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The evaluation of a fourteen week continuing education course in critical care nursing Robinson, Ruth Elizabeth 1975

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THE EVALUATION OF A FOURTEEN WEEK CONTINUING EDUCATION COURSE IN CRITICAL CARE NURSING by RUTH ELIZABETH ROBINSON B.S.N., The University of B r i t i s h Columbia, 1970 A THESIS SUBMITTED IN THE REQUIREMENTS MASTER PARTIAL FULFILLMENT OF FOR THE DEGREE OF OF ARTS i n the Department of Adult Education We accept this thesis as conforming to the requested standard THE UNIVERSITY OF BRITISH COLUMBIA September 1975 In presenting th i s thes is in par t i a l fu l f i lment of the requirements for an advanced degree at the Univers i ty of B r i t i s h Columbia, I agree that the L ibrary shal l make it f ree ly ava i lab le for reference and study. I fur ther agree that permission for extensive copying of th i s thes i s for scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It is understood that copying or pub l i ca t i on of this thes is for f i nanc ia l gain shal l not be allowed without my writ ten permission. Depa rtment The Univers i ty of B r i t i s h Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 i . ABSTRACT This study reports on an evaluation of the f i r s t of two fourteen week continuing education courses in c r i t i c a l care nursing. It focuses on the thirteen nurses who completed the course, examining trends that might be used as predictors of performance in continuing education. The rationale for this approach was that short courses often intensify a learning experience, and because of time restrictions they are presented in a relatively structured way. This particular course was extended in time and also added a c l i n i c a l learning experience. The study looks at the method and techniques used to determine whether prior knowledge of course participants could affect these, and whether a structured approach can meet the learning requirements of the course participants. The methodology employed evaluation instruments designed for the course which measured performance. This included a knowledge pretest and posttest, a c l i n i c a l performance appraisal, and program evaluation questionnaires. The pretest-posttest design used the same questions on both tests in order to measure knowledge gains. The pretest was administered on the f i r s t day of the course. The posttest was given on the second last day. Cl i n i c a l performance was assessed on an on-going basis and a f i n a l assessment and score was determined in the last i i week of the course. A measure of confidence was determined along with each written test by asking the nurse to i n d i c a t e her degree of confidence i n each answer she selected. In addition, a psychological measure of b e l i e f i n locus of c o n t r o l (the Rotter I-E Scale), was administered at the beginning of the course. This measure determines the extent to which a nurse might take r e s p o n s i b i l i t y f o r her own learning, and whether that would u l t i m a t e l y a f f e c t her performance i n a continuing education course. Analysis of the data revealed c e r t a i n f a ctors which affected gains i n knowledge as a r e s u l t of p a r t i c i p a t i o n i n the course, and which could be used as predictors of performance. In p a r t i c u l a r , age, background work experience and the locus of c o n t r o l concept s i g n i f i c a n t l y r e l a t e to knowledge gains. Younger nurses achieved greater gains. Nurses who had had more experience i n c r i t i c a l care nursing performed better than those who had had l i t t l e or no experience. No s i g n i f i c a n t c o r r e l a t i o n s were found among these v a r i a b l e s which influenced c l i n i c a l performance scores. Confidence i n answers given on written tests was found to p o s i t i v e l y c o r r e l a t e with the actual score obtained. The implications f o r the findings of t h i s study are important to continuing education course planners. Based on the s i g n i f i c a n t predictors of performance, s e l e c t i o n of students for courses can be i i i made on these factors. Age and background experience are known prior to the course and should be considered when making selection. The pretest performance revealed areas of strength and weakness i n the group and could be used effectively for planning the development and emphasis of course content. The locus of control concept deserves further study to determine i t s influence on course outcomes. The results of this study revealed that the greater the belief in internal control of reinforcement (one is responsible for what happens), the greater the gain achieved in the course. Further study as to how or why this influence exists could be very helpful to the f i e l d of continuing education. As a beginning attempt at planning for more effective continuing education, this study points out significant areas for further investi-gation. In i t s e l f , i t also has assisted in the planning for the second course in c r i t i c a l care nursing, as the evaluation for the course revealed areas of weakness in the presentation used for the f i r s t course. "We d a n c e ' r o u n d i n a r i n g a n d s u p p o s e , B u t t h e s e c r e t s i t s i n t h e m i d d l e a n d k n o w s . " R o b e r t F r o s t V ACKNOWLEDGEMENTS The author wishes to express appreciation to those people who assisted i n the development of the idea, the implementation of the study and i n the preparation of this report. The members of my thesis committee - - - Dr. J.E. Thornton, Miss E.K. McCann and Dr. J.B. Co l l i n s - - - each played a special role i n the achievement of the objective. Thanks also go to Mrs. Sharon Turnbull, Director, Continuing Nursing Education at U.B.C, and Miss Marilyn Baines, Coordinator of the C r i t i c a l Care Nursing Course, for their assistance i n the development of the evaluation instruments. Special appreciation i s expressed to Miss Barbara Lockyer, who provided invaluable assistance i n the typing and editing of this report. And f i n a l l y , the author wishes to thank Mr. Larry T r u i t t , who made me believe i n the f i r s t place that this day would come. Vancouver, B.C. September 1975 Ruth E. Robinson v i TABLE OF CONTENTS Page ACKNOWLEDGEMENTS V TABLE OF CONTENTS v i LIST OF TABLES v i i i LIST OF FIGURES i x I. PURPOSE AND SCOPE OF STUDY 1 Introduction 1 A Continuing Education Course i n C r i t i c a l Care Nursing , 3 A Description of the Students Who Attended . . . . 4 Rationale 5 Assumptions and Limitations 7 Plan of the" Study 9 I I . SURVEY OF THE LITERATURE 10 Continuing Education i n Nursing 10 Measuring C l i n i c a l Performance 12 Learning Needs 13 External versus Internal Control of Reinforcement 14 Program Evaluation 17 Summary 19 I I I . METHODOLOGY 21 Hypotheses 22 Definitions 23 Evaluation Instruments 25 Design of the Study 30 Data Collection and Analysis 32 v i i TABLE OF CONTENTS (Continued) Page IV. ANALYSIS OF DATA 34 General Summary of Program Outcomes 34 Measures of Knowledge 34 Measures of C l i n i c a l Performance 51 Measures of Program Effectiveness 52 V. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS 54 Summary 54 Conclusions 56 Recommendations for the Second Course . . . . . . 58 Recommendations for Further Study 60 BIBLIOGRAPHY AND REFERENCES 62 APPENDICES 66 v i i i LIST OF TABLES Table Page LIST OF DATA COLLECTION INSTRUMENTS AND DATES THEY WERE USED 33 SCORES OBTAINED ON PRETESTS FOR EACH OF THREE PRETEST GROUPS 35 PRETEST SCORES AND POSSIBLE RELATED VARIABLES TO EXPLAIN DIFFERENCES BETWEEN 3 PRETEST GROUPS 37 SCORES ON ASSIGNMENTS AND EXAMINATIONS FOR 13 NURSE STUDENTS 39 DIFFERENCE IN RANK FOR EACH OF 13 NURSE STUDENTS WHEN PRETEST SCORE IS INCLUDED AS PART OF FINAL SCORE 40 LIST OF VARIABLES TESTED COMPARING 13 NURSE STUDENTS IN A CRITICAL CARE NURSING COURSE WITH 40 CRITICAL CARE NURSES 42 CORRELATIONS OF VARIABLES TESTED USING COMBINED GROUP OF 13 NURSE STUDENTS AND 40 CRITICAL CARE NURSES 47 GAIN SCORES FROM PRETEST TO POSTTEST FOR 13 NURSE STUDENTS 48 i x . LIST OF FIGURES Figure Page MODEL OF COURSE INFLUENCES B PERCENTAGE OF CORRECT RESPONSES AND CONFIDENCE IN ANSWERS GIVEN ON 71 ITEM POSTTEST 28 1. CHAPTER I - PURPOSE AND SCOPE OF THE STUDY Introduction The h a l f - l i f e of science and technology affecting nursing care methods i s now between three and five years, according to Tobin's (47) estimate. This statement alone can justify the need for increased concern and action i n the area of continuing education for nurses. However, i t appears that the l o g i s t i c a l problems that affect the develop-ment of continuing education have not yet been overcome. The National Commission for the Study of Nursing and Nursing Education has suggested that the problems of continuing education in nursing may be greater than in any other profession because of the variety of preservice educational programs used in the preparation of registered n u r s e s . ^ According to a report from the Western Interstate Commission for Higher E d u c a t i o n , t h e assumption is made that " . . . more than 70 per cent of practicing nurses may not be pursuing planned programs to increase their competence as practitioners." The American Nurses' Association has defined three distinct areas of education in nursing - formal academic study, continuing education and ( 2 ) independent learning. It i s the latter two which are the concern of this report. From the focus of a particular program in continuing education, some of the problems inherent in presenting continuing nursing education are examined, considering both the program i t s e l f and i t s 2. objective to motivate ongoing independent learning within the course participants. The need for preparation of nurses to deal with the technological advances i n medicine which affect nursing i s c r i t i c a l . Intensive care units, coronary care units and emergency departments are faced with challenges every day which demand knowledge and expertise of the nurse. Additionally, specialized units such as those for patients with burns, renal conditions and neurosurgery require special s k i l l s of the nurse. Formal education and training programs to prepare nurses i n these areas are minimal. Most nurses learn "on-the-job", with some help from inservice education programs, which at best can only provide the minimum for safety. Dissatisfaction with this level of preparation led to the development of a continuing education course in c r i t i c a l care nursing at the University of British Columbia. This was the f i r s t of two courses to be offered, and concerns expressed not only by the course planners but by many educators both in nursing and elsewhere suggested the f e a s i b i l i t y of an indepth study of selected problems related to continuing nursing education. This study presents an evaluation of the c r i t i c a l care nursing course, identifying trends becoming evident in planning such courses, using knowledge of the learners themselves as a means of studying what the nature of future courses should be i f they would meet the needs of nurse practitioners. As preparation for specialization in nursing becomes more important, and in fact a prerequisite to working in specialized areas, knowledge about the characteristics of nurses which would predict higher performance levels should help to answer whether courses should be more self-directed and f a c i l i t a t i n g , or more structured and directive. A Continuing Education Course in C r i t i c a l Care Nursing A post basic course in C r i t i c a l Care Nursing designed to enable nurses to acquire the theory and c l i n i c a l s k i l l s necessary to provide nursing care to c r i t i c a l l y i l l patients was identified as a need in 1973. An evaluation of two previous short courses i n intensive and coronary care revealed the need for a course capable of providing more extensive know-ledge i n the f i e l d , and the opportunity to learn c l i n i c a l s k i l l s , neither of which could be satisfied by typical short courses. As a result, a 14-week course was developed and sponsored by the Division of Continuing Nursing Education at the University of British Columbia, i n cooperation with the Registered Nurses' Association of British Columbia, Royal Columbian Hospital, Saint Paul's Hospital and Vancouver General Hospital. Financial assistance for the development and implementation of the course was provided by British Columbia Hospital Insurance Service, the University of British Columbia School of Nursing, and the Kellogg Project for Continuing Education for Health Professionals. 4 . It was the intent of the course to assist nurses in learning the nursing process in caring for c r i t i c a l l y i l l patients, and importantly to help nurses learn to identify their own learning needs and seek out ways of meeting them. Classroom time was quite formal and directive i n i t i a l l y , covering content basic to c r i t i c a l care nursing. As the course developed, the nurse students were encouraged to be more independent, and were expected to do more learning on their own or in small groups. Cl i n i c a l practice was provided concurrently with classroom learning. The nurse students spent two - three days each week in selected c l i n i c a l areas under the supervision of c l i n i c a l preceptors. As much as possible, c l i n i c a l experiences were planned to match what was being taught i n class. The majority of c l i n i c a l experience time was spent in intensive care, coronary care and emergency departments. A Description of the Students Who Attended Fifteen nurses were selected representing thirteen smaller communities throughout the province. Preference in selection was given to areas having no easy access to regular continuing nursing education course offerings. Selection was based on a series of c r i t e r i a pertinent to the projected course outcomes. (See Appendix A) Some of the cr i t e r i a for selection included participation in continuing nursing education, involvement in ongoing hospital development a c t i v i t i e s , and 5. employment in a hospital providing opportunities for inservice education and/or staff development. Nurse applicants were sponsored by their employers and applications were required from both the nurse applicant and the employer. Points were given for information obtained from the appli-cation forms and a total score was determined for each nurse applicant. The top 15 scores were accepted for the course, with alternates named from the highest score of the remaining applicants. Application forms and c r i t e r i a for selection forms can be found on f i l e at the Division of Continuing Nursing Education, University of British Columbia. The fifteen nurse students represented a variety of experiential backgrounds. Two were in supervisory positions responsible for c r i t i c a l care areas. Four had had no previous work experience i n c r i t i c a l care. The remainder had some experience, and most of their preparation had been on-the-job learning. Rationale This study examines both the specific course on c r i t i c a l care nursing previously described and i t s learners in order to arrive at some sub-stantiated conclusions that could be used by the course planners to enhance the effectiveness of a second course. Further, i t became the intent to project these conclusions in order to identify trends that might be applicable to continuing nursing education courses in general. Through varied analyses this study undertakes to identify those predictors that 6. might be used both i n the design of continuing education courses and i n adapting such designs as they are implemented for a s p e c i f i c group of learners. To accomplish t h i s task, the study focuses on analyses of the following information: 1. Biographical information about the learners collected from application forms. 2. Formal tests and examinations prepared by course planners and designed to e l i c i t knowledge i n l i n e with stated course objectives. 3. A measure of the confidence nurses have i n the i r own answers given on a test of knowledge. 4. Selected diagnostic tests which were added to the course to e l i c i t other kinds of information about the learners them-selves. This included a test to i d e n t i f y the extent to which the learners believed i n the i r a b i l i t y to control their own experiences (the Rotter I-E Scale i s described i n d e t a i l l a t e r ) . 5. A battery of evaluation devices which were combined to i d e n t i f y levels of achievement i n c l i n i c a l performance. These included C r i t i c a l Incident Technique, observations of the c l i n i c a l preceptors and the Slater Nursing Competencies Rating Scale ( a l l to be described l a t e r ) . 7. The analysis was designed to answer questions to which l i t t l e attention has been given i n previous studies. What i s known about nurses i n general that might help to predict learning gains i n a program of continued learning? What i s known about program development to help to achieve greater gains for individuals who attend? Is anything r e a l l y to be gained from continuing nursing education programs which attempt to advance the knowledge and c l i n i c a l s k i l l s of practicing nurses? Figure A shows the development of the analyses used i n t h i s study which were planned to a s s i s t i n answering these questions. I t represents inputs to the course, the implementation of the course, and what measurable behaviour changes occurred as a r e s u l t . Did the course have a positive or negative effect on knowledge gains or c l i n i c a l performance? And knowing the r e s u l t s , could the course have been developed d i f f e r e n t l y based on the known inputs for a s p e c i f i c group of learners? Assumptions and Limitations The study was r e s t r i c t e d to 15 participants attending the f i r s t of two 14-week continuing education courses i n C r i t i c a l Care Nursing. As a re s u l t , i t was r e s t r i c t e d to the design and experiences provided i n this f i r s t course. The smallness of the sample was recognized to possibly l i m i t significance of the r e s u l t s . I t was an assumption i n t h i s study that the nurse students would have basic background knowledge about the areas of c r i t i c a l care nursing pro-COURSE INPUTS COURSE OUTPUTS Biographical Data C l i n i c a l Performance A b i l i t i e s Cognitive Styles Attendance at a Continuing Education Course 1. Theory Sessions 2. C l i n i c a l Sessions Gains/Losses i n Performance FIGURE A. MODEL OF COURSE INFLUENCES co-9 . vided in the course. This assumption was related to the a b i l i t y and/or motivation of participants to identify needs, and also to the fact that their employers supported their applications and would place them in c r i t i c a l care areas upon completion of the course. Finally, the evaluation tools used to measure performance in the course were approved by a panel of c l i n i c a l experts. However, r e l i a -b i l i t y and validity have not yet been tested. Plan of the Study With the background of the specific course being studied and the learners on whom the research was focussed covered in Chapter I, a review of the literature pertinent to the analysis is presented in Chapter II. The design of the study i s outlined i n Chapter III. Chapter IV presents the findings and the analysis of the data. This includes not only data related to the testing of hypotheses, but also other information which i t was f e l t would have influence on course outcomes. In the f i n a l Chapter, a summary of the evaluation of the course is presented and some conclusions are drawn about this evaluation as i t relates to the total picture of continuing nursing education. Recommendations are made for the second course, for future courses and for future research in evaluation of continuing nursing education courses. 