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The adoption of nursing practices by participants in a continuing education programme 1971

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THE ADOPTION OP NURSING PRACTICES BY PARTICIPANTS IN A CONTINUING EDUCATION PROGRAMME by HELEN LOUISE SHORE B.S.N., U n i v e r s i t y of B r i t i s h Columbia, 1961 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n the F a c u l t y of E d u c a t i o n (Adult Education) We accept t h i s t h e s i s as conforming t o the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA MARCH, 1971 In present ing th i s thes i s in pa r t i a l f u l f i lment of the requirements for an advanced degree at the Un iver s i t y of B r i t i s h Columbia, I agree that the L ib ra ry sha l l make i t f r ee l y ava i l ab le for reference and study. I f u r ther agree that permission for extens ive copying of th i s thes i s f o r s cho l a r l y purposes may be granted by the Head of my Department or by h i s representat ives . It is understood that copying or pub l i c a t i on o f th i s thes i s fo r f i nanc i a l gain sha l l not be allowed without my wr i t ten permiss ion. Department of . Adult Education The Un iver s i t y o f B r i t i s h Columbia Vancouver 8, Canada Date April 8th, 1971 i i ABSTRACT Programmes i n continuing education are necessary to help practitioners keep their s k i l l s and knowledge current. The purpose of this study was two-fold: to evaluate the effectiveness of a nursing institute as a means of introducing new practices by using the adoption concept as a criterion of measurement, and to determine whether certain characteristics of individual nurses are significantly related to the adoption of practices recommended i n a continuing education programme. The population was drawn from 1 2 2 nurses who attended the Nursing Assessment Institute held i n Vancouver, B r i t i s h Columbia on February 1 2 - 1 4 , 1969. Seventy nine participants included i n the sample were interviewed. The innovations included s i s steps i n the nursing process, (l) writing a nursing history using a standardized guide form, ( 2 ) using the nursing history to formulate objectives for nursing care, (3) devising specific nursing methods to achieve the objectives, ( 4 ) evaluating the objectives and methods through the use of progress notes, ( 5 ) modifying the objectives and methods i n terms of the patient's progress, and (6) preparing a nursing discharge summary. An adoption score was computed for each participant by assigning a score for each reported stage i n the adoption process - awareness, interest, evaluation, t r i a l and adoption. Three adoption scores were computed for each participant: the extent to which the recommended practices were i n use prior to the study, the extent to which the practices were adopted as a result of learning about them at the institute and the total adoption from a l l sources. The adoption scores provide a basis ffa dividing participants into adopter categories ranging from those f i r s t to accept an.".idea or practice to those who are last or never adopt. Certain socio-economic characteristics, age, educational background, community participation, occupational position, years of practice, income, job satisfaction i i i and participation i n continuing education were collected about each participant. Interrelationships between the socio-economic characteristics and interrelationships between socio-economic characteristics and adoption scores were computed using zero order and partial correlations and a multiple regression analysis was performed. The adoption concept can be used as a criterion to assess learning that occurs at an institute by measuring the degree to which participants have incorporated into their practice those innovations which have been recommended. The institute on. Nursing Assessment produced a considerable total amount of change i n the participants, a 581 per cent increase i n adoption, and this change seems to have been f a i r l y consistent from person to person within the group. The participants were more prone to adopt the practices when they were relevant to their present nursing a c t i v i t i e s . The adopter categories showed the following percentages: innovator 1.27, early adopter 11.39, early majority 36.71, late majority 37.98, and laggard 12.66. Although previous research suggests a variety of characteristics which have been associated with the acceptance of new ideas, this study found education and occupational position to be the only characteristics that were significant at the .05 level. A significant coefficient of determination showed that some 30 per cent of the variation could be explained by these two variables. TABLE OP CONTENTS CHAPTER PAGE I. THE STUDY 1 The Purpose of the Study 3 Hypothesis 3 D e f i n i t i o n of Terms 4 Nursing Assessment I n s t i t u t e 5 The Procedure 8 Data C o l l e c t i o n 8 Data A n a l y s i s 8 I I . REVIEW OP LITERATURE 12 The I n d i v i d u a l Adoption Process 13 Stages i n the Adoption Process 15 Time and the Adoption Process 17 C l a s s i f i c a t i o n of Adopters 18 C h a r a c t e r i s t i c s of Adopters . 18 Adoption Concept as a C r i t e r i o n of Measurement 20 I I I . ANALYSIS OF DATA 23 Adoption Scores 23 C l a s s i f i c a t i o n of P a r t i c i p a n t s i n t o Adopter C a t e g o r i e s 29 Adopter C a t e g o r i e s and Socio-economic charac- t e r i s t i c s 29 .- V CHAPTER PAGE Correlations between Adoption Scores and Socio-economic Characteristics 50 IV. SUMMARY AND CONCLUSIONS 60 Summary 60 Conclusions 65 BIBLIOGRAPHY 67 APPENDIX A 7 H Socio-economic data sheet 76 Interview Schedule 8 l APPENDIX B . . . . 86 Statements Describing Reactions to Course 87 LIST OP TABLES TABLE PAGE I. D i s t r i b u t i o n of Participants by Adoption Scores due to Prior Influences 24 I I . D i s t r i b u t i o n of Participants by Adoption Scores at the Time of the Interview 26 I I I . A Comparison of Percentage Dis t r i b u t i o n s of Participants by Degree of Adoption Prior to the I n s t i t u t e and Due to Learning at the I n s t i t u t e 28 IV. Per Cent Increase i n Adoption as a Result of the I n s t i t u t e 28 V. C l a s s i f i c a t i o n of Participants into Adopter Categories 30 VI. Percentage D i s t r i b u t i o n of Participants by Age Category 32 VII. Percentage D i s t r i b u t i o n of Participants' Age by Combined Adopter Category 32 VIII. Percentage D i s t r i b u t i o n of Participants by Education 35 IX. Percentage D i s t r i b u t i o n of Participants' Education by Combined Adopter Category . . . . 35 X. Percentage D i s t r i b u t i o n of Participants " by Education and by Pour Adopter Categories . 36 v i i TABLE PAGE XI. Percentage D i s t r i b u t i o n of Number of Continuing Education Courses Attended by Participants by Combined Adopter Category . . . 3 6 XII. Percentage D i s t r i b u t i o n of Participants' Occupation by Combined Adopter Category . . . . 4 0 XIII. Percentage D i s t r i b u t i o n by Years of Practice for A l l Participants 41 XIV. Percentage D i s t r i b u t i o n of Years of Practice by Combined Adopter Category 4 2 XV. Percentage D i s t r i b u t i o n by Monthly Salary for A l l Participants 4 3 XVI. Percentage D i s t r i b u t i o n of Participants Monthly Salary by Adopter Category 4 3 XVII. Percentage D i s t r i b u t i o n of Participants by S o c i a l P a r t i c i p a t i o n Score 4 5 XVIII. Percentage D i s t r i b u t i o n of Participants' Combined Social P a r t i c i p a t i o n Scores by Combined Adopter Category 4 5 XIX. Percentage D i s t r i b u t i o n of Participants by Job S a t i s f a c t i o n Scores 4 7 XX. Percentage D i s t r i b u t i o n of Participants' Job S a t i s f a c t i o n Scores by Combined Adopter Category 4 7 XXI. Percentage D i s t r i b u t i o n by Kropp-Verner Attitude Scale for A l l Participants 4 9 v i i i TABLE PAGE XXII. Percentage D i s t r i b u t i o n of Participants' Kropp-Verner Attitude Scores by Combined Adopter Category 49 XXIII. Correlation Coefficients 52 XXIV. P a r t i a l Correlation Coefficients 54 XXV. Regression Analysis Selected Variables Against Adoption Scores 58 ) ACKNOWLEDGEMENTS The work represented by thi s study could not have been undertaken without the assistance and cooperation of many people. To acknowledge the contributions of some may mean to overlook the assistance of others, however the writer feels there are some who merit p a r t i c u l a r attention. Special thanks are due to the nurses who participated i n t h i s study and who have become involved with change and the introduction of new ideas. This writer must also express a s p e c i a l measure of appreciation to the members of her advisory committee, to Dr. Coolie Verner, Chairman, and to Dr. Gary Dickinson, for t h e i r advice and counsel. CHAPTER I THE STUDY The e x p a n s i o n o f knowledge, t e c h n o l o g i c a l developments and the c o m p l e x i t y o f s o c i a l change have been i d e n t i f i e d as the most i m p o r t a n t and p e r s i s t e n t s o c i a l f o r c e s a f f e c t i n g s o c i e t y as a whole and c r e a t i n g p a r t i c u l a r e d u c a t i o n a l needs f o r the a d u l t s w i t h i n t h a t s o c i e t y . ^ r p h e n e e ( j f o r c o n t i n u i n g e d u c a t i o n i n t h e h e a l t h p r o f e s s i o n s i s p a r t i c u l a r l y a cute due t o t h e r a p i d e x p a n s i o n of h e a l t h s e r v i c e s and t h e i n c r e a s i n g c o m p l e x i t y o f h e a l t h c a r e . I n n u r s i n g not o n l y has t h e e s s e n t i a l knowledge needed f o r p r a c t i c e i n c r e a s e d but a l s o t h e r e has been a change i n t h e n a t u r e o f t h e knowledge, s k i l l s and a b i l i t i e s t h a t are n e c e s s a r y f o r competent p r a c t i c e . I t i s g e n e r a l l y agreed t h a t no b a s i c p r e p a r a t i o n f o r a p r o f e s s i o n , r e g a r d l e s s o f how w e l l founded, w i l l e q u i p t h e p r a c t i t i o n e r f o r a l i f e t i m e o f p r a c t i c e . The Canadian N u r s e s ' A s s o c i a t i o n f o c u s e s a t t e n t i o n on t h i s need t o improve p a t i e n t c a r e by u p d a t i n g n u r s e s ' knowledge: "F o r c o n t i n u i n g p r a c t i c e o f n u r s i n g i t i s e s s e n t i a l t h a t each p r a c t i t i o n e r keep s k i l l s and knowledge c u r r e n t w i t h t h e newer developments. C o n t i n u i n g e d u c a t i o n s h o u l d be 1 C o o l i e V e r n e r and A l a n B o o t h , A d u l t E d u c a t i o n , New Y o r k , The C e n t e r f o r A p p l i e d R esearch i n E d u c a t i o n , I n c . , 1964, pp. 5-7. 2 focused on the improvement of the quality of nursing practice and the development of the i n d i v i d u a l nurse p r a c t i t i o n e r . " c Stated simply, the purpose of continuing education i s to help nurses improve t h e i r practice and to cope with the problems of t h e i r profession more i n t e l l i - gently and crea t i v e l y . Education i s an extensive, diverse and complex enterprise i n terms of i t s nature and i t s process. If we believe that the purpose of education i s not only to accumulate knowledge, but also to change behaviour then the measurement of educational outcomes must be made i n terms of observable differences i n behaviour. Evaluation i s fundamentally a two-step process: ( 1 ) determining exactly what i s to be measured; ( 2 ) selecting or developing an instrument that w i l l best do the measuring. The measurement of the learning achieved by participants i n a pa r t i c u l a r programme can be made i n four major areas: knowledge or information acquired, attitude change, s k i l l - learning, and the acceptance of adoption of ideas and prac t i c e s . ^ How can we determine whether a programme i n continuing education has, i n f a c t , helped nurses to improve t h e i r practice? The measurement of the adoption 2 B e l i e f s About Nursing, mimeographed report, Ottawa, Canadian Nurses' Association, 1 9 6 8 , p. 2. 3 Verner and Booth, op_. c i t . , p. 9 8 . 3 of ideas or practices may provide the best assessment of the learning achieved i n programmes of continuing edu- cation. This procedure has been used e f f e c t i v e l y i n r e l a t i o n to a g r i c u l t u r a l p r a c t i c e s , the dissemination of information, and the use of drugs by p r a c t i c i n g physicians, among other things, but there has been l i t t l e a pplication of the concept of adoption to nursing practice. Purpose of the Study In recognition of the important need f o r con- tinuing education for nurses and the concommitant need for evaluating the effectiveness of programmes of continuing education, t h i s study has a two-fold purpose: 1. to evaluate the effectiveness of a nursing i n s t i t u t e as a means of introducing new practices by using the adoption concept as a c r i t e r i o n of measurement. 