirty hours of
approved continuing education courses before the end of the
renewal period. The Board will approve courses of continu
ing education, and they can include academic studies, home
study courses, in-service education, conferences, insti
tutes, lectures, seminars, and workshops (Buggy, 1976). It
is assumed gerontological courses would be accepted by the
Board providing they meet the Board's criteria. At the
present time, eight nursing schools in California offer a
total of 2 3 courses in continuing education programs, which
. include gerontological or aging content. A variety of
titles are included as seen in Table 4, page 152. In lieu
of continuing education courses, an examination, given by i
the Board, may be taken for relicensure (Buggy, 19 76) ,
191
! Disciplinary Proceedings
i The Board of Registered Nurses has the power to take
I
: disciplinary action against a licensed nurse or an appli
cant for a license for: (1) unprofessional conduct;
(2) procuring his certificate by fraud, misrepresentation,
or mistake; (3) aiding, abetting, or assisting at a crim
inal abortion; (4) giving a false statement in application
for a license; (5) conviction of a felony involving moral
turpitude; (6) impersonating an applicant or allowing a
' proxy to apply for an examination for license; and (7) im
personating a licensed practitioner, or allowing another -
to use his certificate for the purpose of nursing the sick
(Buggy, 19 76). Thus, the California Board of Nursing has
set up specific guidelines which enable it to look at the
Code of Ethics for Professional Nurses in a more specific
manner, and allows for the implementation of the Code,
The Board disciplines the holder of a license, who
has been heard by the Board and found guilty, by suspend
ing judgment, placing him on probation, suspending his
right to practice nursing for a period not to exceed one
year, revoking his license, or taking other action that
the Board deems proper (Buggy, 1976). Therefore, the
Board of Registered Nursing, controlled by the profession
of nursing, has the sanction of the community to take
disciplinary action against licensed nurses
192
I Accreditation of Nursing Schools
The Board accredits and maintains a list of accredited
I schools in the state whose graduates, if they have other
i necessary qualifications, will be eligible to apply for a ;
license to practice nursing. The present criteria set up
by the Board for a school to be accredited are as follows:
1. The philosophy of the nursing .program
must be clearly stated, periodically
reviewed, and accepted by the control
ling institution. The philsophy is
used to guide in the development of
policy, and the purposes of the program
* must be realistically stated.
2. The Administrative commitment to the
nursing program is based on its under
standing of that program. The general
policies governing the nursing program
must be in accord with those of other
units within the controlling institution,
3. The Registered Nurse responsible for the
administration of the nursing program
and the faculty have the responsibility
for developing policies and procedures
relating to the planning, the organizing,
the implementing, and the evaluating all
aspects of the nursing program.
4. The Registered Nurse responsible for the
administration of the nursing program, has
the authority and the responsibility for
the program. The faculty has the responsi
bility for instructing students, advising
students, and evaluating their progress.
The faculty members must be adequately
qualified and sufficient in number to
accomplish the objectives of the program,
and opportunities for self-development
should be provided.
5. Curriculum development and improvement are
major and continuing responsibilities of
the total faculty. Curriculum development
193
I is based on formulated objectives that
I have been defined in terms of accepted
I theory of learning and considers the
I potential capacities of the student.
6. The focus of the educational program is
the student. The type of program in
fluences policies relating to the selec
tion, retention, and promotion of students, ,
counseling services, and student life. |
(Buggy, 19 76, p. 35)
Faculty must meet specific qualifications for a
school to be accredited. Each faculty member must hold a
current, valid license to practice as a professional nurse
: in the State of California. In addition, the administrator,
; assistant administrator, and instructors must hold master's
or higher degrees from an accredited college or university,
and must have certain minimums of experience in practice,
education, or administration (Buggy, 1976).
Course of instruction for the curriculum are formu-
, lated by the Board, both as to content and number of hours
or units. The curriculum must be based upon standards for
competent performance of a nurse upon completion of the
, program. The curriculum is to be concerned with nursing
intervention in preventive, remedial, supportive, rehabili
tative, and teaching aspects of nursing from birth through
all age levels including physical, behavioral, and social
components. Course content is grouped under the areas of:
(1) the art and science of nursing which includes theory
