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The adoption of nursing practices by participants in a continuing education programme Shore, Helen Louise 1971

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THE ADOPTION OP NURSING BY PARTICIPANTS EDUCATION  PRACTICES  IN A CONTINUING  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  C o l u m b i a , 1961  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS  in the Faculty (Adult We a c c e p t required  this  of Education  Education)  t h e s i s as c o n f o r m i n g  t o the  standard  THE UNIVERSITY OF B R I T I S H COLUMBIA MARCH, 1971  In  presenting this  thesis  an advanced degree at the L i b r a r y s h a l l I  f u r t h e r agree  in p a r t i a l  f u l f i l m e n t o f the requirements  the U n i v e r s i t y of  make i t  British  freely available  that permission  for  Columbia,  I agree  r e f e r e n c e and  f o r e x t e n s i v e copying o f  this  for  that  study. thesis  f o r s c h o l a r l y purposes may be g r a n t e d by the Head o f my Department o r by h i s of  this  written  representatives. thesis  for financial  is understood that copying o r p u b l i c a t i o n gain s h a l l  permission.  Department of  . Adult Education  The U n i v e r s i t y o f B r i t i s h Vancouver 8, Canada  Date  It  Columbia  A p r i l 8th, 1971  not  be allowed without my  ii  ABSTRACT Programmes i n continuing education are necessary to help p r a c t i t i o n e r s keep t h e i r s k i l l s and knowledge current. purpose of t h i s study was two-fold:  The  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, and to determine whether c e r t a i n 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 a continuing education programme. 122  nurses who  The population was drawn from  attended the Nursing Assessment Institute held i n  Vancouver, B r i t i s h Columbia on February  12-14,  1969.  Seventy nine  participants included i n the sample were interviewed.  The  innovations included s i s steps i n the nursing process, ( l ) w r i t i n g a nursing h i s t o r y using a standardized guide form, ( 2 ) using the nursing h i s t o r y to formulate objectives f o r nursing care, (3)  devising s p e c i f i c nursing methods to achieve the objectives,  (4)  evaluating the objectives and methods through the use of  progress notes, ( 5 ) of  modifying the objectives and methods i n terms  the patient's progress, and (6)  summary.  preparing a nursing discharge  An adoption score was computed f o r each participant by  assigning a score f o r each reported stage i n the adoption process awareness, i n t e r e s t , evaluation, t r i a l and adoption. adoption scores were computed f o r each p a r t i c i p a n t :  Three the extent to  which the recommended practices were i n use p r i o r to the study, the extent to which the practices were adopted as a r e s u l t of learning about them at the i n s t i t u t e and the t o t a l adoption from a l l sources. The adoption scores provide a basis ffa  d i v i d i n g participants into  adopter categories 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.  Certain socio-economic  c h a r a c t e r i s t i c s , age, educational background, community p a r t i c i p a t i o n , occupational position, years of practice, income, job s a t i s f a c t i o n  iii  and p a r t i c i p a t i o n i n continuing education were c o l l e c t e d about each p a r t i c i p a n t . Interrelationships between the socio-economic c h a r a c t e r i s t i c s and i n t e r r e l a t i o n s h i p s between socio-economic c h a r a c t e r i s t i c s and adoption scores were computed using zero order and p a r t i a l c o r r e l a t i o n s and a multiple regression analysis was performed. 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 p a r t i c i p a n t s have incorporated 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 p a r t i c i p a n t s , a 581 per cent increase i n adoption, and t h 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 present nursing activities.  The adopter categories showed the following  innovator 1.27,  percentages:  early adopter 11.39, early majority 36.71, l a t e  majority 37.98, and laggard 12.66.  Although previous research  suggests a v a r i e t y of c h a r a c t e r i s t i c s which have been associated with the acceptance of new  ideas, t h i s study found education and  occupational p o s i t i o n 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 at the .05 l e v e l .  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 could be explained by these two v a r i a b l e s .  TABLE OP CONTENTS CHAPTER I.  PAGE  THE STUDY  1  The P u r p o s e  o f t h e Study  3  Hypothesis Definition  3 o f Terms  N u r s i n g Assessment  4 Institute  5  The P r o c e d u r e  II.  8  Data  Collection  8  Data  Analysis  8  REVIEW OP LITERATURE The I n d i v i d u a l Stages  12  Adoption Process  13  i n the Adoption Process  15  Time and t h e A d o p t i o n P r o c e s s  17  Classification  18  o f Adopters  Characteristics  of Adopters  A d o p t i o n Concept  .  as a C r i t e r i o n o f  Measurement III.  20  ANALYSIS OF DATA  23  Adoption Scores Classification  23 of Participants  into  Adopter  Categories Adopter  Categories  teristics  18  29 and S o c i o - e c o n o m i c  charac29  .- V  CHAPTER  PAGE  C o r r e l a t i o n s between Adoption Scores and Socio-economic C h a r a c t e r i s t i c s IV.  SUMMARY AND CONCLUSIONS  50 60  Summary  60  Conclusions  65  BIBLIOGRAPHY APPENDIX A Socio-economic data sheet I n t e r v i e w Schedule APPENDIX B . . . . Statements D e s c r i b i n g R e a c t i o n s t o Course  67 7H 76 8 l 86 87  LIST OP TABLES TABLE  PAGE  I.  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 Adoption  Scores due to P r i o r I n f l u e n c e s II.  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  24  by Adoption  Scores at the Time of the I n t e r v i e w III.  A Comparison of Percentage of P a r t i c i p a n t s  26  Distributions  by Degree of Adoption  P r i o r to the I n s t i t u t e and Due  to L e a r n i n g  at the I n s t i t u t e IV.  28  Per Cent Increase i n Adoption as a R e s u l t of the I n s t i t u t e  V.  28  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  into  Adopter  Categories VI.  Percentage D i s t r i b u t i o n of  30 Participants  by Age Category VII.  Percentage D i s t r i b u t i o n of  32 Participants'  Age by Combined Adopter Category VIII.  Percentage D i s t r i b u t i o n of  32  Participants  by E d u c a t i o n IX.  Percentage D i s t r i b u t i o n of  35 Participants'  E d u c a t i o n by Combined Adopter Category X.  Percentage D i s t r i b u t i o n of "  . . . .  35  Participants  by E d u c a t i o n and by Pour Adopter C a t e g o r i e s  .  36  vii  TABLE XI.  PAGE Percentage D i s t r i b u t i o n of Number of Continuing E d u c a t i o n Courses Attended by Participants  XII.  36  . . . .  40  Percentage 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 ' Occupation by Combined Adopter Category  XIII.  . . .  by Combined Adopter Category  Percentage D i s t r i b u t i o n by Years of P r a c t i c e for A l l Participants  XIV.  41  Percentage D i s t r i b u t i o n of Years o f P r a c t i c e 42  by Combined Adopter Category XV.  Percentage D i s t r i b u t i o n by Monthly  Salary  for A l l Participants XVI.  Percentage 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 Monthly  XVII.  S a l a r y by Adopter Category  43  Percentage 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 S o c i a l P a r t i c i p a t i o n Score  XVIII.  43  45  Percentage 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 ' Combined S o c i a l P a r t i c i p a t i o n Scores by Combined Adopter Category  XIX.  Percentage 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 Job S a t i s f a c t i o n Scores  XX.  45  47  Percentage 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 ' Job S a t i s f a c t i o n Scores by Combined Adopter Category  XXI.  47  Percentage D i s t r i b u t i o n by Kropp-Verner A t t i t u d e Scale f o r A l l P a r t i c i p a n t s  49  viii TABLE XXII.  PAGE Percentage 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 ' Kropp-Verner A t t i t u d e  Scores by Combined  Adopter Category XXIII.  Correlation  49  Coefficients  52  XXIV.  Partial Correlation  Coefficients  XXV.  Regression Analysis  Selected  Against Adoption Scores  )  54  Variables 58  ACKNOWLEDGEMENTS The work represented  by t h i s study  could  not have been undertaken without the a s s i s t a n c e and  cooperation  the  c o n t r i b u t i o n s of some may mean t o overlook the  assistance  of many people.  To acknowledge  of o t h e r s , however the w r i t e r f e e l s there  are some who merit  particular attention.  S p e c i a l thanks are due t o the nurses who p a r t i c i p a t e d i n t h i s study and who have become i n v o l v e d with change and the i n t r o d u c t i o n of new ideas. T h i s w r i t e r must a l s o express a s p e c i a l measure o f a p p r e c i a t i o n t o the members o f her advisory and  committee, t o Dr. C o o l i e V e r n e r , Chairman,  t o Dr. Gary D i c k i n s o n ,  counsel.  f o r t h e i r advice and  CHAPTER I THE The  STUDY  expansion of knowledge, t e c h n o l o g i c a l  d e v e l o p m e n t s and  the  been i d e n t i f i e d s o c i a l forces  as  complexity  t h e most i m p o r t a n t and  a f f e c t i n g s o c i e t y as  particular  educational  society.^  rp  professions  of s o c i a l  h e  n  e  e  (  j  f  o  continuing  is particularly  expansion of h e a l t h of h e a l t h care.  In nursing  education  not  the only  b e e n a change i n t h e  and  abilities  It  that  i s generally  complexity  the e s s e n t i a l but  also  there  nature of the knowledge,  a g r e e d t h a t no o f how  practitioner for a life  basic preparation  for  w e l l founded, w i l l  time of p r a c t i c e .  need t o improve p a t i e n t continuing  care  The  newer d e v e l o p m e n t s .  1  updating nurses'  p r a c t i c e of nursing  each p r a c t i t i o n e r keep s k i l l s the  by  and  this knowledge:  i t i s essential that  knowledge c u r r e n t  Continuing  a  equip  C a n a d i a n 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  "For  skills  are n e c e s s a r y f o r competent p r a c t i c e .  profession, regardless the  health  rapid  increasing has  that  i n the  t o the  knowledge needed f o r p r a c t i c e i n c r e a s e d has  creating  adults within  a c u t e due  s e r v i c e s and  persistent  a w h o l e and  needs f o r the r  change h a v e  education  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 New Y o r k , The C e n t e r f o r A p p l i e d R e s e a r c h i n I n c . , 1964, pp. 5-7.  should  with be  Education, Education,  2  focused on the improvement of the q u a l i t y o f n u r s i n g p r a c t i c e and the development of the i n d i v i d u a l practitioner."  c  nurse  S t a t e d simply, the purpose o f c o n t i n u i n g  e d u c a t i o n i s t o h e l p nurses  improve t h e i r p r a c t i c e and t o  cope w i t h the problems o f t h e i r p r o f e s s i o n more  intelli-  g e n t l y and c r e a t i v e l y . E d u c a t i o n i s an e x t e n s i v e , d i v e r s e and complex e n t e r p r i s e i n terms o f i t s nature and i t s p r o c e s s .  I f we  b e l i e v e t h a t the purpose of e d u c a t i o n i s not only t o accumulate knowledge, but a l s o t o change behaviour  then  the measurement o f e d u c a t i o n a l outcomes must be made i n terms o f observable d i f f e r e n c e s i n behaviour. is  fundamentally  Evaluation  a two-step p r o c e s s : ( 1 ) determining  e x a c t l y what i s t o be measured; ( 2 ) s e l e c t i n g or developing an instrument t h a t w i l l best do the measuring.  The  measurement of t h e l e a r n i n g achieved by p a r t i c i p a n t s i n a p a r t i c u l a r programme can be made i n f o u r major areas: knowledge or i n f o r m a t i o n a c q u i r e d , a t t i t u d e change, l e a r n i n g , and the acceptance  skill-  o f adoption o f ideas and  practices.^ How can we determine  whether a programme i n  c o n t i n u i n g e d u c a t i o n has, i n f a c t , helped nurses t o improve t h e i r p r a c t i c e ?  The measurement of the adoption  2  B e l i e f s About N u r s i n g , mimeographed r e p o r t , Ottawa, Canadian Nurses' A s s o c i a t i o n , 1 9 6 8 , p. 2 . 3 Verner and Booth, op_. c i t . ,  p. 9 8 .  3 of  i d e a s or p r a c t i c e s may  p r o v i d e the best assessment of  the l e a r n i n g achieved i n programmes of c o n t i n u i n g education.  T h i s 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 t o a g r i c u l t u r a l p r a c t i c e s , the d i s s e m i n a t i o n of i n f o r m a t i o n , and the use of drugs by p r a c t i c i n g p h y s i c i a n s , among other t h i n g s , but t h e r e has been l i t t l e of  the concept  application  of adoption to n u r s i n g p r a c t i c e .  Purpose of the Study In  r e c o g n i t i o n of the important need f o r con-  t i n u i n g e d u c a t i o n f o r nurses for  and the concommitant need  e v a l u a t i n g the e f f e c t i v e n e s s of programmes of  c o n t i n u i n g e d u c a t i o n , t h i s study has 1.  a two-fold  to evaluate the e f f e c t i v e n e s s of a n u r s i n g  i n s t i t u t e as a means of i n t r o d u c i n g new u s i n g the adoption concept 2. of  purpose:  t o determine  i n d i v i d u a l nurses  p r a c t i c e s by  as a c r i t e r i o n of measurement.  