2. to determine whether certain c h a r a c t e r i s t i c s of i n d i v i d u a l nurses are s i g n i f i c a n t l y related to the adoption of practices recommended i n continuing education programmes. Hypothesis There i s no s t a t i s t i c a l l y s i g n i f i c a n t difference i n the adoption of recommended nursing practices between in d i v i d u a l nurses with varying socio-economic charac- t e r i s t i c s . D e f i n i t i o n of Terms Adoption - The integration of an idea or practice recommended by an educational agent into the normal behaviour pattern of an adult learner. Degree of Adoption - The extent to which an i n d i v i d u a l learner has achieved the successive steps of awareness, i n t e r e s t , active search for additional information, willingness to t r y , and actual t r i a l of an idea or practice recommended by an educational agent. I t i s an index of the individual's progress toward the complete integration of the recommended idea or practice into his normal behaviour pattern. Adoption Score - (1) The score achieved by an i n d i v i d u a l by his degree of adoption of a recommended practice. ( 2 ) The sum of the adoption scores of an i n d i v i d u a l for each of the recommended ideas or practices i n a discrete s e r i e s . Adoption Score for Discrete Study Source (ASs) - That portion of a t o t a l adoption score determined as having resulted from a discrete educational process. (ASt-ASp=ASs) Adoption Score from Prior Sources (ASp) - That portion of a t o t a l adoption score determined to have existed p r i o r to the exposure of an i n d i v i d u a l to a discrete educational process. (ASt-ASs=ASp). T o t a l Adoption Score - The t o t a l adoption score of an i n d i v i d u a l for a discrete recommended practice or series 5 of practices r e s u l t i n g from a l l influences. (ASp+ASs=ASt)^ The I n s t i t u t e on Nursing Assessment I n 1 9 6 8 , the School of Nursing at the University of B r i t i s h Columbia embarked on a programme of continuing education for the nurse population i n the province. This venture was made possible largely by a grant from the Regi- stered Nurses Association of B r i t i s h Columbia of $ 5 , 0 0 0 . 0 0 a year for a period of f i v e years providing the University appoint a fu l l - t i m e faculty member from the School of Nursing to assume th i s r e s p o n s i b i l i t y . The i n s t i t u t e reported on i n this study was one of the ten educational programmes made available to nurees i n B. C. i n the academic year 1 9 6 8 - 1 9 6 9 . For each i n s t i t u t e a l o c a l planning committee was formed to work with the Director of Continuing Nursing Education to determine the needs of the prospective participants and to suggest a tentative programme. The committee for t h i s p a r t i c u l a r i n s t i t u t e was unanimous in wishing to select a topic for the i n s t i t u t e which would be applicable to nursing practice i n any se t t i n g , whether acute or chronic, h o s p i t a l or home, generalized or specialized. 4 John M. Welch, "An Evaluation of Three Adult Education Methods for Disseminating Trade Information to Missouri Restaurant Operators," Unpublished Ph.D. di s s e r t a t i o n , F l o r i d a State University, 1 9 6 1 . 6 A f t e r s e v e r a l e x p l o r a t o r y d i s c u s s i o n s the t o p i c " n u r s i n g assessment" was d e c i d e d upon and a q u a l i f i e d r e s o u r c e p e r s o n a b l e t o meet the r e q u e s t from the committee was sought. Dean Dorothy M. S m i t h , C o l l e g e o f N u r s i n g and C h i e f o f N u r s i n g P r a c t i c e a t t h e J . H i l l i s M i l l e r H e a l t h C e n t e r , U n i v e r s i t y o f F l o r i d a i n G a i n e s v i l l e was s e l e c t e d as the r e s o u r c e p e r s o n t o conduct t h e i n s t i t u t e . The i n s t i t u t e on N u r s i n g Assessment was h e l d i n V a n c o u v e r , B r i t i s h C olumbia on F e b r u a r y 12 - 14, 1969. The two-day I n s t i t u t e was d e s i g n e d t o e n a b l e p a r t i c i p a n t s t o e x p l o r e t h e n a t u r e o f n u r s i n g p r a c t i c e w i t h p a r t i c u l a r emphasis on t h e t e c h n i q u e s o f a s s e s s i n g needs and p l a n n i n g n u r s i n g c a r e f o r i n d i v i d u a l p a t i e n t s . A s y s t e m a t i c approach t o i d e n t i f y i n g n u r s i n g care needs t h r o u g h t h e use o f t h e n u r s i n g h i s t o r y g u i d e was p r e s e n t e d . The n u r s i n g h i s t o r y g u i d e , d e v e l o p e d a t t h e U n i v e r s i t y o f F l o r i d a , c o n s i s t s o f two main p a r t s : a g u i d e t o e l i c i t and o r g a n i z e c e r t a i n i n f o r m a t i o n about th e p a t i e n t t h a t w i l l be used t o p l a n n u r s i n g c a r e , and a g u i d e t o f a c i l i t a t e t h e p r o c e s s o f c l i n i c a l t h i n k i n g used by t h e nurse i n the p l a n n i n g and e v a l u a t i n g o f n u r s i n g c a r e . The programme was d e s i g n e d t o p r o v i d e o p p o r t u n i t y f o r a v a r i e t y o f l e a r n i n g a c t i v i t i e s f o r t h e r e g i s t r a n t s . Arrangements were made f o r each nurse t o v i s i t a p a t i e n t and c o l l e c t a n u r s i n g h i s t o r y u s i n g t h e s t a n d a r d i z e d g u i d e form. They were t h e n t o use the i n f o r m a t i o n c o l l e c t e d t o 7 write objectives for nursing care and the s p e c i f i c nursing methods which could be used to achieve these objectives. Using these resources, Dean Smith further elaborated, discussed and c l a r i f i e d the process for the group. The i n s t i t u t e ended with a discussion of strategies for introducing new ideas into practice settings. Short-term educational a c t i v i t i e s , such as i n s t i t u t e s , are often evaluated by using a reaction form at the end of the programme. The Kropp-Verner Attitude Scale which was designed to measure the general attitude of the participants at the conclusion of an organized educational experience was used to evaluate the i n s t i t u t e . 5 This scale measures participant s a t i s f a c t i o n and i s not a measure of the learning achieved. Population The population for t h i s study was drawn from the 122 nurses who attended the Nursing Assessment I n s t i t u t e . Ninety nurses who were employed within a t h i r t y mile radius of Vancouver were selected for t h i s study but of that number four could not be contacted because they had moved from the area, f i v e were i l l and not avail a b l e , and two were eliminated because they were consultants on nursing 5 Russell Kropp and Coolie Verner, "An Attitude Scale Technique for Evaluating Meetings," Adult Education, 7: 212-215, (Summer, 1957). 8 practice and f a m i l i a r with the material presented at the I n s t i t u t e . The remaining seventy-nine nurse participants i n the I n s t i t u t e were interviewed for purposes of this study. The Procedure Data C o l l e c t i o n Personal interviews were conducted between December 1 , 1969 and February 3 , 1 9 7 0 . An interview schedule 3 which had been pre-tested on f i v e nurses not i n the study population, was used to record the data. After e d i t i n g for consistency of response, the data were keypunched f o r analysis on automatic data processing equipment. Data Analysis The IBM 3 6 0 / 6 7 computer at the University of B r i t i s h Columbia was used for analysis of the data. The t - t e s t and chi-square s t a t i s t i c a l tests of significance were used, zero-order and p a r t i a l correlations between a l l variables were computed and a multiple regression analysis was done. The Innovations The innovations consisted of a series of practices focussed on the process of nursing intervention. The six steps i n t h i s nursing process are: 1 ) writing a nursing h i s t o r y using a standardized guide form, 2) using the nursing history to write objectives for nursing care, 3) using the objectives to write s p e c i f i c nursing methods to achieve them, 4) evaluating the objectives and nursing methods through the use of progress notes, 5) modifying the objectives and nursing methods i n terms of the patient's progress, and 6) writing a nursing discharge summary. These six innovations d i f f e r i n complexity and this factor may influence the acceptance or r e j e c t i o n of the innovations. Stages i n the Adopt ion 'Process The decision to accept or rej e c t an innovation i s not based on a simple dichotomy but involves a complex mental process that has been segregated into f i v e stages summarized by Lionberger as awareness, i n t e r e s t , evalu- c ation, t r i a l and adoption. Beal, et a l , conclude that t h i s concept of stages i n the adoption process i s v a l i d from evidence that i t appears meaningful to adopters, and that they are aware that they do go through a series of sequential stages i n the progress toward adoption.7 Rogers 6 Herbert Lionberger,' The Adoption of New Ideas and Practices, Ames, Iowa, State University Press, I960, pp. 21-23. 7 George Beal, Everett Rogers, and J. M. Bohlen, " V a l i d i t y of the Concept of Stages i n the Adoption Process," Rural Sociology, 22:166-168, June, 1957. i n d i c a t e s t h a t these stages are c o n s i s t e n t with the nature of the phenomenon and p o t e n t i a l l y u s e f u l f o r o p r a c t i c a l a p p l i c a t i o n . These f i v e stages are used as the b a s i s f o r the a n a l y s i s of the data. Adoption Score On the b a s i s of the data c o l l e c t e d about the i n n o v a t i o n s , an adoption score was computed f o r each p a r t i c i p a n t by a s s i g n i n g a score f o r each r e p o r t e d stage i n the adoption p r o c e s s . The values a s s i g n e d each stage were: 0 f o r not aware, 1 f o r awareness, 2 f o r i n t e r e s t , 3 f o r e v a l u a t i o n , 4 f o r t r i a l and 5 f o r a d o p t i o n . T h i s degree o f adoption score was computed f o r each respondent with r e s p e c t t o : 1) the extent to which the recommended p r a c t i c e s were i n use by the nurse p r i o r t o the study, t h e r e f o r e a t t r i b u t a b l e to p r i o r i n f l u e n c e s (ASp); 2) the extent to which the p r a c t i c e s were adopted as a r e s u l t of l e a r n i n g about them at the i n s t i t u t e (ASs); and 3) the t o t a l adoption from a l l sources (ASt).9 Adopter C a t e g o r i e s The adoption score f o r each p a r t i c i p a n t p r o v i d e s a b a s i s f o r d i v i d i n g them i n t o c a t e g o r i e s which i d e n t i f y 8 E v e r e t t M. Rogers,' D i f f u s i o n of I n n o v a t i o n s , New York, The Free P r e s s , 1962, pp. 152-15b. 9 Welch, op_.' c i t . , p. 6-7. 11 the rate of response to innovations, ranging from those f i r s t to accept an idea or practice to those who are l a s t or never adopt. Rogers uses f i v e categories which are i d e n t i f i e d as follows: innovators, early adopters, early majority, late majority and laggards.-1-0 These categories provide a useful t o o l for making gross d i f f e r e n t i a t i o n s among the nurses with respect to the time of adoption. These three measures, the stages i n the adoption process, the adoption score and the adopter categories were used as a framework for the analysis of the data. S o c i o - e c o n oiri i c C h ar a ef e r 1st les Certain socio-economic c h a r a c t e r i s t i c s , such as age, educational background, community p a r t i c i p a t i o n , occupational p o s i t i o n , years of p r a c t i c e , income, job s a t i s f a c t i o n , and p a r t i c i p a t i o n i n continuing education were coll e c t e d about each nurse. These separate items were tested f o r i n t e r r e l a t i o n s h i p s by the use of c o r r e l a t i o n c o e f f i c i e n t s , and they were tested for s i g n i f i c a n t differences between adoption scores, chi square values for the d i s t r i b u t i o n s were calculated at the .05 l e v e l of confidence. 10 Rogers, op. c i t . , pp. 152-158. CHAPTER .II REVIEW OP LITERATURE Research studies on the d i f f u s i o n of innovations can be found i n many d i s c i p l i n e s including agr i c u l t u r e , anthropology, education, market research, mass communi- cation, medicine, public health, sociology, and technical assistance. In f a c t , almost every behavioural science has some interest i n the d i f f u s i o n of new ideas. The exchange of research findings between d i s c i p l i n e s i s scanty i f not nonexistent. Summaries of d i f f u s i o n research findings have been made i n a g r i c u l t u r e 1 1 and education, 1^ and cross- d i s c i p l i n a r y i n a synthesis and evaluation of over 500 research studies from six d i s c i p l i n e s on the d i f f u s i o n of i n n o v a t i o n s . ^ This review of the l i t e r a t u r e attempts to highlight the main research findings i n three major areas: the i n d i v i d u a l adoption process, time and the adoption process, 11 Lionberger, op_. c i t . 12 Donald H. Ross, Administration for 'Adaptability. A Source Book Drawing Together the Results of More Than 150 Individual Studies Related to the Question of Why and How Schools Improve, New York, Metropolitan School Study Council, 1958. 13 Rogers, op_. c i t . and the c h a r a c t e r i s t i c s of adopters. The use of the adoption concept as a c r i t e r i o n of measurement w i l l be outlined. The Individual Adoption Process People do not o r d i n a r i l y accept new ideas or practices immediately upon hearing about them. The time from i n i t i a l knowledge to f i n a l acceptance may range from a few days to many years. The decision to change i s o r d i n a r i l y the product of a sequence of events and influences operating through time. The adoption process has been described as the mental process through which an i n d i v i d u a l passes from f i r s t hearing about an innovation -i ii to f i n a l adoption. Various stimuli about the innovation reach the i n d i v i d u a l from communication sources and as these communications accumulate the i n d i v i d u a l responds to the messages and eventually adopts or rejects the inno- vation. This process should be distinguished from the d i f f u s i o n process which i s the spread of a new idea from i t s source of invention or creation to i t s ultimate users or adopters. J The research t r a d i t i o n of r u r a l sociology has produced the greatest number of research studies using the 14 Rogers, op_. c i t . , pp. 12-20. 