10. CHAPTER I I - SURVEY OF THE LITERATURE A review of the l i t e r a t u r e was planned to cover several topics related to t h i s evaluation study. I t seemed appropriate to look at current thinking i n continuing education for nurses, looking both at the need for i t and what i t s planning should encompass. Program evalu-ation i n general was also considered an area of the l i t e r a t u r e that should be reviewed. As this course included c l i n i c a l experience for the nurse students, i t was necessary to look at trends i n performance appraisal i n nursing. Readings on learning needs and how to meet them were done to explain i n d i v i d u a l differences among students and how this might affect course outcomes. F i n a l l y , as the study intended to i d e n t i f y the interrelationships between achievement, confidence and in d i v i d u a l differences i n perceived levels of control (the Rotter I-E Scale), selected l i t e r a t u r e pertinent to these measures was reviewed. Continuing Education i n Nursing P a r t i c i p a t i o n i n continuing education; programs i s a matter of (33) attitude, motivation, and program relevancy. The concept of l i f e -long learning i s defeated by the "terminal concept" of most education programs. Individuals are not geared to learning as a self-directed task. Motivation to attend continuing education programs may have l i t t l e or nothing to do with motivation to engage in learning. We need to know much more about participants in educational programs before we can determine the extent to which attendance is equivalent to motivation to learn. Relevance is an even more valuable concept. Individuals w i l l participate and learn i f they see that a program offers opportunity for them to meet their learning needs. But what is not"known, i s . how able these individuals are to identify their own.'need for^-learning. Programs offered in the past have been evaluated in varying degrees of completeness and t e l l us l i t t l e about whether the program has met learning needs, identified learning needs, or had any degree of relevance in terms of whether the "right" people are attending; whether the different needs of graduates of different kinds of basic preparation programs are recognized; (30,16) Q r w j i e t j i e r payment for continuing education should be the nurse's personal (22) responsibility or the responsibility of her employing agency. The real question always seems to be, "Does continuing education make a difference?" There are many ways of looking at this question, (22) although the generally accepted measure is improved nursing care. Most research on program evaluation in continuing education has been primarily exploratory. Those evaluations which have provided detail have used techniques which have made the results specific to *t, (33) the course. 12. Curtis describes several techniques that have been used in continuing education course evaluations, including observations of simulated nurse-patient situations, analysis of process recordings and diaries, rating achievement of course objectives, satisfaction ratings such as the Kropp-Verner scale, and Firo-B, which i s a measure of group compatibility. Measuring Cli n i c a l Performance Cl i n i c a l components to continuing education programs have been (^•5 3X 5 3) provided almost exclusively through inservice education. ' ' ' At the same time, the potential for inservice education to aid in the development of c l i n i c a l competence has hardly been touched. Evaluation of c l i n i c a l performance requires a great deal of planning and instruction. There are many forms of evaluation i n existence and some are more successful than others. The developing trend in the literature seems to be towards the use of rating scales. <«.39,21) Standards of nursing care and the use of a nursing audit has current popularity, although i t involves a great deal of preparation time and i t requires training in the use of the tool before i t can be effective. 13. Learning Needs (27) B i t t e l l and Craig, in reference to industry, stated that training needs are determined for various reasons, including: 1. assisting people to be more productive on their present job and preparing them for advancement; 2. meeting requirements which w i l l allow people to perform at an optimum level; 3. providing the chance for people to do a good job because they "can", "want to", and " w i l l " ; 4. making sure that time, money and effort spent on training is based on real needs. Some nursing surveys have been done which ask open-ended questions about " f e l t " learning needs. Although positions and types of agencies varied, expressed needs were quite similar. One of the most prominent needs was that of improving communcation and management s k i l l s . ^ > 2 0 , 1 9 , 1 1 ) Other learning needs that were considered priority were: newer dimensions in nursing care; legal aspects of nursing; and the changing role of the nurse. In an Ontario Survey of N e e d s , e m p l o y e r s of nurses in hospitals and public health agencies identified similar things. They also pointed out needs for courses to increase teaching s k i l l s , and to provide special-ization in nursing, especially in the areas of intensive care nursing, chronic disease, mental health and rehabilitation. Of par t i c u l a r interest to this study was an attempt to i d e n t i f y (34) learning needs of nurses i n two ways. Price asked nurses to report a c r i t i c a l incident encountered the previous year which she considered of extreme significance and related to her lack of pre-paration. Then each was asked to i d e n t i f y the learning need which the nurse thought would best enable her to improve the quality of her nursing care. Price found that, while the nurses reported t h e i r greatest learning needs to be in d i r e c t patient care, most of the c r i t i c a l incidents related to direct patient care. Related to needs, one of the most frequent requests r e l a t i v e to improving i n s t r u c t i o n a l methods and techniques was more learner (4) p a r t i c i p a t i o n . External versus Internal Control of Reinforcement One factor which may affect the amount of influence that one person exerts over another i n changing the l a t t e r ' s attitudes i s the (37) concept of i n t e r n a l versus external control of reinforcement. This concept has developed out of s o c i a l learning theory. Rotter stated that reinforcements act to strengthen an expectancy that a part i c u l a r behaviour or event w i l l be followed by that same reinforce-ment i n the future. The extent to which an in d i v i d u a l feels that he controls his own destiny and i s the effective agent i n determining the occurrence of reinforcements i s the extent to which he believes i n 15. Internal control of reinforcement. The more an individual believes that forces beyond his control are the influence on reinforcement, the more he believes in external control of reinforcement. Such forces might include fate, chance, powerful others, or the complexity of the (37) world or i t s unpredictability. A number of studies have shown that expectancies are d i f f e r -entially affected when tasks are perceived as dependent on s k i l l as C 2^ * 25 35 36 \^ 1) opposed to chance or luck. ' The f i r s t attempt to measure individual differences i n a belief in control of reinforcement (35) was begun by Phares. After several changes, this measure is now a 29-item forced-choice scale, including six f i l l e r items. This scale is developed to measure a person's generalized expectancy of how his reinforcements are controlled. The scale has satisfactory internal consistency, test-retest r e l i a b i l i t y , convergent valid i t y , and discriminant va l i d i t y . The scale is most suitable for investigations of group differences. The internal versus external concept has shown relationships to a variety of behaviours, including those in learning situations(10*24,35,8) conformity situations, ^ ^ ' ^ and risk taking. It i s worth comment that Rotter's explanation of the IE (Internal-External) control construct included the concept of reward value as affecting a person's expectancy that a given behaviour w i l l result in an expected reinforcement: Behaviour Potential = f (Expectancy + Reward Value) (26 ^  Jeffrey identifies an example of this by suggesting that a student may have a very internal attitude about studying for a course and getting a good grade, but i f the course has l i t t l e reward value to him, he is unlikely to study for the course. Rotter comments that, theoretically, one would expect some relationship between internality and good adjustment but that the (9) relationship i s probably quite complex. Broskowski noted that extremely external and extremely internal persons w i l l probably have a greater degree of d i f f i c u l t y in adjustment than those nearer the center of the continuum. His just i f i c a t i o n for this prediction is that extreme externals w i l l not have feelings of guilt or responsibility, but may have increased debilitating anxiety. Extreme internality may produce guilt and an over-riding sense of personal responsibility, not to mention anxiety in the many fate-controlled or other-controlled situations in modern l i f e . 17. Program Evaluation In the foreword to Evaluating Educational Performance.,, J. Thomas Hastings emphasizes that those people involved i n educational measurement must "cease to depend solely upon the methodologies of psychometrics, and correlation; rather to adapt and adopt procedures, instrumentation and logic from sociology, economics, history and elsewhere" i f they are to (48) better understand the complexities of education today. . (23) Evaluation-is»noti-ancevent,v- but-rather .ai.process.:. -•HS. '.It contributes to a l l aspects of program management by ide n t i f y i n g needs, measuring achievement, assessing the learning climate, and determining change. (13) Cronbach -.. > explained a judgmental strategy for evaluation. He outlined three types of decisions for which evaluation i s used: course improvement; decisions about individuals; and administrative regulation. He also i d e n t i f i e d four approaches to evaluation: 1. Process Studies - to examine what i s happening during i n s t r u c t i o n ; 2. Attitude Measures - to e l i c i t feelings and b e l i e f s , not just expressions of approval or disapproval; 3. Follow-up Studies - to attempt to observe ultimate educational contributions; 4. Proficiency Measures - to measure student performance by observation or by achievement on written tests. (32) Merwin v .. suggests that there are four considerations to evaluation: who (or what) should be evaluated; who should evaluate; how evaluations 18. should be conducted; and how evaluations can best be Integrated into the educational process. In a study of the Labour College of Canada, Dickinson and Lamoureux ^-.^ considered five theoretical units to be crucial to program evaulation. Their study was concerned with educative temporary systems and how useful the pro-grams were when participants returned to their work setting. Those five units were: 1. change in participation behaviour following the educative temporary system; 2. participant satisfaction with the design and management of the educative temporary system; 3. personal goal attainment by participants in the educative temporary system;. 4. cognitive achievement within the educative temporary system; 5. participant attitudes related to the goals of the educative temporary system. Barclay .^11 ^ states that a major problem in implementing new learning strategies in the schools is that learning is influenced by student, teacher, curriculum, parental and other environmental factors. As a result, when evaluating behaviours one must not only consider behaviours that relate to achievement, but also to self-competency, self-management, group interaction, motivation, and other affective and social variables. Schulberg and Baker V'+J'' discussed two evaluation models that (2Q) relate to Knutson's identification of the categories of evaluation as being organization oriented and personally oriented. The f i r s t model i s a goal-attainment model, which i s basically a measure of goal achievement. The second i s a systems model of evaluation. It is concerned with establishing a working model of a social unit which is capable of achieving a goal. Summary This literature review points out several important points for consideration in the evaluation of the c r i t i c a l care nursing course. The f i r s t is that attendance at a continuing education course may not necessarily mean desire to learn. Given the premise that the locus of control concept may correlate to performance in the course, the nurse students attending the course may have an internal locus of control, but may have quite separate reasons for attending the course. Therefore the implications of the correlation may not be answered directly in the analysis. C l i n i c a l performance evaluations have been researched a great deal; however, objectivity in such evaluations has never been satisfactorily achieved. It should be recognized at the outset that instruments were selected which i t was hoped would be as objective as possible. However, the known d i f f i c u l t i e s of c l i n i c a l 20. performance evaluation presented p o t e n t i a l problems with part of the data a n a l y s i s . Individual learning needs are always a d i f f i c u l t part of the design of any education course. The l i t e r a t u r e reviewed on learning needs recognized by nurses indicates that nurses attending a continuing education course may have d i f f e r e n t expectations of what the course can o f f e r to them. Although t h i s p a r t i c u l a r course was designed with i n d i v i d u a l learning needs i n mind, i t was recognized that the course may s t i l l not meet the expectations of some of the nurse students. 21 CHAPTER I I I - METHODOLOGY The rationale for the study was outlined i n Chapter I. The main focus was to examine a group of students i n a continuing nursing education course, how they performed i n that course and what was known about them as learners and as people that would help to predict th e i r performance. Factors related to knowledge of the subject, confidence i n that knowledge, c l i n i c a l performance i n c r i t i c a l care nursing areas, and b e l i e f i n internal-external locus of control were a l l used to predict achievement. The p a r t i c u l a r appeals of the internal-external locus of control concept i n understanding and explaining nursing performance i n the learning and performing areas are that: 1) i t helps to i d e n t i f y the i n i t i a t i v e that might be taken by a nurse about the care of a c r i t i c a l l y i l l patient; 2) i t may serve as a predictor of a nurse's confidence i n her/his a b i l i t y to perform a given task; and 3) i t may also predict a nurse's a b i l i t i e s to achieve greater gains as a result of par t i c i p a t i n g i n a continuing education course. Therefore, the locus of control concept assumed a central role i n this study. 22. Hypotheses Based on this rationale, the following hypotheses were proposed. They are expressed as null hypotheses (Ho) and alternate hypotheses (Ha). Testing was performed on the null hypotheses. Hypothesis One Ho^: There is no significant correlation between the score obtained on a test of knowledge and the degree of confidence a student has in the answers given. Ha^: (i) Greater confidence in answers given on a test of knowledge w i l l be associated with lower test scores. ( i i ) Greater confidence in answers given on a test of knowledge w i l l be associated with higher test scores. Hypothesis Two Ho2: There is no significant correlation between the score on a test of knowledge and the belief i n external control of reinforcement. Ha2: (i) Higher scores on knowledge tests relate to a belief in internal control of reinforcement. ( i i ) Higher scores on knowledge tests relate to a belief in external control of reinforcement. Hypothesis Three Ho3: There is no significant degree of confidence in of knowledge and belief reinforcement. correlation between the answers given on a test in external control of Ha^: (i) A higher degree of confidence in answers given on a knowledge test relates to a belief in internal control of reinforcement. ( i i ) A higher degree of confidence in answers given on a knowledge test relates to a belief in external control of reinforcement. 23. Hypothesis Four Ho, There i s no s i g n i f i c a n t correlation between the gain i n score between a knowledge pretest and a posttest and b e l i e f i n external control of reinforcement. Ha 4: ( i ) A greater gain i n score between a knowledge pretest andiposttest relates to b e l i e f i n int e r n a l control of reinforcement. ( i i ) A greater gain i n score between a knowledge pretest and posttest relates to b e l i e f i n external control of reinforcement. Hypothesis Five Ho 5' There i s no s i g n i f i c a n t correlation between the performance of a nurse i n a c r i t i c a l care nursing area and b e l i e f i n external control of reinforcement. Ha,.: ( i ) A higher l e v e l of performance of a nurse i n a c r i t i c a l care nursing area relates to b e l i e f i n i n t e r n a l control of reinforcement. ( i i ) A higher l e v e l of performance of a nurse i n a c r i t i c a l care nursing area relates to b e l i e f i n external control of reinforcement. Definitions In order to avoid c o n f l i c t or confusion i n the use of certain terms i n the study, the following d e f i n i t i o n s were used: (49) Confidence - the b e l i e f one has i n one's own a b i l i t i e s . I t leads to an expressed sense of security i n knowledge and performance. C r i t i c a l l y i l l - refers to a patient with acute problems threatening the following life-maintaining parameters: cardiovascular function, respiratory function, f l u i d - i o n balance, central nervous system regulation. Such patients as those with traumatic i n j u r i e s , 24. severe burns, respiratory failure and acute myocardial infarction require frequent to continuous specialized nursing care.(12) Such care involves complicated technological a b i l i t i e s as well as indepth knowledge on the part of the nurse. the perception of positive and/or negative events as being unrelated to one's own behaviour in certain situations and therefore beyond personal control. (42) In the context of this study, such factors as the laid-on program, including content, methods and approach appear to the learner to be i n -evitable and immutable. the perception of positive and/or negative events as being a consequence of one's own actions and thereby under personal control.(42) The learner perceives the planned program as meeting needs or not, and applies herself to learning the laid-on content only to the extent that i t seems useful to her. refers to the addition, profit or advantage achieved as a result of something. (49) It represents the differences measured between the i n i t i a l state of the learner and the end state in regard to knowledge and c l i n i c a l s k i l l s in c r i t i c a l care nursing. the range of understanding or information one has about something. (49) In this study, the limits of knowledge are restricted to the understanding of c r i t i c a l care nursing. 