whether c e r t a i n  characteristics  are 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 p r a c t i c e s recommended i n c o n t i n u i n g e d u c a t i o n programmes. Hypothesis There i s no s t a t i s t i c a l l y  significant  difference  i n the adoption of recommended n u r s i n g p r a c t i c e s between i n d i v i d u a l nurses w i t h v a r y i n g socio-economic teristics.  charac-  D e f i n i t i o n o f Terms Adoption - The i n t e g r a t i o n of an i d e a or p r a c t i c e recommended by an e d u c a t i o n a l agent i n t o the normal behaviour p a t t e r n  of an adult  learner.  Degree o f Adoption - The extent t o which an i n d i v i d u a l l e a r n e r has achieved the s u c c e s s i v e steps o f awareness, i n t e r e s t , a c t i v e search f o r a d d i t i o n a l willingness  to t r y , and a c t u a l t r i a l  information,  of an i d e a or  p r a c t i c e recommended by an e d u c a t i o n a l agent. an  index of the i n d i v i d u a l ' s progress toward the complete  i n t e g r a t i o n of the recommended i d e a or p r a c t i c e normal behaviour  into his  pattern.  Adoption Score - (1)  The score achieved by an i n d i v i d u a l  by h i s degree o f adoption o f a recommended (2)  Iti s  practice.  The sum of the adoption scores o f an i n d i v i d u a l f o r  each o f the recommended ideas or p r a c t i c e s  i n a discrete  series. Adoption Score f o r D i s c r e t e portion resulted  Study Source (ASs) - That  of a t o t a l adoption score determined as having from a d i s c r e t e e d u c a t i o n a l p r o c e s s . (ASt-ASp=ASs)  Adoption Score from P r i o r Sources (ASp) - That p o r t i o n o f a t o t a l adoption score determined t o have e x i s t e d p r i o r t o the  exposure of an i n d i v i d u a l t o a d i s c r e t e  process.  educational  (ASt-ASs=ASp).  T o t a l Adoption Score - The t o t a l adoption score o f an i n d i v i d u a l f o r a d i s c r e t e recommended p r a c t i c e  or s e r i e s  5  o f p r a c t i c e s r e s u l t i n g from a l l i n f l u e n c e s . The  (ASp+ASs=ASt)^  I n s t i t u t e on Nursing Assessment I n 1 9 6 8 , t h e School o f Nursing at the U n i v e r s i t y  of B r i t i s h Columbia embarked on a programme o f c o n t i n u i n g e d u c a t i o n f o r the nurse p o p u l a t i o n i n the p r o v i n c e .  This  venture was made p o s s i b l e l a r g e l y by a grant from the Regis t e r e d Nurses A s s o c i a t i o n o f B r i t i s h Columbia of  $ 5 , 0 0 0 . 0 0  a year f o r a p e r i o d o f f i v e years p r o v i d i n g t h e U n i v e r s i t y appoint a f u l l - t i m e f a c u l t y member from the School o f N u r s i n g t o assume t h 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  r e p o r t e d on i n t h i s study was one o f the t e n e d u c a t i o n a l programmes made a v a i l a b l e t o nurees academic year  1  9  6  8  -  1  9  6  9  i n B. C. i n the .  For each i n s t i t u t e a l o c a l p l a n n i n g committee was formed t o work with t h e D i r e c t o r o f C o n t i n u i n g Nursing E d u c a t i o n t o determine  the needs of t h e p r o s p e c t i v e  p a r t i c i p a n t s and t o suggest  a t e n t a t i v e programme.  The  committee f o r 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 i n wishing t o s e l e c t a t o p i c f o r the i n s t i t u t e which would be a p p l i c a b l e t o n u r s i n g p r a c t i c e i n any s e t t i n g , whether acute or c h r o n i c , h o s p i t a l or home, g e n e r a l i z e d or s p e c i a l i z e d .  4  John M. Welch, "An E v a l u a t i o n of Three Adult E d u c a t i o n Methods f o r D i s s e m i n a t i n g Trade Information to M i s s o u r i 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 U n i v e r s i t y , 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 a s s e s s m e n t " was  decided  u p o n and  topic "nursing  a qualified  resource  p e r s o n a b l e t o meet t h e r e q u e s t  from the  committee  was  sought.  College of Nursing  and  Dean D o r o t h y M.  Chief of Nursing  Smith,  P r a c t i c e at the J . H i l l i s M i l l e r  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 as t h e r e s o u r c e  person t o conduct the  i n s t i t u t e on N u r s i n g  A s s e s s m e n t was  B r i t i s h C o l u m b i a on F e b r u a r y The participants  12  institute.  planning n u r s i n g care  to  enable  of nursing p r a c t i c e  w i t h p a r t i c u l a r e m p h a s i s on t h e t e c h n i q u e s n e e d s and  of  assessing  for individual patients.  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 through The  t h e use  The  1969.  designed  to explore the nature  selected  held i n Vancouver,  - 14,  t w o - d a y I n s t i t u t e was  Health  of the n u r s i n g h i s t o r y  n u r s i n g h i s t o r y guide, developed  guide  was  needs presented.  at the U n i v e r s i t y of  Florida,  c o n s i s t s o f two m a i n p a r t s : a g u i d e  organize  c e r t a i n i n f o r m a t i o n about the p a t i e n t t h a t  be  u s e d t o p l a n n u r s i n g c a r e , and  the process planning  and The  for  of c l i n i c a l  a guide  t h i n k i n g u s e d by  evaluating of nursing programme was  designed  to e l i c i t  to  the nurse i n the  care. to provide  a v a r i e t y of l e a r n i n g a c t i v i t i e s  collect  form.  a nursing history  They w e r e t h e n  t o use  f o r the  using the the  will  facilitate  opportunity registrants.  A r r a n g e m e n t s were made f o r e a c h n u r s e t o v i s i t and  and  a patient  standardized  guide  information collected  to  7 write objectives f o r nursing  care and the s p e c i f i c  n u r s i n g methods which could be used t o achieve objectives.  Using these r e s o u r c e s , Dean Smith f u r t h e r  e l a b o r a t e d , d i s c u s s e d and c l a r i f i e d group.  these  the process  f o r the  The i n s t i t u t e ended with a d i s c u s s i o n o f  s t r a t e g i e s f o r i n t r o d u c i n g new ideas i n t o p r a c t i c e s e t t i n g s . Short-term e d u c a t i o n a l a c t i v i t i e s , such as i n s t i t u t e s , are o f t e n evaluated by u s i n g a r e a c t i o n form at the end of the programme. S c a l e which was designed  The Kropp-Verner A t t i t u d e  t o measure the g e n e r a l a t t i t u d e  of the p a r t i c i p a n t s at the c o n c l u s i o n o f an organized e d u c a t i o n a l experience  was used t o evaluate the i n s t i t u t e . 5  T h i s s c a l e measures p a r t i c i p a n t s a t i s f a c t i o n and i s not a measure o f the l e a r n i n g  achieved.  Population The  p o p u l a t i o n f o r t h i s study was drawn from the  122 nurses who attended Ninety  the Nursing  Assessment  Institute.  nurses who were employed w i t h i n a t h i r t y m i l e  radius  of Vancouver were s e l e c t e d f o r t h i s study but o f t h a t number f o u r c o u l d not be contacted from the a r e a , f i v e were i l l  because they had moved  and not a v a i l a b l e , and two  were e l i m i n a t e d because they were c o n s u l t a n t s on n u r s i n g  5 R u s s e l l Kropp and C o o l i e V e r n e r , "An A t t i t u d e S c a l e Technique f o r E v a l u a t i n g Meetings," Adult E d u c a t i o n ,  7: 212-215, (Summer, 1957).  8 p r a c t i c e and Institute.  f a m i l i a r with the m a t e r i a l presented The  remaining  seventy-nine  i n the I n s t i t u t e were i n t e r v i e w e d  at the  nurse p a r t i c i p a n t s  f o r purposes of t h i s  study. The  Procedure  Data C o l l e c t i o n P e r s o n a l i n t e r v i e w s were conducted between December 1 , schedule  3  1969  and February 3 ,  1970.  An  interview  which had been p r e - t e s t e d on f i v e nurses not  i n the study p o p u l a t i o n , was After e d i t i n g for consistency  used to r e c o r d the  data.  of response, the data were  keypunched f o r a n a l y s i s on automatic data  processing  equipment. Data A n a l y s i s The  IBM  3 6 0 / 6 7 computer at the U n i v e r s i t y of  B r i t i s h Columbia was t - t e s t and  chi-square  used f o r a n a l y s i s of the data.  The  s t a t i s t i c a l t e s t s of s i g n i f i c a n c e  were used, z e r o - o r d e r and p a r t i a l c o r r e l a t i o n s between a l l v a r i a b l e s were computed and a n a l y s i s was The  a multiple regression  done.  Innovations The  innovations  c o n s i s t e d of a s e r i e s of  p r a c t i c e s focussed on the process The  of n u r s i n g i n t e r v e n t i o n .  s i x steps i n t h i s n u r s i n g process  are: 1 )  writing a  n u r s i n g h i s t o r y u s i n g a s t a n d a r d i z e d guide form, 2 )  using  the n u r s i n g h i s t o r y t o w r i t e o b j e c t i v e s f o r n u r s i n g c a r e , 3) u s i n g the o b j e c t i v e s to w r i t e s p e c i f i c n u r s i n g methods to achieve them, 4) e v a l u a t i n g the o b j e c t i v e s and n u r s i n g methods through the use of progress n o t e s , 5) m o d i f y i n g the o b j e c t i v e s and n u r s i n g methods i n terms o f the p a t i e n t ' s p r o g r e s s , and 6) w r i t i n g a n u r s i n g discharge summary. this  These s i x i n n o v a t i o n s d i f f e r i n complexity and  f a c t o r may i n f l u e n c e the acceptance  or r e j e c t i o n of  the i n n o v a t i o n s . Stages  i n the Adopt i o n 'Process The d e c i s i o n t o accept or r e j e c t an i n n o v a t i o n  i s not based on a simple dichotomy but i n v o l v e s a complex mental process t h a t has been segregated i n t o f i v e  stages  summarized by L i o n b e r g e r as awareness, i n t e r e s t , e v a l u c  a t i o n , t r i a l and a d o p t i o n . this  concept  B e a l , et a l , conclude t h a t  of stages i n the adoption process i s v a l i d  from evidence t h a t i t appears meaningful  t o adopters, and  that they are aware t h a t they do go through  a series of  s e q u e n t i a l stages i n the progress toward adoption.7  Rogers  6 Herbert Lionberger,' The Adoption o f New Ideas and P r a c t i c e s , Ames, Iowa, State U n i v e r s i t y P r e s s , I960, pp. 2 1 - 2 3 . 7 George B e a l , E v e r e t t Rogers, and J . M. Bohlen, " V a l i d i t y o f the Concept of Stages i n the Adoption Process," R u r a l S o c i o l o g y , 2 2 : 1 6 6 - 1 6 8 , June, 1 9 5 7 .  indicates nature  that these  stages  are  o f t h e phenomenon and  consistent with  potentially  the  useful for  o  practical  application.  the b a s i s f o r the Adoption  a n a l y s i s of the  the b a s i s of the data  i n n o v a t i o n s , an participant  by  adoption  were: 0 f o r n o t  computed  The  s c o r e was  w i t h r e s p e c t t o : 1)  the  attributable  and  to which the  to p r i o r  prior  from  a l l sources  stage  This  respondent  recommended  t o the  study,  i n f l u e n c e s (ASp);  institute  stage  interest,  computed f o r e a c h  the nurse  about them a t t h e  adoption  f o r each  5 f o r adoption.  t o w h i c h t h e p r a c t i c e s were a d o p t e d  Adopter  as  the  v a l u e s a s s i g n e d each  extent  p r a c t i c e s were i n u s e by  learning  about  aware, 1 f o r a w a r e n e s s , 2 f o r  degree o f a d o p t i o n  therefore  collected  a s s i g n i n g a s c o r e f o r each r e p o r t e d  3 for evaluation, 4 for t r i a l  total  are used  data.  s c o r e was  adoption process.  extent  stages  Score On  i n the  These f i v e  as  2)  a result  ( A S s ) ; and  3)  of  the  (ASt).9  Categories The  adoption  a basis for dividing  score  f o r each p a r t i c i p a n t  them i n t o  c a t e g o r i e s which  provides identify  8 New  the  E v e r e t t M. Rogers,' D i f f u s i o n o f I n n o v a t i o n s , Y o r k , The F r e e P r e s s , 1962, pp. 152-15b.  9  W e l c h , op_.' c i t . , p.  6-7.  11 the r a t e of response first  to i n n o v a t i o n s , r a n g i n g from those  to accept an i d e a or p r a c t i c e to those who  or never adopt.  are  last  Rogers uses f i v e c a t e g o r i e s which are  i d e n t i f i e d as f o l l o w s : i n n o v a t o r s , e a r l y a d o p t e r s , m a j o r i t y , l a t e m a j o r i t y and  laggards.- 1  p r o v i d e a u s e f u l t o o l f o r making gross  early  These c a t e g o r i e s  0  differentiations  among the nurses with r e s p e c t to the time of a d o p t i o n . These three measures, the stages  i n the  p r o c e s s , the adoption score and the adopter  adoption  categories  were used as a framework f o r the a n a l y s i s of the  data.  S o c i o - e c o n oiri i c C h ar a ef e r 1st l e s  C e r t a i n socio-economic age,  c h a r a c t e r i s t i c s , such  as  e d u c a t i o n a l background, community p a r t i c i p 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 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 c o n t i n u i n g e d u c a t i o n were c o l l e c t e d about each nurse.  These separate  were t e s t e d f o r i n t e r r e l a t i o n s h i p s by the use c o r r e l a t i o n c o e f f i c i e n t s , and  items  of  they were t e s t e d f o r  s i g n i f i c a n t d i f f e r e n c e s between adoption s c o r e s , c h i square the  values f o r the d i s t r i b u t i o n s were c a l c u l a t e d at  .05 l e v e l of  10  confidence.  