15 Loc. c i t . adoption concept. An investigation of the d i f f u s i o n of hybrid seed corn was, perhaps, the f i r s t to use a stage concept to study the adoption of a farm practice,16 Ryan and Gross recognized three stages i n the adoption process: awareness or f i r s t hearing about the new idea, t r i a l or f i r s t use and adoption or complete acceptance and use of the innovation. Wilkening noted that an individual's decision to adopt an innovation was composed of stages which he described as learning, deciding and acting over a period of time. The adoption of a s p e c i f i c p r a c t i c e , therefore, i s not the r e s u l t of a single decision to act, but the r e s u l t of a series of action and thought decisions. He i d e n t i f i e d four stages i n the adoption process consisting of i n i t i a l knowledge, acceptance of the practice as a good idea, acceptance on a t r i a l basis and adoption of the practice on his own farm.17 A committee of r u r a l s o c i o l o g i s t s subsequently 16 Bryce Ryan and Neal Gross, "The D i f f u s i o n of Hvbrid Seed Corn i n Two Iowa Communities,"' Rural 'Sociology, 8": 15-24, 1943. 17 Eugene A. Wilkening,' Acceptance of Improved Farm Practices, Raleigh, North Carolina A g r i c u l t u r a l Experiment Station Technical B u l l e t i n 98, 1952. 15 added a f i f t h stage to the sequence. 1^ Both Rogers 1^ and Lionberger 2 0 have refined the f i v e stages i n the adoption process and these have been generally accepted for purposes of research. Two major investigations of the v a l i d i t y of the stages concept concluded they were a v a l i d conceptualization of the adoption p r o c e s s . 2 1 2 2 Stages i n the Adoption Process Awareness: The stage at which an i n d i v i d u a l knows of the existence of an idea or practice but lacks d e t a i l s con- cerning i t s i n t r i n s i c nature and use. Awareness may begin as an involuntary act or an accidental discovery. Information: The stage at which the i n d i v i d u a l becomes 18 North Central Rural S o c i o l o g i c a l Sub-committee for the Study of D i f f u s i o n of Farm Practices, How' Farm People Accept New Ideas, Ames, Iowa A g r i c u l t u r a l Extension Service Special Report 15, 1955. 19 Rogers, op. c i t . , p. 17. 20 Lionberger, op_. c i t . , pp. 21-32. 21 G. M. Beal, E. M. Rogers and I. M. Bohlen, " V a l i d i t y of the Concept of Stages i n the Adoption Process," Rural Sociology, 22: 166-168, June, 1957. 22 James H. Copp, Maurice L. S i l l and Emory J . Brown, "The Function of Information Sources i n the Farm Practice Adoption Process," Rural Sociology, 23: 146-157, 1958. interested i n the idea. He seeks further basic information of a general nature regarding i t . He wants to know why and how i t works, how much i t costs and how i t compares with other ideas or practices purported to perform the same or simi l a r functions. He i s concerned with knowing the con- ditions of use and the resources necessary to get optimum benefits from i t s use. Evaluation: The i n d i v i d u a l takes the knowledge he has about the idea and weighs the alternatives i n terms of his own use. He considers his own resources of land, labor, c a p i t a l and management a b i l i t y and decides whether or not he has the necessary resources to adopt the idea. He also evaluates the idea i n terms of the alternatives available and of his o v e r a l l goal structure. He considers whether or not the adoption of the idea w i l l help him maximize his goal and objectives. I f he thinks i t w i l l , i n most cases, he makes the decision to give the idea or practice a physical t r i a l . T r i a l : The stage at which the i n d i v i d u a l has the empirical experience of observing the idea i n use. The t r i a l stage i s c h a r a c t e r i s t i c a l l y one of small-scale use by the pote n t i a l adopter or his observation of use under conditions which simulate those of his own s i t u a t i o n . At t h i s stage the i n d i v i d u a l i s concerned with the s p e c i f i c s of a p p l i - cation and use and the mechanics and actions related to how to use the idea. AdoptIon: The stage at which the i n d i v i d u a l uses the idea on a f u l l - s c a l e basis i n his operations and i s s a t i s f i e d with i t . He i s no longer try i n g to decide whether or not the idea i s good for him i n his operation but has accepted i t as an i n t e g r a l part of the p a r t i c u l a r operation into which he has incorporated i t . Time and the Adoption Process A l l people do not adopt a new idea or practice at the same time. Ordinarily adoptions are very slow at f i r s t then increase at a faster rate u n t i l approximately h a l f of the target population have accepted the innovation. After t h i s , acceptance continues but at a decreasing rate. A ch a r a c t e r i s t i c "S" or growth curve may be obtained by p l o t t i n g the number of persons accepting a s p e c i f i c change against a scale of successive time. This curve was found in the cumulative proportions of farmers using hybrid seed,23 and i n the adoption of a new drug by the medical profession, 2** as well as i n other studies. C h a r a c t e r i s t i c a l l y , f i r s t adoptions take much longer from awareness to f i n a l adoption than subsequent 23 B. Ryan, "A Study of Technological Di f f u s i o n , " Rural Sociology, 13: 273-283, September, 1948. 24 J. Coleman, E. Katz, and H. Menzel, "The Diff u s i o n of an Innovation Among Physicians,"' Sociometry, 20: 253-270, December, 1957. ones. T y p i c a l l y i t may take as long for the f i r s t f i v e to six per cent to adopt as i t does for the next 80 per cent. 2^ Tn e time for completing the adoption cycle varies, depending partly on the nature of the innovation, however, when the rate of change in other aspects of culture i s considered, changes appear to be coming at an increasing rate. The adoption cycle for most things may in fact be shorter now than a generation ago and may continue to shorten i n future. C l a s s i f i c a t i o n of Adopters The fact that people adopt new ideas or practices at d i f f e r e n t times means that they can be c l a s s i f i e d i n terms of t h e i r p o s i t i o n i n the adoption pattern by time. A c l a s s i f i c a t i o n system that divides people on the basis of the time of adoption r e l a t i v e to each other has been developed.^ Since adoption of s p e c i f i c changes tends to conform to the normal curve, standard units were used to c l a s s i f y the categories of innovators, early adopters, early majority, late majority and laggards. Characteristics of Adopters In research studies on adoption and d i f f u s i o n , 25 Lionberger, op. c i t . , p. 35. 26 Loc. c i t . 27 Rogers,' op.' c i t • , p. 162. 19 variables r e l a t i n g to s o c i a l , c u l t u r a l , personal and s i t u a t i o n a l factors have been selected by investigators attempting to categorize adopters i n the various categories. Many of the researchers correlate inno- vativeness with generally similar variables. A number of the more important and well researched c h a r a c t e r i s t i c s w i l l be presented i n the form of ge n e r a l i z a t i o n s . 2 ^ Age. E a r l i e r adopters are younger i n age than l a t e r adopters. So c i a l Status. E a r l i e r adopters have higher s o c i a l status than l a t e r adopters. F i n a n c i a l Position. E a r l i e r adopters have a more favorable f i n a n c i a l p o sition than l a t e r adopters. Spe c i a l i z at ion. E a r l i e r adopters have a more spe c i a l i z e d operation than l a t e r adopters. Information Sources. E a r l i e r adopters tend to use im- personal sources, as well as those outside t h e i r p a r t i c u l a r s o c i a l system, such as those sources i n closer contact with the o r i g i n of new ideas, than do l a t e r adopters. E a r l i e r adopters use a greater number of di f f e r e n t sources than do l a t e r adopters. So c i a l Relationships. E a r l i e r adopters have a broader s p a t i a l orientation than have l a t e r adopters and they have 28 See also Rogers, pp. c i t . , pp. 172-186, and 20 more opinion leadership. The extent to which an in d i v i d u a l shares i n the s o c i a l l i f e of h i s community through i n t e r - action has been found to be s i g n i f i c a n t l y related to his adoption of practices recommended through educational experiences.^9 30 Enjoyment of Work. An individual's enjoyment of his occupation should a f f e c t his rel a t i o n s h i p to i t by making him more or less susceptible to innovations according to his involvement with his work. Those individuals reporting the greater enjoyment of work have also been found to have achieved higher scores on the adoption of new practices.31 32 Adoption Concept as a C r i t e r i o n of Measurement Welch, applying the adoption concept as a c r i t e r i o n of measurement, evaluated three adult education processes 29 Herbert Menzel and E l i h u Katz, "So c i a l Relation- ships and Innovation i n the Medical Profession: The Epidemiology of a New Drug," Public Opinion Quarterly, 19: 337-352, Winter, 1955. 30 C. P. Carter and B. R. Williams, "The Charac- t e r i s t i c s of Technically Progressive Firms."' Journal of i n d u s t r i a l Economics, 7: 87-104, 1959. 31 C. Verner and P. M. Gubbels, The' Adoption or Rejection of Innovations by Dairy Farm Operators i n the Lower' Fraser' Valley, A g r i c u l t u r a l Economics Research Council or uanada, i y 6 y . 32 C. Verner and F. M i l l e r d , Adult Education arid the Adoption of Innovations, Vancouver, Department of A g r i c u l t u r a l Economics, University of B r i t i s h Columbia, 1966. for disseminating trade information to Missouri restaurant operators.33 He selected for testing three adult education processes: 1) an adult educational group method; 2) a mass communication method; and 3) a combination of both. Using four sample groups to test the r e l a t i v e effectiveness -of the selected processes scales were developed and used to test 1) the socio-economic status of respondents, 2) the extent of each respondent's p a r t i c i p a t i o n i n those formal organizations open to members of the restaurant industry, and 3) the degree of adoption of seven recommended practices by each respondent. The Degree of Adoption Scale enabled the investigator to compute three types of adoption scores for each respondent: the extent to which recommended practices were i n use p r i o r to the study and therefore attributable to p r i o r influences (ASp); the extent to which practices were adopted as a r e s u l t of the method used (ASs); and the t o t a l adoption from a l l sources (ASt). Findings regarding the re l a t i o n s h i p of personal c h a r a c t e r i s t i c s of respondents to adoption of the recommended practices may be summarized as follows. Socio-economic status was s i g n i f i c a n t l y related t o t o t a l adoption score and to the adoption score from p r i o r influences i n a l l groups. Social p a r t i c i p a t i o n score was s i g n i f i c a n t l y related 33 Welch, op_.' c i t . , pp. 98-107. to t o t a l adoption and to adoption from p r i o r influences for the group receiving the c i r c u l a r only, but not for the group method groups. Neither age, nor managerial experience was s i g n i f i c a n t l y r e l a t e d to adoption, but education was s i g n i f i c a n t l y related to t o t a l adoption score. The concept of adoption was u t i l i z e d to determine the degree to which respondents made use of s p e c i f i c s k i l l s and techniques taught i n three courses i n a business management t r a i n i n g programme. There was found to be a s i g n i f i c a n t increase i n the degree of adoption among respondents i n a l l courses following p a r t i c i p a t i o n i n the programme although the degree of adoption was not uniform among the techniques. Three c h a r a c t e r i s t i c s , education, the r e l a t i o n s h i p of the respondent to the business and the number of employees i n the business, were found to re l a t e s i g n i f i c a n t l y to the degree of adoption. 