A STUDY OFINSTRUCTIONAL DEVELO PMENTKNOWLEDGEAND USE DURINGINST RUCT IONALPLANNINGBYNURSEEDUCATORS
INNEWFOUNDLAND ANDlABRADOR
by
Sherid a R. He a l y , B.Voc.Ed.,R.N.
Athesi s submitted tothe Sch o o l of Gr a du a teStudies in pa rt i a l fulfilment of the requ irements
for the deg reeof Master of Educ a t i on
Faculty of Education Melllorial university of Ne wfoun dl an d
March , 199 4
St.John's Ne wf oun dland
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Abstract
The purpose of this descript ive st udy isto 01tctt;data fro m nur s e educ a t ors in Newfoundlandand La b radorcon cerning their knowledge anduse of in stru c t i o na l developmentduring instructionalplanning. The study is a con tinuation o r previousstudiesundertaken in thesc ho o l system an d withi n nursingeducation. Gallant (1989 ) ,Tobin (19 89 ), Thome y (1 9 9 1 ), and Graham (1 9 9 1) studied primar yandeLemencnr-y te ac h e r s, high schoolteachers, andteacher-libra r Lan sand dete r mi nedthat thegro up s stud ied di dnot novea co mpr e h e ns i ve kncwLedqn of and compete ncy in inatr-uc tionaI de vel o p men t . Gorman (1 99 4 ) co nd ucte d anet h nog r nphi cstudy of fiv e nurse educa t o r sand conc l ud e d tha t this groupdid ha v e a func t i o nal knowLed qe of instruct i o na l de velopment and planned instructionsystemat i cally.
This study wasex e c ut e d dur i ng th e Fa l l of19 9 3 and uti l i zeda surveydesign with a wr ittenque s tionnai re. Respondents consisted of twenty-ninenurs eeduca t ors from the fi ve provincialschoolsof nursing. Re sul t s 01' the stud y in dic a t e thatthenurse educatorswho parti ci p ated in the stud yhavea funct io na l knowledge 01' Lnstruc cionat devel opment.
i i
Acknowledge ments
'rne resea rcher would li k e to exte nd her appreciat ionto those individ ualswhohelpedtolIIake the comple t i o n of this wor k a rea li ty .
Aspecial gra t i t u d e is exten d e dtomy the sis advi s or, Dr. HaryKennedy, fo r he r continue d assista n c e. gui danc eand pa t ience at home andby dis tancein go odtimes and bad.
I wou ld like toacknowledge the assistanceof all tccutt.y, staf f and fellowstudent s in the Learnin g Resour c e s pr.ogramduring the course of my graduate studies.
Aape ciaI note of thanks is extended to all nu r s e educato rs whopartic ipated in the studyduring a periodof profou ndcha nge wi t hi n our profession, and es p e ci a l ly tomy coll e ague s and friend s at theGenera l Ho s pi talSchoolof Nursin g. 'l'haircons t a n t enc ourage ment and support was gratefullyapp reciated. Th a n/!:.you Ch ris ti ne andallth e re st!
Fin,lIlyI wou l d liketo ackn c wledqethe pat i e n ceand unde r s tandi ng of my sig nif i c a nt ot h e rs : Mo m,Dad. Bern a rd, M.lrk , Paul, Peter, Davi d, Me li t a and family . I hav egi v en th e mju s t cause for co n c e r n over the lasttwo years. Ma y b e now lif e will returntono rm a l!
iii
Table of Conte nts Ab s t r a c t . . • •
Acknowledgeme nts Listof Tables List of Figu res
Page
. ii
i i i viii
CHAPTER1: Na t u r e of the Study Introd u ct i o n
Pu r po seof the St u dy . • . Sig n i fican ce of the study Limitations of theStudy . Def inition of Terms . . . Organizat ionof the Study
CHAPTER 2: Reviewof the t.Lter-acure Nu r sin g Educ ation
Historyof Nursing Education . • • . . . • . 10 Nu r si ng Educationat the Dip lomaLevel
Nu r sin g Education atthe Ba cca Lau r-ea tte Level '-"
Cur riculum De v elopme n t . . '-'J
Th o:"Fut u r e of Nu rs ingEduc a t ion )1
Su mma ry . . )9
Ins t r u c t i onal De v elopment Introduction . . . .
Hi s t ory of Instructio na l Dev e l opme nt
iv
'0
Theor iesof Le a r n i ng . . . . . 51 Theor iesof Ins t r uc tio n and Instructional Design 63 The Sy s t e ms Approach . . . 71 Instruct io na lDevelopment Model s . . . . 75 Th eFut ur e ofInstr u c t i ona l Development 80 Summary . .
Nur singEducationand Ins t ru c t i onal Development
Design of the St udy In t rod uction .
ThePopulation aes e crcnQue s ti on
Deve l op ment ofthe ResearchInstrument Administrati o nof the Study
net.c Analysis Pr o c e d ures . .
82 84
89 91 92 94 97 97
CHAPTER4: Report and Analysis of Results In t r oduc ti o n . . . .
Organizationof theFi nd i ng s Demographi c Information . . Instr uc t i onal DevelopmentKnowledge and
Use .
Instructiona l de ve lopment Cur r ic ul umdevelopment .
100 100 101
105 10 5 10 6
Educationaltechnology Needs assessment Learneranalysis The o ri e s of Le a r ninq Behavi ora l objectives Concept/ t askanalysis Sequ"2ncing of co nte nt Mea su re mentofstudent learni ng Developmentof cr-Lterion-eror m-or-c on test s . . • . • . . . . Devel opmentof ins tru c t iona l stra t egies an d materials
Teaching strategies . .
~:va l ue_ t i o n . . , . • .
Ad va nc ed Ins tru c t i ona l Developmen t Know ledg e Genera l systems theor y . systematic versussystemicappr-oach AlgorIthmsandheu r istics . Summary .
106 110
115 U7 I:!O 121
"0
14]
'"
CHAPTER 5: conclusi on and Re commenda tions Summaryof theStud y
Conclusions . . Recommenda t ions References • • . . .
vi
15:1 15') lfil IG:.!
APPENDIX A: CNA Standard sfor Nursi ng
Educationin ca nada (1978) 170
APPENDIXB:AFNN Standards forscnc c t s of Nursing
(1991) . . . • • • • 176
APPENDIXC: Resea rchIns tr ument . 181 APPENDI X0: Cor res po nden c e . • • 204
vii
ListofTab l es
Tabl e Page
Responde nts' Demog r ap hi c Information . . 10 :l Responde nts' Know l e dge of Instructional De velo p mentand Curricu l umDevelopment
Processes . . • . • . . . 10.1
Re s pon de n t s' KnowLe d qe of Ins tructionaI cevetcpeent.Definitio n and't'hocry
Base. . IOI,
Respo nd en ts'Perceivedutr terencc Between InstructionalDevelopme ntandcurrl cu tue Deve l op me nt . • . • . . • • • lOt Responde nts ' Knowledge of ecucev tcnc1
Technology . . . 10'-)
Responde nts' Percepti onsofIn s t r uc t i o nal Development 's FitWith in curriculum
Stag e s . . . 110
Re s po nd e nt s' Kn c wLedqe and Use ofNe ed s As s e s s me nt . . . .
Respondents' Kno wl e dgeand Use of
Learne r Ana l y s i s . . . 11]
Respondents' Per ce p t i on s of Importa nt Le ar nerchar-act. er-Lst Ica . . • • • 114 10
11
12
13
Respondents' KncvLed q e andUse of Theories ofLe arn ing • • . . • . Respondents' Kno wledgeandUs c of Be havioral Objectives • • • • . . r.espcncenes' Know l e d g e and Use of Concep t/Tas k Anal y s i s . . • • . Respon d ents ' Metho d s tor sequencing Teaching Con te nt. • . • • • • . . •
viii
116
11'
17.1
122
15
Respond e n t s' Us e of Tests toMeas ure St ude n t Learning
Kespondents' Knowledgeand Use of cr Iterio n-Refe r e n c e d Tests
124
126 Respondents' Knowledgeand Us e of
Instr uct i onal Strategies 128
17
18
19
21
22
Reapcnderrts" Methodsof select ing In s t r u ct i o nal Materials Res pondents' S~ lf-De ve l o p e d InstructionalMaterials Re s poruf errt.a" RegularlyUsed Teachingstrategies Responde nts' Me t h o d/Gui d e fo r SelectingLea r n i n g Ac.tivities Respondents' KnowledgeandUs e of Ev al u ati o n
Respondents' Basis for Evalua t ion of Instructio n
129
130
U2
133
135
136 Respondents' Views of Whatto Eva luate
in an Instructional Program 137
2<1 Respondents' Views asto Most Appr-op r-Lat.eTime to DevelopTe s t i ng
Mechanisms 138
25 Respondents' Sourceand Use of
Feedback on Ins tr uct ion 139
26 Respondents' Kno wledgeof Advanced In s t r u c t i o na l DevelopmentConcepts 143 27 Summa r y of Respondents'Kno wLedq.e
of DiscreteInstructional Development
Tasks/Skills 151
28 Summaryof Responde nts'Use of Discrete In str uc ti on a l Deve l op me nt Ta s k s / Sk i ll s 15 2
ix
Listof Fi g u r e s
Fig ur e Page
Stage s andTasks Commonto System
Desig nmode ls . . . • . ·'·1
Components CommontoIns t r u c tio na .!
