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UBC Theses and Dissertations

The relationship between level of nursing education and intellectual and ethical development Dams, Zoe Ann 1990

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THE RELATIONSHIP BETWEEN LEVEL OF NURSING EDUCATION AND INTELLECTUAL AND ETHICAL DEVELOPMENT By ZOE ANN DAMS B.S.N., The U n i v e r s i t y of B r i t i s h Columbia, 1977 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE FACULTY OF GRADUATE STUDIES (Sc h o o l o f N u r s i n g ) We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA December 1990 (c) Zoe Ann Dams, 1990 4 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. The University of British Columbia Vancouver, Canada Department of DE-6 (2/88) A b s t r a c t P u r s u i t of u n i v e r s i t y e d u c a t i o n f o r n u r s e s has been a c o n t r o v e r s i a l and p o o r l y u n d e r s t o o d i d e a l . I t has been d i f f i c u l t t o c l e a r l y demonstrate and a r t i c u l a t e t h e b e n e f i t s of h i g h e r e d u c a t i o n f o r n u r s e s and n u r s i n g . In t h i s r e s e a r c h the m i s s i o n of undergraduate e d u c a t i o n i n g e n e r a l , and the Canadian Nurses A s s o c i a t i o n p o s i t i o n paper on b a c c a l a u r e a t e e d u c a t i o n s e r v e d as the b a s i s of i n q u i r y i n t o a s p e c t s of u n i v e r s i t y e d u c a t i o n f o r n u r s e s and n u r s i n g . From t h e s e s o u r c e s and r e v i e w of the l i t e r a t u r e i t was a s c e r t a i n e d t h a t a p r i m a r y v a l u e of e d u c a t i o n i s seen as h e l p i n g i n d i v i d u a l s d e v e l o p i n t e l l e c t u a l and e t h i c a l m a t u r i t y which a l l o w s them t o make judgments and commitments i n a r e l a t i v i s t i c w orld. T h i s t h e o r e c t i c a l o r i e n t a t i o n was o p e r a t i o n a l i z e d t h r o u g h P e r r y ' s t h e o r y of i n t e l l e c t u a l and e t h i c a l development (1970). The Measure of E p i s t e m o l o g i c a l R e f l e c t i o n <MER), a t o o l based on t h i s t h e o r y , was de v e l o p e d t o measure a p e r s o n ' s l e v e l of i n t e l l e c t u a l and e t h i c a l m a t u r i t y . In t h i s s t u d y t h e MER was a d m i n i s t e r e d t o diploma.and b a c c a l a u r e a t e n u r s i n g g r a d u a t e s t o deter m i n e i f t h i s c o n s t r u c t c o u l d be used t o d i f f e r e n t i a t e the e f f e c t s of the two l e v e l s of e d u c a t i o n . The f i n d i n g s i n d i c a t e d t h a t t h e r e was no d i f f e r e n c e between d i p l o m a and b a c c a l a u r e a t e groups of n u r s e s on t h e i r s c o r e s on the MER. There was no c o r r e l a t i o n between s c o r e s on the MER and age or e x p e r i e n c e . There was, however, a s i g n i f i c a n t d i f f e r e n c e between a group of n u r s e s who p a r t i c i p a t e d i n u n i v e r s i t y e d u c a t i o n i n a d d i t i o n t o t h e i r b a s i c n u r s i n g program, and a group who had no o t h e r u n i v e r s i t y c r e d i t o u t s i d e of t h e i r b a s i c n u r s i n g program. These f i n d i n g s , and t h e i r i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e , e d u c a t i o n , and r e s e a r c h are d i s c u s s e d . i v Acknowledgements A s i n c e r e thank you i s extended t o members of my t h e s i s committee, M a r i l y n Dewis, c h a i r p e r s o n , and C a r o l J i l l i n g s f o r t h e i r v a l u a b l e c o n t r i b u t i o n s t o t h i s p r o j e c t . T h e i r e x p e r i e n c e , b r e a d t h of knowledge, and i n s i g h t i n t o the c o m p l e x i t i e s of n u r s i n g e d u c a t i o n p r o v i d e d encouragement and d i r e c t i o n f o r my r e s e a r c h . These i n d i v i d u a l s g e n e r o u s l y s h a r e d t h e i r t h o u g h t s and i d e a s which a s s i s t e d me i n c l a r i f y i n g my own. The w i l l i n g p a r t i c i p a t i o n of n u r s e s who responded t o t h e q u e s t i o n n a i r e i s g r a t e f u l l y a p p r e c i a t e d . I a l s o w i s h t o thank the R e g i s t e r e d Nurses A s s o c i a t i o n of B.C. f o r a l l o w i n g me a c c e s s t o the s t u d y sample, and t o C l a i r e Kermacks f o r her h e l p f u l s u g g e s t i o n s and a s s i s t a n c e d u r i n g the d a t a g a t h e r i n g p r o c e s s . I acknowledge the a s s i s t a n c e and s u p p o r t o f f e r e d t o me by my c o l l e a g u e s and the a d m i n i s t r a t i o n of M a l a s p i n a c o l l e g e . L a s t l y , many t h a n k s t o ray husband, C u r t i s Dams, f o r h i s genuine i n t e r e s t i n and s u p p o r t of my s t u d i e s , and t o my c h i l d r e n , C o l i n , Ann, and Bramley, f o r g r a c i o u s l y t o l e r a t i n g my absences. C o n t e n t s ABSTRACT i i ACKNOWLEDGEMENTS i v LIST OF TABLES x LIST OF FIGURES x i CHAPTER I I n t r o d u c t i o n Background t o the Problem 1 Problem Statement. 5 Purpose of t h e Study 6 Research Q u e s t i o n 6 D e f i n i t i o n of Terms 7 Assumpt i ons 8 L i m i t a t i o n s of the Study 9 S i g n i f i c a n c e of t h e Study 10 Summary 11 CHAPTER I I T h e o r e t i c a l Framework 12 Making of Meaning 15 C o g n i t i v e S t r u c t u r e s 17 Development , 17 Sta g e s o r P o s i t i o n s 18 M o t i v a t i o n 18 P e r r y Scheme 19 v i Summary 21 CHAPTER I I I L i t e r a t u r e Review 23 B a c c a l a u r e a t e N u r s i n g E d u c a t i o n 24 T h e o r e t i c a l L i t e r a t u r e 24 Research L i t e r a t u r e 26 C o g n i t i v e Domain i n N u r s i n g E d u c a t i o n ..31 T h e o r e t i c a l L i t e r a t u r e 31 Research L i t e r a t u r e 32 P r o f e s s i o n a l i s m 33 Autonomy 35 S e l f - d i r e c t e d l e a r n i n g 37 C r i t i c a l T h i n k i n g 38 Research on the P e r r y Scheme 40 N u r s i n g R e s e a r c h U s i n g t h e P e r r y Scheme 43 E t h i c a l and Mor a l Reasoning 51 Summary 56 CHAPTER IV Methodology 58 Re s e a r c h Design. . . 58 Sample S e l e c t i o n 58 Data C o l l e c t i o n P r o c e d u r e s 60 Ins t r u m e n t s 61 Demographic Data Sheet 61 Measure of E p i s t e m o l o g i c a l R e f l e c t i o n 63 v i i R e l i a b i l i t y a n d V a l i d i t y o f t h e M E R . , . . , 6 9 S u m m a r y 6 9 C H A P T E R V A n a l y s i s a n d D i s c u s s i o n o f F i n d i n g s 7 1 A n a l y s i s o f D e m o g r a o h i c D a t a 7 1 M e a s u r e o f I n t e l l e c t u a l a n d E t h i c a l D e v e l o p m e n t 7 4 C o m p a r i s o n o f L e v e l o f I n t e l l e c t u a l a n d E t h i c a l D e v e l o p m e n t a n d L e v e l o f N u r s i n g E d u c a t i o n 7 7 C o m p a r i s o n o f L e v e l o f I n t e l l e c t u a l a n d E t h i c a l D e v e l o p m e n t a n d O t h e r U n i v e r s i t y C r e d i t 7 9 C o r r e l a t i o n B e t w e e n I n t e l l e c t u a l a n d E t h i c a l L e v e l a n d - D e m o g r a p h i c V a r i a b l e s 8 0 L i m i t a t i o n s 8 0 D i s c u s s i o n 8 2 S u m m a r y 8 7 C H A P T E R VI S u m m a r y , C o n c l u s i o n s , I m p l i c a t i o n s a n d R e c o m m e n d a t i o n s S u m m a r y 8 9 C o n c l u s i o n s 9 2 I m p l i c a t i o n s f o r N u r s i n g P r a c t i c e 9 4 v i i i Theory Based P r a c t i c e 96 Research O r i e n t a t i o n t o P r a c t i c e 97 T e c h n o l o g i c a l Change 98 H e l p i n g R e l a t i o n s h i p s • 99 E t h i c a l I s sues, 100 Community Based H e a l t h Care 100 I m p l i c a t i o n s f o r N u r s i n g E d u c a t i o n 102 Student Assessment 104 C u r r i c u l u m P l a n n i n g 105 Teaching S t r a t e g i e s I l l I m p l i c a t i o n s f o r F u t u r e R e s e a r c h 120 Summary 122 REFERENCES 125 APPENDICES Appendix A G u i d e l i n e s f o r u s i n g RNABC R e g i s t r y f o r Sample S e l e c t i o n . 136 Appendix B L e t t e r s t o P a r t i c i p a n t s 141 Appendix C Demographic Data 144 Appendix D Measure of E p i s t e m o l o g i c a l R e f l e c t i o n 147 Appendix E R a t i n g S c o r e s on the Measure o f E p i s t e m o l o g i c a l R e f l e c t i o n X L i s t of T a b l e s T a b l e 1 Ranked MER S c a r e s w i t h Demographic Data 72 Ta b l e 2 D e s c r i p t i v e S t a t i s t i c s f o r MER S c o r e s 78 x i L i s t of F i g u r e s F i g u r e 1 P r o c e s s of Change i n Developmental P o s i t i o n 114 F i g u r e 2 A c h i e v i n g New P o s i t i o n s and A l t e r n a t i v e s t o Growth 115 F i g u r e 3 R e a f f i r m a t i o n of P o s i t i o n 117 F i g u r e 4 D u a l i s t i c C u r r i c u l u m I n t e r v e n t i o n 118 1 CHAPTER I I n t r o d u c t i o n Background t o the Problem In 1982 t h e Canadian Nurses A s s o c i a t i o n <CNA) adopted the p o s i t i o n t h a t "by t h e y e a r 2000 the minimal e d u c a t i o n a l r e q u i r e m e n t f o r e n t r y i n t o t h e p r a c t i c e of n u r s i n g s h o u l d be s u c c e s s f u l c o m p l e t i o n of a b a c c a l a u r e a t e degree i n n u r s i n g . " S i n c e 1982 t h e CNA has put f o r t h the r a t i o n a l e f o r t h i s p o s i t i o n t h r o u g h A s s o c i a t i o n meetings, p u b l i c forums, and the E n t r y t o P r a c t i c e n e w s l e t t e r . A case f o r the e n t r y t o p r a c t i c e p o s i t i o n was p r e s e n t e d i n the A p r i l 1988 e d i t i o n of the n e w s l e t t e r . I t s t a t e s t h a t n u r s e s need u n i v e r s i t y e d u c a t i o n so t h a t t h e y a r e b e t t e r p r e p a r e d t o d e a l w i t h "changes i n the p r a c t i c e of n u r s i n g w i t h an emphasis on t h e o r y based p r a c t i c e , a r e s e a r c h o r i e n t a t i o n t o p r a c t i c e , t h e e f f e c t s of t e c h n o l o g i c a l advances, the importance of h e l p i n g r e l a t i o n s h i p s , e t h i c a l i s s u e s and community based n u r s i n g c a r e " <p. 12). I t f u r t h e r p o s t u l a t e s t h a t b a c c a l a u r e a t e e d u c a t i o n promotes the development of a b i l i t i e s r e q u i r e d f o r p r o f e s s i o n a l p r a c t i c e . I t s t a t e s t h a t a c c e s s t o a u n i v e r s i t y e d u c a t i o n s h o u l d : 1. Develop b r e a d t h of knowledge. 2. B u i l d i n t e l l e c t u a l power. 3. A s s i s t i n the c r e a t i o n of a c o h e r e n t scheme of v a l u e s . 2 The advantages of a b a c c a l a u r e a t e e d u c a t i o n are many and v a r i e d and are not l i m i t e d s i m p l y t o a g r e a t e r q u a n t i t y of knowledge. A l i b e r a l e d u c a t i o n h e l p s a p e r s o n a c h i e v e t h o s e s k i l l s and h a b i t s of r e a s o n i n g which c o n s t i t u t e i n t e l l e c t u a l competence. In sum, t h e s e f a c u l t i e s c o u l d c o l l e c t i v e l y be d e s c r i b e d as the c a p a c i t y t o o r d e r and i n t e r p r e t a complex s e t of c i r c u m s t a n c e s i n the p h y s i c a l , s o c i a l , or a r t i s t i c w o r l d , and t o b r i n g one's f u l l i n t e l l e c t u a l r e s o u r c e s s k i l l f u l l y t o bear on the s o l u t i o n of a problem. An e d u c a t i o n t h a t i n c l u d e s the h u m a n i t i e s and l i b e r a l a r t s as w e l l as t h e b i o l o g i c a l and n a t u r a l s c i e n c e s w i l l p r o v i d e n u r s e s w i t h t h e de p t h and q u a l i t y of knowledge t o a l l o w them t o r e a c h t h e i r f u l l p o t e n t i a l as p r a c t i t i o n e r s . <CNA n e w s l e t t e r , A p r i l 1988 adapted from R u s s e l l , 1959, p. 9) T h i s e x c e r p t r e p r e s e n t s one of the c l e a r e s t a r t i c u l a t i o n s of t h e advantages of a b a c c a l a u r e a t e e d u c a t i o n f o r nurs e s . Yet t h e s e c h a r a c t e r i s t i c s a r e a b s t r a c t and do not l e n d t h e m s e l v e s e a s i l y t o o p e r a t i o n a l d e f i n i t i o n . How a r e t h e s e i d e a l i z e d c h a r a c t e r i s t i c s o b s e r v e d and measured i n g r a d u a t e s ? In the p a s t , nurse r e s e a r c h e r s have s t u d i e d many t r a i t s and c h a r a c t e r i s t i c s i n an attempt t o i d e n t i f y t he e f f e c t s of e d u c a t i o n on p r a c t i c e . Many s t u d i e s were d e s i g n e d t o d i f f e r e n t i a t e d i p l o m a and b a c c a l a u r e a t e s t u d e n t s or gr a d u a t e s . Some of the c h a r a c t e r i s t i c s t h a t have been s t u d i e d i n c l u d e s e l f a c t u a l i z a t i o n ( G o l d s t e i n , . 1 9 8 0 ) , performance on s p e c i f i c c o m p e t e n c i e s (DeBack and Mentkowski, 1986), p r o f e s s i o n a l i z a t i o n ( L a w l e r and Rose, 1987), r o l e c o n c e p t i o n ( I t a n o , V a r r e n , and I s h i d a , 3 1987), autonomy, (Murray and M o r r i s , 1982), l e a d e r s h i p ( M e l e i s and F a r r e l l , 1974); and c r i t i c a l t h i n k i n g and moral r e a s o n i n g ( K e t e f i a n , (1981). In s p i t e of t h e s e a t t e m p t s t o i l l u s t r a t e d i f f e r e n c e s , many p r a c t i s i n g n u r s e s , the p u b l i c , and p o l i c y makers a r e s t i l l t o be c o n v i n c e d of t h e b e n e f i t s of u n i v e r s i t y e d u c a t i o n f o r nurses. Rose (1988), i n an a r t i c l e e n t i t l e d "ADN vs BSN: The S e a r c h f o r D i f f e r e n t i a t i o n , " n o t e s t h a t the t h e o r e t i c a l d i f f e r e n c e s a re broad and can be t e s t e d i n many ways. She d e f i n e s the problem c l e a r l y i n the f o l l o w i n g s t a t e m e n t s . "The f i r s t q u e s t i o n i s how t o c a p t u r e the essence of t h e d i f f e r e n c e between the two t y p e s of nur s e s . Put q u i t e s i m p l y , what s h a l l we measure?" (p. 275). In her r e v i e w of n u r s i n g r e s e a r c h , Rose found: c o n s i s t e n t s u p p o r t f o r the b e l i e f t h a t BSN s t u d e n t s were more p r o f e s s i o n a l ; i n c o n s i s t e n t d i f f e r e n c e s i n d e c i s i o n making a b i l i t i e s ; v e r y l i t t l e s u p p o r t f o r t h e o r e t i c a l d i f f e r e n c e s i n l e a d e r s h i p ; no d i f f e r e n c e i n j o b s a t i s f a c t i o n between ADN and BSN gr a d u a t e s ; and no d i f f e r e n c e s i n p e r s o n a l i t y f a c t o r s . In c o n c l u s i o n , Rose s t a t e s t h a t we need a more r i g o r o u s r e s e a r c h base from which t o make d e c i s i o n s about n u r s i n g e d u c a t i o n . She n o t e s a n o t h e r a r e a which has not been w e l l i n v e s t i g a t e d . "The BSN program, i n c o n t r a s t w i t h 4 the ADN program, p r o v i d e s an e d u c a t i o n w i t h l i b e r a l a r t s , s o c i a l s c i e n c e s , and b a s i c and a p p l i e d s c i e n c e s c o n t e n t . T h i s broad, w e l l rounded e d u c a t i o n s h o u l d have some impact on g r a d u a t e s . A l t h o u g h i t may not be apparent i n the d i r e c t p r a c t i c e of n u r s i n g , e s p e c i a l l y i n the h o s p i t a l s e t t i n g , i t may be most c r i t i c a l f o r the p r o f e s s i o n . " <p. 278). The purpose of moving n u r s i n g e d u c a t i o n from h o s p i t a l - b a s e d d i p l o m a t r a i n i n g t o u n i v e r s i t y - b a s e d b a c c a l a u r e a t e e d u c a t i o n i s d i r e c t l y r e l a t e d t o t h e m i s s i o n of undergraduate u n i v e r s i t y e d u c a t i o n i n g e n e r a l . I t was b e l i e v e d t h a t t h e n u r s i n g p r o f e s s i o n would b e n e f i t f rom a c c e s s t o h i g h e r e d u c a t i o n <Weir, 1932, Spohn, 1962, K e r g i n , 1970, p. 51). The C a r n e g i e F o u n d a t i o n f o r the Advancement of T e a c h i n g (1977) o f f e r s the f o l l o w i n g s t a t e m e n t s i n d e s c r i b i n g t h e m i s s i o n of undergraduate e d u c a t i o n . E d u c a t i o n c o n s i s t s of a s e r i e s of e v e n t s and a c t i v i t i e s t h a t a r e d e s i g n e d t o h e l p i n d i v i d u a l s t o i n c r e a s e t h e i r i n t e l l e c t u a l , s o c i a l , p e r s o n a l , and moral p o t e n t i a l s . At i t s b e s t , i t c o n f r o n t s people of a l l ages w i t h t h e r e a l i t i e s of t h e i r environment, the human c o n d i t i o n , and t h e i d e a l s toward which human b e i n g s have s t r i v e n t h r o u g h o u t h i s t o r y . I t p r e p a r e s them f o r p r o d u c t i v e a c t i v i t y . I t opens t h e i r minds t o a l t e r n a t i v e ways f o r t h i n k i n g and l i v i n g . I t a c q u a i n t s them w i t h ways of l e a r n i n g and makes i t p a s s i b l e f o r them t o educate themselves. I t p r o v i d e s a f o u n d a t i o n f o r making judgments, f o r d e t e r m i n i n g p e r s o n a l and c u l t u r a l v a l u e s , f o r c h o o s i n g a p p r o p r i a t e c o u r s e s of a c t i o n . I t b u i l d s consensus and t h e r e f o r e can be an i n s t r u m e n t of 5 s o c i a l i z a t i o n and s o c i a l c o n t r o l . I t a l s o i n c r e a s e s the t o l e r a n c e i n d i v i d u a l s have f o r d i v e r s i t y and t h e r e f o r e can e n l a r g e freedom. The work of e d u c a t i o n i s t o make a p o s i t i v e d i f f e r e n c e i n p e o p l e ' s l i v e s and a l s o t o change s o c i e t y , o ver time, t h r o u g h the works of t h o s e i t e d ucates. (1977, p. 152) Any measure of the advantages of b a c c a l a u r e a t e e d u c a t i o n f o r n u r s e s must e v o l v e from t h i s and o t h e r d e s c r i p t i o n s of u n i v e r s i t y undergraduate e d u c a t i o n . O p e r a t i o n a l i z i n g t h e s e a b s t r a c t s t a t e m e n t s so t h a t the c h a r a c t e r i s t i c s can be o b s e r v e d and measured has been a problem f o r n u r s i n g r e s e a r c h e r s . In t h i s r e s e a r c h , the c o n s t r u c t of i n t e l l e c t u a l and e t h i c a l development, as d e f i n e d by P e r r y <1970), was used t o c o n c e p t u a l i z e t h e d e s i r e d outcomes of a u n i v e r s i t y e d u c a t i o n f o r n u r s e s . P e r r y ' s t h e o r y of a d u l t c o g n i t i v e development d u r i n g the undergraduate y e a r s was chosen as t h e g u i d i n g t h e o r e t i c a l framework because i t r e p r e s e n t s the d e s i r e d outcomes of a l i b e r a l u n i v e r s i t y e d u c a t i o n ( B a x t e r Magolda & P o r t e r f i e l d , 1988, p. 13, V a l i g a , 1983, P e r r y , 1981). U s i n g t h e P e r r y scheme as a frame of r e f e r e n c e a l l o w e d i n t e r p r e t a t i o n of s t u d y f i n d i n g s and d i r e c t a p p l i c a t i o n f o r n u r s i n g e d u c a t i o n . Problem Statement The r a t i o n a l e f o r p u r s u i n g b a c c a l a u r e a t e e d u c a t i o n f o r n u r s e s has been d i f f i c u l t t o d e s c r i b e ( V o o l l e y , 6 1986, p. 199). In o r d e r t o more c l e a r l y d e f i n e the r a t i o n a l e , t h e e f f e c t s of b a c c a l a u r e a t e e d u c a t i o n must be i n v e s t i g a t e d . S p e c i f i c a l l y , the problem t o be i n v e s t i g a t e d i n t h i s r e s e a r c h i s c o n t a i n e d i n t h e f o l l o w i n g q u e s t i o n : Do b a c c a l a u r e a t e g r a d u a t e s d i f f e r from d i p l o m a g r a d u a t e s i n t h e i r l e v e l of i n t e l l e c t u a l and e t h i c a l development? Purpose The purpose of t h i s s t u d y was t o d e s c r i b e the l e v e l of i n t e l l e c t u a l and e t h i c a l development of p r a c t i s i n g d i p l o m a and b a c c a l a u r e a t e - p r e p a r e d nurses. T h i s r e s e a r c h a s s i s t e d i n i d e n t i f y i n g whether o r not the v a r i a b l e of i n t e l l e c t u a l and e t h i c a l development can be c o n s i d e r e d d i f f e r e n t i a t i n g outcomes of d i p l o m a and b a c c a l a u r e a t e e d u c a t i o n . The purposes can be summarized i n the f o l l o w i n g s t a t e m e n t s . 1. To i d e n t i f y the l e v e l of i n t e l l e c t u a l and e t h i c a l development of p r a c t i s i n g b a c c a l a u r e a t e - p r e p a r e d nurses. 2. To i d e n t i f y the l e v e l of i n t e l l e c t u a l and e t h i c a l development of p r a c t i s i n g d i p l o m a - p r e p a r e d n u r s e s . 3. To d e t e r m i n e whether t h e r e i s a d i f f e r e n c e between groups of p r a c t i s i n g d i p l o m a and b a c c a l a u r e a t e n u r s e s on the v a r i a b l e of i n t e l l e c t u a l and e t h i c a l development. Research Q u e s t i o n Is t h e r e a d i f f e r e n c e between the l e v e l o f 7 i n t e l l e c t u a l and e t h i c a l development of a group of p r a c t i s i n g d i p l o m a n u r s e s and the l e v e l o f i n t e l l e c t u a l and e t h i c a l development of a group of p r a c t i s i n g b a c c a l a u r e a t e n u r s e s ? D e f i n i t i o n of Terms  I n t e l l e c t u a l and E t h i c a l L e v e l In a ccordance w i t h t h e P e r r y scheme, i n t e l l e c t u a l and e t h i c a l l e v e l i s d e f i n e d ' as an i n d i v i d u a l ' s p e r s p e c t i v e o r way of t h i n k i n g about the n a t u r e of knowledge, t r u t h , and v a l u e s , and the meaning o f l i f e and r e s p o n s i b i l i t i e s . I n t e l l e c t u a l and E t h i c a l Development I n t e l l e c t u a l and e t h i c a l development r e f e r s t o the s e q u e n t i a l p r o g r e s s i o n toward i n c r e a s i n g l y more complex c o g n i t i v e s t r u c t u r e s which a l l o w i n d i v i d u a l s t o p r o c e s s i n f o r m a t i o n o r connect knowledge i n i n c r e a s i n g l y complex ways. S t a g e s o r l e v e l s of development can be r e c o g n i z e d where each s t a g e r e p r e s e n t s a q u a l i t a t i v e l y d i f f e r e n t way of t h i n k i n g . Each l e v e l of i n t e l l e c t u a l and e t h i c a l development r e p r e s e n t s a more d i f f e r e n t i a t e d and i n t e g r a t e d s t r u c t u r a l o r g a n i z a t i o n subsuming t h a t of t h e p r e v i o u s s t a g e s . O p e r a t i o n a l d e f i n i t i o n . The l e v e l of an i n d i v i d u a l ' s i n t e l l e c t u a l and e t h i c a l development w i l l be the s c o r e o b t a i n e d on the 8 Measure of E p i s t e m o l o g i c a l R e f l e c t i o n (MER) ( T a y l o r , 1982) which i s based on the P e r r y scheme. L e v e l of E d u c a t i o n L e v e l of e d u c a t i o n w i l l be d e s c r i b e d as t h e d i p l o m a o r degree h e l d by the r e g i s t e r e d , p r a c t i s i n g nurse. Diploma l e v e l of e d u c a t i o n i s o b t a i n e d upon o f f i c i a l g r a d u a t i o n from a c o l l e g e or h o s p i t a l - b a s e d n u r s i n g program. B a c c a l a u r e a t e degree l e v e l of e d u c a t i o n i s o f f i c i a l g r a d u a t i o n from a g e n e r i c , u n i v e r s i t y - b a s e d b a c c a l a u r e a t e program i n n u r s i n g . E x p e r i e n c e The number of y e a r s employed i n n u r s i n g . F i f t e e n hundred hours of p a r t time work w i l l be c o n s i d e r e d one year of f u l l t i me employment. B a s i c N u r s i n g E d u c a t i o n The i n i t i a l n u r s i n g e d u c a t i o n , e i t h e r d i p l o m a or b a c c a l a u r e a t e , l e a d i n g t o nurse r e g i s t r a t i o n . L i b e r a l E d u c a t i o n U n i v e r s i t y l e v e l e d u c a t i o n c o n s i s t i n g of a b r e a d t h of m u l t i d i s c i p l i n a r y p e r s p e c t i v e s . Assumpt i ons 1. I n t e l l e c t u a l and e t h i c a l development i s a c e n t r a l v a r i a b l e i n a c h i e v i n g h i g h l e v e l s k i l l s i n the c o g n i t i v e r e a l m of n u r s i n g e d u c a t i o n . 