3 4 Gordon B e l l , "The Adoption of Business Practices by Participants i n the Small Business Management Training Programme," Unpublished M. A. th e s i s , University of B r i t i s h Columbia, June, 1968. CHAPTER III ANALYSIS OF THE DATA The data were col l e c t e d , compiled, tabulated and subjected to s t a t i s t i c a l analysis. This chapter presents a detailed analysis of adoption scores and adopter categories, the socio-economic c h a r a c t e r i s t i c s of the participants and t h e i r response to the i n s t i t u t e . The relationships between the socio-economic charac- t e r i s t i c s of the participants and adoption are analysed. ADOPTION SCORES Establishing a Base Line The base l i n e for measuring the effectiveness of the i n s t i t u t e was established by measuring the degree of adoption of each of the recommended practices p r i o r to attending the i n s t i t u t e and scoring the responses on the interview schedule. The r e s u l t i n g score i s termed the adoption score due to prior influences. (ASp) The range of scores was 0 to 12, the mean was 2 .53 and the standard deviation was 2.04. (Table I) The d i s t r i b u t i o n shows 59.2 per cent of the participants were not aware of the nursing practices which were presented at the i n s t i t u t e . Although 40 per cent of the participants were aware of the practices which were presented at the i n s t i t u t e they had not incorporated them into t h e i r nursing practice. TABLE I DISTRIBUTION OF PARTICIPANTS BY ADOPTION SCORES DUE TO PRIOR INFLUENCES FOR EACH OF THE SIX RECOMMENDED PRACTICES Recommended Practice DEGREE OF ADOPTION Not Aware Aware Interest Evaluation T r i a l Adoption 2 i 2 3 4 5 Writing nursing history 44 35 using guide form Using nursing history to 33 4-6 write objectives for nursing care Using the objectives to 4-5 34 write specific nursing methods Evaluating objectives 58 and methods by using progress notes Modifying objectives and 37 methods by the patient's progress Writing a nursing discharge 65 summary 20 40 13 Range of scores 0 - 1 2 Mean 2.53 S.D. 2.04 2-5 The a d o p t i o n s c o r e s from p r i o r i n f l u e n c e s were used as a base l i n e from w h i c h a d o p t i o n r e s u l t i n g from l e a r n i n g at t h e i n s t i t u t e was measured. A d o p t i o n R e s u l t i n g from the I n s t i t u t e The degree of a d o p t i o n o f i n n o v a t i o n s was e s t a b l i s h e d a t t h e ti m e o f the i n t e r v i e w by q u e s t i o n i n g t h e p a r t i c i p a n t s and by o b s e r v i n g t h e use o f t h e recommended p r a c t i c e s . Responses were s c o r e d on the i n t e r v i e w s c h e d u l e i n terms o f the degree of a d o p t i o n s c a l e . The degree o f a d o p t i o n at the ti m e o f t h e i n t e r v i e w was e n t e r e d as the t o t a l a d o p t i o n s c o r e (ASt) ( T a b l e I I ) . The t o t a l a d o p t i o n s c o r e minus the a d o p t i o n s c o r e from p r i o r i n f l u e n c e s p r o v i d e s the a d o p t i o n s c o r e r e s u l t i n g from l e a r n i n g a t the i n s t i t u t e . (ASt - ASp = ASs) The range o f t h e a d o p t i o n s c o r e s due t o l e a r n i n g a t t h e i n s t i t u t e was 7 t o 30 w i t h a mean s c o r e o f 14.72 and a s t a n d a r d d e v i a t i o n o f 4.60. A comparison o f t h e p e r c e n t a g e d i s t r i b u t i o n s o f p a r t i c i p a n t s by degree o f a d o p t i o n o f a l l p r a c t i c e s p r i o r t o the I n s t i t u t e and as a r e s u l t o f l e a r n i n g a t t h e i n s t i t u t e i s shown i n T a b l e I I I . The d i s t r i b u t i o n of p a r t i c i p a n t s a c c o r d i n g t o t h e i r degree o f a d o p t i o n f o r a l l p r a c t i c e s has shown c o n s i d e r a b l e movement toward the acceptance and f u l l use o f t h e recommended p r a c t i c e end of the degree o f a d o p t i o n s c a l e . A l t h o u g h o n l y 1 per cent TABLE II DISTRIBUTION OF PARTICIPANTS BY ADOPTION SCORES AT THE TIME OF THE INTERVIEW FOR EACH OF THE SIX RECOMMENDED PRACTICES Recommended Practice Not Aware 0 Aware 1 DEGREE OF Interest 2 ADOPTION Evaluation 3 T r i a l 4 Adoption 5 Writing nursing history using guide form 19 2 57 1 Using nursing history to write objectives for nursing care 40 14 24 1 Using the objectives to write specific nursing methods 39 15 23 2 Evaluating objectives and methods by using progress notes 44 17 17 1 Modifying objectives and methods by the patient's progress 41 14 23 1 Writing a nursing discharge summary 1 49 11 17 1 Range-of scores 12 - 30 Mean 17.25 S.D. 4.63 of participants report complete adoption of the practices, 14 per cent have moved to the point where they are using the recommended practices on a t r i a l b asis, another 67 per cent of participants continue to gather more i n f o r - mation about the practices and to evaluate t h e i r p o t e n t i a l usefulness. Eighteen per cent of the participants have remained at the awareness stage without having progressed beyond t h i s point. A comparison of the percentage d i s t r i b u t i o n s of participants by degree of adoption of a l l practices p r i o r to the i n s t i t u t e and as a r e s u l t of learning at the i n s t i t u t e i s shown i n Table I I I . The percentage increase for a l l practices i s 581. (Table IV) This percentage increase i n adoption i s considerably greater than the 113 per cent increase found by Welch i n his study of Missouri restaurant operators. J The mean of the adoption scores due to p r i o r influences were roughly similar i n both studies, 2.64 i n Welch's study, and 2.53 i n this study. A possible explanation for t h i s difference might be due to an economic factor which might have resulted i n the restaurant operators being less w i l l i n g to r i s k adoption of certain recommended practices than nurses where thi s factor was not present, however, t h i s finding cannot be s a t i s f a c t o r i l y explained on the basis of the data available. 35 Welch, bp.' c i t . , p. 86. 28> TABLE I I I A COMPARISON OP PERCENTAGE DISTRIBUTIONS OP PARTICIPANTS BY DEGREE OP ADOPTION FOR ALL PRACTICES PRIOR TO THE INSTITUTE AND DUE TO LEARNING AT THE INSTITUTE Degree o f A d o p t i o n P r i o r t o Due t o L e a r n i n g I n s t i t u t e a t I n s t i t u t e ASp ASs 0. Not aware 59.2 . 1. Aware 40.0 18.0 2. I n t e r e s t .4 34.0 3. E v a l u a t i o n 33.0 4. T r i a l .4 14.0 5. A d o p t i o n 1.0 T o t a l 100.0 100.0 TABLE IV PERCENT INCREASE IN ADOPTION AS A RESULT OF THE INSTITUTE Mean Mean Mean A d o p t i o n A d o p t i o n A d o p t i o n Score a t - Score due t o = Score due t o A S s x l 0 0 = $ i n c r e a s e I n t e r v i e w P r i o r I n f l u e n c e I n s t i t u t e ASp 17.25 - 2.53 14.72 14.72 = c-o-, 2.53 ° CLASSIFICATION OF PARTICIPANTS' INTO ADOPTER CATEGORIES The t o t a l adoption score f o r each p a r t i c i p a n t was used to determine adopter c a t e g o r i e s using the method proposed by Rogers.^6 Rogers suggests any g i v e n group of adopters w i l l approximate a normal curve i n the d i s t r i - b u t i o n i n t o adopter c a t e g o r i e s . No s i g n i f i c a n t d i f f e r e n c e was found by a chi-square t e s t at the .05 l e v e l between a normal d i s t r i b u t i o n and the d i s t r i b u t i o n of the p a r t i c i - pants' adoption s c o r e s . (Table V) Socio-ecoriomic C h a r a c t e r i s t i c s I n f o r m a t i o n about c e r t a i n socio-economic c h a r a c t e r i s t i c s was c o l l e c t e d f o r each p a r t i c i p a n t . T h i s i n f o r m a t i o n i n c l u d e d age, sex, m a r i t a l s t a t u s , number of c h i l d r e n , e d u c a t i o n , p a r t i c i p a t i o n In c o n t i n u i n g e d u c a t i o n , o c c u p a t i o n a l p o s i t i o n , years of n u r s i n g p r a c t i c e , income, job s a t i s f a c t i o n and community p a r t i c i p a t i o n . 36 Rogers, op_. c i t . , p. 162 TABLE V CLASSIFICATION OF PARTICIPANTS INTO ADOPTER CATEGORIES Adopter C l a s s No. o f P e r c e n t a g e o f Category Boun- S.D. P a r t i c i p a n t s i n d a r i e s from mean Each Cate E x p e c t e d (e) gory Observed (o) (o-e) e I n n o v a t o r 25-30 + 2 2.5 1.27 .6051 E a r l y Adopter 20-24 +1 13.5 11.39 . 3297 E a r l y M a j o r i t y 15-19 0 34 36.71 .2160 L a t e M a j o r i t y 10-14 -1 34 37.98 .4658 Laggard 5- 9 -2 16 12.66 .6972 2 c h i - s q u a r e v a l u e 2.3138 NOTE: The n u l l h y p o t h e s i s t h a t t h e sample f r e q u e n c y d i s t r i b u t i o n a p p r o x i m a t e d t h e normal curve d i s t r i b u t i o n was t e s t e d at the .05 l e v e l o f s i g n i f i c a n c e . The h y p o t h e s i s was a c c e p t e d s i n c e the c a l c u l a t e d c h i - s q u a r e v a l u e was below t h e c r i t i c a l v a l u e o f 3.841. 31 Each of the nurses had completed an e v a l u a t i o n sheet, the Kropp-Verner A t t i t u d e S c a l e , at the i n s t i t u t e which was scored to g i v e the i n d i v i d u a l ' s r e a c t i o n t o the > i n s t i t u t e . Socio-economic c h a r a c t e r i s t i c s were t e s t e d a g a i n s t the c l a s s i f i c a t i o n of p a r t i c i p a n t s i n t o adopter c a t e g o r i e s u s i n g the c h i - s q u a r e t e s t with a n u l l h ypothesis o f no s i g n i f i c a n t d i f f e r e n c e at the .05 l e v e l of s i g n i f i c a n c e . In order t o t e s t f o r any gross d i f f e r e n c e s between e a r l i e r and l a t e r adopters' the f i v e adopter c a t e g o r i e s were com- bi n e d i n t o two c a t e g o r i e s ; the i n n o v a t o r , e a r l y adopter and e a r l y m a j o r i t y formed the e a r l i e r adopter category and the l a t e m a j o r i t y and l a g g a r d formed the l a t e r adopter category. Age The age range of the p a r t i c i p a n t s was from 21 t o 60 y e a r s . Twenty-one per cent were i n the 36 t o 40 year category which was the median group. (Table VI) As Table V I I i n d i c a t e s , t h e r e was no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n the d i s t r i b u t i o n of p a r t i c i p a n t s by adopter category and age. TABLE V I PERCENTAGE DISTRIBUTION OP PARTICIPANTS BY AGE CATEGORY Age i n y e a r s N P e r c e n t a g e 21-25 9 11,4 26-30 6 7.6 31-35 10 12.7 36-40 1 7 21.5 41-45 9 11.4 46-50 14 17.7 51-55 11 13.9 56-60 3 3.8 T o t a l 79 100.0 TABLE V I I PERCENTAGE DISTRIBUTION OP PARTICIPANTS' AGE BY COMBINED ADOPTER CATEGORY Age T o t a l E a r l y Adopter L a t e Adopter C a t e g o r y No. % No. % No. % 21 - 40 42 5^.0 21 54 .0 21 52 .5 41 - 60 37 47.0 1 8 46 .0 19 47 .5 T o t a l 79 100 .0 39 100 .0 40 100 .0 xd = 0.012, d . f . l . , not s i g n i f i c a n t . Sex There were 78 female nurses and 1 male nurse i n the sample. In view of t h i s d i s t r i b u t i o n no further analysis by sex i s reported. Marital Status There were 4l single nurses, 32 married and 6 who were separated, widowed, or divorced. Number of Children F i f t y - t h r e e nurses (67%) had no children, while 16 had one or two, and 10 had three or four. Education The educational preparation i n nursing was measured by the type of programme from which the nurse graduated: diploma school of nursing, diploma school of nursing plus one year c e r t i f i c a t e programme i n a un i v e r s i t y , baccalaureate degree i n nursing or master's degree. Nearly h a l f of the nurses, 49.4 per cent, were graduates of a diploma school of nursing, while 26.6 per cent were diploma school graduates with a one year university c e r t i - f i c a t e . The number of nurses with a university degree accounted for 24 per cent of the t o t a l and 18 nurses reported the baccalaureate and one had a master's degree. (Table VIII) As Table IX indicates, there was a s t a t i s - t i c a l l y s i g n i f i c a n t difference i n the d i s t r i b u t i o n of participants by combined education and adopter categories. 34 Two-thirds of the l a t e r adopters reported a nursing diploma while two-thirds of the e a r l i e r adopters had a university degree. The chi-square value obtained i n an analysis by four adopter categories (Table X) was also s t a t i s t i c a l l y s i g n i f i c a n t . The majority of diploma nurses were found i n the late majority category whereas the bulk of the uni- v e r s i t y graduates were c l a s s i f i e d as early majority. The data suggest that the d i f f e r e n t type of educational pro- gramme engaged i n by the university graduates results i n more receptiveness to new ideas and practices. P a r t i c i p a t i o n i n Continuing Education The number of short courses attended i n the past two years was taken into account as an additional measure that might be related to the adoption of new practices. The median number of courses attended was two with 37 per cent of the participants i n t h i s category. The remaining nurses were f a i r l y evenly d i s t r i b u t e d among the other categories ranging from no courses to more than three. (Table XI) There xuas no s t a t i s t i c a l l y s i g n i f i c a n t difference i n the d i s t r i b u t i o n by combined adopter category and number of continuing education courses taken. TABLE V I I I PERCENTAGE DISTRIBUTION OP PARTICIPANTS BY EDUCATION Type of Programme N Percentage Diploma 39 49.4 Diploma plu s U n i v e r s i t y c e r t i f i c a t e 21 26.6 Baccal a u r e a t e 18 22.8 Master's 1 1.2 T o t a l 79 100.0 TABLE IX PERCENTAGE DISTRIBUTION OP PARTICIPANTS' EDUCATION BY COMBINED ADOPTER CATEGORY Type of T o t a l E a r l y Adopter Late Adopter Programme No. % No. % No. % Diploma 39 49.4 13 33.3 26 65.0 U n i v e r s i t y 40 50.6 26 66.7 14 35.0 T o t a l 79 100.0 39 100.0 40 100.0 x 2 = 7 .-9-20 3 d. f . 1 . 9 p. <.01. 36 TABLE X PERCENTAGE DISTRIBUTION OP PARTICIPANTS BY EDUCATION AND BY POUR ADOPTER CATEGORIES Type of T o t a l E a r l y E a r l y Late Programme No. % Adopter M a j o r i t y M a j o r i t y Laggard No. % No. % No. % No. % Diploma 39 49.4 4 40.0 9 31.0 23 77.0 3 30.0 U n i v e r s i t y 40 50.6 6 60.0 20 69.0 7 23.0 7 70.0 T o t a l 79 100.0 10 100.0 29 100.0 30 100.0 10 100.0 x 2 = 24.828, d.f. 3, p. <.001 TABLE XI PERCENTAGE DISTRIBUTION OP NUMBER OP CONTINUING EDUCATION COURSES ATTENDED BY PARTICIPANTS BY COMBINED ADOPTER CATEGORY Number of Courses T o t a l No. % E a r l y No. Adopter cf 10 Late No. Adopter % None 11 14.0 6 15.4 5 12.0 1 13 16.0 6 15.4 7 17.5 2 29 37.0 13 33.3 16 40.0 3 12 15.0 8 20.5 4 10.0 More 3 14 18.0 6 15.4 8 20.5 T o t a l 79 100.0 39 100.0 40 100.0 x 2 = 2.076, d . f . 