25. Evaluation Instruments Knowledge Pretest. A pretest, consisting of multiple choice questions and completion items, was administered on the f i r s t day of the course. The questions were based on content to be covered during the 14 weeks of the course and included a l l subject areas: cardiovascular system, respiratory system, renal system, central nervous system, psychosocial aspects of nursing care, teaching patients and others, administration i n nursing, and self learning. Because i t was assumed that the nurse students would have basic knowledge in a l l these areas, that some would also have more indepth knowledge because of previous attendance at short courses on c r i t i c a l care nursing, and that some would have work experience in c r i t i c a l care areas, the purpose of the pretest was to establish the extent to which the nurse students already knew the content to be presented during the course. This would serve as a baseline from which knowledge gains could be measured as a result of the course. The fifteen nurse students were divided into three groups of five and each group wrote a different pretest. Items on each test were matched for content, complexity and item types. The three pretests combined made up the posttest. This design was used to measure the gain in score for the nurse students from pretest to posttest. For the pretest, the questions were reviewed by a panel of c l i n i c a l nursing experts, but were not tested for vali d i t y or r e l i a b i l i t y . 26. Confidence Measures. For each question on the pretest, the nurse students were asked to indicate their degree of confidence in their answers; that i s , after each question they were asked to indicate on a scale of 1 - 4 whether: 1 - I have no idea what the answer is 2 - 1 guessed at my answer 3 - My answer may be right 4 - I am confident my answer i s right A l l confidence responses for the total number of pretest items were then summed. This measure was used to determine a confidence score for each nurse student. The a b i l i t y to perform in a continuing education course of the design proposed was measured against the confidence of the nurse student as indicated on the knowledge test. Knowledge Posttest. (See Appendix B) The f i n a l examination was administered on the second last day of the course to 13 nurses completing the course. The test consisted of items from the three pretests that were tested for validity and r e l i a b i l i t y by having a group of 40 nurses currently working in c r i t i c a l care areas write the test. Item analysis was done, and of the 119 items on the original posttest, 71 items were selected for scoring on the f i n a l examination. Forty-eight items were eliminated because of ambiguous stems, confusing distractor items, more than one right answer for selection, and negative differential discriminability (that i s , items which selectively disadvantaged high performers and advantaged low per-27. formers i n the control group of 40 nurses). The thirteen nurse students were asked to answer a l l 119 items, but only the 71 items were counted for their f i n a l mark. Figure B plots the number of correct responses for each of the 71 items on the revised posttest against the confidence expressed by the whole group of nurses i n that question. In addition, the subject content of each question appears and demonstrates a range of d i f f i c u l t y for each subject covered. I t also shows a O.k-2 correlation between high confidence and easier questions and low confidence and more d i f f i c u l t questions. This correlation w i l l be discussed i n Chapter IV. Rotter I-E Scale. This forced-choice questionnaire, which measures be l i e f i n in t e r n a l versus external control of reinforcement, has been described i n the l i t e r a t u r e review. I t was administered on the morning of the second day of the course. The scale has 23 items plus s i x f i l l e r items. Scoring i s based on answers r e f l e c t i n g b e l i e f i n external control of reinforcement. That i s , the higher the score, the more external the ind i v i d u a l i s . Items indicating externality on the scale include the b e l i e f that many of the un-happy things i n people's l i v e s are partly due to bad luck; that the world i s run by the few people i n power and there i s not much the " l i t t l e guy" can do about i t ; or that many times we might just 4.0 4* 3.5 3.0 w o MEAN CONFIDENCE 5 3 - " il-T 20 *7 ~287 £1't t t ti-c 2,-C <?/-r sin 9-* *'T&t. n-r SCORE 53--I? 2 * C *>* 2.5 J f7-A HO-h ui-F 2.0 \ la-r H w H 1.5 SUBJECT CONTENT' LEGEND C-Cardiovascular System R-Respiratory System N-Central Nervous System F-Renal System (Fluid-ion) P-Psychosocial Aspects T-Teaching-Learning A-Administration 65,92,etc. -Test question number 20 FIGURE B. I T 1 1 : 1 "~ 1 1 1 : r 3 0 4 0 50 60 70 80 90 100 PERCENTAGE ANSWERING CORRECTLY PERCENTAGE OF CORRECT RESPONSES AND CONFIDENCE IN ANSWERS GIVEN ON 71 - ITEM POSTTEST ^  • -:~ ... : 29. as well decide what to do by flipping a coin. Items indicating internality on the scale include the belief that people are lonely because they don't try to be friendly; that there i s really no such thing as "luck"; or that people's misfortunes result from the mistakes they make. The Rotter Scale can be found in Appendix C. Cl i n i c a l Performance Evaluation. A number of evaluation tools were used to assess c l i n i c a l performance. Those tools included the C r i t i c a l Incident Technique, (Appendix D) using standards of care for c r i t i c a l l y i l l patients as guidelines, and a summary checklist of performance i n i t i a t i v e . The f i n a l evaluation tool used was the standardized Slater Nursing Competencies Rating Scale (Appendix E). A f i n a l grade for c l i n i c a l performance was determined by the researcher. It was based on a point system applied to the Slater Scale and other performance evaluation information. C l i n i c a l performance evaluation was carried out weekly by the c l i n i c a l preceptors. Final evaluation was carried out during the last week of the course. Midterm and Final Evaluation Questionnaires. These questionnaires provided information about the nature of the c l i n i c a l experience, classroom learning and administrative aspects about the course. Parts of the results obtained from the questionnaires were used to enhance the results of this study. As c o n f i d e n t i a l i t y i n answering the questionnaires was ensured, some information that might otherwise have been helpf u l i n t h i s study could not be used. The questionnaires were lengthy and descriptive, and thus are not included i n the Appendices, but can be found on f i l e at the D i v i s i o n of Continuing Nursing Education at the University of B r i t i s h Columbia. Questionnaire to Obtain Background Information about Participants . The questionnaire was administered on the f i r s t day of the course. Data collected included: - age and sex - kind of basic preparation i n nursing - location and name of school (basic preparation) - degree and diplomas held and dates received - location and name of school(s) where any post-basic preparation was received - t o t a l years working - t o t a l time spent working i n c r i t i c a l care area - marital status - number and ages of children - most l i k e l y reasons for attending this course Design of the Study The l i s t of variables used i n the testing of the hypotheses i s as follows: Target Variable: 1. Gains i n performance as a r e s u l t of the course. 31. Predictor Variables: 1. Age (in years) 2. Years worked since graduation (in years) 3. Years worked in c r i t i c a l care (in years) 4. Pretest score 5. Posttest score 6. Confidence score on posttest 7. C l i n i c a l performance score 8. Rotter I-E Scale score. Data analysis was carried out on two groups, sometimes jointly, sometimes independently. The group of 13 nurse,.;students who completed the course constituted the experimental group. The group of 40 c r i t i c a l care nurses who wrote the posttest and also completed the Rotter I-E Scale and the questionnaire on background information formed the control group. Testing was done on the experimental group and on the experimental and control groups combined. This yielded information about the experimental group as a select group of nurses attending a continuing education course, and on the two groups together as a larger population of c r i t i c a l care nurses. » In addition to the testing of the hypotheses, this study examines information collected about the participants and attempts to determine trends relevant to continuing nursing education courses of this type. In effect, each participant's background, contribution and outcome was examined. 32. Data Collection and Analysis Table 1 i d e n t i f i e s a l l instruments used for data c o l l e c t i o n . S t a t i s t i c a l analysis of the data included co r r e l a t i o n a l and multivariate analysis. For the 13 nurse students' data analysis alone, correlations were tabulated using the Spearman Rank Order Method of analysis. Pearson Product Moment correlation was used i n c o r r e l a t i o n a l analyses of data combining the 13 nurse students and the control group of 40 nurses. (Both of these are standard computer programs used at the University of B r i t i s h Columbia Computer Center.) Tabulation of results of tests proceeded by means of OMR Multiple Choice Examination Answer Cards and the program OMR Mulmark, which tabulated a l l data and were used for a l l computer-run programs in. the analysis of the data. (OMR Mulmark i s also a standard program used at the University of B r i t i s h Columbia Computer Center.) Sigma (z) scores* were tabulated to obtain gain scores between pretest and posttest. This was done i n order to eliminate differences i n pretests. Although the three pretests were matched for content, complexity and item types, the tests were not pretested for v a l i d i t y or r e l i a b i l i t y and therefore i t was not known i n advance whether the tests were i n fact equal. *Formula found i n Best, J. Research i n Education. Englewood C l i f f s , New Jersey: Prentice-Hall, Inc., 1970, p. 243. TABLE 1 - LIST OF DATA COLLECTION INSTRUMENTS AND DATES THEY WERE USED Data Collection Instruments Dates Used Questionnaire on Background Information Day 1 Knowledge Pretest Day 1 Rotter Scale Day 2 C r i t i c a l Incidents Daily i n C l i n i c a l Areas Slater Nursing Competencies Rating Scale F i n a l Week i n C l i n i c a l Area Midterm Course Evaluation Week 10 Knowledge Posttest Week 14 Fi n a l Course Evaluation Week 14 34 CHAPTER IV - ANALYSIS OF DATA General Summary of Program Outcomes The overall opportunities and experiences of the course were reported by the majority to be useful. Thirteen of the fifteen nurse students completed the course. Two withdrew before completion. One was asked to leave because i t was f e l t that she was not able to meet the course objectives. The second l e f t voluntarily, as she f e l t that the course was not relevant to her particular needs. Course evaluation statis t i c s are based on the thirteen students who completed the course. Measures of Knowledge As the pretests contained questions based on content that would be presented in the course, i t was not expected that the nurse students would obtain high scores. Table 2 shows scores obtained on the pre-tests. (The two nurse students who withdrew from the course were in Pretest Group I.) Although the three pretests were presumably matched for complexity, this table demonstrates considerable differences among the three groups in results. In a pretest situation, where the students were grouped randomly, these differences may be explained by the premise that the groups happened to be divided into similar groups of natural a b i l i t y , previous experience or other factors which would c l a r i f y the differences i n scores. Alternately, i t may be that Pretest Group III 35. TABLE 2 - SCORES OBTAINED. ON PRETESTS FOR EACH OF THREE PRETEST GROUPS Pretest Pretest Mean Pretest Mean Sigma Sigma Identification Score* (in %) Score (in %) (z) Score Score Pretest Group I 1 5 8 33 49 33 38.3 - 0.35 + 1.77 - 0.35 + 0.36 2 35 + 0.68 Pretest Group II 4 6 9 13 38 28 33 25 31.5 + 1.16 - 0.77 + 0.19 - 1.26 0 3 54 + 0.31 Pretest Group III 7 10 11 12 54 41 59 51 51.8 + 0.31 - 1.62 + 1.08 - 0.08 0 *Because the test was constructed primarily in multiple choice format, with four alternative answers for each question, a pretest score of 25% should be expected by chance alone. Therefore, a student's on-hand knowledge of the course content should be regarded as the obtained pretest value minus the chance value (25%). 36. had the easiest test and Pretest Group I I the most d i f f i c u l t . Without v a l i d i t y and r e l i a b i l i t y known for the pretests, the answer to this question of differences was not immediately known. Table 3 shows some variables which may have affected the performance of the pretest groups. Pretest Group I I , with the lowest mean score on the pretest (M = 31.5), also had had less previous work experience i n c r i t i c a l care nursing. Group I I I , (M = 51.8), showed the most previous experience i n c r i t i c a l care. However, i t i s interesting to note that their confidence scores on the pretest were considerably lower than the other two groups. This group may have been more aware of what they didn't know because of their experience, and would therefore be less confident i n answers given on the pretest. Group I I I also revealed the most external scores on the Rotter Scale, (M = 11.4), possibly supporting the hypothesis that externals are less confident i n their performance (Hypothesis Ha^). Age does not appear to be a notable factor i n the differences i n pretest scores. On the basis of the information presented i n Table 3, i t may be possible to make some predictions about needs of the nurse students r e l a t i v e to the development of the course. Pretest r e s u l t s , as indicators of knowledge about c r i t i c a l care nursing already present, might predict the content that should be presented, or what parts of the subject content should be emphasized. On the basis of pretest TABLE 3 - PRETEST SCORES AND POSSIBLE RELATED VARIABLES TO EXPLAIN DIFFERENCES BETWEEN 3 PRETEST GROUPS Years Pretest Worked i n Pretest Pretest Confidence Age C r i t i c a l Rotter Sigma I d e n t i f i c a t i o n Score Mean (Years) Care Score Score (in %) (z score) Pretest 1 33 3.42 34 2 4 - 0.35 5 49 3.31 54 1 4 + 1.77 Group I 8 33 2.77 28 1 8 - 0.35 M = 38.1 M = 3.17 M = 39 M - 1.3 M = 5.3 2 35 3.22 27 1 5 + 0.68 Pretest 4 38 2.36 26 0 9 + 1.16 6 28 3.52 38 1 11 - 0.77 Group I I 9 33 3.16 26 0 11 + 0.19 13 25 2.86 46 0 9 - 1.26 •M = 31.5 M = 3.02 M -• 33 M - 0.4 M = 9.0 3 54 2.55 23 0 15 + 0.31 7 54 3.02 27 ' 3 11 + 0.31 Pretest 10 41 2.54 47 5 12 - 1.62 Group I I I 11 59 2.92 24 2 10 + 1.08 12 51 2.95 22 1 9 - 0.08 M = 51.8 M = 2.80 M = 29 M = 2.2 M - 11.4 Total Group Means 41.0 2.97 32.5 1.3 9.1 38. scores, predictions could be made about performance on the posttest. In the interest of drawing some conclusions about what information known prior to a continuing education course might prove useful i n the development and success of the course for a particular group of learners, trends that evolved in this particular continuing education course i n c r i t i c a l care nursing were reviewed. Table 4 shows a l l scores obtained on tests and assignments through-out the course. Even though the pretest scores appeared to present possible significant differences between the three pretest groups, the pretest scores were included in the calculation of the average score for each nurse student on a l l written tests and assignments. Calculation of the mean score for each nurse student when the pretest score was not included showed l i t t l e difference in results. This i s best shown by indicating the rank of each nurse student when the pretest score was and was not included in the calculation of a total mean score. (See Table 5, page 40.) Despite differences between Pretest Groups as shown in Table 2, Table 5 indicates that pretest scores did not greatly affect the rank for each nurse student. The mean score of the differences between ranks i s zero. Mean scores calculated on a l l tests and assignments less pretest scores did, however, show a greater increase in scores for Pretest Group II than for either of the other two groups. (See Table 4.) TABLE 4 - SCORES ON ASSIGNMENTS AND EXAMINATIONS FOR 13 NURSE STUDENTS ! Mean Midterm Score Pretest Test Posttest A C C T P M M T T M T C ; Mean Less Identification Score Score Score :-./0 s Total Score Pretest (%) (%) (%) 1 2 3 4 5 Score (%) (%) 1 33 52 55 50 65 55 55 55 420 52.5 55.3 Pretest 5 49 . 68 77 75 75 65 55 55 519 64.9 67.1 Group I 8 33 52 61 65 65 65 75 70 486 60.8 64.7 (M=59.4) (M=62.4) ' 2 35 75 80 75 85 75 75 75 575 71.9 77.1 4 38 61 69 70 75 60 55 75 503 62.9 66.4 Pretest fy — _ _ . — 6 28 46 76 65 75 75 75 75 515 64.4 69.6 Group II 9 33 70 90 75 75 75 75 75 568 71.0 76.4 . 13 25 33 54 75 65 65 65 75 457 58.1 61.7 (M=65.7) (M=70.2) 3 54 51 76 55 65 65 70 55 491 61.4 62.4 7 54 71 76 75 85 85 75 75 596 74.5 77.4 Pretest -^>__ „ T T T 10 41 53 63 70 65 70 70 75 507 63.4 66.6 Group III 11 59 71 70 70 65 70 75 75 555 69.4 70.9 12 51 73 79 70 75 75 75 75 573 71.6 74.6 (M=68.1) (M=70.4) Total Group Means 41 59 71 73 71 69 68 70 520 65.1 68.5 VO 40. TABLE 5 - DIFFERENCE IN RANK FOR EACH OF 13 NURSE STUDENTS WHEN PRETEST SCORE IS INCLUDED AS A PART OF FINAL SCORE Rank on Rank Difference Total Less i n I d e n t i f i c a t i o n Score Pretest Rank Pretest 1 c 13 c. 13 •7 0 Group I J 8 o 11 / 10 + l - 1 2 2 2 0 Pretest Group I I 4 6 9 9 7 4 9 6 3 0 * - 1 - 1 13 12 12 0 3 10 11 + 1 Pretest 7 10 11 1 8 5 1 8 5 0 Group I I I u 0 12 3 4 + 1 41. Although the rank of each nurse student was not affected by the pretest, Group I I , having the lowest mean pretest score, probably also had the most d i f f i c u l t p r e t e s t. Seven nurse students reported on the f i n a l course evaluation questionnaire that they f e l t the f i n a l examination was not s a t i s f a c t o r y i n providing adequate feedback f o r t h e i r learning needs, while only two f e l t the pretest and the midterm were unsat i s f a c t o r y . A l l but one student increased t h e i r score from midterm to posttest. The one nurse student whose score dropped only dropped by 1%, whereas increases i n scores ranged from 3% to 30%. (See Table 4.) Table 6 i d e n t i f i e s the v a r i a b l e s that were tested for both groups of nurses. The group of 13 nurse students (experimental group) and the group of 40 c r i t i c a l care nurses (control group) were r e l a t i v e l y s i m i l a r i n many respects. Their ages, m a r i t a l status and number of c h i l d r e n were s i m i l a r , as was the number of years worked since gradu-ation . The c o n t r o l group had had s i g n i f i c a n t l y more years of experience i n c r i t i c a l care nursing than had the experimental group, which was to be expected as the course was designed to prepare the nurses to work i n c r i t i c a l care. The experimental group showed a more external mean on the Rotter Scale, but not s i g n i f i c a n t l y d i f f e r e n t from the c o n t r o l group. There was a s i g n i f i c a n t d i f f e r e n c e between the experimental and c o n t r o l groups on the scores obtained on the t o t a l posttest and the 71 item post-t e s t . The experimental group scored higher i n both instances. The TABLE 6 - LIST OF VARIABLES TESTED COMPARING 13 NURSE STUDENTS IN A CRITICAL CARE NURSING COURSE WITH 40 CRITICAL CARE NURSES Possible range Actual range Grand mean Grand standard deviation Experimental mean (N = 13) Control mean (N = 40) Si g n i f i c a n t difference E vs. C v _'. Age i n years 0 - ? 