and clinical practice in medical-surgical, maternal/child,
194 !
! mental health, psychiatrie nursing, and geriatrics; (2)
I communication skills; (3) related natural, behavioral and
I social sciences which requires an emphasis to be placed on
I
cultural and societal patterns, human development and be
havior relevant to nursing practice.
It is of note that geriatric nursing is now a separ
ate area to be included in course content. In addition,
: since an emphasis is to be placed on human development and
i behavior in the related behavioral and social sciences, it
‘ is assumed aging aspects will be included. Since some of
. the schools in this sample reported a low percentage of
aging concepts within courses, it can also be assumed that
aging content will be increased within courses.
Summary
The California Board of Registered Nursing is the
designated body which deals with matters of education for
registered nurses and licensing of registered nurses. The
Board has the responsibility for examination for licensure^
taking disciplinary action against licensed nurses or
applicants for a license, and for the accreditation of
nursing schools. Through the makeup of the Board, re
gistered nurses constitute the majority of the members
which allows the nursing discipline control of its own
accrediting and examination procedures. In addition,
nurses have obtained public sanction by persuading the
195,
! community to institute a licensing system, and through the
I
j Board maintains control over the disciplinary actions,
I At the present time, geriatric nursing has not been
; included as a separate and distinct clinical area in the
State Board Test Pool Examination. However, it is con
ceivable that content of a geriatric or gerontological
nature could be included in the areas of medical^surgical
nursing and psychiatric nursing. But it is the impression
! of this researcher, by virtue of the interviews held, that
gerontological content is limited in scope within the ex-
; amination for licensure. It is a reasonable assumption,
: however, that geriatric nursing will become a separate area
for testing in the future. This assumption is based upon
the fact that geriatrics is now included as one of the
areas in the art and science of nursing course content for
: curriculums in accredited nursing schools. The other areas
of medical-surgical, maternal/child, and psychiatric nurs
ing, included in courses in the art and science of nursing,
are presently areas being tested in the State Board Test
Pool Examination.
.196
CHAPTER VIII
CONCLUSIONS AND RECOMMENDATIONS
Introduction
! This research project has been primarily involved with
; an examination of the field of nursing's professional
status and its inter-relationship with the field of geron
tology. An investigation was made of nursing school
curriculas, faculty attitudes toward the relevance of
gerontology and prospects for future development of courses
' in aging. The licensure procedure for registered nurses
was also explored. Research in professionalism and the
'status of gerontology as a profession included in this
study are presented in chapters written collaboratively by
the members of the research project. The final report o-f
the research project entitled, "Analysis of Professional
Education in the State of California for Services to the
Retired and Aged," which examines inter-relations between
disciplines, is not a part of this study.
19 7
Conclusions
i As a result of the extensive literature review, it was
I
I concluded that the nursing discipline can ostensibly be
j considered a profession. It has met, in varying degrees, |
the requirements of each of the criteria. On the other
hand, gerontology has not developed some of the designated
criteria essential to a profession.
On the basis of the results of investigation of 19
schools of nursing offering baccalaureate programs in the
' State of California, certain conclusions can be made:
: (1) Gerontological content in course curricula is limited.
This is particularly true at the undergraduate level where
required theory and clinical subject courses contain the
lowest percentage of gerontological content, but represent
the greatest number of courses with aging content.
(2) Graduate courses offer more specific content, but the
total percentage of courses is low. (3) It is in the area
of clinical practicums that students receive their major
exposure to gerontology. Nursing schools use a wide
variety of gerontological agencies, but the single most
i utilized agency is the hospital. Although it was deter
mined that 6 4 percent of the nursing students have an
opportunity to work with the older adult, it cannot be con-
, eluded that each student receives an adequate educational
and clinical exposure to the needs of the elderly. (4) Con-
19 8 J
' tinuing education courses containing aging content are ex-
^ tremely low (23). The inference is that practitioners in
I
I the field of gerontology have limited avenues to further
I their education and competence in the field, (.5) The
amount of aging content in courses is less than assumed by ,
the respondents from nursing school curricula. The major
ity of respondents reported that courses with aging con