DesignMo d e l s . . . . . Dick and Carey's Mod l.'l l of Instr uctionalDesign . • .
CHAPTEH 1 Na t u r eof thestudy
Introduc tio n
Ac cordingto Wagn er (1986 )therear e severalrea sons forencouragi ngre seerch in t o instructional design and development:
...less efficient plan n i ng is likel yu- yield less errIcLentpro d uc t s , whereas more efficient planni r.g is likely to yield more efficient, cost-effective products...i twi ll heightenbothpractitione r and general pub lic awareness of the signif ica nc eof process reIoted activities wit h i n eachco mpon ent of the [sic) entire educationalt",chnology system. (p.39) The is sue s of cost-effectiveproduction and »wareness 01 process-relatc.dactiviti esareap plicableto all levels ofeducation, i:-:vludingpost-seconda ryedu ca tion, and, specif ically, tonurs i ng education .
Th isstudy took place withi nthe basic nursing educaticn programswi t h i n the pr-ovinceofNew f o und l a nd and Labrado r , p r-eaent.Ly, ther-e ar e fourprog r a ms leading to dip loma certification and one baccala ureate program at Memorialuni versityof Newfoundland.
The educators whote ach in th e s e progr ams, with fe w exceptions, are nurses. Theseed ucato r s are re spo ns i bl e for notonly the academicaspectof education, butal s o clinical
teach ing. In keepingwi th standa rdsset by theprofessiona l governing body of nursingwithintheprov in c e,the Association of RegisteredNurses ofNewfou nd l a nd (1\RNN), tho majorityof nurseeducato rswi thi n each diplomaschoolhave to possessa baccalaurea tedegreein nursing and the majority of faculty membersteachingat theunive r sit y le v e l have to have achievedaMas t e r ' sde g ree in nu r s i n g. 1\swell all instructorsre q u i r e clinical nu r s ing competency (1\RNN, 1991, p.24). The nurse educators who have not achievedthe minimumacademic requirements fo r theirpositi onare cu r r e n tl y studying at varyi ngle vel s inad uo ation a Iprograms to arriveat thestandard, whichwas originally setin198(,.
Purposeofthe study
The curriculumcommittee in eachschool of nurs ingset s the guidelines for contentfor eucn course wi th i n its curric ulum. Th eseauidelinesare inkeep ingwith recommendatio nsset down by th eCanadianNurses' Asso ciat ion (CNA) andARNN standards fo r school sof nursing . Nurse educators arere s p o n s i b l e for the plann ingof instruction for each course of study whichadheres to the indivi dual schoo l 's philosophy, goalsand conceptu alframewor k. The planningof instruction inmost instances Invctvee
developmentof cou rseand co ntentobjectives,
teaching/learni ngmethods, andmethodsof studentand course evaluation.
Therefore the purposeof this stuc.yis to determine nu r s e educators' knowledge and use of the instructional dev elopment proces sduring instructionalplanning.
Signifi canceof theStudy
The Associationof RegisteredNurses of Newfoundland (AIWN)ov e r s e e s specificregulations governingtheeducation andlic ensureof nurses in the province . The ARNN(199l) ou t l i ne s the minimum clil'lica1and theoretical componen ts whi ch ar e requiredof th e nursingprograms . Aswell, th e NursingEducationConsu ltantwith the ARNN is ame mbe r of th ecur ri cu lum committeeineach school ofnu rsing.
All provinc ialdip lomaschools of nursi ng undergoan appr-oveI or ac creditation process, as do theirrespe ct i v e affil iat ing hospi ta ls. The approval process for th e diploma school s of nursing is conducted bytheARNN. Theunive rsity nursingprogrampartici pa tesintheCanadian Ass ociat i o nof UniversitySchoo lsof Nurs i ngAccreditati onProgram(1987 ) .
Nursing educatio n is currentlyundergo i ngmajor restruct uri ngin responseto the changi ng ne e d s ofsociety ar.d , as well, to the cha ngesbeing made by governme nt in
he althcare fu nding. All schoo l s of nursi ngareprese ntl y collaboratingtodevelopa curricul um for future nursing educa tio n in the province. Thispr ogramwi ll permit students toex i t with a nursingdiplom a aft e r threeyearsof study, or cont inue fo r one add itionalyear to obtaina baccala u reatein nursing (B.N.). Th i s new collaborative cur-r-I c-u.u m offersdynamicchal l e ngesfor bo t h stude ntsand nurse educators.
with thema n y changes andcha llengesthat arenow evident in nur s ing education, a definitiveapproachto the developmentofin s t r uc tion would helpensurethatthe curriculumis asef f e c t i ve andas productive as possib le. Educational technology can be seento be inval uable in ach ievingthisend.
Wa gn e r (1986) writes:
If one looks to improve learningand pe r fo r ma nc e outcomes through theappli c a ti on of educational technology ba s ed solut i ons, it may be most appropriate to consider educ a t i onal technology as themeans through whicheducat iona l syste msanalysismay be enabled.
This broad ba s e d perspective prov i d esa con tinuumwhic h includ e s not only the "hi gh tech"is s ue s whi ch typify educational te ch n o l ogyend e a vors , butalsoaccomecdaties exa n t stre ng t hs of the int e r d i s c i pl inar yfoun d at i o n upon whi c h educationa l tec hnolo gy is based. {p , J6)
Educ a tiona l te chnology wa s co nc eive d ina systems-based mod el , and co n tains theoreti c alelements from a number of di s c ip l ines . "In its br o ad est sense, the pr edete r mined purpo se of educat i onal technologyistomaximize learn ing and/orperforma n c e outco me s through the development,design, de livery , and evalua tionof instructional and/or tra in ing programs, procedures,and material s" (Wagner,1986, p.3 6 ).
Instruc t ionalde v e l o pmen t isa subset of educa tional t.echncLcqy , and He inich (197 0 )views inst r u ct iona l de v eLcpment;asent erin"::f int o the tota l ins t ru c t i o nal pro c e ss at t.hecurr icul um plann ing le ve l, fol l owi n g cur r i cu l um deter minatio nand beforeclassroom imp lemen ta t i on (p.170).
'rh ocol la bo r a tivecu r r i c u l umfo r future nu rsing education in Newfoundland is nowatcnest a ge of curricu lu m planning.
Snelbeck e r (19 88) states:
.. . , the classroomteach e r need notha v e tho hi gh le v e l of exper ti s e we might expect from fu l l-ti me professio nal in str u ctiona l designers but teachers do need at le ast fu ndame nta l instr u ct i on a l de si g n st r a teg ie stoplan, eva l ua teand modifyinstructionas a r-e q uLar- and con t i n u i ng part of their cl a s s r oom work.
(p.J5)
A seriesof studieson ins tructiona l development knowledg eand competencies of speci f i c groups of
Newfound land te ac hershas be e ncompletedby Ga llan t (1<)89). Tobin(1989 ), Thomey (l99~ ) andGra ha m(19'H). Th ese studies concl ud e d that teachers donot po s se s s si g n ifica nt explicit le vels of knowledgeor compe t e ncy in Lnstr-uctione r development.
Gor man (199 4) conduc t edan et hnog r a ph i c case s tud y of five nur s eeducators' knowledge ofinstr uc t i ona ldeve l op men t and th e inst r uc tio nal plan ning pr oce s s . Result sof this et.u d yind i cat ed that the fivenurs e educ ctor s who part i ci p ated in the studyhad a funct io na l kno wladgeof ins tr uc t i onalde v e l opme ntandplanned inst ruc t ion syste ma tica lly . Sh e re commendedthat a further stu d y be under t aken to dete rm inenurse educa to rs ' kno wledge oas e of discre t e ins truc t i o nal development components (p. 1J5). This presentstudy, designed as afollow-up to Gorma n's ethn ograp h i c resear ch, wa s carri e doutduring the F'll1 of 19 9 3.
Limitatio nsof the study.
While impl e menti n gth i s stud y, the follo win g limitations we r e recogni zed :
The study wa s co nd uc ted within the fi v e basic nursing edu c at io n programs in the provinceof Ncwfoundlu.nd and Labrad or. The respon serate to the quest ionna i re was
thirty-nin eperc ent (39\) . Therefore, the applications and cc ncIueLc ns can onlybe made withinthe limits of this min o r i t y gr oup. It should be noted, however, that th e nurse educators who respondedwere representativein educational background s and teachingexperiencesof the majority of the nurse educato rsre gistered with the ARNN.