22 - 54 30.2 7.2 32.5 29.4 0.18 M a r i t a l status* 1 - 2 1 - 2 1.39 - 1.53 1.34 0.20 Number of ch i l d r e n 0 - ? 0 - 5 ' 0.7 1.4 1.2 0.5 0.14 Years worked since graduation 0 - ? 1 - 2 3 7.2 5.2 7.1 7.2 0.89 Years worked i n c r i t i c a l care 0 - ? 0 - 1 2 ' 3.3 2.8 1.3 3.9 0.002 Rotter score 0 - 2 3 0 - 1 6 8.7 3.3 .9-1 8.6 0.67-Raw score on posttest 0 -100 30 - 76 54.8 8.7 61.8 52.5 0.0006 Adjusted score on 71 posttest items 0 -100 27 - 90 63.4 12.1 71.1 60.9 0.007 Confidence i n answers given 7fc--284 140--264 „> 51.2 222 -204 0.08 * 1 " Single, separated, divorced or widowed 2 = Married. 43. experimental group could be expected to score higher because they had been reading and studying the subject content throughout the course. Confidence was higher for the experimental group, and although the diffe r e n c e between the groups was not s i g n i f i c a n t , t h i s higher confidence might be expected for two reasons. F i r s t , as they scored higher on the t e s t s , the experimental group would l i k e l y have more confidence i n what they knew. The c o n t r o l group, on the other hand, may be more aware of what they don't know, and therefore be le s s sure of the answers they gave. One of the questions o r i g i n a l l y posed was whether the confidence a nurse has i n her answers to questions on a t e s t of knowledge has any r e l a t i o n s h i p to how she performs on that t e s t . That i s , does a high degree of confidence mean that the nurse w i l l score higher on a knowledge test about c r i t i c a l care? For the 13 nurse students i n the course, the c o r r e l a t i o n between t h e i r confidence and t h e i r score on a t e s t of knowledge was 0.25 (Spearman rho). This i s not s i g n i f i c a n t at the .05 l e v e l . However, the c o r r e l a t i o n c o e f f i c i e n t between confidence and test score for the t o t a l group of 53 nurses was 0.36 (Pearson Product Moment), which i s s i g n i f i c a n t at the .01 l e v e l (see Table 6). Thus, the more confidence the nurses have about t h e i r answers, the higher the knowledge score l i k e l y earned. This r e s u l t , for the group of 53 nurses, r e j e c t s the n u l l hypothesis Ho1 and accepts the alternate hypothesis Ha^ ( i i ) that 4 4 . there is a significant positive correlation between confidence and the knowledge score. The confidence indicated in each answer on the posttest was corre-lated with the percentage of people answering the question correctly. (See Figure B, page 28.) As might be expected, the correlation was 0.42 (Pearson Product Moment), positive and significant at the .01 level. If a question is relatively easy, i t seems logical that most nurses w i l l answer the question correctly and w i l l have a high degree of confidence in their answer. What becomes interesting i s why some questions were not answered correctly by the majority, but high confidence was expressed in the answer given. Question #14, which asked the nurse to interpret signs of cardiovascular changes, is an example of this, where the mean confidence score was 3.3, (above the mean confidence for the whole test), while only 40% answered the question correctly. Alternately, Question #56, which asked for understanding about the implications of subcutaneous emphysema after surgery in infants, was answered correctly by 91% of the nurses, but the confidence expressed was only 2.4, which was lower than the confidence scores on 87% of the test. Even though these questions were included after the item analysis was completed, something about the nature of the question caused a disparity between confidence and accuracy. The knowledge test scores might also have been affected by the locus of control concept. If the nurses scored higher on the test, were they more internal or external in their belief in control of reinforcement? • 45, For the group of 13 nurse students the Spearman rho correlation was - 0.1, while for the 53 nurses, the Pearson r correlation was - 0.07. Neither correlation i s significant and therefore the null hypothesis must be accepted, that belief in internal or external control of re-inforcement does not significantly relate to performance on a knowledge test. The negative direction of the correlation would suggest that high scores are more related to internal belief. At the same time, the lack of significance between these two variables might support the con-cept developed by Broskowski in Chapter Two, that those nearer the center of the continuum of the internal - external locus of control would adjust better to a given situation. Since confidence was a predictor of test scores but the locus of control concept was not, i t was then asked whether high confidence was a predictor of internality or externality, or vice versa. This correla-tion was not significant for either group, (N = 13, rho = - 0.29; N = 53, r = - 0.19), but the negative direction suggests that high confidence is more related to internals. The question of confidence and internality is d i f f i c u l t to predict within the confines of the methods used to test the variables in this study. Confidence as a personal and independent expression of a b i l i t y , and not restricted to feelings about knowledge of test question content, might reveal more interesting results when correlated with the locus of control concept score. Whether such a measure exists and could be used was not i n -vestigated in this study. 46. Table 7 shows the correlation matrix for a l l variables tested for both groups of nurses. Significance at the .01 and .05 levels i s noted. Other than correlations which have already been discussed in relation to the hypotheses tested, there are other significant correlations which are of potential interest. The performance on the test of knowledge of c r i t i c a l care nursing correlated more positively with years worked since graduation than years worked in c r i t i c a l care. This may be due to the fact that the subject content of the posttest demanded more general know-ledge and judgment about nursing than specific knowledge about c r i t i c a l care nursing. It i s also interesting to note that age correlated nega-tively with posttest scores. As the age of the nurse increased, her score on the posttest decreased. Detailed discussion follows, but i t suggests that older nurses adapt less well to the restrictions imposed by a multiple choice examination for testing knowledge. It may also mean that older nurses know less, but more support would have to be offered to that supposition than this correlation alone. Referring back to the 13 nurse students in the course, the next step was to look at the performance of these nurses at the end of the course and compare i t to what we knew about them at the beginning of the course. If a nurse is more external or internal in her belief in control of re-inforcement, does she improve more significantly as a result of a learning experience? If the answer to this i s yes, why i s i t so? Table 8 shows the gain scores between pretest and posttest for each nurse student. The table separates the students into their original pretest groups to indicate group differences. TABLE 7 - CORRELATIONS OF VARIABLES TESTED USING COMBINED GROUP OF 13 NURSE STUDENTS AND 40 CRITICAL CARE NURSES Age i n years M a r i t a l status Number of c h i l d r e n Years worked since graduation Years worked i n c r i t i c a l care Rotter score Score on 119 posttest items Score on 71 posttest items Confidence score Age i n yrs. 1.00 M a r i t a l status 0.17** 1.00 Number of ch i l d r e n 0.65** 0.47** 1.00 Years worked since graduation 0.76** 0.21 0.59** 1.00 Years worked i n c r i t i c a l care 0.22 - 0.06 0.23 0.45** 1.00 Rotter score - 0.19 0.02 - 0.07 - 0.06 - 0.17 1.00 Score on 119 post-test items - 0.27* - 0.30* - 0.45** - 0.36** - 0.35** - 0.06 1.00 Score on 71 post-test items - 0.27* - 0.36** - 0.47** - 0.37** - 0.28* - 0.07 0.96** 1.00 Confidence score - 0.09 - 0.03 - 0.15 - 0.04 - 0.03 - 0.19 0.41** 0.36** 1.00 Gain .score*** - 0.08,._7\ -.0.03 , - 0.18 -." -0.06- - 0.00 - 0.17 0.47 0.49 0.56 •Significant at r.„ " S i g n i f i c a n t at r.-, ***Gain scores are based on computations for 05 01 15 nurse students only TABLE 8 - GAIN SCORES FROM PRETEST TO POSTTEST FOR 13 NURSE STUDENTS Pretest Posttest Gain Score Score Score Gain z Identification (%) (%) (%) Score Pretest 1 33 55 22 - 1.18 5 49 77 28 - 1.16 Group I 8 33 61 28 - 0.65 2 35 80 45 + 0.05 Pretest 4 48 69 21 - 1.37 6 28 76 48 +.1.23 Group II 9 33 90 57 + 1.60 13 25 54 29 - 0.41 3 54 76 22 + 0.05 Pretest 7 54 '76 22 + 0.05 10 41 63 22 + 1.12 Group III 11 59 70 11 - 1.15 12 • 51 79 28 + 0.81 Total Group Means 41.0 71.1 29.0 49. Calculation of correlations between gain scores and b e l i e f i n control of reinforcement revealed some unusual r e s u l t s . The correlation coef f i c i e n t between these two variables using the gain score i n percentage revealed a correlation - 0.15, (Spearman rho), which i s not s i g n i f i c a n t . However, using gain z scores, the correlation c o e f f i c i e n t became - 0.61 (Spearman rho). That i s , the more in t e r n a l the i n d i v i d u a l , the greater was the gain i n score from pretest to posttest. This correlation of - 0.61 i s s i g n i f i c a n t at the .05 l e v e l . The most l i k e l y explanation for t h i s difference i n correlations may be the difference i n o r i g i n a l pretests. Actual gain scores expressed as a percentage do not necessarily r e f l e c t s i g n i f i c a n t changes, primarily because higher pretest scores had less opportunity to make s i g n i f i c a n t gains to the posttest. The z scores, on the other hand, attempt to eliminate the differences between groups, and are therefore l i k e l y to be a better r e f l e c t i o n of gain than are gain scores expressed as percentages. I t •. seems . that * nurses who have a greater b e l i e f i n in t e r n a l control of reinforcement apply themselves more to the learning at hand, and work harder to perform better i n the course. I t might also suggest that internals have a greater motivation to do better i n the course as a result of pretest performance. 50. When a l l eleven variables tested f o r 53 nurses i n Table 6 (page 42) are used j o i n t l y to predict the amount of gain from pretest to posttest for 13 nurse students, the s t a t i s t i c s are considerably more encouraging. The s i n g l e best predictor of nurses' gain scores i s confidence i t s e l f and accounts for about 31% of the p r e d i c t a b i l i t y of gain scores. The second best predictor (and indeed the only other one s t a t i s t i c a l l y s i g n i f i c a n t ) i s the posttest score. Taken together, these two pre-d i c t o r v a r i a b l e s accounted for 41% of the nurses' gain scores. The f a c t that a posttest score i s a better predictor than any of the pretest scores i s encouraging. That suggests that i t i s the effectiveness of the course content, rather than the student's p r i o r knowledge, that i s the de c i s i v e f a c t o r . In short, how f a r the learner went i n the course made more di f f e r e n c e than the point from which she started. The only other v a r i a b l e s that approached s i g n i f i c a n c e as predictors of gain were age and the number of years worked i n c r i t i c a l care, but both f e l l j u s t s l i g h t l y short of the .05 l e v e l of s i g n i f i c a n c e . The other v a r i a b l e c r i t i c a l to t h i s study, Rotter's measure of i n t e r n a l i t y , e x h ibits a p a r t i a l c o r r e l a t i o n with gain scores of 0.15 - - - f a r from the l e v e l needed for s i g n i f i c a n c e . 51. Measures of C l i n i c a l Performance Several d i f f i c u l t i e s were encountered in the use of the evaluation instruments selected to measure c l i n i c a l performance in the course. Some of the d i f f i c u l t y was probably related to the lack of c l i n i c a l teaching experience of the clinicalppreceptors. Some d i f f i c u l t y was also due to the ambiguity of the instruments and the lack of opportunity for practice with the instruments by the c l i n i c a l preceptors. Differences were encountered in the scores obtained by the nurse students according to the c l i n i c a l preceptor who evaluated the perfor-mance. Discussion with the c l i n i c a l preceptors about the Slater Nursing Competencies Rating Scale revealed a lack of sufficient under-standing about the meaning"of the terms used for rating (e.g. "best nurse", "poorest nurse", etc.). Despite these d i f f i c u l t i e s , f i n a l c l i n i c a l performance results were considered representative of the performance of each nurse student. Recognizing the limitations of the subjective evaluation that was carried out, the researcher reviewed a l l evaluation materials on each nurse student, including a score calculated from the results of the Slater Scale. The group was then ranked from 1 (best performance) to 13 „ (poorest performance). Spearman rho correlations were carried out on this ranking. The relationship between c l i n i c a l performance and belief in control of reinforcement was of no significance. (rho = - 0.28). The direction of the correlation, however, suggests that^betiter;-performance is _ f .52-. seen in more internal nurses. Correlation of c l i n i c a l performance with confidence again showed no significance (rho = - 0.16). The direction suggests in this instance, however, that c l i n i c a l performance is associated with lower confidence. Comparison of c l i n i c a l performance with posttest score showed a Spearman rho correlation of 0.38. Thus i t seems that c l i n i c a l performance does not have significance in relation to other knowledge about the nurse students in the course. A larger group, however, may begin to show stronger correlations which would support the concept that c l i n i c a l performance could be used as a predictor for performance in a continuing education course. Alternately, Rotter scores and confidence in answers on a knowledge test may be predictors of performance in c r i t i c a l care nursing. These appear to be areas for further investigation, using more refined tools for measurement of performance. Measures of Program Effectiveness Midterm and f i n a l evaluation questionnaires provided, primarily, confirmation of problems or d i f f i c u l t i e s already identified informally. The design of the course was considered.satisfactory, and content pre-sentations were reported as positive. It was pointed out by some students that there would have been an advantage to having more resource people available for specific content areas. Other than problems related to the lack of appropriate learning experiences in one c l i n i c a l area, the c l i n i c a l experience was good. 53. Several students identified a need for more experience in specific c l i n i c a l areas related to their needs. A significant result of the questionnaires was the identification of the need for more pre-course preparation by the students. A l i s t of reading requirements and the identification of resource text books to be used during the course was considered to be most important. This was not done for the f i r s t course. Some students also reported that a more similar background experience would have made the teaching task easier and the learning experience more valuable. The course length was generally considered satisfactory, -although i t was f e l t that more c l i n i c a l time, together with more prior preparation of the students by pre-reading, would have made the total experience more worthwhile. 54 CHAPTER V - SUMMARY, CONCLUSIONS  AND RECOMMENDATIONS This report has presented the results of the performance of 13 nurses attending the f i r s t of two 14-week continuing education courses in c r i t i c a l care nursing. The evaluation of the course has brought to light several pieces of information which should prove useful in planning the second course and indeed future courses which include c l i n i c a l and classroom learning experiences. Summary The major focus of the study was on the gains achieved by the nurses as a result of attending the course. Specific measures of gain were tested to determine achievement in the areas of knowledge and performance. Factors which were f e l t to be predictors of performance were also tested. Analysis of the results revealed certain gains specific to the particular course and possibly gains that could be predicted for future courses. Figure A (page 8) represented a model of the intent of the study. It was found that there were indeed certain pieces of information that could be obtained about nurses prior to a course which could predict performance in the course. Selection of students for this course was based on what were considered to be important c r i t e r i a (see Appendix A). However, other factors were found to be just as important i f not more so. 55. Age and the number of years worked in c r i t i c a l care nursing became significant predictors of performance. Both of these factors, although not considered in need of weighting for selection, were known prior to the course and may have played a part in the selection process. A pretest given to the students on the f i r s t day of the course also helped to identify areas of strength and weakness in the knowledge each nurse had about c r i t i c a l care nursing. The test, made up of questions based on content to be presented in the course, could well have been used to plan for individualized learning experiences for the nurses. A posttest administered at the end of the course provided important information about gains achieved in the course. The posttest consisted of questions that had been on the pretest, and therefore gave a signi-ficant measure of increases in knowledge as a result of attendance at the course. Also, by measuring confidence in answers given on the test, predictions could be made as to whether confidence is a predictor of performance on a knowledge test. The internal-external locus of control concept (Rotter I-E Scale) was chosen for this study because i t was considered a predictor of c l i i i c a l performance a b i l i t y , confidence in performance and gain. The The results have shown that i t was indeed a significant predictor of gain, but not s t a t i s t i c a l l y significant for confidence or c l i n i c a l per-formance. Neither was i t a significant predictor of testis scores. Because the test group was very small (N = 13), and because there were 56. c o r r e l a t i o n a l analyses which were not s i g n i f i c a n t f o r the experimental group but were for the experimental and c o n t r o l groups combined, further t e s t i n g i s needed of these v a r i a b l e s using l a r g e r groups. Five hypotheses were stated and the analysis of the r e s u l t s has revealed the following p o s i t i v e f i n d i n g s : Greater confidence i n answers given on a knowledge tes t w i l l r e l a t e to higher scores. (Ha^ ( i i ) ) A greater gain i n score between a knowledge pretest and posttest r e l a t e s to b e l i e f i n i n t e r n a l c o n t r o l of reinforcement. (Ha^ ( i ) ) Conclusions Evaluation of a 14-week continuing education course i n c r i t i c a l care nursing has demonstrated some p o s i t i v e f i n d i n g s . I t has also revealed areas of weakness i n planning such courses, and t h i s study has i d e n t i f i e d some of these weaknesses and how they could be improved to achieve a better r e s u l t . Further, p r i o r knowledge about course p a r t i -cipants can predict performance c a p a b i l i t i e s and can u s e f u l l y a f f e c t the program design for a s p e c i f i c group of students. In the course j u s t completed, several f a c t o r s have been i d e n t i f i e d which might have improved the course f o r t h i s group of learners. For instance, knowledge about the varied e x p e r i e n t i a l backgrounds of the nurse students could have affected the c l i n i c a l learning experiences and the value those experiences had to i n d i v i d u a l students. Although not d i r e c t l y r e f l e c t e d by course 57. results, the d i f f i c u l t y in adjusting to the concept of self-directed learning was stated as a problem more frequently by the older nurse students. Although i t was attempted to give attention to individual needs, the group also had to function as a unit in order to accomplish the task in the time allowed. The two students who withdrew from the course both suffered from this need to conform to group norms, as they seemed to have greater and more individual needs than most of the other nurse students. The d i f f i c u l t i e s encountered with the c l i n i c a l performance evalu-ation instruments have already been discussed in Chapter IV. The need to develop inter-rater r e l i a b i l i t y and more objective instruments became evident early in this program. It also seemed important to concentrate on the assessment of each nurse as she came into the program and to attempt to plan for c l i n i c a l experiences that would be most beneficial to her. Changes were made in the course for some students to provide for special learning experiences, but i t was evident in the f i n a l course evaluation that this was not sufficient and that more could have been done to meet more individual needs. The data analyses reported i n this study have particularly identified factors which can affect achievement potential in a continuing education course. Those factors, more specifically, are: - age - previous experience in c r i t i c a l care nursing - confidence - belief in locus of control (Rotter I-E Scale) - pretest score on course content. 