4, not s i g n i f i c a n t 37 Employing Agencies Fi f t e e n hospitals and 3 public health agencies represented the employing i n s t i t u t i o n s for the nurses who attended the i n s t i t u t e . There were ten general hospitals varying i n size from 103 to 17^9 beds, one veteran's hospital of 1157 beds, two psy c h i a t r i c hospitals of 3091 beds and 60 beds, and two extended care hospitals of 70 and 91 beds respectively. The numbers of nurses attending the i n s t i t u t e from one i n s t i t u t i o n tended to be small except for three large hospitals which were represented by 31, 11 and 8 nurses. One nurse attended from each of eight agencies, two nurses from two hospitals and three to four nurses from the remaining f i v e h o s p i t a l s . Although a larger number of nurses attended from the 3 larger hospitals i n the d i s t r i c t the nurses were from various wards and units within these large i n s t i t u t i o n s which i n effect produced the same si t u a t i o n as one nurse attending from the smaller h o s p i t a l , that i s the r e l a t i v e i s o l a t i o n of that nurse from others who had attended the i n s t i t u t e when she returned to her work. When asked about the number of other nurses from t h e i r unit or ward who had attended the i n s t i t u t e , 56$ of the nurses reported that no one else had attended, 2k% reported one other nurse attending, 1L\% reported two nurses attending and 6% reported more than t h i s number, although these l a t t e r were nurses i n supervisory positions who were responsible for a number of wards or areas within the ho s p i t a l . 38 In view of the fact that the innovations presented at the i n s t i t u t e were ones which are not part of current nursing practice or h o s p i t a l p o l i c y , the fact that the nurse who had attended the i n s t i t u t e was separated from other nurses who had si m i l a r knowledge and understanding undoubtedly created strains for the nurse who was t r y i n g to introduce nex-j practices. In an attempt to overcome thi s s i t u a t i o n the nurses i n several hospitals formed groups of those who had attended the i n s t i t u t e i n order to gain support for each other and for t h e i r attempts to get new practices started. These groups were formally sanctioned by administration, were frequently chaired by nurses i n administrative positions and met at regular times for a number of months. The nurses used these meetings to d i s - cuss t h e i r personal involvement i n the use of the nursing practices and to discuss possible ways to get these practices adopted i n t h e i r respective I n s t i t u t i o n s . These group meetings provided a group f e e l i n g which helped offset the i s o l a t i o n that i n d i v i d u a l nurses had f e l t , however, perhaps because they were adhoc groups within the admini- s t r a t i v e structure they did not prove to be i n f l u e n t i a l i n the d i f f u s i o n of the practices. Gradually the purpose of the groups meeting seemed less relevant and they were no longer held. Sources of Information The source of information about the nursing practices that the nurses found most he l p f u l was reported 39 to be the i n s t i t u t e i t s e l f by 95% of the nurses while the remaining 5% c i t e d previous educational experiences or the group meetings. Considering the fact that the i n s t i t u t e was held i n a two day time period and that the resource person was not available for further help, the majority of the nurses were thrown back to t h e i r own resources and to the help that they could get from each other. The adoption of new practices by an i n d i v i d u a l i s often d i f f i c u l t , however, the problems inherent i n i n t r o - ducing new practices into a complex bureaucratic organization which has strong t r a d i t i o n a l norms of behaviour i s a much more d i f f i c u l t task. Occupational Position Nurses holding a head nurse p o s i t i o n accounted for 5 0 per cent of the p a r t i c i p a n t s , while another 3 7 per cent occupied positions of supervisors, directors of nursing, or i n s t r u c t o r s . A small number of participants ( 1 3 per cent) were i n the s t a f f nurse p o s i t i o n . (Table XII) The p a r t i c u l a r nursing practices discussed i n the i n s t i t u t e were those which are carried out by the nurse responsible for d i r e c t patient care. In view of the d i s t r i b u t i o n by p o s i t i o n of the population studies, only a small percentage were s t a f f nurses consequently the adoption of the recommended practices would apt to be less than had that portion of the population been larger. The di s t r i b u t i o n s by occupational p o s i t i o n and adopter category show more s t a f f nurses to be early adopters than nurses i n o t h e r o c c u p a t i o n a l p o s i t i o n s a l t h o u g h the d i f f e r e n c e i n the d i s t r i b u t i o n by ad o p t e r c a t e g o r y was not s t a t i s t i c a l l y s i g n i f i c a n t . ( T a b l e X I I ) TABLE X I I PERCENTAGE DISTRIBUTION OP PARTICIPANTS' OCCUPATION BY COMBINED ADOPTER CATEGORY P o s i t i o n T o t a l E a r l y Adopter L a t e Adopter No. % No. % No. % S t a f f Nurse 10 13. ,0 6 15, ,0 4 10 .0 Head Nurse 40 50. .0 18 46, .0 22 55 .0 S u p e r v i s o r 18 23. .0 10 26, .0 8 20 .0 D i r e c t o r 4 5. .0 2 5. .0 2 5 .0 I n s t r u c t o r 7 9. .0 3 8, .0 4 10 .0 T o t a l 79 100. .0 39 100, .0 40 100 ..0 x = 1.148 3 d . f . 4, not s i g n i f i c a n t Years o f P r a c t i c e i n N u r s i n g Most o f the p a r t i c i p a n t s at t h e i n s t i t u t e were e x p e r i e n c e d n u r s e p r a c t i t i o n e r s . The median was i n the 15 t o 19 y e a r s o f p r a c t i c e c a t e g o r y which a c c o u n t e d f o r 24 p e r cent of t h e group and a n o t h e r 30 per cent had p r a c t i c e d f o r twenty y e a r s o r more. ( T a b l e X I I I ) As Tab l e XIV i n d i c a t e s , t h e r e was no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n the d i s t r i b u t i o n of p a r t i c i p a n t s by ad o p t e r c a t e g o r y and y e a r s o f p r a c t i c e . 41 Income Income was d e t e r m i n e d on the b a s i s o f the monthly s a l a r y and was r e c o r d e d i n c a t e g o r i e s . Monthly s a l a r i e s ranged from $500 t o $999 and t h e median c a t e g o r y was $600 t o $699. ( T a b l e XV) There was no s t a t i s t i c a l l y s i g n i f i - cant d i f f e r e n c e i n the d i s t r i b u t i o n o f p a r t i c i p a n t s by a d o p t e r c a t e g o r y and income. ( T a b l e XVI) TABLE X I I I PERCENTAGE DISTRIBUTION BY YEARS OP PRACTICE FOR ALL PARTICIPANTS Years N P e r c e n t a g e 0 - 4 9 11.3 5 - 9 9 11.3 10 - 14 18 23.1 15 - 19 19 24.0* 20 or more 24 30.3 T o t a l 79 100.0 * Median TABLE XIV PERCENTAGE DISTRIBUTION OF YEARS OF PRACTICE BY COMBINED ADOPTER CATEGORY Years of T o t a l E a r l y Adopter Late Adopter P r a c t i c e No. % No. % No. • % 0 - 9 19 24.0 11 28.2 8 20 .0 10 - 19 36 45.7 17 43.6 19 47 .5 20 or more 24 30.3 11 28.2 13 32 .5 T o t a l 79 100.0 39 100.0 40 100 .0 x 2 = 0.732, d . f . 1 , not s i g n i f i c a n t . TABLE XV PERCENTAGE DISTRIBUTION BY MONTHLY SALARY FOR ALL PARTICIPANTS Monthly S a l a r y N Percentage $500 - 4599 21 26.6 $600 - $699 23 29.1* $700 - $799 30 38.0 $800 - $899 . 3 3.8 $900 - $999 2 2.5 T o t a l 79 100.0 * Median 43 TABLE XVI PERCENTAGE DISTRIBUTION OF PARTICIPANTS' MONTHLY SALARY BY ADOPTER CATEGORY Monthly Total Early Adopter Late Adopter Salary No. % No. % No.- % $500 - $699 44 55.7 19 49'.0 25 62.5 $700 - $999 35 44.3 20 51.0 15 37.5 T o t a l 79 100.0 39 100.0 40 100.0 xd = 1.516, d . f . l , not s i g n i f i c a n t . Community P a r t i c i p a t i o n Chapin's S o c i a l P a r t i c i p a t i o n Scale^ 7 was used to measure the degree of p a r t i c i p a t i o n i n community groups and i n s t i t u t i o n s . The extent of p a r t i c i p a t i o n i s measured by the number of memberships held during the previous year and each membership counts as one point toward the t o t a l scale score. Intensity or degree of involvement i s measured by attendance at meetings, f i n a n c i a l contributions, committee memberships, and the holding of o f f i c e s . A high scale score r e f l e c t s a high rate of p a r t i c i p a t i o n . Standard 37 F. Stuart Chapin, Experimental Designs' i n Soc i o l o g i c a l Research, New York, Harper, 1955, Appendix B., pp. 275-27«. 44 scores have been computed for various occupational groups with the mean score for professional groups being 20.38 The range of scores for the nurses was between 10 and 55j with the median f a l l i n g i n the 16 to 20 score category. (Table XVII) Membership i n no organizations was reported by 40.5 per cent of the sample with 33 per cent indicating membership i n two or more l o c a l organi- zations. 39 The maximum number of memberships was held i n four organizations but t h i s was reported by 0.9 per cent of the p a r t i c i p a n t s . The acceptance of leadership r e s p o n s i b i l i t y i s not c h a r a c t e r i s t i c of the nurses studied. No committee memberships were reported by 80 per cent, while 16.4 per cent reported membership on one committee and 3.9 per cent two or more committee positions. Si m i l a r l y no o f f i c e s i n l o c a l organizations were held by 77.2 per cent, while 20.5 per cent reported holding one o f f i c e and 2.5 per cent holding a maximum of three o f f i c e s . No f i n a n c i a l c o n t r i - butions were reported by 45.5 per cent, while 45.5 per cent reported contributing to one or two organizations and 9 per cent contributed to three to f i v e organizations. As Table XVIII indicates, there was no s t a t i s t i c a l l y s i g n i f i c a n t 38 Delbert C. M i l l e r , Handbook' of Research Design and S o c i a l Measurement, New York, David McKay Co., Inc., 1964, p. 209. 39 Membership In the professional nurses' associations was excluded as a l l nurses reported t h i s . 45 d i f f e r e n c e i n the d i s t r i b u t i o n of p a r t i c i p a n t s by adopter category and s o c i a l p a r t i c i p a t i o n . TABLE XVII PERCENTAGE DISTRIBUTION OF PARTICIPANTS BY SOCIAL PARTICIPATION SCORE (CHAPIN SCALE) Score N Percentage 6-10 1 1.3 11 - 15 25 31.6 16 - 20 19 24.0* 21 - 25 13 16.5 26-30 3 4.0 31-35 9 11.3 36 or more 9 11.3 T o t a l 79 100.0 * Median TABLE XVIII PERCENTAGE DISTRIBUTION OF PARTICIPANTS' COMBINED SOCIAL PARTICIPATION SCORES BY COMBINED ADOPTER CATEGORY Scores T o t a l E a r l y Adopter Late Adopter No. % No. % No. % 6-20 45 57.0 21 54.0 24 60.0 21 - 36 34 43.0 18 46.0 16 40.0 Totalv/,:.79 100.0 39 100.0 40 100.0 xd = 0.304, d . f . l , not s i g n i f i c a n t . Job S a t i s f a c t i o n The B r a y f i e l d and Rothe Index i s a general measure 4o of job s a t i s f a c t i o n . A shortened version of th i s index using nine of the eighteen items was administered. Five responses ranging from "strongly agree" to "strongly d i s - agree" were available for each item and a response was scored from one to f i v e points. A maximum scale score of 45 would indicate a highly favorable attitude whereas a minimum score of 9 would be in d i c a t i v e of extreme d i s - s a t i s f a c t i o n . The d i s t r i b u t i o n of scores showed a range from 25 to 40 with the median i n the 33 to 36 point c l a s s . (Table XIX) Since over h a l f of the nurses were i n the median category t h i s would indicate that they are generally s a t i s f i e d with t h e i r jobs. There was no s t a t i s t i c a l l y s i g n i f i c a n t difference i n the d i s t r i b u t i o n of participants by adopter category and job s a t i s f a c t i o n . (Table XX) 40 A. H. B r a y f i e l d and H. F. Rothe, "An Index of Job S a t i s f a c t i o n , " Journal of Applied 'Psychology, 35: 307-311, October, 1951. TABLE XIX PERCENTAGE DISTRIBUTION OP PARTICIPANTS BY JOB SATISFACTION SCORES Score N Percentage 2 5 - 2 8 1 1.3 29 - 32 21 26.6 .33 - 36 47 59.5* 37 - 40 10 12.6 T o t a l 79 100.0 * Median TABLE XX PERCENTAGE DISTRIBUTION OF PARTICIPANTS' JOB SATISFACTION SCORES BY COMBINED ADOPTER CATEGORY Score T o t a l E a r l y Adopter Late Adopter No. % No. % No. % 25 - 32 22 28.0 10 26.0 12 30.0 33 - 40 57 72.0 29 74.0 28 70.0 T o t a l 79 100.0 39 100.0 40 100.0 x 2 = 0.184, d . f . l , not s i g n i f i c a n t . 48 P a r t i c i p a n t s R e a c t i o n t o the' I n s t i t u t e The K r o p p - V e r n e r A t t i t u d e S c a l e was u s e d t o measure p a r t i c i p a n t s ' a t t i t u d e s t o t h e c o u r s e . E a c h p a r t i c i p a n t c o m p l e t e d an e v a l u a t i o n s h e e t a t t h e end o f 4 l t h e i n s t i t u t e w h i c h was s u b s e q u e n t l y s c o r e d . The measurement o f t h e r e s p o n s e t o t h e i n s t i t u t e i s made by c o m p a r i n g t h e m e d i a n v a l u e o f a l l s c o r e s t o t h e e l e v e n p o i n t s c a l e . On t h i s s c a l e t h e l o w e r t h e s c o r e t h e more 4? f a v o r a b l e t h e r e a c t i o n . R e a c t i o n s r a n g e d f r o m t h e most f a v o r a b l e , " I t was one o f t h e most r e w a r d i n g e x p e r i e n c e s I have had" t o s t a t e - ment 12 " I t was n o t e x a c t l y what I n e e d ed." The mean s c o r e f o r t h e i n s t i t u t e was 2.91 w h i c h s u g g e s t s t h a t t h e p a r t i c i - p a n t s were g e n e r a l l y p l e a s e d w i t h t h e i n s t i t u t e and f e l t t h a t i t was h e l p f u l . The r a n g e o f s c o r e s was 2.1 t o 4.7.' N e a r l y h a l f o f t h e p a r t i c i p a n t s (48 p e r c e n t ) r a t e d t h e c o n f e r e n c e t o w a r d t h e f a v o r a b l e end o f t h e s c a l e . ( T a b l e XXI) As T a b l e X X I I i n d i c a t e s , t h e r e was no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n t h e d i s t r i b u t i o n o f p a r t i c i p a n t s by a d o p t e r c a t e g o r y and a t t i t u d e s c a l e s c o r e . 41 See A p p e n d i x A. ,' S t a t e m e n t s D e s c r i b i n g R e a c t i o n s t o C o u r s e . 