Rogers, op. c i t . , pp.  152-158.  CHAPTER .II REVIEW OP  LITERATURE  Research s t u d i 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 can be found  i n many d i s c i p l i n e s i n c l u d i n g  anthropology,  e d u c a t i o n , market r e s e a r c h , mass communi-  c a t i o n , medicine, assistance.  agriculture,  p u b l i c h e a l t h , s o c i o l o g y , and  In f a c t , almost  technical  every b e h a v i o u r a l s c i e n c e has  some i n t e r e s t i n the d i f f u s i o n of new  ideas.  The  exchange  of r e s e a r c h f i n d i n g s between d i s c i p l i n e s i s scanty i f not nonexistent.  Summaries of  been made i n a g r i c u l t u r e  1 1  d i f f u s i o n r e s e a r c h f i n d i n g s have and e d u c a t i o n , ^ and c r o s s 1  d i s c i p l i n a r y i n a s y n t h e s i s and e v a l u a t i o n of over  500  r e s e a r c h s t u d i e s from s i x d i s c i p l i n e s on the d i f f u s i o n of innovations.^ T h i s review  of the l i t e r a t u r e attempts to h i g h l i g h t  the main r e s e a r c h f i n d i n g s i n three major areas:  the  i n d i v i d u a l adoption p r o c e s s , time and the adoption  process,  11  L i o n b e r g e r , op_. c i t . 12  Donald H. Ross, A d m i n i s t r a t i o n f o r ' A d a p t a b i l i t y . A Source Book Drawing Together the R e s u l t s of More Than 150 I n d i v i d u a l S t u d i e s Related t o the Question of Why and How Schools Improve, New York, M e t r o p o l i t a n School Study C o u n c i l , 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. adoption concept  The  use of the  as a c r i t e r i o n of measurement w i l l  be  outlined. The  I n d i v i d u a l Adoption  Process  People do not o r d i n a r i l y accept new p r a c t i c e s immediately  ideas or  upon h e a r i n g about them.  from i n i t i a l knowledge t o f i n a l acceptance a few days to many y e a r s .  The  may  The  time  range  from  d e c i s i o n t o change i s  o r d i n a r i l y the product of a sequence of events i n f l u e n c e s o p e r a t i n g through time.  The  and  adoption process  has been d e s c r i b e d as the mental process through which an i n d i v i d u a l passes  from f i r s t  h e a r i n g about an i n n o v a t i o n  -i ii to  f i n a l adoption.  V a r i o u s s t i m u l i about the i n n o v a t i o n  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 the messages and e v e n t u a l l y adopts vation.  or r e j e c t s the inno-  T h i s process should be d i s t i n g u i s h e d from  d i f f u s i o n process which i s the spread of a new its or  to  the  i d e a from  source of i n v e n t i o n or c r e a t i o n t o i t s u l t i m a t e users adopters.  J  The r e s e a r c h t r a d i t i o n of r u r a l s o c i o l o g y has produced  the g r e a t e s t number of r e s e a r c h s t u d i e s u s i n g the 14  Rogers, op_. c i t . , pp. 15  Loc. c i t .  12-20.  adoption concept.  An i n v e s t i g a t i o n o f the d i f f u s i o n of  h y b r i d seed corn was,  perhaps, the f i r s t  t o use a stage  concept t o study the adoption of a farm p r a c t i c e , 1 6  Ryan  and Gross r e c o g n i z e d three stages i n the adoption p r o c e s s : awareness or f i r s t first  h e a r i n g about the new  use and adoption or complete  idea, t r i a l  acceptance  or  and use of  the i n n o v a t i o n . Wilkening noted that an i n d i v i d u a l ' s d e c i s i o n to adopt  an i n n o v a t i o n was  composed of stages which he  d e s c r i b e d as l e a r n i n g , d e c i d i n g and a c t i n g over a p e r i o d of  time.  The adoption of a s p e c i f i c p r a c t i c e , t h e r e f o r e ,  i s not the r e s u l t of a s i n g l e d e c i s i o n t o a c t , but the r e s u l t of a s e r i e s of a c t i o n and thought  decisions.  i d e n t i f i e d f o u r stages i n the adoption process of  i n i t i a l knowledge, acceptance  i d e a , acceptance  He  consisting  of the p r a c t i c e as a good  on a t r i a l b a s i s and adoption of the  p r a c t i c e on h i s 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,"' R u r a l 'Sociology, 8": 15-24, 1943. 17 Eugene A. Wilkening,' Acceptance of Improved Farm P r a c t i c e s , R a l e i g h , North C a r o l i n a A g r i c u l t u r a l Experiment S t a t i o n T e c h n i c a l B u l l e t i n 98, 1952.  15 added a f i f t h stage t o the sequence. ^ 1  and L i o n b e r g e r  Both R o g e r s ^ 1  have r e f i n e d the f i v e stages i n the  2 0  adoption process and these have been g e n e r a l l y accepted f o r purposes  of r e s e a r c h .  the v a l i d i t y  of the stages concept  valid Stages  Two  major i n v e s t i g a t i o n s  concluded they were a  c o n c e p t u a l i z a t i o n of the adoption p r o c e s s . i n the Adoption  Awareness:  The  of  2 1  2 2  Process  stage at which an i n d i v i d u a l knows of the  e x i s t e n c e of an i d e a or p r a c t i c e but l a c k s d e t a i l s c e r n i n g i t s i n t r i n s i c nature and use.  Awareness may  conbegin  as an i n v o l u n t a r y act or an a c c i d e n t a l d i s c o v e r y . Information:  The  stage at which the i n d i v i d u a l becomes  18 North C e n t r a l R u r a l S o c i o l o g i c a l Sub-committee f o r the Study of D i f f u s i o n of Farm P r a c t i c e s , How' Farm People Accept New Ideas, Ames, Iowa A g r i c u l t u r a l E x t e n s i o n S e r v i c e S p e c i a l Report 15, 1955. 19 Rogers, op. c i t . , p.  17.  20 L i o n b e r g e r , op_. c i t . , pp.  21-32.  21  G. M. B e a l , 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," R u r a l S o c i o l o g y , 22: 166-168, June, 1957. 22  James H. Copp, Maurice L. S i l l and Emory J . Brown, "The F u n c t i o n of Information Sources i n the Farm P r a c t i c e Adoption P r o c e s s , " R u r a l S o c i o l o g y , 23: 146-157, 1958.  i n t e r e s t e d i n the i d e a . of a general  He seeks f u r t h e r b a s i c  nature r e g a r d i n g  information  i t . He wants t o know why and  how i t works, how much i t c o s t s and how i t compares w i t h other ideas  or p r a c t i c e s purported t o perform the same or  similar functions.  He i s concerned w i t h knowing the con-  d i t i o n s o f use and the r e s o u r c e s necessary t o get optimum b e n e f i t s from i t s use. Evaluation:  The i n d i v i d u a l takes the knowledge he has  about the i d e a and weighs t h e a l t e r n a t i v e s i n terms o f h i s own use.  He c o n s i d e r s  h i s own r e s o u r c e s o f l a n d ,  c a p i t a l and management a b i l i t y  labor,  and decides whether or not  he has the necessary r e s o u r c e s t o adopt t h e i d e a . evaluates and  He a l s o  t h e i d e a i n terms o f the a l t e r n a t i v e s a v a i l a b l e  of h i s o v e r a l l goal structure.  He considers  whether o r  not t h e a d o p t i o n of the i d e a w i l l help him maximize h i s g o a l and o b j e c t i v e s .  I f he t h i n k s  i t w i l l , i n most  cases,  he makes the d e c i s i o n t o give the i d e a o r p r a c t i c e a physical Trial:  trial. The stage at which the i n d i v i d u a l has the e m p i r i c a l  experience o f observing is  the i d e a i n use.  stage  c h a r a c t e r i s t i c a l l y one of s m a l l - s c a l e use by the  p o t e n t i a l adopter or h i s o b s e r v a t i o n which simulate the  The t r i a l  o f use under  those o f h i s own s i t u a t i o n .  conditions  At t h i s stage  i n d i v i d u a l i s concerned w i t h the s p e c i f i c s of a p p l i -  c a t i o n and use and the mechanics and a c t i o n s r e l a t e d t o how to use the i d e a .  AdoptIon:  The stage at which the i n d i v i d u a l uses the i d e a  on a f u l l - s c a l e b a s i s i n h i s o p e r a t i o n s and i s s a t i s f i e d with i t .  He i s no l o n g e r t r y i n g t o decide whether or not  the i d e a i s good f o r him i n h i s o p e r a t i o n but has accepted it  as an i n t e g r a l p a r t o f the p a r t i c u l a r o p e r a t i o n i n t o  which he has i n c o r p o r a t e d i t . Time and the Adoption  Process  A l l people do not adopt the same time.  a new i d e a or p r a c t i c e at  O r d i n a r i l y adoptions are very slow at f i r s t  then i n c r e a s e at a f a s t e r r a t e u n t i l approximately h a l f of the t a r g e t p o p u l a t i o n have accepted the i n n o v a t i o n . t h i s , acceptance  continues but at a d e c r e a s i n g r a t e .  After A  c h 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 o f persons  a c c e p t i n g a s p e c i f i c change  a g a i n s t a s c a l e o f s u c c e s s i v e time.  T h i s curve was found  i n the cumulative p r o p o r t i o n s of farmers u s i n g h y b r i d seed,23 and i n the adoption of a new drug by the medical p r o f e s s i o n , * * as w e l l as i n o t h e r s t u d i e s . 2  Characteristically, first  adoptions take much  longer from awareness t o f i n a l adoption than  subsequent  23 B. Ryan, "A Study o f T e c h n o l o g i c a l D i f f u s i o n , " R u r a l S o c i o l o g y , 1 3 : 2 7 3 - 2 8 3 , September, 1948. 24  J . Coleman, E. Katz, and H. Menzel, "The D i f f u s i o n o f an Innovation Among Physicians,"' Sociometry, 20: 2 5 3 - 2 7 0 , December, 1 9 5 7 .  ones. to  T y p i c a l l y i t may take as long f o r the f i r s t  five  s i x per cent t o adopt as i t does f o r the next 80  per c e n t . ^  Tn  2  e  time f o r completing the adoption  cycle  v a r i e s , depending p a r t l y on the nature of the i n n o v a t i o n , however, when the r a t e of change i n other aspects o f c u l t u r e i s c o n s i d e r e d , changes appear t o be coming at an increasing rate. in  The adoption c y c l e f o r most t h i n g s may  f a c t be s h o r t e r now than a g e n e r a t i o n ago and may  continue t o shorten i n f u t u r e . C l a s s i f i c a t i o n of Adopters The at  f a c t t h a t people  adopt new ideas or p r a c t i c e s  d i f f e r e n t times means t h a t they can be c l a s s i f i e d i n  terms o f t h e i r p o s i t i o n i n the adoption p a t t e r n by time. A c l a s s i f i c a t i o n system t h a t d i v i d e s people on the b a s i s of  the time o f adoption r e l a t i v e t o each other has been  developed.^  Since adoption o f s p e c i f i c  changes tends t o  conform t o the normal curve, standard u n i t s were used t o c l a s s i f y the c a t e g o r i e s o f i n n o v a t o r s , e a r l y  adopters,  e a r l y m a j o r i t y , l a t e m a j o r i t y and l a g g a r d s . C h a r a c t e r i s t i c s of Adopters In  25  r e s e a r c h s t u d i e s on adoption and d i f f u s i o n ,  L i o n b e r g e r , op. c i t . , p. 35.  26  Loc. c i t . 27  Rogers,' op.' c i t • , p. 162.  19 variables relating situational  t o s o c i a l , c u l t u r a l , p e r s o n a l and  f a c t o r s have been s e l e c t e d by i n v e s t i g a t o r s  attempting t o c a t e g o r i z e adopters i n the v a r i o u s categories.  Many o f the r e s e a r c h e r s c o r r e l a t e i n n o -  v a t i v e n e s s with g e n e r a l l y s i m i l a r v a r i a b l e s . of the more important and w e l l researched  A number  characteristics  w i l l be presented i n the form o f g e 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  later  adopters. S o c i a l Status. than l a t e r  E a r l i e r adopters have h i g h e r s o c i a l s t a t u s  adopters.  Financial Position.  Earlier  adopters have a more f a v o r a b l e  f i n a n c i a l p o s i t i o n than l a t e r Spe c i a l i z at i o n .  adopters.  E a r l i e r adopters have a more s p e c i a l i z e d  o p e r a t i o n than l a t e r I n f o r m a t i o n Sources.  adopters. E a r l i e r adopters tend t o use im-  p e r s o n a l s o u r c e s , as w e l l as those o u t s i d e t h e i r  particular  s o c i a l system, such as those sources i n c l o s e r contact with the o r i g i n o f new i d e a s , than do l a t e r a d o p t e r s . adopters use a g r e a t e r number of d i f f e r e n t later  Earlier  sources than do  adopters.  Social Relationships. spatial  E a r l i e r adopters have a broader  o r i e n t a t i o n than have l a t e r adopters and they have  28 See a l s o Rogers, pp. c i t . , pp. 172-186, and  20 more o p i n i o n l e a d e r s h i p .  The  extent to which an  individual  shares i n the s o c i a l l i f e  of h i s community through  inter-  a c t i o n has been found t o be s i g n i f i c a n t l y r e l a t e d t o h i s adoption of p r a c t i c e s recommended through e d u c a t i o n a l experiences.^9  30  Enjoyment of Work.  An i n d i v i d u a l ' s enjoyment of h i s  o c c u p a t i o n should a f f e c t h i s r e l a t i o n s h i p to i t by making him more or l e s s s u s c e p t i b l e t o i n n o v a t i o n s a c c o r d i n g t o h i s involvement  with h i s work.  Those i n d i v i d u a l s r e p o r t i n g  the g r e a t e r enjoyment of work have a l s o been found to have achieved h i g h e r scores on the adoption of new  p r a c t i c e s . 3 1 32  Adoption Concept as a C r i t e r i o n of Measurement Welch, a p p l y i n g the adoption concept  as a  criterion  of measurement, e v a l u a t e d three a d u l t education processes  29 Herbert Menzel and E l i h u Katz, " S o c i a l R e l a t i o n ships and I n n o v a t i o n i n the M e d i c a l P r o f e s s i o n : The Epidemiology of a New Drug," P u b l i c Opinion Q u a r t e r l y , 19: 3 3 7 - 3 5 2 , Winter, 1 9 5 5 . 