58. Many times throughout the course i t became evident that different approaches to evaluation would have revealed more significant results. Information collected about the nurse students on observation was i n -valuable in assessing and understanding their a b i l i t i e s , but was not documented in any way that could be used in the data analysis. Although this became a frustrating situation for the evaluation of the f i r s t course, i t helped a great deal i n making recommendations for the second and any subsequent courses. Gains in knowledge have clearly been demonstrated as a result of attendance at a continuing education course. This i s encouraging and supports the concept of a course such as the 14-week course described in this study. The more that can be determined through further study as to what factors can allow for optimum gain,tthe better such courses w i l l become. Recommendations for the Second Course Selection of students for such courses may be one of the most important factors to consider, based on evaluation of the 15 nurses who began this particular course, problems that arose, and what was known about the nurses prior to the commencement of the course. There were similarities in the two nurses who withdrew from the course. Both were older (45 and 54 years). Both had very individual learning needs which apparently could not be met, even though the total class number was small. 59. Background experience i n c r i t i c a l care nursing also seemed to affect learning performance in the course. The variety of backgrounds presented d i f f i c u l t y in setting out course material in the depth required and at the pace of learning that was set early i n the course. On f i n a l evaluation, some nurses commented on the need to engage in extensive individual study in order to keep up with the material being presented in class. Twelve of the 13 students completing the course f e l t that the course objectives were relevant to their learning needs. With respect to the evaluation instruments used, d i f f i c u l t i e s encountered in the f i r s t course resulted in the following recommendations for the second course: 1. Content and structure of the written examination should be refined for the second course. Major d i f f i c u l t i e s with the pretest and posttest appeared to be ambiguity within the structure of the questions, and confusion in the selection of distractor items. 2. C l i n i c a l evaluation instruments should be revised in order to make them easier to use for the c l i n i c a l preceptors. C l i n i c a l preceptors were recognized to have a b i l i t y i n identifying problems and planning learning experiences. However, the differences between the preceptors in their a b i l i t y to document observations objectively has already been discussed. It is recommended that in future, one course evaluator be used to keep documentation about the c l i n i c a l performance of the nurse students. This does not solve the problem of inter-rater differences, but would give 60. more consistent results for the next course u n t i l more objective instruments and more preceptor training were available. 3. Attempts should be made to plan c l i n i c a l learning experiences around the needs of each nurse and with consideration of the current experiences available in the c l i n i c a l areas. Recommendations for Further Study This study has revealed information which can prove useful in the development of future courses in continuing nursing education. It has hopefully presented some explanation for the differences in nurse student performance in a continuing education course that can be used to plan more effectively for meeting individual learning needs of nurses attending such a course. Most importantly, this study may be useful to others in determining needs for further study about nurses and their participation in continuing education. It has only touched the surface of planning and providing learning experiences to maintain competence. There i s a long way yet to go. As mentioned in^the introduction to this report, the l o g i s t i c a l problems that affect the development of continuing education are s t i l l not overcome. However, the design of the 14-week c r i t i c a l care nursing course, -and the evaluation of the nurses attending, have taken a f i r s t step i n v(dealing with the problem. 61. Based on the results of the hypotheses tested in this study, recommendations for further study in certain areas of learning for nurses in continuing education courses are: 1. to examine the relationship between a nurse's belief in locus of control and her ability to perform in a directive or non-directive continuing education course; 2. to examine the relationship between a nurse's belief in locus of control and performance in cl inical nursing areas; 3. to study factors related to past experience and age to determine their relationship to different abilities to perform in a continuing education course. The needs of the future are increasing at a greater rate than the problems of the past are being solved. Although this sounds depressing, studies such as reported here and those recommended can clarify issues which have been hidden or unknown barriers to successful continuing edu-cation programs, not only in nursing but hopefully in other professional disciplines as well. Greater sensitivity to the individual and more alert tuning to differences between individuals, together with s k i l l f u l application of known scientific methods for obtaining such data, suggest a challenging and fruitful future to those engaged in this v i ta l educa-tional f ie ld . This report and its implications should provide a guide for others in dealing with the problems and finding some solutions. 62. BIBLIOGRAPHY AND REFERENCES 1. An Abstract for Action; Report on the National Commission for the Study of Nursing and Nursing Education, New York: The McGraw-Hill Book Co., 1970. 2. American Nurses' Association: Avenues for Continued Learning, Kansas C i t y , Mo.: The Association, 1967. 3. Alfano, G. "The Loeb Center for Nursing and Rehabilitation". Nursing C l i n i c s of North America, Sept. 1969, pp. 487-493. 4. Anderson, J. and Pareigis, J . Continuing Nursing Education  Survey. Pennsylvania State University, Department of Nursing, June - A p r i l , 1968-69. 5. Argyris, C. Diagnosing Human Relations i n Organization: A Case Study of a Hospital. New Haven: Yale University Press, 1956. 6. Balch, P. and Ross, A.W. "Predicting Success i n Weight Reduction as a Function of Locus of Control: A Unidimensional and M u l t i -dimensional Approach". Journal of Consulting and C l i n i c a l  Psychology, February 1975, p. 119. 7. Barclay, J.R. "Needs Assessment", i n Walberg, H.J. (ed.) Evaluating Educational Performance, Berkley, Cal.: McCutchan Publishing Co., 1974. 8. Bass, B.A., Ollendick, T.H. and Vuchinich, R.E. "Study Habits as a Factor i n the Locus of Control - Academic Achievement Relationship", Psychological Reports, June 1974, p. 906. 9. Broskowski, A. "A Review of the Internal-External Control of Reinforcement", Unpublished Manuscript, Indiana University, 1966. 10. B i a l e r , I. "Conceptualization of Success and Failure i n Mentally Retarded and Normal Children". Journal of Personality, 29: 1961, pp. 303-320. 11. Continuing Education for Nurses: A Study of the Need for  Continuing Education for RNs i n Ontario. Toronto: School of Nursing and the Division on University Extension, University of Toronto, 1969. 12. Course Announcement, C r i t i c a l Care Nursing Course, The University of B r i t i s h Columbia School of Nursing, 1974. 63. 13. Cronbach, Lee J. "Course Improvement through Evaluation", i n Worthen, B.R. and Sanders, J.R. Educational Evaluation: Theory and Practice, Belmont, Cal.: Wadsworth Publishing Co., 1973. 14. Crowne, D.P. and Liverant, S. "Conformity under Varying Conditions of Personal Commitment". Journal of Abnormal and Social Psychology, 66: 1963, pp. 547-555. 15. Curtiss, F. et a l . Continuing Education i n Nursing. Boulder, Colorado: Western Interstate Commission on Higher Education, 1969. 16. "Do Beginning Jobs for Beginning Graduates D i f f e r ? " American  Journal of Nursing, Sept. 1969, pp. 1903-1907. 17. Dickinson, G. and Lamoureux, M.E. "Evaluating Educative Temporary Systems", unpublished report. 18. Dubin, S. and Marlow, H. Supervisory Training Needs of Hospital  Personnel i n Pennsylvania Nursing Service and Nursing Education. Pennsylvania State University, 1965. 19. Dubin, S. et a l . Correspondence Courses as an Educational Method  i n Hospitals. Pennsylvania State University and the Hospital Research and Educational Trust of the American Hospital Association, 1967. 20. Flaherty, J. An Enquiry into the Need for Continuing Education  for RNs i n the Province of Ontario. University of Toronto, Master's Thesis, 1965. 21. Glaser, W.A. and McVey, F.A. "Evaluation of Performance i n Public Health Nursing". Nursing Research, Winter 1961, pp. 32-37. 22. Henry, R. (ed.) Ends and Means: The National Conference on  Continuing Education i n Nursing. New York: Syracuse University Publications i n Continuing Education, 1971. 23. Hospital Research and Education Trust. Training and Continuing  Education. Chicago: The Trust, 1970. 24. James, W.H. Internal vs. External Control of Reinforcement as  a Basic Variable i n Learning Theory. Unpublished doctoral dissertation, Ohio State University, 1957. 25. James, W.H. and Rotter, J.B. " P a r t i a l and 100% Reinforcement Under Chance and S k i l l Conditions". Journal of Experimental  Psychology, 55: 1958, pp. 397-403. 64 26. J e f f r e y , B. "Internal'External Control of Reinforcement: A C r i t i c a l Summary and Synthesis of the L i t e r a t u r e " , U n i v e r s i t y of Utah, Department of Psychology, May 1970. 27. Johnson, R. "Determining Training Needs", i n Craig, R. and B i t t e l l , L. (ed.) The Training and Development Handbook. New York: McGraw-Hill Book Co. 28. Knutson, A.L. "Evaluation for What?" Proceedings of the Regional I n s t i t u t e of Neurologically Handicapping Conditions i n Children, held at the Un i v e r s i t y of C a l i f o r n i a , Berkley, June 1961. 29. Liverant, S. and Scodel, A. "Internal and External Control as Determinants of Decision Making under Conditions of Risk". Psychological Reports, 7: 1960, pp. 59-67. 30. Lysaught, J . (Di r e c t o r ) . Abstract for Action: National  Commission f o r the Study of Nursing and Nursing Education. New York: McGraw-Hill Book Co., 1970. 31. McClellan, M. "St a f f Development i n Action". American Journal , of Nursing, Feb. 1968, pp. 288-300. 32. Merwin, J.C. " H i s t o r i c a l Review of Changing Concepts of Evaluation", i n Tyler, R.W. (ed.) Educational Evaluation: New Roles, New Means, Chicago: Un i v e r s i t y of Chicago Press, 1969. 33. Nakamoto, J . and Verner, C. Continuing Education i n the Health  Professions: A Review of the L i t e r a t u r e Pertinent to North  America. Syracuse: The ERIC Clearinghouse on Adult Education, 1973. 34. P r i c e , E. "Learning Needs^ of Registered NujrsesV Teachers College, D o c t o r i a l D i s s e r t a t i o n , Columbia U n i v e r s i t y , 1967. 35. Phares, E.J. "Expectancy Changes i n S k i l l and Chance Situations", Journal of Abnormal and S o c i a l Psychology, 54: 1957, pp. 339-342. 36. Phares, E.J. "Perceptual Threshold Decrements as a Function of S k i l l and Chance Expectancies". Journal of Psychology, 53: 1962, pp. 399-407. 37. Phares, E.J. "Internal-External Control as a Determinant of Amount of S o c i a l Influence Exerted". Journal of Personality and  Soc i a l Psychology, V o l . 2, No. 5, 1965, pp. 642-647. 38. Ramey, I.G. "Setting Nursing Standards and Evaluating Care". Journal of Nursing Administration, May - June 1973, pp. 27-35. 65. 39. Rosen, A. and Abraham, G.D. "Evaluation of a Procedure for Assessing the Performance of Staff Nurses". Nursing Research, Spring 1963, pp. 78-82. 40. Rotter, J.B. S o c i a l Learning and C l i n i c a l Psychology. Englewood C l i f f s : P r e n t i c e - H a l l , 1954. 41. Rotter, J.B., Liverant, S. and Crowne, D.P. "The Growth and E x t i n c t i o n of Expectancies i n Chance Controlled and S k i l l e d Tests". Journal of Psychology, 52: 1961, pp. 161-177. 42. Rotter, J.B., Seeman, M. and Liverant, S. "Internal vs. External Control of Reinforcements: A Major Variable i n Behaviour Theory", i n Washburn, N.F. (ed.) Decisions, Values and Groups, V o l . 2. London: Pergamon Press, 1962, pp. 473-516. 43. Schulberg, H.C. and Baker, F. "Program Evaluation Models and the Implementation of Research Findings". American Journal of Public  Health, V o l . 58, No. 7, July 1968, pp. 1248-1255. 44. Second Annual Report, Continuing Education i n Nursing. U n i v e r s i t y of B r i t i s h Columbia Health Sciences Centre, School of Nursing, 1969-1970. 45. Skinner, G. "What do P r a c t i c i n g Nurses Want to Know?" American  Journal of Nursing, August 1969, pp. 1662-1664. 46. Tate, B. "Evaluating the Nurse's C l i n i c a l Performance". Nursing Outlook, Jan. 1962, pp. 35-37. 47. Tobin, H.M., Yoder, P.S., H u l l , P.K. and Clark, B.S. The Process of Staff Development, Saint Louis: The C V . Mosby Co., 1974. 48. Walberg, H.J. (ed.) Evaluating Educational Performance: a  Sourcebook of Methods, Instruments and Examples, Berkley, C a l . : McCutchan Publishing Co., 1974. 49. Webster's^New World* Dictionary7of the"-.American^Language. New York^-The World Publishing .Co..,.'li§57., ; •; ]>. -• " 50. Western Interstate Commission f o r Higher Education: Continuing Education i n Nursing, Boulder, Colo.: The Commission, 1967. 66. APPENDICES APPENDIX A 67. CRITERIA FOR S t i EC T J O r ^ F ^ P ART IC I PA NT S FOR TH E C R I T I C A L CARE COUR S E C r i t e r i a Va I ue Has c u r r e n t B r i t i s h C o l u m b i a n u r s i n g r e g i s t r a t i o n . 8 . 0 Employed by h o s p i t a l i n need o f c r i t i c a l c a r e n u r s i n g s t a f f . 7 . 5 Has had one y e a r of r e c e n t (1972-197-1 ) f u l l I imo n u r s i n g e x p e r i e n c e g i v i n g d i r e c t c a r e i n a c u t e c a r e s e t t i n g s , e . g . m e d i c i n e a n d / o r s u r g e r y , e m e r g e n c y , P . A . R . , c o r o n a r y and i n t e n s i v e c a r e . • 7 . 0 Has p a r t i c i p a t e d i n c o n t i n u i n g e d u c a t i o n ( i n c l u d i n g i n s e r v i c e and i n d e p e n d e n t l e a r n i n g , e . g . r e a d i n g ) on a r e g u l a r b a s i s o v e r t h e p a s t f i v e y e a r s . Has been i n v o l v e d i n o n g o i n g h o s p i t a l d e v e l o p m e n t a l a c t i v i t i e s ( e . g . n u r s i n g p o l i c y and p r o c e d u r e c o m m i t t e e s ; p a t i e n t c a r e commit I c e s . ) Employed by a h o s p i t a l w_ith s u p p o r t i v e p r o f e s s i o n a l and t e c h n i c a l r c s x : : ~ c e s ( e . g . p h y s i c i a n s , p h y s i o t h e r a p i s t s , l a b o r a t o r y t e c h n i c i a n s , l a b o r a t o r y e q u i p m e n t , m o n i t o r i n g e q u i p m e n t , r e s p i r a t o r y e q u i p m e n t . ) 3 , 5 Employed by a h o s p i t a l w h i c h p r o v i d e s o p p o r t u n i t i e s f o r i n s e r v i c e e d u c a t i o n a n d / o r s t a f f d e v e l o p m e n t . 5 . 0 T o t a l 4 2 . 5 -APPENDIX B* CRITICAl CAPE ?-TKSIN'C  Knowlrdi-c test The folloving questions arti a selection of multiple choice sr.d, completion Iters. ' The questions arc designed to help you dctcrsls. vhat your learning r.ccds arc in c r i t i ca l care r.ureir.^. PART I: Multiple choice Questions^ For each cultiple choice question, select che answer which icst completes the statement or encuers the question. Circle the letter of your chosen answer, PART II: Correction cuc-itt:ns These itcr.s <"5k you co f i l l in the appropriate answer. Vrlte your answer in tho space provided. Scoring is based or. the nur.bcr of right answers, eo fee sure t o answer every question. X-In addition, you crc acted co indicate your decree cf cor.fidtsce in your answer. After each question, please circle the word chit besc doscrlbcs how cure you are of your sx.awcr. e.g. Hov cure are you? Ko Pretty s' *—* idea Cuesscd 6\;re (Confident]) If you arc confident char Questions eliminated from 71 item posttest are marked Ihe c o r r e c t answer f o r each multiple choice question i s ^ c i r c l e d 69. y. 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J « »• ..: tr- n -t A J . 1 r-i u 1. t. :» -j w .j 11 ft is. r . -J : i '* -J »• >. 1 J ^: iv vi !• U t. .* f J-. ..1 ; » fx, tfl •) IV Vi 1: rs o st v p. i l r-i f l r*i TJ ci ci -> J: ti o » ci v. -1 --t 3 r: o n o t i o n. • -- 1 -) n ci v ' j o j : • J 14 •* II iJ VI « O 1: -t O i l t l rt -J 41 C VI t< "J O r t X n •) <J rt -1 !; " i : -' --i **i ?S vi Ct ti l l ti 3 Pi M t: X *J •"J ti (t •i rv 11 t< 11 rv o '/ 'j ti u m > O -1 O  «yi (1 > rv c. 1 r c/ w !•• 0. 5-» u v i rt ti U I* 3 f 3 O •1 It rt c r: o u ti ci tt O j-: .1: J : :l "I 41 II II vl * 1 -.1 i i w <« ti I T J ; - i 13. l i . 15. T h i s ICC t r a c i n g i s an example o f : A. v e n t r i c u l a r t a c h y c a r d i a . 2. pacemaker r h y t h = . ^TD a t r i a l f i b r i l l a t i o n . 