42 K r o p p and V e r n e r , op_. c i t . , pp. 212-215. TABLE XXI PERCENTAGE DISTRIBUTION BY KROPP-VERNER ATTITUDE SCALE FOR ALL PARTICIPANTS K-V Score N Percentage 2.0 - 2.9 48 61.0 3.0 - 3.9 28 35.4 4.0 - 4.9 ^ 3.8 Total 79 100.0 TABLE XXII PERCENTAGE DISTRIBUTION OF PARTICIPANTS1 KROPP-VERNER ATTITUDE SCORES BY COMBINED ADOPTER CATEGORY K-V Score Total Early Adopter Late Adopter No. % No. % No. % 2.1 - 3.2 62 78.5 31 79.5 31 77.5 3.3 - 4.7 17 21.5 8 20.5 9 22.5 Total 79 100.0 39 100.0 40 100.0 x2 = 0.044, d . f . l , not s i g n i f i c a n t . 50 CORRELATIONS BETWEEN ADOPTION SCORES AND SOCIO-ECONOMIC CHARACTERISTICS Zero order c o r r e l a t i o n c o e f f i c i e n t s among the variables were computed and tested for s t a t i s t i c a l ho s i g n i f i c a n c e . J To control for in t e r a c t i o n e f f e c t s , p a r t i a l c o r r e l a t i o n c o e f f i c i e n t s were also computed. A multiple regression analysis was performed to determine the combined a b i l i t y of a l l of the socio-economic c h a r a c t e r i s t i c s studied to account for variations i n the adoption score. ZERO ORDER CORRELATIONS Zero order c o r r e l a t i o n c o e f f i c i e n t s were computed to measure the relationships between adoption score, socio-economic c h a r a c t e r i s t i c s and attitude scale. This procedure provides a numerical estimate of the magnitude of the rel a t i o n s h i p between two sets of data. A number of relationships were found to exist as shown i n Table XXIII. Age and years of practice were strongly r e l a t e d i n d i c a t i n g that older nurses had practiced nursing for 43 As the data consisted of ordinal and i n t e r v a l variables t h i s factor was considered i n the se l e c t i o n of the correct c o r r e l a t i o n formula to be used for any pai r of variables. Jaspen's Coefficient of M u l t i s e r i a l Correlation ( o r d i n a l - i n t e r v a l ) , Pearson's Co e f f i c i e n t of Correlation ( i n t e r v a l - i n t e r v a l ) , and Goodman's and Kruskal's C o e f f i c i e n t of Rank Association (ordinal-ordinal) were used with the P tests and G test of sig n i f i c a n c e . longer periods of time. The re l a t i o n s h i p between a nurse's income and her pos i t i o n on the occupational scale was r e f l e c t e d i n the c o r r e l a t i o n , obviously ad- vancement i n the hierarchy i s rewarded by f i n a n c i a l recompense ind i c a t i n g that f i n a n c i a l reward i n the nursing profession does not accrue from the number of years practice or experience i n bedside nursing, but rather from moving into administrative or teaching positions. It was also evident, however, that those nurses with more years of practice did receive more income than those who had practiced for a shorter period of time. A direct r e l a t i o n s h i p existed between the nurse's position i n the organizational structure and the educational l e v e l that she had achieved, those nurses with more education tending to occupy higher positions. As the length of time that the nurse had practiced i n - creased so did her p a r t i c i p a t i o n i n programmes of continuing education. Those nurses who had practiced for the longest time period and who were, therefore, farther away from t h e i r i n i t i a l educational preparation apparently recognized the need to keep up-to-date with current practices and as a r e s u l t enrolled i n a greater number of courses i n continuing education than did those nurses who had more recently completed the educational experience. None of the socio-economic c h a r a c t e r i s t i c s showed a s i g n i f i c a n t zero order c o r r e l a t i o n i n r e l a t i o n to the adoption score. TABLE X X I I I CORRELATION COEFFICIENTS 1 2 3 4 5 6 7 8 9 1 0 1. Adoption Score 1.00 2. Attitude Scale -0.1320 1.00 3. Job Satisfaction 0.0819 -0.0437 1.00 4. Social Participation 0.0560 0.1239 -0.0634 1.00 5. Continuing Education -0.0494 -0.0377 0.1507 0.1630 1.00 6. Income -0.0245 -0.1183 0.2305 0.0258 0.2063 1.00 7. Years of Practice -0.0102 -0.0225 0.0548 0.1885 0.4932 0.4452 1.00 8. Occupational Position -0.2022 -0.0830 -0.1465 0.2272 0.2991 0.6895 0.4160 1.00 9. Education 0.1544 -0.1681 -0.1191 0.2332 -0.2182 0.2792 -0.2625 0.5172 1.00 LO. Age 0.0005 0.0121 0.0184 0.0520 0.3094 0.4256 0.7850 0.3086-0.3510 1.00 1 2 3 4 5 6 7 8 9 1 0 NOTEJ Underlined values indicate a significant degree of association. For the tests of significance a null hypothesis of no correlation was used with a .05 level of significance. The criterion i s to reject the null hypothesis i f the correlation coefficient i s less than <-.43 or greater than .43. PARTIAL CORRELATIONS P a r t i a l c o r r e l a t i o n c o e f f i c i e n t s were computed as a means of i s o l a t i n g underlying relationships between variabl e s . E s s e n t i a l l y t h i s i s a computational procedure for removing or p a r t i a l l i n g out the tendency other variables have to i n f l a t e the c o r r e l a t i o n between two variables when they are related to each of the two. The p a r t i a l c o r r e l a t i o n c o e f f i c i e n t indicates the degree of association among a l l variables with each variable held constant i n turn, and therefore, i s an i n d i c a t i o n of those variables which assume most importance i n r e l a t i o n to the variable being tested. The p a r t i a l c o r r e l a t i o n c o e f f i c i e n t s revealed two variables which were s i g n i f i c a n t l y r e l a t e d to adoption score. (Table XXIV) Those nurses who had achieved a higher l e v e l of education were those who achieved higher adoption scores, i n d i c a t i n g that nurses with more education were more receptive to the adoption of new practices. That i s , nurses who had graduated from baccalaureate or master's degree programmes i n nursing were found i n the innovator and early adopter categories to a greater extent than were nurses who had graduated from diploma programmes i n nursing. This was not an unexpected finding i n view of previous research studies which have found education to be s i g n i f i c a n t l y related to the adoption of new practices. A negative c o r r e l a t i o n c o e f f i c i e n t existed between occupational p o s i t i o n and adoption score which means that 54 TABLE XXIV PARTIAL CORRELATION COEFFICIENTS 1. A d o p t i o n -1.000 Score 2. A t t i t u d e -0.128 -1.000 S c a l e 3. Job 0.073 0.008 -1.000 S a t i s f a c t i o n 4. S o c i a l 0.080 0.210 -0.104 -1.000 P a r t i c i p a t i o n 5. C o n t i n u i n g 0.030 -0.068 0.113 0.143 -1.0.00 E d u c a t i o n 6. Income 0.015 -0.056 ' 0.240 -0.054 -0.022 7. Years o f -0.053 -0.084 0.090 0.177 0.258 P r a c t i c e 8. O c c u p a t i o n a l -0.278 -0.004 -0.129 0.054 0.231 P o s i t i o n 9. E d u c a t i o n 0.236 -0.120 -0.072 0.162 -0.249 10. Age 0.109 0.075 -0.154 -0.081 -0.052 1 2 3 4 5 TABLE XXIV ( c o n t ' d ) PARTIAL CORRELATION COEFFICIENTS 6 7 8 9 10 1.000 0.010 -1.000 0.390 0.004 -1.000 0.203 0.063 0.407 -1.000 0.318 0.691 0.022 -0.318 -1.000 6 7 8 9 10 NOTE: U n d e r l i n e d c o e f f i c i e n t s show a s i g n i f i c a n t degree o f a s s o c i a t i o n . A s i g n i f i c a n c e t e s t f o r r was c a r r i e d out u s i n g t h e n u l l h y p o t h e s i s o f no c o r r e l a t i o n w i t h a .05 l e v e l o f s i g n i f i c a n c e . The t e s t i s based on t h e assumption t h a t under the n u l l h y p o t h e s i s o f no c o r r e l a t i o n , t h e s a m p l i n g d i s t r i b u t i o n o f t h e c o r r e l a t i o n c o e f f i c i e n t can be approximated c l o s e l y w i t h a normal curve h a v i n g t h e mean 0 and the s t a n d a r d d e v i a t i o n ' 1 where n e q u a l s the sample s i z e . T h e r e f o r e J-h-l t h e c r i t e r i o n i s t o r e j e c t the n u l l h y p o t h e s i s i f r < - 1.96 o r r V I . ' 9 6 ( i . e . I f the p a r t i a l c o r r e l a t i o n f n - 1 J T I - I c o e f f i c i e n t i s l e s s t h a n -.217 or g r e a t e r t h a n .217) 6. Income .' 7. Years o f P r a c t i c e 8. O c c u p a t i o n a l P o s i t i o n 9. E d u c a t i o n 10. Age 56 nurses who were i n higher occupational positions tended to adopt the recommended practices to a lesser degree than did those nurses who were i n s t a f f positions. This finding i s not surprising i n that the nursing practices which were presented i n the i n s t i t u t e were those which would be most l i k e l y c a r r i e d out by the nurse providing dire c t patient care. Head nurses and supervisors are usually more occupied with administrative functions than with the nursing process described i n t h i s i n s t i t u t e . Directors of nursing and instructors are l i k e l y to be equally removed from dire c t patient care a c t i v i t i e s . The s i g n i f i c a n t relationships among the remaining socio-economic c h a r a c t e r i s t i c s were similar to those found In the zero order correlations with the following additional findings. The age of the nurse was related to her income and to her educational l e v e l , that i s as age increased so did income. The reverse was true for age and education, older nurses tended to have less educational preparation than did younger ones. An unexpected finding was that those nurses with more education had attended fewer courses i n continuing education. This finding may be linked to another finding i n t h i s study that the nurses with more education were younger and therefore closer to t h e i r educational preparation than the older nurses who had less education and who participated more In programmes of continuing education. Another finding i n r e l a t i o n to p a r t i c i p a t i o n i n programmes of continuing education was that nurses i n higher occupational positions attended more courses than did nurses at the s t a f f l e v e l . Whether th i s finding r e f l e c t s more intere s t i n continuing edu- cation, or that s t a f f nurses f i n d i t less easy to get away to attend these courses, i s not possible to say. The amount of income and the degree of job s a t i s f a c t i o n were found to be congruent factors In the population studied, for as the income increased so did the degree of job s a t i s f a c t i o n reported. MULTIPLE REGRESSION ANALYSIS The multiple regression analysis provides an estimate of the value of the adoption score on the basis of a set of measurements of the socio-economic charac- t e r i s t i c s . This analysis indicates the combined a b i l i t y of a l l the socio-economic c h a r a c t e r i s t i c s studied to account for variations i n the adoption score. This analysis i d e n t i f i e d two c h a r a c t e r i s t i c s , education and occupational p o s i t i o n , as s i g n i f i c a n t l y related to adoption score. (Table XXV) The c o e f f i c i e n t of determination (.297) i n - dicated that' some 30 per cent of the v a r i a t i o n i n adoption was explained by these two variables. These findings are not wholly i n agreement with the r e s u l t s of other research. Rogers notes that e a r l i e r adopters tended to be younger than l a t e r adopters, but he TABLE XXV REGRESSION ANALYSIS SELECTED VARIABLES AGAINST ADOPTION SCORE Variable Coefficient Std Err P-Ratio • P Prob Education Position 0.6625 -1.2718 0.3102 0.5220 4.5608 5.9364 0.0340 0.0164 RSQ = 0.0884 P Prob. = 0.0290 Std Err Y = 4.4539 r = .297 (multiple c o r r e l a t i o n c o e f f i c i e n t ) does i n d i c a t e a l a c k of agreement on t h i s p o i n t . ^ Age was not found to be a s i g n i f i c a n t c h a r a c t e r i s t i c i n t h i s study. The r e l a t i o n s h i p between adoption and e d u c a t i o n i s e q u a l l y u n c l e a r , L i o n b e r g e r found the r e l a t i o n s h i p l i k e l y to be i n d i r e c t , however, he i n d i c a t e d t h a t more years of s c h o o l i n g was a s s o c i a t e d with h i g h e r r a t e s of adoption l ie than fewer y e a r s . J On the other hand, Rogers c o n s i d e r s e d u c a t i o n a l l e v e l as one f a c t o r i n s o c i a l s t a t u s and notes s t u d i e s i n which edu c a t i o n was s i g n i f i c a n t l y r e l a t e d to 46 adoption. Those i n d i v i d u a l s r e p o r t i n g g r e a t e r enjoyment of work were found t o have achieved h i g h e r scores i n the 47 48 adoption of new p r a c t i c e s . ' S o c i a l p a r t i c i p a t i o n has been found to be s i g n i f i c a n t l y r e l a t e d t o the adoption of 4Q SO new p r a c t i c e s . ^ I t i s not p o s s i b l e to say whether the f i n d i n g s i n t h i s study are unique t o a nurse p o p u l a t i o n or whether they are unique to the nurses i n t h i s study as there have not been other s t u d i e s of the adoption of new p r a c t i c e s by nurses. 44 Rogers,' 0 £ . b i t . , p. 1 7 2 . 45 L i o n b e r g e r , op_.' c i t . , p. 91. 46 Rogers,' op_. c i t . , p. 175. 47 Verner and Gubbels, op_.' c i t . , p. 11. 48 Verner and M i l l e r d , op_. c i t . , p. 19. 49 Menzel and Katz, op. c i t . , pp. 337-352. 