This st ud y soughtto determ i nenu r s e educators' know l edgeand useof instructional developmentonly. No attem ptwas made, within the parameters of thisstudy,to deter mi n ewhetheror not instructi ona l developmentkllowledge and us e hod any impact onthe effi ciencyor effec tive nessof instruc t i onwi thin th e sc hoo l s of nursing.
De fi ni ti cnofTe r ms
For the purpo seof thisst ud y , the followingtermsand defi n itions apply .
BasicNursingEducation : Refers to diplomaor ba cc alaurea teprograms that prepare candidatesto apply for LnLt ial reg istrat i on orlice n s ur e as professionalnu r s e s (Ca n ad i a n Nurse s Association (CNA ) , 1978, p.7) .
Curric u l um: A systematic and comprehensiveplanof learnin g act i vi t i e s (CNA, 1978, p, 7) .
Educational Technology : A complex, integrated process fo r anal yz ingproblems and dev is i n g , implementing,
evaluating and manag ing so l ut i o ns tothosepro b l ems involved in all aspects of human lea r ni n g (As s o ciatio nof Edu cation al Communicat ions and Technolony (AECT), 1977, p.12).
Instructi onalDev elopment: A systema t i cappr oa chto the design, production, evaluation, and utilizat ionor completesystemsofin s t.r uc t i on, includingallapprop r iat e component s and ama na ge ment pattern forus ingthem;
instructi on aldevelopment is largerthaninst r uctio na l pr odu c t developme n t , which is concern ed withonlyLscln t.cd produ c ts , andislar g erthan instruction a l des ign , Which is on l y onephase of instruc tionaldevelopmen t (J\ECT,19 7 7 , p. 20) .
Nursinq Edu c ation: The proces sthat facilitate s acquis i t ionand modificat i onof nursing knowledge ,sk i ll s andattitud e stopreparebeginning pr acti tio ne rs of nurs ing andto enhanc e th e comp e t e nc e of experiencednu r s e s (CNA, 197 8 , p. 7 ).
Nurse Educator : One who fac ilita te sac qu is i ti on and modificat ion ..:nursing knowledge, skillsand atttcucesto preparebe g inningpract i ti oners of nur s ing and enha nc esth e competence of exper iencednurses.
organization Clf the study
Thereport of thisstudy onthe knowle d ge and use of the instruct ionaldevelopmentpr oc e s s during ins t r uc t i o n a l planning by nur s e educat ors is organized inthe following
Chapter2discussesa review of therele van t literature r-aqar-dinq nursingedu..ar.L on and instructionaldevelopmen t. Itals o presentsan overvie wof thein s t r u c t ion al developmen t proc ess.
Cha pt er3pro t Lj es th e methodol ogy used inthe Lmpl ernent.aticn of th i s study.
Chapter 4 reports andanalyzesthe results of the data gat he reddur- Lnqthe study.
Chapter 5 draws conclusionsfrom the studyan d makes e-ec oaeoendatLonsfor futurestudy.
10 CHAPTER 2
Re v i e w of the Litera ture Nursing Educatign
History of Nursing Education
Thehis t o r y of the nursing professionis irre vocab l y linkedto that of the educatio nof its prac t i tioners, who havetr a diti o n a ll y been women.
Grif fin and Griffin (1969) seethe n Iscor Icc I perspecti ves of nursi ng in termsof:
. . . the evolutionof anorg anizedgroup wi thinsocie t y wh o haverecei v e d a recognizedpreparationfor their- work, devoti ng th e major partof the ir timeand effor t to the systematicpursuitof a task - withrecog ni t ion as a soc i al group devoted to thist.as k . (p, 5) Theseauthorsdi v idenursing'Shist orica l development in to three main categorie s:
(1 ) from early times to the la t t er part or'the ei g ht e e n t hce n tu r y ;
(2) fromthela t t er partofthe eighteenth cen tur yto the es tabl ishmentof th e firstmode rn schoo l fo r nurses ilt St. Thomas' Hospital, England, in 1860;
(J) from1860 tothe present.
Reverby (1990) writes that nu r s i n g wasa duty that was speci fic to females in the home throug h out history. I twas
11 comlllo n for voeentocar etor members of the familyin times of ill n ess. "Embeddedin thE:seeminglyna t u r a l or ordained char ac ter01women, it becamean itlport a nt manife s t a tio nof women 'sexp re ssionof love of ot h e rs,andwa s thus integral to thefemale sens e ofse l f " (p. 4 ).
Whenhospitals beca me po pUl a r,workerswho provided care were labelled vr.ursese. Gri f f in andG>:iffin (1969) c I t.e that there wa s nospec ia l tr a in ing , otherthan p r-cctLc aI expe ri en c e atthe beds i d e , gi v en to wome n. 11 nat ural ability, intuit ion,or affiliationwit hone of the t-e11qIousor de rswho minist e red tothe sick andth e poor were thestand ards b} wh l c hthe abi lity tonursewa s eeasurec . sometimesjust being inth e rightplace mean t delega tio nof nur sing re s po ns ibil i ties, asRe verbydenotes in her storyot' the hospita l la un d ressadv ancedto a nu r s i ng po s itionbec a u se of lack of staff. Bau mgartand ":irkwood (1990) noteth at thi s mind-s e t ofwomanhoo d as nurturi ng and caring moth ers , mora l andspiritual guidersand househo ld aenaqe r-s fit tedwithi n thesphe r e of na tura l nursing abi lity.
Yet, Nu':ti nq and Dock, 1907 (cited inPalmer, 198 5 ) docume n t that :
Dr. Vale n tineSeaman,a ph ysi cianat theNew York Hospital, isgenerall y recogn i z e d asthe initiatorof th e firstsy stematicatte mpt topro vide instructi on for
12 nursing attendants. In 1798, be f o r e Nightintjille, he organized thefirstre gular tr a i n i n gof nurses; gave them a seriesof 24 lectures, whic hinc lud ed anatomyI
physiology, the care of children, and midwifery.
(p.102)
While the humanitarian philosophy wasth e drivingforce behi ndthe provisionofthis formofnur s i ng service, it wa u not until the work of Flore nc eNight inga lethat the modern conceptof nursing and nursingeducation evolved. peIwer- (1985) citesthatNightinga l ehad sufficient insight to know that special trai ningwas needed for thosecaring for cne si ck,and he r efforts towar dsthis goalwe r ero s teredby certainsocial factors ofth e time: (1) a qreeerut Br itish publichonored her services inth e CrimeanWar with a large amountof mone y and pressuredher to establisha school fo r nurs e training; and(2) nursesof thetime were held in disrespe ct . IIIiee re c v, dru nke nness. andalac k of ski11 were ide n tifiedas problema ticin these individuals .
As we ll,Mi ssNigh t in ga lehad certain notions concern ingwomen 'sneeds of the era. Shesaw thenecessity for cr e ating the means for a useful occupat ion forwo men who hadto suppor t themsel ves, and of Lrnpr-ovinq the moral atmosphere. The r e f or e , the cardinal principles ofWh ichthe Nighti nga leSchool(1 8 6 0 )at st.'rncnee' Hospital were as follows:
13 1. Nursesshou l d be technically trained inhospitals
organized for that purpose.
2. Nurses should live in "homes" fit toform their moral lives and discip line . (Griffin&Griffin, 1969, p.77)
The Sc h o o l , which was financedby the Nightingale Fund, independentof St.Thomas' Hospital in terms of budget, althoughthe nurses provided services to the hospital.
Prince(1 9 84) deecrIb e e thegr a d u a t e sof the schoolas
"Ni ght i ngalenurses"and statesthat these graduates went on toestabl ishschoolsand tobecome matrons throughout Englandand the colonies. These nurses found thatth e y could not totallyremain apart from thehospitalsin terms of fina nces, so few schools ultimatelyre ma i ne d as separate enti ties. Inthis aspect, Miss Nightinga le'sideal that the school be an educationaland not a service institutionwas not upheld. In the UnitedSt a t e s and Canada, as well as England, this systemof providing low cost service to hospitals took precedence ove r educational requirements.