tent compared importantly to total curriculum. However,
: no correlation was found between the mean number of courses'
: with gerontological content and the respondents’ attitudes .
. in rating importance of courses to total curriculum. This
disparity points up the difficulty of judging the amount of
aging content in courses in an integrated curriculum where
courses are not labeled aging or gerontological. (5) In
like manner, no significant correlation was found between
mean number of courses and the respondents’ attitudes of
: importance of gerontological issues to total professional
concerns. The speculation can be made that the nursing
profession regards gerontological issues as important, but
nursing schools have not regarded aging to be as important
as other developmental areas and have not given it equal
status in the curricula. (7) Courses will be implemented
, which are more specifically related to aging rather than
integrating aging content into current courses. Categories
related to the biological-psychological-social aspects of
199
I aging reflect an awareness that nurses who will work with
I the aged need to have knowledge beyond the strictly nursing
j care area. Of note is that 20 percent of the courses will
be directed to the gerontological practitioner. A better
balance will, therefore, be brought to the certification
and credentialing programs. At the present time, these
programs are heavily weighted in the direction of the
pediatric and school nurse areas. (8) A significant re
lationship was not found between the percentage of faculty
I with specialized gerontological training and the mean
j number of gerontological courses offered. However, it was
i
' found that the least number of courses were offered by 32
percent of the schools where faculty had the least amount
of training. The highest mean number of courses were
offered by 53 percent of the schools where 5-15 percent of
the faculty had training in gerontology. Sixteen percent
of the schools where 15 percent or more of the faculty had
training offered a mean number of courses almost equal to
those offered by the schools with 5-15 percent of their
faculty trained in gerontology. Therefore, it can be con
cluded that faculty having specialized training does in
fluence numbers of courses to some extent. The fact that
faculty are interested and seek training in the area of
: aging does not necessarily mean they will find introducing
new courses into well-established curricula an easy task.
2 00
I (9) All of the respondents stated that faculty who teach
! aged related courses should have specific gerontological
j training. Hence, it can be concluded that current faculty
will require training, and that implementation of new
courses will create a demand for new faculty possessing
specialized training. (10) Membership of faculty in geron
tological societies did not result in a significant corre-
, lation of mean number of courses. Since all faculty having
: specialized training do not hold membership in the socie-
' ties, it can only be inferred that membership is a matter
; of individual faculty member interest. (11) In the light
of the respondents' attitudes that gerontological issues
are of importance to the profession, and that gerontology
has important implications for the future of nursing, it is
essential to expand research and specialized training in
: the field of gerontological nursing. The question is, do
graduate schools possess the resources to expand geron-
. tological programs? The situation seems to be that nursing
schools have fewer resources than necessary to establish
added courses in aging. Furthermore, there is the problem
of faculty obtaining specialized training to teach these
courses. (12) Gerontology is not included as a separate
area in the examination for licensure of registered nurses
: in the State of California. However, since geriatric
nursing has been mandated by the Board of Registered
201
! Nursing to be included in curricula, it is assumed it will i
be a separate area in the future. At the present time it
I
is not considered of equal importance to the areas of i
I
medica-surgical, maternal/child, and psychiatric nursing j
i I
! presently being tested. Mandatory continuing education j
i _ I
for relicensure beginning in 1978, will further increase '
the need for courses with aging content for those regis-
!tered nurses interested in the field of gerontology. !
Recommendations j
I This study was limited to 19 schools of nursing j
offering the baccalaureate program in the State of Califor- |
nia. Schools offering associate degree programs and i
hospital schools offering diplomas were not included,
I
Within the limitations of this study, and from the results |
; 1
: of the study, the following recommendations are made: '
Because of the limitations of gerontological content i
I
in undergraduate course curricula, it is suggested that
nursing schools investigate the feasibility of students
earning a minor in gerontology at the undergraduate level.
In lieu of a minor, prerequisite courses prior to the pro
fessional program could be required. It is further sug
gested that nursing schools investigate the possibility of
I a dual degree in nursing and gerontology at the graduate