30  C. P. C a r t e r and B. R. W i l l i a m s , "The Charact e r i s t i c s of T e c h n i c a l l y P r o g r e s s i v e Firms."' J o u r n a l of i n d u s t r i a l Economics, 7: 8 7 - 1 0 4 , 1959. 31 C. Verner and P. M. Gubbels, The' Adoption or R e j e c t i o n of Innovations by D a i r y Farm Operators i n the Lower' Fraser' V a l l e y , A g r i c u l t u r a l Economics Research C o u n c i l or uanada, i y 6 y . 32 C. Verner and F. M i l l e r d , Adult E d u c a t i o n arid the Adoption of I n n o v a t i o n s , Vancouver, Department of A g r i c u l t u r a l Economics, U n i v e r s i t y of B r i t i s h Columbia, 1966.  f o r d i s s e m i n a t i n g trade i n f o r m a t i o n t o M i s s o u r i r e s t a u r a n t operators.33 processes:  He s e l e c t e d f o r t e s t i n g t h r e e a d u l t e d u c a t i o n 1) an a d u l t e d u c a t i o n a l group method; 2) a mass  communication method; and 3) a combination  o f both.  Using  four sample groups t o t e s t the r e l a t i v e e f f e c t i v e n e s s -of the s e l e c t e d processes  s c a l e s were developed  t e s t 1) the socio-economic extent o f each respondent's  and used t o  s t a t u s of respondents,  2) the  p a r t i c i p a t i o n i n those  formal  o r g a n i z a t i o n s open t o members of the r e s t a u r a n t i n d u s t r y , and  3) the degree o f adoption o f seven recommended p r a c t i c e s  by each respondent.  The Degree o f Adoption S c a l e  enabled  the i n v e s t i g a t o r t o compute t h r e e types o f adoption f o r each respondent:  scores  the extent t o which recommended  p r a c t i c e s were i n use p r i o r t o the study and t h e r e f o r e a t t r i b u t a b l e t o p r i o r i n f l u e n c e s (ASp); the extent t o which p r a c t i c e s were adopted as a r e s u l t  of the method used  and the t o t a l adoption from a l l sources  (ASs);  (ASt).  F i n d i n g s r e g a r d i n g the r e l a t i o n s h i p of p e r s o n a l c h a r a c t e r i s t i c s o f respondents  t o adoption of the recommended  p r a c t i c e s may be summarized as f o l l o w s .  Socio-economic  s t a t u s was s i g n i f i c a n t l y r e l a t e d t o t o t a l adoption  score  and t o the adoption score from p r i o r i n f l u e n c e s i n a l l groups.  S o c i a l 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  33  Welch, op_.' c i t . , pp. 9 8 - 1 0 7 .  related  to t o t a l adoption and t o adoption from p r i o r  influences  f o r the group r e c e i v i n g the c i r c u l a r o n l y , but not f o r the group method groups.  N e i t h e r 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 t o a d o p t i o n , but e d u 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 t o t a l  adoption  score. The the degree  concept  o f adoption was u t i l i z e d t o determine  t o which respondents  made use o f s p e c i f i c  skills  and techniques taught i n three courses i n a business management  t r a i n i n g programme.  There was found t o be a  s i g n i f i c a n t i n c r e a s e i n the degree respondents  of a d o p t i o n among  i n a l l courses f o l l o w i n g p a r t i c i p a t i o n i n the  programme although the degree among the t e c h n i q u e s .  Three  o f a d o p t i o n was not uniform 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 o f the respondent  to the b u s i n e s s and  the number o f employees i n the b u s i n e s s , were found t o r e l a t e s i g n i f i c a n t l y t o the degree  of adoption.  3 4  Gordon B e l l , "The Adoption of Business P r a c t i c e s by P a r t i c i p a n t s i n the Small Business Management T r a i n i n g Programme," Unpublished M. A. t h e s i s , U n i v e r s i t y of B r i t i s h Columbia, June, 1968.  CHAPTER I I I ANALYSIS OF THE DATA The and  data were c o l l e c t e d , compiled,  subjected to s t a t i s t i c a l a n a l y s i s .  This  tabulated chapter  presents a d e t a i l e d a n a l y s i s o f adoption scores and adopter c a t e g o r i e s ,  the socio-economic c h a r a c t e r i s t i c s  of the p a r t i c i p a n t s  and t h e i r response t o the i n s t i t u t e .  The  r e l a t i o n s h i p s between the socio-economic charac-  teristics  o f the p a r t i c i p a n t s  and adoption are analysed.  ADOPTION SCORES Establishing The  a Base L i n e base l i n e f o r measuring the e f f e c t i v e n e s s  of the i n s t i t u t e was e s t a b l i s h e d  by measuring the degree  of adoption o f each o f the recommended p r a c t i c e s a t t e n d i n g the i n s t i t u t e and s c o r i n g interview  schedule.  prior to  the responses on the  The r e s u l t i n g score i s termed the  a d o p t i o n score due t o p r i o r i n f l u e n c e s .  (ASp) The range  of scores was 0 t o 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 p a r t i c i p a n t s were not aware of the n u r s i n g p r a c t i c e s which were presented a t the i n s t i t u t e . Although 40 per cent o f the p a r t i c i p a n t s were aware o f the  p r a c t i c e s which were presented at the i n s t i t u t e they  had  not i n c o r p o r a t e d  them i n t o t h e i r n u r s i n g  practice.  TABLE I DISTRIBUTION OF PARTICIPANTS BY ADOPTION SCORES DUE TO PRIOR INFLUENCES FOR EACH OF THE SIX RECOMMENDED PRACTICES Recommended Practice  Not Aware 2  DEGREE OF ADOPTION Aware Interest Evaluation i 2 3  Writing nursing history using guide form  44  35  Using nursing history to write objectives f o r nursing care  33  4-6  Using the objectives to write s p e c i f i c nursing methods  4-5  34  Evaluating objectives and methods by using progress notes  58  20  Modifying objectives and methods by the patient's progress  37  40  discharge 65  13  Writing a nursing summary Range of scores Mean S.D.  0-12 2.53 2.04  Trial 4  Adoption  5  2-5  The a d o p t i o n s c o r e s f r o m p r i o r i n f l u e n c e s base l i n e  from which  were used as a  a d o p t i o n r e s u l t i n g from  learning  a t t h e i n s t i t u t e was m e a s u r e d . Adoption Resulting  from the I n s t i t u t e  The d e g r e e o f a d o p t i o n o f i n n o v a t i o n s was established  at the time  of the interview  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 b y o b s e r v i n g t h e u s e o f t h e recommended practices.  R e s p o n s e s w e r e s c o r e d on t h e i n t e r v i e w  i n terms o f t h e degree of a d o p t i o n s c a l e . adoption at the time o f the i n t e r v i e w total  adoption score  schedule  The d e g r e e o f  was e n t e r e d as t h e  (ASt) (Table I I ) .  The t o t a l a d o p t i o n s c o r e m i n u s t h e a d o p t i o n from p r i o r i n f l u e n c e s from  learning  score  provides the adoption score r e s u l t i n g  at the i n s t i t u t e .  ( A S t - ASp = A S s )  r a n g e 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  The  at the  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 standard deviation  o f 4.60.  A comparison  of t h e percentage  d i s t r i b u t i o n s of  p a r t i c i p a n t s by d e g r e e o f a d o p t i o n o f a l l p r a c t i c e s t o t h e I n s t i t u t e and a s a r e s u l t o f l e a r n i n g institute  i s shown i n T a b l e  prior  at the  I I I . 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 a c c o r d i n g t o t h e i r degree o f adoption f o r a l l p r a c t i c e s h a s shown c o n s i d e r a b l e movement t o w a r d t h e acceptance  and f u l l  u s e o f t h e recommended p r a c t i c e e n d  of t h e degree o f a d o p t i o n s c a l e .  Although  only 1 p e r cent  TABLE I I 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 ADOPTION Interest Evaluation 2 3  Trial 4  Adoption  5  Writing nursing history using guide form  19  2  57  1  Using nursing h i s t o r y to write objectives f o r nursing care  40  14  24  1  Using the objectives to write s p e c i f i c 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  49  11  17  1  Writing a nursing discharge summary Range-of scores 12 - 30 Mean 17.25 S.D. 4.63  1  of p a r t i c i p a n t s r e p o r t complete adoption of the p r a c t i c e s , 14 per cent have moved t o the p o i n t where they are u s i n g the recommended p r a c t i c e s on a t r i a l b a s i s , another  67  per cent of p a r t i c i p a n t s continue t o gather more i n f o r mation about the p r a c t i c e s and to evaluate t h e i r usefulness.  potential  E i g h t e e n per cent of the p a r t i c i p a n t s have  remained at the awareness stage without having  progressed  beyond t h i s p o i n t . A comparison of the percentage  d i s t r i b u t i o n s of  p a r t i c i p a n t s by degree of adoption of a l l p r a c t i c e s  prior  to the i n s t i t u t e and as a r e s u l t of l e a r n i n g at the i n s t i t u t e i s shown i n Table I I I .  The percentage  f o r a l l p r a c t i c e s i s 5 8 1 . (Table IV)  This  increase  percentage  i n c r e a s e i n adoption i s c o n s i d e r a b l y g r e a t e r than the 113 per cent i n c r e a s e found by Welch i n h i s study  of  Missouri restaurant operators.  adoption  scores due  The mean of the  to p r i o r i n f l u e n c e s were roughly s i m i l a r i n  both s t u d i e s , 2.64 study.  J  i n Welch's study, and 2.53 i n t h i s  A p o s s i b l e e x p l a n a t i o n f o r t h i s d i f f e r e n c e might  be due t o an economic f a c t o r which might have r e s u l t e d i n the r e s t a u r a n t operators being l e s s w i l l i n g t o r i s k adoption of c e r t a i n recommended p r a c t i c e s than nurses where t h i s f a c t o r was  not p r e s e n t , however, t h i s f i n d i n g  cannot  be s a t i s f a c t o r i l y e x p l a i n e d on the b a s i s 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 Adoption  0.  Not  1.  Aware  2.  Interest  3.  Evaluation  4.  Trial  5.  Adoption  aware  Prior to Institute ASp 59.2  Due t o L e a r n i n g at I n s t i t u t e ASs  .  40.0  18.0  .4  34.0 33.0  .4  14.0 1.0  Total  100.0  100.0  TABLE I V PERCENT INCREASE I N ADOPTION AS A RESULT OF THE INSTITUTE  Mean Mean Mean Adoption Adoption Adoption S c o r e a t - S c o r e due t o = S c o r e due t o A S s x l 0 0 = $ i n c r e a s e Interview Prior Influence Institute ASp 17.25  -  2.53  14.72  14.72 2.53  =  c-o-,  °  CLASSIFICATION OF PARTICIPANTS' INTO ADOPTER CATEGORIES The was  adopters bution  Rogers.^6  will  into  f o u n d by  pants'  adopter  and  scores.  Information characteristics  was  the  (Table  using the  and  i n the  .05  of  distridifference  l e v e l between of the  a  partici-  V)  sex,  m a r i t a l s t a t u s , number  participation years  socio-economic  f o r each p a r t i c i p a n t .  In c o n t i n u i n g  of nursing  community  c i t . , p.  practice,  participation.  36 R o g e r s , op_.  g i v e n group  significant  at the  method  Characteristics  age,  position,  participant  any  distribution  collected  included  satisfaction  test  No  about c e r t a i n  education,  occupational  suggests  categories.  Socio-ecoriomic  children,  categories  Rogers  a chi-square  adoption  information  f o r each  approximate a normal curve  normal d i s t r i b u t i o n  job  score  used t o determine adopter  p r o p o s e d by  was  t o t a l adoption  162  This of  education, income,  TABLE V C L A S S I F I C A T I O N OF PARTICIPANTS INTO ADOPTER CATEGORIES  Adopter Category  Class Boundaries  No. o f P e r c e n t a g e o f S.D. Participants i n from E a c h C a t eg o r y mean Expected (e)  Observed (o-e) 2 (o) e  Innovator  25-30  +2  2.5  1.27  .6051  Early  Adopter  20-24  +1  13.5  11.39  . 3297  Early  M a j o r i t y 15-19  0  34  36.71  .2160  10-14  -1  34  37.98  .4658  5- 9  -2  16  12.66  .6972  Late  Majority  Laggard  chi-square value  NOTE:  2.3138  The n u l l h y p o t h e s i s t h a t t h e s a m p l e f r e q u e n c y d i s t r i b u t i o n approximated t h e normal curve d i s t r i b u t i o n was t e s t e d a t t h e .05 l e v e l o f significance. 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 t h e 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 b e l o w 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  evaluation 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 was  which  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 >  institute. Socio-economic the  classification  using the  difference  In order to t e s t later  bined  of p a r t i c i p a n t s  chi-square test  significant  and  characteristics  i n t o two  at the  f o r any  adopters' the  with  gross  five  e a r l y m a j o r i t y formed the l a t e m a j o r i t y and  into  adopter  categories  a n u l l hypothesis .05  level  of  of  adopter  l a g g a r d formed the  earlier  c a t e g o r i e s were com-  innovator, early  earlier  no  significance.  d i f f e r e n c e s between  adopter  c a t e g o r i e s ; the  were t e s t e d a g a i n s t  later  adopter  category  and  adopter  and the  category.  Age The 60 y e a r s .  age  r a n g e o f t h e p a r t i c i p a n t s was  Twenty-one p e r  c a t e g o r y w h i c h was VII  the median group.  