TheNi g h ting a l e system of nurses' trainingwas duplicatedthroughout England and North America, incorporatingboth the positive and negative elements. The first training school for nurses in Canada was established by Dr. Theophilus Mack in st. catber-Lnese s , ontario, in 1874 , one year after the first"Ni ght i ngale School "was
opened inthe United states (Mussallem, 19 6 5,p.6). Palmer (1985) summar izes the effectsupo nnur s ing:
As a conseque nce of Mi s s Nightln g a le's inf Luence , nursingbe ga n as a service to th e si ck In ho s pit a l s, with the riut ies and re sponsibi lities ofnu r s e s SUbj ec t totheappr o val ofphy s i c ians whoal s o determin ed, toa largeextent, what; nu r s e swo u l d be taught. Moreover, students wereused,..., as the ho sp i t al' smainLab o r force. Another impact of nissNi qh tin q ill e 's aut.horLty was th e exclusion of men from nursingwork , ther eby setting up the sexist bias and pa te r n a li st ic attitude towardnu r s e s wh ich persistto this day. (p.10g) Reverby (1990) refersto several re a s on s why the exp l o i ta t i o n ofst.udent.s wastolerate d in th i s way: caring atrtLbude , self-sa c rifi ce, and subm issionwere expect ed andenccur-a qed r thetraining emphasizedd Lsc LpI inc, order andpra ct i c a l skills; andth e r e were no standards to indicate wha t was anacceptablewo r kl oa d for students. "In this kind of envi ro nmen t, nurseswere tra i n e d . Aut they were noteducated " (p.8).
'rhe pe r iod encompassing the turn of thecent u r y wasi\
time of growth for nursing education. 'rtrI c evol v e d main ly fr o m the scientificprogr essbeingma d e through. the vo r k of peo p l e such as pee'ceu r and Lister. The numbe r s of phys i cians , su r geo ns, and hospi t al fac ilities gr e wand , with
15 these, inevita b ly grew the de mandfo r mo r e train ednurses.
The one yearof train ingadvocatedbyHiss Nigh tingale now stre t c h e d in tothre eyear programs, with emphasis being pl ace d in tea c hing stu"~ntsnot only howtodothings, but why also. ButGri f fin' Griffin (19 6 9 )citea pe rvasi ve attitude,among me mbers ofthe medica l pr o f e s s i on atthe time, that modern nur s e s we r e be i ng overtrained.
Itwa sargued tha t byknowi ngto omuc hthe nurses became unfi t for theesse ntial nu r s ing task orthat we were wastingourtime ed uc ati ng a grou pof
"s emipr o f es si on a l s". Thi s attitude amongme rnbere of the me d i c a l professionand amongot her s uponwhom the nu r s e smus t rel yfor advanci ngtheirstandinghas been the chiefobs tacl e against whichtheyhave had to fight . Ho....eve r. it ratherstrengthenedthanweakened their fight . because it madeit nec ess a r y for every adva nce to pos sessth e vitalityof inh e r e nt va l ueto survi ve. Sinc e187 2 theed uc a t i o not nurs es has adva nced in sp i t e ofthi soppos i t i o n. (p.104) To furt he r hi g h lightth isnot i on Hunter (ci t ed in Baumgart and Ki r kwo od, 1990) is quoted as emph asi z i ng tiM': good he a lthand a pleasa ntpe r s on a lity in190 5 were moreimporta ntqualitie s inthe nur s e thanscie nt ific knowl e dg eandski ll (p.512).
By 189 ), agrou prepr esentingpr ominentnursing school s
16 had band ed toge t h e r and formedThe America n societ yot Su p e ri n te n de ntsof Tra ining Scb o ols of the UnitedSta te s lind Ca n a da in order to provideleadership to improve e ducat.LonaI standar ds. Thisgroup lat er divided to form theNa t i o na l Leaguefor Nursing inthe UnitedStatesand the Canadian Nurses' Association .
The concept of the apprenticeship-trainingethicwas prevalent throughout the early19005, ye t it "wa s not even a respectably run apprenticeship, because novices learned from their peers and not from skilled masters" (Keddy and Luk nn , 1985, p.41).
In 1917 the curriculum committee of the NationalLeague of Nursing Education published a guide entitledAstan da r d Cu r r icu lum for Sch oo lsof Nursin g. This guidemade suggestionson improvementsto be made in nursing schools regardingthe o r e t i c a l courses, and Lt; outli nedthe cj asswork requiredfor a three yearpr og r a m. Thiscurriculumvas used wi d e l y alsoin Canada.
Mussallem (1965) describes fourmain typesof formal programs fo r the education ofdi f f e ri ng levels of nur sing practi tionersexisting in Canada by196 3 : 16 university schoolsof nursing leading to a ba c c a l a u r e a t e deg ree, 170 hospital diplomaschools, 79 programsfor th e preparationof nursi ngassistants and seven programsfor thepreparationof psychiatricnur s e s. The university schoolswere lHithin the
17 forma l educationalsystQm, and the hospital schools,wh ich providedthe main supply of skilled manpowerfor the nursing service, were under the control of the individualoperating ag e nci e s .
Educati onalreformfor nursingin Canada eventually tookonfourma i n themes:
(1) developmentof a scientificand humanist icknowledge bas e ;
(2) recru i t ing of a highercalibre of stude n t ; (3) changi n g of the work image of nursing;
(4) improvi ngthetr a i n i ng schoolswhich made up the main bulk ofthe nursingeducation sy s te m (Russell, 195 0 cite d in Baumgart&Kirkwood, 1990 ).
In the194 05 severalevents helpedto directthe focus of change in nursing. Abo o k byMary Ella chayer entitled Nursing inMode r nsoc iety, made the profession aware of th e crit ical analysisof nursing and nursingeducut.Ionthat was needed:
A revolu ti o n is ne e ded in nursingtoday. One is being experi e nced whe ther it is being recognizedor no t. Our time-honoredmethodsof serving the public are no longe r adequate...What was good enough , or at least ec iere eee at one stage of deve lopmentis not qood enough for another. The "ho r s e and buggy age" gives pl a c e tothe "atomicage,"with its new
18 resp on sibil i t i e s andda ng ers. (Chayer, 19 4 7 cited in Do l an , 196 8, p.346)
In1942 a study of nursing educa tio n wa s commissioned bytheNatio n alNursin gCouncilofthe UnitedSta tes.
Deficienc ies in the quant ityand qua lityof nursingservice, asdocumen ted in pr evi o us nur s i ng studies , were attributed tothe pr evailingsyste mofnur s in g education. Thisstudy, knownas the BrownReport, emphasizedtho::necessityof educat ion topr ep are nurses to meet theneeds of society in the second ha l fof the twentieth ce nt ury. The
recommendatio ns for the fut ureof nursi ng educo tIoncanbe seenin thedefinitionof nurs ingas given in thisreport:
Nursing initsbroadest se nsemaybe defined as an art and a sciencewhich inv a l ves the wholepatient - body, mindand spiri t ; promo t e s hi s spiritual, mental, a nd phy s i c a l hea lth by teachingand by example; stresses he a l t heduc a t i o nand hea l thpreservation, as wellas min is t r a ti o n to the sick; inv olv e s thecar e of th e patient'senvironment -social and spiritual as well as phy s i c a l ; and giveshe a l th se rv Lceto thefoJmily and commu n ityas well asto th e individual. (Brown, 19<1 8 ci te d in Do l a n , 19 6 8,p.349)
19 Nursin g Educationat the Diplo ma Level
Becauseof th eNi ght i ng a le tradi tion, nursi n geducation develop edwit hin thehospital-controlled env ironmen t, essent iallyba s ed on the apprent i c e sh ip system. Thestuden t worke din the hospit a l, andbydoingso,pa id for he r room andboardandpa rt of her tra i n i ng . Shere ceive d a sma ll stipend fo r her eff orts . Students wereadmi ttedtothe school, and immediatelywent to work. Teaching was incidenta l anddone spo r a d icall y by physic ian s . Itis within thisstructure that thediplo maschool sof nur s ing evo lv e d and flourished. Mu s s a ll em(196 5 j rep o rts that by 1909. the r ewere70 such scncors in Cana da.
McQua r rie (195 5). writingfor thefiftiethanniversary of the jour na l ,The CanadianNurse, cites that "the tug-of- WClrbetweenthe serviceneedsof thehospital and the educationof the studentrema insa major is sue..•" (p. 1941. This stillcontinuestobeproblemat ic, eventoda y, with hospital -based diploma education.
Traini ngschools for nurs es, althoughexpa nded in numbers in the firstquarter ofthetwentiethce ntur y ,were und e r the tota l control oftheind i v i d ual hospi t a l s who su ppor te dthe mfinanc i ally . Some of thesma l l e r school s provided no r-equLar-theoret ical cou rses , ac c ept e d stud en ts wit hout hi gh schoolentr anc e require mentsandappearedto exi st sol ely for economicreasons. Many ofthelarger
20
schools developed good programs, incorporating theory with practice. Most programs offered one to two years of scant education mixed wi t h service, andthe final yearas internship or totalservice.
In 1927th e Can a d i a n Nurses' Associat ion (CNA) and the Canadian Medical Association (CMA) formed a jo i n t committee to investigatethe problemsinnu r sin g education. Professo r George Wei r, head of the Department of Education of the Uni vers i tyof British Colu mbia ,wa sgiven the casjc of co n duc ti n ga detailedsurveyofnursing education in con cue andmale i n g recommendations. The report was publishedin 19 3 2,and asa result of the finding s of weaknesses in administrative policies and ove ralleducational programs, the CNA organized a NationalCurriculum commi ttee which developed APropos edCu rriculumfor Schoolsof Nur sin gin Ca nada in 19 3 6. This proposalwas updated in 19<\0 to in c l u d e clinical experiences also.