level. When gerontological programs are not available at
the parent schools, college and university consortium pro-
202
* grams might offer the means toward a dual degree program.
I Nursing schools with graduate programs are encouraged to
j expand research in the area of nursing of the aged. The
I
demand for nurses with expertise in this field exists and
will continue to increase. Due to limitations in special
ized gerontological training, it is recommended that cur
rent and future faculty obtain expertise in aging at Insti
tutes of Gerontology and Continuing Education Programs
offered by many universities and colleges. It is advised
that nursing schools develop gerontological courses for
; continuing education programs. Such courses would be of
benefit for the nurse practitioner working with the aged,
and would be a means for these nurses to meet the re
licensure requirement. It is strongly recommended that
the area of gerontological nursing, as a separate area, be
included in the examination for licensure of registered
nurses.
I Although this study was limited to the State of Cali-
' fornia, the literature review revealed a parallel of the
profession's concerns with the results of this study.
Further research is indicated which could lead to general
ization beyond the state level. This study examined in de
tail the relationship of certain variables. Further re
search using the data from this study might examine other
correlations between variables. For example, are the
203
' number of gerontological courses related to the number of
j gerontological journals in the library, or to the number
i of faculty with doctoral degrees? This study could be ex-
' panded to cover the 6 5 schools of nursing not included in ,
the sample. A comparison of the findings from associate
degree programs and hospital programs to baccalaureate
programs would be of interest and might aid in future
planning of gerontological nursing programs.
Turning to the field of gerontology, it is recommended
' that the field of gerontology should be established as a
; self“Standing discipline within colleges and universities,
' Once this has been accomplished, programs can be developed
involving a reciprocity of courses and research with de
partments and professions in which service to the aging is
a major priority. It is felt that the field of gerontology
must immediately begin to identify the role and services of
, a gerontologist. It is only in this way that it can be de
termined if professional status and the process of pro
fessionalization should be pursued.
This study has examined the relationship of the dis
cipline of nursing and the field of gerontology. At the
present time, the increasing demand for gerontological
nursing is in juxtaposition with the evolvement and expan
sion of gerontology into a discipline. The opportunity for
an increased interrelationship of the discipline of nursing
204:
! and the field of gerontology exists which will be mutually
: beneficial to both.
I
I
205 '
BIBLIOGRAPHY
206
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216
APPENDIX A
217
APPENDIX A I
1
Outline of Areas to be Coveted ^
I
1. Literature review on professionalism? i
2. Literature review on the development of specific dis- |
cipline as it moves toward Cor hpw it became) profes
sional status. Relate to criteria from #1? j
3. An examination of the relationships between the dis
ciplines and the field of gerontology,
4. An examination of where the field of gerontology is j
on the continuum of professional status,
5. A study of educational institutions and their offer- |
I
ings in your discipline,
6. A study of credentialing boards and their processes
and expectations as related to gerontology,
7. Conclusions, next steps and proposals for gerontology- '
218
APPENDIX B
219
APPENDIX B
Sample of Nursing Schools
1. Azusa Pacific College, Department of Nursing^
Highway 66 at Citrus Avenue^ Azusa 91702,
2. Biola College, Department of Nursing,
13 80 0 Biola Avenue, La Mirada 90638.
3. California State College, Bakersfield, Department of
Nursing, 9 001 Stockdale Highway, Bakersfield 9 3309,
4. California State University, Chico, Division of
Nursing. First and Normal Streets, Chico 95926%
5. California State University, Fresno, Department of
Nursing. Shaw and Cedar Avenues, Fresno 9 3740,
6. California State University, Hayward, Department of
Nursing.' 25800 Hillary Street, Hayward 94542,
7. California State University, Long Beach, Department of
Nursing, 6101 E, Seventh St., Long Beach 90840,
8. California State University, Los Angeles, Department
of Nursing. 5151 State University Drive, Los
Angeles 90032,
9. California State University, Sacramento, Division of
Nursing. 6000 "J" Street, Sacramento 95819,
10. Humboldt State University, Department of Nursing,
Areata 95521.
220
11. Loma Linda University, School of Nursing,
Loma Linda 92 354.
12. Mount St. Mary's College, Department of Nursing,
12001 Chalon Road, Los Angeles 90049.
13. Point Loma College, Department of Nursing,
3900 Lomaland Drive, San Diego, 92106,
I
14. San Diego State University, School of Nursing, j
5402 University Avenue, San Diego 92105. ;
15. San Francisco State University, Department of Nursing,;