2. I n t e l l e c t u a l and e t h i c a l m a t u r i t y i s a d e s i r a b l e 9 a t t r i b u t e , and can be a c q u i r e d t h r o u g h i n t e r a c t i o n w i t h the environment. 3. Assumptions which u n d e r l i e t h e t h e o r e t i c a l framework of t h i s s t u d y w i l l a l s o o p e r a t e d u r i n g t h i s r e s e a r c h . These i n c l u d e a s s u m p t i o n s about the making of meaning, c o g n i t i v e s t r u c t u r e , development, m o t i v a t i o n , and t h e p r o c e s s e s of a s s i m i l a t i o n and accommodation. 4. An i n d i v i d u a l ' s s t a g e of i n t e l l e c t u a l and e t h i c a l development can be i n f e r r e d f r om what th e i n d i v i d u a l w r i t e s about the r e l a t i o n s h i p of i d e a s , a c t i o n s , e v e n t s , and t h e o r i e s . 5. The q u a l i t i e s of independence, r e s p o n s i b i l i t y , and commitment, as a c h i e v e d a t h i g h l e v e l s of i n t e l l e c t u a l and e t h i c a l m a t u r i t y , a r e d e s i r a b l e a t t r i b u t e s of a p r o f e s s i o n a l i n a human s e r v i c e , p r a c t i c e - o r i e n t e d , d i s c i p l i n e s u ch as n u r s i n g . 6. The l e v e l of i n t e l l e c t u a l and e t h i c a l development i n f l u e n c e s t h e p r a c t i c e of n u r s i n g a t the i n d i v i d u a l l e v e l , and the growth of t h e p r o f e s s i o n a t the o r g a n i z a t i o n a l l e v e l . L i m i t a t i o n s The scope of t h i s p r o j e c t and f i n a n c i a l r e q u i r e m e n t s n e c e s s a r i l y l i m i t e d the s i z e of t h e sample i n t h i s r e s e a r c h . T h i s d e c r e a s e s the^ p o s s i b i l i t y 10 o f a c h i e v i n g s t a t i s t i c a l l y s i g n i f i c a n t r e s u l t s ( B u r n s a n d G r o v e , 1 9 8 7 ) . T h e MER r e q u i r e s t h a t s u b j e c t s b e a b l e t o a r t i c u l a t e a n d w r i t e o u t t h e i r c o g n i t i v e p r o c e s s e s . T h e r e f o r e , r e s u l t s a r e d e p e n d e n t u p o n t h i s a b i l i t y . C o m p l e t i o n o f t h e i n s t r u m e n t i s v o l u n t a r y a n d r e q u i r e s a t i m e c o m m i t m e n t . I n d i v i d u a l s w h o w e r e w i l l i n g t o c o m p l e t e t h e MER m a y p o s s e s s c h a r a c t e r i s t i c s t h a t m i g h t i n f l u e n c e t h e r e s u l t s . A l t h o u g h t h e s a m p l e w a s r a n d o m , i t i n c l u d e d o n l y p r a c t i s i n g n u r s e s i n B r i t i s h C o l u m b i a . T h e r e s u l t s m a y r e f l e c t t h e c u r r i c u l a o f t h e s c h o o l s o f n u r s i n g a t t e n d e d b y t h e s u b j e c t s . I t w a s n o t b e p o s s i b l e t o c o n t r o l e x t r a n e o u s v a r i a b l e s s u c h a s 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 o r w o r k s e t t i n g , b u t s o m e o f t h e s e v a r i a b l e s w e r e r e c o g n i z e d w h e n g a t h e r i n g d e m o g r a p h i c d a t a . S i g n i f i c a n c e o f t h e S t u d y S c i e n t i f i c T h i s s t u d y w i l l a d d t o o u r k n o w l e d g e a b o u t t h e d e v e l o p m e n t o f i n t e l l e c t u a l a n d e t h i c a l r e a s o n i n g a b i l i t i e s o f n u r s e s w i t h d i f f e r e n t e d u c a t i o n a l b a c k g r o u n d s . T h e d a t a w i l l c o n t r i b u t e t o o u r u n d e r s t a n d i n g o f t h e e f f e c t s o f t h e d i f f e r e n t l e v e l s o f n u r s i n g 11 e d u c a t i o n . The f i n d i n g s w i l l be i n t e r p r e t e d i n r e l a t i o n t o the s t u d i e s r e f e r e n c e d i n the l i t e r a t u r e r e v i e w . Areas of s u b s t a n t i a t i o n or disagreement w i l l be r e v e a l e d . Compiled, anonymous s c o r e s and r e s u l t s of the s t u d y w i l l be s e n t t o the a u t h o r s of t h e MER s c a l e t o a s s i s t them i n e s t a b l i s h i n g v a l i d i t y and r e l i a b i l i t y f o r t h e i r i n s t r u m e n t . P r a c t i c a l An u n d e r s t a n d i n g of i n t e l l e c t u a l and e t h i c a l development d u r i n g n u r s i n g e d u c a t i o n may a s s i s t e d u c a t o r s i n i d e n t i f y i n g a p p r o p r i a t e c u r r i c u l u m g o a l s . I d e n t i f y i n g t h e s e g o a l s e x p l i c i t l y may h e l p f a c u l t y g a i n consensus around the aims of n u r s i n g e d u c a t i o n . Knowing a s t u d e n t ' s l e v e l of development w i l l a s s i s t i n p l a n n i n g e f f e c t i v e t e a c h i n g s t r a t e g i e s . Summary The a f o r e m e n t i o n e d backgound and purpose g u i d e the r e v i e w of t h e l i t e r a t u r e and methodology f o r t h i s r e s e a r c h . As i n d i c a t e d , P e r r y ' s (1970) t h e o r y of i n t e l l e c t u a l and e t h i c a l development p r o v i d e s the t h e o r e t i c a l frame of r e f e r e n c e . T h i s t h e o r y and a p p r o p r i a t e c o n c e p t s a r e the f o c u s of t h e f o l l o w i n g c h a p t e r . 12 C H A P T E R I I T h e o r e t i c a l F r a m e w o r k T h e P e r r y s c h e m e o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t p r o v i d e s a p r e c i s e f r a m e w o r k f r o m w h i c h t o v i e w t h e a b s t r a c t a n d c o m p l e x n a t u r e o f t h e g o a l s o f u n i v e r s i t y e d u c a t i o n . T h i s t h e o r e t i c a l f r a m e w o r k h e l p s t o e x p l a i n t h e r e l a t i o n s h i p b e t w e e n e d u c a t i o n a n d t h e d e v e l o p m e n t a l p r o c e s s e s i t n u r t u r e s . T h e P e r r y s c h e m e w a s f o r m u l a t e d a n d r e f i n e d d u r i n g a q u a l i t a t i v e s t u d y w h i c h t r a c e d c h a n g e s i n s t u d e n t s ' i n t e l l e c t u a l a n d e t h i c a l c h a r a c t e r i s t i c s d u r i n g t h e i r f o u r y e a r s o f u n d e r g r a d u a t e e d u c a t i o n . T h e P e r r y s c h e m e w a s d e v e l o p e d o v e r f i f t e e n y e a r s b y m o r e t h a n t h i r t y r e s e a r c h e r s ( P e r r y , 1 9 8 1 , p . 7 7 ) . T h e r e s e a r c h e r s c o l l e c t e d q u a l i t a t i v e d a t a f r o m s t u d e n t s a b o u t t h e m e a n i n g o f l e a r n i n g d u r i n g f o u r y e a r s o f l i b e r a l a r t s e d u c a t i o n a t H a r v a r d U n i v e r s i t y d u r i n g t h e 1 9 5 0 ' s . A l t h o u g h t h e d a t a w e r e c o l l e c t e d f r o m y o u n g a d u l t s , r e c e n t s t u d i e s h a v e s h o w n t h a t c o g n i t i v e d e v e l o p m e n t w a s m o r e r e l a t e d t o t h e e d u c a t i o n a l e x p e r i e n c e t h a n t h e a g e o f t h e i n d i v i d u a l ( P e r r y , 1 9 8 1 , p . 9 7 ) . D u r i n g i n t e r v i e w s w i t h s t u d e n t s , t h e i n v e s t i g a t o r s n o t e d t h a t t h e r e w a s c o n s i s t e n c y i n t h e w a y i n w h i c h s t u d e n t s d e v e l o p e d i n c r e a s i n g l y c o m p l e x c o g n i t i v e s t r u c t u r e s , " e s p e c i a l l y t h o s e s t r u c t u r e s i n w h i c h t h e y 13 c o n s t r u e the n a t u r e and o r i g i n s of knowledge, of v a l u e , and of r e s p o n s i b i l i t y " ( P e r r y , 1970, p. 1). The r e s e a r c h e r s came t o b e l i e v e t h a t i t would be more f r u i t f u l t o examine a g i v e n s t u d e n t ' s p r e f e r e n c e f o r d u a l i s t i c , r i g h t - w r o n g t h i n k i n g or a n o t h e r s t u d e n t ' s a f f i n i t y f o r more q u a l i f i e d , r e l a t i v i s t i c and c o n t i n g e n t t h i n k i n g as e x p r e s s i o n s of de v e l o p m e n t a l s t a g e s r a t h e r than p e r s o n a l i t y t r a i t s (p. 7 ) . The v a l i d i t y and u t i l i t y of the P e r r y scheme i s enhanced by i t s t h o r o u g h g r o u n d i n g i n t h e c o g n i t i v e d e v e l o p m e n t a l t h e o r i e s of Dewey (1965) and P i a g e t (1950). The p h i l o s o p h y of e d u c a t i o n and democracy put f o r t h by John Dewey i n t h e e a r l y p a r t of t h i s c e n t u r y can be c o n s i d e r e d the t h e o r e t i c a l p r o t o t y p e of t h e c o g n i t i v e d e v e l o p m e n t a l approach t o e d u c a t i o n (Archambault, 1964). The c h i e f f u n c t i o n of e d u c a t i o n became t h e i n d i v i d u a l development of t h e whole person. F o s t e r i n g t h e development of t h e c r e a t i v e , t h i n k i n g i n d i v i d u a l would c o n t r i b u t e t o the growth and w e l l b e i n g of a d e m o c r a t i c s o c i e t y . A c c o r d i n g t o Dewey, t h e aim of e d u c a t i o n i s t o s u p p l y c o n d i t i o n s which e n a b l e i n t e l l e c t u a l and moral development ( K o h l b e r g , 1975). Jean P i a g e t ' s e m p i r i c a l r e s e a r c h w i t h c h i l d r e n b u i l t upon t h e t h e o r e t i c a l w r i t i n g s of Dewey. He d e l i n e a t e d and d e s c r i b e d c h i l d h o o d c o g n i t i v e development 14 w h e r e t h e d i f f e r e n t i a t i o n o f i n c r e a s i n g l y c o m p l e x c o g n i t i v e s t r u c t u r e s c o u l d b e o b s e r v e d . P i a g e t ' s d e v e l o p m e n t a l t h e o r y a r o s e f r o m a b a c k g r o u n d i n b i o l o g y a n d t h u s e m p h a s i z e s g e n e t i c p r e d i s p o s i t i o n i n t h e d e v e l o p m e n t o f l e a r n i n g a n d b e h a v i o r . C r i t i c s s u g g e s t t h a t c u l t u r a l a n d e n v i r o n m e n t a l i n f l u e n c e s o n l e a r n i n g a n d b e h a v i o r a r e t h u s g i v e n s e c o n d a r y s i g n i f i c a n c e i n t h i s t h e o r y ( B i g g e , 1 9 8 2 , p . 1 9 ) . A l t h o u g h B i g g e a c k n o w l e d g e s t h e b e n e f i t o f P i a g e t ' s t h e o r y f o r t e a c h e r s , h e a l s o s u g g e s t s t h a t P i a g e t ' s w o r k c o n t r i b u t e s m o r e t o t h e d i s c i p l i n e o f p s y c h o l o g y t h a n t o a n a p p l i c a b l e l e a r n i n g t h e o r y f o r t e a c h e r s . P i a g e t ' s e m p h a s i s o n g e n e t i c d e v e l o p m e n t a l f a c t o r s i s c o n t r a r y t o t h e b e h a v i o u r i s t ' s t h e o r e t i c a l p o s i t i o n w h e r e e n v i r o n m e n t a l i n f l u e n c e s o n l e a r n i n g a n d b e h a v i o r a r e p r i m a r y . B e h a v i o r i s t s d e f i n e l e a r n i n g a s c o n d i t i o n i n g o r r e i n f o r c e m e n t o f b e h a v i o r s ( B i g g e , 1 9 8 2 , p . 8 0 ) . H i g h e r i n t e l l e c t u a l p r o c e s s e s s u c h a s t h o u g h t a n d i n s i g h t a r e n o t d e a l t w i t h i n d e t a i l b y b e h a v i o r a l l e a r n i n g t h e o r i s t s . F r o m a n o p p o s i n g v i e w p o i n t , g e s t a l t - f i e l d l e a r n i n g t h e o r i s t s d e f i n e l e a r n i n g a s t h e d e v e l o p m e n t o f i n s i g h t s , w h i c h p r o v i d e a p o t e n t i a l g u i d e f o r b e h a v i o r ( p . 8 0 ) . T h e s e t h e o r i s t s v i e w l e a r n i n g w i t h m o r e c o m p l e x i t y a n d f o c u s o n t h e h i g h e r c o g n i t i v e p r o c e s s e s o f t h o u g h t , i n s i g h t , i n t e l l i g e n c e a n d 15 p e r c e p t i o n . The g e s t a l t - f i e l d t h e o r i e s i n c o m b i n a t i o n w i t h fundamental p r e m i s e s d e v e l o p e d by P i a g e t s e r v e as a f o u n d a t i o n f o r P e r r y ' s scheme of development. P i a g e t d e s c r i b e d c o g n i t i v e development t h r o u g h the s t a g e s of p r e - c o n c r e t e , c o n c r e t e , and f o r m a l o p e r a t i o n s from e a r l y c h i l d h o o d t o a d o l e s c e n c e . Tomlinson-Keasey and Keasey (1974) c i t e s i x s t u d i e s which i n d i c a t e t h a t P i a g e t ' s s t a g e of f o r m a l o p e r a t i o n s does not r e a c h f u n c t i o n a l m a t u r i t y u n t i l w e l l i n t o a d u l t h o o d (p. 292). U s i n g t h e ass u m p t i o n s and c o n c e p t s put f o r t h i n the s e e a r l i e r t h e o r i e s , P e r r y f o r m u l a t e d a t h e o r y of a d u l t c o g n i t i v e development. Some of t h e components of g e s t a l t c o g n i t i v e - f i e l d t h e o r y and P i a g e t ' s r e s e a r c h a r e i n t e g r a l t o P e r r y ' s t h e o r y . They i n c l u d e a s s u m p t i o n s about the making of meaning, the c o n c e p t s of s t r u c t u r e , development, and s t a g e s , and ass u m p t i o n s about m o t i v a t i o n . These ass u m p t i o n s w i l l be r e v i e w e d next. Waking of Meaning I n d i v i d u a l s s t r i v e t o make o r d e r l y meaning-of t h e i r e x p e r i e n c e s and t h e i r environment. The i n d i v i d u a l makes sense of e n v i r o n m e n t a l i n t e r a c t i o n s t h r o u g h the e s t a b l i s h e d forms of o r d e r l i n e s s t h a t t h e i n d i v i d u a l c o n t i n u a l l y d e v e l o p s and b r i n g s t o new e x p e r i e n c e s . I n d i v i d u a l s i n t e r a c t w i t h the environment, and 16 e x p e r i e n c e new e v e n t s which may be e i t h e r c ongruent or i n c o n g r u e n t w i t h e s t a b l i s h e d c o g n i t i v e s t r u c t u r e s . C o g n i t i v e s t r u c t u r e s a r e the e x p e c t a t i o n s , based on p a s t e x p e r i e n c e s , t h a t the i n d i v i d u a l b r i n g s t o new s i t u a t i o n s . These e x p e c t a t i o n s a r e a p a r t of the p e r s p e c t i v e from which the i n d i v i d u a l v i e w s the world. The work of making meaning of new e v e n t s i n the environment c o n s i s t s of a b a l a n c e between the p r o c e s s e s of a s s i m i l a t i o n and accommodation ( P e r r y , 1970, p. 42). A s s i m i l a t i o n i s a more i m p l i c i t merging of the e x p e r i e n c e t o e s t a b l i s h e d e x p e c t a n c i e s of the i n d i v i d u a l by means of s e l e c t i o n , s i m p l i f i c a t i o n , or d i s t o r t i o n . Accommodation i s a more e x p l i c i t r e a l i z a t i o n , where e s t a b l i s h e d e x p e c t a n c i e s a r e t r a n s f o r m e d i n t o a new i n s i g h t t h a t r e v e a l s t h e meaning of an i n c o n g r u e n t e x p e r i e n c e . In P e r r y ' s s t u d y , s t u d e n t s ' a c c o u n t s of such r e v e l a t i o n s o r developments of new i n s i g h t s were v a l u a b l e i n r e v e a l i n g "a) the s t r u c t u r e of the e a r l i e r e x p e c t a n c i e s which had proved i n a d e q u a t e , b) t h e s t r u c t u r e of the new i n t e r p r e t a t i o n which r e s o l v e d the i n c o n g r u i t y , and c) t h e t r a n s i t i o n a l p r o c e s s by which th e new s t r u c t u r e was c r e a t e d " (p. 42). S i n c e t h e aim of e d u c a t i o n i s t o f a c i l i t a t e development, the t r a n s i t i o n a l p r o c e s s i s a c e n t r a l c oncern. 17 C o g n i t i v e S t r u c t u r e s S t r u c t u r e i n the P e r r y scheme (1970) r e f e r s t o the " f o r m a l p r o p e r t i e s of the a s s u m p t i o n s and e x p e c t a n c i e s a p e r s o n h o l d s a t a g i v e n time i n r e g a r d t o the n a t u r e and o r i g i n s of knowledge and v a l u e " (p. 42). The s t r u c t u r e s can be e x p e c t a n c i e s of the w o r l d as d u a l i s t i c , r e l a t i v i s t i c , a u t h o r i t a r i a n , o r e q u a l i t a r i a n . I n d i v i d u a l s o f t e n p r e f e r t e a c h i n g and l e a r n i n g forme which a r e congruent w i t h t h e i r l e v e l of c o g n i t i v e s t r u c t u r e o r t h e i r e x p e c t a t i o n s and assumptions. However, t h e y r e q u i r e exposure t o new and i n c o n g r u e n t e x p e r i e n c e s i n o r d e r t o d e v e l o p t o the next s t a g e . Development W i t h i n the P e r r y scheme the concept of development i s d e f i n e d as a p r o g r e s s i o n i n which more complex s t r u c t u r e s a r e c r e a t e d by the d i f f e r e n t i a t i o n and r e i n t e g r a t i o n of e a r l i e r , s i m p l e r s t r u c t u r e s . P e r r y s t a t e s t h a t "each s t e p i n the development p r e s e n t s a c h a l l e n g e t o a p e r s o n ' s p r e v i o u s a s s u m p t i o n s and r e q u i r e s t h a t he r e d e f i n e and e x t e n d h i s r e s p o n s i b i l i t i e s i n the midst of i n c r e a s e d c o m p l e x i t y and u n c e r t a i n t y , h i s growth does ind e e d i n v o l v e courage" (p. 44). Each s t e p i n v o l v e s abandoning a way of t h i n k i n g , and p o s s i b l y a sense of l o s s of s e l f . T h i s e x p e r i e n c e can be u n c o m f o r t a b l e and some s t u d e n t s w i l l r e s i s t the change. P e r r y s u g g e s t s t h e r e a r e t h r e e 18 a l t e r n a t i v e s t o d e v e l o p m e n t w h i c h a s t u d e n t m i g h t c h o o s e w h e n t h e c h a l l e n g e i s o v e r w h e l m i n g . T h e s e a r e : a ) t e m p o r i z i n g , w h e r e a s t u d e n t h e s i t a t e s t o t a k e t h e n e x t s t e p f o r a n e x t e n d e d l e n g t h o f t i m e ; b ) e s c a p e , w h e r e a s t u d e n t c h o o s e s d e t a c h m e n t a n d d e n i e s r e s p o n s i b i l i t y -t h r o u g h p a s s i v i t y o r a l i e n a t i o n ; c ) r e t r e a t , w h e r e t h e s t u d e n t e n t r e n c h e s i n d u a l i s m o r a b s o l u t i s m . S t a g e s o r P o s i t i o n s S t a g e s o r p o s i t i o n s a r e u s e d t o d e s c r i b e t h e l e v e l o f c o g n i t i v e s t r u c t u r e a t t a i n e d b y t h e i n d i v i d u a l . T h e t e r m p o s i t i o n s i s p r e f e r r e d a s i t r e p r e s e n t s t h e p e r s p e c t i v e f r o m w h i c h t h e i n d i v i d u a l v i e w s t h e w o r l d . P o s i t i o n s a r e r e l a t i v e l y s t a b l e s t r u c t u r e s w i t h i d e n t i f i a b l e c h a r a c t e r i s t i c s . D e v e l o p m e n t i n v o l v e s a c h i e v i n g h i g h e r p o s i t i o n s . I n d i v i d u a l s e x p e r i e n c e a t r a n s i t i o n a l p r o c e s s a s t h e y d e v e l o p t o w a r d h i g h e r p o s i t i o n s o f c o g n i t i v e m a t u r i t y . M o t i v a t i o n M o t i v a t i o n t o p r o c e e d t o n e w p o s i t i o n s i s c o n s i d e r e d t o b e p r i m a r i l y i n t e r n a l . P e r r y s t a t e s t h a t t h e i m p e t u s t o d e v e l o p i n c l u d e s m a n y s t u d e n t e x p e r i e n c e s s u c h a s " s h e e r c u r i o s i t y ; a s t r i v i n g f o r t h e c o m p e t e n c e t h a t c a n e m e r g e o n l y f r o m a n u n d e r s t a n d i n g o f o n e ' s r e l a t i o n t o t h e e n v i r o n m m e n t ; a n u r g e t o m a k e o r d e r o u t o f i n c o n g r u i t i e s , d i s s o n a n c e s , a n d a n o m a l i e s o f 19 e x p e r i e n c e ; a w i s h f o r a community w i t h men l o o k e d upon as mature; a w i s h f o r a u t h e n t i c i t y i n p e r s o n a l r e l a t i o n s h i p s ; a w i s h t o d e v e l o p and a f f i r m an i d e n t i t y " (p. 51). There a r e n i n e p o s i t i o n s of c o g n i t i v e development i n the P e r r y scheme. These p o s i t i o n s r e p r e s e n t the p e r s p e c t i v e of the i n d i v i d u a l , o r the way i n which an i n d i v i d u a l t h i n k s about " t h e n a t u r e of knowledge, t r u t h , and v a l u e s , and the meaning of l i f e and r e s p o n s i b i l i t i e s " ( K i n g , 1978, p. 37). The scheme w i l l be p r e s e n t e d next. P o s i t i o n 1: The s t u d e n t s e e s the w o r l d i n p o l a r terms of w e - r i g h t - g o o d vs. other—wrong-bad. R i g h t answers e x i s t i n t h e a b s o l u t e , known t o a u t h o r i t y whose r o l e i t i s t o mediate ( t e a c h ) them. . . P o s i t i o n 2: The s t u d e n t p e r c e i v e s d i v e r s i t y of o p i n i o n , and u n c e r t a i n t y , and a c c o u n t s f o r them as unwarranted c o n f u s i o n i n p o o r l y q u a l i f i e d a u t h o r i t i e s or as mere e x e r c i s e s e t by a u t h o r i t y "so we can l e a r n t o f i n d t h e answer f o r o u r s e l v e s . " P o s i t i o n 3: The s t u d e n t a c c e p t s d i v e r s i t y and u n c e r t a i n t y as l e g i t i m a t e but s t i l l temporary i n a r e a s where a u t h o r i t y " h a sn't found the answer y e t . " He supposes a u t h o r i t y g rades him i n t h e s e a r e a s on "good e x p r e s s i o n " but r emains p u z z l e d as t o s t a n d a r d s . P o s i t i o n 4: (a) The s t u d e n t p e r c e i v e s l e g i t i m a t e u n c e r t a i n t y (and t h e r e f o r e d i v e r s i t y of o p i n i o n ) t o be e x t e n s i v e and r a i s e s i t t o t h e s t a t u s of an u n s t r u c t u r e d e p l s t e m o l o g i c a l r e a l m of i t s own i n which "anyone has a r i g h t t o h i s own o p i n i o n , " a r e a l m which he s e t s over a g a i n s t a u t h o r i t y ' s r e a l m where r i g h t - w r o n g s t i l l p r e v a i l s ; o r (b) the s t u d e n t d i s c o v e r s q u a l i t a t i v e c o n t e x t u a l r e l a t i v i s t i c r e a s o n i n g as a s p e c i a l case of "what t h e y want" w i t h i n a u t h o r i t y ' s realm. P o s i t i o n 5: The s t u d e n t p e r c e i v e s a l l knowledge and v a l u e s ( i n c l u d i n g a u t h o r i t y ' s ) as c o n t e x t u a l 20 and r e l a t i v i s t i c and s u b o r d i n a t e s d u a l i s t i c r i g h t - w r o n g f u n c t i o n s t o the s t a t u s of a s p e c i a l case, i n c o n t e x t . P o s i t i o n 6: The s t u d e n t apprehends the n e c e s s i t y of o r i e n t i n g h i m s e l f i n a r e l a t i v i s t i c w o r l d t h r o u g h some form of p e r s o n a l commitment (as d i s t i n c t f r om u n q u e s t i o n e d or u n c o n s i d e r e d commitment t o s i m p l e b e l i e f i n c e r t a i n t y ) . P o s i t i o n 7: The s t u d e n t makes an i n i t i a l commitment i n some area. P o s i t i o n 8: The s t u d e n t e x p e r i e n c e s the i m p l i c a t i o n s of commitment, and e x p l o r e s t h e s u b j e c t i v e and s t y l i s t i c i s s u e s of r e s p o n s i b i l i t y . P o s i t i o n 9: The s t u d e n t e x p e r i e n c e s the a f f i r m a t i o n of i d e n t i t y among m u l t i p l e r e s p o n s i b i l i t i e s and r e a l i z e s commitment as an ongoing, u n f o l d i n g a c t i v i t y t h r o u g h which he e x p r e s s e s h i s l i f e s t y l e . ( P e r r y , 1970, pp. 9-10.) Four themes of development a r e apparent t h r o u g h the p o s i t i o n s . These a r e : a) Dualism, r e p r e s e n t e d i n the f i r s t two p o s i t i o n s where the s t u d e n t s e e s the w o r l d i n p o l a r terms; b) M u l t i p l i c i t y , r e p r e s e n t e d i n p o s i t i o n s 3 and 4 where the s t u d e n t a c c e p t s m u l t i p l e s o u r c e s of knowledge; c) R e l a t i v i s m , r e p r e s e n t e d i n p o s i t i o n 5 and 6 where th e s t u d e n t r e c o g n i z e s knowledge as r e l a t i v e ; and d) Commitment, r e p r e s e n t e d i n p o s i t i o n s 7, 8, and 9 where th e s t u d e n t a c c e p t s r e s p o n s i b l i t y f o r d e c i s i o n s and c h o i c e s i n a p l u r a l i s t i c w o r l d . P e r r y (1981) d e f i n e s t h e s e a s f o l l o w s . Dualism. D i v i s i o n of meaning i n t o two realms-Good v e r s u s Bad, R i g h t v e r s u s Wrong, We v e r s u s They, A l l t h a t i s not S u c c e s s i s F a i l u r e , and the l i k e . R i g h t Answers e x i s t somewhere f o r e v e r y problem, and a u t h o r i t i e s know them. R i g h t Answers a r e t o be memorized by h a r d work. Knowledge i s Q u a n t i t a t i v e . Agency i s e x p e r i e n c e d as "out t h e r e " i n A u t h o r i t y , t e s t s c o r e s , the R i g h t j o b . 