i n d i c a t e s , t h e r e was  difference category  c e n t were i n t h e  no  and  age.  21  t o 40  (Table VI)  statistically  i n the d i s t r i b u t i o n  36  from  to  year  As  Table  significant  o f p a r t i c i p a n t s by  adopter  TABLE V I PERCENTAGE DISTRIBUTION OP PARTICIPANTS BY AGE CATEGORY  Age i n y e a r s  N  Percentage  21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60  9 6 10 9 14 11 3  11,4 7.6 12.7 21.5 11.4 17.7 13.9 3.8  79  100.0  1 7  Total  TABLE V I I PERCENTAGE DISTRIBUTION OP P A R T I C I P A N T S ' AGE BY COMBINED ADOPTER CATEGORY  Age Category  Total No. %  21 - 40 41 - 60  42 37  Total x  d  5^.0 47.0  79 100 .0  E a r l y Adopter No. % 21 1 8  39  Late No.  Adopter %  54 .0 46 .0  21 19  52 .5 47 .5  100 .0  40  100 .0  = 0.012, d . f . l . , n o t 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 o f t h i s d i s t r i b u t i o n no f u r t h e r  a n a l y s i s by sex i s r e p o r t e d . M a r i t a l Status There were 4 l s i n g l e nurses, 32 married and 6 who were s e p a r a t e d , widowed, or d i v o r c e d . Number o f C h i l d r e n F i f t y - t h r e e nurses  (67%) had no c h i l d r e n , while  16 had one or two, and 10 had three or f o u r . Education The  e d u c a t i o n a l p r e p a r a t i o n i n n u r s i n g was  measured by the type of programme from which the nurse graduated:  diploma s c h o o l o f n u r s i n g , diploma  school of  n u r s i n g p l u s one year c e r t i f i c a t e programme i n a u n i v e r s i t y , b a c c a l a u r e a t e degree i n n u r s i n g or master's  degree.  Nearly h a l f of the nurses, 49.4 per cent, were graduates of a diploma diploma  s c h o o l o f n u r s i n g , w h i l e 26.6 per cent were  s c h o o l graduates  ficate.  with a one year u n i v e r s i t y  The number o f nurses with a u n i v e r s i t y degree  accounted  f o r 24 per cent o f the t o t a l and 18 nurses  r e p o r t e d the b a c c a l a u r e a t e and one had a master's (Table V I I I ) tically  certi-  degree.  As Table IX i n d i c a t e s , there was a s t a t i s -  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 o f  p a r t i c i p a n t s by combined e d u c a t i o n and adopter c a t e g o r i e s .  34 Two-thirds  of the l a t e r adopters r e p o r t e d a n u r s i n g  while t w o - t h i r d s of the e a r l i e r adopters had degree.  The  diploma  a university  chi-square value obtained i n an a n a l y s i s by  four adopter  c a t e g o r i e s (Table X) was  significant.  also  statistically  The m a j o r i t y of diploma nurses were found i n  the l a t e m a j o r i t y category whereas the bulk of the u n i v e r s i t y graduates were c l a s s i f i e d as e a r l y m a j o r i t y .  The  data suggest t h a t the d i f f e r e n t type of e d u c a t i o n a l programme engaged i n by the u n i v e r s i t y graduates more r e c e p t i v e n e s s to new  ideas and  results i n  practices.  P a r t i c i p a t i o n i n Continuing E d u c a t i o n The number of short courses attended i n the past two years was  taken i n t o account  as an a d d i t i o n a l measure  that might be r e l a t e d to the adoption of new The median number of courses attended was cent of the p a r t i c i p a n t s i n t h i s category.  practices.  two with 37 per 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 c a t e g o r i e s r a n g i n g from no courses t o more than t h r e e . (Table XI)  There xuas no s t a t i s t i c a l l y  significant  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 combined adopter and number of c o n t i n u i n g e d u c a t i o n courses  taken.  category  TABLE V I I I PERCENTAGE DISTRIBUTION OP PARTICIPANTS BY EDUCATION  Type o f Programme Diploma Diploma plus University certificate Baccalaureate Master's  Total  N  Percentage  39  49.4  21 18 1  26.6 22.8 1.2  79  100.0  TABLE IX PERCENTAGE DISTRIBUTION OP PARTICIPANTS' EDUCATION BY COMBINED ADOPTER CATEGORY  Type o f Programme  Total No. %  Early No.  Diploma University  39 40  49.4 50.6  13 26  33.3 66.7  26 14  65.0 35.0  79  100.0  39  100.0  40  100.0  Total  x  2  =  7 .-9-20 d . f . 1 . 3  9  Adopter Late % No.  p . <.01.  Adopter %  36 TABLE X PERCENTAGE DISTRIBUTION OP PARTICIPANTS BY EDUCATION AND BY POUR ADOPTER CATEGORIES  Type o f Programme  Total Early Early Late No. % Adopter Majority Majority No. % No. % No. %  Diploma University  39 40  Total  x  49.4 50.6  79 100.0  4 6  40.0 9 60.0 20  10 100.0  31.0 69.0  29 100.0  23 7  Laggard No. %  77.0 23.0  3 7  30.0 70.0  30 100.0  10  100.0  = 24.828, d . f . 3, p. <.001  2  TABLE X I PERCENTAGE DISTRIBUTION OP NUMBER OP CONTINUING EDUCATION COURSES ATTENDED BY PARTICIPANTS BY COMBINED ADOPTER CATEGORY  Number o f Courses  Total No. %  None 1 2 3 More 3  11 13 29 12 14  Total  x  2  79  14.0 16.0 37.0 15.0 18.0 100.0  Early No. 6  Adopter cf 10  Late Adopter No. %  8 6  15.4 15.4 33.3 20.5 15.4  16  39  100.0  40  6 13  = 2.076, d . f . 4, n o t s i g n i f i c a n t  5 7 4  8  12.0 17.5 40.0 10.0 20.5 100.0  37 Employing  Agencies  F i f t e e n h o s p i t a l s and 3 p u b l i c h e a l t h agencies r e p r e s e n t e d the employing attended the i n s t i t u t e .  institutions  f o r the nurses  who  There were t e n g e n e r a l h o s p i t a l s  v a r y i n g i n s i z e from 103 t o 17^9 beds, one v e t e r a n ' s h o s p i t a l of 1157 beds, two p s y c h i a t r i c h o s p i t a l s o f 3091 beds and 60 beds, and two extended respectively.  care h o s p i t a l s o f 70 and 91 beds  The numbers of nurses a t t e n d i n g the i n s t i t u t e  from one i n s t i t u t i o n tended t o be s m a l l except f o r t h r e e l a r g e h o s p i t a l s which were r e p r e s e n t e d by 31, 11 and 8 nurses.  One nurse attended from each o f e i g h t a g e n c i e s , two  nurses from two h o s p i t a l s and t h r e e t o f o u r nurses from the remaining f i v e h o s p i t a l s .  Although a l a r g e r number of  nurses attended from the 3 l a r g e r h o s p i t a l s i n the d i s t r i c t the nurses were from v a r i o u s wards and u n i t s w i t h i n these l a r g e i n s t i t u t i o n s which i n e f f e c t produced the same s i t u a t i o n as one nurse a t t e n d i n g from the s m a l l e r 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 o f that nurse from others who had attended the i n s t i t u t e when she r e t u r n e d t o her work.  When asked about the number of other nurses  from  t h e i r u n i t o r ward who had attended the i n s t i t u t e , 56$ o f the nurses r e p o r t e d that no one e l s e had attended, 2k% r e p o r t e d one other nurse a t t e n d i n g , 1 \% r e p o r t e d two nurses L  a t t e n d i n g and 6% r e p o r t e d more than t h i s number, although these l a t t e r were nurses i n s u p e r v i s o r y p o s i t i o n s who were r e s p o n s i b l e f o r a number o f wards or areas w i t h i n the hospital.  38 In view of the f a c t t h a t the i n n o v a t i o n s presented at the i n s t i t u t e were ones which are not p a r t of c u r r e n t n u r s i n g p r a c t i c e or h o s p i t a l p o l i c y , the f a c t t h a t the nurse who  had attended the i n s t i t u t e was  other nurses who undoubtedly  separated from  had s i m i l a r knowledge and understanding  c r e a t e d s t r a i n s f o r the nurse who  t o i n t r o d u c e nex-j p r a c t i c e s .  In an attempt  was  trying  to overcome  t h i s s i t u a t i o n the nurses i n s e v e r a l h o s p i t a l s formed of those who  groups  had attended the i n s t i t u t e i n order t o g a i n  support f o r each o t h e r and f o r t h e i r attempts practices started.  t o get  new  These groups were f o r m a l l y s a n c t i o n e d  by a d m i n i s t r a t i o n , were f r e q u e n t l y c h a i r e d by nurses i n a d m i n i s t r a t i v e p o s i t i o n s and met number of months.  at r e g u l a r times f o r a  The nurses used these meetings  to d i s -  cuss t h e i r p e r s o n a l involvement i n the use of the n u r s i n g p r a c t i c e s and to d i s c u s s p o s s i b l e ways to get these p r a c t i c e s adopted group meetings  i n their respective Institutions.  p r o v i d e d a group  These  f e e l i n g which helped o f f s e t  the i s o l a t i o n t h a t i n d i v i d u a l nurses had f e l t , however, perhaps because  they were adhoc groups w i t h i n the  s t r a t i v e s t r u c t u r e they d i d not prove to be i n the d i f f u s i o n of the p r a c t i c e s . of the groups meeting  admini-  influential  G r a d u a l l y the  purpose  seemed l e s s r e l e v a n t and they were  no l o n g e r h e l d .  Sources of I n f o r m a t i o n The source of i n f o r m a t i o n about the n u r s i n g p r a c t i c e s that the nurses found most h e l p f u l was r e p o r t e d  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  the group meetings.  e d u c a t i o n a l experiences  Considering  or  the f a c t t h a t the  i n s t i t u t e was h e l d i n a two day time p e r i o d and that the resource  person was not a v a i l a b l e f o r f u r t h e r h e l p , the  m a j o r i t y o f the nurses were thrown back t o t h e i r resources other.  and t o the help t h a t they  The adoption  own  could get from each  of new p r a c t i c e s by an i n d i v i d u a l i s  o f t e n d i f f i c u l t , however, the problems inherent i n i n t r o ducing new p r a c t i c e s i n t o a complex b u r e a u c r a t i c o r g a n i z a t i o n 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 P o s i t i o n Nurses h o l d i n g a head nurse p o s i t i o n accounted for  5 0 per cent o f the p a r t i c i p a n t s , while  cent occupied  another 3 7 per  p o s i t i o n s o f s u p e r v i s o r s , d i r e c t o r s of  n u r s i n g , or i n s t r u c t o r s .  A s m a l l number of p a r t i c i p a n t s  ( 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 n u r s i n g p r a c t i c e s d i s c u s s e d i n the  i n s t i t u t e were those which are c a r r i e d out by the nurse r e s p o n s i b l e f o r d i r e c t p a t i e n t 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 p o p u l a t i o n s t u d i e s , only a s m a l l percentage were s t a f f nurses consequently adoption  the  o f the recommended p r a c t i c e s would apt to be l e s s  than had that p o r t i o n of the p o p u l a t i o n been l a r g e r . d i s t r i b u t i o n s by o c c u p a t i o n a l p o s i t i o n and adopter show more s t a f f nurses t o be e a r l y adopters  The  category  than nurses i n  other occupational p o s i t i o n s t h e d i s t r i b u t i o n by a d o p t e r significant.  although the difference i n c a t e g o r y was n o t s t a t i s t i c a l l y  (Table X I I )  TABLE X I I PERCENTAGE DISTRIBUTION OP PARTICIPANTS' OCCUPATION BY COMBINED ADOPTER CATEGORY  Position  Total No. %  S t a f f N u r s e 10 Head N u r s e 40 Supervisor 18 4 Director Instructor 7  Total  x  Years  79  = 1.148  3  Early No.  13.,0  50..0  23..0 5..0 9..0  100. .0  Adopter %  Adopter %  15,,0 46,.0 26,.0 5..0  4 22  8  8,.0  2 4  10 .0 55 .0 20 .0 5 .0 10 .0  100, .0  40  100 ..0  6  18  10 2  3  39  Late No.  d . f . 4, n o t s i g n i f i c a n t  of Practice i n Nursing Most o f t h e p a r t i c i p a n t s a t t h e i n s t i t u t e  experienced nurse p r a c t i t i o n e r s . 15 t o 19 y e a r s o f p r a c t i c e  were  The m e d i a n was i n t h e  category which  accounted f o r  24 p e r c e n t o f t h e g r o u p a n d a n o t h e r  30 p e r c e n t h a d  practiced  (Table X I I I )  f o r twenty  y e a r s o r more.  T a b l e X I V 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 difference  significant  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  c a t e g o r y and y e a r s o f p r a c t i c e .  As  adopter  41 Income Income was d e t e r m i n e d s a l a r y and was r e c o r d e d ranged  from  t o $699.  i n categories.  o f the monthly  Monthly  salaries  $500 t o $999 and t h e m e d i a n c a t e g o r y was  ( T a b l e XV)  cant d i f f e r e n c e adopter  on t h e b a s i s  T h e r e was no s t a t i s t i c a l l y  signifi-  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  c a t e g o r y and income.  TABLE  (Table XVI)  XIII  PERCENTAGE DISTRIBUTION BY YEARS OP PRACTICE FOR A L L PARTICIPANTS  Years  N  0 5 10 15 20  9  - 4 - 9 - 14 - 19 o r more  9  18  19 24 Total  * Median  $600  79  Percentage 11.3 11.3 23.1 24.0* 30.3 100.0  TABLE XIV PERCENTAGE DISTRIBUTION OF YEARS OF PRACTICE BY COMBINED ADOPTER CATEGORY  Years o f Practice  Total No. %  Early No.  0 9 10 - 19 20 o r more  19  24.0 45.7 30.3  11 17 11  28.2  8  43.6  28.2  19 13  20 .0 47 .5 32 .5  79 100.0  39  100.0  40  100 .0  Total  x  2  36 24  = 0.732, d . f . 1 , not  Adopter %  Late No.  Adopter • %  significant.  TABLE XV PERCENTAGE DISTRIBUTION BY MONTHLY SALARY FOR ALL PARTICIPANTS  Monthly  $500 $600 $700 $800 $900  -  Salary  4599 $699 $799 $899 $999  .  Total  *  Median  N  Percentage  21 23 30 3 2  26.6 29.1* 38.0 3.8 2.5  79  100.0  43 TABLE XVI PERCENTAGE DISTRIBUTION OF PARTICIPANTS' MONTHLY SALARY BY ADOPTER CATEGORY  Monthly Salary  Total No. %  E a r l y Adopter No. %  Late Adopter No.%  $500 - $699 $700 - $999  44 35  19 20  25 15  62.5 37.5  40  100.0  Total  x  d  55.7 44.3  79 100.0  39  49'.0 51.0  100.0  = 1.516, d . f . l , not s i g n i f i c a n t .  Community  Participation  Chapin's S o c i a l P a r t i c i p a t i o n S c a l e ^  7  was used t o  measure the degree of p a r t i c i p a t i o n i n community and i n s t i t u t i o n s .  groups  The extent of p a r t i c i p a t i o n i s measured  by the number of memberships h e l d during the p r e v i o u s year and each membership counts as one p o i n t toward the t o t a l scale score.  