2. v e n t r i c u l a r f i b r i l l a t i o n . E cu s u r e o r e you? P r e t t y i d e a C u c s s c d C o n f i d e n t A p a t i e n t e x h i b i t s a t r i a l f i b r i l l a t l o a c n h i s SCC s t r i p . I f he has been h c s p i t a l i z e d :e r . a r y e c a r d i a l i n -f a r c t i c r . and has been c i g i t a l i z e d , i t i s r e a s o n a b l e t o a n t i c i p a t e t h a t t h o t r e a t m e n t f o r t h i s a r r h y t h m i a w o u l d t e t o : A. char.ro t h e d i a g n o s i s , a. d i s c o n t i n u e d i g i t a l i s . c c r . t i n u c o r i n c r e a s e d i g i t a l i s . D. a r r a n g e f o r e l e c t i v e c a r d i o v e r s i o n . How- s u r e a r e y c u ? i d e a C u e s s c d P r e t t y s u r e C o n f i d e n t S o r u a p o t a s s i u m i s n o r m a l l y : A. 0.5 - 1.5 =£q/l. s . i : c r i q / i . C. 7.25 - 7.40 c E q / 1 , (3^  3.5 - 5.0 a£q/l. Eav c u r * a r e y o u ? Ko P r e t t y i d e a G u e s s e d s u r a C o n f i d a n t \ 16* S t r e s s t-nhancer. r.odlua r e t e n t i o n t h r o u g h ' tho r o l e . i r e o f c o r t i c o t r o p i n f r o a t h e ' a n t e r i o r l c b o o f t h u p i t u i t a r y g l a n d . C o r t i c o t r o p i n a c t s on t h e a d r e n a l c o r t e x t o i n c r e a s e s e c r e t i o n , p r i m a r i l y , o f t A. <9 C. D. ( r . i n c r n l o c o r t I c o l d o . g l u c o c o r t i c o i d s , n o r e p i n e p h r i n e , a c e t y l c h o l i n e . How s u r e a r e you? Ko . i d e a C u e s s c d P r e t t y s u r e C o n f i d a n t D i g i t a l i s t o x i c i t y o f t e n d e v e l o p s A S A r e s u l t o f : A. s c r u a e o d i u = d e p l e t i o n . (^} s e r u a p o t a s s i u m d e p l e t i o n . C. s c r u m p o t a s s i u m i n c r e a s e . D. s c r u a s o d i u - i n c r e a s e . How c u r e a r c you? No P r e t t y i d e a Guessed s u r e C o n f i d e n t 18. The p u r p o s e o f a p u l s e g e n e r a t o r - i s t o ; A. Improve t he p u l s e when i t i s v c a k . p r o d u c e s a a l l v o l t a g e s h o c k s . C. p r o v i d e emergency l i g h t i n g i n t h e e v e n t o f a power f a i l u r e . D. p a c e a p a t i e n t i n v e n t r i c u l a r t a c h y c a r d i a . : E o v s u r e A r c y o u ? No P r e t t y i d e a C u e s s e d s u r a C o n f i d a n t When you s e c t h i s ZCC t r a c i n g , y o u r f i r s t a c t i o n s h o u l d be t o : A. a d m i n i s t e r p r e c o r d i a l t h u z p . B. e d r . i n l c t e r p r e c o r d i a l s h o c k . c o n t i n u e t o o b s e r v e . D. -do n o t h i n g , as t h i s i s a n o r m a l s i n u s rhythm. How s u r e a r c you? Ko i d e a P r e t t y C u e s s c d s u r e C o n f i d e n t 20. Syspcorns o f c a r d i o g e n i c s h o c k i n c l u d e : A. s k i n v a r a and f l u s h e d . B. d r o p i n c e n t r a l venous p r e s s u r e . © o l i g u r i a . D. a l l o f the above. How s u r e a r c you? i d e a P r e t t y C u e s s c d s u r e C o n f i d e n t 21. H r . J o h n s o n was a d m i t t e d t o the c o r o n a r y c a r e u n i t 3 days n r o . At t h a t t i n . c , a d e f i n i t e c" i .if.r.o*.; i:v o i i n f e r i o r ir.yo-c a r d i a l i n f a r c t i o n wa:» r,.ade. Sub-s e q u e n t l y , a transvor.ous tiir.'pornry p a c e -r . r.kcr was i n s e r t e d b e cause o f :r .irked s i n u b b r a d y c a r d i a and - l i d h y p o t e n s i o n . E f f e c t i v e pacir.;; has been - r . i n t i i r . e d f o r the l a s t 3 d a y s , and : : r . J o h n s o n ' s v i t a l s i g n s have been r . o r r . a l . A r e c e n t c h e c k c: t h e pacemaker d e m o n s t r a t e d t h a t i t was s e t at a r a t e o: 75 b e a t s p e r r . i n u t c , 2.5 c-.il l i a s . p u r o a on dc-.a;.d p a c i n g . K r . J o h n s t o n e has j u s t r x v f i n i s h e d s l i d a c t i v e e x e r c i s e o f h i s l e f t u p per c x -t r c o i t y , p r e s c r i b e d t o c a i n t a i n c o b i l i t y Your best- a c t t e n I s t o : A. n o t i f y the p h y s i c i a n i z e c c i a t e i y . wt why. t h * l n w s t l ; , . u c t o ii p a c r . r I s n ' t w n a t be ccr.ee r rhy t h m i s r.c r : o r t h i s J c h a s D. i n s t r u c t Mr. Jc-hnscr. n o t t o do any n.ore e x e r c i s e s " t o d a y . How s u r e a r id e y o u ; C u e s s e d ro t t y ire;,-:r.a :s a . i ^ y e a r - c l c r-ir. wr.c a d - l ; t o d t o tho c c r c r . i r y c a r e u r . i t f . i r c t l o n . i-'-j has t-:cn p a i n - f r e e f a r ti:e l.-:r.t £ he-.::.-,, h.is c r 1 c r . c o i -z c a t i o n . Ko r.cw c a l l r . y:u i r . t : h i s Ycu n o t i c e t h a t h i s r . c r . i t c r c e - o c t s a ccccr.d-de;;:*ec a t r l e v e r . : r i c u i a r b l c c k . a p o t e n t i a l p r o b l e m ? E. an a c t u a l ( r e a l ) p r c b l c n ? C. a p o s s i b l e ( p r o b a b l e ) p r o b l e m ? T>. no p r a b l c a ? Kow c u r e a r e ya-u? Ko i d e a C u e s s e d o P r e t t y s u r e C o n f i d e n t 7 1 . t l • > «.» i i >: •J .>: I I --J rt ti l l CJ I J ii I I TJ •it tt y - ' ii l l ft LI rj (» o 'j >** •j »• >i i. it iv, J ; j - l i it ^ U 1 <J t* i o >. t i - J u . O >-t ( J . <1 U , \ : l ^: n o o •• t l «.« (1 o ( J J J H o >t f » • r ( U ' i; ii-'i ii " i: o v. R .> u i . : i t . . u o M rj 1. r| '1 !} <y 1; t t : i ^ n •-• o o -J l - I. o '•C c >, . t : — - j r; >» -t o ;, •J j : " >; - T w a w « ^ it .» u . i a . j ,! ',3 J; m -u O J C cJ -.1 •-• v. u U * ' ' J • 'J l i *J C» l i ; l > > (V. <J o o -» J-J 3 ->J •J 'J O ^ >* k rs ( I I . u M i iJ i : vi n '* x i P . « l i •<> i i . M n i : o c '-! - J " '•: -y 1 ul J >i w O i k . > LI u o U <J |] -, i ; l <•'• '> i i i i • »J I I 'J c i : .< u M I J •J i> - » O -I ll i - •• -1 u . i I . o i : >* J y. x >» u n ut -• o • • 'j >i '1 i i i: i : l . l . ; l o F J :> '•• o .» i i -j w u ci o t. •: x O O l l it « vt rr »: >» y o : J .... o i ; u o o i j *u — r: i : -« o o o • J U - « u .1 (J c -< ET r+ .3 u •J O c- o 3 •Pv • • 3 <~i 'J u -1 -• N . -1 -t O - J I . 3 -'- -< 3^ O — _ "9" •** 1* U o o n u .r: t: ty o O "J rj ~< r. u o O ~J o . u a a a x n ^ « ti J o u i : t i u f : i a K o t . - U io u l l i i n 3 « « u Q x C s> u i ) u <J ,; tJ i - u •> .-j n it .j -; n ;i r: X u o v. ;< i . i j t . .-j .4 o C c y J X t: " i : - * \1 ^ ,i -rj i j ^ W -J O O r< l i v1 rl 1 3 ^ 13 <*4 i : y . i ' i i < ta o O M (. c c, 1. m 9 <• M J C u i i « u n. u i g M -a ta J "* « n u w 1 O L> 1? « O 4 ct jz a jti •J> Ll «J -t u •9 1 rt . r c & S) O is -^t TJ M "a y o o» o ' R « 3 * *-» i: « C i i CI CI ka Vt (J .G O •*< Ll t-l 1> V. •rt M -r« O <- •>"-> C « (Z '» o Xt *J H ( J JS o u w u o a : •5 "-fiP tl « rfi CI U "V Ll Ss •»< 3 O -3 ^ r« a a t j >» 3 *i <a 3 & C O ' • e O L« li <* 3 « a «i u i> cj j3 «-» < • V *-* u : . e . u •-( > »-4 M (3 o • £ ' J ft k. • n i l •a o t: 1 %z w o «l O 01 M a *« d . io ^ H rt u ci ta ct M U u 3 Ij >» k. 3 *U 3 *• o Js d O _T r-< U •J rj o jC U r« n (X c o o O • .fl CI Ll xx n j* 1. Ll U r. 3 o . n Q o i i a ••H n ig - t >» > > > > *3 T C» O CI O X '*. c c u c «-<a c «~< ^ u -<1 ffl U ffl t l « , X •J U *4 « J - * •o t ; «-* Ct 1 u « C O u o o c O *-« ' J tl t l Q 1 '« O C» tu -O >, 13 i_> o a u x ^ :> U 3 O F -l* O ' rH 3 —« <s »H -n o o <w u - H o ct u 5s in •-< -o >s- u c a o '5 r~* >ri U 3 H 3 L I . L I i9 W O «'C > Ll - i > . C C Cu " •* u, z rH • J « r. n o J T i l r j Ll Vt 4 O ti 11 U J n) n . «U • rj • CI O 9 rj -O U U (S rt t0 ^ o o n L* o d •SO CI « CI «^ ^ ^ v< r: c c c « c <g U rj t . v. u -u v. 3 o U U U U O C fJ c c S >! ft. • »-H l*J n n. j : o ca i v» c V* o u <a o . ta u O &< 3 (9 M 4J VI O ki rH X Vi | CI O •*« f 'S X. Ll O C *• * t l C M M r-l ri rH -H ^; 3 rj • v> n u u o. 3 ci ci r: co v v c u t . ~* c -< L. c O k. CI o u n ct \: ji 'j tt c i U Vt c ^: ci s*> 4 u 3 ^  rt CI ^4 w M U o -o - o *^ o \ m a CI c o -o •« -* 3 l ; -rt c o. « /"<v • • o y <* < \cn\ C J o w 13 M O >. [i It »H n-j^  < < ^ O « ! M <D CO o» **4 i I 0 •J U V* 0 L* « U ki Vi 3 ti :J <u o I I <J COrH (I CI 0 4 -J 3 S3 .Eov jure arc you? No Pretty idea Cuessed sure Confident ^ 37* A patient with a head Injury under ;.v observation cay be given: ^ codeine 32 rg . for pain. E. ccdcir.e 120 tig. for pain. C. corphir.e 10 eg. for pain. D. no eedicatioa for pain, Eov sure are you? Pretty idea Cuessed sure Confident 33. Keferred pain i s : A. caused by degeneration of the distal portion of the nerve. S. transmitted by branching, non-myelinated, finely beaded naked nerve endings. / t j aroused by efferent endings i n the viscera. D. arcused by afferent endings i n the viscera. Eov sure are you? Ko' Pretty idea Cuessed sure Confident £X 39. K i s s R. i s a p a t i e n t in che ICU. She i s 19 years o l d and WOJ Involved i n a s c t c r c y c l c accident wi th her b o y f r i e n d , Ke has a f ractured fer-ur. She has r u l t l p l c f r a c t u r e s . Two days ago, her r i g h t l e g was a rp j ta ted above the knee due to gar.rr<:.-.e. Since the surgery she hai been qu ie te r than usual and very ccc re rac i ve v i t h the nurses. The nurses have rcr.air.cti cheer fu l and t a l k -a t i v e and provided as auch reassurance as p a s s i b l e . Thei r approach to Kiss R. was: . A. the boat under the circumstances. 3. poor beca-sa Kiss St.. Is not talkative. neglectful of the grief and rournlng process. • 0. t o v because Miss R. knew that people s t i l l cared about har aven though she had lost her leg. How sure are you? Ko idea Pretty Cuesscd sure Confident , Sensory deprivation ia demonstrated In such behaviours as: . restlessness. B. outbursts of crying. C. talking cons tan ly about past experiences. D. a l l of the abova. How sure are you? Ko idea Cuessed Pretty sure Confident i 41. Regardless of their physical status, ' a l l patients in a c r i t i c a l care unit should be: -A. bathed dally to prevent skin breakdown. oriented to date, tine and place. C. both of the above. D. none of the above. How 6ure ore you? Ko idea Cuesscd Pretty sure Confident -42. Th? presenting syrr.ptor-s of a new patient in the unit arc fatigue, nusclc weakness, rusclo c r a r p s , headache and . vertigo. The skin shows .oss of turgor and you cannot detect a peripheral pulse. These synptocs are cosoa signs of: sodiux depletion. E. todius excess. C. potassiun depletion. D. potassiua axcoss. • « . ( 4 2 . c o n t ' d ) . How sure Arc you? Ko - V r c t t y idea Guessed sure Confident 43* Edcr-.i that aecor.p.'.nles a severe burn ia a resu l t of the accumulation cf I n t e r -s t i t i a l f l u i d as the end resu l t of hypo-proc; i r .o ; i a . This accumulation takes place btjc.Tuse of che a l t e r a t i o n of a p r i - a r y factor of c a p i l l a r y dyr.aaica, na=ely: a reduct ion i n the c o l l o i d osmotic pressure f r o a 23 -jr.. HG. to - • 6 S.T.. i!g. B. an increase i n t i s s u e pressure fror. - 7 s.t. Hg. to -r7 =.= . V:g. C. an increase i n the c o l l o i d osmotic pressure f roa 6 z.i. H£. to 26 Kg-D. a decrease i n the t i s s u e pressure f r o a +7 nr.. Ilg. to - 7 an. Hg. Kov sure are you? Ko P r e t t y idea Cuesscd sure Confident 44. The r.;sc ser ious e f f e c t of hypocalcemia, c l i n i c a l l y , i s : (T} card iac f l a c c i d i t y . 3. r esp i ra to ry a r res t in tetany. C. cardiac i r r i t a b i l i t y . D. h y p e r v e n t i l a t i o n . Eow sure are you? Ko P r e t t y idea Guessed cure Confident X. 45. Which of the fo l low ing s igns and syuptoas c f hypoglycemia rost represents the need ^ * for i c ved iu tc act ion? . A. cveat ir .g . incont inence of urine. C. slight increase In systolic pressure. &. nuabneas about tho south. How sure are you? Ko P re t t y idea Guessed sure Ccnf ident 46. F lu id s h i f t s zrc a gre.-.t danger i n the pat ient wi th c u : n s . Which a : tha fo l lowing would be- orr . ic ted to cccur?. A. increa.'.ed. f l u i d . ' .hiftc A l t e r 2 hay.':;, v i i l ch r e s u l t i a i r r e v t r i i b l e c h o c k . less of scdiur: ar.i increase i n blcud r c tass iu r . . C. decreased c a p i l l a r y p e m c a b i l i t y . D, r i s e i n fc lo rd volume. How cure arc you? Ko P r e t t y idea Guessed 'swre Confident 47. Miss Closer.. 22 years e l d , vas ac r - i t t cd JO to the turn uni t wi th sc ccr . i - sc rree & bu:r.s over 4C\ cf hcr^bady and f a c e . durir.?, \,i>z convalescent pcr icC v t u l d uast concern the nurse? A. rer.oval of the n i r r o r f r c a the r c c a . 3. requesting each of her v i s i t e r s to C. cry ing and say ing , ' V - y d id t h i s happen to L i e ? " T^j) re fus ing zo see v i s i t o r s . • How sure arc you? •'0 P r e t t y idea C\ic<ic,ci sure Confident 4 3 , . To r - : in ta in Miss Cibccr . 's (Question 47) of th res vcu-d se ra iaportant? A. reduce p ro te in intake so as cot to - overtax the k idneys . £• l i r . i t c a l o r i c intake sa as to de -crease tha work of the body. . . . ( 4 8 c o n t ' d ) . . -ro \ 73. 1. u i SL3 J O -o » -a o i< u • r: • f• « rf 'J 1< Il U 1.1 <.! a n o (-* W i t u e O Q W 4J <a d r-t a D. O. a d A M n H I J d rt % rt o t< d o to ci (3 W a U O 6 -<:. (PU u Q s n ^: o o (s •i , r . o o v»; o ct «t ^: o. - j J t< r t < 1 V- U ['• o r-4 • r: r: i> £ . • <•' o u <J 1, •»« y •j t . a • i : tt i i j- « Z ^  -ti & » Jfci ^  iw ^- -ru 3 .r. »^ i o a ti ii o O it - I O -rt O W 0) •9 -.1 ->1 3 3 cr o u u O > 11 II 3 3 oi o a a 0 sf O. < PI O i: ,c o < vq) ° 0 o r J d • i rt c CI -o t4 O c -« w «-i 0 r- (J o n d t: J : J * *J - J - » T •' ' ' j k> 'J Li *J C O. >• - H ti U v l 4 ii -.1 •* *• rt -o •.1 14 d 5 fl J » ^ a o X of or « o o 1. O "'J n 3 it C «J 5 « '* .. CJ ? I* •!» 'J c i t j a c\ 'j uI e\ <J O 4 •4 O <J o d 4 c i i t i: Ti^, 3 <3 -J ,t -** '1 3 t: *M « * J t; > « U *4 ** P ^ w o o u O ' J .r: o »• >> « oi i i «i i : . 3 u n to H o ci i t a c «H ^ : Vi ^1 vt (1 'J u \* :> P i u r v i l u o «* • U *M » o n >. O • O rj o • o t< CI o u *« CI V u "tJ \ : :t t: et rj •! \j i : -* ^: a n n «J t>. i i i O o i v O i • t ! i* J -* • -t « H o o c ct :i u . ( i< ' j i f l - . i o •u o ct •1 J O 4 U r-l >t |1i « l» O 14 ri i : i l^ ? |J *» o r. '=; o i l n n n • »« J i ) -» « U - l i l i \\ I I t« r. • i o - • * -J 2 ii !•!;•!?:• t: i t n * i ->i o n u n r i rt r*> r\ ct )« <i <i t i --t > i : n. -1 u O O CI (> 1. t . ,11 'J l l u» e •J i* U '* O ">J ;i v. •»< n a w «J 'U It •i *» • 3l r l <7» <s> I) "ti. .< in rt r i .< »-l rH M 14 •< o d i f l ci n j ' . j <> .•: It .» . t ct -J :> J : I» 0 r\ • ;» •! j y « o It • 0) 74. C. t e l l M r s. A. t h a t i t dwr.r.'t r a t t e r i t " h e r husband dees r e p o r t t h e n u r s i n g c a r e t o h o s p i t a l a d m i n i -s t r a t i o n . D. ask M r s . A. i f she thicks her caro has b een p o o r . Eov s u r e are you? No P r e t t y i d e a G u e s s e d s u r e C o n f i d a n t 73. Ir. w o r k i n g w i t h p a t i e n t s who h a v a i n j u r i e s w-hlch r c c t i l t i n permanent d l * a ' ; i l i i y , i t i s c o s t i m p o r t a n t t h a t the n u r s e : a c c e p t t h e p a t i e n t ' s p s y c h o -i c ^ i c a l and p h y s i c a l l i r - i t a -2. r e : a i h c n c p t i n i s t i c and c h e e r -f u l a p p r o a c h no n a t t e r what t h e • p a t i e n t ' s b e h a v i o u r . C. kr.ov t h e cor-n.ur.ity r e s o u r c e s t h a t p r o v i d e s e r v i c e t o p e o p l e w i t h h a n d i c a p s . 0. t e l l t h e p a t i e n t and h i s f a n i l y h c v t o d e a l w i t h a c c e p t a n c e o f the, d i s a b i l i t y . How s u r e a r e you? No P r e t t y i d e a G u e s s e d s u r e . C o n f i d e n t 7i. • S e n s o r y d e p r i v a t i o n has been known to c a u s e : 1. no a d v e r s e e f f e c t s cn t h e p a t i e n t ' s a b i l i t y t o cope w i t h h i s i l l n e s s . 2. a c u t e p s y c h o t i c r e a c t i o n f o l l o w e d by cer.: ir.ua t i o r . of d e l u s i o n s for s e v e r a l d a y s . 3. s e v e r e depression and anxiety for a period of several weeks. A. 1, 2, 3. 3. 1, 2. C. 1, 3. Q 2. 3. How s u r e a r e you? No P r e t t y i d e a C u e s s c d s u r e C c n f i d e a t , 75. Mr. B., a 25 y e a r o l d p r o f e s s i o n a l * b a s e b a l l p l a y e r , w.ir. I n v o l v e d i n a s e v e r e a u t o m o b i l e a c c i d e n t , lie was a d m i t t e d t o h o s p i t a l , p . i r . i l y r o d i r o n the n e ck down. Mr. B. has g r a d u a l l y r o r y i i n r d t o t a l f u n c t i o n c f the u pper ' e x t r e m i t i e s . I n o r d e r t o u n d e r s t a n d and a c c e p t h i s d i s a b i l i t y , Mr. 5. r.eeds t o d e v e l o p a p o s i t i v e a t t i t u d e . T i c f i r s t s t e p i n t h i s d e v e l o p m e n t is known ns r e c e i v i n g . The s e c o n d stage i s r e s p o n d i n g . What is the third s t a g e ? A. a c c e p t i n g . 3. . a n a l y s i n g . v a l u i n g . D, e v a l u a t i n g . How sure are you? No P r e t t y i d e a C u e s s e d s u r e C o n f i d e n t 76. S e l e c t t h e n u r s i n g c o ; i l w h i c h w i l l b e e t p r e p a r e Mr. B. ( s e e o e s t i o n 75) f o r c r u t c h w a l k i n g w i t h b r a c e s . A. t h e p a t i e n t w i l l a s s i s t t he n u r s e ' i r . d o i n g p a s s i v e and a c t i v e e x e r c i a e s o f h i s e r r s and l e g s . E, Mr. 2. w i l l do 10 pushups e v e r y h o u r d u r i n g t h e day. Mr. 3. w i l l do 10 pushups w i t h h i s hands U t i n e s a day f o r one week. D. t h e r.ursc w i l l s u p e r v i s e t h e p a t i e n t d o i n g 3 t y p e s o f a c t i v e e x e r c i s e s f o r his arr.s twica a day tor 10 = i n u t e s . How sura ara you? Ko ' Pretty idea Cuesscd sure • 77. >!ia.. Brown i n a 3? y e n * o l d wrn.m who " li n * ; been a p . . t i e : i t I n the i C U t o r 3 d a y i i . She w.ir. I r . v o l v o d i n j c a r A c c i -dent .ind ha.1" 3 f r a c t u r e d r i b s , a c o n -pound f r a c t u r e o f h e r r l f . h t a m nnd a b a d l y b r u i s e d h i p . Mr:i. liruwn's i n j u r i e s have been c o m p l i c a t e d by t h o f a c t t h a t she has cr.-physcn-.i, Deep b r e a t h i n g and c o u g h i n g e x e r c i s e r h a v a been o r d e r e d q.2.h. Mrs. Brown has been u n c o o p e r a t i v e and bccor.es u p s e t when r h e knows i t i s t i n e t o do t h o e x e r c i s e s . The n u r s e ' s b e s t a c t i o n i s t o : A, p r o v i d e p a i n r e l i e f b e f o r e t h e e x e r c i s e s , and e n c o u r a g e h e r w h i l e she i s d o i n g the e x e r c i s e s . B. r a k e h e r do t h e e x e r c i s e s f o r a l o n g e r p e r i o d co t h a t h e r cough i s -rorc p r o d u c t i v e and she r e a i i r e s t he v a l u e o f che cxe r c i s c s . f i n d c u t what M r s . Ercu-n knows about h e r emphysema and h e l p h e r t o u n d e r s t a n d t h e i r . p l i c a t i o n a I f s he d o e s n ' t e x e r c i s e , c e l l h e r t h a t she has t o do t h e e x e r c i s e s o r she w i l l p e t pneu-c o n i a , and e x p l a i n t h a t abdomi-n a l b r e a t h i n g r.i<;ht h e l p r e l i e v e p a i n a f t e r w a r d s . Confident How s u r e a r c ycu? Ko I d e a Guessed P r e t t y s u r e C o n f i d e n t 78. Mrs. S m i t h i s a p a t i e n t i n the TCU who was a d r i u c d t o t h e ICU a f t r r t a k i n g an o v e r d e s e of b a r b i t u r a t e s . D i s c u s s i o n s w i t h h e r husband r e v e a l t h a t .".re. S m i t h i s an a l c o h o l i c , and she h.-.i; been i n -s i s t i n g l a t e l y ch.tt s h e wantr. t o have h e r ir.other co:re co l i v e w i t h the f a r a l l y t o c a r e f o r h e r s e l f and h e r two sr.:-11 c h i l d r e n , b e c a u s e she i a o f t e n u n a b l e to be r e s p o n s i b l e f o r h e r c h i l d r e n due to h e r i l l n e s s . Her husband has r e f u s e d to a g r e e to t h i s , and as a r e s u l t the S i a i c h s a r c h a v i n g c a r i o u s l a a r i t a i p r o b -lem. Mrs. S s i c h ' s c o n d i t i o n haa b c e a critical, but it a p p e a r s now that hor c o n d i t i o n h..:;. * t a h i I i n-C. lz c r i e r .to p l a n f o r cc: ->'.