21 M u l t i p l i c i t y . D i v e r s i t y o f o p i n i o n a n d v a l u e s i s r e c o g n i z e d a s l e g i t i m a t e i n a r e a s w h e r e r i g h t a n s w e r s a r e n o t y e t k n o w n . O p i n i o n s r e m a i n a t o m i s t i c w i t h o u t p a t t e r n o r s y s t e m . N o j u d g m e n t s c a n b e m a d e a m o n g t h e m s o " e v e r y o n e h a s a r i g h t t o h i s o w n o p i n i o n ; n o n e c a n b e c a l l e d w r o n g . " R e l a t i v i s m . D i v e r s i t y o f o p i n i o n , v a l u e s , a n d j u d g m e n t d e r i v e d f r o m c o h e r e n t s o u r c e s , e v i d e n c e , l o g i c s , s y s t e m s , a n d p a t t e r n s a l l o w i n g f o r a n a l y s i s a n d c o m p a r i s o n . S o m e o p i n i o n s m a y b e f o u n d w o r t h l e s s , w h i l e t h e r e w i l l r e m a i n m a t t e r s a b o u t w h i c h r e a s o n a b l e p e o p l e w i l l r e a s o n a b l y d i s a g r e e . K n o w l e d g e i s q u a l i t a t i v e , d e p e n d e n t o n c o n t e x t s . C o m m i t m e n t . A n a f f i r m a t i o n , c h o i c e , o r d e c i s i o n ( c a r e e r , v a l u e s , p o l i t i c s , p e r s o n a l r e l a t i o n s h i p ) m a d e i n t h e a w a r e n e s s o f R e l a t i v i s m ( d i s t i n c t f r o m l o w e r c a s e " c " o f c o m m i t m e n t s n e v e r q u e s t i o n e d ) . A g e n c y i s e x p e r i e n c e d a s w i t h i n t h e i n d i v i d u a l . ( P e r r y , 1 9 8 1 , p . 7 9 ) S u m m a r y T h e P e r r y s c h e m e i s a t h e o r e t i c a l r e f l e c t i o n o f t h e s t a t e m e n t s o f t h e p u r p o s e o f a u n i v e r s i t y e d u c a t i o n f o r n u r s e s , p r e s e n t e d a t t h e b e g i n n i n g o f t h i s p a p e r . A s s u c h , i t p r o v i d e s a f r a m e w o r k w h i c h d e s c r i b e s t h e c o n n e c t i o n s b e t w e e n t h e c o m p l e x v a r i a b l e s w h i c h a r e c o m p o n e n t s o f t h i s i s s u e . T h e t h e o r y i s c o m p r e h e n s i v e i n d e s c r i b i n g t h e i n t e r r e l a t i o n s h i p s a m o n g c o n c e p t s i m p o r t a n t f o r n u r s i n g e d u c a t i o n . A d d e d c l a r i t y a r o u n d t h e p r o c e s s o f d e v e l o p m e n t o f h i g h e r l e v e l s o f i n t e l l e c t u a l a n d e t h i c a l a b i l i t y p r o v i d e s n u r s i n g e d u c a t o r s w i t h a f r a m e o f r e f e r e n c e w h i c h d e s c r i b e s h o w l e a r n i n g i n t h e c o g n i t i v e r e a l m i s a c h i e v e d . T h e P e r r y s c h e m e h a s b e e n u s e d i n r e s e a r c h w i t h n u r s i n g s t u d e n t s ( V a l i g a , 1 9 8 3 , F r i s c h , 1 9 8 7 ) , i n c a r e e r 22 development (Knefelkamp and S l e p i t z a , 1976), and i n s t u d y i n g s e l f d i r e c t e d l e a r n i n g and dependence on a u t h o r i t y (Shaw-Berget, 1988). The P e r r y scheme o f f e r s good f a c e v a l i d i t y as most peop l e can see t h e i r own, as w e l l as t h e i r s t u d e n t s development i n the d e s c r i p t i o n s of t h e p o s i t i o n s . 23 C H A P T E R I I I L i t e r a t u r e Review Review o f t h e l i t e r a t u r e w i l l i n c l u d e an o v e r v i e w of t h e o r e t i c a l p u b l i c a t i o n s and r e s e a r c h r e l a t e d t o : 1) .the e f f e c t s o f b a c c a l a u r e a t e n u r s i n g e d u c a t i o n ; 2 ) t h e body o f knowledge r e l a t e d t o t h e c o g n i t i v e d o m a i n i n n u r s i n g e d u c a t i o n ; 3 ) t h e a p p l i c a t i o n o f t h e P e r r y scheme i n e d u c a t i o n ; a n d 4 ) d e v e l o p m e n t o f e t h i c a l and moral r e a s o n i n g a b i l i t i e s . Review o f t h e o r e t i c a l l i t e r a t u r e on b a c c a l a u r e a t e n u r s i n g e d u c a t i o n w i l l be h e l p f u l i n i l l u s t r a t i n g t h e s i g n i f i c a n c e o f t h i s s t u d y i n c l a r i f y i n g t h e e f f e c t s o f e d u c a t i o n . T h i s l i t e r a t u r e w i l l a l s o b e h e l p f u l i n i d e n t i f y i n g b i a s a n d u n f o u n d e d a s s u m p t i o n s . R e v i e w o f r e s e a r c h i n t h i s a r e a w i l l i d e n t i f y v a r i a b l e s w h i c h h a v e b e e n s t u d i e d i n r e l a t i o n t o l e v e l o f e d u c a t i o n . L i t e r a t u r e o n t h e c o g n i t i v e d o m a i n w i t h i n n u r s i n g e d u c a t i o n h a s c o n t r i b u t e d t o o u r u n d e r s t a n d i n g o f l e a r n e r c h a r a c t e r i s t i c s a n d t e a c h i n g s t r a t e g i e s w h i c h c a n b e u s e d t o e n h a n c e t h e e f f e c t i v e n e s s o f n u r s i n g p r o g r a m s w i t h i n t h i s r e a l m . M a n y o f t h e c o n c e p t s w i t h i n t h e c o g n i t i v e d o m a i n w h i c h h a v e b e e n i n v e s t i g a t e d b y n u r s i n g r e s e a r c h e r s , s u c h a s c r i t i c a l t h i n k i n g a n d c l i n i c a l j u d g m e n t , a r e c l o s e l y r e l a t e d t o i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t . R e v i e w o f t h e l i t e r a t u r e i n 24 t h i s a r e a w i l l h e l p t o p l a c e r e s e a r c h on i n t e l l e c t u a l and e t h i c a l development w i t h i n the broader c o n t e x t of n u r s i n g e d u c a t i o n . T h e o r e t i c a l w r i t i n g s on the P e r r y scheme w i l l i d e n t i f y the a p p l i c a b i l i t y and a p p r o p r i a t e n e s s of t h i s t h e o r y t o n u r s i n g e d u c a t i o n . Research s t u d i e s i n o t h e r d i s c i p l i n e s u s i n g the P e r r y scheme have c o n t r i b u t e d t o v a l i d a t i o n of the t h e o r y , and have extended a p p l i c a t i o n s of the scheme. N u r s i n g r e s e a r c h u s i n g the P e r r y scheme w i l l be c r i t i q u e d and w i l l be p a r t i c u l a r l y h e l p f u l i n d e t e r m i n i n g a p p r o p r i a t e methodology f o r t h i s s t u d y . T h e o r e t i c a l and e m p i r i c a l w r i t i n g s on e t h i c a l and moral r e a s o n i n g w i l l be r e v i e w e d as t h e y r e l a t e t o i n t e l l e c t u a l development. B a c c a l a u r e a t e N u r s i n g E d u c a t i o n  T h e o r e t i c a l L i t e r a t u r e The g o a l of b a c c a l a u r e a t e n u r s i n g e d u c a t i o n most w i d e l y a c c e p t e d by a u t h o r s i s t h a t put f o r t h by Kramer (1981). She s t a t e s t h a t " t h e g o a l of b a c c a l a u r e a t e n u r s i n g e d u c a t i o n i s t o p r e p a r e a l i b e r a l l y e ducated p e r s o n t o f u n c t i o n as a p r o f e s s i o n a l nurse i n a v a r i e t y o f nurse r o l e s and h e a l t h c a r e s e t t i n g s " (p. 224). G a l l o p (1984) r e l a t e s the c o n c e p t s of l i b e r a l e d u c a t i o n , i n t e l l e c t u a l and e t h i c a l development, and the e n t r y t o p r a c t i c e p o s i t i o n i n the f o l l o w i n g s t a t e m e n t s . 25 B y e x p o s i n g t h e s t u d e n t t o t h e a r t s a n d h u m a n i t i e s a s w e l l a s b i o l o g i c a l s c i e n c e s t h e s t u d e n t a c q u i r e s a r i c h f o u n d a t i o n f o r s e l f g r o w t h . I d e a l l y t h e n u r s i n g s t u d e n t w i l l h a v e a n o p p o r t u n i t y t o a c q u i r e t h e a b i l i t y t o t h i n k i n c o m p l e x p a t t e r n s , t o p r o b l e m s o l v e , t o t o l e r a t e a m b i g u i t y , a n d t o p u r s u e k n o w l e d g e f o r i t s o w n e n d . T h e b a c c a l a u r e a t e p r o g r a m s h o u l d e n c o u r a g e c o g n i t i v e d e v e l o p m e n t t h a t w i l l p r e p a r e t h e n u r s e m o r e f u l l y f o r p r o b l e m s o l v i n g a n d d e c i s i o n m a k i n g i n t h e e v e r i n c r e a s i n g c o m p l e x i t i e s o f n u r s i n g p r a c t i c e < p , 5 7 ) . G a l l o p f u r t h e r s t a t e s t h a t n u r s e s c o n f r o n t i s s u e s o f e n o r m o u s m o r a l a n d e t h i c a l c o n s e q u e n c e s , a n d t h a t a u n i v e r s i t y e d u c a t i o n p r e p a r e s n u r s e s w i t h t h e c o g n i t i v e s k i l l s n e e d e d t o d e a l w i t h t h e s e i s s u e s . S h e s u g g e s t s t h a t o p p o r t u n i t y t o d e v e l o p t h e s e s k i l l s d i f f e r e n t i a t e s t h e u n i v e r s i t y d e g r e e p r o g r a m f r o m t h e t w o y e a r d i p l o m a p r o g r a m i n n u r s i n g . T o b e a b l e t o c o n s i d e r t h e s e a n d o t h e r i s s u e s i n a c o m p l e x m a n n e r r e q u i r e s t h e a b i l i t y t o t h i n k i n a r e l a t i v i s t i c m a n n e r ( P e r r y , 1968). T h e s t u d e n t i n a t w o y e a r p r o g r a m h a s n o t h a d t h e o p p o r t u n i t y t o a c q u i r e t h e s e c o g n i t i v e s k i l l s . T h e v e r y n a t u r e o f t h e p r o g r a m m a y r e q u i r e t h e 2 6 s t u d e n t t o v i e w i s s u e s a s s i m p l y r i g h t o r w r o n g ( G a l l o p , 1 9 8 4 , p . 5 9 ) . W o o l l e y ( 1 9 8 6 ) d e f i n e s t h e p r o d u c t o f b a c c a l a u r e a t e e d u c a t i o n a s " a n a u t o n o m o u s , a c c o u n t a b l e p r a c t i t i o n e r o f n u r s i n g w h o s e e s a n d a c t s b e y o n d t h e b o u n d a r i e s o f f o l l o w i n g o r d e r s a n d c o m p l e t i n g t a s k s ; w h o s e e s t h e w h o l e p e r s o n a n d t h e w h o l e p r o b l e m ; w h o h a s a k n o w l e d g e o f t h e l a r g e r w o r l d a n d i t s m a n y d i m e n s i o n s o f k n o w l e d g e ; w h o i s a c t i v e r a t h e r t h a n r e a c t i v e ; a n d w h o h a s t h e p e r s p e c t i v e o f a n e d u c a t e d p e r s o n w h o k n o w s h o w m u c h m o r e t h e r e i s t o k n o w a n d n e v e r f e e l s t h a t h e o r s h e h a s l e a r n e d a l l s h e n e e d s t o k n o w " ( p . 1 9 9 ) . T h e s e s t a t e m e n t s d e m o n s t r a t e c o n s i s t e n c y a m o n g t h e o r e t i c i a n s a s t o t h e e x p e c t e d o u t c o m e s o f b a c c a l a u r e a t e n u r s i n g e d u c a t i o n . H o w e v e r , t h e t h e o r e t i c a l c o n s i s t e n c i e s a r e n o t r e f l e c t e d i n t h e r e s e a r c h . R e s e a r c h L i t e r a t u r e M a n y o f t h e r e s e a r c h s t u d i e s o n t h e e f f e c t s o f b a c c a l a u r e a t e e d u c a t i o n h a v e i n c l u d e d p e r f o r m a n c e c o m p a r i s o n s o f d i p l o m a a n d b a c c a l a u r e a t e s t u d e n t s . M a n y o f t h e A m e r i c a n s t u d i e s f o c u s e d o n d i f f e r e n c e s b e t w e e n t e c h n i c a l a n d p r o f e s s i o n a l r o l e s . I n C a n a d a , t h e t e c h n i c a l - p r o f e s s i o n a l d i c h o t o m y h a s n o t b e e n a 27 c o m p o n e n t o f t h e e n t r y t o p r a c t i c e i s s u e , b u t s t u d i e s , w i t h t h i s o r i e n t a t i o n w e r e r e v i e w e d f o r t h e i r c o n t r i b u t i o n t o u n d e r s t a n d i n g t h e e f f e c t s o f e d u c a t i o n . M c C l o s k e y ( 1 9 8 1 ) r e v i e w e d t h e l i t e r a t u r e o n t h e e f f e c t i v e n e s s o f n u r s i n g e d u c a t i o n a s i t r e l a t e s t o j a b p e r f o r m a n c e . S h e r e v i e w e d 33 p u b l i s h e d a n d u n p u b l i s h e d s t u d i e s a n d c o n c l u d e d t h a t t h e l i t e r a t u r e " r e v e a l e d c o n t r a d i c t o r y e v i d e n c e o n t h e v a l u e o f b a c c a l a u r e a t e e d u c a t i o n . " S i g n i f i c a n t l y , s h e r e c o m m e n d e d t h a t f u t u r e r e s e a r c h s h o u l d f o c u s o n " m e a s u r e m e n t o f i n d i v i d u a l p e r f o r m a n c e r a t h e r t h a n t h e p e r c e p t i o n o f g r o u p p e r f o r m a n c e " ( p . 355). M c C l o s k e y (1983) a l s o i d e n t i f i e d o t h e r v a r i a b l e s s u c h a s t h e w o r k s e t t i n g , c a r e e r m o t i v a t i o n , l i b e r a l o r g e n e r a l e d u c a t i o n c o n t e n t i n t h e b a s i c p r o g r a m , a n d t h e e f f e c t o f c o n t i n u i n g e d u c a t i o n o n j o b p e r f o r m a n c e . M e l e i s a n d F a r r e l l (1974) s t u d i e d 188 s t u d e n t s f r o m d i p l o m a , a s s o c i a t e d e g r e e , a n d b a c c a l a u r e a t e p r o g r a m s . S t u d e n t s f r o m s i x s c h o o l s w e r e t e s t e d f o r i n t e l l e c t u a l c h a r a c t e r i s t i c s , l e a d e r s h i p , r e s e a r c h o r i e n t a t i o n , a n d s o c i o p s y c h o l o g i c a l f a c t o r s . " I n t e l l e c t u a l c h a r a c t e r i s t i c s , a s t e s t e d b y f o u r s c a l e s o n t h e O m n i b u s p e r s o n a l i t y i n v e n t o r y s h o w e d n o s i g n i f i c a n t d i f f e r e n c e s a m o n g s t u d e n t s i n t h e t h r e e p r o g r a m s " ( p . 464). T h e f o u r s c a l e s o f t h i s m e a s u r e m e n t t o o l i n c l u d e d t h i n k i n g 28 i n t r o v e r s i o n o r r e f l e c t i v e t h o u g h t , t h e o r e t i c a l o r i e n t a t i o n , e s t h e t i c i s m , a n d a u t o n o m y , c o n c e p t s w h i c h a r e s i m i l a r t o t h o s e o f i n t e r e s t i n t h i s s t u d y . S t u d e n t s h a d s i m i l a r l e v e l s o f l e a d e r s h i p ; d i p l o m a s t u d e n t s v a l u e d r e s e a r c h m o r e t h a n b a c c a l a u r e a t e s t u d e n t s ; a n d a l l s t u d e n t s s c o r e d " s t r i k i n g l y l o w " o n s e l f e s t e e m . T h e a u t h o r s c o n c l u d e d t h a t " t h e r e a r e m o r e s i m i l a r i t i e s a m o n g s t u d e n t s i n t h e t h r e e t y p e s o f n u r s i n g e d u c a t i o n p r o g r a m s t h a n m a n y n u r s i n g e d u c a t o r s a r e w i l l i n g t o a c c e p t " ( p . 466). R e s u l t s o f t h i s s t u d y s h o w e d s t u d e n t s o f a l l t h r e e p r o g r a m s w e r e e s s e n t i a l l y a l i k e i n t e l l e c t u a l l y a n d i n t h e i r c o n s i d e r a t i o n f o r o t h e r s . S i g n i f i c a n t l y , M e l e i s a n d F a r r e l l n o t e d t h a t d i f f e r e n c e s i n e d u c a t i o n m i g h t i n v o l v e c o n s t r u c t s t h a t h a v e n o t b e e n c l e a r l y d e f i n e d a n d s t u d i e d a s y e t . M a n d r i l l o (1969), i n a n u n p u b l i s h e d s t u d y c i t e d b y R o s e (1988) a n d M c C l o s k e y (1981), c o n d u c t e d " a c o m p a r a t i v e s t u d y o f t h e c o g n i t i v e s k i l l s o f g r a d u a t i n g b a c c a l a u r e a t e d e g r e e a n d a s s o c i a t e d e g r e e n u r s i n g s t u d e n t s . " S h e a d m i n i s t e r e d a m u l t i p l e c h o i c e t e s t t o 1 5 5 b a c c a l a u r e a t e s t u d e n t s a n d 106 d i p l o m a s t u d e n t s t o a s c e r t a i n t h e i r c o g n i t i v e s k i l l s i n r e l a t i n g s c i e n t i f i c k n o w l e d g e t o p a t i e n t p r o b l e m s . S h e c o n c l u d e d t h a t b a c c a l a u r e a t e d e g r e e s t u d e n t s p o s s e s s e d m o r e k n o w l e d g e a n d r e l a t e d t h i s k n o w l e d g e t o p a t i e n t p r o b l e m s b e t t e r 29 t h a n a s s o c i a t e d e g r e e s t u d e n t s . B o t t o m s ( 1 9 8 8 ) i n v e s t i g a t e d l i b e r a l e d u c a t i o n c o m p e t e n c i e s u s e d b y n u r s e s i n t h e i r p e r s o n a l a n d p r o f e s s i o n a l l i v e s i n r e l a t i o n t o l e v e l o f n u r s i n g e d u c a t i o n . S h e u s e d D r e s s e l ' s ( 1 9 7 9 ) s i x c o m p e t e n c i e s o f a l i b e r a l l y e d u c a t e d p e r s o n i n d e f i n i n g t h e i n t e n d e d o u t c o m e s o f l i b e r a l n u r s i n g e d u c a t i o n . T h e s e c o m p e t e n c i e s i n c l u d e d k n o w l e d g e , c o m m u n i c a t i o n , v a l u e s , c o l l a b o r a t i o n , c i t i z e n s h i p , a n d i n t e g r a t i o n . H e r s t u d y s a m p l e c o n s i s t e d o f 3 6 6 d i p l o m a , 1 2 3 a s s o c i a t e , a n d 7 6 b a c c a l a u r e a t e g r a d u a t e s c u r r e n t l y p r a c t i s i n g n u r s i n g . S t u d y f i n d i n g s s h o w e d t h a t n u r s e s r e p o r t e d m o r e l i b e r a l e d u c a t i o n b e h a v i o r s i n t h e i r p e r s o n a l l i v e s t h a n i n t h e i r p r o f e s s i o n a l l i v e s . A l s o , b a c c a l a u r e a t e g r a d u a t e s a p p l i e d m a r e c o m p e t e n c i e s i n t h e i r p e r s o n a l l i v e s t h a n d i d a s s o c i a t e d e g r e e g r a d u a t e s a n d m o r e c o m p e t e n c i e s i n t h e i r p r o f e s s i o n a l l i v e s t h a n d i d h o s p i t a l - b a s e d d i p l o m a g r a d u a t e s ( p . 1 2 9 ) . T h e a u t h o r n o t e d t h a t p o s s i b l e i n e q u a l i t y o f t h e p e r s o n a l a n d p r o f e s s i o n a l m e a s u r e m e n t s c a l e s m a y h a v e m a d e c o m p a r i s o n o f p e r s o n a l a n d p r o f e s s i o n a l r e a l m s i m p r e c i s e . L i k e S h e a h a n ( 1 9 7 2 ) a n d V o o l l e y ( 1 9 8 6 ) , B o t t o m s q u e s t i o n e d w h e t h e r " t h e s t r u c t u r e o f t h e w o r k p l a c e h i n d e r s t h e f u l l u s e o f n u r s i n g a b i l i t i e s " ( p . 1 2 9 ) . D o e s t h e h i e r a r c h i c a l b u r e a u c r a c y o f t h e h o s p i t a l 30 s e t t i n g i n h i b i t p r o f e s s i o n a l p r a c t i c e ? I n a d d i t i o n , s h e s t a t e d t h a t " T h e s e f i n d i n g s a l s o s u p p o r t t h e n o t i o n t h a t d i f f e r e n c e s i n g r a d u a t e b e h a v i o r m a y m o r e l i k e l y b e f o u n d i n s t u d y o f t h e b r o a d e r g o a l s o f t h e p r o f e s s i o n r a t h e r t h a n i n t h e m o r e s p e c i f i c a s p e c t s o f t h e w o r k s e t t i n g " ( p . 1 2 9 ) . J o h n s o n ( 1 9 8 8 ) c o n d u c t e d a m e t a - a n a l y s i s o f 1 3 9 s t u d i e s o f n u r s e s e d u c a t e d i n o n e o f t h r e e b a s i c n u r s i n g p r o g r a m s ( a s s o c i a t e d e g r e e , d i p l o m a , a n d b a c c a l a u r e a t e d e g r e e ) . S h e c o n c l u d e d t h a t " b a c c a l a u r e a t e n u r s e s p e r f o r m b e t t e r t h a n t e c h n i c a l n u r s e s i n b e h a v i o r s i d e n t i f i e d w i t h p r o f e s s i o n a l e d u c a t i o n a n d p r a c t i c e : c o m m u n i c a t i o n , k n o w l e d g e , p r o b l e m s o l v i n g , p r o f e s s i o n a l r o l e , a n d t e a c h i n g . " S h e a l s o f o u n d t h a t " p r o f e s s i o n a l n u r s e s ' a u t o n o m y a n d l e a d e r s h i p b e h a v i o r s d i d n o t d i f f e r f r o m t h o s e o f t e c h n i c a l l y p r e p a r e d n u r s e s " ( p . 