I n t e n s i t y 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 h o l d i n g o f o f f i c e s .  A high  s c a l e score r e f l e c t s a high r a t e of p a r t i c i p a t i o n .  Standard  37 F. S t u a r t Chapin, E x p e r i m e n t a l Designs' i n S o c i o l o g i c a l Research, New York, Harper, 1955, Appendix  pp. 275-27«.  B.,  44 scores have been computed f o r v a r i o u s o c c u p a t i o n a l groups with the mean score f o r p r o f e s s i o n a l groups being 20.38 The range of s c o r e s f o r the nurses was between 10 and  55j with the median f a l l i n g i n the 16 t o 20  category.  (Table XVII)  was r e p o r t e d by 40.5  score  Membership i n no o r g a n i z a t i o n s  per cent o f the sample with  33 per  cent i n d i c a t i n g membership i n two or more l o c a l o r g a n i z a t i o n s . 39  The maximum number o f memberships was h e l d i n  f o u r o r g a n i z a t i o n s but t h i s was r e p o r t e d by 0.9  per cent  of the p a r t i c i p a n t s . The acceptance of l e a d e r s h i p r e s p o n s i b i l i t y c h a r a c t e r i s t i c of the nurses  studied.  No committee  memberships were r e p o r t e d by 80 per cent, w h i l e cent r e p o r t e d membership  16.4 per  on one committee and 3.9  two or more committee p o s i t i o n s .  per cent  S i m i l a r l y no o f f i c e s i n  l o c a l o r g a n i z a t i o n s were h e l d by 77.2  per cent, while  per cent r e p o r t e d h o l d i n g one o f f i c e and 2.5 h o l d i n g a maximum of three o f f i c e s . b u t i o n s were r e p o r t e d by 45.5  i s not  20.5  per cent  No f i n a n c i a l  contri-  per cent, while 45.5 per  cent r e p o r t e d c o n t r i b u t i n g t o one or two o r g a n i z a t i o n s and 9 per cent c o n t r i b u t e d t o three to f i v e o r g a n i z a t i o n s . Table XVIII 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  As  significant  38  D e l b e r t C. M i l l e r , Handbook' o f Research Design and S o c i a l Measurement, New York, David McKay Co., I n c . , 1964, p. 209.  39 Membership In the p r o f e s s i o n a l nurses' a s s o c i a t i o n s was excluded as a l l nurses r e p o r t e d t h i s .  45 difference and  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 a d o p t e r  category  social participation.  TABLE  XVII  PERCENTAGE DISTRIBUTION OF PARTICIPANTS BY SOCIAL PARTICIPATION SCORE (CHAPIN SCALE)  Score  N  6-10 11 - 15  1 25  16 - 20  1.3 31.6  19  21 - 25 26-30 31-35  Total  24.0*  13 3 9  16.5 4.0 11.3  9  11.3  79  100.0  36 o r more  *  Percentage  Median TABLE  XVIII  PERCENTAGE DISTRIBUTION OF PARTICIPANTS' COMBINED SOCIAL PARTICIPATION BY COMBINED ADOPTER CATEGORY  Scores  Total No. %  Early No.  6-20 21 - 36  45 34  57.0 43.0  21 18  54.0  46.0  16  24  60.0  Totalv/,:.79  100.0  39  100.0  40  100.0  x  d  Adopter %  = 0.304, d . f . l , n o t s i g n i f i c a n t .  Late No.  SCORES  Adopter %  40.0  Job  Satisfaction The B r a y f i e l d and Rothe Index i s a g e n e r a l measure  4o of  job s a t i s f a c t i o n .  A shortened v e r s i o n o f t h i s  u s i n g nine o f the e i g h t e e n items was a d m i n i s t e r e d .  index Five  responses r a n g i n g from " s t r o n g l y agree" to " s t r o n g l y  dis-  agree" were a v a i l a b l e f o r each item and a response was scored from one t o f i v e p o i n t s .  A maximum s c a l e score of  45 would i n d i c a t e a h i g h l y f a v o r a b l e a t t i t u d e whereas a minimum score of 9 would be i n d i c a t i v e of extreme d i s satisfaction . The d i s t r i b u t i o n o f scores showed a range 25 t o 40 with the median i n the 33 t o 36 p o i n t (Table XIX)  from  class.  Since over h a l f o f the nurses were i n the  median category t h i s would i n d i c a t e that they are generally s a t i s f i e d with t h e i r jobs. statistically  There was no  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 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 , " J o u r n a l of A p p l i e d 'Psychology, 35:  307-311, October, 1951.  TABLE XIX PERCENTAGE DISTRIBUTION OP PARTICIPANTS JOB SATISFACTION SCORES  Score 25 29 .33 37  N  -28 - 32 - 36 - 40  Percentage  1 21 47 10  Total  BY  1.3 26.6 59.5* 12.6  79  100.0  * Median  TABLE XX PERCENTAGE DISTRIBUTION OF PARTICIPANTS' JOB SATISFACTION SCORES BY COMBINED ADOPTER CATEGORY  Score  Total No. %  Early No.  25 - 32 33 - 40  22 57  28.0 72.0  10 29  26.0 74.0  12 28  30.0 70.0  Total  79  100.0  39  100.0  40  100.0  x  2  = 0.184, d . f . l ,  Adopter %  not s i g n i f i c a n t .  Late No.  Adopter %  48 Participants The measure  Reaction  to  the'  Kropp-Verner  participants'  participant  Institute  Attitude Scale  attitudes  completed  an  to  the  was  used  to  course.  e v a l u a t i o n sheet  at  Each  the  end  of  4l the  institute  measurement comparing point  which  of  the  scale.  the  was  response  median On  subsequently  value  this  to of  scale  the  scored.  institute  a l l scores  the  The  lower  to  the  i s made the  by  eleven  score  the  more  4? favorable  the  reaction.  Reactions one  of  ment for  the  12  " I t was  the  pants that  most  half  conference XXI)  As  of  was  the  Table  adopter  e x a c t l y what  helpful.  toward  significant by  not  the  2.91  The  XXII  range  indicates,  category  and  i n the  favorable, "It I have  the  of  The  that  (48  per  end  of  was  was  no  distribution scale  score  partici-  and  felt  to  rated  scale.  was state-  mean  2.1  cent) the  to  the  institute  scores  there  attitude  had"  needed."  suggests  with  favorable  difference  I  which  participants the  most  experiences  generally pleased  i t was  Nearly  from  rewarding  institute  were  ranged  4.7.' the  (Table  statistically of  participants  score.  41 See to  Appendix  A. ,' S t a t e m e n t s  Describing  Reactions  Course.  42 Kropp  and  Verner,  op_.  cit.,  pp.  212-215.  TABLE XXI PERCENTAGE DISTRIBUTION BY KROPP-VERNER ATTITUDE SCALE FOR ALL PARTICIPANTS  K-V Score  N  2.0 - 2.9 3.0 - 3.9 4.0 - 4.9  48  28 ^  61.0 35.4 3.8  79  100.0  Total  Percentage  TABLE XXII PERCENTAGE DISTRIBUTION OF PARTICIPANTS KROPP-VERNER ATTITUDE SCORES BY COMBINED ADOPTER CATEGORY 1  K-V Score  Total No. %  E a r l y Adopter No. %  Late Adopter No. %  2.1 - 3.2 3.3 - 4.7  62 17  78.5 21.5  31 8  79.5 20.5  31 9  77.5 22.5  79  100.0  39  100.0  40  100.0  Total  x  2  =  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 t e s t e d  for s t a t i s t i c a l  ho  significance.  J  To c o n t r o l  for interaction  effects,  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 a l s o computed. A multiple the  regression  combined a b i l i t y  analysis  was performed t o determine  of a l l of the socio-economic  c h a r a c t e r i s t i c s studied  t o account f o r v a r i a t i o n s  i n the  adoption s c o r e . 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 r e l a t i o n s h i p s  between a d o p t i o n s c o r e ,  socio-economic c h a r a c t e r i s t i c s and a t t i t u d e  scale.  This  procedure p r o v i d e s a n u m e r i c a l estimate of the magnitude of the r e l a t i o n s h i p between two sets of r e l a t i o n s h i p s XXIII.  of data.  were found to e x i s t as shown i n Table  Age and years o f p r a c t i c e were s t r o n g l y  i n d i c a t i n g that  A number  older  nurses had p r a c t i c e d  related  nursing f o r  43 As the data c o n s i s t e d of o r d i n a l and i n t e r v a l v a r i a b l e s t h i s f a c t o r was considered i n the s e l e c t i o n of the c o r r e c t c o r r e l a t i o n formula t o be used f o r any p a i r of v a r i a b l e s . Jaspen's C o e f f i c i e n t of M u l t i s e r i a l C o r r e l a t i o n ( o r d i n a l - i n t e r v a l ) , Pearson's C o e f f i c i e n t of C o r r e l a t i o n ( i n t e r v a l - i n t e r v a l ) , and Goodman's and K r u s k a l ' s C o e f f i c i e n t of Rank A s s o c i a t i o n (ordinal-ordinal) were used with the P t e s t s and G t e s t o f s i g n i f i c a n c e .  longer periods  o f time.  The r e l a t i o n s h i p between a  nurse's income and her p o s i t i o n on the o c c u p a t i o n a l s c a l e was r e f l e c t e d i n the c o r r e l a t i o n , o b v i o u s l y advancement i n the h i e r a r c h y i s rewarded by f i n a n c i a l recompense i n d i c a t i n g t h a t f i n a n c i a l reward i n the n u r s i n g p r o f e s s i o n does not accrue years p r a c t i c e or experience  from the number of  i n bedside  n u r s i n g , but  r a t h e r from moving i n t o a d m i n i s t r a t i v e or t e a c h i n g positions.  I t was a l s o e v i d e n t , however, t h a t  those  nurses with more years o f p r a c t i c e d i d r e c e i v e more income than those who had p r a c t i c e d f o r a s h o r t e r p e r i o d of time.  A d i r e c t r e l a t i o n s h i p e x i s t e d between the  nurse's p o s i t i o n i n the o r g a n i z a t i o n a l s t r u c t u r e and the e d u c a t i o n a l l e v e l that she had achieved, with more education  those  nurses  tending t o occupy higher p o s i t i o n s .  As the l e n g t h of time t h a t the nurse had p r a c t i c e d i n creased  so d i d her p a r t i c i p a t i o n i n programmes of  continuing education.  Those nurses who had p r a c t i c e d f o r  the longest time p e r i o d and who were, t h e r e f o r e , f a r t h e r away from t h e i r i n i t i a l e d u c a t i o n a l p r e p a r a t i o n recognized  the need t o keep up-to-date with  apparently  current  p r a c t i c e s and as a r e s u l t e n r o l l e d i n a g r e a t e r number of courses  i n continuing education  than d i d those nurses who  had more r e c e n t l y completed the e d u c a t i o n a l  experience.  None o f the socio-economic c h a r a c t e r i s t i c s showed a significant adoption  zero order c o r r e l a t i o n i n r e l a t i o n t o the  score.  TABLE  XXIII  CORRELATION C O E F F I C I E N T S  1  1 . Adoption Score 2. Attitude Scale  2  3  4  5  6  7  8  -0.1320  1.00  0.0819 - 0 . 0 4 3 7  4. S o c i a l P a r t i c i p a t i o n  0.0560  0.1239  1.00  -0.0634 1.00  5. Continuing Education - 0 . 0 4 9 4  -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 . 0 0  0.1544 - 0 . 1 6 8 1  -0.1191  0.2332 - 0 . 2 1 8 2  LO. Age  10  1.00  3. Job S a t i s f a c t i o n  9. Education  9  0.0005 1  0.0121  2  0.0184  3  0.0520  4  0.3094 5  0.2792 -0.2625 0.5172 1.00 0.4256 6  0.7850 0.3086-0.3510 7  8  9  1.00  10  NOTEJ Underlined values indicate a s i g n i f i c a n t degree of association. For the tests of significance a n u l l hypothesis of no c o r r e l a t i o n was used with a .05 l e v e l of s i g n i f i c a n c e . The c r i t e r i o n i s to r e j e c t the n u l l hypothesis i f the c o r r e l a t i o n c o e f f i c i e n t i s l e s s 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 u n d e r l y i n g r e l a t i o n s h i p s between variables.  E s s e n t i a l l y t h i s i s a computational  f o r removing or p a r t i a l l i n g out the tendency  procedure  other  v a r i a b l e s have t o i n f l a t e the c o r r e l a t i o n between two v a r i a b l e s when they are r e l a t e d t o 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 i n d i c a t e s the degree of a s s o c i a t i o n among a l l v a r i a b l e s w i t h each v a r i a b l e h e l d constant i n t u r n , and t h e r e f o r e , i s an i n d i c a t i o n of those v a r i a b l e s which assume most importance  i n relation  t o the v a r i a b l e being t e s t e d . 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 r e v e a l e d  two  v a r i a b l e s which were s i g n i f i c a n t l y r e l a t e d t o adoption score.  (Table XXIV)  Those nurses who  had achieved a  h i g h e r l e v e l o f e d u c a t i o n were those who  achieved h i g h e r  adoption s c o r e s , i n d i c a t i n g t h a t nurses with more e d u c a t i o n were more r e c e p t i v e t o the adoption o f new i s , nurses who  had graduated  practices.  That  from b a c c a l a u r e a t e or master's  degree programmes i n n u r s i n g were found i n the i n n o v a t o r and e a r l y adopter c a t e g o r i e s t o a g r e a t e r extent than were nurses who nursing.  had graduated T h i s was  from diploma programmes i n  not an unexpected  f i n d i n g i n view of  p r e v i o u s r e s e a r c h s t u d i e s which have found e d u c a t i o n t o 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 new  practices.  A n e g a t i v e c o r r e l a t i o n c o e f f i c i e n t e x i s t e d between o c c u p a t i o n a l p o s i t i o n and adoption score which means t h a t  54 TABLE X X I V P A R T I A L CORRELATION COEFFICIENTS  1. A d o p t i o n Score  -1.000  2. A t t i t u d e Scale  -0.128  -1.000  3. J o b  0.073  0.008  -1.000  4. S o c i a l Participation  0.080  0.210  -0.104  5. C o n t i n u i n g  0.030  -0.068  0.113  6. Income  0.015  -0.056  ' 0.240  -0.054  -0.022  7. Y e a r s o f  -0.053  -0.084  0.090  0.177  0.258  8. O c c u p a t i o n a l  -0.278  -0.004  -0.129  0.054  0.231  0.236  -0.120  -0.072  0.162  -0.249  0.109  0.075  -0.154  1  2  Satisfaction  Education  Practice  -1.000  0.143 -1.0.00  Position  9. E d u c a t i o n  10. Age  3  -0.081 -0.052  4  5  TABLE X X I V  (cont'd)  PARTIAL CORRELATION COEFFICIENTS  6  7  8  9  6. Income .'  1.000  7. Y e a r s o f Practice  0.010  -1.000  8.  Occupational Position  0.390  0.004  -1.000  9.  Education  0.203  0.063  0.407  -1.000  Age  0.318  0.691  0.022  -0.318  6  7  8  10.  