•:;<• n u r s i n p c i r e f c r H r o . I ' . T i i h , th<- n u r s e r.ur. 1 f i r t t : A. ur.«!e r r ; r .-ind Mrs. S r . i t h ' s e r c t i c r . a l prt<h\crr.. B. u n d e r s t a n d h e r h u s b a n d ' s f e e l i n g s of f r u s t r a t i o n and h o s t i l i t y , r e c o g n i s e h e r c-n f c e l i a ; s t o w a r d M r s . S n l t h . D. a s k the d o c t o r i f p s y c h i a t r i c h e l p c o u l d be a r r a n g e d f o r M r s . 5-rich. How s u r e a r e y o u ? Ko P r e t t y i d e a C u e s s e d s u r e C o n f i d e n t 79. When a p a r Ii-r.c d e c s n e t a p p e a r t o b e a c c e p t Irip, h i s i l l n e s s , i t i s * i c s t i r . p o r t a r . t - t h a t the n u r s i n g s t a f f : A. r.ot f o r c e h i r . t o do a n y t h i n g he does n e t want t o do. S. t t e l l h i r . t h a : he has t o l o a m t o l i v e w i t h ( i t . fCJ be c o n s i s t e n t i n t h e i r a j p r a a c h w i t h h i r _ . * T>. g i v e h i m r e a d i n g t - a t c r i a l a b o u t h i s i l l n e s s s o t h a t h« c a ; l e a r n by h i r . & c l f a t h i s ovn r a t e . How s u r e a r e y c u ? Ko P r e t t y . i d e a C u e s s c d s u r e C o n f i d t a t 30. Which o f t h e f o l l o w i n g c h a r a c t e r i s t i c s i s N C T t r u e o f l e a r n i n g ? A. r e s u l t s i n a change i a b e h a v i o u r , o c c u r s n a t u r a l l y . C. p r o d u c e s a r e l a t i v e l y permanent c h a n g e . D. c a n ' t be d i r e c t l y o b s e r v e d . Kov s u r e a r a y o u ? Ko- . Pretty idea Cuesscd sure Confident VJ1 31. Learning Is an experience which occur* inside the learner ar.d is activated by: the lo.irr.or. 3. tha teacher. C. the environment. D. a l l of the above. Ecw cure are ycu? X. No Pretty idea Guessed sure Confident 62* Learning tasks should proceed: Che faniliar to the unknown, 5. free the ur.kr.o--T. to the familiar. C. at a speed greater than the students would like in order to keep then interested. 0. at a slower pace for children than for adults. He- sure are you? No Pretty idea Guessed sure Confident 53. A i l patier.es should be taught'about their i l lness : A. frcr: the f i rs t day they are ad_u.ttcd. :c hcspical. 2. after the faniiy has been told. C. when they have recovered and are ready to ga hone. fo) vr.cn they indicate willingness W to learn. Ecw sure are ycu? No Pretty idea Guessed sure Confidant B i . Leamins that is reinforced i a ; A. rezenbercd forever. 3. less l ikely to recur. (5T) nore l ikely to racur. D. the oi ly £ c c i kind of Icanvinj. Hew sure ore you7 No • Pretty idea Cuossed sure Confident 8S, Educational contact between a patient's physician and the responsible curses should occur; (T) daily. B. weekly. C. r.or.thly. D. yearly. Kow sure are you? No Pretty idea Cucsscd sure Confident £6, Uith advancing adult learninjt a b i l i t i e s : A. decline. B. increase, C. arc difficult , to identify. ^ ) are affected by i l l n e s s . How sure are you? Ko Pretty idea Cuessed sure Confident 87* A useful way to help adults is to: A. withhold results of learning for 3 days. give constant and irtnediate feed-back of results. C. reinforce successes And punish failures. D. none of the above. Slow sure are you? No Pretty idc« Guessed sura Confidant SS. Nurses probably learn better fron; QC^ otlicr nurses. £. doctors. C. s-ilesr.cn. D. i t doesn't natter who taachca then. How sure are you? No Pretty idea Cutascd sure Confident e £9. A &ood group leader ia one who does not: A. direct discussion toward tho purpc-ie. 3. restate cor.ir.cntn and aak pertinent questions. ^ C j ar.ume the role of fin expert on the topic. D. cake brief sur.?.arics cf areas of csreer.ent or dis acre cn'-cnt. Eow jure are you? No Pretty .idea Cucsscd sure Confident 90. A system called "primary nursing" was introduced by a head r.urr.c to the R.H. staff on hor ur.it. She oncour.ti-red izsizzcr.ee to the change in r.ar.y forsa, Vhich of the follovir.s is an unreason-able expression -of rcsistar.ee? A. resentrcnt at the way the change was introduced.. apathy towards the entire cystea. C. expressed concerns chst nursing care standards would deteriorate. 0. cc_.plair.es of lack of understanding X of che way the eye ton would work. How sure ore you? No Pretty Idea CuesBed sure Confident 91. which of the frtl ' . ' .v . - ! . -? ir." h.i-,:c principles ot r..>:.v,,:icr.? 1 . Lf.'ii'ni :••>', rcpiiri;:; th.1t the i.-.ci-vik'>;1 I-.: in a c: c>;c:--cnt1.il i*-a.!Ir.ef.;., ( i . e . he has h experiences that n.Vt:e h i - ready le.irn what is debited), 2. Incentives motivate 1 c - rr. 1 z c ; . 3* Learning is nost effective whan individual is ready to loam, th-i n , vhcr. ho feels a need to knew coiothir .£. < £ > : » 2. 3-3. 1, 2. C. 1, j . D. 2, 3. Uow uure -are you? No Pretty idea Cuc-Socd sure Confident 92. The sost i:. p a r t factor to conaide i n the estivation cf a patient is his A. a£c and occupatica. £ . - dia^r.osic and pror^-.osis. C. role in family and society. ^ ) l i f e i i r e values and attitudes. Hc-w bure arc you? No Pretty idea Cucssed sure - Confident 93. A standard of care can best be defined as a: criterion. 3. £ 0 3 l . C. principle. 0, cotivc. ' Kow sure arc you? No Pretty Idea Cues&cd sura. Confident 77. " o -J u "6-™ f-i n c-> u n J3 <* 14 >' U C\ O to C 3* * o rt w X - ° <J t« O c •--•rt w« 1 M Ss rt O H C "o 3 ~* w i * 00 H a u U 0 at "ro • y n r - « W O u _o > x: * « o U i . I* 3 P * ia o u > >*. « O Ci l i £j « i : o f O <*< li c w c a e •o o 3 u J 2 c ^ >*J u r3 O J= 3 O >» TJ CJ W C -rt t» 'uj •a u n u •J -H Ci 3 • -c H Q * tl _•; t j « " M -o C «J *-» Ci 19 w "° °* >M O V V* (1 3 o C i i a a _< >u.rt o C- O (j X <u ct *J *J Ji i — - i ' j I «3 U u •* ** TJ "u o c 3 ta n CI « n w o -3 c u ; - *"• w 5 5 3 < > o W o -a is n « n . i j ^ 3 n i , P o i y o ( >• U r l 14 1 r*. > »• c •? b 3 3 3 O o "3 S 2 » ~ u S £ g " S3 *t s s 3 c P „ « 2 ~ * 3 5 S S g 8" 2fi s g - ' i i J! S'sJ ? r 6 5 S a ii i g & > « S s -> * C r. S 2 5 ^ o_2 U <J U <; i v "M U O 14 At U 0) j a l l * i i v a) II s (a) o -3 78. ° s-vt at m i l l III a l l mm .« VI > " o o o VI •u c o 4J tj r-( U - H O vi u > O rj « <N V. Cl <* Cl v> a; «* v> Vt 3 • 3 a 5^ •>.'• i " . v. '* 1 H M I V. ^ " o n o V 3 TJ i 2 3 " -3 rv u u- a -TJ (J L' I VI ct ^ 1 ) : <0 u •i 8 i "i °i i <i) 79 <0 3 w — . "5. .5 3 •b <L) «* 14 O w o 13 4 3 iu > It o a *o l*t rH O * o : J o u rH 11 O o a. u C » J u t« -< c c* >« *4 X O. U -4 rH Co X o •» >, -S ct. ii W ri IT) v* -C 'J w u 3 sloth d cou 3 -O O « •>* ta « >, L* rj * M i : •3 U X 01 u O 3 rj U (J o u r« O. 3 O (*• T J rH fi-a 3 2 3 O 3 O >* U ti Id u I* '» 3 O a I •» w 8 3-APPENDIX C 80 OBSERVATION GUIDELINES The following items are provided as guidelines to observation of per-formance. C r i t i c a l incidents should be written with these standards i n mind. To each question the observer should be able to answer: Yes - the student did th i s (or accounted for i t ) . No - the student did not indicate consideration for t h i s . ? - I don't know whether the student did or did not consider t h i s . N/A - This was not applicable to the s i t u a t i o n . GUIDELINES FOR CRITICAL INCIDENTS Q1 • THE PATIENT WITH A DEFICIENCY IN CARDIOVASCULAR FUNCTION A. Patient Assessment 1. Has the nurse taken into account - medical history? - consultants' reports? , - nursing history? 2. Have results of laboratory and radiological examinations been taken into account? 3. Has the nurse assessed the patient's status? a) The patient has optimum pump action - urinary output? - heart sounds? - a r t e r i a l blood pressure? - central venous pressure? - jugular vein pressure? - pulses - peripheral? - apical? - pain? - cerebral perfusion? - breath sounds? - ECG - arrhythmias? - conduction defects? - ST segments T wave changes? - drug effects? b) . The patient has optimum blood volume - a l l items i n (a)? - temperature? - thirst? - skin turgor and colour? c) The patient has optimum vascular tone - a l l items in (a) and (b)? - level of consciousness? - skin temperature? B. Problem I d e n t i f i c a t i o n 32, 1. Has the nurse co r r e c t l y i d e n t i f i e d those items i n assessment which are abnormal? 2. Has the nurse co r r e c t l y i d e n t i f i e d the problems ( p o t e n t i a l , a c t u a l , possible) which can or have resulted from the findings? 3. Has the nurse c o r r e c t l y i d e n t i f i e d those problems which are p r i o r i t y ? ( i . e . has she/he ranked the problems?), 4. Has the nurse produced a problem l i s t which outlines her/his findings? C. Goal S p e c i f i c a t i o n 1. Has the nurse proposed a plan of nursing care? 2. Has she included a l l relevant data? 3. Has she outlined nursing goals? 4. Has she suggested an approach to goal achievement? D. Nursing Approach 1. Within the scope of nursing p r a c t i c e , has the nurse provided care which w i l l meet nursing goals? , a) Basic care to patients. ' b) The patient has optimum pump action i) prophylactic therapy - I.V. route established and/or maintained? - volume and e l e c t r o l y t e control? - drug therapy as ordered? - oxygen and v e n t i l a t i o n ? - positioning of patient? - control of a c t i v i t y and rest? - control of environment - noise? - v i s i t o r s ? - l i g h t s ? - e l e c t r i c a l hazards? i i ) emergency treatment Cardiac arrest - f i r s t aid r e s u s c i t a t i o n - precordial thump? - v e n t i l a t i o n ? - cardiac massage? - es t a b l i s h I.V. route? - drug therapy - prepared? - in s t i t u t e d ? - a s s i s t physician i n cardiac pacing? ... - d e f i b r i l l a t i o n ? Acute Pulmonary Edema - positioning patient? - oxygen and v e n t i l a t i o n ? - e s t a b l i s h I.V. route? - drug therapy - prepared? - instituted? 85» - rotating tourniquets? Cardiogenic Shock - positioning patient? - oxygen and ventilation? - establish I.V. route? - drug therapy - prepared? - instituted? Cardiac Tamponade Acute - hemodynamic support? - immediate notification of surgeon? - preparation for surgical intervention? Subacute - preparation for pericardial tap? c) The patient has optimum blood volume, i ) treatment for hypovolemia - obtains specimen for group and match? - appropriate f l u i d intake? - appropriate position? i i ) treatment for hypervolemia - appropriate f l u i d intake? - drug therapy - prepared? - instituted? - rotating tourniquets? - phlebotomy as ordered? d) The patient has optimum vascular tone. i ) Has the nurse carried out intervention measures to provide adequate pump support? (See #1, D) i i ) Has the nurse carried out intervention measures to provide adequate volume control? i i i ) Has the nurse implemented - drug therapy - prepared? - instituted? - positioning of patient? - oxygen and ventilation? - temperature control - patient? - environment? E. Evaluation 1. Has the nurse indicated that she has assessed her care by - reassessing the patient? - selecting new goals? - selecting new approaches? - justifying continuation of approach? GUIDELINES FOR CRITICAL INCIDENTS 84. I I . THE PATIENT WITH A DEFICIENCY IN RESPIRATORY FUNCTION A. Patient Assessment 1. Has the nurse taken into account - medical history? - consultants' reports? - nursing history? 2. Have results of laboratory and radiological examinations been taken into account? 3. Has the nurse assessed the patient's status? a) The patient has a patent airway - free from obstruction (mechanical or physiological)? b) The patient has optimum ventilation - breathing movements? - breath sounds? - respiratory rate? - f l a r i n g nostrils? - indrawing of intercostal muscles? - secretions (nature and amount)? - patient's colour - restlessness? - euphoria? ' - level of consciousness? - pain? c) The patient has optimum alveolar capillary diffusion - a l l items i n (b)? - nature of cough B. Problem Identification 1. Has the nurse correctly identified those items in assessment which are abnormal? 2. Has the nurse correctly identified the problems (potential, actual, possible) which can or have resulted from the findings? 3. Has the nurse correctly identified those problems which are priority? (i.e. has she/he ranked the problems?) 4. Has the nurse produced a problem l i s t which outlines her/his findings? C. Goal Specification 1. Has the nurse proposed a plan of nursing care? 2. Has she included a l l relevant data? 3. Has she outlined nursing goals? 4. Has she suggested an approach to goal achievement? Nursing Approach 85. • 1. Within the scope of nursing practice has the nurse taken measures to ensure a) Basis care has been given? b) The patient has a patent airway - positioned the patient? - loosened and removed secretions by appropriate means: - moisture? - inspired gas hydration? - deep breathing? - coughing? - physiotherapy? - removal - manually? - by suction? - prevented aspiration: - of vomitus? - use of gastric suction? ^ - i n f l a t i o n of cuff of tracheal tube i f i n use? - gastric feed: - positioned properly? - administered properly? - for patients with tracheal tube maintained - patency? - suction? - correct position of tube? - appropriate moisture - patient hydration - inspiratory gas hydration / - minimal cuff i n f l a t i o n - supplies for intervention i n the event of accidental decannulation c) The patient has optimum ventilation - emergency ventilation? - used equipment for -- assisted mechanical ventilation? - controlled mechanical ventilation? r - maintenance of function of thoracotomy tubes? - patency? • - seal? - maintenance of function of chest suction apparatus? d) The patient has optimum alveolar capillary diffusion - physiotherapy? - clapping? - vibration? - deep breathing and coughing? - postural draining? provided supportive therapy for pulmonary edema? - position? - oxygen? - I.V.? - medication? - provided oxygen therapy by 86. - recognizing a l t e r e d PG^? - i n t e r p r e t i n g blood gas analysis? - d i f f e r e n t i a t e d between problems of v e n t i l a t i o n and d i f f u s i o n ? - administering oxygen c o r r e c t l y ? - used lowest concentration o f 0^ to t maintain safe PO^ l e v e l s ? - used moisturized C^? - continuous therapy e s s e n t i a l to maintain safe P 0 2 l e v e l ? - prevented hazards of 0^ therapy? - prevented sustained high blood l e v e l s of 0 2 ? - prevented high 0^ concentration f o r p a t i e n t s with chronic r e s p i r a t o r y a c i d o s i s ? - prevented f i r e hazards? Ev a l u a t i o n 1. Has the nurse i n d i c a t e d that she has assessed her care by - reassessing the patient? - s e l e c t i n g new goals? - s e l e c t i n g new approaches? - j u s t i f y i n g continuation of approach? GUIDELINES FOR CRITICAL INCIDENTS IV. THE PATIENT WITH A DISTURBANCE IN THE CENTRAL NERVOUS SYSTEM 87. A. P a t i e n t Assessment 1. Has the nurse taken i n t o account - medical h i s t o r y ? - consultants' reports? - nursing h i s t o r y ? 2. Have r e s u l t s of laboratory and r a d i o l o g i c a l examinations been taken i n t o account? 3. Has the nurse assessed the p a t i e n t ' s status? a) The p a t i e n t has optimum l e v e l of consciousness, autonomic motor sensory and i n t e l l e c t u a l functions - n e u r o l o g i c a l v i t a l signs taken to measure i n t r a c r a n i a l pressure? - aroused p a t i e n t by voice and/or touch? - assessed l e v e l of consciousness-orientation as to person, time, place? - checked p u p i l s i z e and reaction? - assessed p a t i e n t ' s response to auditory and v i s u a l stimulation? - blood pressure, pulse, r e s p i r a t i o n ? - temperature? - motor function? - hand grip? - arm and l e g movement? - nervous system i n t e g r i t y ? - bladder functions? - s p e c i a l senses? - speech? - a b i l i t y to reason? - memory? - swallowing - gag r e f l e x ? - CSF drainage? - headache? - vomiting? - seizures? - pattern? - duration? - presence or absence of incontinence? - presence or absence of aura? B. Problem I d e n t i f i c a t i o n 1. Has the nurse c o r r e c t l y i d e n t i f i e d those items i n assessment which are abnormal? 2. Has the nurse c o r r e c t l y i d e n t i f i e d the problems ( p o t e n t i a l , a c t u a l , p o s s i b l e ) which can or have r e s u l t e d from the findings? 3. Has the nurse c o r r e c t l y i d e n t i f i e d those problems which are p r i o r i t y ? ( i . e . has she/he ranked the problems?) 4. Has the nurse produced a problem l i s t which o u t l i n e s her/his findings? C . G o a l S p e c i f i c a t i o n . 88 • 1. H a s t h e n u r s e p r o p o s e d a p l a n o f n u r s i n g c a r e ? 2. H a s s h e i n c l u d e d a l l r e l e v a n t d a t a ? 3. H a s s h e o u t l i n e d n u r s i n g g o a l s ? 4. H a s s h e s u g g e s t e d a n a p p r o a c h t o g o a l a c h i e v e m e n t ? D . N u r s i n g A p p r o a c h 1. W i t h i n t h e s c o p e o f n u r s i n g p r a c t i c e , h a s t h e n u r s e t a k e n m e a s u r e s t o e n s u r e t h a t a) B a s i c c a r e h a s b e e n g i v e n ? b ) T h e p a t i e n t h a s o p t i m u m l e v e l o f c o n s c i o u s n e s s , a u t o n o m i c m o t o r , s e n s o r y a n d i n t e l l e c t u a l f u n c t i o n s - p r o m p t l y r e p o r t e d c h a n g e s ? - i d e n t i f i e d a n d p r e v e n t e d p o t e n t i a l h a z a r d s ? - i n a p p r o p r i a t e a n a l g e s i a a n d s e d a t i o n ? - e n v i r o n m e n t a l f a c t o r s ? - p a t i e n t d i s a b i l i t y ? - s p e c i a l c o n s i d e r a t i o n f o r t h e u n c o n s c i o u s p a t i e n t ? - p o s i t i o n ? - h e a r i n g ? - v e r b a l s t i m u l i ? E . E v a l u a t i o n 1. H a s t h e n u r s e i n d i c a t e d t h a t s h e h a s a s s e s s e d h e r c a r e b y - r e a s s e s s i n g t h e p a t i e n t ? - s e l e c t i n g n e w g o a l s ? - s e l e c t i n g n e w a p p r o a c h e s ? - j u s t i f y i n g c o n t i n u a t i o n o f a p p r o a c h ? " V ^ L X T O S tun CRITICAL INCIDENTS I I I . THE PATIENT WITH A DEFICIENCY IN RENAL FUNCTION 89. A. P a t i e n t Assessment 1. Has the nurse taken i n t o account - medical h i s t o r y ? - consultants' reports? - nursing h i s t o r y ? 2. Have r e s u l t s of laboratory and r a d i o l o g i c a l examinations been taken i n t o account? 3. Has the nurse assessed the p a t i e n t ' s status? a) The p a t i e n t has optimum body water volume - volume of water gain known? - volume of water l o s s known? - ur i n e - g a s t r o i n t e s t i n a l - vomiting - s u c t i o n - d i a r r h e a - wound drainage - hemorrhage - p e r s p i r a t i o n - h y p e r v e n t i l a t i o n - a s c i t e s - burns - d a i l y weight? - c e r e b r a l signs? - headache? - twitching? - convulsions? - coma? - mucous membrane? - t h i r s t ? b) The p a t i e n t ' s body f l u i d s have optimum s a l i n e content? - s a l i n e gain? - g a s t r o i n t e s t i n a l ? - parenteral? - renal? - s a l i n e loss? - urine? - g a s t r o i n t e s t i n a l ? - hemorrhage? - p e r s p i r a t i o n ? - plasma extravasation? - signs of plasma volume change? - hemodynamic? - - e x t r a c e l l u l a r f l u i d ? (CVP, JVD, BP, urine) - edema? - s k i n turgor? - sunken eyeballs? c) The p a t i e n t ' s body potassium i s at optimum l e v e l - p o t a s s i u m g a i n ? - g a s t r o i n t e s t i n a l ? " - p a r e n t e r a l ? - r e n a l ? - p o t a s s i u m l o s s ? - g a s t r o i n t e s t i n a l ? - r e n a l ? - m e n t a l s t a t e ? - m u s c l e t o n e ? d ) T h e p a t i e n t h a s o p t i m u m a c i d - b a s e b a l a n c e - o b s e r v e d f o r a c i d o s i s ? - h y p o x i a ? - r e n a l f a i l u r e ? - h y p o v e n t i l a t i o n ? - g a s t r o i n t e s t i n a l HCO^ l o s s ? - d i a r r h e a ? - s m a l l i n t e s t i n e f l u i d l o s s ? - p a n c r e a t i c f i s t u l a ? - m e t a b o l i c p r o d u c t i o n o f a c i d s ? - o b s e r v e d f o r a l k a l o s i s ? - e x c e s s a l k a l i i n t a k e ? - g a s t r o i n t e s t i n a l l o s s ? - e m e s i s ? - g a s t r i c s u c t i o n ? - h y p e r v e n t i l a t i o n ? - l o w b o d y p o t a s s i u m ? - m e n t a l s t a t e ? - c o n v u l s i o n s ? - h e a d a c h e ? P r o b l e m I d e n t i f i c a t i o n 1. H a s t h e n u r s e c o r r e c t l y i d e n t i f i e d t h o s e i t e m s i n a s s e s s m e n t w h i c h a r e a b n o r m a l ? 