1600 Holloway Avenue, San Francisco 94132, j
f
16. San Jose State University, Department of Nursing, I
125 S. Seventh STreet, San Jose 95112, !
17. University of California, Los Angeles^ School of i
Nursing. UCLA Center for Health Sciences, Los
Angeles 9002 4.
18. University of California^ San Francisco, School of i
Nursing. Office of the Dean N^319Y, San Francisco ;
94143.
19. University of San Francisco, School of Nursing,
Golden Gate and Park Avenue, San Francisco 94117. I
221
APPENDIX C
222
INFORIWION COLLECTION FORM - LDS STUDENTS, PROFESSIONALISM PROJECT
1, Name of institution
(1-3)
2. Name of department/discipline
(4-5)
3. Types of degrees/certificates offered by department
Certi fi cates :
(6-20)
Bachelors:
(21-30)
Masters :
(31-40)
Academic doctorate (indicate speciality)
(41-60)
Professional doctorate;
(61-70)
(80=1)
223
4. Do courses in the departmental curricula - as indicated in
the course catalog description - contain content related
to gerontology?
( 1)
1 Yes 2____ No
IF YES, list course titles and check appropriate spaces:
(2-76, 77, 78. 79) (80=2)
Required Overview Graduate
224
5. Does the department offer a dual degree, minor or emphasis
In gerontology at the graduate level? Check all categories
which apply.
(1-4)
1 None 2 Dual degree 3_ Minor 4 Emphasis
6. Does the department require a field practicum, internship, or
traineeship?
(5)
1 Yes 2 No
7. What is the student population of the institution?
(6-8)
# of students
8. What is the total number of faculty members comprising the
department?
(9-10)
■ ^ of faculty members
9. What is the total number of faculty holding doctorates within
the department?
(11-12)
__________# of faculty members
10. On a scale from one to seven, using the information you have
assimilated from reading the university catalog of your
department, rate the extent to which this department incorporates
the subject matter of gerontology into its departmental
curriculum,
C13)
Does not incorporate Does incorporate
gerontological subject gerontological subject
- matter matter
11. Is there anything else, not on this data collection form, that
you would like to address yourself to in terms of how this department
relates to the field of gerontology? Please respond freely.
(14-79) (80=3)
225
12. Does department/school have a division of continuing
education?
( 1)
•1 Yes 2 No
If yes, please list the course titles containing aging
(i.e., gerontological) content within the continuing ed
ucation curriculm.
(2-78)
Course titles :
(80=
226
r'
APPENDIX D
227
1. What is your name and complete title, inclusive of discipline?
(1-2)
2. What is the number of students enrolled in your department/school?
(3-5)
. ______# of students
3. If applicable, please list the course titles containing aging
(i.e., gerontological) content within your departmental/school
curricula, and please estimate what percentage of each course
is devoted to aging content.
(6-79, 80=5. 1-6)
Course titles : %
If applicable, do the instructors teaching the above courses hold
membership in the Gerontological Society (GS), or Che Western
Gerontological Society (WGS)?
(7)
1 GS 2 WGS 3 Bo th 4 Don ’ t know
4. If your department requires a field practicum, traineeship, or
internship-
What is the total number of agencies/settings being utilized?
(8-9)
__________Total # of agencies/settings being utilized
About how many students are placed in such agencies/settings?
(10-12)
______# of students placed in all agencies/settings utilized
END OF PAGE 1, PLEASE GO TO NEXT PAGE
228
Question # 4 (continued)
About how many agency/settings, which provide students with the
opportunity to work with or on behalf of older adults, are being
utilized?
(13-14)
/_____# of agencies which provide students with the
- opportunity to work with or on behalf of older adults
About how many students are placed in these agencies/settings?
(15-17)
__________# of students placed in agencies/settings which
provide opportunity to work with or on behalf of
older adults
If applicable, would you please list the names of the agencies/
settings being utilized which provide students with the opportunity
to work with or on behalf of older adults.
(18, 19, 20-21)
Names of agencies :
5, How important would you rate
courses with aging (i.e., geron
tological) content, in relation
to your total departmental/
school curriculm?
(22)
1 Of no importance
2 __Not very important
3 __Somewhat important
4 __Important
5 Very important
6. How important would you rate
aging (i.e., gerontological)
issues, in comparison with all
other issues your profession is
concerned with?
(23)
1 Of no importance
2 __Not very important
■ 3 Somewhat important
4 Important
5_Very important
END OF PAGE 2, PLEASE GO TO NEXT PAGE
229
7. If applicable, about how many doctoral dissertations and masters
theses related to aging (i.e., gerontology) have been completed
V in your department/school since 1971?
(24-25, 26.-27)
__________# of dissertations related to aging completed
since 1971
_____ # of masters theses related to aging completed
since 1971
8. To which of the following journals does your departmental/school
library subscribe? Please check all that apply.
(28-50)
Aging
Aging and Human Development
^American Geriatrics Society
"Current Literature on Aging