1 9 1 ) . D i f f i c u l t i e s w i t h t h e m e t a - a n a l y s i s t e c h n i q u e i n c l u d e d t h e c a t e g o r i z a t i o n o f t h e m y r i a d o f v a r i a b l e s u s e d b y t h e r e s e a r c h e r s w h o i n v e s t i g a t e d d i f f e r e n c e s r e l a t e d t o e d u c a t i o n . A l s o , r e s e a r c h e r s o f t e n d e f i n e d t h e s a m e v a r i a b l e s , s u c h a s l e a d e r s h i p , i n d i f f e r e n t w a y s a n d m e a s u r e d t h e s e v a r i a b l e s w i t h d i f f e r e n t i n s t r u m e n t s . S o m e r e s e a r c h e r s s t u d i e d s t u d e n t s a n d s o m e s t u d i e d g r a d u a t e s . M a n y s t u d i e s d i d n o t a c k n o w l e d g e e x t r a n e o u s v a r i a b l e s s u c h a s l i b e r a l c o n t e n t o f t h e 31 p r o g r a m , a g e , p r e v i o u s e d u c a t i o n , o r e x p e r i e n c e . O f t e n s m a l l c o n v e n i e n c e s a m p l e s w e r e u s e d . J o h n s o n ( 1 9 8 8 ) n o t e d t h a t t h e r e i s o n l y o n e r e p l i c a t i o n i n t h e l i t e r a t u r e . M a n y s t u d i e s p o l l e d t h e o p i n i o n s o f s u p e r v i s o r s o r p e e r s o n t h e r e l a t i v e m e r i t o f t h e t w o t y p e s o f n u r s e s r a t h e r t h a n f o c u s i n g o n a s i n g l e c h a r a c t e r i s t i c ( R o s e , 1 9 8 8 ) . V e r y f e w s t u d i e s u s e d a n e x p l i c i t t h e o r e t i c a l o r c o n c e p t u a l f r a m e w o r k t o g u i d e t h e i r i n q u i r y . A s a r e s u l t , f i n d i n g s a r e d i f f i c u l t t o i n t e r p r e t a n d a p p l y . A l l o f t h i s m a k e s c o m p a r i s o n o f s t u d i e s d i f f i c u l t , a n d r e s u l t s i n i n c o n c l u s i v e f i n d i n g s . T h u s , r e s e a r c h o n t h e e f f e c t s o f b a c c a l a u r e a t e e d u c a t i o n h a s n o t b e e n s i g n i f i c a n t l y h e l p f u l i n g u i d i n g p o l i c y m a k e r s w i t h i n t h e p r o f e s s i o n a l o r g a n i z a t i o n s , e m p l o y i n g i n s t i t u t i o n s , o r g o v e r n m e n t , i n m a k i n g d e c i s i o n s a b o u t t h e e n t r y t o p r a c t i c e i s s u e . T h e C o g n i t i v e D o m a i n i n N u r s i n g E d u c a t i o n L i t e r a t u r e r e v i e w i n t h i s s e c t i o n w i l l b e c o n c e r n e d w i t h c u r r e n t t r e n d s a n d c o n c e p t s i n n u r s i n g e d u c a t i o n w h i c h a r e r e l a t e d t o i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t . T h e o r e t i c a l L i t e r a t u r e R e i l l y a n d O e r m a n n ( 1 9 8 5 ) i n c l u d e d c o n c e p t a t t a i n m e n t , p r o b l e m s o l v i n g , d e c i s i o n m a k i n g , c r i t i c a l t h i n k i n g , a n d c l i n i c a l j u d g m e n t w i t h i n t h e c o g n i t i v e 32 d o m a i n f o r n u r s i n g e d u c a t i o n ( p . 1 4 6 ) . T h e s e a u t h o r s s t a t e d t h a t p r o f i c i e n c y i n t h e s e s k i l l s c a n b e a t t a i n e d o n l y a t a d v a n c e d l e v e l s o f c o g n i t i v e d e v e l o p m e n t a s d e s c r i b e d i n t h e P e r r y s c h e m e ( p . 1 5 7 ) - . T h e y n o t e d t h a t " P e r r y ' s t h e o r y h a s a p p l i c a b i l i t y t o n u r s i n g e d u c a t i o n s i n c e t h e l e a r n e r ' s s t a g e o f d e v e l o p m e n t i n f l u e n c e s t h e c o g n i t i v e p r o c e s s e s u s e d i n p r a c t i c e . I t a l s o p r o v i d e s a t h e o r e t i c a l f r a m e w o r k f o r i n t e r p r e t i n g s t u d e n t b e h a v i o r i n r e s p o n s e t o s i t u a t i o n s a r i s i n g i n t h e c l i n i c a l s e t t i n g " ( p . 1 5 7 ) . I n t h i s r e s e a r c h , t h e n , i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t w i l l b e c o n c e p t u a l i z e d a s a n u n d e r l y i n g , o r p r e r e q u i s i t e f a c t o r t o t h e c o g n i t i v e s k i l l s o f c o n c e p t a t t a i n m e n t , p r o b l e m s o l v i n g , d e c i s i o n m a k i n g , c r i t i c a l t h i n k i n g , a n d c l i n i c a l j u d g m e n t . O t h e r c o n c e p t s w i t h i n t h e n u r s i n g l i t e r a t u r e w h i c h a r e c l o s e l y r e l a t e d t o i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t i n c l u d e p r o f e s s i o n a l i s m a n d a u t o n o m y . R e s e a r c h L i t e r a t u r e I n n u r s i n g e d u c a t i o n r e s e a r c h , c o g n i t i v e d e v e l o p m e n t h a s b e e n r e l a t e d t o t h e c o n c e p t s o f : p r o f e s s i o n a l i s m ( V a l i g a , 1 9 8 2 ) ; a u t o n o m y ( M u r r a y a n d M o r r i s , 1 9 8 2 , B o u g h n 1 9 8 8 ) ; s e l f d i r e c t e d n e s s ( C l a r k , 1 9 8 6 ) ; c r i t i c a l t h i n k i n g a n d p r o b l e m s o l v i n g ( B a i l e y , M c D o n a l d , a n d C l a u s , 1 9 7 0 ; S u l l i v a n , 1 9 8 7 ; P e s u t , 1 9 8 8 ) ; 33 a n d d e c i s i o n m a k i n g ( P a r d u e , 1987). P r o f e s s i o n a l i s m . I n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t i s c l o s e l y r e l a t e d t o t h e c o n c e p t o f p r o f e s s i o n a l i s m . A u n i v e r s i t y e d u c a t i o n i s s e e n a s a n i m p o r t a n t c h a r a c t e r i s t i c o f a p r o f e s s i o n . S t u a r t ( 1 9 8 1 ) u s e d a s c a l e o f p r o f e s s i o n a l i s m d e v e l o p e d b y M o o r e ( 1 9 7 4 ) t o a n s w e r t h e q u e s t i o n : " H o w p r o f e s s i o n a l i z e d i s N u r s i n g ? " T h e s c a l e i n c l u d e d : e x i s t e n c e a s a n o c c u p a t i o n ; a t o t a l p e r s o n a l c o m m i t m e n t t o a c a l l i n g ; p o l i t i c a l a c t i v i t y o f a n o r g a n i z a t i o n ; e d u c a t i o n , i n c l u d i n g a s p e c i f i c b o d y o f k n o w l e d g e a n d p r o f e s s i o n a l t h e o r y ; c o m p e t e n t a n d c o n s c i e n t i o u s p e r f o r m a n c e o f a s e r v i c e ; a n d p r o f e s s i o n a l a u t h o r i t y a n d a u t o n o m y a s t h e u l t i m a t e v a l u e d e p e n d e n t u p o n a c h i e v e m e n t o f t h e p r e v i o u s c h a r a c t e r i s t i c s . S h e c o m p a r e d n u r s i n g t o t h i s s c a l e a n d c o n c l u d e d t h a t e d u c a t i o n a n d a u t o n o m y a r e t h e w e a k e s t a r e a s f o r n u r s i n g . P r o f e s s i o n a l i s m o f t h e i n d i v i d u a l m u s t b e a t t a i n e d t o a c h i e v e p r o f e s s i o n a l i s m o f t h e d i s c i p l i n e . S c h e i n ( 1 9 7 2 ) c o n s i d e r e d " t r a i n i n g f o r u n c e r t a i n t y " a s a n i m p o r t a n t c o m p o n e n t o f p r o f e s s i o n a l i s m . T h e s k i l l s i n c l u d e d " m a i n t e n a n c e o f o n e ' s s e l f - c o n f i d e n c e e v e n w h e n o n e d o e s n o t h a v e a c l e a r a n s w e r t o t h e p r o b l e m ; w i l l i n g n e s s t o t a k e r e s p o n s i b i l i t y f o r k e y d e c i s i o n s 34 t h a t m a y r e s t o n o n l y p a r t i a l i n f o r m a t i o n , a n d w i l l i n g n e s s t o m a k e d e c i s i o n s u n d e r c o n d i t i o n s o f h i g h r i s k " <p. 4 5 ) . T h i s s t a t e m e n t i s c o n s i s t e n t w i t h a r e l a t i v i s t i c p o s i t i o n o n t h e P e r r y s c a l e . V a l i g a ( 1 9 8 2 ) f o u n d a l o w r e l a t i o n s h i p b e t w e e n c o g n i t i v e d e v e l o p m e n t a n d p e r c e p t i o n s a b o u t n u r s i n g a s a p r o f e s s i o n . C o g n i t i v e d e v e l o p m e n t w a s m e a s u r e d b y a n i n s t r u m e n t d e v e l o p e d b y K n e f e l k a m p a n d V i d d i c k ( 1 9 7 5 ) ( K n e V i t e s t ) , w h i c h w a s b a s e d o n t h e P e r r y s c h e m e . P e r c e p t i o n s a b o u t n u r s i n g a s a p r o f e s s i o n w e r e m e a s u r e d b y t h e V i e w s A b o u t N u r s i n g i n s t r u m e n t , w h i c h w a s d e v e l o p e d b y V a l i g a ( p . 2 0 2 ) . V a l i g a c o n c l u d e d t h a t " c o g n i t i v e d e v e l o p m e n t a n d p e r c e p t i o n s a b o u t n u r s i n g a r e t w o d i f f e r e n t c o n s t r u c t s r a t h e r t h a n t w o a s p e c t s o f t h e s a m e c o n s t r u c t " ( p . 2 0 3 ) . H o w e v e r , s h e a l s o r e c o m m e n d e d f u r t h e r d e v e l o p m e n t a n d r e f i n e m e n t o f t h e i n s t r u m e n t s , a n d r e p e t i t i o n o f t h e s t u d y b e f o r e c o n c l u s i o n s a r e d r a w n . A l s o , o n t h e n i n e p o i n t P e r r y s c a l e , V a l i g a o b t a i n e d a l o w r a n g e o f s c o r e s f o r c o g n i t i v e d e v e l o p m e n t , w i t h m o s t s t u d e n t s a t p o s i t i o n s 2 , 3 , a n d 4 . B u r n s a n d G r o v e ( 1 9 8 7 ) s t a t e t h a t " I n c o r r e l a t i o n a l d e s i g n s , a l a r g e v a r i a n c e i n . t h e v a r i a b l e s c o r e s i s n e c e s s a r y t o d e t e r m i n e t h e e x i s t e n c e o f a r e l a t i o n s h i p " ( 1 9 8 7 , p . 2 5 2 ) . L a w l e r a n d R o s e ( 1 9 8 7 ) s t u d i e d t h e v a r i a b l e o f 35 p r o f e s s i o n a l i s a t i o n a s m e a s u r e d b y b' t o n e ' s H e a l t h C a r e P r o f e s s i o n a l I n v e n t o r y S c a l e a n d C o r w i n ' s N u r s i n g R o l e C o n c e p t i o n S c a l e . T h e i r s a m p l e c o n s i s t e d o f 2 5 s e n i o r -g e n e r i c b a c c a l a u r e a t e s t u d e n t s , 18 s e n i o r R N / b a c c a l a u r e a t e s t u d e n t s a n d 3 6 s e n i o r a s s o c i a t e d e g r e e -s t u d e n t s a l l o f whom w e r e w i t h i n t h r e e w e e k s o f g r a d u a t i o n . T h e a u t h o r s f o u n d t h a t r e g i s t e r e d n u r s e s who r e t u r n e d f o r b a c c a l a u r e a t e e d u c a t i o n ( R N / B S N s t u d e n t s ) , s c o r e d s i g n i f i c a n t l y h i g h e r o n t h r e e o f t h e f i v e s c a l e s o n t h e S t o n e i n s t r u m e n t . O v e r a l l r e s u l t s s h o w e d s i g n i f i c a n t l y h i g h e r p r o f e s s i o n a l i z a t i o n a m o n g t h e R N / B S N g r a d u a t e s . T h e a u t h o r s e x t r a p o l a t e d t h e f i n d i n g s t o s t a t e t h a t " t h e A D N w h o r e t u r n s t o s c h o o l t o e a r n t h e B S N i s a m o r e p r o f e s s i o n a l p r o d u c t t h a n e i t h e r t h e g e n e r i c B S N o r t h e A D N g r a d u a t e . " A l s o , t h e r e t u r n i n g R N m a y b e " m o r e m a t u r e , c o m m i t t e d , s e l f - d i r e c t e d , a n d w i s e r i n t h e w a y s o f t h e w o r l d " ( p . 2 2 ) . U n f o r t u n a t e l y , t h e a u t h o r s d i d n o t c o n d u c t a n y a n a l y s e s o n v a r i a b l e s s u c h a s a g e o r e x p e r i e n c e . T o d r a w s t r o n g c o n c l u s i o n s f r o m a s u c h a s m a l l , n o n r a n d o m s a m p l e s e e m s p r e m a t u r e . A u t o n o m y . T h e c o n c e p t o f a u t o n o m y i s r e f e r e n c e d f r e q u e n t l y i n t h e t h e o r e t i c a l l i t e r a t u r e o n p r o f e s s i o n a l i s m a n d i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t . 36 B a c c a l a u r e a t e e d u c a t i o n i s s e e n a s m o v i n g n u r s i n g t o w a r d p r o f e s s i o n a l i s m a n d a u t o n o m o u s p r a c t i c e < I C U , 1985, S t u a r t , 1981, p . 1 8 ) . A s p r e v i o u s l y s t a t e d , e m p i r i c a l s u p p o r t f o r t h i s a s s u m p t i o n h a s b e e n i n c o n c l u s i v e . M u r r a y a n d M o r r i s ( 1 9 8 2 ) s t u d i e d p r o f e s s i o n a l a u t o n o m y a m o n g s e n i o r n u r s i n g s t u d e n t s i n d i p l o m a , a s s o c i a t e d e g r e e , a n d b a c c a l a u r e a t e n u r s i n g p r o g r a m s . T h e y f o u n d t h a t b a c c a l a u r e a t e s t u d e n t s " s c o r e d s i g n i f i c a n t l y h i g h e r o n a s c a l e o f p r o f e s s i o n a l a u t o n o m y t h a n s t u d e n t s f r o m e i t h e r t h e d i p l o m a o r a s s o c i a t e d e g r e e p r o g r a m s " ( p . 3 1 3 ) . T h e y c o n c l u d e d t h a t " b a c c a l a u r e a t e n u r s i n g e d u c a t i o n i n c u l c a t e s p r o f e s s i o n a l a u t o n o m y " ( p . 3 1 3 ) . T h e g e n e r a l i z a b i l i t y o f t h e s e f i n d i n g s i s r e s t r i c t e d b e c a u s e t h e s a m p l e s w e r e o b t a i n e d f r o m o n l y o n e s c h o o l f o r e a c h p r o g r a m . T h e p a r t i c u l a r s c h o o l s i n t h e s t u d y m a y h a v e c u r r i c u l a w h i c h f o s t e r o r r e s t r a i n t h e d e v e l o p m e n t o f a u t o n o m y i n a w a y t h a t i s n o t r e p r e s e n t a t i v e o f t h e g e n e r a l n u r s i n g s t u d e n t p o p u l a t i o n . B o u g h n < 1 9 8 8 ) s t u d i e d a u t o n o m y i n n u r s i n g s t u d e n t s f r o m a d i f f e r e n t p e r s p e c t i v e . S h e c o m p a r e d d e g r e e s o f a u t o n o m y a m o n g f e m a l e s t u d e n t s f r o m t h e s c h o o l s o f n u r s i n g , e d u c a t i o n , b u s i n e s s , a n d a r t s a n d s c i e n c e . S h e f o u n d t h a t t h e m e a n s c o r e f o r a u t o n o m y w a s s i g n i f i c a n t l y l o w e r f o r t h e s t u d e n t s i n t h e s c h o o l o f n u r s i n g t h a n f o r 37 t h e s t u d e n t s i n t h e s c h o o l o f b u s i n e s s a n d t h e s c h o o l o f a r t s a n d s c i e n c e s ( p . 1 5 5 ) . S c o r e s f o r n u r s i n g s t u d e n t s w e r e a l s o l o w e r t h a n s c o r e s f o r e d u c a t i o n s t u d e n t s , b u t n o t s i g n i f i c a n t l y s o . T h e s e r e s u l t s c o u l d b e r e l a t e d t o t h e n a t u r e o f t h e b a c c a l a u r e a t e p r o g r a m o r t o t h e n a t u r e o f t h e t y p e s o f s t u d e n t s a t t r a c t e d t o n u r s i n g . B o u g h n s t a t e s " N u r s i n g e d u c a t i o n i s p o s i t i o n e d t o b e t h e f o r c e f o r d e a l i n g w i t h i n c r e a s i n g t h e c h a r a c t e r i s t i c o f a u t o n o m y i n n u r s i n g s t u d e n t s " ( p . 1 5 5 ) . T h e p o w e r o f e d u c a t i o n i s a h o p e f u l s t r a t e g y f o r c h a n g e i n p u r s u i t o f a u t o n o m y a n d p r o f e s s i o n a l i s m f o r n u r s e s . T h e a i m s o f e d u c a t i o n w h i c h i n c l u d e i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t s h o u l d t h e o r e t i c a l l y p r o m o t e t h e s e c h a r a c t e r i s t i c s . S e l f - d i r e c t e d l e a r n i n g . S e l f - d i r e c t e d l e a r n i n g h a s r e c e i v e d c o n s i d e r a b l e a t t e n t i o n i n b o t h b a s i c n u r s i n g p r o g r a m s a n d i n c o n t i n u i n g e d u c a t i o n f o r n u r s e s . I t i s s t a t e d t h a t b a s i c p r o g r a m s m u s t f o s t e r t h e s k i l l o f s e l f - d i r e c t e d l e a r n i n g s o t h a t s t u d e n t s c a n c o n t i n u e t o a c q u i r e k n o w l e d g e i n a n i n d e p e n d e n t f a s h i o n a f t e r g r a d u a t i o n ( C l a r k a n d D i c k e n s o n , 1 9 7 7 ; H e g g e , 1 9 8 5 ; U r b a n o , J a h n s , a n d U r b a n o , 1 9 8 8 ; O d d i , 1 9 8 8 ) . A n u r s i n g e d u c a t i o n p r o g r a m c a n n o t p r o v i d e a l l t h e i n f o r m a t i o n n e w p r a c t i t i o n e r s w i l l n e e d i n t h e i r f u t u r e p r a c t i c e . 38 S e l f - d i r e c t e d l e a r n i n g i s d e f i n e d a s t h e p u r s u i t o f k n o w l e d g e w h e r e t h e i n d i v i d u a l t a k e s t h e i n i t i a t i v e a n d r e s p o n s i b i l i t y f o r t h e l e a r n i n g p r o c e s s ( C o o p e r , 1 9 8 0 , p. 4 ) . C o o p e r s t a t e s t h a t " s i g n i f i c a n t i m p r o v e m e n t i n n u r s i n g p r a c t i c e - t h e u l t i m a t e g o a l o f n u r s i n g e d u c a t i o n - w i l l o c c u r o n l y w i t h a p e r s o n a l c o m m i t m e n t b y n u r s e s t o l i f e - l o n g l e a r n i n g " ( p . 1 3 ) . C o m m i t m e n t a n d r e s p o n s i b i l i t y f o r s e l f l e a r n i n g a r e r e c u r r i n g t h e m e s i n t h e m i s s i o n o f u n d e r g r a d u a t e e d u c a t i o n a n d i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t t h e o r y . C r i t i c a l T h i n k i n g . -° S u l l i v a n ( 1 9 8 7 ) s t u d i e d c r i t i c a l t h i n k i n g , c r e a t i v i t y , c l i n i c a l p e r f o r m a n c e , a n d a c h i e v e m e n t i n a s a m p l e o f 5 1 RET's who e n t e r e d a p o s t b a s i c b a c c a l a u r e a t e p r o g r a m . I n t h i s l o n g i t u d i n a l s t u d y , s h e f o u n d t h a t f l e x i b i l i t y , c l i n i c a l p e r f o r m a n c e , a n d g r a d e p o i n t , a v e r a g e i n c r e a s e d s i g n i f i c a n t l y ; o v e r a l l c r e a t i v i t y a n d o r i g i n a l i t y d e c r e a s e d ; a n d , c r i t i c a l t h i n k i n g a b i l i t y a n d f l u e n c y d i d n o t c h a n g e t h r o u g h o u t t h e p r o g r a m . S u l l i v a n ' s s t u d y s u p p o r t s e a r l i e r f i n d i n g s b y E i s e n m a n ( 1 9 7 0 ) . He s t u d i e d . 2 6 6 n u r s i n g s t u d e n t s c r o s s - s e c t i o n a l l y a n d 6 0 s t u d e n t s l o n g i t u d i n a l l y t h r o u g h o u t t h e f o u r y e a r s o f a n u r s i n g p r o g r a m . He f o u n d a d e c l i n e i n o r i g i n a l i t y a n d c r e a t i v i t y f r o m t h e b e g i n n i n g t o t h e e n d o f t h e n u r s i n g p r o g r a m . E i s e n m a n 39 s t a t e s t h a t " s i n c e i t seems u n r e a s o n a b l e t o t h i n k t h a t o r i g i n a l i t y c a n j u s t d i s a p p e a r , t h e m o s t r e a s o n a b l e e x p l a n a t i o n o f t h e i r l o w e r e d s c o r e s o n o r i g i n a l i t y m i g h t b e t h a t t h e i r p e r s o n a l s e t h a d c h a n g e d t o a g r e a t e r e m p h a s i s o n d o i n g t h i n g s ' t h e r i g h t w a y ' : S u c h a c o n f o r m i n g o r c o n v e n t i o n a l f o c u s w o u l d b e i n c o n s i s t e n t w i t h c r e a t i v i t y i n m a n y i n s t a n c e s " <p. 3 2 4 ) . T h i s r a i s e s t h e q u e s t i o n : Do n u r s i n g p r o g r a m s a c t u a l l y p r o m o t e d u a l i s m ? V a l i g a < 1 9 8 3 ) r a i s e d s i m i l a r c o n c e r n s i n h e r s t u d y o f c o g n i t i v e d e v e l o p m e n t i n n u r s i n g s t u d e n t s . P a r d u e ( 1 9 8 7 ) s t u d i e d d e c i s i o n - m a k i n g s k i l l s a n d c r i t i c a l t h i n k i n g a b i l i t y a m o n g a s s o c i a t e d e g r e e , d i p l o m a , b a c c a l a u r e a t e , a n d m a s t e r ' s - p r e p a r e d n u r s e s . H e r r e s u l t s s h o w e d t h a t n u r s e s w i t h m a s t e r s a n d b a c c a l a u r e a t e d e g r e e s h a d t h e h i g h e s t s c o r e s i n c r i t i c a l t h i n k i n g a b i l i t y . N o s i g n i f i c a n t d i f f e r e n c e s w e r e f o u n d a m o n g t h e f o u r g r o u p s r e l a t e d t o d e c i s i o n - m a k i n g s k i l l s . I n c o n c l u s i o n , t h e l i t e r a t u r e r e v i e w e d i n t h i s s e c t i o n d e s c r i b e s c o g n i t i v e p r o c e s s e s a n d a t t r i b u t e s w h i c h a r e i m p o r t a n t i n n u r s i n g e d u c a t i o n . I t i s p o s t u l a t e d t h a t t h e s e e d u c a t i o n a l g o a l s c a n o n l y b e a c h i e v e d w h e n s t u d e n t s a r e c h a l l e n g e d t o r e a c h a d v a n c e d l e v e l s o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t . V i s u a l i z i n g t h e r e l a t i o n s h i p b e t w e e n i n t e l l e c t u a l a n d 40 e t h i c a l d e v e l o p m e n t a n d t h e c o n c e p t s o f p r o f e s s i o n a l i s m , a u t o n o m y , s e l f d i r e c t e d n e s s , c r i t i c a l t h i n k i n g , c r e a t i v i t y , p r o b l e m s o l v i n g , a n d c l i n i c a l j u d g m e n t i n t h i s w a y w i l l e n h a n c e t h e u s e f u l n e s s o f t h i s r e s e a r c h . R e s e a r c h o n t h e P e r r y s c h e m e P e r r y ( 1 9 8 1 ) r e p o r t e d t h a t h i s o r i g i n a l t h e o r y p u b l i s h e d i n 1 9 7 0 h a d b e e n e x t e n d e d a n d i m p l e m e n t e d i n s e v e r a l w a y s . S o m e o f t h e s e i n c l u d e d : c o l l e g e l e v e l m a t h e m a t i c s i n s t r u c t i o n ( C o p e s , 1 9 7 8 ) ; e l a b o r a t i o n t o c r e a t e a m o d e l o f d e v e l o p m e n t a l i n s t r u c t i o n ( W i d d i c k a n d S i m p s o n , 1 9 7 8 , K n e f e l k a m p a n d C o r n f e l d , 1 9 7 7 ) ; i m p l i c a t i o n s f o r p e e r t r a i n i n g ( C l e m e n t , 1 9 7 7 ) ; c a r e e r e d u c a t i o n ( T o u c h t o n , W e r t h e i m e r , a n d C o r n f e l d , 1 9 7 7 ) ; g r a d u a t e c u r r i c u l u m i n c o u n s e l l i n g ( K n e f e l k a m p a n d C o r n f e l d , 1 9 7 7 ) ; t e a c h i n g h i s t o r y ( W i d i c k a n d S i m p s o n , 1 9 7 8 ) ; a n d t e a c h i n g E n g l i s h d r a m a ( S o r u m , 1 9 7 6 ) ( p . 1 0 1 ) . M o s t o f t h e s e s t u d i e s u s e d c o n t r o l l e d , e x p e r i m e n t a l d e s i g n s . " T h e w o r k o f t h e s e i n v e s t i g a t o r s m o v e d t h e d e s c r i p t i v e t h e o r y o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t t o o n e w i t h p r e s c r i p t i v e u t i l i t y . v S t e p h e n s o n a n d H u n t ( 1 9 7 7 ) c o n d u c t e d a n e x p e r i m e n t a l s t u d y w h e r e a d u a l i s t i c c u r r i c u l u m i n t e r v e n t i o n w a s u s e d w i t h t w o g r o u p s o f f i r s t y e a r l i b e r a l a r t s s t u d e n t s . T h e t e a c h i n g p a r a d i g m f o r t h e e x p e r i m e n t a l g r o u p s i n c l u d e d e l e m e n t s w h i c h w o u l d 41 c h a l l e n g e s t u d e n t s t o m o v e t o n e w p o s i t i o n s , w h i l e p r o v i d i n g s u p p o r t s y s t e m s a s s t u d e n t s l e f t o l d w a y s o f t h i n k i n g a b o u t v a l u e s , r e s p o n s i b i l i t i e s , a n d t h e n a t u r e o f k n o w l e d g e . T h e y f o u n d t h a t e x p e r i m e n t a l g r o u p s e a c h m o v e d a n a v e r a g e o f . 8 5 p o s i t i o n i n e l e v e n w e e k s , w h i l e c o n t r o l g r o u p s m o v e d . 4 2 a n d . 