9  10  -1.000  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 d e g r e e o f association. 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 o u t 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 b a s e d 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 c a n be a p p r o x i m a t e d closely w i t h a n o r m a l c u r v e h a v i n g t h e mean 0 and t h e 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 t h e sample s i z e . Therefore J-h-l the c r i t e r i o n i s t o r e j e c t the n u l l hypothesis 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 fn-1  coefficient  JTI-I  i s l e s s t h a n -.217 o r g r e a t e r t h a n  .217)  56 nurses who  were i n higher o c c u p a t i o n a l p o s i t i o n s tended  to adopt the recommended p r a c t i c e s to a l e s s e r degree than d i d those  nurses who  f i n d i n g i s not  s u r p r i s i n g i n that the n u r s i n g p r a c t i c e s  which were presented  were i n s t a f f p o s i t i o n s .  This  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 p r o v i d i n g d i r e c t p a t i e n t care.  Head nurses and  u s u a l l y more occupied  with  with the n u r s i n g process  supervisors  a d m i n i s t r a t i v e f u n c t i o n s than  described i n t h i s  institute.  D i r e c t o r s of n u r s i n g and i n s t r u c t o r s are l i k e l y e q u a l l y removed from d i r e c t p a t i e n t care The  to be  activities.  s i g n i f i c a n t r e l a t i o n s h i p s among the  socio-economic c h a r a c t e r i s t i c s were s i m i l a r to found In the zero order additional findings.  are  remaining those  c o r r e l a t i o n s with the f o l l o w i n g  The  age  of the nurse was  r e l a t e d to  her income and to her e d u c a t i o n a l l e v e l , t h a t i s as i n c r e a s e d so d i d income. and  education,  The  r e v e r s e was  o l d e r nurses tended to have l e s s  p r e p a r a t i o n than d i d younger ones. was  true for  age  educational  An unexpected f i n d i n g  that those nurses with more education had  fewer courses  age  i n c o n t i n u i n g education.  attended  This finding  may  be l i n k e d to another f i n d i n g i n t h i s study t h a t the nurses with more education were younger and t h e r e f o r e c l o s e r to t h e i r e d u c a t i o n a l p r e p a r a t i o n than the o l d e r nurses had  l e s s education  and who  of c o n t i n u i n g education.  who  p a r t i c i p a t e d more In programmes Another f i n d i n g 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 c o n t i n u i n g education  was  t h a t nurses i n h i g h e r o c c u p a t i o n a l p o s i t i o n s  attended  more courses than d i d nurses at the s t a f f l e v e l . t h i s f i n d i n g r e f l e c t s more i n t e r e s t  Whether  i n c o n t i n u i n g edu-  c a t i o n , or t h a t s t a f f nurses f i n d i t l e s s easy t o get away t o attend these c o u r s e s , i s not p o s s i b l e t o say. The  amount of income and the degree of job  were found t o be congruent  satisfaction  f a c t o r s In the p o p u l a t i o n  s t u d i e d , f o r as the income i n c r e a s e d so d i d the degree of job s a t i s f a c t i o n r e p o r t e d . MULTIPLE REGRESSION ANALYSIS The m u l t i p l e r e g r e s s i o n a n a l y s i s p r o v i d e s an estimate of the value of the adoption score on the b a s i s of a s e t o f measurements o f the socio-economic teristics.  charac-  T h i s a n a l y s i s i n d i c a t e s the combined  of a l l the socio-economic  c h a r a c t e r i s t i c s s t u d i e d to  f o r v a r i a t i o n s i n the adoption s c o r e . i d e n t i f i e d two  ability account  This analysis  c h a r a c t e r i s t i c s , e d u c a t i o n and o c c u p a t i o n a l  p o s i t i o n , as s i g n i f i c a n t l y r e l a t e d t o adoption s c o r e . (Table XXV)  The  c o e f f i c i e n t of d e t e r m i n a t i o n  (.297)  in-  d i c a t e d that' some 30 per cent of the v a r i a t i o n i n adoption was  e x p l a i n e d by these two  variables.  These f i n d i n g s are not wholly i n agreement w i t h the r e s u l t s of other r e s e a r c h .  Rogers notes t h a t e a r l i e r  adopters tended t o be younger than l a t e r a d o p t e r s , but  he  TABLE XXV REGRESSION ANALYSIS SELECTED VARIABLES AGAINST ADOPTION SCORE  Variable Education Position  RSQ P Prob. Std E r r Y r  Coefficient 0.6625 -1.2718  Std E r r 0.3102 0.5220  = 0.0884 = 0.0290 = 4.4539 = .297 ( m u l t i p l e  P-Ratio  • P Prob  4.5608 5.9364  0.0340 0.0164  correlation  coefficient)  does i n d i c a t e  a l a c k o f agreement  on t h i s  was  t o be  characteristic  not  found  a significant  study.  The  equally  unclear, Lionberger  t o be  relationship  between a d o p t i o n  i n d i r e c t , h o w e v e r , he  s c h o o l i n g was  point.^  found  in  this  education i s  the r e l a t i o n s h i p  indicated  associated with  and  Age  likely  t h a t more y e a r s  higher r a t e s of  of  adoption  lie than  fewer y e a r s .  educational studies  level  i n which  adoption.  46  On  J  as  the  one  o t h e r hand, Rogers  factor  in social  e d u c a t i o n was  Those i n d i v i d u a l s  o f work were f o u n d  considers  s t a t u s and  significantly  related  notes to  r e p o r t i n g g r e a t e r enjoyment  t o have a c h i e v e d h i g h e r  scores  i n the  47 48 adoption been  o f new  found  practices.  t o be  4Q new  practices.  findings  or whether they t h e r e have not practices  44  by  significantly  Social participation related  t o the  adoption  I t i s not  study  are unique  are unique been other  t o a nurse  t o the n u r s e s s t u d i e s of the  in this adoption  study of  Rogers,' 0 £ . b i t . , p. 1 7 2 . 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,  Verner  and M i l l e r d ,  op_.' c i t . , p.  11.  op_. c i t . ,  19.  48 49 M e n z e l and  Katz,  op.  337-352. . . b i t . , pp. 87-104.  cit.,  and W i l l i a m s , op_.  p.  pp.  the  population  nurses.  Carter  of  p o s s i b l e t o say w h e t h e r  45  50  has  SO ^  in this  '  as new  CHAPTER IV SUMMARY AND CONCLUSIONS The need f o r a method o f e v a l u a t i n g t h e e f f e c t i v e n e s s o f a n u r s i n g i n s t i t u t e was the m o t i v a t i n g f a c t o r i n undertaking t h i s stud;/. as t o how i t can be determined  The q u e s t i o n was posed  whether a programme i n  c o n t i n u i n g e d u c a t i o n has helped nurses t o improve t h e i r practice.  T h i s study r e p o r t s on the r e s u l t s o f a p p l y i n g  the adoption concept  as a c r i t e r i o n t o measure l e a r n i n g  that o c c u r r e d at one i n s t i t u t e attended by 122 nurse p a r t i c i p a n t s from whom a sample o f 79 were s e l e c t e d . • ADOPTION Three kinds o f adoption scores f o r each p a r t i c i pant  i n r e l a t i o n t o the p r a c t i c e s recommended at the i n s t i -  t u t e were computed: adoption score r e s u l t i n g from  prior  i n f l u e n c e s ; adoption score at the time o f i n t e r v i e w ; and adoption score 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 . The  adoption score was determined  by a s s i g n i n g values t o  each stage o f the adoption p r o c e s s : 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 adoption. A comparison between adoption scores p r i o r t o the i n s t i t u t e and the adoption scores due t o l e a r n i n g a t the  il i n s t i t u t e shows the percentage i n c r e a s e t o be 5 8 l . percentage i n c r e a s e was  This  very much g r e a t e r than was  found  by Welch i n h i s study of M i s s o u r i r e s t a u r a n t o p e r a t o r s . In h i s study the per cent i n c r e a s e i n adoption due t o an I n s t i t u t e was factorily  113.  T h i s f i n d i n g cannot be  satis-  e x p l a i n e d from the data a v a i l a b l e .  The adoption concept can be used as a c r i t e r i o n t o measure l e a r n i n g that occurs at an i n s t i t u t e . adoption concept can be used to measure degree  The  of adoption  of recommended p r a c t i c e s , and t h e r e f o r e , can measure the degree to which nurses have i n c o r p o r a t e d i n t o  their  n u r s i n g p r a c t i c e those p r a c t i c e s which have been recommended at an  institute. 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  c a t e g o r i e s was  shown to approximate  the. normal  adopter curve with  the f o l l o w i n g percentages of p a r t i c i p a n t s i n each category: Innovator 1.27; E a r l y Adopter 1 1 . 3 9 ; E a r l y M a j o r i t y 3 6 . 7 1 ; Late M a j o r i t y 3 7 . 9 8 ; and Laggard 12.66. SUMMARY OF FINDINGS Socio-economic  c h a r a c t e r i s t i c s and the a t t i t u d e  of the p a r t i c i p a n t s t o the i n s t i t u t e were measured a g a i n s t adopter c a t e g o r i e s t o determine what r e l a t i o n s h i p s  existed.  In order t o t e s t f o r 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 combined 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 forming the " e a r l y " adopter  category, and  the l a t e m a j o r i t y and l a g g a r d forming the " l a t e "  adopter  category. E d u c a t i o n was the only c h a r a c t e r i s t i c which was shown t o have a s i g n i f i c a n t adopter was  r e l a t i o n s h i p t o the combined  category u s i n g the chi-square t e s t .  s i g n i f i c a n t l y r e l a t e d t o a two adopter  Education category,  early  and l a t e , at the .01 l e v e l of s i g n i f i c a n c e and t o a f o u r adopter  category made up of the i n n o v a t o r and e a r l y  category  adopter  combined, e a r l y m a j o r i t y , l a t e m a j o r i t y and  l a g g a r d a t the .001 l e v e l of s i 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  t h a t e a r l y adoption o f new p r a c t i c e s was f r e q u e n t l y c o r r e l a t e d with younger age, more f a v o r a b l e f i n a n c i a l p o s i t i o n , g r e a t e r s o c i a l p a r t i c i p a t i o n and enjoyment o f work.  I n the present study, zero order  correlations,  p a r t i a l c o r r e l a t i o n s and a m u l t i p l e r e g r e s s i o n a n a l y s i s were performed t o determine the r e l a t i o n s h i p o f such c h a r a c t e r i s t i c s t o adoption.  Some of the f i n d i n g s were  i n agreement w i t h other r e s e a r c h s t u d i e s and other f i n d i n g s were i n disagreement. r e l a t e d t o a d o p t i o n , although literature younger.  i t was expected  Age was not s i g n i f i c a n t l y on the b a s i s o f the  t o f i n d e a r l y adopters  t o be  A m u l t i p l e r e g r e s s i o n a n a l y s i s i n c l u d e d education  which was p o s i t i v e l y c o r r e l a t e d x«7ith a d o p t i o n , and occup a t i o n a l p o s i t i o n , which was n e g a t i v e l y a s s o c i a t e d with  63 adoption.  A significant  c o e f f i c i e n t of d e t e r m i n a t i o n  showed t h a t some 30 per cent o f the v a r i a t i o n i n adoption c o u l d be e x p l a i n e d by these two  variables.  Previous  r e s e a r c h s t u d i e s have found e d u c a t i o n t o be a s s o c i a t e d w i t h h i g h e r r a t e s of adoption. I t was  not s u r p r i s i n g t o f i n d a n e g a t i v e c o r r e -  l a t i o n between adoption and o c c u p a t i o n a l p o s i t i o n s i n c e the n u r s i n g p r a c t i c e s presented at the i n s t i t u t e were those most l i k e l y t o be  c a r r i e d out by the s t a f f nurse  providing d i r e c t p a t i e n t care. f a c t i o n was is  The  f a c t t h a t job  satis-  not a s s o c i a t e d with h i g h e r adoption scores  c o n t r a r y to other r e s e a r c h f i n d i n g s , however, the  other s t u d i e s were done on d a i r y farmers These farmers and o r c h a r d i s t s had  and  orchardists.  a financial  investment  i n the o p e r a t i o n and improved p r a c t i c e s might be more r e a d i l y r e f l e c t e d i n the p r o s p e r i t y of the o p e r a t i o n than a group of nurses who  are s a l a r i e d employees and where  rewards f o r improved p r a c t i c e s are i n t a n g i b l e at best or not present at l e a s t .  In such a s i t u a t i o n job  satisfaction  might, i n f a c t , be a d e t e r r e n t t o the adoption of practices.  S o c i a l p a r t i c i p a t i o n was  new  not a s s o c i a t e d with  adoption scores i n t h i s study although others have  found  t h a t the extent t o which an i n d i v i d u a l shares i n the social l i f e  of h i s community has been s i g n i f i c a n t l y  to h i s adoption of new  practices.  related  <6h  Other r e l a t i o n s h i p s between the v a r i a b l e s were those which might w e l l be expected.  Older nurses had  p r a c t i c e d n u r s i n g f o r more years and r e c e i v e d h i g h e r s a l a r i e s than younger nurses.  Those occupying  higher  p o s i t i o n s on the o c c u p a t i o n a l s c a l e r e c e i v e d more income, r e f l e c t i n g the f i n a n c i a l rewards p r o v i d e d f o r p o s i t i o n s i n education or a d m i n i s t r a t i o n .  Nurses, who had more  e d u c a t i o n , tended t o occupy h i g h e r p o s i t i o n s w i t h i n the profession.  