50 . . C a r t e r and W i l l i a m s , op_. b i t . , pp. 87-104. CHAPTER IV SUMMARY AND CONCLUSIONS The need for a method of evaluating the effectiveness of a nursing i n s t i t u t e was the motivating factor i n undertaking t h i s stud;/. The question was posed as to how i t can be determined whether a programme i n continuing education has helped nurses to improve t h e i r p r a c t i c e . This study reports on the results of applying the adoption concept as a c r i t e r i o n to measure learning that occurred at one i n s t i t u t e attended by 122 nurse participants from whom a sample of 79 were selected. • ADOPTION Three kinds of adoption scores for each p a r t i c i - pant i n r e l a t i o n to the practices recommended at the i n s t i - tute were computed: adoption score r e s u l t i n g from p r i o r influences; adoption score at the time of interview; and adoption score r e s u l t i n g from learning at the i n s t i t u t e . The adoption score was determined by assigning values to each stage of the adoption process: 0 for not aware, 1 for awareness, 2 for i n t e r e s t , 3 for evaluation, 4 for t r i a l and 5 for adoption. A comparison between adoption scores p r i o r to the i n s t i t u t e and the adoption scores due to learning at the il i n s t i t u t e shows the percentage increase to be 5 8 l . This percentage increase was very much greater than was found by Welch i n his study of Missouri restaurant operators. In his study the per cent increase i n adoption due to an I n s t i t u t e was 113. This finding cannot be s a t i s - f a c t o r i l y explained from the data av a i l a b l e . The adoption concept can be used as a c r i t e r i o n to measure learning that occurs at an i n s t i t u t e . The adoption concept can be used to measure degree of adoption of recommended prac t i c e s , and therefore, can measure the degree to which nurses have incorporated into t h e i r nursing practice those practices which have been recommended at an i n s t i t u t e . The c l a s s i f i c a t i o n of participants into adopter categories was shown to approximate the. normal curve with the following percentages of participants i n each category: Innovator 1.27; Early Adopter 11.39; Early Majority 36.71; Late Majority 37.98; and Laggard 12.66. SUMMARY OF FINDINGS Socio-economic ch a r a c t e r i s t i c s and the attitude of the participants to the i n s t i t u t e were measured against adopter categories to determine what relationships existed. In order to test for gross differences between e a r l i e r and l a t e r adopters the f i v e adopter categories were combined into two categories: the innovator, early adopter, and early majority forming the "early" adopter category, and the late majority and laggard forming the " l a t e " adopter category. Education was the only c h a r a c t e r i s t i c which was shown to have a s i g n i f i c a n t r e l a t i o n s h i p to the combined adopter category using the chi-square t e s t . Education was s i g n i f i c a n t l y related to a two adopter category, early and l a t e , at the .01 l e v e l of significance and to a four adopter category made up of the innovator and early adopter category combined, early majority, late majority and laggard at the .001 l e v e l of si g n i f i c a n c e . The review of the l i t e r a t u r e on adoption showed that early adoption of new practices was frequently correlated with younger age, more favorable f i n a n c i a l p o s i t i o n , greater s o c i a l p a r t i c i p a t i o n and enjoyment of work. In the present study, zero order correlations, p a r t i a l correlations and a multiple regression analysis were performed to determine the relat i o n s h i p of such c h a r a c t e r i s t i c s to adoption. Some of the findings were i n agreement with other research studies and other findings were i n disagreement. Age was not s i g n i f i c a n t l y r e l a t e d to adoption, although on the basis of the l i t e r a t u r e i t was expected to f i n d early adopters to be younger. A multiple regression analysis included education which was p o s i t i v e l y correlated x«7ith adoption, and occu- pational p o s i t i o n , which was negatively associated with 63 adoption. A s i g n i f i c a n t c o e f f i c i e n t of determination showed that some 30 per cent of the v a r i a t i o n i n adoption could be explained by these two variables. Previous research studies have found education to be associated with higher rates of adoption. It was not surprising to f i n d a negative corre- l a t i o n between adoption and occupational p o s i t i o n since the nursing practices presented at the i n s t i t u t e were those most l i k e l y to be carried out by the s t a f f nurse providing direct patient care. The fact that job s a t i s - f a c t i o n was not associated with higher adoption scores is contrary to other research findings, however, the other studies were done on dairy farmers and orchardists. These farmers and orchardists had a f i n a n c i a l investment i n the operation and improved practices might be more re a d i l y r e f l e c t e d i n the prosperity of the operation than a group of nurses who are s a l a r i e d employees and where rewards for improved practices are intangible at best or not present at lea s t . In such a s i t u a t i o n job s a t i s f a c t i o n might, i n f a c t , be a deterrent to the adoption of new practices. S o c i a l p a r t i c i p a t i o n was not associated with adoption scores i n this study although others have found that the extent to which an i n d i v i d u a l shares i n the s o c i a l l i f e of his community has been s i g n i f i c a n t l y r e l a t e d to his adoption of new practices. <6h Other relationships between the variables were those which might well be expected. Older nurses had practiced nursing for more years and received higher sa l a r i e s than younger nurses. Those occupying higher positions on the occupational scale received more income, r e f l e c t i n g the f i n a n c i a l rewards provided for positions in education or administration. Nurses, who had more education, tended to occupy higher positions within the profession. The nurses p a r t i c i p a t i o n i n programmes i n continuing education increased i n r e l a t i o n to the number of years practiced, those having practiced the longest were the ones who attended the greatest number of courses i n continuing education. Another finding indicated that nurses In higher occupational positions attended more programmes i n continuing education than nurses i n s t a f f positions. An unexpected finding was that those nurses with more education attended fewer courses i n continuing education, however, as these nurses xvere also younger they had more recently completed t h e i r educational pre- paration and therefore perhaps f e l t less need to attend. Nurses receiving a higher income reported greater job s a t i s f a c t i o n than the others. The Kropp-Verner Attitude Scale and the Social P a r t i c i p a t i o n Scale were the only two variables that did not correlate s i g n i f i c a n t l y with any of the other variables. The Kropp-Verner Scale showed participants to be generally pleased with the i n s t i t u t e and to have found i t h e l p f u l . The Soc i a l P a r t i c i p a t i o n Scale showed, that acceptance of leadership r e s p o n s i b i l i t y was not c h a r a c t e r i s t i c of the nurses studied. No committee memberships were reported by 80 per cent and no o f f i c e s i n l o c a l organizations were held by 77 per cent of the sample. CONCLUSIONS The adoption concept can be used as a c r i t e r i o n to assess learning that occurs at an i n s t i t u t e by measuring the degree to which participants have incor- porated into t h e i r practice those innovations which have been recommended. The i n s t i t u t e on Nursing Assessment produced a considerable t o t a l amount of change i n the par t i c i p a n t s , a 58l per cent increase i n adoption, and th i s change seems to have been f a i r l y consistent from person to person within the group. The participants were more prone to adopt the practices when they were relevant to t h e i r nursing a c t i v i t i e s . Although previous research suggests a variety of ch a r a c t e r i s t i c s which have been associated with the acceptance of new ideas, this study found education and occupational position to be the only c h a r a c t e r i s t i c s that were s i g n i f i c a n t . It i s in t e r e s t i n g to speculate on what factors i n the nursing environment contribute to making t h i s population d i f f e r e n t from those farmers, restaurant operators, and physicians who have made up other study populations. One major difference between these populations i s that nurses are employees in i n s t i t u t i o n s rather than independent workers as the others are. T r a d i t i o n a l norms of behavior would influence a l l of these workers, but the influence of the i n s t i t u t i o n where the nurses work should be taken into account. These i n s t i t u t i o n s are usually complex bureaucratic organizations which assign authority according to p o s i t i o n within the administrative hierarchy rather than according to competence within a profession. A study of the adoption of new practices by a nurse population should perhaps examine i n s t i t u t i o n a l c h a r a c t e r i s t i c s as well as the i n d i v i d u a l c h a r a c t e r i s t i c s of the nurse. BIBLIOGRAPHY BIBLIOGRAPHY A. THESES B e l l , Gordon. The Adoption of Business Practices by Participants i n the Small Business Management Training Programme. Unpublished M. A. the s i s . The University of B r i t i s h Columbia, June, 1968 Welch, John M. An Evaluation of Three Adult Education Methods for Disseminating Trade Information to Missouri Restaurant Operators. Unpublished Ph.D. d i s s e r t a t i o n , F l o r i d a State University, 1961. B. GOVERNMENT PUBLICATIONS Herzog, Elizabeth. 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BOOKS Abdellah, Faye and Eugene Levine. Through Nursing Research. Company, 1965. Better Patient Care New York, The Macmillan Avenues for Continued Learning. New York, American Nurses Association, 1967. Barnett, H. G. Innovation': The Basis of C u l t u r a l Change. New York, McGraw-Hill Book Co.. Inc., 1953. B e l i e f s About Nursing. Ottawa, Canada.. The Canadian Nurses* Association., 1968. Chapin,F. Stuart. Experimental Designs i n S o c i o l o g i c a l Research. New York, Harper, 1955. Ebel, Robert L. : Measuring Educational Achievement. Englewood C l i f f s , N. J . , Prentice-Hall Inc., 1965. Herzberg, Frederick et a l . Job Attitudes: Review of Research arid OpTriionT Pittsburgh, Pennsylvania, Psychological Service of Pittsburgh, 1957. Knowles, Malcolm S. ed. Handbook of Adult Education i n the United States. Chicago, Adult Education Association of the U.S.A., I960. Lionberger, Herbert F. Adoption of New Ideas arid Practices. Ames, Iowa, The Iowa State University Press, I960. Lorge, Irving. "The Fundamental Nature of Measurement," Educational Measurement. E. F. Lindquist, ed. Washington, D.C. American Council on Education, 1951. M i l l e r , Delbert C. ' Handbook of Research Design and Social Measurement. New York, David McKay Co., 1964. Moore, Wilbert E. S o c i a l Change. Englewood C l i f f s , N. J . Prentice-Hall Inc., 1963. Morse, Nancy C. S a t i s f a c t i o n s i n the White-Coliar Job. Ann Arbor, University of Michigan, 1953. P r i c e , Elmina Mary.' Learning Needs of Registered Nurses. New York, Teachers College Press, 1967. Rogers, Everett M. D i f f u s i o n of 'Innovations. New York, The Free Press, 1962. Ross, Donald H. Admiriistration for Adaptability. A Source Book Drawing Together the Results of More Than 150 Individual Studies Related to the Question of Why and How Schools Improve. New York, Metropolitan School Study Council, 1958. Verner, Coolie and Alan Booth. Adult Education. New York, The Center for Applied Research i n Education, 1964. 70 D. PERIODICALS Abel l , Helen C. "The Use of Scale Analysis i n a Study of the D i f f e r e n t i a l Adoption of Homemakins: Practices," Rural Sociology, 1 7 : * l 6 l - l 6 7 , (June, 1952). Beal, George M., Everett M. Rogers and Joe M. Bohlen. " V a l i d i t y of the Concept of Stages i n the Adoption Process," Rural Sociology, 22: 166-168, (September, 1957). Belcher, John C. "Acceptance of the Salk Polio Vaccine," Rural Sociology, 23: 158-170, 1958. Blum, Richard H. and Joseph J. Downing. "Staff Response to Innovation i n a Mental Health Service," American Journal of Public Health, 54: 1230-1240, (August, 1964). B r a y f i e l d , A. H. and H. F. Rothe.. "An Index of Job Sa t i s f a c t i o n , " Journal of Applied Psychology, 35: 307-311, (October, 195D. Brophy, Al f r e d . " S e l f , Role and S a t i s f a c t i o n , " Genetic Psychology Monographs, 59: 263-308, May, 1959. Brandner, Lowell and Bryant Kearl. "Evaluation for Con- gruence as a Factor i n Adoption Rate of Innovations," Rural Sociology, 29: 288-303, (September, 1964). Bullock, M. "Position, Function and Job S a t i s f a c t i o n i n Soci a l System of a Modern Hospital," Nursing Research, 2: 4-l4, (1953). Burnett, Florence and Maurice Greenhill. "Some Problems In the Evaluation of an Inservice Training Program i n Mental Health,"' American Journal of Public Health, 44: 1546-1556, (December, 1954). Caplow, Theodore and John J . Raymond. "Factors Influencing the Selection of Pharmaceutical Products." The Journal of Marketing, 19: 18-23, (July, 195W7 Carter, C. F. and B. R. Williams. "The Characteristics of Technically Progressive Firms," Jburna.l of Indus t r i a l Economics, 7: 87-104, (1959). Chaoin, F. S. "So c i a l P a r t i c i p a t i o n and Social I n t e l l i - gence,"' Am£ri£^ 4: 157-166, ( A p r i l , 1939). ' 71 Coleman, A. Lee. " D i f f e r e n t i a l Contact with Extension Work i n a New York Rural Community, Rural 'Sociology, 16: 207-216, (September, 1951). Coleman, A. Lee and C. Paul Marsh. " D i f f e r e n t i a l Communication Among Farmers i n a Kentucky County," Rural Sociology, 20: 93-101,(June, 1955). Coleman, James, E l i h u Katz and Herbert Menzel. "The