1 2 p o s i t i o n , a s m e a s u r e d o n t h e n i n e p o s i t i o n s c a l e . T h e s e a u t h o r s u s e d t h e K n e W i t e s t t o a s s e s s l e v e l o n t h e P e r r y s c a l e . T h e K n e W i t e s t w a s d e v e l o p e d b y K n e f e l k a m p ( 1 9 7 4 ) a n d r e f i n e d b y V i d i c k ( 1 9 7 5 ) . I t c o n s i s t s o f t w o e s s a y - t y p e q u e s t i o n s a n d s e v e n s e n t e n c e c o m p l e t i o n i t e m s . T h e r e s p o n s e s a r e s c a r e d b y t r a i n e d r a t e r s a n d r e s u l t s r e v e a l t h e s u b j e c t ' s p o s i t i o n o n t h e P e r r y s c a l e . K n e f e l k a m p a n d S l e p i t z a ( 1 9 7 6 ) u s e d P e r r y ' s t h e o r y t o d e v e l o p a m o d e l f o r c a r e e r d e v e l o p m e n t . F r o m q u a l i t a t i v e i n t e r v i e w s t h e y d e s c r i b e d n i n e d i m e n s i o n s of c h a n g e i n t h e p r o c e s s e s o f h o w o n e v i e w s a c a r e e r , h o w o n e v i e w s c a r e e r c o u n s e l l i n g , a n d c a r e e r d e c i s i o n m a k i n g . T h e s e n i n e d i m e n s i o n s c o u l d b e f a l l o w e d t h r o u g h P e r r y ' s d e v e l o p m e n t a l l e v e l s . T h e s e d i m e n s i o n s a r e : l o c u s o f c o n t r o l ; a n a l y s i s ; s y n t h e s i s ; s e m a n t i c s t r u c t u r e ; s e l f - p r o c e s s i n g ; o p e n n e s s t o a l t e r n a t i v e p e r s p e c t i v e s ; a b i l i t y t o a s s u m e r e s p o n s i b i l i t y ; a b i l i t y t o t a k e o n n e w r o l e s ; a n d a b i l i t y t o t a k e r i s k s w i t h s e l f ( p . 5 4 ) . T h i s a d a p t e d c a r e e r m o d e l a l l o w e d 42 p r o g r e s s i v e r e s e a r c h i n t o t h e a p p l i c a b i l i t y o f t h e t h e o r y . T h e n i n e d i m e n s i o n s o f d e v e l o p m e n t w e r e u s e d i n a l a t e r n u r s i n g s t u d y b y V a l i g a ( 1 9 8 3 ) , a n d a s s i s t e d i n e x t e n d i n g t h e r e s e a r c h f i n d i n g s t o o b s e r v a b l e s t u d e n t c h a r a c t e r i s t i c s . T o u c h t o n , W e r t h e i m e r a n d C o r n f e l d ( 1 9 7 7 ) a p p l i e d t h e K n e f e l k a m p - S l e p i t z a m o d e l b y u s i n g d e v e l o p m e n t a l t e a c h i n g a p p r o a c h e s i n a c o l l e g e c o u r s e o n c a r e e r p l a n n i n g a n d d e c i s i o n m a k i n g . T h e y u s e d a n i n s t r u m e n t d e s i g n e d t o m e a s u r e c o m p l e x i t y i n t h i n k i n g a b o u t c a r e e r s . T h e y f o u n d t h a t 76% o f s t u d e n t s i n t h e d e v e l o p r a e n t a l l y t a u g h t e x p e r i m e n t a l s e c t i o n s s h o w e d s o m e m e a s u r a b l e m o v e m e n t a l o n g t h e P e r r y p o s i t i o n s , a n d i n t h e t r a d i t i o n a l s e c t i o n s 4 1 % o f t h e s t u d e n t s s h o w e d s i m i l a r g r o w t h . M e y e r ( 1 9 7 7 ) m e a s u r e d i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t t h r o u g h a n a l y s i s o f r e s p o n s e s b a s e d o n r e l i g i o u s c o n t e n t . S t u d e n t s c l e a r l y a d v a n c e d o n t h e c o n s t r u c t o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t . He f o u n d s i g n i f i c a n t d i f f e r e n c e s i n a c r o s s - s e c t i o n a l s t u d y b e t w e e n a l l f o u r y e a r s a t a p u b l i c c o l l e g e a n d a c h u r c h a f f i l i a t e d p r i v a t e c o l l e g e . T h e r e w e r e n o d i f f e r e n c e s b e t w e e n s t u d e n t s f r o m t h e d i f f e r e n t c o l l e g e s . S h a w - B e r g e t ( 1 9 8 8 ) s t u d i e d i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t i n r e l a t i o n t o s e l f - d i r e c t e d l e a r n i n g a m o n g 43 s t u d e n t s f r o m a l l f o u r y e a r s i n a l i b e r a l a r t s c o l l e g e . T h e r e s e a r c h w a s b a s e d o n t h e a s s u m p t i o n t h a t t h e r o l e o f a u t h o r i t y i s a c r i t i c a l c o m p o n e n t i n b o t h c o n s t r u c t s . S e l f - d i r e c t e d l e a r n i n g w a s m e a s u r e d b y t h e O d d i C o n t i n u i n g L e a r n i n g I n v e n t o r y ( O C L I ) w h i c h w a s d e v e l o p e d b y O d d i ( 1 9 8 8 ) d u r i n g h e r r e s e a r c h w i t h n u r s i n g s t u d e n t s . T h e M e a s u r e o f E p i s t e m o l o g i c a l R e f l e c t i o n < T a y l o r , 1 9 8 3 ) w a s u s e d t o d e t e r m i n e t h e s t u d e n t ' s p o s i t i o n o n t h e P e r r y s c a l e . S h a w - B e r g e t f o u n d t h a t t h e r e w a s a r e l a t i o n s h i p b e t w e e n s e 1 f - d i r e c t e d l e a r n i n g , a n d i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t , b u t t h a t n e i t h e r w a s a s u b s t a n t i a l ' p r e d i c t o r o f t h e o t h e r ( p . 1 5 5 ) . S h a w - B e r g e t a l s o f o u n d t h a t t h e r e w e r e d i f f e r e n c e s b e t w e e n t h e g r o u p o v e r 2 5 y e a r s o f a g e a n d t h e g r o u p u n d e r 2 5 o n s c o r e s o n t h e M E R . N u r s i n g R e s e a r c h u s i n g t h e P e r r y S c h e m e T h e r e a r e t h r e e p u b l i s h e d n u r s i n g s t u d i e s t h a t u s e d t h e P e r r y s c h e m e : V a l i g a < 1 9 8 3 ) , F r i s c h ( 1 9 8 7 ) , a n d F r i s c h ( 1 9 9 0 ) . B e f o r e p r o c e e d i n g t o r e v i e w t h e s e s t u d i e s , i t i s n e c e s s a r y t o c l a r i f y t h e n o m e n c l a t u r e u s e d i n t h e r e s e a r c h . B o t h F r i s c h a n d V a l i g a u s e d t h e t e r m s i n t e l l e c t u a l d e v e l o p m e n t a n d c o g n i t i v e d e v e l o p m e n t i n t e r c h a n g e a b l y , a l t h o u g h p r e f e r e n c e w a s g i v e n t o t h e t e r m c o g n i t i v e . I n l a t e r y e a r s , P e r r y ( 1 9 8 1 ) a l s o b e g a n t o u s e t h e t e r m c o g n i t i v e d e v e l o p m e n t s y n o n y m o u s l y w i t h 44 i n t e l l e c t u a l d e v e l o p m e n t . I n t e l l e c t u a l d e v e l o p m e n t i s o f t e n c o n f u s e d w i t h i n t e l l i g e n c e a n d , f o r t h e ' p u r p o s e s o f t h i s s t u d y , t h e t w o c o n c e p t s a r e v e r y d i f f e r e n t . H o w e v e r , t h i s r e s e a r c h e r h a s d e c i d e d t o r e t a i n t h e l a b e l o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t i n o r d e r t o r e m a i n c o n s i s t e n t w i t h t h e t h e o r e t i c a l f r a m e w o r k , a l t h o u g h t h e t e r m c o g n i t i v e d e v e l o p m e n t m o r e c l e a r l y d e f i n e s t h e c o n c e p t o f i n t e r e s t t o t h e r e s e a r c h e r . V a l i g a ( 1 9 8 3 ) d e s c r i b e d i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t i n r e l a t i o n t o n u r s i n g p r a c t i c e a n d t h e m a n d a t e f o r b a c c a l a u r e a t e n u r s i n g e s t a b l i s h e d b y t h e N a t i o n a l L e a g u e f o r N u r s i n g a c c r e d i t i n g b o d y . O n t h e p r e m i s e t h a t i n t e l l e c t u a l d e v e l o p m e n t i s a c e n t r a l a i m o f h i g h e r e d u c a t i o n , V a l i g a s t a t e d t h a t n u r s e e d u c a t o r s s h o u l d d e v e l o p a c l e a r p i c t u r e o f h o w t h e c h a r a c t e r i s t i c s o f i n t e l l e c t u a l o r c o g n i t i v e d e v e l o p m e n t a r e f o s t e r e d a n d m e a s u r e d t h r o u g h o u t t h e f o u r y e a r n u r s i n g c u r r i c u l u m , V a l i g a d e f i n e d c o g n i t i v e m a t u r i t y a s " t h e a b i l i t y t o s t r u c t u r e a n d o r g a n i z e k n o w l e d g e a n d e x p e r i e n c e , t o d e a l w i t h c o n f l i c t i n g i n f o r m a t i o n a n d d i v e r s i t y o f i n t e r p r e t a t i o n o f d a t a , a n d t o m a k e i n d e p e n d e n t d e c i s i o n s " ( 1 9 8 3 , p . 1 1 5 ) . F o s t e r i n g c o g n i t i v e d e v e l o p m e n t i n a n u r s i n g p r o g r a m t h e n , p r e p a r e s n u r s e s " w h o a r e c a p a b l e o f m a k i n g i n d e p e n d e n t d e c i s i o n s , 45 d e a l i n g w i t h t h e u n c e r t a i n t y o f m a n y n u r s i n g s i t u a t i o n s , d e a l i n g w i t h a b s t r a c t i d e a s , a n d a c c e p t i n g t h e d i v e r s i t y o f b e l i e f s , v a l u e s , a t t i t u d e s , l i f e s t y l e s , l i f e g o a l s , a n d d e c i s i o n m a k i n g p a t t e r n s e m p l o y e d b y p e r s o n s w i t h whom t h e y i n t e r a c t " ( 1 9 8 2 , p . i ) . V a l i g a s t u d i e d t h e c o g n i t i v e d e v e l o p m e n t o f s t u d e n t s i n a l l f o u r y e a r s o f a b a c c a l a u r e a t e n u r s i n g p r o g r a m . S h e h y p o t h e s i z e d t h a t s t u d e n t s a t h i g h e r e d u c a t i o n a l l e v e l s w o u l d b e a t a m o r e a d v a n c e d s t a g e o f c o g n i t i v e d e v e l o p m e n t , a n d t h a t t h e r e w o u l d b e a n i n c r e a s e i n s c o r e s o v e r t h e a c a d e m i c y e a r . C o g n i t i v e d e v e l o p m e n t w a s m e a s u r e d b y t h e K n e W i i n s t r u m e n t w h i c h r e f l e c t s t h e P e r r y s c h e m e a n d r e v e a l s s c o r e s o f o n e t o n i n e . T h e s a m p l e i n h e r s t u d y c o n s i s t e d o f 2 9 f r e s h m e n , 2 7 s o p h o m o r e s , 3 4 j u n i o r s , a n d 3 3 s e n i o r s f r o m t h r e e s c h o o l s o f n u r s i n g . T h e K n e W i t e s t w a s a d m i n i s t e r e d a t t h e b e g i n n i n g o f t h e a c a d e m i c y e a r ( p r e t e s t ) a n d a t t h e e n d o f t h e y e a r ( p o s t t e s t ) . T h e s c o r e s o n p r e t e s t s f o r a l l s u b j e c t s r a n g e d f r o m 2 . 2 5 t o 4 . 0 0 w i t h t h e f o l l o w i n g m e a n s : f r e s h m e n , 2 . 7 3 ; s o p h o m o r e s , 3 . 0 6 ; j u n i o r s , 2 . 9 6 ; s e n i o r s , 3 . 1 0 ; a n d t o t a l g r o u p 2 . 9 6 . T h e s c o r e s o n t h e p o s t t e s t s r a n g e d f r o m 2 . 0 8 t o 5 . 5 9 . M o s t o f t h e s c a r e s a n d a l l o f t h e m e a n s , r e f l e c t e d P e r r y ' s c a t e g o r y o f D u a l i s m . No s t u d e n t s s c o r e d i n t h e 46 C o m m i t m e n t i n R e l a t i v i s m c a t e g o r y . O n t h e p r e t e s t , t h e s c o r e s o f t h e f r e s h m a n s t u d e n t s w e r e s i g n i f i c a n t l y l o w e r t h a n t h o s e o f t h e s o p h o m o r e s a n d s e n i o r s ( P < . 0 1 ) ; n o o t h e r p a i r w i s e c o m p a r i s o n s w e r e s i g n i f i c a n t b e y o n d t h e . 0 5 l e v e l o f s i g n i f i c a n c e . O n t h e p o s t t e s t s c o r e s , t h e o n l y p a i r w i s e c o m p a r i s o n t h a t w a s s i g n i f i c a n t w a s t h a t b e t w e e n t h e f r e s h m a n a n d s e n i o r s t u d e n t s ( p . 1 1 8 ) . T h e h y p o t h e s i s t h a t t h e r e w o u l d b e a n i n c r e a s e i n s c o r e s o n t h e c o g n i t i v e d e v e l o p m e n t s c a l e , t h e r e f o r e , w a s o n l y p a r t i a l l y s u p p o r t e d . O v e r t h e a c a d e m i c y e a r f r e s h m a n s t u d e n t s i n c r e a s e d . 0 9 8 p o s i t i o n ; s o p h o m o r e s . 1 2 3 ; j u n i o r s . 0 9 1 ; s e n i o r s . 2 7 5 . N o n e o f t h e s e d i f f e r e n c e s w a s s i g n i f i c a n t , c o g n i t i v e d e v e l o p m e n t w a s m i n i m a l o v e r a n a c a d e m i c y e a r . T h e s e r e s u l t s a r e n o t c o n s i s t e n t w i t h t h e o r i g i n a l f i n d i n g s i n P e r r y ' s r e s e a r c h . H e f o u n d t h a t s t u d e n t s a t t h e e n d o f y e a r 1 " n o r m a t i v e l y e x p r e s s e d t h e o u t l o o k s o f P o s i t i o n s 3 , 4, o r 5 , a n d s t u d e n t s i n t h e i r f o u r t h y e a r w e r e f o u n d t o f u n c t i o n i n p o s i t i o n s 6 , 7 , a n d 8 ( P e r r y , 1 9 7 0 , p . 5 6 ) . I n t h e r e p o r t o f h e r r e s e a r c h , V a l i g a d i d n o t c o m p a r e h e r f i n d i n g s w i t h t h o s e o f o t h e r e d u c a t i o n a l o r n u r s i n g r e s e a r c h . A r e s e a r c h p r o b l e m o c c u r s i n m e a s u r e m e n t o f t h e P e r r y s c h e m e . T h e K n e V i t e s t c o n s i s t s o f t w o e s s a y 47 q u e s t i o n s w h i c h a r e s c o r e d b y t w o i n d e p e n d e n t r a t e r s . B o t h V a l i g a ( 1 9 8 2 ) a n d K i n g ( 1 9 7 8 ) n o t e t h e r e a r e m e a s u r e m e n t d i f f i c u l t i e s w i t h t h e i n s t r u m e n t . V a l i g a a l s o u s e d s m a l l s a m p l e s i z e s w h i c h r e d u c e s t h e p o w e r o f t h e a n a l y s i s . T h e r e s u l t s o f h e r s t u d y m u s t b e c o n s i d e r e d i n l i g h t o f t h e l o w p o w e r . T h e p o w e r o f a s t a t i s t i c a l t e s t i s c l o s e l y r e l a t e d t o s a m p l e s i z e a n d i s d e f i n e d a s t h e p r o b a b l i l i t y o f r e j e c t i n g t h e n u l l h y p o t h e s i s w h e n i t i s f a l s e . " I n p u b l i s h e d n u r s i n g r e s e a r c h s t u d i e s w i t h v e r y s m a l l s a m p l e s a n d n o n s i g n i f i c a n t r e s u l t s , r e s e a r c h e r s c o m m o n l y c o n c l u d e t h a t t h e n u l l h y p o t h e s i s i s t r u e " ( V o i d e r , 1 9 8 4 , p . 3 0 5 ) . T h e l i k e l i h o o d o f a c c e p t i n g t h e n u l l h y p o t h e s i s e v e n w h e n i t i s f a l s e w a s h i g h i n V a l i g a ' s s t u d y b e c a u s e o f t h e s m a l l s a m p l e s i z e . A l a r g e r s a m p l e s i z e w o u l d h a v e i n c r e a s e d t h e p r o b a b i l i t y o f d e t e c t i n g s i g n i f i c a n t d i f f e r e n c e s a m o n g t h e g r o u p s . V a l i g a ( 1 9 8 3 ) f o u n d t h a t " o n l y 7 o f 1 2 3 " n u r s i n g s t u d e n t s i n h e r s t u d y a p p r o a c h e d o r w e r e a t P e r r y ' s p o s i t i o n 5 . S h e c o n c l u d e d t h a t " a c c o r d i n g t o P e r r y ' s t h e o r y ( 1 9 7 0 ) , t h i s i m p l i e s t h a t m o s t o f t h e g r a d u a t e s c a n n o t f u n c t i o n i n d e p e n d e n t l y , c a n n o t t a k e r e s p o n s i b i l i t y f o r m a k i n g d e c i s i o n s i n c o m p l e x / a m b i g u o u s / u n c e r t a i n s i t u a t i o n s , h a v e n o t e s t a b l i s h e d a n i d e n t i t y a s a n u r s e w i t h a l i f e l o n g 48 commitment to. t h e advancement of the p r o f e s s i o n , and are l i k e l y t o a c t i n a s u b o r d i n a t e r o l e t o p h y s i c i a n s and/or o t h e r members of the h e a l t h c a r e team" (p. 119). A c c o r d i n g t o V a l i g a , the f i n d i n g s p r o v i d e d i r e c t i o n f o r s t u d y i n g the c h a r a c t e r i s t i c s of s t u d e n t s a d m i t t e d t o n u r s i n g , the e d u c a t i o n a l environment i n n u r s i n g s c h o o l s , and the r o l e of f a c u l t y i n the e d u c a t i o n a l e x p e r i e n c e of s t u d e n t s <p. 118). She asked p e r t i n e n t q u e s t i o n s such as: Does n u r s i n g a t t r a c t s t u d e n t s who a r e d u a l i s t i c and p r e f e r dependence and e x t e r n a l d i r e c t i o n ? Are n u r s i n g s t u d e n t s g i v e n pat answers so t h a t t h e y never make m i s t a k e s i n p r a c t i c e ? Do c o u r s e r e a d i n g s and f a c u l t y p r e s e n t a s i m i l a r p e r s p e c t i v e and agreement on i s s u e s so t h a t a u n i t e d f r o n t and c o n f o r m i t y t o s t a n d a r d s and r u l e s i s v a l u e d ? V a l i g a ' s f i n d i n g s , and t h e i r s i g n i f i c a n c e f o r n u r s i n g e d u c a t i o n , o f f e r a s t r o n g background f o r f u r t h e r r e s e a r c h i n t o i n t e l l e c t u a l and e t h i c a l development. Her work p r o v i d e d the major impetus f o r t h i s r e s e a r c h . F r i s c h (1987) s t u d i e d c o g n i t i v e development among 42 j u n i o r l e v e l b a c c a l a u r e a t e n u r s i n g s t u d e n t s from two u n i v e r s i t y s c h o o l s . She used the P e r r y scheme as the t h e o r e t i c a l framework and measured s t u d e n t s ' p o s i t i o n s u s i n g an e s s a y response q u e s t i o n a i r e d e v e l o p e d by A l l e n (1983). S t u d e n t s were e v a l u a t e d a t the b e g i n n i n g and 49 end of an academic semester i n t h e i r j u n i o r year. S t u d e n t s were exposed t o "numerous c l i n i c a l and c l a s s r o o m l e a r n i n g e x p e r i e n c e s t h a t c o u l d have an impact on c o g n i t i v e development" (p. 26). She found "a m a j o r i t y of s t u d e n t s i n b o t h groups were o p e r a t i n g a t P e r r y p o s i t i o n 3; some were o p e r a t i n g i n p o s i t i o n 2; and o n l y 1 of 42 had r e a c h e d p o s i t i o n 4. There were no d i f f e r e n c e s i n P e r r y p o s i t i o n s a t the b e g i n n i n g and end of the semester" (p. 27). F r i s c h compared her f i n d i n g s t o r e s u l t s o b t a i n e d i n an u n p u b l i s h e d s t u d y by C o l l i n s (1981). Her f i n d i n g s were c o n s i s t e n t w i t h t h o s e of C o l l i n s who c o n c l u d e d t h a t " p r o f e s s i o n a l commitment cannot be e x p e c t e d u n t i l a f t e r g r a d u a t i o n " (p. 27). I n t e r e s t i n g l y , she d i d not compare her f i n d i n g s t o V a l i g a ' s s t u d y , p u b l i s h e d f o u r y e a r s e a r l i e r . V a l i g a found t h a t development i n the j u n i o r y e a r was the lowest of a l l f o u r y e a r s . She found s i g n i f i c a n t i n c r e a s e i n p o s i t i o n o n l y i n the sophomore and s e n i o r y e a r s (1983, p. 118). F r i s c h d i d not s t a t e her r a t i o n a l e f o r s t u d y i n g s t u d e n t s i n t h e i r j u n i o r year. F r i s c h o f f e r s an i n t e r e s t i n g e x p a n s i o n by r e l a t i n g her f i n d i n g s t o the phenomenon of r e a l i t y shock and the e x p e c t a t i o n s of the work s e t t i n g . She s u g g e s t s t h a t a new g r a d u a t e o p e r a t i n g a t d u a l i s t i c o r m u l t i p l i s t i c l e v e l s of c o g n i t i o n may have d i f f i c u l t y a d j u s t i n g t o 50 p r o f e s s i o n a l p r a c t i c e which r e q u i r e s the " i n d i v i d u a l t o c o n s i d e r e v e n t s from m u l t i p l e p o i n t s of view and t o make independent judgments based on an assessment of the c o m p l e x i t i e s of each s i t u a t i o n . " She a l s o s u g g e s t s t h a t p r o f e s s i o n s which r e q u i r e an undergraduate degree p r i o r t o a d m i s s i o n may produce more c o g n i t i v e l y mature g r a d u a t e s . Research w i t h s t u d e n t s a d m i t t e d t o the new g r a d u a t e n u r s i n g programs w i t h n o n n u r s i n g b a c h e l o r ' s d egrees may p r o v i d e i n s i g h t f u l i n f o r m a t i o n . F r i s c h b e l i e v e s t h a t " p r o f e s s i o n a l commitment cannot be "expected u n t i l a f t e r g r a d u a t i o n . A p e r i o d of s o c i a l i z a t i o n i n t o t h e p r o f e s s i o n a l r o l e and a chance t o grow i n r e a s o n i n g a b i l i t y a r e e s s e n t i a l f o r the new g r a d u a t e " (p. 27). W ith t h i s c o n c l u s i o n i n mind the p r e s e n t r e s e a r c h w i l l be c o n ducted w i t h g r a d u a t e n u r s e s w i t h v a r y i n g degrees of e x p e r i e n c e . Most r e c e n t l y , F r i s c h (1990) s t u d i e d the i n t e l l e c t u a l and e t h i c a l development of a group of s e n i o r n u r s i n g s t u d e n t s who p a r t i c i p a t e d i n an i n t e r n a t i o n a l s t u d e n t exchange. She s u g g e s t e d t h a t measuring c o g n i t i v e development would be an o b j e c t i v e way to a s s e s s t h e impact of exchange programs. The Measure of E p i s t e m o l o g i c a l R e f l e c t i o n (MER) was used t o measure the p a r t i c i p a n t s ' p o s i t i o n on the P e r r y s c a l e b e f o r e and a f t e r the exchange e x p e r i e n c e . A c o h o r t 51 s t u d y d e s i g n was used w i t h s i x exchange p a r t i c i p a n t s and 21 n o n p a r t i c i p a n t s from the same s e n i o r c l a s s . R e s u l t s showed t h a t "exchange s t u d e n t s were 3.5 t i m e s as l i k e l y t o improve on P e r r y t e s t i n g t h a n were s t u d e n t s who d i d not p a r t i c i p a t e . Seventy-one p e r c e n t of the measured c o g n i t i v e improvement seen i n the s e n i o r c l a s s can be a t t r i b u t e d t o the Mexico program." (p. 11). E t h i c a l and M o r a l Reasoning K o h l b e r g (1975) f u r t h e r e d t h e work of Dewey and P i a g e t t h r o u g h r e s e a r c h aimed a t r e d e f i n i n g and v a l i d a t i n g s t a g e s of moral development. He d e s c r i b e d the r e l a t i o n s h i p of i n t e l l e c t u a l and e t h i c a l development i n the f o l l o w i n g way. " S i n c e moral r e a s o n i n g c l e a r l y i s r e a s o n i n g , advanced moral r e a s o n i n g depends upon advanced l o g i c a l r e a s o n i n g ; a p e r s o n ' s l o g i c a l s t a g e p u t s a c e r t a i n c e i l i n g on the moral s t a g e he can a t t a i n " (p. 671). K o h l b e r g s t u d i e d a d o l e s c e n t s and young a d u l t s and f o r m u l a t e d a framework of s i x s t a g e s of moral development. K o h l b e r g a s s e r t e d t h a t t h e m a j o r i t y of the a d u l t p o p u l a t i o n f u n c t i o n s a t t h e f o u r t h moral s t a g e of law and o r d e r o r i e n t a t i o n . He s t a t e d t h a t o n l y a m i n o r i t y p o s s e s s the a b i l i t y t o f u n c t i o n a t the p o s t c o n v e n t i o n a l , autonomous and p r i n c i p l e d l e v e l of moral and p o l i t i c a l r e a s o n i n g . Tomlinson-Keasey and Keasey (1974) e m p i r i c a l l y 52 t e s t e d t h e h y p o t h e s i s t h a t c o g n i t i v e development i s c e n t r a l t o o t h e r a r e a s such as s o c i a l and a f f e c t i v e development, p a r t i c u l a r l y K o h l b e r g ' s a s s u m p t i o n t h a t moral r e a s o n i n g i s dependent upon l o g i c a l r e a s o n i n g . The a u t h o r s s t u d i e d s i x t h g r a d e r s and c o l l e g e s t u d e n t s and o b t a i n e d measures a c c o r d i n g t o K o h l b e r g ' s s t a g e s of moral r e a s o n i n g and s c o r e s a c c o r d i n g t o P i a g e t ' s c o g n i t i v e s t a g e c r i t e r i a . The s c a r e s were c o r r e l a t e d , and c o n f i r m e d a r e l a t i o n s h i p between f o r m a l o p e r a t i o n s and p r i n c i p l e d moral r e a s o n i n g <p. 294). The s t u d y " s u p p o r t e d the h y p o t h e s i z e d c e n t r a l i t y of c o g n i t i v e development" (p. 296). "At the p r e s e n t time t h e r e i s a s u g g e s t i o n t h a t c o g n i t i v e development i s a m e d i a t o r of development i n o t h e r a r e a s , and t h a t c o g n i t i v e development i s accompanied by p r e d i c t a b l e and c o n s i s t e n t changes i n o t h e r a r e a s " (p. 297). In n u r s i n g , c o g n i t i v e development can be c e n t r a l t o t h e development of p r o f e s s i o n a l i s m , moral judgment, c r e a t i v e and d i v e r g e n t t h i n k i n g , and r e a s o n i n g a b i l i t i e s . The c o n s t r u c t of i n t e l l e c t u a l and e t h i c a l development can be c o n s i d e r e d a c e n t r a l v a r i a b l e f o r r e s e a r c h w i t h s i g n i f i c a n c e f o r the aims of n u r s i n g e d u c a t i o n . K e t e f i a n (1981) s t u d i e d the r e l a t i o n s h i p between c r i t i c a l t h i n k i n g , e d u c a t i o n a l p r e p a r a t i o n , and l e v e l s of moral r e a s o n i n g among groups of p r a c t i s i n g n u r s e s . 