McQuarrie (1955) lists th e followingpositive ou tcomes on nursingeducation of thesecu r r i c ul u m proposa l s: (1) A greateremphasis on thedevelopmentofcu rr-LcuIum,
both planned co u r s e s and clin ical expe r i ence s;
(2) An in c r e as e inthe number of qualifi edclassroomand clinical in s t r u c t o r s;
(3) Better te ac h i ng facil i t i es;
(<\) Better school of nursingrecords;
21 (5) Better healthfacilities fo r studen ts;
(6 ) Closure of those small schools with inadequate clinical experiencefacilities;
(7) Increasedresponsibilityof atudent; organizationsfor their own non-professional activities;
(8 ) Establishment of minimum curriculum standards for reg istrationon a provincial level; facilities for provid ing guidance to schools; activenursingeducation co mmi t t e es .
Thes eparti cu larareas ca me under thepro vincia l re gist ered nurses' associations, since the standardsof nurs i ng educationwere maintained by the ten prov inc ial nurs es' reg istrat ionor licensing act s inCana da .
So meof therecomme ndat i o ns from ProfessorWeir's sur v eyofNur s i n g Education inCanada.which wereno t impleme nte d by 1955, thereby remainingmajorissues inc l u d ed:
(1 ) Hospitalsconducting approvedtrainingschools should budgetseparately for the school.
(2) The sc h o o l of nursingshouldbe consideredas an educat iona l institutionandno t an economic asset to the hospital.
(3) Thethe ory compo n e nt of cu r r icu l u m should be revised, but nat reduced, as studentsare given toolittletime tostudy the theory.
22 (4) Greater attention should be given, both in curriculum
conten t andt.eachLnqmetho ds, to individ ua l differences in abilit iesand ac h i evem en t s of the students . (5) There isaneed fo r bettercor rela tionbet ween the o r y
and practice.
(6) Educationshou ldbe li b e ral , as well as technical.
(7) Thereshouldbe greater us e 01' the problem method of teaching.
(8) Studentnurses shouldbe givenmoret ime for independentstudy.
(9) Studentsshould ha v e more expe rLer-c e in mentalhc n l t h andneuro logica l nu rsing (McQuarrie , 1955).
Mussallem (1965) discussesthe authorityfor nursing and nu r s in g education in Canada :
Canadian legislation re q u i r e s that nu r s i ng affa irs come under provincial control wi thinthe ge ne r a l categoryof health. In mos t of the pr o v i n c e s , thepr o v i n c i al nurses' association is aut hor izedby legislatio nto deal with matte rsconcerningthe educationa l practice of nursingand the gran t ing of registration ...
InCan ada, unli ke most cou ntries , the pr o v inc i a l nurses ' associatio ns (exce p t in Ontario) actually admi n ister the nu r s i ng practiceacts. Thisauthority is qr-arrt.ed to the nurses'associationby provinc ial leg i sl a t ur e s . (p . ll)
23 The Cana d ian Nurse s' Assoc ia tion (CNA) is a fede ra tion of the tenpr ovinci a las sociat i on sandacts in an advi s ory ca pa c ity . Theseprov i nc i a lassoc i a t i ons ar e se l f - gover n ing units, andare freeto acce pt or reject any adv i c e offe r e d by theCNA. In1978, theCNA Bo ar dof Dire c t o r s appr o v e d the Standards For NursingEducatioDIn Canada (seeApp en d ix A). These:standards define the basic criteria for accreditationof schools of nursing.The specific criteria us ed for ac cred i tationcanbe found in tne Pol icies, ProceduresAnd standards ForApp r o va l Of Schools Of Nursing In Newfoundland (ARNN, 19 9 1 ). Ind i vi d ua l schools of nursing are stillfreeto structu re their theo re t icaland cli n i ca l components accordingtothe i r ownconc ep tual mod el and perceivedneeds, aslong asthecurr iculumst ructurefollows the guidelinessetdown by the As s oci a tion of Regi stered Nurses of Newfound land (ARNN).
Theseguidelinesalsocite th e qualifications needed for ta cu ltyto tea ch inadipl omasch oo l of nursing. At least 75%of the nursing recui cy must have a baccalaureate in nursingor its equiva lent, as well as at lea s t two years of clinical nu r s ing experience (ARNN, 1991 , p.23-24) .
Presently thereare fourdiploma schoolsof nursingin the pro vi nceof Newfou nd lan d: Wes t ern Memo rialReg i on al Uo sp i t a l School of Nursin g , CornerBro ok; Grac e Ge ne ra l Hospita l, St. Cl are' s Merc y Ho spi t aland the General
Hospital Schools of Nur s ing , all in St. John's. Courses of studyinc l ud e bas i c sciences and nursing courses, aswell as comp rehensive cl in i c a l experie nces wi t h i n the firsttwo years, and an inte r n s h i p , or service ye a r for Year3.
CornerBr o ok' s program is compl etedshortlyafter twoyears.
All theseprograms offer th estudentopportunity to write thena t i o n al licens u r e examinations fo r nurseregistration upon successfulcompletion of thediplomaprogram .
Di p l oma nursing educationin Newfoundland is pr-eeenbIy go i ng throughmajor change in ter msoffi na n c i al responsibilityfor educationand the serv icerequirements expected of stud en t s. Gover nmentis qr-aduaLjydec r e as ing the specialize dfunding for thispost-secondaryeducation that has beenhistorically in place;'{e a r J isbe coming an educationallybased year instead of a service year i and tu i t i o n payment.sarebeing setfor students.
Nursing Educa tjo natth e Bacca laureateLevel
Minnesotais credi tedwith having the firstschool a nursing organizedas an in t e g r a l part 0::a un Lve r-sLt.y in the Unites States in1909. Two years prevtous iv, Mary Adela ide Nutti ng be c a me the"fi r s t nurse in the world to become a professor in aun i v e r s i t y (Griffin"Griffin, 1969, p.1 25). Aspecial departmen t ofhou s eh oldadministrationwhich included the division of hospitaleconomics wa s etr-uck to
25 of feradvanced courses forth o se nursesseeking positionsin tea c hing and administration.
Baumgart and K1rkwood (1 99 0 ) state that nurses have had a diffi cul t struggleto maintainparitywith other pr o fes si o nal groups regarding hi g her education. This st r ug g l e was, in part, due to cultural views of women and ult imatesocial inequality :
Nurs ingeducation in Canadaand, particUlarly , th e deve lopment of nu rsi ng sc hola r s h i p , has been con stra inedby the cultura l views ofwomenand of the prop erusesof higher educat ion for women. The
"g het to iz a t i on" of nurs ingwithinthe un iversity illustra t es the limit.atio ns ofthe promise of equality wherei nschol arly pur suitshavebee n made subservient totrai ningfo r domesticity, motherhood and women's assi g ne d responsi b ilit iesfor protectingth e moral fi b r e andsocia l well - be i ng of society . (p.Sll ) Nurses ,as ind eedallwomen at the turn of the century, vie we d higheredu c a ti o n as a way of tryingtoovercome the soci al inequalitiesthat were prevalent. The goal of nu r s ingwas Ul t i ma t e l y to be profe s s i on al status, and with this statusattained , the old id e a s of women's inte l lectual infe r iorityand bio logicalrolesofmotherandho us e k e e pe r could be eradicated. seigel (1984) agr e e s thatnu r s e s , both prac t it ionersand educators, have struggledto attain
26 re c o gn i t i on aspro f e s s iona l s. "Th e combinat io nof women, nurs ing, andhigh e r educationresultedina self- perpetuat ingcycleof low status , low pay, and no pr o f e s si o n a li z a t i on , th a t is unti l all th r e eareas worke don theirown senseof wo rth " (p.1 14) . The ha ll ma rk s of a profession (stronglevel of commLtn nent; , lon g anddi s c i p li ne d educationalprocess ,uniquebody of k.nowledge ,discretionary authorityandjUdgement, cohesive professionalorganization and acknowledged social worthand contribution) arcwi.tihLn the grasp ofnu r s e s due to anumb e r of factors:
(1) the bacca laureatedegr ee as minimalrequ irementfor entry to practice;
(2) improvementinthe qua Lity of nursing curricuLa throug h universityplacement;
(3) unLjrc a tion of nur s ing serviceandnursingeducation;
(4) autonomyof staffnurses be c a use of the responsibility fortota l patient car e;
(5) increas e inthe number ofdoc'tora Ll.y-iprepar-ed nurses;
(6) more flexible and accessibleeducational programswhich can accommodate working and no n- tra d i t i o na l students;
(7) emphasis oncontinuing edu c a t i o n to maintain clinical and the or et i c a l expe rt i s e ;
(8) recognitionof clinicalexpertise:
(9) co nt inuat i o n ofna t i on a l lic e n s ur e exami natio n:
27 (1 0 ) the increa s e in numbe rs and percent ofwomen inhigher
ed ucati o n(Se ige l, 19 8 4 p. 11 6 ).
unive r s i t ynur s ingeducationwa s ai d ed inCanada from 1919 -19 23 bythe Red Cross. Thisor ga n i z a tio n rec og nized the need for increa sedpub Li c health servicesandaddressed the needby fin a nci ng courses fo r se l e c t e d graduatenurses al rea dy work i ng in the pubjIc healthfield.