2. H a s t h e n u r s e c o r r e c t l y i d e n t i f i e d t h e p r o b l e m s ( p o t e n t i a l , a c t u a l , p o s s i b l e ) w h i c h c a n o r h a v e r e s u l t e d f r o m t h e f i n d i n g s 3. H a s t h e n u r s e c o r r e c t l y i d e n t i f i e d t h o s e p r o b l e m s w h i c h a r e p r i o r i t y ? ( i . e . h a s s h e / h e r a n k e d t h e p r o b l e m s ? ) 4. H a s t h e n u r s e p r o d u c e d a p r o b l e m l i s t w h i c h o u t l i n e s h e r / h i s f i n d i n g s ? G o a l S p e c i f i c a t i o n 1. H a s t h e n u r s e p r o p o s e d a p l a n o f n u r s i n g c a r e ? 2. H a s s h e i n c l u d e d a l l r e l e v a n t d a t a ? 3. H a s s h e o u t l i n e d n u r s i n g g o a l s ? 4. H a s s h e s u g g e s t e d a n a p p r o a c h t o g o a l a c h i e v e m e n t ? N u r s i n g A p p r o a c h ' . W i t h i n t h e s c o p e o f n u r s i n g p r a c t i c e , h a s t h e n u r s e t a k e n measures to ensure a) Basic care to patients 91 • b) The patient has optimum body water volume - planned f l u i d requirements according to route of intake? - distributed f l u i d intake over an appropriate period of time? - i n i t i a t e d and/or monitored - parenteral therapy? - gastric feedings? - dialysis? - re-evaluated water requirements and reported same? c) The patient's body fluids have optimum saline content - implemented and maintained administration of saline as prescribed? - transmitted data which indicated a change of orders? - adjusted the administration of saline according to assessed needs? d) The patient's body potassium i s at optimum level - implemented and maintained intake of potassium as prescribed? - distributed intake over an appropriate period of time? - performed or assisted with procedures to control body potassium? - parenteral therapy? - gastric feedings? - dialysis? - drugs? •e) The patient has optimum acid-base balance - implemented and maintained ventilation to achieve 0^ and levels within the patient's normal range? - correct cause of acid base disturbance? - administered prescribed medications? Evaluation 1. Has the nurse indicated that she has assessed her care by - reassessing the patient? - selecting new goals? - selecting new approaches? - j u s t i f y i n g continuation of approach? GUIDELINES FOR CRITICAL INCIDENTS 92. PSYCHOSOCIAL ASPECTS A. Patient Assessment 1. Has the nurse assessed the patient's psychological status? 2. Have socio-demographic factors been considered? B. Problem Identification 1. Has the nurse correctly identified those items i n assessment which ar abnormal? 2. Has the nurse correctly identified the problems (potential, actual, possible) which can or have resulted from the findings? 3. Has the nurse correctly identified those problems which are priority? (i.e. has she/he ranked the problems?) 4. Has the nurse produced a problem l i s t which outlines her/his findings C. Goal Specification 1. Has the nurse porposed a plan of nursing care? 2. Has she included a l l relevant data? 3. Has she outlined nursing goals? 4. Has she suggested an approach to goal achievement? D. Nursing Approach 1. Within the scope of nursing practice, has the nurse provided care to meet nursing goals? a) The patient has optimum psychosocial reaction to illness? b) The patient experiences optimal effect from the environment? c) The patient experiences beginning process of rehabilitation? E. Evaluation 1. Has the nurse indicated that she has assessed her care by - reassessing the patient? - selecting new goals? - selecting new approaches? - justifying continuation of approach? APPENDIX D m STATE UNIVERSITY Lege of Nursing Date SLATER NURSING COMPETENCIES RATING SCALE ;e being rated: Rater (name or No.)" 93. Page 1 of 7 pages JHO-SOCIAL: INDIVIDUAL Actions directed toward meeting psycho-needs of individual patients. 1. Gives f u l l attention to patients . . . . 2. Is a receptive listener . . . . . . . . 3. Approaches patient in a kind, gentle and friendly manner 4 . Responds in a therapeutic manner to patient's behavior 5. Recognizes anxiety in patient and takes appropriate action . . . . , 6. Gives explanation and verbal reassurance when needed 7. Offers companionship to patient without becoming involved in a non-therapeutic way 8. Considers patient as a member oil a family and of a society 9. Is alert to patient's spiritual needs 10. Identifies individual needs expressed through behavior and initiates actions to meet them 11, 12. 13. Accepts rejection or ridicule and continues effort to meet needs . , Communicates belief in the worth and dignity of man Utilizes healthy aspects of patient's personality E: To facilitate identification, Best, Average, and Poorest Nurse co those with the parens marking spaces. utnns are v r i e h t f c ) 1967 C O I I P P P n f N u r q i n o SLATER NCRS 14. Creates an atmosphere of mutual trust, acceptance, and respect, rather than showing concern for power, prestige, and authority ( ) 15. Is well informed about current events and common interests that can be shared with patient ( ) 16. Chooses appropriate topics for conversation ( ) 17. Offers purposeful experiences and a c t i v i t i e s that w i l l help the patient to participate and communicate with others ( ) 18. Conducts herself with same professional demeanor when caring for an unconscious or non-oriented patient as when caring for a conscious patient ( ) PSYCHO-SOCIAL: GROUP Actions directed toward meeting psycho-social needs of patients as members of groups. 19. Conveys warmth and interest in group situations with patients ( ) 20. Helps groups of patients accept necessary limits.to freedom ( ) 21. Encourages patients to participate in planning their own group l i v i n g experiences ( ) 22. Delegates responsibility to patients according to their capabilities . . . . ( ) 23. Proposes a c t i v i t i e s appropriate to interests and needs of various patients within group ( ) 24. Changes a c t i v i t i e s to meet priority needs in group, even though i t would be easier to continue with a c t i v i t y already begun ( ) 25. Structures a c t i v i t i e s for the purpose of helping patients vent their emotions in a socially acceptable way ( ) SLATER NCRS 26. Participates in group a c t i v i t i e s without dominating the situation . . . . ( ) 27. Gives praise and recognition for achieve-ment according to individual's needs and with reepect for others i n the group . . ( ) 28. Conducts a c t i v i t i e s with enthusiasm and without emphasizing individual • competition ( ) 29. Converses with patients during group a c t i v i t i e s ( ) 30. Shares time with a l l patients in group' . ( ) 31. Guides group discussion when this ia desirable ( ) # PHYSICAL Actions directed toward meeting physical needs of patients 32. Adapts nursing procedureo to maet neads of individual patients for daily hygiene and for treatment ( ) 33. Attends to daily hygenic needs for cleanliness and acceptable appearance . ( ) 34. U t i l i z e s nursing procedures as media for communication and interaction with patients ( ) 35. Identifies physical aymptom3 and physical changes ( ) 36. Recognizes physical distress and actfc to provide r e l i e f for the patient ( ) 37. Encourages patient to observe adequate rest and exercise .' ( ) 38. Encourages patient to take adequate diet ( ) 39. Recognizes and reports behavioral and physiological changes that are due • to drugs ( ) SLATER NCRS 40. Adjusts expectations of patient's behavior according to the e f f e c t the drug has on the patient . . . 41. Demonstrates understanding of both medical and s u r g i c a l asepsis . . . 42. Recognizer- hazards to patient safety and takes appropriate a c t i o n to maintain a safe environment and to give patient f e e l i n g of being safe 43. C a r r i e s out saf e t y measures developed to prevent p a t i e n t s from harming themselves or others '. . 44. C a r r i e s out es t a b l i s h e d technique f o r safe a d m i n i s t r a t i o n of medications and par e n t e r a l f l u i d s . . . . . GENERAL Actions that may be d i r e c t e d toward meeting e i t h e r psycho-social or p h y s i c a l needs o f pa t i e n t s , or both at once. 45. U t i l i z e s p a t i e n t teaching opportunities 46. Involves p a t i e n t and family i n planning f o r care and treatments 47. Protects s e n s i t i v i t i e s of the patient 48. Encourages p a t i e n t to accept dependence/ independence as appropriate to h i s con d i t i o n 49. U t i l i z e s resources w i t h i n the m i l i e u to provide patient with opportunities f o r problem s o l v i n g 50. Allows patient freedom of choice i n d e t a i l s of d a i l y l i v i n g whenever p o s s i b l e and w i t h i n p a t i e n t ' s a b i l i t y to make choice 51. Encourages p a t i e n t to take part i n a c t i v i t i e s of d a i l y l i v i n g that w i l l stimulate h i s p o t e n t i a l f o r p o s i t i v e SLATER NCRS Page 5 of 7 pages 53. Adapts nursing care to patient's level and pace of development ( ) ( ) , ( ) _ _ 54. Provides for diversional and treatment activities appropriate to patient's capabilities and needs ( ) ( ) ( ) 55. Allows for slow or unskilled performance without showing annoyance or impatience. ( ) ( ) ( ) 56. Establishes nursing care goals within the framework of the therapist's plan o f care ( ) ( ) ( ) 57. Adapts to and works with varied approaches to treatment ( ) ( ) ( ) ____ 58. Relates with patient within the frame-work of the therapeutic plan ( ) ( ) ( ) 59. Watchfulness is carried out in an unobtrustive manner , . . . . ( ) ( ) ( ) 60. Responds appropriately to emergency situations ( ) ( ) ( ) COMMUNICATION Communications on behalf of patients 61. Communicates ideas, facts, feelings, and concepts clearly in speech ( ) ( ) ( ) 62. Communicates ideas, facts, feelings, and concepts clearly in writing ( ) ( ) ( ) 63. Establishes a well-developed nursing care plan ( ) ( ) ( ) 64. Gives accurate reports, verbal/written, of patient behavior, including behavior that involved interaction with herself . ( ) ( ) ( ) 65. Participates freely in ward patient care conferences ( ) ( ) ( ) ATER NCRS P a 8 e J L o f _Z_ P a S e s • , . ^ ^ . 98. \ \ \ \ \ \ \ *^ \ \ f > \ o \ A \ P \ o \ ^ X *^  X \ *. \ <1 \ ^  X C X \ *sr X O X X \ £ \ * \ < i \ f l X >» \ 1* X \ \\ W \ ^ \ * \ s \ fl \ \ < p \ X X X P X ^ X ^ X V \ Y * \ v A A \ 66. Communicates effectively and establishes \ \ \ ^ \ \ \ X \ good relationships with other disciplines ( ) ( ) ( ) 67. Attends to patient's needs through use of referrals, both to departments in the hospital as agency and to other community agencies ( ) ( ) ( ) , ROFESSIONAL Actions directed toward f u l f i l l i n g responsibilities of a nurse in a l l facets and varieties of patient care situations. 68. Is self-directing: takes initiative and goes ahead on own ( ) ( ) ( ) 69. Makes decisions willingly and appropriately ( ) ( ) ( ) 70. Makes decisions that reflect both knowledge of facts and good judgment . . ( ) ( ) ( ) [ 71. Gives verbal evidences of good insight into deeper problems and needs of patients ( ) ( ) ( ) 72. Contributes as nurse member of medical team to planning and evaluating care . . ( ) ( ) ( ) 73. Spends time with patients, rather than with other nurses or hospital personnel. ( ) ( ) ( ) 74. Reliable: follows through with responsibilities ( ) ( ) ( ) . 7 5 . Stays with assigned patients, or knows where and how they are ( ) ( ) ( ) . • 76. Impresses others with sincerity of interest and nursing effort ( ) ( ) ( ) 77. Gives continued interest and encourage-ment to various-level programs, whether directed to care of patients of her immediate concern or institution-wide programs ( ) ( ) ( ) ER NCRS P a g e 7 o f 7 8 . P a r t i c i p a t e s i n s t a f f m e e t i n g s 7 9 . A v a i l s s e l f o f o p p o r t u n i t i e s f o r l e a r n i n g 8 0 . I s a g o o d f o l l o w e r ( h e l p f u l , c o o p e r a t i v e ) . 8 1 . I s a g o o d l e a d e r ( c o n s t r u c t i v e ) . . . . 8 2 . I s h e l p f u l t o w a r d p e r s o n n e l . . . . . . . 8 3 . C o o p e r a t e s w i t h w a r d r o u t i n e s a n d h o s p i t a l r e g u l a t i o n s 8 4 . A c c e p t s a u t h o r i t y s i t u a t i o n s w i t h u n d e r s t a n d i n g . . . . , APPENDIX E 100. THE ROTTER SCALE Instructions This is a questionnaire to find out the way in which certain important events in our society affect different people. Each item consists of a pair of alternatives lettered a or b. Please select the one state-ment of each pair (and only one) which you more strongly believe to be the case as far as you're concerned. Be sure to select the one you actually believe to be more true rather than the one you think you should choose or the one you would like to be true. This is a measure of personal belief; obviously there are no right or wrong answers. Your answers to the items on this questionnaire are to be recorded in the box to the lef t of your choice. For example, i f you choose (a) as the statement that is more true, place an X in the box to the left of the (a) statement. Please answer these items carefully but do not spend too much time on any one item. Be sure to find an answer for every choice. Select the statement you believe to be more true and place an X in the box to the left of i t . In some instances you may discover that you believe both statements or neither one. In such cases, be sure to select the one you more strongly believe to be the case as far as you're concerned. Also try to respond to each item independently when making your choice; do not be influenced by your previous choices. 1. Q a. Children get Into trouble because their parents punish them too much. I I b. The trouble with most children nowadays is that their parents are too easy with them. 2 - CZ3  a' Many of the unhappy things in people's lives are partly due to bad luck. I I b. People's misfortunes result from the mistakes they make. - 2 -101 . 3. £^ 3 a. One of the major reasons why we have wars is because people don't take enough interest in politics . | | b. There w i l l always be wars, no matter how hard people try to prevent them. A. a . In the long run people get the respect they deserve in this world. j | b. Unfortunately, an individual's worth often passes unrecognized no matter how hard he tries. 5. |T[] a . The idea that teachers are unfair to students is nonsense. | I b. Most students don't realize the extent to v/hich their marks are influenced by accidental happenings. 6. a . Without the right breaks one cannot be an effective leader. | | b. Capable people who f a i l to become leaders have not taken advantage of their opportunities. 7. a . No matter how hard you try some people just don't like you. | | b. People who can't get others to like them don't understand how to get along with others. 8. j^Jl a ' Heredity plays the major role in determining one's personality. | | b. It is one's experiences in l i f e which determine what they're l ike . 9. [3 a> I have often found that what Is going to happen w i l l happen. j | b. Trusting to fate has never turned out as well for me as making a decision to take a definite course of action. 10. [^] a . In the case of the well prepared student there is rarely i f ever such a thing as an unfair test. | | b. Many times exam questions tend to be so unrelated to course work that studying is really useless. 11. a. Becoming a success is a matter of hard work, luck has l i t t l e or nothing to do with i t . | | b. Getting a good job depends mainly on being in the right place at the right time. - 3 -102 . 12. [~] a. The average citizen can have an influence i n government decisions. | | b. This world i s run by the few people in power, and there i s not much the l i t t l e guy can do about i t . 13. \~_) a* When I make plans, I am almost certain that I can make them work. | | b. It is not always wise to plan too far ahead because many things turn out to be a matter of good or bad fortune anyhow. 14. (~] a. There are certain people who are just no good. | | b. There i s some good in everybody. 15. [~ a. In my case getting what I want has l i t t l e or nothing to do with luck. | | b. Many times we might just as well decide what to do by flipping a coin. 16. L_ a. Who gets to be the boss often depends on who was lucky enough to be i n the right place f i r s t . f | b. Getting people to do the right thing depends upon a b i l i t y , luck has l i t t l e or nothing to do with i t . 17. L_ a. As far as world affairs are concerned, most of us are the victims of forces we can neither understand, nor control. | | b. By taking an active part in p o l i t i c a l and social affairs the people can control world events. 18. Q a. Most people don't realize the extent to which their lives are controlled by accidental happenings. | | b. There really i s no such thing as "luck". 19. a. One should always be willing to admit mistakes. j | b. It is usually best to cover up one's mistakes. 20. [~ a« It i s hard to know whether or not a person really likes you, | | b. How many friends you have depends upon how nice a person you are. - 4 -103. 21. t^ ] a. In the long run the bad things that happen to us are balanced by the good ones. I | b. Most misfortunes are the result of lack of a b i l i t y , ignorance, laziness, or a l l three. 22. D a. With enough effort we can wipe out p o l i t i c a l corruption. { | b. It i s d i f f i c u l t for people to have much control over the things politicians do i n offi c e . 23. Q a. Sometimes I can't understand how teachers arrive at the grades they give. \ | b. There i s a direct connection between how hard I study and the grades I get. 24. Q a. A good leader expects people to decide for themselves what they should do. | | b. A good leader makes i t clear to everybody what their jobs are. 25. a. Many times I feel that I have l i t t l e influence over the things that happen to me. | | b. It is impossible for me to believe that chance or luck plays an important role in my l i f e . 26. ]~] a. People are lonely because they don't try to be friendly. | | b. There's not much use In trying too hard to please people, i f they l i k e you, they like you. 27. Q a. There i s too much emphasis on athletics in high school. | | b. Team sports are an excellent way to build character. 28. Q a. What happens to me i s my own doing. | | b. Sometimes I feel that I don't have enough control over the direction my l i f e i s taking. 29. Q a. Most of the time I can't understand why p o l i t i c i a n s behave the way they do. | | b. In the long run the people are responsible for bad government on a national as well as on a local l e v e l . 

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