53 The r e s e a r c h was f o r m u l a t e d In response t o " t h e r e t h i n k i n g underway i n c o l l e g e s and u n i v e r s i t i e s r e l a t i v e t o g o a l s of l i b e r a l and h u m a n i s t i c s t u d i e s i n undergraduate e d u c a t i o n " and a noted l a c k of r e s e a r c h on the v a r i a b l e s t h a t might a f f e c t e t h i c a l d e c i s i o n making. The r e s e a r c h t e s t e d the f o l l o w i n g hypotheses: 1) t h e r e i s a p o s i t i v e r e l a t i o n s h i p between c r i t i c a l t h i n k i n g and moral r e a s o n i n g , 2) t h e r e i s a d i f f e r e n c e i n moral r e a s o n i n g between p r o f e s s i o n a l and t e c h n i c a l n u r s e s , and 3) c r i t i c a l t h i n k i n g and e d u c a t i o n a l p r e p a r a t i o n t o g e t h e r w i l l p r e d i c t g r e a t e r v a r i a n c e i n moral r e a s o n i n g t h a n e i t h e r v a r i a b l e t a k e n s e p a r a t e l y (p. 100) . The sample i n c l u d e d p r a c t i s i n g n u r s e s from t h r e e acute c a r e f a c i l i t i e s w i t h a wide range of age and work e x p e r i e n c e (p. 101). There were 43 d i p l o m a and a s s o c i a t e degree g r a d u a t e s and 43 n u r s e s had a b a c c a l a u r e a t e or h i g h e r degree. The Watson-Glaser (1964) C r i t i c a l T h i n k i n g A p p r a i s a l , and the Rest D e f i n i n g I s s u e s Test (1974) t o measure moral r e a s o n i n g , were a d m i n i s t e r e d t o s u b j e c t s . A l l hypotheses were u p h e l d f o l l o w i n g s t a t i s t i c a l a n a l y s e s . A l s o " a d d i t i o n a l a n a l y s e s c a r r i e d out between p e r s o n a l c h a r a c t e r i s t i c s such as age, r e l i g i o n , and e t h n i c i t y and moral r e a s o n i n g , d i d not y i e l d n o teworthy r e s u l t s " ( K e t e f i a n , 1981, p. 102). 54 T h i s s t u d y demonstrated a r e l a t i o n s h i p between c r i t i c a l t h i n k i n g and moral r e a s o n i n g which i s c o n s i s t e n t w i t h K o h l b e r g ' s a s s e r t i o n of t h e r e l a t i o n s h i p between l o g i c a l r e a s o n i n g and moral r e a s o n i n g . The i n t e g r a t i o n of i n t e l l e c t u a l and e t h i c a l development as i n the P e r r y scheme i s t h e r e f o r e j u s t i f i e d . The f i n d i n g t h a t t h e r e i s a d i f f e r e n c e i n moral r e a s o n i n g between p r o f e s s i o n a l and t e c h n i c a l n u r s e s i s s i g n i f i c a n t f o r t h i s s t u d y a l s o . " E d u c a t i o n and c r i t i c a l t h i n k i n g a c c o u n t e d f o r 32.9 p e r c e n t of t h e v a r i a n c e i n moral judgment" ( K e t e f i a n , 1981, p. 102). G i l l i g a n (1982) t h e o r e t i c a l l y p o s t u l a t e d t h a t K o h l b e r g ' s t h e o r y i s s e x u a l l y b i a s e d and t h a t males a r e s o c i a l i z e d toward autonomy i n judgment and, t h e r e f o r e , have h i g h e r moral r e a s o n i n g s c o r e s t h a n females. Rest (1979) found t h a t f o r m a l e d u c a t i o n i s s i g n i f i c a n t l y r e l a t e d t o development of m o r a l / e t h i c a l r e a s o n i n g . He found no gender d i f f e r e n c e s on s c o r e s of the D e f i n i n g I s s u e s t e s t . Mustapha and S e y b e r t (1989) s t u d i e d moral r e a s o n i n g among t h r e e groups of s t u d e n t s f rom a t r a d i t i o n a l l i b e r a l a r t s c u r r i c u l u m , a t r a d i t i o n a l n u r s i n g c u r r i c u l u m , and a new c u r r i c u l u m e n t i t l e d " F o u n d a t i o n s f o r the F u t u r e " which c o n s i s t e d of s i x c o u r s e s i n s c i e n c e , s o c i a l s c i e n c e , h u m a n i t i e s , and r e l i g i o n . In 55 the f o u n d a t i o n s c u r r i c u l u m , "each c o u r s e combined the s t u d y of two t o t h r e e of t h e s e s u b j e c t s , was m u l t i d i s c i p l i n a r y , and was o r g a n i z e d around the c e n t r a l i d e a of d e c i s i o n making" <p. 108). The t r a d i t i o n a l c u r r i c u l a i n c l u d e d i n d i v i d u a l c o u r s e s i n p h i l o s o p h y and e t h i c s . S t u d e n t s i n a l l f o u r academic y e a r s were i n c l u d e d i n the sample. The D e f i n i n g I s s u e s t e s t was used t o measure moral r e a s o n i n g and the S h i p l e I n s t i t u t e of L i v i n g S c a l e was used t o measure i n t e l l i g e n c e (IQ). There was no e f f e c t f o r academic year. The f o u n d a t i o n s s t u d e n t s had s i g n i f i c a n t l y h i g h e r moral r e a s o n i n g s c o r e s t h a n the n u r s i n g s t u d e n t s , and t h e n u r s i n g s t u d e n t s had s i g n i f i c a n t l y h i g h e r s c o r e s t h a n the t r a d i t i o n a l l i b e r a l a r t s s t u d e n t s . The a u t h o r s suggest t h a t moral r e a s o n i n g i s enhanced t h r o u g h an i n t e g r a t e d c u r r i c u l u m approach more th a n t h r o u g h a s i n g l e c o u r s e i n e t h i c s . Ho c o r r e l a t i o n s between th e IQ and the D e f i n i n g I s s u e s t e s t s c o r e s were r e p o r t e d . Mahon and F o w l e r (1979) a l s o a p p l i e d K o h l b e r g ' s t h e o r y t o n u r s i n g e d u c a t i o n . They conducted a s t u d y d u r i n g a c l i n i c a l c o u r s e where an e x p e r i m e n t a l group of t e n n u r s i n g s t u d e n t s was exposed t o moral c o n t e n t i n a n u r s i n g rounds format. The c o n t r o l group r e c e i v e d c l i n i c a l e x p e r i e n c e i n a s i m i l a r s e t t i n g but w i t h o u t the planned moral c o n t e n t d i s c u s s i o n s . Both c o n t r o l and 56 e x p e r i m e n t a l groups were exposed t o e t h i c a l c o n t e n t i n l e c t u r e s . S t u d e n t s were r a t e d on moral development u s i n g t h e D e f i n i n g I s s u e s t e s t . "The i n c r e a s e i n l e v e l of moral judgment development of the e x p e r i m e n t a l group was found t o be s i g n i f i c a n t l y g r e a t e r (p=.05) t h a n t h a t of the c o n t r o l group" <p. 10). The a u t h o r s suggest t h a t a moral m i l i e u which f o s t e r s development s h o u l d i n c l u d e c h a l l e n g e s of moral c o n f l i c t where genuine u n c e r t a i n t y and disagreement e x i s t , and where the s t u d e n t ' s s t a g e of t h i n k i n g o f f e r s no easy answers. As w e l l , s t u d e n t s s h o u l d be p r e s e n t e d w i t h r e s p o n s e s one s t a g e h i g h e r than t h e i r own. The l i t e r a t u r e on moral and e t h i c a l r e a s o n i n g shows s i m i l a r i t i e s between K o h l b e r g ' s t h e o r y of moral r e a s o n i n g and P e r r y ' s t h e o r y of i n t e l l e c t u a l and e t h i c a l development. K o h l b e r g ' s t h e o r y p r o v i d e d an a p p r o p r i a t e framework f o r n u r s i n g r e s e a r c h i n the a r e a . Summary T h i s c h a p t e r has p r e s e n t e d a r e v i e w of t h e o r e t i c a l and r e s e a r c h l i t e r a t u r e r e l a t e d t o b a c c a l a u r e a t e n u r s i n g e d u c a t i o n and i n t e l l e c t u a l and e t h i c a l development. L i t e r a t u r e on b a c c a l a u r e a t e e d u c a t i o n r e v e a l e d s i m i l a r i t i e s i n a r t i c u l a t e d g o a l s of u n i v e r s i t y e d u c a t i o n , and a broad e m p i r i c a l s e a r c h f o r d i f f e r e n c e s between g r a d u a t e s of d i p l o m a and b a c c a l a u r e a t e programs. 57 The second s e c t i o n demonstrated r e l a t i o n s h i p s between the c o n c e p t s of p r o f e s s i o n a l i s m , autonomy, s e l f - d i r e c t e d l e a r n i n g , c r i t i c a l t h i n k i n g , and the u n d e r l y i n g development of c o g n i t i v e s k i l l s . Review of r e s e a r c h u s i n g t h e P e r r y scheme r e v e a l e d r e s e a r c h m e t h o d o l o g i e s which s u c c e s s f u l l y a l l o w e d e x t e n s i o n and a p p l i c a t i o n of the t h e o r y f o r t e a c h i n g . The P e r r y scheme was a l s o used i n e d u c a t i o n a l r e s e a r c h i n n u r s i n g where i t a l l o w e d assessment of s t u d e n t development w i t h i n the c o g n i t i v e realm. These s t u d i e s i n c l u d e d measurement of i n t e l l e c t u a l and e t h i c a l development of s t u d e n t s a t i n t e r v a l s t h r o u g h o u t the c u r r i c u l u m , and assessment of the impact of s e l e c t e d e d u c a t i o n a l e x p e r i e n c e s on c o g n i t i v e development. The f i n a l s e c t i o n of the l i t e r a t u r e r e v i e w r e l a t e d the c o n c e p t s of i n t e l l e c t u a l development and moral and e t h i c a l r e a s o n i n g . Review of n u r s i n g s t u d i e s p r o v i d e d i n s i g h t i n t o the c o n c u r r e n t development of c o g n i t i v e s k i l l s and moral r e a s o n i n g a b i l i t i e s i n n u r s i n g s t u d e n t s and g r a d u a t e s . T h i s l i t e r a t u r e r e v i e w p r o v i d e s a broad background f o r the r e s e a r c h proposed i n t h i s paper. I t p r o v i d e s d i r e c t i o n f o r t h e d e s i g n and methodology of the r e s e a r c h . Study f i n d i n g s w i l l be a n a l y z e d and d i s c u s s e d w i t h i n the c o n t e x t of t h i s l i t e r a t u r e r e v i e w . 5 8 C H A P T E R I V M e t h o d o l o g y R e s e a r c h D e s i g n T h i s s t u d y w a s d e s i g n e d t o a n s w e r t h e f o l l o w i n g r e s e a r c h q u e s t i o n : I s t h e r e a d i f f e r e n c e b e t w e e n t h e l e v e l o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t o f a g r o u p o f p r a c t i s i n g d i p l o m a n u r s e s a n d t h e l e v e l o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t o f a g r o u p o f p r a c t i s i n g b a c c a l a u r e a t e n u r s e s ? A c o m p a r a t i v e d e s c r i p t i v e d e s i g n w a s u s e d t o d e t e r m i n e d i f f e r e n c e s b e t w e e n g r o u p s o n t h e l e v e l o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t . T h e d a t a w e r e a n a l y z e d u s i n g t h e t - t e s t f o r i n d e p e n d e n t s a m p l e s . A d e s c r i p t i v e c o r r e l a t i o n a l d e s i g n w a s u s e d t o t e s t r e l a t i o n s h i p s b e t w e e n l e v e l o f i n t e l l e c t u a l a n d e t h i c a l d e v e l o p m e n t , a n d t h e v a r i a b l e s o f a g e a n d y e a r s o f e x p e r i e n c e . P e a r s o n ' s p r o d u c t - m o m e n t c o r r e l a t i o n c o e f f i c i e n t w a s u s e d t o a n a l y z e t h e s e r e l a t i o n s h i p s ( B u r n s a n d G r o v e , 1 9 8 5 p . 5 0 8 ) . S a m p l e S e l e c t i o n A r a n d o m s a m p l e o f d i p l o m a a n d b a c c a l a u r e a t e p r e p a r e d p r a c t i s i n g n u r s e s i n B r i t i s h C o l u m b i a w a s o b t a i n e d t h r o u g h t h e c o m p u t e r i z e d r e g i s t r y o f t h e R e g i s t e r e d N u r s e s A s s o c i a t i o n o f B r i t i s h C o l u m b i a ( R N A B C ) . G u i d e l i n e s f o r a c c e s s t o m e m b e r s t h r o u g h t h i s 59 s e r v i c e a r e i n c l u d e d i n Appendix A. Membership i n t h i s a s s o c i a t i o n i s mandatory f o r a l l p r a c t i s i n g n u r s e s i n B r i t i s h Columbia. The p o p u l a t i o n f o r t h i s s t u d y , t h e r e f o r e , i n c l u d e d a l l p r a c t i s i n g n u r s e s i n B.C. who are r e g i s t e r e d w i t h the RNABC. S u b j e c t s were s e l e c t e d u s i n g d e s i r e d c r i t e r i a l i s t e d on the a p p l i c a t i o n f o r r e g i s t r a t i o n form of the RNABC (Appendix A). C r i t e r i a s e l e c t i o n was based on v a r i a b l e s i d e n t i f i e d i n the l i t e r a t u r e r e v i e w , e s p e c i a l l y t h o s e v a r i a b l e s i d e n t i f i e d by McCloskey (1983). McCloskey's m e t a - a n a l y s i s s u g g e s t e d t h a t v a r i a b l e s such as work s e t t i n g , c a r e e r m o t i v a t i o n , and c o n t i n u i n g e d u c a t i o n were s i g n i f i c a n t i n r e s e a r c h on the v a l u e of b a c c a l a u r e a t e e d u c a t i o n . To c o n t r o l f o r th e s e , and o t h e r e x t r a n e o u s v a r i a b l e s , t h e f o l l o w i n g c r i t e r i a were s e l e c t e d : 1. Employed i n n u r s i n g on a r e g u l a r b a s i s . 2. Worked 1,000 hours o r more i n the l a s t year. 3. Not on a l e a v e of absence. 4. Hol d s c u r r e n t p r a c t i c i n g membership. 5. P r i m a r y a r e a of r e s p o n s i b i l i t y i s d i r e c t p a t i e n t c a r e . 6. P o s i t i o n h e l d i s s t a f f / g e n e r a l d u t y nurse. 7. Employed i n an a c u t e c a r e h o s p i t a l . 8. B a s i c e d u c a t i o n i s a d i p l o m a - 100 s u b j e c t s 60 9. B a s i c e d u c a t i o n i s a b a c c a l a u r e a t e degree- 100 s u b j e c t s . 10. Has no post b a s i c n u r s i n g e d u c a t i o n . 11. I s not c u r r e n t l y e n r o l l e d i n an e d u c a t i o n program. 12. R e s i d e s i n B.C.. The above c r i t e r i a a r e e n t e r e d i n t h e RNABC computer as n u r s e s renew t h e i r membership a t the b e g i n n i n g of each year. T h i s means t h a t sample s e l e c t i o n d a t a can become o u t d a t e d . A l s o , a c c u r a c y of i n f o r m a t i o n i s dependent upon members f i l l i n g i n the forms c o r r e c t l y . S e l e c t i o n of the above c r i t e r i a a l s o l i m i t e d p a r t i c i p a t i o n i n the s t u d y , t h e r e b y l i m i t i n g p r o j e c t i o n of f i n d i n g s . Data C o l l e c t i o n P r o c e d u r e s M a i l i n g l a b e l s were produced f o r the sample g e n e r a t e d t h r o u g h the c o m p u t e r i z e d r e g i s t r y of the RNABC. The i n v e s t i g a t o r p r o v i d e d the RNABC w i t h 200 p a c k e t s i n stamped e n v e l o p e s . The packages c o n t a i n e d the MER, demographic d a t a s h e e t , l e t t e r of i n t r o d u c t i o n , and a stamped r e t u r n envelope. These documents a r e i n c l u d e d i n the Appendices. L a b e l s were a p p l i e d and packages m a i l e d a t the end of June 1990. Reminder l e t t e r s were sen t f o u r weeks a f t e r the i n i t i a l m a i l i n g . P r o t e c t i o n of human r i g h t s was a t t a i n e d t h r o u g h p r o c e d u r e s which ensured anonymity and v o l u n t a r y consent 61 t o p a r t i c i p a t e i n the study. M a i l i n g l a b e l s were produced and a p p l i e d by RNABC s t a f f , no r e c o r d was kept of s u b j e c t s i n the sample. S u b j e c t s were r e q u e s t e d not t o i n d i c a t e t h e i r names on any of the forms. An i n t r o d u c t o r y l e t t e r , (Appendix B) e x p l a i n e d the s t u d y and the time commitment r e q u i r e d . S u b j e c t s were in f o r m e d t h a t consent t o p a r t i c i p a t e was assumed by c o m p l e t i o n of t h e q u e s t i o n n a i r e . Raw d a t a was d e s t r o y e d upon c o m p i l a t i o n of r e s u l t s . Twenty-nine packages were completed, 11 from the diplo m a group and 18 from the b a c c a l a u r e a t e group. R e t u r n r a t e was 14.5 per cent . Burns and Grove (1987) s t a t e t h a t " i f the response r a t e i s lower t h a n 50 per cen t , the r e p r e s e n t a t i v e n e s s of the sample i s s e r i o u s l y i n q u e s t i o n " (p. 314). T h i s w i l l be c o n s i d e r e d when a n a l y s i n g r e s u l t s . I n s t r u m e n t s Demographic Data Sheet The demographic d a t a s heet (Appendix C) was d e s i g n e d t o c o l l e c t i n f o r m a t i o n on l e v e l of n u r s i n g e d u c a t i o n as w e l l as v a r i a b l e s which might be p e r t i n e n t t o t h i s s t u d y . Burns and Grove (1987) s t a t e t h a t d e s c r i p t i v e d a t a on a t t r i b u t e v a r i a b l e s s h o u l d be g a t h e r e d so t h a t c h a r a c t e r i s t i c s which may i n f l u e n c e s t u d y f i n d i n g s can be i d e n t i f i e d . A l s o , t h e s e 62 c h a r a c t e r i s t i c s can be used f o r s e c o n d a r y a n a l y s i s f o r the purpose of e x a m i n i n g p o s s i b l e a l t e r n a t i v e hypotheses (p.440). For t h i s s t u d y , a t t r i b u t e v a r i a b l e s which might i n f l u e n c e f i n d i n g s i n c l u d e d y e a r s of e x p e r i e n c e , 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 c o u r s e s , p a r t i c i p a t i o n i n p r o f e s s i o n a l or u n i o n a c t i v i t i e s , c a r e e r m o t i v a t i o n , u n i v e r s i t y c r e d i t o u t s i d e of n u r s i n g , l o c a t i o n of n u r s i n g s c h o o l , and age. A c c o r d i n g t o P e r r y ' s t h e o r y , an i n d i v i d u a l ' s i n t e r a c t i o n w i t h the environment, or e x p e r i e n c e , i s the b a s i s f o r the p r o c e s s e s of accommodation and a s s i m i l a t i o n which e n a b l e c o g n i t i v e growth ( P e r r y , 1970). I t f o l l o w s then, t h a t y e a r s of n u r s i n g e x p e r i e n c e might i n f l u e n c e s c o r e s on the i n t e l l e c t u a l and e t h i c a l development t o o l . N u r s i n g s t u d i e s i n the a r e a of c o g n i t i v e development have used samples of n u r s i n g s t u d e n t s or new g r a d u a t e s ( V a l i g a , 1982, F r i s c h , 1987, 1990), so t h a t the v a r i a b l e of p r o f e s s i o n a l e x p e r i e n c e has not been s t u d i e d . 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 c o u r s e s may r e v e a l an u n d e r l y i n g a t t i t u d e t o l e a r n i n g , or sense of r e s p o n s i b i l i t y f o r s e l f e d u c a t i o n which might be p o s i t i v e l y c o r r e l a t e d w i t h c o g n i t i v e m a t u r i t y . P a r t i c i p a t i o n i n p r o f e s s i o n a l o r u n i o n a c t i v i t i e s may be r e l a t e d t o commitment, a component of c o g n i t i v e 63 m a t u r i t y . C a r e e r m o t i v a t i o n has a l s o been i d e n t i f i e d as an i n f l u e n c i n g a t t r i b u t e . I n f o r m a t i o n on o t h e r u n i v e r s i t y l e v e l c r e d i t i n a d d i t i o n t o n u r s i n g e d u c a t i o n was g a t h e r e d because of the e f f e c t s of l i b e r a l e d u c a t i o n c o n t e n t , as d i s c u s s e d i n t h e l i t e r a t u r e r e v i e w . Name and l o c a t i o n of n u r s i n g s c h o o l was r e q u e s t e d because d i f f e r e n t c u r r i c u l a may be found t o promote or i n h i b i t i n t e l l e c t u a l and e t h i c a l development. F i n a l l y , the v a r i a b l e of age has been a s s o c i a t e d w i t h i n t e l l e c t u a l and e t h i c a l m a t u r i t y w i t h c o n f l i c t i n g r e s u l t s ( P e r r y , 1980, K i n g , 1977). The Measure of E p i s t e m o l o g i c a l R e f l e c t i o n The Measure of E p i s t e m o l o g i c a l R e f l e c t i o n (MER) (Appendix D) was used t o measure i n t e l l e c t u a l and e t h i c a l development a c c o r d i n g t o the P e r r y scheme. The MER was s e l e c t e d on the b a s i s of i n s t r u m e n t c r i t i q u e found t h r o u g h o u t t h e l i t e r a t u r e r e v i e w . The MER was the i n s t r u m e n t of c h o i c e i n two of t h e most r e c e n t s t u d i e s c r i t i q u e d i n t h i s r e s e a r c h ( F r i s c h , 1990, Shaw-Berget, 1988). The MER i s a s h o r t answer response q u e s t i o n a i r e which p r o v i d e s i n f o r m a t i o n o n s i x c o n t e n t a r e a s of i n t e l l e c t u a l and e t h i c a l development. These i n c l u d e d e c i s i o n making, the r o l e o f the l e a r n e r , t h e r o l e of the i n s t r u c t o r , the r o l e o f p e e r s , e v a l u a t i o n , and the 64 n a t u r e o f knowledge (Ba x t e r Magolda and P o r t e r f i e l d , 1988). These c o n t e n t a r e a s were I d e n t i f i e d by the i n s t r u m e n t ' s a u t h o r s t h r o u g h a r e v i e w of o t h e r r e s e a r c h and i n t e r p r e t a t i o n s of the P e r r y scheme. The a u t h o r s s t a t e t h a t t h e s e s i x c o n t e n t a r e a s "demonstrate q u a l i t a t i v e d i f f e r e n c e s i n u n d e r l y i n g c o g n i t i v e s t r u c t u r e s d e s c r i b e d by the P e r r y p o s i t i o n s " (p. 22). S u b j e c t s must produce a response i n each of the s i x domains. The a u t h o r s s t a t e t h a t " p r o d u c t i o n t a s k format was chosen based on r e s e a r c h i n d i c a t i n g t h a t a c c u r a t e measurement of u n d e r l y i n g c o g n i t i v e s t r u c t u r e s r e q u i r e s p r o d u c t i o n r a t h e r t h a n r e c o g n i t i o n of a r e s p o n s e " (p. 22). W i t h i n each domain, q u e s t i o n s are posed which d i r e c t the r e s p o n d e n t ' s t h i n k i n g t o t h e c o n t e n t of t h a t domain. F o l l o w up prompting q u e s t i o n s h e l p the respondent e x p l a i n or j u s t i f y t h e response t o t h e opening q u e s t i o n s , t h e r e b y r e v e a l i n g the r e a s o n i n g s t r u c t