The nurses p a r t i c i p a t i o n i n programmes i n  c o n t i n u i n g e d u c a t i o n i n c r e a s e d i n r e l a t i o n to the number of years p r a c t i c e d , those having p r a c t i c e d the l o n g e s t were the ones who attended the g r e a t e s t number of courses i n continuing education. nurses  Another f i n d i n g i n d i c a t e d that  In h i g h e r o c c u p a t i o n a l p o s i t i o n s attended more  programmes i n c o n t i n u i n g e d u c a t i o n than nurses positions.  An unexpected  in staff  f i n d i n g was t h a t those  nurses  with more education attended fewer courses i n c o n t i n u i n g e d u c a t i o n , however, as these nurses xvere a l s o younger they had more r e c e n t l y completed  t h e i r e d u c a t i o n a l pre-  p a r a t i o n and t h e r e f o r e perhaps f e l t  l e s s need t o a t t e n d .  Nurses r e c e i v i n g a h i g h e r income r e p o r t e d g r e a t e r job s a t i s f a c t i o n than the o t h e r s .  The Kropp-Verner A t t i t u d e  S c a l e and the S o c i a l P a r t i c i p a t i o n Scale were the only two v a r i a b l e s t h a t d i d not c o r r e l a t e s i g n i f i c a n t l y any o f the other v a r i a b l e s .  with  The Kropp-Verner Scale  showed p a r t i c i p a n t s t o be g e n e r a l l y p l e a s e d w i t h the  i n s t i t u t e and t o have found i t h e l p f u l . P a r t i c i p a t i o n S c a l e showed, that acceptance  The S o c i a l 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 o f the nurses studied.  No committee memberships were r e p o r t e d by 80  per cent and no o f f i c e s i n l o c a l o r g a n i z a t i o n s were h e l d by 77 p e r cent o f the sample. CONCLUSIONS The  adoption concept  can be used as a c r i t e r i o n  t o assess l e a r n i n g t h a t occurs at an i n s t i t u t e by measuring the degree t o which p a r t i c i p a n t s have i n c o r porated i n t o t h e i r p r a c t i c e those i n n o v a t i o n s which have been recommended. produced  The i n s t i t u t e  on Nursing Assessment  a c o n s i d e r a b l e t o t a l amount of change i n the  p a r t i c i p a n t s , a 5 8 l per cent i n c r e a s e i n a d o p t i o n , and t h i s change seems t o have been f a i r l y person t o person w i t h i n the group. more prone t o adopt  c o n s i s t e n t from  The p a r t i c i p a n t s were  the p r a c t i c e s when they were r e l e v a n t  to t h e i r n u r s i n g a c t i v i t i e s .  Although  previous r e s e a r c h  suggests a v a r i e t y of c h a r a c t e r i s t i c s which have been a s s o c i a t e d w i t h the acceptance  of new i d e a s , t h i s  study  found e d u c a t i o n and o c c u p a t i o n a l p o s i t i o n t o 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 . I t i s i n t e r e s t i n g to s p e c u l a t e on what f a c t o r s i n the n u r s i n g environment c o n t r i b u t e t o making t h i s population different  from those farmers, r e s t a u r a n t  operators,  and p h y s i c i a n s who  populations. populations  One  have made up other  study  major d i f f e r e n c e between these  i s t h a t nurses are employees i n i n s t i t u t i o n s  r a t h e r than independent workers as the others T r a d i t i o n a l norms of behavior  are.  would i n f l u e n c e a l l of  these workers, but the i n f l u e n c e of the  institution  where the nurses work should be taken i n t o account. These i n s t i t u t i o n s are u s u a l l y complex  bureaucratic  o r g a n i z a t i o n s which a s s i g n a u t h o r i t y according p o s i t i o n w i t h i n the according  a d m i n i s t r a t i v e h i e r a r c h y r a t h e r than  to competence w i t h i n a p r o f e s s i o n .  of the adoption  to  of new  p r a c t i c e s by a nurse  A study 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 w e l l 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 P r a c t i c e s by P a r t i c i p a n t s i n the Small Business Management T r a i n i n g Programme. Unpublished M. A. t h e s i s . The U n i v e r s i t y o f B r i t i s h Columbia, June, 1968 Welch, John M. An E v a l u a t i o n of Three Adult E d u c a t i o n Methods f o r D i s s e m i n a t i n g Trade Information t o M i s s o u r i Restaurant Operators. 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"A Study of T e c h n o l o g i c a l D i f f u s i o n , " ' R u r a l S o c i o l o g y , 1 3 : 273-285, (September, 1948).  73  R y a n , 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 S e e d C o r n i n Two I o w a C o m m u n i t i e s , " ' R u r a l S o c i o l o g y , 8: 1 5 - 2 4 , ( 1 9 4 3 ) . S i m o n , 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 of Nursing S e r v i c e Personnei,"' Nursing O u t l o o k , 8: 4 2 4 - 4 2 7 , ( A u g u s t , i 9 6 0 ) . Verner,  C o o l i e and J o h n S. N e w b e r r y . • "The N a t u r e 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: (Summer, 1 9 5 8 ) .  of 208-222,  W a l l a c h , M i c h a e l A. and N a t h a n K o g a n . "Aspects of J u d g e m e n t and D e c i s i o n - m a k i n g : Interrelationships 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: 23-35 , (January, 196l). W i l k e n i n g , E u g e n e A. " I n f o r m a l L e a d e r s 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 : 272-275, (September, 1 9 5 2 ) . Winick,  Charles. "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 L a r g e C i t y , " ' Soci'ome'try, 24: 384-396,  (1961).  Y o u n g , James M. and A. Lee C o l e m a n . " N e i g h b o r h o o d 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 : I n t e r v i e w 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 i n non-credit nursing courses in order to:  1. 2. 3. 4. 5.  assist in course planning; improve program design; analyze trends i n participation; prepare annual reports; 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 i n formation collected i n 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 F o r m A. Persons in other health professions are requested to complete F o r m B. Your co-operation will be greatly appreciated.  FORM  A  76  (To be completed by nurse registrants) I  COURSE D A T A Title Length  1 day 2 days 3 days 1 week evening series of sessions day series of sessions other  Location  Vancouver other  II  G E N E R A L BIOGRAPHICAL D A T A Name (please print, surname first) Address city  street Marital Status:  Single Married Other  Sex:  Male Female  No. of children:  0 1-2 3-4 more than 4  Age Group:  20 or under 21 - 25 26 - 30 31 - 35 36 - 40  province  - 2  III  77  41 - 45  (  )  46 - 50  (  )  51 - 55  (  )  56 - 60  (  )  61 - 65  (  )  Over 65  (  )  Member of Registered Nurses' Association of B. C.  (  )  Member of Psychiatric Nurses' Association  (  )  Other  (  )  Age Group (cont'd.)  MEMBERSHIP IN PROFESSIONAL ASSOCIATION  (please specify) IV E D U C A T I O N A L P R E P A R A T I O N IN NURSING (a) Graduate from  non-university school  Vocational school General hospital Institute of technology Other (please specify)  (b) Graduate from university school  Diploma or certificate Baccalaureate degree Master's degree Doctoral degree  V  EMPLOYING  AGENCY  General hospital  201 beds or over 75 to 200 beds 30 to 74 beds Under 30 beds  Specialized hospital  Geriatric Paediatric Psychiatric Rehabilitative  Public health agency Private hospital  V  E M P L O Y I N G A G E N C Y (Cont'd.) School of Nursing Mental health clinic Correctional services Physician Self Not presently employed Other (please specify)  VI  POSITION IN A G E N C Y Nurse's aide  (  )  Orderly  (  )  Staff nurse  (  )  Head nurse  (  )  Supervisor  (  )  Director  (  )  Instructor  (  )  Consultant  (  )  (  )  (  )  10-14  (  )  1 5 - 1 9  (  )  20 or more  (  )  Practical nurse  VII  Y E A R S OF P R A C T I C E IN NURSING 0 - 4 9  5 -  V m N U M B E R OF Y E A R S DURING WHICH I H A V E NOT P R A C T I C E D AS A NURSE SINCE GRADUATION 0 - 4  5 -9 10-14 15 -  19  20 or more  -4IX  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 R E A D ABOUT THIS COURSE F R O M 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, T R A V E L , LIVING E X P E N S E S E T C . ) WAS PAID B Y Self Employer Shared by above Professional association Other (please specify) XIII NUMBER O F SHORT COURSES A T T E N D E D IN LAST 2 Y E A R S 0 1 2 3 more than 3  XIV  S U B J E C T S ON WHICH I WOULD L I K E T O S E E A COURSE O F F E R E D IN T H E N E X T Y E A R I N C L U D E 1. 2. 3.  .  T O B E C O M P L E T E D BY NON B. C. GRADUATES ONLY XV  I G R A D U A T E D IN Another Canadian province Great Britain Phillipine s Australia Other (please specify) I H A V E P R A C T I C E D IN B. C. 0 5 10 15 20  4 years  - 9 years - 14 years - 19 years years or more  Item  II  INTERVIEW GUIDE  Record o f A d o p t i o n  o f Recommended  Respondent's  Practices  I would l i k e t o f i n d out your use o f c e r t a i n n u r s i n g practices. P l e a s e r e p l y t o each statement by s e l e c t i n g one o f the s i x phrases l i s t e d on the answer s h e e t . 1. W r i t i n g a n u r s i n g h i s t o r y s t a n d a r d i z e d guice form  using  2. U s i n g t h e n u r s i n g h i s t o r y to w r i t e nursing goals  3. U s i n g the n u r s i n g g o a l s t o w r i t e n u r s i n g methods ( o r d e r s )  4. E v a l u a t i n g t h e g o a l s and methods through the use o f p r o g r e s s notes  5. M o d i f y i n g t h e g o a l s a n d methods i n terms o f p a t i e n t ' s p r o g r e s s  6. W r i t i n g a n u r s i n g summary  Note:  S c o r e the degree o f Score the practices adoption.  Before  19  After  20  Total  21  Before  22  After  23  Total  24  Before  25  After  26  Total  27  Before  28  After  29  Total  30  Before  31  After  32  Total  33  Before  34  After  35  Total  36  discharge  " b e f o r e " column to i n d i c a t e the p r a c t i c e b e f o r e the i n s t i t u t e . " a f t e r " column w i t h 0.2 f o r a l l not showing h i g h e r degree o f  No.  8?  -2Use o f Source o f Information I would l i k e to f i n d out the source o f information which has been most h e l p f u l to you f o r each of the nursing p r a c t i c e s . Please select one source f o r each from the answer sheet. 7. Writing a nursing h i s t o r y using standardized guide form  37  8. Using the nursing h i s t o r y 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  i n terms  of patient's progress 12. Writing a nursing discharge summary  41 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 p r a c t i c e s . a) b) 14.  O Name the three most important factors that i n h i b i t e d your use of new p r a c t i c e s . 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 d a i l y assignment  47, 48  18. Number of other nurses on your u n i t attending i n s t i t u t e on nursing assessment s i m i l a r to one you attended  49  -3-  19. P a r t i c i p a t i o n i n Community Groups (Chapin Scale) I would l i k e you to r e c a l l the names of a l l the organizations that you have belonged to i n the past year. (Do not include attendance at church) Total Score  Name of Organization  Attendance  Financial Contribution  50, 51  Member of Committee  Offices Held Score  1.  0  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  Over 35  9  T o t a l (xl)  (x2)  (x3)  (x4)  (x5)  52  1  84  -4-  Index o f Job S a t i s f a c t i o n  (rev. Brayfield  and Roth)  I would l i k e to f i n d out how you f e e l about your job. Please reply to each statement using one of the f i v e phrases on the answer sheet.  a> aJ w  u  •H  CB  T3  <D  T3  C  o  u  4-> W  20. My job i s l i k e a hobby to me.  53  21. I t seems that my friends are more interested i n t h e i r jobs than I am.  54  22. I enjoy my work more than my leisure  time^  5  <D 0  U  W  <u o ec  •H O <D  u  T3  05  w  I-I  be-  C  o u  <  =3  C  •H Q  4  3  2  1  4  5  to  5  4  3  2  1  1  2  3  4  5  2  1  23. I am often bored with my job.  56  24. I f e e l f a i r l y well s a t i s f i e d with my job.  57  25. I f e e l that my job i s no more i n t e r e s t i n g than others I could get.  58  1  2  3  4  5  26. I d e f i n i t e l y d i s l i k e my work.  59  1  2  3  4  5  27. Each day of work seems l i k e i t w i l l never end.  60  1  2  3  4  5  28. I f i n d r e a l enjoyment i n my work.  61  5  4  3  2  1  Total Score  6 2 , 63_ Code  Total Scale Score 9-12 13-16 17-20 21-24 25-28 29-32 33-36 37-40  41 and over  64  1 2 3 4 5 6 7 8 9  85  -5Answer 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. T r i a l 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 d e s c r i b i n g r e a c t i o n s t o course  87 Statements D e s c r i b i n g Reactions  to Course  Please check o f f only those statements which most a c c u r a t e l y d e s c r i b e your p e r s o n a l r e a c t i o n t o the t o t a l course. I t was one of the most rewarding experiences  I have ever had  E x a c t l y what I wanted I hope t h a t we can have another i n the near f u t u r e I t p r o v i d e d the k i n d of experience my own s i t u a t i o n I t helped  t h a t I can apply t o  me p e r s o n a l l y  I t s o l v e s some problems f o r me I t h i n k i t served  i t s purpose  I t had some merits I t was  fair  It was n e i t h e r very good nor very poor I was m i l d l y  disappointed  I t was not e x a c t l y what I needed I t was too g e n e r a l I am not t a k i n g any new ideas away I t d i d n ' t h o l d my  interest  I t was much t o o s u p e r f i c i a l I leave  dissatisfied  I t was very poorly  planned  I didn't learn a thing I t was a complete waste o f time  

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