Mus salle m (19 65) not es chzt, th e re wer e six t een universityschoolsof nursing offering bas ic co u rs es le a d i ng toa baccalau re ate degre einCa n a daat the timeof her stud y. She lists the objec t ives of the s e schoo ls as:
(1) Theprof'es s Lo naLprepara tionof anur s e who is te chni ca lly ef f ici e nt, well - g ro u nded in the sci e nti fic knowledgeessent i a l inherfield,and who posse s s e s thoseunderstanding s and insights that make for good human relationships and social effecti veness.
(2 ) The profes si on alpreparat ion of a nurs ewho can make decis ionswhich involv e some understand ingof the basicprinciplesof economics , re l i gio n , socio logy, polit ical and biological sciences,etc. (J ) The preparat i on ofa nurse who can accept nursing respons ibilities in hosp ita ls and othercommun i ty heal t h service s,and with exp e r ience assume posit ionsof lead e r shi p in the profession . (p.SO)
28 In her re po r t on nurs ing educatio n, Mus s a lle m makes thes e recommendationsregardi ng un i v ers i t y anddiploma nurs i ngprog ram mes:
Theun i v e r s i typrogra mme shouldbe entir elypla nne d and controlle d by the uni v e rsi t yus ing hospitalsandheal th agenciesas teaching laboratories. The bac c a l a ur e a t e degreeawarded shouldrepresent a sound edu c a t i on a l programme in the libe ra l artsaswe l l as in professionaleducation. Thisgroup wouldbe pr epc r ed to provide leadershipro les innursingpractice. Preparationfor adminis tration , teaching,consulta tion andres e a r c h should be provided at th epo s t- baccalaureatelevel. Thediploma senoal ofnur s ing shouldbe int r odu c ed into the educational systemsof the countryand be designe d toprep a r e pr-actI ti onersto assistthe pr o f e s s i on a l nurse. Presentevidence indicatesthat the pr o f e s sion a l nu r s e and the qr-aduat.e of the diplomaprogra mmesho uldbe pr-epar-ed in a ratio of one toth r e e. (p . 1 38 )
Ma n y ofthes e recommendationsrela ti ngtoth e universitypro g rams ha v ebee n institu ted insome provinces in Canada, aswe l l as the placingof diploma schools into the communityco llegesystem. The latterha s not been initiC'.tedin Ne wfou ndla nd.
The baccalaureateprograms offer ed at Memoria l
29 University ofNe wf o u nd land are "de s i gn e d to providestudents wi tha liberal educationwhic h prep are s th em tobe direct care-givers, teachers, counsellorsandadvocates for thei r clients " ( Memo r i a l university , 19 92-93 p.265). Two programsof studyare offered: a Bachelor of Nur s ing (B.N.) roc basicst uden tswhi c h requ i re sthe completionof 54 eredits anda Bachelo r of Nursing followi n gcomp letionof Registered Nu....se (R.N.) li c e n surewhi c h re q uires the completio nof 45 credits, of which15areawardedas unspeci fiedtransfer nursing credits on the basis of succeasrui completionof a diplomaprogram in nursing .
Th e minimumrequireme nt fo r nursing faculty teaching in the baccalaureateprograms is that at least 75% of recur cy have a Master'sDegree inNu r s ing(M.N.) (or itsequ i v a l e nt ) (f\RNN, 1991 ,p.2 J ) .
curriculumDevelopment
ARNN (1991) outli nessp ecificpolicies, proceduresand stc nda r-ds thatare required inorder fo r Schools of Nu r s in g in Newfoundlan dto be accredited. standardII add resses developmentand implementa tion of thenur s inged u c a t i o n program (seeAPPENDI XB). Th i s standardprovidesthe found a tio n for curri cu lumdevelopmen t wit hin nu r s i ng education. In ad d i t i o n to referencesto writtenstatements orphil o s op h y and objectives, each school is expectedto
)0
adhere to a conceptua l framewor kor model of nursing which servesas a basis for the de velop me nt of th e curricu lum in that schoolan d pro v ide s a rationa le fo r the selec tionand organizationoftheprogram conte ntand lea rn i ngexperie nces for the stude nts. The curricu l umis ex pected to provide the direction for ac h i evi ngtheoverall progr amobjectives. The curricu lumdesignisexpe c t e d toin t e g r a te nursingknowledge and nursi ng practice, reflect current trends inhe a lth, demonstrateevidence of curricu larrevision inresponse to changesoccurringin ed uca t ion , nursi ngpractice andthe health care system,providean ordered progressionof contentand learningexper ie nces Whichare reflected in <111 course and level objectives,and provide direction forthe evaluationof studen t achievement of objectives. The curriculumcontent mu s t inclu d e conte ntareasessential to th e practice ofnur s ing as out lined by the Canad ianNurses' As s o c i a t i o n , but is not res tricted totho se areasal one (ARNN, 1991,p.21).
To ensure thatthesestandards are add r e s s ed , each school of nur si n g has a curriculum committee . In the diplomaschools, all faCUlty mus t submit course out.Line s to their respective curriculum committeeforapp r o va l of cours e content, course objectives, teaching/lea rning meth o d s to be utilized, evalua tioncrite ri a and recommendedtextbooks. In the baccalaureate pr o g r am, th e cu rriculumcommitteepro v id e s
31 guidancefor general conte ntand broa d obj ectives, as well as approvingoverall coursecont e n t.
TheFu ture ofNu r s i ng Educatio n McQuarrie (1955) writes:
One of the most significant conflictsin oursociety duringthe past decade ha sbe en the mounti ngargument over educati on . On one handstandthe forces of speci a li z a t i o n , firm Ln their belief that education must be practical trainingand a preparationof the studentto perform specific role s. On the other hand ra nk the forces ad voc a t in g educationof theall-round per soncapable of flexible and ima g inative performance inaworld wh ich is in a stateof constant change.
(p.19 9 )
Mussallem(1965) alsoshows awarenessof the need for cha nge as she states in hel'" Royal Commission Reporton Nursing EducationinCanada:
Themajorityof educational nu r s i ng programmesarein hospitals and are la r g ely basedona poor
apprenticeshipsystem . Poorut il i za t ion ofnur ses is still carried on anddoe s not provide them withthe kno wledgeor skillsneed ed . Preparati o nfor servicein hospitalsaloneis ave r yna r r ow and limitedapproach totheed uc a t i o n of nursesand is outdated app r oa c hto
32 the total healthneed s ofth eco mmun i t y. (p. 1J 6) It wa s notun t il1982thatthe cenad Ian xuraes ' Associat ion (eNA) ad opte d afo rma l posit i on on thefut u r e educa tionalrequiremen ts for entryinto nur s ingpract i c e.
Ba s e dupon studies o~trends in health care andhealth care del ivery systerns, i twa s determined tha t bacca l a ure a t e preparat ionwillbe req uired fo r all nur s e s enticr-L nqthe professio n bythe ye a r 2000, in orde r topro v idequali t y nu r singcere, both inthe hospital and inth ecommu ni ty.
The rati on a le for thech a ng e in minima l lev el of educa t.LcnaI preparati onfor entry into nur s ingpra ctice froma diploma in nursingtoa baccala ur ea t e degree in nurs i ng liesinthe belief that the nurs e of the futu r e willrequ ire the lat terpreparatio n to be ttermeet the nu rsingneeds of thepubli c an dto con tin ue to fu nct ion comp etently in the everchanging and inc r ea singly compl e x health car e system. Change s in theheal th st atu s of the publi c and the hea lth car e delive ry sys t e m indica t e thatboththe role expe c t a ti ons and performan ce ca p a bil ities of the nurse arecha n gi ng. (ARNN, 1988 , p.4 )
A "NationalPlan"we s developedin 1984 whLch specified national ob j e c tive s , atr a tie qie s , accountableorgani zat ions and targetgroups, andi twca from this pl an thatall pro v inc i alorganizat ions have takendirec tio n (ARNN, 19 88,
33
p.9)•
In April 198 6, the Associ a t i o n of Registered Nur s e s of Ne wf ou nd l an d CARNN) struck a Task Force on Entry toPractice to davelcp amore comprehensiveprovincia l bluep r intto achieve the B.N. 2000. Si nce that time, va r ious committee s have worked an a collaborativenursing education model that would meet the basic edu c at i on needsof futu regraduatesof Newf oundland.