u r e used by t h e i n d i v i d u a l . The MER r a t i n g manual c o n t a i n s s p e c i f i c r e a s o n i n g s t r u c t u r e s f o r each p o s i t i o n w i t h i n each domain. " R a t i n g r e q u i r e s f i n d i n g t h e c l o s e s t match between the manual r e a s o n i n g s t r u c t u r e s and t h o s e i d e n t i f i e d i n t h e r e s p o n s e " (p. 23). The f o l l o w i n g example demonstrates how the r a t e r d e t e r m i n e s p o s i t i o n and r e a s o n i n g s t r u c t u r e i n domain s i x : n a t u r e of knowledge, t r u t h , and r e a l i t y . The r e a s o n i n g 65 s t r u c t u r e s which might o c c u r w i t h i n P e r r y p o s i t i o n t h r e e a r e used i n the example. W i t h i n domain s i x , t h e p o s i t i o n t h r e e p e r s o n has l e f t the n o t i o n t h a t a l l knowledge i s known by a u t h o r i t i e s , They b e l i e v e t h a t t h e r e a r e two c a t e g o r i e s of knowledge, known and unknown. For t h e f i r s t c a t e g o r y , the p e r s o n who uses p o s i t i o n t h r e e r e a s o n i n g s t r u c t u r e s may b e l i e v e t h a t c o n f l i c t i n g e x p l a n a t i o n s o ccur because one t e a c h e r i s wrong, degree of d e t a i l s d i f f e r , o r o p i n i o n s about the f a c t s d i f f e r . D i f f e r e n c e s w i l l be r e s o l v e d i n the f u t u r e when t r u t h i s known. Fo r t h e unknown c a t e g o r y the i n d i v i d u a l d e c i d e s what t o b e l i e v e on the b a s i s of l o g i c o r the most r e c e n t i n f o r m a t i o n . Major d i s t i n c t i o n s between the p o s i t i o n s a r e as f o l l o w s : Nature of knowledge: a l l known by a u t h o r i t i e s ( p o s i t i o n 1), a l l known by most a u t h o r i t i e s but not a lways p r e s e n t e d c l e a r l y ( p o s i t i o n 2 ) , some known, some unknown ( p o s i t i o n 3 ) , a l l unknown ( p o s i t i o n 4) , u n c e r t a i n but d e f i n a b l e i n a c o n t e x t ( p o s i t i o n 5) . How one e v a l u a t e s knowledge: b e l i e v e s a u t h o r i t i e s ( p o s i t i o n 1), b e l i e v e s good a u t h o r i t i e s ( p o s i t i o n 2 ) , b e l i e v e s what one t h i n k s i s l o g i c a l and r e c e n t ( p o s i t i o n 3 ) , b e l i e v e s whatever one wants ( p o s i t i o n 4 ) , e v a l u a t e s e v i d e n c e i n a c o n t e x t ( p o s i t i o n 5) . The f o l l o w i n g r e a s o n i n g s t r u c t u r e s o c c u r i n domain s i x , p o s i t i o n t h r e e . Reasoning s t r u c t u r e s a r e i n d i c a t e d by the l a s t d i g i t (one, two, or t h r e e ) , 6,3.1 Knowledge f a l l s i n t o two c a t e g o r i e s ; 66 t h a t which i s known and t h a t which i s not. D i f f e r e n t e x p l a n a t i o n s f o r the f i r s t c a t e g o r y r e s u l t f r om d i f f e r e n c e i n d e t a i l s , v i e w p o i n t s and a u t h o r i t i e s . In the second c a t e g o r y d i f f e r e n c e s are e x p l a i n e d by knowledge b e i n g unknown. Example of response: Yes t h e y c o u l d . I would take the one t h a t seemed t o be more l o g i c a l and seemed a p p r o p r i a t e t o the s i t u a t i o n . A l s o I would check i f t h e r e were s u p p o r t i n g f a c t s f o r t h e e x p l a n a t i o n . One can be s u r e by the f a c t s s u p p o r t i n g the e x p l a n a t i o n . Who's g o i n g t o b e l i e v e something t h a t c a n ' t be s u p p o r t e d ? One c a n ' t be s u r e i f n e i t h e r e x p l a n a t i o n has s u p p o r t . The e x p l a n a t i o n s a r e p r o b a b l y f a r - o u t o p i n i o n s , or a concept not based on any r e a l f a c t s . 6.3.2 Assuming the same two c a t e g o r i e s of knowledge (known and unknown), i f one i s d i s c u s s i n g a b s t r a c t a r e a s , one cannot be s u r e what t o b e l i e v e but can choose on the b a s i s of l o g i c , a c c e p t a n c e , one's b e l i e f s , and the most r e c e n t i n f o r m a t i o n . Example: Yes. H i s t o r i c a l e v e n t s a r e f a c t s . You cannot change t h e i r i n t e r p r e t a t i o n . S c i e n t i f i c phenomena may be e x p l a i n e d d i f f e r e n t l y . I would a c c e p t the one t h a t sounds more l o g i c a l t o me and i s more w i d e l y a c c e p t e d . One c a n ' t be s u r e u n l e s s they p e r s o n a l l y i n v e s t i g a t e t h i s ; one w i l l not know whether i t was e x p l a i n e d by t h e p e r s o n ' s o p i n i o n s or s t r i c t l y be f a c t u a l o c c u r r e n c e s . 6.3.3 Assuming the same two c a t e g o r i e s of knowledge, d i f f e r e n t e x p l a n a t i o n s i n the f i r s t c a t e g o r y a r e a r e s u l t of i n s t r u c t o r s ' own v i e w p o i n t s about the f a c t s . However, i n t h e unknown c a t e g o r y o p i n i o n s may become l e g i t i m a t e t r u t h i f e v i d e n c e i s found t o s u p p o r t them i n the f u t u r e . Example: I f no p r e v i o u s knowledge on the s u b j e c t i s i n the memory v a u l t of the b r a i n , t h e r e a r e many books, magazines, and so f o r t h t o c o n s u l t i n o r d e r t o come t o an u n b i a s e d o p i n i o n . Research e x p l a n a t i o n s and d e c i d e i f t h e y a r e o p i n i o n a t e d i n any way or f a c t u a l . O p i n i o n a t e d or unproven e x p l a n a t i o n s a r e d i f f i c u l t t o b e l i e v e , u n l e s s one f i n d s f a c t s t o s u p p o r t them. (pp. 216-217) 67 G a t h e r i n g d a t a on the way i n which a p e r s o n r e a s o n s w i t h i n each of the s i x domains adds s e n s i t i v i t y t o t h e i n s t r u m e n t and i d e n t i f i c a t i o n of r e a s o n i n g s t r u c t u r e s c o n t r i b u t e s t o a c c u r a c y and ease of i n t e r p r e t a t i o n of responses. The MER p r o v i d e s a P e r r y r a t i n g of P o s i t i o n one t o f i v e . P o s i t i o n s " s i x , seven, e i g h t and n i n e do not r e p r e s e n t r e s t r u c t u r i n g as do t h e f i r s t f i v e p o s i t i o n s " ( B a x t e r Magolda, P o r t e r f i e l d , 1988). T h i s l a c k of m e a s u r a b l i 1 i t y of change i n the upper p o s i t i o n s i s c o n c u r r e n t w i t h a c r i t i q u e of the P e r r y scheme found i n V a l i g a (1982). V a l i g a c i t e d S t r a n g e (1978) who s t a t e d t h e scheme shows a s h i f t from e p i s t e m o l o g i c a l development i n the f i r s t f i v e p o s i t i o n s t o p e r s o n a l i d e n t i t y development i n the upper p o s i t i o n s . The d e c i s i o n i s a l s o congruent w i t h s t u d i e s where i t was d i f f i c u l t t o d i s t i n g u i s h between l e v e l s of commitment, and where s u b j e c t s d i d not a c h i e v e upper p o s i t i o n s ( K u r f i s s , 1975, K i t c h e n e r 1976). Upon a n a l y s i s , the r a t e r a s s i g n s a P e r r y p o s i t i o n s c o r e f o r each c o n t e n t a r e a . A t h r e e d i g i t r a t i n g i s produced, (6.3.1). The f i r s t d i g i t i n d i c a t e s the domain, the second d i g i t i n d i c a t e s the P e r r y p o s i t i o n , and the t h i r d d i g i t r e p r e s e n t s the r e a s o n i n g s t r u c t u r e . I f a response i s deemed u n r a t a b l e i n domain s i x , f o r 68 e x a m p l e , a s c o r e o f 6 . 0 . 0 i s g i v e n . T h e z e r o v a l u e i s n o t c a l c u l a t e d i n t h e t o t a l p r o t o c o l r a t i n g . I f i t i s p o s s i b l e t o i d e n t i f y a p o s i t i o n i n t h e r e s p o n s e , b u t t h e r e a s o n i n g s t r u c t u r e d o e s n o t m a t c h d e f i n e d s t r u c t u r e s , a z e r o i s a s s i g n e d f o r t h e r e a s o n i n g s c o r e d i g i t ( e . g . , 6 . 3 . 0 ) . A t o t a l p r o t o c o l r a t i n g ( T P R ) i s o b t a i n e d b y d e t e r m i n i n g t h e a r i t h m e t i c a v e r a g e o f t h e P e r r y p o s i t i o n s i n e a c h c o n t e n t a r e a . I n t h i s s t u d y t h e T P R s c o r e s w e r e u s e d t o d e t e r m i n e d i f f e r e n c e s b e t w e e n g r o u p s . T h e r e s p o n s e s w e r e a n a l y z e d b y t w o c e r t i f i e d r a t e r s , t h e r e s e a r c h e r a n d a c o l l e a g u e . C e r t i f i c a t i o n w a s a t t a i n e d t h r o u g h c o m p l e t i o n o f t h e r a t e r t r a i n i n g p r o g r a m ( B a x t e r M a g o l d a , P o r t e r f i e l d , 1 9 8 8 ) . S c o r i n g o f p r o t o c o l s w a s c a r r i e d o u t u s i n g t h e p r o c e d u r e a s s t a t e d b y t h e a u t h o r s o f t h e MER i n t h e r a t e r t r a i n i n g m a n u a l ( p p . 8 5 - 9 2 ) . R a t e r s i n d e p e n d e n t l y r a t e d e a c h p r o t o c o l , w h i c h h a d b e e n s e p a r a t e d f r o m t h e d a t a s h e e t t o p r e v e n t b i a s . I n t e r r a t e r a g r e e m e n t f o r P e r r y p o s i t i o n s b y d o m a i n w a s 89.7 %. F o l l o w i n g i n d e p e n d e n t s c o r i n g , r a t e r s m e t t o a c h i e v e c o n s e n s u s o n t h e f i n a l s c o r e , a s o u t l i n e d i n t h e m a n u a l . D o m a i n r a t i n g s a n d t o t a l p r o t o c o l r a t i n g s f o r s u b j e c t s i n t h i s s t u d y a r e i n c l u d e d i n A p p e n d i x E . 69 R e l i a b i l i t y and V a l i d i t y of the MER, The d i f f i c u l t i e s i n d e v e l o p i n g an a p p r o p r i a t e t o o l t o measure i n t e l l e c t u a l and e t h i c a l l e v e l and placement on the P e r r y scheme has impeded u t i l i z a t i o n of the t h e o r y i n r e s e a r c h and p r a c t i c e . The a u t h o r s of the MER d e v e l o p e d t h i s assessment t o o l so t h a t t h e o r y and p r a c t i c e w i t h i n the r e a l m of i n t e l l e c t u a l development c o u l d be more c l o s e l y l i n k e d . Broad c r i t e r i a f o r the t o o l i n c l u d e d a c c u r a c y and p r a c t i c a l i t y ( B a x t e r Magolda, P o r t e r f i e l d , 1988, p.2). E i g h t s t u d i e s were co n d u c t e d i n o r d e r t o e s t a b l i s h r e l i a b i l i t y and v a l i d i t y of t h e MER ( B a x t e r Magolda and P o r t e r f i e l d , 1988). I n t e r r a t e r agreement was one means used t o t e s t r e l i a b i l i t y . For a group of 121 b a c c a l a u r e a t e s o c i a l work s t u d e n t s , e x a c t i n t e r — r a t e r agreement f o r t h e t o t a l p r o t o c o l r a t i n g s was 64%. W i t h i n one p o s i t i o n agreement was 100% ( B a x t e r Magolda and P o r t e r f i e l d , 1988, p. 34). In a n o t h e r s t u d y of 39 b a c c a l a u r e a t e and g r a d u a t e s t u d e n t s e n r o l l e d i n an i n t e r d i s c i p l i n a r y program, v a l i d i t y based on c o r r e l a t i o n w i t h i n t e r v i e w s c o r e s was .93 (p. 48). The a u t h o r s s u g g e s t t h a t more l o n g i t u d i n a l d a t a would be h e l p f u l i n e s t a b l i s h i n g r e l i a b i l i t y and v a l i d i t y . 70 Summary T h i s c h a p t e r d e s c r i b e d the s t r a t e g i e s used t h r o u g h o u t t h i s r e s e a r c h . Methods of sample s e l e c t i o n of p r a c t i s i n g n u r s e s were o u t l i n e d , and p e r t i n e n t v a r i a b l e s were i d e n t i f i e d . Some of t h e s e v a r i a b l e s were c o n t r o l l e d t h r o u g h sample s e l e c t i o n , and some were i d e n t i f i e d i n c o n s t r u c t i o n of the demographic d a t a sheet. S e l e c t i o n of the t o o l used t o measure i n t e l l e c t u a l and e t h i c a l development was d i s c u s s e d , and a s p e c t s of p r o c e d u r e s used i n r a t i n g were o u t l i n e d . The d a t a produced by the q u e s t i o n n a i r e were r i c h and i n f o r m i n g , A n a l y s i s and i n t e r p r e t a t i o n of t h e s e d a t a i s p r e s e n t e d i n the next c h a p t e r . 71 CHAPTER V A n a l y s i s , I n t e r p r e t a t i o n and D i s c u s s i o n of F i n d i n g s A n a l y s i s of Demographic Data The sample was composed of 18 b a c c a l a u r e a t e program g r a d u a t e s and 11 d i p l o m a g r a d u a t e s . A l l d a t a must be i n t e r p r e t e d w i t h c a u t i o n because of the s m a l l sample s i z e . The b a c c a l a u r e a t e g r a d u a t e s ranged i n age from 23 t o 51. The di p l o m a g r a d u a t e s ranged i n age from 27 t o 57. Y e a r s of e x p e r i e n c e ranged from 2 t o 29. The demographic d a t a i n d i c a t e t h a t the c o m p o s i t i o n of bo t h groups was s i m i l a r i n c h a r a c t e r i s t i c s , s u c h as age and y e a r s of e x p e r i e n c e , which have a l r e a d y been i d e n t i f i e d as p o t e n t i a l i n f l u e n c i n g v a r i a b l e s . T a b l e 1 shows ranked MER s c o r e s w i t h accompanying demographic d a t a . There were no p a t t e r n s d i s t i n g u i s h a b l e f o r l o c a t i o n of e d u c a t i o n a l i n s t i t u t i o n , so t h e s e d a t a a r e not i n c l u d e d i n the t a b l e . S i x t e e n n u r s e s r e p o r t e d e n r o l l i n g i n c o n t i n u i n g e d u c a t i o n ; t h i r t e e n n u r s e s had never e n r o l l e d i n c o n t i n u i n g e d u c a t i o n . Only two n u r s e s r e p o r t e d b e i n g i n v o l v e d i n RNABC o r BCNU a c t i v i t i e s . Three n u r s e s e x p e c t e d t o advance t o an a d m i n i s t r a t i v e p o s i t i o n w i t h i n the next f i v e y e a r s . Nine n u r s e s r e p o r t e d h a v i n g u n i v e r s i t y or c o l l e g e l e v e l c r e d i t i n a d d i t i o n t o b a s i c n u r s i n g 72 T a b l e 1 Ranked MER S c o r e s w i t h Demographic Data S u b j e c t TPR 18 161 46 170 149 11 167 106 55 4. 00 4. 00 3. 83 3. 80 3. 67 3. 50 3. 50 3. 40 3. 33 Educ Hosp Uni v Hosp Univ Univ Hosp Univ Univ Hosp Age 45 27 36 36 27 56 36 42 32 Exp 15 4 11 10 5 29 12 20 10 Cont ed Y Y N Y Y Y Y Y Other u n i v Y Y Y Y N N N H 122 171 100 128 135 24 88 44 47 3. 20 3. 17 3. 00 3. 00 3. 00 2. 83 2. 83 2. 67 2. 67 Uni v U n i v C o l l U n i v U n i v Hosp Hosp Hosp Hosp 36 35 27 35 40 45 30 35 45 12 14 3 8 19 24 5 12 22 N Y N Y Y Y N Y N Y Y N Y N N Y ( t a b l e c o n t i n u e s ) 73 S u b j e c t TPR Educ Age Exp Cont Other Ed U n i v 101 2.67 Univ 51 27 Y N 118 2.67 Univ 38 14 Y N 157 2.67 Univ 28 5 N N 166 2.67 Univ 27 4 N Y 168 2.67 Univ 30 3 N N 187 2.67 Univ 23 2 N N 124 2.50 Univ 41 t 18 N N 129 2.50 Univ 31 8 Y N 60 2.33 Hosp 40 10 Y N 153 2.33 Uni v 28 5 N N 3 2.17 Hosp 57 26 N N Note, TPR = T o t a l P r o t o c o l R a t i n g Educ = L e v e l of E d u c a t i o n Hosp = H o s p i t a l Diploma program C o l l = C o l l e g e Diploma program Univ = U n i v e r s i t y B a c c a l a u r e a t e program Exp = Y e a r s of N u r s i n g E x p e r i e n c e Cont. Ed. = P a r t i c i p a t i o n i n a c o n t i n u i n g e d u c a t i o n program Y = yes N = No RNABC/BCNU = P a r t i c i p a t i o n i n RNABC/BCNU a c t i v i t i e s Other u n i v = U n i v e r s i t y or c o l l e g e c r e d i t i n a d d i t i o n b a s i c n u r s i n g e d u c a t i o n 74 e d u c a t i o n ; 20 d i d not. Ta b l e 1 p e r m i t s v i s u a l comparison of r e s u l t s . From t h i s t a b l e i t i s e v i d e n t t h a t the v a r i a b l e o f u n i v e r s i t y -c r e d i t o t h e r t h a n n u r s i n g may be r e l a t e d t o h i g h s c o r e s on the MER. T h i s r e l a t i o n s h i p i s i m p o r t a n t t o t h e r e s e a r c h q u e s t i o n i n t h i s s t u d y and w i l l be examined i n the a n a l y s i s . I t a l s o a p p e a r s t h a t t h e r e may be a r e l a t i o n s h i p between 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 and s c o r e s on the MER. A l t h o u g h a l i n k between c o g n i t i v e development and c o n t i n u i n g e d u c a t i o n has been demonstrated i n the l i t e r a t u r e r e v i e w , t h i s r e l a t i o n s h i p i s not germane t o t h e r e s e a r c h q u e s t i o n of t h i s s t u d y , and i t w i l l be l e f t f o r f u t u r e a n a l y s i s . The Measure of I n t e l l e c t u a l and E t h i c a l Development As d i s c u s s e d i n c h a p t e r IV, t o t a l p r o t o c o l r a t i n g s c o r e s on the MER were used t o a n a l y z e d i f f e r e n c e s between t h e two groups of p r a c t i s i n g n u r s e s . R a t e r t r a i n i n g , a l t h o u g h time consuming, a l l o w e d f u r t h e r i n s i g h t s i n t o t h e c o n s t r u c t of i n t e l l e c t u a l and e t h i c a l development. These i n s i g h t s p e r m i t t e d e x t r a p o l a t i o n of r e s u l t s as t h e 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 s ' t h i n k i n g a t v a r i o u s p o s i t i o n s c o u l d be p r o f i l e d . T o t a l p r o t o c o l r a t i n g s c o r e s on t h e MER ranged from 2.17 t o 4.0, w i t h a mean of 3.01. The range and mean are c o n s i s t e n t w i t h r e s u l t s of V a l i g a ' s (1982) and 75 F r i s c h ' s (1987, 1990) r e s e a r c h w i t h n u r s i n g s t u d e n t s . E x p e r i e n c e d p r a c t i s i n g n u r s e s i n t h i s s t u d y d i d not p r e s e n t h i g h e r l e v e l s of c o g n i t i v e m a t u r i t y t h a n the n u r s i n g s t u d e n t s i n t h e s e o t h e r s t u d i e s . Review of r e a s o n i n g s t r u c t u r e s t y p i c a l of p o s i t i o n t h r e e w i t h i n the s i x domains of the MER w i l l h e l p t o p r o v i d e a p r o f i l e of the l e v e l t h r e e person. Domain 1: D e c i s i o n Making i n an E d u c a t i o n a l C o n t e x t . In p o s i t i o n t h r e e c h o o s i n g i s s t i l l a m a t t e r of f i n d i n g the r i g h t answer, but i s c o m p l i c a t e d by the n o t i o n t h a t a l l t r u t h i s not known y e t . A u t h o r i t i e s s t i l l know the t r u t h t h a t can be known, and t h u s m a i n t a i n much of t h e i r i n f l u e n c e . A l t e r n a t i v e s a r e s t i l l c o n f u s i n g because i t i s even ha r d e r t o f i n d the r i g h t one. The p o s i t i o n t h r e e p e r s o n g e n e r a l l y d e s c r i b e s c h o o s i n g as e n g aging i n the r i g h t p r o c e s s o r f o r m u l a f o r d e c i d i n g , w i t h the n o t i o n t h a t i f the p r o c e s s i s r i g h t i t w i l l work out i n the end. C r i t e r i a d i s c u s s e d w i t h r e g a r d t o c h o o s i n g a r e u s u a l l y f u t u r e h a p p i n e s s , s u c c e s s , and f u l f i l l m e n t of g o a l s . Domain 2: R o l e of t h e L e a r n e r i n the L e a r n i n g P r o c e s s In p o s i t i o n t h r e e the n o t i o n t h a t some of the t r u t h i s unknown a t p r e s e n t even t o a u t h o r i t i e s c o m p l i c a t e s f i n d i n g the r i g h t answers. A b s t r a c t l e a r n i n g c o n t e x t s l i k e p h i l o s o p h y a r e l i k e l y t o be viewed as a r e a s where the t r u t h i s y e t t o be d i s c o v e r e d . In c o n c r e t e c o n t e x t s , t h e l e a r n e r ' s r o l e remains one of r e c e i v i n g the answers but i n u n c e r t a i n c o n t e x t s i t s h i f t s t o one of l e a r n i n g a l o n g w i t h t h e a u t h o r i t y how t o f i n d the answer. Domain 3: R o l e of the I n s t r u c t o r i n the L e a r n i n g P r o c e s s In p o s i t i o n t h r e e i n s t r u c t o r s m a i n t a i n a g r e a t d e a l of t h e i r a u t h o r i t y . However, the l e a r n e r has d i s c o v e r e d t h a t some t r u t h i s not known a t p r e s e n t . As t h e l e a r n e r ' s f o c u s t u r n s t o f i n d i n g a p r o c e s s t o use t o d i s c o v e r the unknowns, the i n s t r u c t o r ' s r o l e a l t e r s from one of g i v i n g the answers t o one of h e l p i n g the s t u d e n t s l e a r n the p r o c e s s of f i n d i n g them. The t e a c h e r ' s r o l e becomes one of g u i d i n g the l e a r n e r t o u n d e r s t a n d i n f o r m a t i o n . The 76 l e a r n e r i s more open t o a b s t r a c t t e a c h i n g methods tha n b e f o r e but i s s t i l l l i k e l y t o see s t u d e n t s p a r t i c i p a t i o n as h a v i n g m i n i m a l s i g n i f i c a n c e t o l e a r n i n g . P r e f e r r e d t e a c h i n g methods a r e t h o s e t h a t a s s i s t i n l e a r n i n g the p r o c e s s f o r t h i n k i n g and s e a r c h i n g , The i n s t r u c t o r - s t u d e n t r e l a t i o n s h i p i s b e g i n n i n g t o expand because the s t u d e n t views g e t t i n g t o know the i n s t r u c t o r as p a r t of t h i s l e a r n i n g p r o c e s s . A p o s i t i v e a t t i t u d e on the p a r t of the i n s t r u c t o r toward s t u d e n t s i s e s s e n t i a l t o h e l p i n g them l e a r n b e t t e r . Domain 4: Role of P e e r s i n the L e a r n i n g P r o c e s s Student i n v o l v e m e n t i s a b i t more a c c e p t a b l e i n p o s i t i o n t h r e e because even the i n s t r u c t o r may not know a l l the answers. Peer i n t e r a c t i o n i s seen as l e g i t i m a t e as i t r e l a t e s t o d i s c o v e r i n g the p r o c e s s of f i n d i n g the t r u t h , s uch as i n s m a l l group d i s c u s s i o n s . I n t e r a c t i o n has a number of advantages as l o n g as the i n s t r u c t o r keeps the c l a s s under c o n t r o l and has the knowledge t h a t he or she s h o u l d share w i t h t h e c l a s s . Domain 5: Ro l e of E v a l u a t i o n i n the L e a r n i n g P r o c e s s In p o s i t i o n t h r e e e v a l u a t i o n i s no l o n g e r a b s o l u t e and q u a n t i f i a b l e . T h e r e f o r e the i s s u e of t r u e u n d e r s t a n d i n g v e r s u s r e c i t a t i o n a r i s e s . A d d i t i o n a l i s s u e s i n c l u d e o b j e c t i v i t y , i n d i v i d u a l l e a r n i n g s t y l e s , p r a c t i c a l i t y of m a t e r i a l , and c o n f u s i o n over a l t e r n a t e methods. I t i s s t i l l t he r e s p o n s i b i l i t y of t h e i n s t r u c t o r t o t a k e t h e s e i n t o account when g r a d i n g . The i n s t r u c t o r i s r e s p o n s i b l e f o r f i n d i n g a f a i r and o b j e c t i v e way t o a c c o m p l i s h t h i s . Domain 6: Nature of Knowledge, T r u t h , and R e a l i t y In p o s i t i o n t h r e e i t i s p o s s i b l e f o r t h e t r u t h t o be d i s p u t e d because some t h i n g s a r e y e t t o be known f o r s u r e . I t becomes d i f f i c u l t , however, t o d e f i n e how t h e disagreement can be r e s o l v e d . S h o u l d one e x p e r t seem t o have a b e t t e r p r o c e s s f o r f i n d i n g t h e t r u t h , he or she may be presumed t o be r i g h t , a t l e a s t u n t i l t he t r u t h i s r e a l l y d i s c o v e r e d . The p o s i t i o n t h r e e p e r s o n b e l i e v e s t h a t the t r u t h w i l l be known f o r s u r e i n t h e f u t u r e . However, i n the meantime, o p i n i o n s could' become l e g i t i m a t e t r u t h i f s u p p o r t e d by enough f a c t u a l e v i d e n c e . ( B a x t e r Magolda, P o r t e r f i e l d , 1988, p. 93) 77 The p o s i t i o n t h r e e i n d i v i d u a l i s i n t r a n s i t i o n between a d u a l i s t i c , a b s o l u t e view of the w o r l d and knowledge, and a more c o n f u s i n g and complex view of the w o r l d as r e l a t i v e and u n c e r t a i n . Through the above e x c e r p t i t i s apparent t h a t the MER i s g e n e r a l l y used w i t h s t u d e n t s or peopl e who have had a r e c e n t e d u c a t i o n a l e x p e r i e n c e , a l t h o u g h the g e n e r a l p o p u l a t i o n were used i n i t s development. In f a c t , many of the r e s p o n d e n t s i n t h i s s t u d y answered q u e s t i o n s r e g a r d i n g e d u c a t i o n as i t r e l a t e d t o t h e i r own b a s i c n u r s i n g e d u c a t i o n . F o r many, the d e c i s i o n s around e n t e r i n g n u r s i n g and c h o o s i n g a s c h o o l o c c u r r e d s e v e r a l y e a r s ago. Some n u r s e s d i d r e l a t e r e a s o n i n g s t r u c t u r e s t h a t t h e y used i n the p a s t , r a t h e r t h a n p r e s e n t r e a s o n i n g s t r u c t u r e s . T h i s seemed t o o c c u r most i n domain 1. For f u t u r e samples of mature a d u l t s , an i n t r o d u c t o r y note on the MER which d i r e c t s s u b j e c t s t o use r e c e n t e x p e r i e n c e s and respond w i t h p r e s e n t t h o u g h t s might be h e l p f u l . Comparison of L e v e l of I n t e l l e c t u a l and E t h i c a l  Development and L e v e l of N u r s i n g E d u c a t i o n The d e s c r i p t i v e s t a t i s t i c s f o r t h e two groups on the v a r i a b l e o f s c o r e s on the MER a r e p r e s e n t e d i n t a b l e 2. 