"Developments in Aging
"Educational Gerontology
"Experimental Aging Research
"Geriatrics
"Human Development
[Industrial Gerontology
[Journal of Gerontology
[Journal of Gerontological Nursing
[The Gerontologist
Any other aging related journals? IF YES, please list them.
END OF PAGE 3, PLEASE GO TO NEXT PAGE
230;
4
' 9. Do you plan to Implement aging related courses into your departmental/
achool curriculm within the next 2 years, or 3 to 5 years ?
(51)
1 JWithin next 2 years 2 Within next 3 to 5 years
If you do not plan to implement aging related courses into your school/
departmental curriculm, is it because of - (Please check all that apply
(52-57)
1___Lack of money 4 Lack of faculty interest
2___Lack of qualified faculty 5____Lack of relevance for your
to teach courses discipline
3 Lack of student interest 6___Other reasons, please specify
If you do plan to implement aging related courses into your school/
departmental curriculm within the next 1 to 5 years, in what topical
areas of your discipline would such courses be implemented? Please
list such areas,
(57-79, 80=6, 1-40)
Topical areas where aging related courses would be implemented:
10. If applicable, what percentage of your faculty, who teach aging related
courses, have specific gerontological training?
(41)
1_5-157, 2__15-25% 3__25-35% 4__35-507, 5__50-757, 6_757,+
11. If applicable, do you feel that faculty who teach your aging
related courses should have specific gerontological training?
(42)
1___Yes 2 No
12. Do you feel that the content (i.e., subject matter) of gerontology
.has important implications for the future of your discipline?
(43)
1 _It has very important implications
2 _It has important implications
3 ____Its implications are slightly important
4 The implications of gerontology have no
importance for my discipline
This interview was -
(44, 80=7)
1 ___Face to face
2 Over the telephone
THANK YOU FOR YOUR COOPERATION
231
APPENDIX E
232
APPENDIX E
Data From Test-Retest for Reliability
Question #5
How Important would you rate courses with aging Cl,e,, geron
tological content, in relation to your total department/school
curriculum?
1 - Of no Importance
2 - Not very important
3 - Somewhat important
4 - Important
5 - Very Important
Subjects
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Test Score
5
4
5
5
4
4
5
5
5
3
4
5
5
5
4
Retest
5
3
5
5
4
3
5
5
5
4
4
5
5
5
5
Difference
0
1
0
0
0
1
0
0
0
1
0
0
0
0
0
Spearman ran-order coefficient of correlation = r = 1-
6D
n(n-f)
r “ 0,9953
At the .01 level of significance, the critical value Is 0,715,
The null hypothesis is rejected and a positive correlation Is
demonstrated between the answers given on the test and the rest
for question #5.
233
APPENDIX F
234'
APPENDIX F
Data From Test-Retest for Reliability
Question #6
How important would you rate aging (i.e., gerontological) issues
in comparison with all other issues your profession is concerned with?
1 - Of no importance
2 - Not very important
3 - Somewhat important
4 - Important
5 - Very important
Subjects
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Test Score
5
4
4
5
4
4
5
5
5
3
4
5
5
5
5
Retest
5
4
4
5
3
3
5
5
5
5
4
5
5
5
5
Difference
0
0
0
0
1
1
0
0
0
2
0
0
0
0
0
Spearman ran-order coefficient of correlation r = 1 -
6D__
n(n-l)
r = 0.9893
At the .01 level of significance, the critical value is 0.715.
The null hypothesis is rjected and a positive correlation is
demonstrated between the answers given on the test and the retest for
question #6.
2 3 5
APPENDIX G
2361
APPENDIX G
Data From Test-Retest for Reliability
Question 12
Do you feel that the content (i.e., subject matter) of geron
tology has important implications for the future of your discipline?
1 - It has very important implications
2 - It has important implications
3 - Its implications are slightly important
4 - The implications of gerontology have no
importance for my discipline
Subjects Test Score Retest Difference
1 1 1 0
2 2 2 0
3 2 1 0
4 1 1 0
5 2 2 0
6 2 2 0
7 1 1 0
8 1 1 0
9 1 1 0
10 3 2 1
11 2 2 0
12 1 4 3
13 1 1 0
14 1 1 0
15 1 1 0
irman rank-order coefficient of correlation = r = 1
6D
n(n-l)
r = 0.981
.01 level of significance, the critical value is 0.715.
The null hypothesis is rejected and a positive correlation is
demonstrated between the answers given on the test and the retest
for question #12.
237

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Asset Metadata

Creator Cooke, Dagney May (author)

Core Title Nursing and gerontology: A study of professionalism

School Leonard Davis School of Gerontology

Degree Master of Science

Degree Program Gerontology

Degree Conferral Date 1977-09

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

Tag health and environmental sciences,OAI-PMH Harvest,social sciences

Format application/pdf (imt)

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Albert, William C. (committee chair), Wiswell, Robert (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c37-401912

Unique identifier UC11657087

Identifier EP58854.pdf (filename),usctheses-c37-401912 (legacy record id)

Legacy Identifier EP58854.pdf

Dmrecord 401912

Document Type Thesis

Format application/pdf (imt)

Rights Cooke, Dagney May

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