In 1992 , the Liaison Crmmitteeon Future Nursing Education completed their pap e r on thestrategicPlantor FutureNursingEducation andout l i ned th e basic elements of a preferred model:
(1) The curriculum wo ul d be join t lydevelopedbyall schools of nursing. Dip lomaschoolswouldbe affiliated withMemorialuniversity .
(2) Th e curriculum wouldha ve t....o exits, both a diploma and a de greeexit initially. The diplomaschool would grantthe di p l o ma ; theuniversi ty wo u l d grant the degree. The diploma exi t wou ldbe a tr a n s i t ory and time-limitedmeasure.
(J) The sharingof resources among schools wouldbe negotiated (ARNN,1992).
In June 1993 the Futu re Nurs i ng Educatio nCurriculum DevelopmentCommittee, comprisedof representativesof all five schools of nursingin th e prov inc e , completed its
"
repo rton Phase1 on the dev e l opment ofthenew colla borativecurricul um. Todate , the philosophyand conceptual fr ame wo r k based on abeha v i or i s t /h uman i st model, charact eristicsof th e graduate, le ve lle d objectives, content map andba sicco u r s eoutli ne shavebe en completed. This pr op os ed cur r icul u mdes ign waspres ente d to governmen t in Janu ar y 1994 for ap p r o val (ARNN, 1993).
Thestructureofnurs ing educa tionis only one meaaur-e of the change that is currently ev o lv ing inthe pr o f e s s i on . Tanner (1990) writes ofth e "c ur r i c u lu m revolution" thatha s been occurringsince the 198 05. Nur s i ng curricula, traditionallycontent-ladenanddi s e a s e-orien t e d , ha v e not prepared nurses for thesocietalchanges: and respons ibility of the approachingtwenty-fi rs t cen tury.
Tanner relates the term "re vo l ut i o n" to the writ ingof Thomas Kuhnon scientific revolut ions, impl y i ng a developme ntalchange occurri ng asthe old pa r ad i g m,or world view, is repl a c e d by a new one. "Hen c e , a revolutionin this se ns e would occur when the community of nur s e educat.or-s tacitly or expli citlyag r e e s to ane wworl d view 01: our edu c at i on a l pra ctic e s" (p.296). Tanne r se es thecha nge re lated to thedisco nte ntwith the conti nued use of the be ha v i o r i s t modelof educa t ionfor nurs ing, with its rationa l- tech nica l view:
Ifthe ana logyof the cur ric u l um re vo l ut i on to a
35
scientificrevolut i o n holds, itisli ke l y tha t a new model and world viewwill repla c eth e old. Andthi s pos s i b il i t y presentsama j or dilemma as we stri ve for change ; no ne of uswi s h toadopt a new equally enslavingmodel of educa t ion, bu t ratherencourage the diversityne ce s sary toachieveour goals of re spo nd ing to our socialrespons i bility as a he a lthpr o f e s s i o n and mai ntai ninglocal controlover curriculardecision making. (p .298)
Tanner cal lsthis "e ma nc i p ati on" from using one view of education as"t he o r e t i ca l plur al i s m", one of the major themes of the current curr icu l um re v o lut i o n , along with the sense of social responsibility,caringas a centralcor e value, an interpretivestanceon th e assumptions and meanings ofnurs i ng practice , andthe primacyof the student-teacher relationsh ip.
Be vi s and Cl ayton (1.988) also crit ic i ze nursing's hi s t o r i c al depend enceuponthe beha v i cr i s t i c Tylerianmodel of curriculumdesign. "We were at a crossroads and needed structureand guida nce to continuetoqr ow , to increaseth e quali tyof ed ucat ional progra ms, and to be congrue ntwith the very pragmaticage of post-wor ld War II" (p.1 4 ) . Becausebehavioristic mod els ·...ork ed efficiently in delineati ng specificobjectives andevaluating
accomplishments, they became th eend s an dnotth e means of
36 curriculumdesig n:
using onlyone model for all nursing programs, especiallyone that emphasizessuchr estr Lccive and behaviorist le ar n i ng theory products, is too limiting for professional nursing. It keeps nursing educnt Ion focused ontraining not education. (p.lS).
Bevis andWatson (1989) pr e s e nt a curriculumparadigm for nursing educationbasedon a humanisticview. Theyse c th e Tylerian /behavioristmodel, whichha sdirected the professi on for nearlyfortyyears, as unabl e toaddress tn o needs of nurses in an increasingly ch a ng ing society, if it is used to guide all of nursing education. Theircent ral theses Invo Ivea fivepositions:
(1) The curriculum is seen as the egalitarian
"interactionsand transactionsthat occur bccvccn and among students and teachers with the intent thatle a r n i ng occ ur"
(p.5 ) .
(2) Active learning whichchallengesthe in t e l l ec t u a l abilitie sof both student andte a c he r is necessary to develop the creative thinkinghallmark of the educated individua l.
(3) Curricular teaching strategies must inspire students to take a matureresponsibility for theirown le a r n i n g needs.
(4) No one theory can explain the ce n p t extt Iee of the
37 le a r n ing processas thetype s of lear ning fal l in totwo dist inc tivecategories: trai ni ng-and educati on.
(5) All curric ulu lIldevelopment begi ns withthe de ve l o pme nt ofthefacult y, an dmost facultyareprep a re d for only the behav ior ist vi e wpo i nt.
The educat ivelllode l propos e dby Bev isand wat s on and endor sedbynumer ou s others iscalled"the Car ing curri c u lu m".
Mo s t nurs e educat o rs recogni zetha t the behav ior i sti c mode l ha s applicati on in so me eleme nts, such as intech ni c al ski ll acquisitionandmemor izat ion.
Coulter (1990) seesthe ad o pti on of athe oryof le arni ngconti ngent upon thesituat i o n . She not es that Ga gne'sbehavioristic app r o ach, withthe conditio nsof lea r ningand hi s the o ryof instruc ti on, isappli ca b l e to psyc homotorskills learning, while thehumanis tic vi ew of Roge r s isappr op riate fo r develop mentof interpe rsonal skil ls and se lf -awarenes s . "Anursing cur ricu lum that is too heavil y bia s e din favo u rof oneapproach ma yrestr ic t the ed ucat iona l de ve l opment of st udents" (p. 336 ). de Tornyay (1990) als oag r e e s thatit isimperative th a t whatha s proved to be func t i o na l and effec tive continue to be ut.:ilized.
t:ondellandEl liott (1989) view Gagne'stheo r yof inst r uc ti o n asrel e vant tonursing education becauseof its
38 sys te mat i c approach . Histhreedimensionsof motorskil l and sk ill analysishave applicabilityin the pr ocedu r a l- lad e n clinical pract iceenvironment .
By r ne s (19 86 ) compares the behavioristand humanistic views onte a c h i ng and learning innu r s i ng education. While she fin d s behaviorismmechanistic and restrictive, there are elem e ntsthat are benef i cial in training student stopp.rform sp ecif i c tasks. Ahuman i stic pers pe ctive , ontheot her ha n d , allows st ude ntsto tak e re s ponsi b i l i ty [or thei r own learni ng,whi l e fost er ing affecti v e aswellas cognitive gr owt h.
Nu r singhasboth an intellectualand prac t i cal aspect. If we expectthe st u d e ntto achieve a certain leve l of cognitive dev e lo p me ntan d mas ter y of pragma t i c sk i l l s, wemu s t beabletous e observab l e behav i oral outcome s as part of ourobject ive eval uat i on of fulf il men t of those expe ctati ons. Likewise, nurses have a particular ca ri ng relationshipwith humans. If we expect the stUden t toprac ticenur singfr o m a holisticand humanist ic fr a me of reference , sure l y we must attend to herpersonal deve lopment witha human isti c or i e n t a tio n. (p. J05)
de Tornyay (19 9 0) fore s ee s thefu t u r e of nursing educ at i o nalso in termsof a curri c ulumrevolut ion :
The cu r ri c u l umrevol ution is abou t teach er-student
39 par t ne r s hi p s . It is about fle x i b i li t y and individual differences in howand wha t onele a r ns . Itis about instructors spendi ng the i r time doin gwh a t no text, no program of learning ,nocomputer, or learn ingresource can accomplish: devel op ingthe mind of the individ ua l stud e ntthrough intililate give and take based on sound knowLedqe and understanding. (p.293)
summary
Education andnur s ing have commonhistorical elements:
bothwere influenced by the Churchearly in their deveIo p me rrtj both la c k e d sta tusin society; both had l i t tle career eevancene.reoppo r tun it i e s (seigel, 1984).