Di f f u s i o n of an Innovation Among Physicians," Sociomefry, 20: 253-270, (December, 1957). Coleman, James, Herbert Menzel and E l i h u Katz. "Social- Processes In Physician's Adoption of a New Drug." Journal of Chronic' Diseases, 9- 1-19, (January, 1959). Copp, James H. "Toward Generalization i n Farm Practice Research," Rural Sociology, 23: 103-111, (1958). Copp, James H., Maurice L. S i l l and Emory J. Brown. "The Function of Information Sources i n the Farm Practice Adoption Process,"' Rural Sociology, 2^: 146-157, (1958). Coughenour, C. Milton. "The Problem of R e l i a b i l i t y of Adoption Data i n Survey Research,"' Rural Sociology, 30: 184-203, (1965). Dodd, Stuart Carter. "Diffusion Is Predictable: Testing p r o b a b i l i t y Models for Laws of Interaction," American So c i o l o g i c a l Review, 20: 392-401, (August, 1955). Gross, Neal. "The D i f f e r e n t i a l Characteristics of Acceptors and Nonacceptors of an Improved Technological Practice," Rural -Sociology, 14: 148-156, (June, 1949). Gross, Neal and Marvin J . Taves. "Characteristics Associated ~with Acceptance of Recommended Farm Practices," • Rural Sociology, 17: 321-328, (December, 1952). Havens, A. Eugene. "Increasing the Effectiveness of Predicting Innovativeness,"' Rural Sociology, 30: 150-165, (1965). Hoffer, Charles R. and Dale Stangland. "Farmer's Attitudes and Values i n Relation to Adoption of Approved Practices i n Corn Growing," Rural Sociology, 23: 112-120, (1958). Katz, E l i h u , "The Two-Step Flow of Communication: An Up-To-Date Report on a Hypothesis," Public 'Opinion Quarterly, 21: 61-78, (Spring, 1957). Kropp, Russell P. and Coolie Verner. "An Attitude Scale Technique for Evaluating Meetings," Adult Education, 7: 212-215, (Summer, 1957). Lionberger, Herbert P. and Edward Hassinger. "The Relation of Parmer Characteristics to the Adoption of Recommended Farm Pr act i ce s ,"' Rural Socio logy, 19: 377-384, (September-December, 1954). McLaughlin, Curtis P. and Roy Penchensky. "Di f f u s i o n of Innovation i n Medicine: A Problem of Continuing Medical Education,"' Journal of Medical Education, 40: 437-447, (May, 196~5~ [ Menzel, Herbert. "Innovation, Integration and Marginality: A Survey of Physicians,"' American S o c i o l o g i c a l Review, 25: 704-714, (October, I960). Menzel, Herbert and E l i h u Katz. "Social Relations and Innovations i n the Medical Profession: The Epidemiology of a New Drug,"' The Public Opinion Quarterly, 19: 337-352, (Winter, 1955-1956). Photiadis, John D. "Motivation, Contacts and Technological Change," Rural Sociology, 27: 316-326, (September, 1962). Pickens, M. Elizabeth and Matthew Tayback. "A Job S a t i s - faction Survey," Nursing Outlook, 5: 157-199, (March, 1957). Ramsey, Charles E., Robert A. Poison and George E. Spencer. "Values and the Adoption of Practices," Rural Sociology, 24: 34-47, (1959). Rogers, Everett M. "Personality Correlates of the Adoption of Technological Practices," Rural Sociology, 22: 267-268, (1957). ' , "Categorizing the Adopters of A g r i c u l t u r a l Practices," Rural Sociology, 23: 346-354, (1958). _ _ _ _ _ _ 3 "A Conceptual Variable Analysis of Technological Change,"' Rural Sociology, 23: 136-145, (1958). Rvan, Brvce. "A Study of Technological Diffusion,"' Rural Sociology, 13: 273-285, (September, 1948). 73 Ryan, B r y c e and N e a l C. G r o s s . "The D i f f u s i o n o f H y b r i d Seed Corn i n Two Iowa Communities,"' R u r a l S o c i o l o g y , 8: 15-24, ( 1 9 4 3 ) . Simon, J . R i c h a r d and M a r i a n E. O l s o n . " A s s e s s i n g Job A t t i t u d e s o f N u r s i n g S e r v i c e Personnei,"' N u r s i n g O u t l o o k , 8: 424-427, (August, i 9 6 0 ) . V e r n e r , C o o l i e and John S. Newberry. • "The N a t u r e of A d u l t P a r t i c i p a t i o n , " ' A d u l t E d u c a t i o n , 8: 2 0 8 - 2 2 2 , (Summer, 1 9 5 8 ) . W a l l a c h , M i c h a e l A. and Nathan Kogan. " A s p e c t s o f Judgement and D e c i s i o n - m a k i n g : I n t e r r e l a t i o n s h i p s and Changes w i t h Age,"' B e h a v i o r a l S c i e n c e , 6: 2 3 - 3 5 , ( J a n u a r y , 1 9 6 l ) . W i l k e n i n g , Eugene A. " I n f o r m a l Leaders and I n n o v a t o r s i n Farm P r a c t i c e s , " R u r a l S o c i o l o g y , 1 7 : 2 7 2 - 2 7 5 , (September, 1 9 5 2 ) . W i n i c k , C h a r l e s . "The D i f f u s i o n o f an I n n o v a t i o n Among P h y s i c i a n s i n a Large C i t y , " ' Soci'ome'try, 24: 3 8 4 - 3 9 6 , ( 1 9 6 1 ) . Young, James M. and A. Lee Coleman. "Neighborhood Norms and t h e A d o p t i o n o f Farm P r a c t i c e s , " R u r a l S o c i - o l o g y , 24: 3 7 2 - 3 8 0 , ( 1 9 5 9 ) . APPENDIX A Item I: Socio-economic data sheet Item I I : Interview Schedule Item I The University of British Columbia Health Sciences Centre Continuing Education in the Health Sciences School of Nursing The faculty responsible for continuing education in the Health Sciences Centre wish to collect certain information concern* ing registrants in non-credit nursing courses in order to: 1. assist in course planning; 2. improve program design; 3. analyze trends in participation; 4 . prepare annual reports; 5. provide data for research studies. You are asked to take a few minutes to fill out the attached data sheet by checking in the appropriate brackets. The in- formation collected in this questionnaire will not be made available to licensing bodies or employing agencies unless the registrant authorises release of the information. Nurses and nursing personnel are requested to complete Form A. Persons in other health professions are requested to complete Form B. Your co-operation will be greatly appreciated. FORM A (To be completed by nurse registrants) 76 I COURSE DATA Title Length 1 day 2 days 3 days 1 week evening series of sessions day series of sessions other Location Vancouver other II GENERAL BIOGRAPHICAL DATA Name (please print, surname first) Address street Marital Status: Single Married Other city province Sex: No. of children: Age Group: Male Female 0 1-2 3-4 more than 4 20 or under 21 - 25 26 - 30 31 - 35 36 - 40 - 2 Age Group (cont'd.) 41 - 45 46 - 50 51 - 55 56 - 60 61 - 65 Over 65 ( ) ( ) ( ) ( ) ( ) ( ) 77 III MEMBERSHIP IN PROFESSIONAL ASSOCIATION Member of Registered Nurses' Association of B. C. ( ) Member of Psychiatric Nurses' Association ( ) Other ( ) (please specify) IV EDUCATIONAL PREPARATION IN NURSING (a) Graduate from non-university school (b) Graduate from university school Vocational school General hospital Institute of technology Other (please specify) Diploma or certificate Baccalaureate degree Master's degree Doctoral degree V EMPLOYING AGENCY General hospital Specialized hospital Public health agency Private hospital 201 beds or over 75 to 200 beds 30 to 74 beds Under 30 beds Geriatric Paediatric Psychiatric Rehabilitative V EMPLOYING AGENCY (Cont'd.) School of Nursing Mental health clinic Correctional services Physician Self Not presently employed Other (please specify) VI POSITION IN AGENCY Nurse's aide ( ) Practical nurse Orderly ( ) Staff nurse ( ) Head nurse ( ) Supervisor ( ) Director ( ) Instructor ( ) Consultant ( ) VII YEARS OF PRACTICE IN NURSING 0 - 4 ( ) 5 - 9 ( ) 1 0 - 1 4 ( ) 1 5 - 1 9 ( ) 20 or more ( ) Vm NUMBER OF YEARS DURING WHICH I HAVE NOT PRACTICED AS A NURSE SINCE GRADUATION 0 - 4 5 - 9 1 0 - 1 4 15 - 19 20 or more - 4 - IX MAJOR INTERESTS Nursing care of children Maternal health nursing Nursing care of acutely i l l adult - General - Psychiatric Nursing care of adult with long term illness - General - Psychiatric Geriatrics Generalized practice in a hospital Generalized practice in a public health agency Other (please specify) X 1 FIRST HEARD OR READ ABOUT THIS COURSE FROM Director, supervisor or head nurse In-service co-ordinator Friend or colleague Personal mail Brochure posted on bulletin board Professional journal Canadian Nurse U. B. C. Calendar for Continuing Nursing Education Other (please specify) XI MONTHLY SALARY less than $300 $ 300 - $ 399 400 - 499 500 - 599 600 - 699 700 - 799 800 - 899 900 - 999 1000 or more XII COST OF COURSE (FEES, TRAVEL, LIVING EXPENSES ETC. ) WAS PAID BY Self Employer Shared by above Professional association Other (please specify) XIII NUMBER OF SHORT COURSES ATTENDED IN LAST 2 YEARS 0 1 2 3 more than 3 XIV SUBJECTS ON WHICH I WOULD LIKE TO SEE A COURSE OFFERED IN THE NEXT YEAR INCLUDE 1. 2. 3. . TO BE COMPLETED BY NON B. C. GRADUATES ONLY XV I GRADUATED IN Another Canadian province Great Britain Phillipine s Australia Other (please specify) I HAVE PRACTICED IN B. C. 0 - 4 years 5 - 9 years 10 - 14 years 15 - 19 years 20 years or more Item I I INTERVIEW GUIDE Respondent's No. Record of Adoption of Recommended Practices I would l i k e to f i n d out your use of c e r t a i n nursing p r a c t i c e s . Please r e p l y to each statement by s e l e c t i n g one of the s i x phrases l i s t e d on the answer sheet. 1. Writing a nursing h i s t o r y using standardized guice form 2. Using the nursing h i s t o r y to write nursing goals 3. Using the nursing goals to write nursing methods (orders) 4. Evaluating the goals and methods through the use of progress notes 5. Modifying the goals and methods i n terms of patient's progress 6. Writing a nursing discharge summary Note: Score the "before" column to i n d i c a t e the degree of p r a c t i c e before the i n s t i t u t e . Score the " a f t e r " column with 0.2 f o r a l l p r a c t i c e s not showing higher degree of adoption. Before 19 A f t e r 20 T o t a l 21 Before 22 A f t e r 23 T o t a l 24 Before 25 A f t e r 26 T o t a l 27 Before 28 A f t e r 29 T o t a l 30 Before 31 A f t e r 32 T o t a l 33 Before 34 A f t e r 35 T o t a l 36 8 ? -2- Use of Source of Information I would like to find out the source of information which has been most helpful to you for each of the nursing practices. Please select one source for each from the answer sheet. 7. Writing a nursing history using standardized guide form 37 8. Using the nursing history to write nursing goals 38 9. Using the nursing goals to write nursing methods (orders) 39 10. Evaluating the goals and methods through the use of progress notes 40 11. Modifying the goals and methods in terms of patient's progress 41 12. Writing a nursing discharge summary 42 Factors Influencing Adoption 13. Name the three most important factors that f a c i l i t a t e d your use of new practices. a) b) O 14. Name the three most important factors that inhibited your use of new practices. a) b) c) Information About Nursing Unit 15. How many patients (approx) on unit 43, 44 16. Number of nurses on days 45, 46 17. Number of patients on nurses daily assignment 47, 48 18. Number of other nurses on your unit attending institute on nursing assessment similar to one you attended 49 -3- 19. Participation in Community Groups (Chapin Scale) I would like you to recall the names of a l l the organizations that you have belonged to in the past year. (Do not include attendance at church) Total Score 50, 51 Name of Atten- Financial Member of Offices Organization dance Contribution Committee Held Score 1. 0 52 1 2. 1-5 2 3. 6-10 3 4. 11-15 4 16-20 5 6. 21-25 6 7. 26-30 7 8. 31-35 8 Total (xl) (x2) (x3) (x4) (x5) Over 35 9 -4 - 84 Index of Job Satisfaction (rev. Brayfield and Roth) I would like to find out how you feel about your job. Please reply to each statement using one of the five phrases on the answer sheet. 20. My job is like a hobby to me. 21. It seems that my friends are more interested i n their jobs than I am. 53 54 a> aJ u w •H CB T 3 <D <u T 3 o I - I •H u be-C <D O ec C o 0 <D 05 o u U T 3 w u 4-> W C •H W < = 3 Q to 5 4 3 2 1 4 5 22. I enjoy my work more than my leisure time^ 23. I am often bored with my job. 24. I feel f a i r l y well satisfied with my job. 25. I feel that my job is no more interesting than others I could get. 26. I definitely d i s l i k e my work. 27. Each day of work seems like i t w i l l never end. 28. I find real enjoyment in my work. Total Score 62, 63_ Total Scale Score 56 57 58 59 60 61 9-12 13-16 17-20 21-24 25-28 29-32 33-36 37-40 41 and over 64 Code 1 2 3 4 5 6 7 8 9 5 1 1 1 1 5 4 2 2 2 2 4 3 3 3 3 3 3 2 1 4 5 2 1 4 5 4 5 4 5 2 1 85 -5- Answer Sheet for Respondent's Use USE OF NURSING PRACTICES 0. Not aware of practice 1. Aware of practice but lack specific details 2. Interested in the practice 3. Search for information on the practice 4. Willingness to try the recommended practice 5. Trial of the recommended practice SOURCE OF INFORMATION 1. institute on nursing assessment 2. nursing text 3. nursing journal 4. staff nurse 5. Head nurse/supervisor 6. inservice coordinator 7. inservice programme 8. staff meeting 9. other (specify) JOB SATISFACTION Strongly agree Agree Undecided Disagree . STrongly disagree APPENDIX B Item I: Statements describing reactions to course 87 Statements Describing Reactions to Course Please check o f f only those statements which most accurately describe your personal reaction to the t o t a l course. It was one of the most rewarding experiences I have ever had Exactly what I wanted I hope that we can have another i n the near future It provided the kind of experience that I can apply to my own s i t u a t i o n It helped me personally It solves some problems for me I think i t served i t s purpose It had some merits It was f a i r It was neither very good nor very poor I was mildly disappointed It was not exactly what I needed It was too general I am not taking any new ideas away It didn't hold my interest It was much too s u p e r f i c i a l I leave d i s s a t i s f i e d It was very poorly planned I didn't learn a thing It was a complete waste of time

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