Davie s (1978) documentsawareness of the pervasive notion thatbehavioristicobjectivity isth e value dparadigm in educatio n :
This has le d to a suspic ionamongsteducators tha t th e notion of objectivity is the onlyparadigmpossible in educationaltechnology, especially in the areas of cu r ri c u lum, course and instructionaldevelopment... Yet an alternative is ava ila ble, and an alternative that is particularly valuab lein thedo ma in of educational technology. This alternativein vo lvesthenotio nthat there is availablea SUbj ective paradigm, and tha t both objectivityand SUbjectivityare thems e l ve s
40 assumptions. (p . 19)
Nursingeducati o nis undergoing radi ca l cha nge in the 199 05 , both in it s st ru c t ur e with theentry topractice issue of baccalaureate educationas mini malr-equ'i r-e rsent; , and in it s philosophy of teaching/learningwhich is moving awa y fromto t a l re l ianceonthe behavioristmodeL The emphasi s is shifting fromthe traini ngof a purelytechnically competenthospital -basedprac titio nertothe educationof ,) professional nurse pr e pa red to functio ninallare asof the healthcare environment.
conse quently, ins t r uc t i o na l dev elopme nthas a signi f i cant roleto play inth e prep arati onof nurses to mee t thechal le nges awaiting the profe s s ion in the twcnty- firstcentury .
In struct iona l De ve lop ment
In t r od ucti on
Educ at i ona l te chno logy isa co mp l e x, integratedpro c e s s invol vingpeople,procedures, ideas , dev ices and orga nization for ana lyzi ng problems and de vi s ing , impl e ment i ng , evalua t i ngand managingsolut io ns to th o s e problemsin vo l ve din all aspectsofhuman le a r ning... (AECT, 1977p.12)
Beckwith (1988) definesthe goal of edu cational
41 technology as "t he transformationofle a r ning and learning process"andputs for.th a stateme ntof philosophy as fol l o....s: "We be lie vethat all le a rn e r s canbetra ns f o r me d tothe highes t lev e l of cognitive ability" (p. 1S). He envisions educational technology as assumingthe responsibilityfor managementof thele a r ner and forthe transforming of learning.
Educationaltech nologyhas its th eo rybase in several commu n i tie s: ps y c h o l o g y with the differentviews on human behaviorand le a rn i ng of the behav iorist, Gestalt and cognitivepsychologists; educetiLcne I psychology with the or i e s of learning and instruction, motivation and human growthand development whichprovide the theoretica l foundationuponwhi c h strategiestomax i miz e learning outc omes can be deve loped;hardwaretechnologywhich provides means of transmittinginstructiona l messages;
ergonom icsandhuma n factors engineeri ng which provides guidelinesfor strategiesto improvehumanperformance;
orga nizat ionalmanageme ntand administrationwhich provide a fr a me wo r k for the dissemi nationof instruction; and comm unicationtheory wh i c h isexpand e d to encompassaspects of pe r c e pt i o n andinformation- processi n gtheory.
Da vie s (1978) delineatesthr ee different ed u c a t i o nal technologies. EducationalTechnologyOneis aha r d ware approach, whose roots lie in the "a ppl i c a ti o n of the
42
physicalsciences and engineering tothe problems of educa tion ", and whi ch emphasizes the importanceof aid s for tea ching (p. 1J). Educat ional Technolog y Twoisa soft ware approa ch, whose originsare founded inthe "a ppLioatIonof beh avio ralscie nc eto the probl emsof educ ati o n", and which highlightthe importanceof aidstole a r ni n g (p.lJ). EducationalTe c h n o l ogyTh r e e combinesthe two prev Lous techni qu es witha systemi c ap proac h and focuseson the processesaswell as thepr od uc t s of te ac hingand learn i ng .
Whil s t Te Ch no log y One is lar ge lyconc e rn e dwith tra n s mi s s ion -r e c e pti o n pr obl ems,andTechnology Two withpurposef u l sha p i n g of behaviour, 'rec m.otoqyThr e e is warmly human in i tstotal and integratedap p r-oach , It s emph a si s is on a rangeofcontra st i ngsk i l l s ,from whic h selections ca n be made depend ingup ontho nat.ur e of the problemposed. It is fun damentallya prob lem- solv i n g appro a ch,heavy in its diagnost i c Lnc o reot;and inq u i r y orientati on. (p.1 4)
One of the sub-sets of edu cational te chno Icqv is in struc t i onaldevelopment.
Severaldefinitionsof thissub-se t appearinth e literature. Kemp andSmellie (19 89 ) defin e instru ct i ona l deve lopm e ntas the "process of designingan instru ct i o na l pro gram emp l o yin g an objective,systema t ic proc e du re , such as an instructionaldesign plan" (p . J8 1). Sac hs (1981)
43 provicies a definition:
a systematicapp r o a c h for improving instructionby making instruc t i o nal design decisions that take into accountmany factors including principlesof le a r n i ng, st u d e n t ch a ract.erLstIo s, instructor skills, developer skill s, resou r ces, content, time and evaluationda t a . (p.8)
The Assoc iat ionfor Ed uc a t i on al Commu nic a t i o n s and 't'n cn noLoqy (AECT , 1977) defines ins t ru c t i ona lde v e lopme nt
a sys te mat ic approachto the desi gn, pr-odu c c Lcn, evaluationand util izat ionof complete systems of instruction, inc l ud ing allappropria te components and a managementpattern for using them; instructio nal developmentis largerthan instructional product development, which is concerned with only isolated products, and is largerth a n inst ructiona l des i g n, whic his onlyonephaseof instructionaldevelopment. (p.2 0 j
Robert Hein ich (1970 ) sees instructionaldaveLcpraent;
entering int o the total instructio na l process atth e cur -ricu l u m planninglevel , fo ll o wi ng curriculum dete rmtnatIcn and beforeclassroomimpleme nta t i on:
Ins truc t ionaldevelopmentis the term used in knowledgeablecir clesinhigher education to describe
attempts to enter theinstru c tio n a l pro cessat th e levelof curri culumplanning...instructional dev e lo p me nt seek s to de s i g n ins t r uc tionrather than supplement it. (p.170 )
Historyof Instruct ional Deve lQRwnt
Inst r uctiona l theory and methodha vean ancient heritage tha t can be tracedto thetime when tri bal pr i ests systematized bod i e s of kncwLedqe and curly cultur es invent e dpict og raphs or sign writing to record, pre serve,transmi t, andre p roduceLnr o r uetIon. (Sa e tt l e r , 1990,p.24)
Edward Thorndike (187 4 - 1949) , an education al psych o log i st , "f a sh i o ne d the first sc i e n t ifi clear n i ng theory andes t a bl i s h e d empi rical inv esti g a ti o n as the basis for ascienceof instruction" (Sae t tler, 1968, p.o16 ). Hi s three primary laws ofle a rni ng (t h e law ofexerci se or repetition, thelawof effec t , and thela w ofre a di ness ) were all based on thest i mulus - r e s pon s e hypo th e s i s . 'rho basicprinc iplesunder lyi nghis technol og yof ins t ructi on inc lu ded: (1) self-activi ty; (2) interest (moti vation); (3) preparationand mental se t ; (4) ind i vid ualiza ti on ; and (5) socializ a t ion. Hi s stud i es onin s tr ucti on al medi a des i gn, th eor g a n iz a tio n of ins t r u c ti o n , indi v i d u al diff e r en ces , evalua t i onmethods andempiri ca l-induct ive
4S researchmade hispl a c einhis t o r y as the first modern instructionaltech nologist (Saettler, 19 6 8 ).
John Dewey's (18 59- 195 2 ) intellectualfocus on analysis of thinking in reflective, pr ob l e m- s o l vi ng ber-ms had a profound inf luenc e onAme r i c a n education. Hebelieve d tha t learning in vo lvedinteraction or two-wayac t i o n betweenth e learnerandhi s env i r o n me nt, and thatthe exp e r ienc e s which learners have with their environmentbecomethe foundations upon whichmeaning is made. Dewey believed that the primary goal of instru ct ionwas the improvement of int e lli g enc e, and tohi mall wort h whilethinking was reflection. He saw pr ob lem-solvingas central to the instructional proces s (Sa e t tle r , 19 68, p.53-56) .
An Italia n ed ucat o r , Maria Montessori (1870- 1952) , developeda teaching methodology with two basicprinciples - respect fo r the learner's in d i v i dua l i t y and encourage mentof hi.s /her fr e e d om. He r te c hno l o gy of instructio n had these cha r ac t e ris t ic s:
odaptationof scno cIvorkto the individualityof each Ibu rner; pr o v i s i o n forfr e e do m in which the teacher did not dominate the lea r n e r nor did the lea rnerbecome overlydependent on thete a t.:h e r; and emphasison sensorydiscr i mination..• (Saettler, 196 8 , p.60) Mo nt e sso r i ' s instructionalsystem was one of the first tobe sc i entif i cal ly based. As well, "shewas th e first to