78 T a b l e 2 D e s c r i p t i v e S t a t i s t i c s f o r MER S c o r e s S t a t i s t i c B a c c a l a u r e a t e Diploma Graduates G r a d u a t e s Sample s i z e n = 18 n = 11 Mean x = 3.01 x = 3.01 Range 2.33 - 4.00 2.17 - 4.00 S t a n d a r d D e v i a t i o n 0.48 0.56 S i n c e the means of the two samples were e x a c t l y the same i t was un n e c e s s a r y and i m p o s s i b l e t o c a r r y out the t t e s t on the dat a . A c c o r d i n g t o Burns and Grove (1987), " i f t h e r e s u l t s i n d i c a t e no s i g n i f i c a n t d i f f e r e n c e , power a n a l y s i s must be done" (p. 505). The power i s d e f i n e d as the p r o b a b i l i t y t h a t a s t a t i s t i c a l t e s t w i l l d e t e c t a s i g n i f i c a n t d i f f e r e n c e t h a t e x i s t s (p. 751). "A type II e r r o r o c c u r s when the r e s e a r c h e r c o n c l u d e s t h a t t h e r e i s no s i g n i f i c a n t d i f f e r e n c e between the samples examined, when, i n f a c t , a d i f f e r e n c e e x i s t s " (p. 480). Power c a l c u l a t i o n i n c l u d e s the sample s i z e and e f f e c t s i z e which r e f l e c t s t h e degree t o which the phenomenon i s p r e s e n t i n t h e p o p u l a t i o n (p.483). T h e r e f o r e , t h e s m a l l sample s i z e and low v a r i a b i l i t y i n MER s c o r e s i n d i c a t e s t h a t the power i n t h i s s t u d y i s low. 79 Comparison of L e v e l of I n t e l l e c t u a l and E t h i c a l  Development and Other U n i v e r s i t y C r e d i t Overview a n a l y s i s of the raw d a t a i n d i c a t e d t h a t r e s p o n d e n t s who had e n r o l l e d i n u n i v e r s i t y e d u c a t i o n o t h e r t h a n t h e i r n u r s i n g program s c o r e d h i g h e r on the MER t h a n those who d i d not. The sample of s u b j e c t s who had o t h e r e d u c a t i o n was 9 and the sample of n u r s e s w i t h no o u t s i d e e d u c a t i o n was 20. The means f o r t h e s e groups were 3.39 and 2.84 r e s p e c t i v e l y . A n a l y s i s of d i f f e r e n c e s between the means was c a r r i e d out on t h e s e samples. The t s t a t i s t i c was c a l c u l a t e d by hand u s i n g the f o l l o w i n g f o r m u l a <X, -X a) t = s. - _ With a t s t a t i s t i c of 3.1, w i t h 27 degrees of freedom, the d i f f e r e n c e between means was found t o be s i g n i f i c a n t a t the 0.005 l e v e l of s i g n i f i c a n c e ( H o w e l l , 1985, p. A21). Burns and Grove suggest t h a t i f s i g n i f i c a n t r e s u l t s a r e found, magnitude t e s t i n g s h o u l d be done t o d e t e r m i n e the amount of v a r i a n c e e x p l a i n e d . Magnitude t e s t i n g was performed u s i n g the Omega squ a r e d s t a t i s t i c ( H o w e l l , 1985, p. 247) y i e l d i n g a v a l u e of 0.2267. T h e r e f o r e we can c o n c l u d e t h a t u n i v e r s i t y or c o l l e g e c r e d i t i n a d d i t i o n t o b a s i c n u r s i n g e d u c a t i o n accounted f o r 23 per c e n t of the v a r i a t i o n i n MER s c o r e s . 80 C o r r e l a t i o n Between I n t e l l e c t u a l and E t h i c a l  L e v e l and Demographic V a r i a b l e s P e a r s o n p r o d u c t moment c o r r e l a t i o n c o e f f i c i e n t was used t o dete r m i n e r e l a t i o n s h i p s between v a r i a b l e s . The c o r r e l a t i o n between age and s c o r e on the MER was 0.10. The c o r r e l a t i o n between e x p e r i e n c e and s c o r e on the MER was -0.03. Both of the s e r e l a t i o n s h i p s a r e n e g l i g i b l e (Burns and Grove, 1987, p. 510). Lack of a r e l a t i o n s h i p between i n t e l l e c t u a l and e t h i c a l development and age i s c o n s i s t e n t w i t h t h e f i n d i n g s r e p o r t e d i n V a l i g a ' s (1982) r e s e a r c h . K i t c h e n e r (1977) s t a t e s t h a t " a l t h o u g h development of h i g h e r forms of r e a s o n i n g i s age r e l a t e d , age i s not s u f f i c i e n t t o p r e d i c t a p e r s o n ' s p o i n t i n t h e de v e l o p m e n t a l p r o c e s s " ( K i t c h e n e r i n V a l i g a , 1977). A l s o , s u r p r i s i n g l y , no r e l a t i o n s h i p was found between i n t e l l e c t u a l and e t h i c a l l e v e l and n u r s i n g e x p e r i e n c e . L i m i t a t i o n s L i m i t a t i o n s of t h i s s t u d y r e l a t e t o problems i n methodology and t h e r e s u l t a n t s m a l l sample s i z e . When i n t e r p r e t i n g r e s u l t s i t i s i m p o r t a n t t o note t h a t , a l t h o u g h u t i l i z i n g the RNABC r e g i s t r y a l l o w e d a c c e s s t o a l a r g e r , random sample, the m a i l out proce d u r e produced a poor r e t u r n r a t e which r e d u c e s r e p r e s e n t a t i v e n e s s of the sample. The m a i l i n g l i s t was g e n e r a t e d 81 a p p r o x i m a t e l y two months i n advance of the m a i l out and packages were m a i l e d a t the b e g i n n i n g of the summer. These f a c t o r s may have i n f l u e n c e d the r e t u r n r a t e . A l s o , the q u e s t i o n n a i r e r e q u i r e d thought and t ime f o r c o m p l e t i o n . Nurses w i l l i n g t o c o n t r i b u t e t h i s time may have p o s s e s s e d a t t r i b u t e s which would a l s o a f f e c t r e p r e s e n t a t i v e n e s s of the sample. I t s h o u l d a l s o be n o t e d t h a t c o n s i d e r a b l y more b a c c a l a u r e a t e g r a d u a t e s t h a n d i p l o m a g r a d u a t e s r e t u r n e d t h e q u e s t i o n n a i r e . Reasons f o r t h e v a r i a t i o n i n r e t u r n r a t e c o u l d i n c l u d e commitment or r e s p o n s i b i l i t y which ar e f a c t o r s r e l a t e d t o the study. S i n c e s t a t i s t i c a l r e s u l t s f o r b o t h groups were s i m i l a r , the v a r i a b l e r e t u r n r a t e i s not r e f l e c t e d i n f i n d i n g s of the study. In r e t r o s p e c t , e l i m i n a t i n g c r i t e r i a 6, 7, 10, and 11 ( p o s i t i o n h e l d , w o r k p l a c e , and p o s t b a s i c e d u c a t i o n ) may have p r o v i d e d g r e a t e r v a r i a t i o n i n d a t a and a more r e p r e s e n t a t i v e sample of p r a c t i s i n g nurses. Many r e s e a r c h e r s who s t u d i e d d i f f e r e n c e s between b a c c a l a u r e a t e and d i p l o m a g r a d u a t e s used c o n v e n i e n c e samples of s t u d e n t s i n the f i n a l weeks of t h e i r n u r s i n g program (Johnson, 1988). T h i s method produced a b e t t e r r e t u r n r a t e of q u e s t i o n n a i r e s , but r e d u c e s g e n e r a l i z a b i l i t y of r e s u l t s . A d m i n i s t e r i n g the MER t o groups of d i p l o m a and b a c c a l a u r e a t e s t u d e n t s j u s t p r i o r 82 t o g r a d u a t i o n would c o n t r o l the v a r i a b l e s of e x p e r i e n c e and impact of t h e work s e t t i n g . A s t u d y of t h i s d e s i g n might produce i n t e r e s t i n g r e s u l t s f o r comparison w i t h o t h e r s t u d i e s on b a c c a l a u r e a t e e d u c a t i o n and c o g n i t i v e development. D i s c u s s i o n The d i s c u s s i o n i n t h i s s e c t i o n w i l l be r e l a t e d t o the f o u r f i n d i n g s of t h i s s t u d y . These were: 1) most p r a c t i s i n g n u r s e s s c o r e d a t P e r r y p o s i t i o n s 2 and 3; 2) t h e r e was not a r e l a t i o n s h i p between l e v e l of e d u c a t i o n and i n t e l l e c t u a l and e t h i c a l development; 3) t h e r e was a r e l a t i o n s h i p between p a r t i c i p a t i o n i n u n i v e r s i t y c o u r s e s o u t s i d e of the n u r s i n g program and l e v e l of i n t e l l e c t u a l and e t h i c a l development; and 4) t h e r e was no r e l a t i o n s h i p between i n t e l l e c t u a l and e t h i c a l development and the v a r i a b l e s of age and e x p e r i e n c e . The r e l a t i v e l y low l e v e l of i n t e l l e c t u a l and e t h i c a l development a c h i e v e d by t h e p r a c t i s i n g n u r s e s i n t h i s sample has i m p l i c a t i o n s f o r n u r s i n g e d u c a t o r s and c u r r i c u l u m p l a n n e r s . A s p e c t s of n u r s i n g e d u c a t i o n which might promote or i n h i b i t c o g n i t i v e development w i l l be d i s c u s s e d i n the s e c t i o n on i m p l i c a t i o n s of s t u d y i f i n d i n g s f o r n u r s i n g e d u c a t i o n . V a l i g a (1983) i n t e r p r e t e d the p o s i t i o n 2 and 3 r e s u l t s i n her s t u d y t o s t a t e t h a t the m a j o r i t y of 83 n u r s i n g s t u d e n t s " a r e s t i l l i n a p o s i t i o n of e x p e c t i n g some a u t h o r i t y t o make d e c i s i o n s f o r them and f i n d THE answer t o problems; s t i l l v e r y dependent, not making a commitment t o the p r o f e s s i o n a l mode of b e h a v i o r " (p. 118). The s t a g e of development of independent n u r s i n g p r a c t i c e and n u r s i n g r e s e a r c h w i t h i n the p r o f e s s i o n may a l s o i n f l u e n c e e p i s t e m o l o g i c a l b o u n d a r i e s f o r i n d i v i d u a l n u r s e s . S i n c e a l l n u r s e s i n t h i s s t u d y were employed i n a c u t e c a r e h o s p i t a l s , f u r t h e r e x a m i n a t i o n of the r e l a t i o n s h i p between c o g n i t i v e l e v e l and work s e t t i n g might be u s e f u l . Other a u t h o r s (Bottoms, 1988, Sheahan, 1972, and Woolley, 1986) q u e s t i o n whether the s t r u c t u r e of t he work p l a c e , p a r t i c u l a r l y a c u t e c a r e h o s p i t a l s e t t i n g s , i n f l u e n c e s the development of p r o f e s s i o n a l p r a c t i c e . The impact of the p r a c t i c e s e t t i n g on i n t e l l e c t u a l and e t h i c a l development w i l l be f u r t h e r d i s c u s s e d i n the s e c t i o n on i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e . The second f i n d i n g of t h i s s t u d y i n d i c a t e s t h a t t h e r e was no s i g n i f i c a n t d i f f e r e n c e between a group of p r a c t i s i n g b a c c a l a u r e a t e and di p l o m a g r a d u a t e s on the l e v e l of i n t e l l e c t u a l and e t h i c a l development. A l t h o u g h the sample s i z e i n t h i s s t u d y does not a l l o w s t r o n g c o n c l u s i o n s , t h i s f i n d i n g c o n c u r s w i t h t h o s e of e a r l i e r 84 s t u d i e s which a t t e m p t e d t o d i s t i n g u i s h between t e c h n i c a l and p r o f e s s i o n a l e d u c a t i o n and p r a c t i c e ( M e l e i s and F a r r e l l , 1974, McCloskey, 1983) i n which a t t e m p t s t o i s o l a t e d i f f e r e n c e s and d i s t i n g u i s h i n g c h a r a c t e r i s t i c s were i n c o n c l u s i v e , The l a c k of c o r r e l a t i o n between i n t e l l e c t u a l and e t h i c a l development and l e v e l of n u r s i n g e d u c a t i o n c o u l d be i n t e r p r e t e d t o mean t h a t t h i s c o n s t r u c t i s not an a p p r o p r i a t e one t o d i s t i n g u i s h between the e f f e c t s of b a c c a l a u r e a t e and d i p l o m a e d u c a t i o n . The r e s u l t may a l s o i m p l y t h a t u n i v e r s i t y e d u c a t i o n i s not p r o v i d i n g s t u d e n t s w i t h o p p o r t u n i t i e s f o r c o g n i t i v e growth i n a more e f f e c t i v e manner t h a n h o s p i t a l programs. In 1960, as n u r s i n g e d u c a t i o n began t o s h i f t f r o m h o s p i t a l d i p l o m a programs t o u n i v e r s i t y b a c c a l a u r e a t e programs, R u s s e l l (I960) warned t h a t the n u r s i n g p r o f e s s i o n s h o u l d make f u l l use of the u n i v e r s i t y s e t t i n g . She saw the p o s s i b i l i t y t h a t n u r s i n g e d u c a t i o n might j u s t change l o c a t i o n w i t h o u t r e t h i n k i n g t h e f o c u s and methods of e d u c a t i o n (p. 21). T h i s p o s s i b i l i t y c o u l d be e x p l o r e d by comparing n u r s i n g g r a d u a t e s t o g r a d u a t e s from o t h e r u n i v e r s i t y - b a s e d p r o f e s s i o n a l programs on t h e i r s c o r e s on t h e MER. P r e v i o u s s t u d i e s by P e r r y (1971) found g r a d u a t e s of l i b e r a l a r t s programs t o be r a t e d a t h i g h e r p o s i t i o n s on 85 the P e r r y s c a l e . However, the s e r a t i n g s were s c o r e d u s i n g an i n t e r v i e w format which makes comparison t o r e s u l t s i n t h i s s t u d y i n a p p r o p r i a t e . The f i n d i n g s of t h i s s t u d y have i m p l i c a t i o n s f o r c u r r i c u l u m p l a n n e r s and nurse e d u c a t o r s , and suggest a need f o r f u r t h e r r e s e a r c h i n t o the e f f e c t s of n u r s i n g e d u c a t i o n . The t h i r d f i n d i n g i n t h i s s t u d y r e v e a l s the s i g n i f i c a n t l y h i g h e r c o g n i t i v e l e v e l of s t u d e n t s who had been exposed t o u n i v e r s i t y c r e d i t c o u r s e s o t h e r than n u r s i n g . T h i s f i n d i n g s u p p o r t s c u r r i c u l u m d e s i g n s which i n c l u d e b r e a d t h of e d u c a t i o n . B r e a d t h of e d u c a t i o n i s c l o s e l y r e l a t e d t o the terms l i b e r a l e d u c a t i o n and g e n e r a l e d u c a t i o n i n the l i t e r a t u r e . Through exposure t o u n i v e r s i t y c o u r s e s i n more t h a n one d i s c i p l i n e , s t u d e n t s l e a r n about human b e i n g s , s c i e n c e , o r the w o r l d from a v a r i e t y of p e r s p e c t i v e s . Reed (1987) s t a t e s t h a t " l i b e r a l e d u c a t i o n p r o v i d e s a f o u n d a t i o n f o r u n d e r s t a n d i n g human wholeness, human p o t e n t i a l , and the c o m p l e x i t y of human e x p e r i e n c e s t h a t i n f l u e n c e h e a l t h " (p. 37). She proposes a p r o g r e s s i v e c u r r i c u l u m d e s i g n which i n t e g r a t e s l i b e r a l a r t s and n u r s i n g s t u d i e s t h r o u g h o u t a l l y e a r s of t h e program. She d e s c r i b e s a "rhythm of e d u c a t i o n " where movement between l i b e r a l a r t s , n u r s i n g s c i e n c e , and n u r s i n g p r a c t i c e e x p e r i e n c e a l l o w s the development of judgment and a 86 " d e v e l o p m e n t a l l y m a t u r i n g l e v e l of l e a r n i n g " (p. 38). "The s t u d e n t ' s n u r s i n g p r a c t i c e a c t i v i t i e s , then, are not i s o l a t e d f r o m the l i b e r a l i z i n g e x p e r i e n c e s of o t h e r a r t s and s c i e n c e s . These c o u r s e s , i n a d d i t i o n t o p e r s o n a l e x p e r i e n c e , s e n s i t i z e s t u d e n t s t o t h e u b i q u i t o u s s e a r c h f o r the meaning of l i f e and d e a t h w i t h o u t c o n v e y i n g pat s o l u t i o n s . " (p. 39). In t h i s way s t u d e n t s a r e exposed t o m u l t i p l i c i t y and r e l a t i v i s m which encourages development df a broad p e r s p e c t i v e and c h a l l e n g e s s t u d e n t s t o change d u a l 1 s t i c modes of t h i n k i n g . Perhaps n u r s i n g i s not t a k i n g f u l l advantage of i t s p resence i n the u n i v e r s i t y s e t t i n g i n pro m o t i n g b r e a d t h t h r o u g h l i b e r a l e d u c a t i o n . S t u d e n t s may be r e c e i v i n g a t r a i n i n g s i m i l a r t o t h a t i n the h o s p i t a l s c h o o l s i n the g u i s e of the u n i v e r s i t y l o c a t i o n . The f o u r t h f i n d i n g i n d i c a t e s t h a t i n t e l l e c t u a l and e t h i c a l l e v e l was not r e l a t e d t o age and/or n u r s i n g p r a c t i c e e x p e r i e n c e i n t h i s s t u d y sample. Lack of c o r r e l a t i o n between age and s c o r e s on the MER i s c o n s i s t e n t w i t h o t h e r f i n d i n g s ( V a l i g a , 1982, B a x t e r Magolda, P o r t e r f i e l d , 1988). Many s t u d i e s on b a c c a l a u r e a t e n u r s i n g e d u c a t i o n and c o g n i t i v e development used samples of n u r s i n g s t u d e n t s . T h e r e f o r e , t h e v a r i a b l e of e x p e r i e n c e i n n u r s i n g p r a c t i c e has not r e c e i v e d as much a t t e n t i o n . A s t u d y by 87 DeBack and Mentkowski (1986), however, d i d examine the i n f l u e n c e of e x p e r i e n c e and e d u c a t i o n on n u r s i n g p r a c t i c e competencies. They q u e s t i o n e d "whether assumed advantages of b a c c a l a u r e a t e e d u c a t i o n can be s u b s t i t u t e d by o n - t h e - j o b e x p e r i e n c e " (p. 275). They found t h a t " A l t h o u g h e x p e r i e n c e i s a l s o an i m p o r t a n t f a c t o r i n the development of e f f e c t i v e p r a c t i t i o n e r s , l e v e l of e d u c a t i o n i m p a c t s a b r o a d e r range of b e h a v i o r s t h a n y e a r s of e x p e r i e n c e " (p. 284). These r e s u l t s a l o n g w i t h the l a c k of c o r r e l a t i o n between e x p e r i e n c e and c o g n i t i v e l e v e l i n t h i s s t u d y suggest t h a t r e s e a r c h i n t o t h e v a l u e of e x p e r i e n c e , and the i n t e r a c t i o n of e d u c a t i o n and e x p e r i e n c e might p r o v i d e new i n s i g h t s . The f i n d i n g s of t h i s s t u d y w i l l be f u r t h e r e x p l o r e d i n the f a l l o w i n g c h a p t e r i n t h e s e c t i o n s on i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e , e d u c a t i o n , and r e s e a r c h . .Summary T h i s c h a p t e r p r e s e n t e d demographic c h a r a c t e r i s t i c s of the s t u d y sample. The sample c o n s i s t e d of b a c c a l a u r e a t e and d i p l o m a p r e p a r e d n u r s e s who were employed i n a c u t e c a r e h o s p i t a l s i n B r i t i s h Columbia. There was a broad range of e x p e r i e n c e and age. S t a t i s t i c a l a n a l y s i s of v a r i a b l e s was p r e s e n t e d . S m a l l sample s i z e and low v a r i a b l i t i y i n s c o r e s on the MER made the power of t h i s s t u d y low. R a t i n g i n t e l l e c t u a l 88 and e t h i c a l development was d i s c u s s e d , and s t a t i s t i c a l f i n d i n g s r e l a t e d t o t h i s v a r i a b l e were g i v e n . Most n u r s e s s c o r e d a t p o s i t i o n 2 or 3 on the P e r r y s c a l e as measured by the MER. S i g n i f i c a n t l y , t h e r e was no d i f f e r e n c e between groups of p r a c t i s i n g b a c c a l a u r e a t e and d i p l o m a n u r s e s on the v a r i a b l e of i n t e l l e c t u a l and e t h i c a l development. The average s c o r e on the MER f o r both groups was 3.01. A p r o f i l e of the i n d i v i d u a l a t p o s i t i o n t h r e e on the P e r r y scheme was p r e s e n t e d . Overview of the demographic d a t a and MER s c o r e s s u g g e s t e d t h a t t h e v a r i a b l e of p a r t i c i p a t i o n i n e d u c a t i o n a l c o u r s e s o u t s i d e of n u r s i n g s h o u l d r e c e i v e f u t h e r e x a m i n a t i o n . In f a c t , a s t a t i s t i c a l l y s i g n i f i c a n t r e l a t i o n s h i p was found between s c o r e s on the MER and p a r t i c i p a t i o n i n e d u c a t i o n o u t s i d e o f the n u r s i n g program. Secondary a n a l y s i s r e v e a l e d no c o r r e l a t i o n between s c a r e s on the MER and the v a r i a b l e s of age and e x p e r i e n c e . L i m i t a t i o n s of t h i s s t u d y do not a l l o w s t a t e m e n t s o f s t r o n g c o n c l u s i o n s . However, the f i n d i n g s w i l l be d i s u s s e d w i t h i n the c o n t e x t of the l i t e r a t u r e r e v i e w and c o n c e p t u a l framework t o p r o v i d e i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e , e d u c a t i o n and f u r t h e r r e s e a r c h . 89 CHAPTER V I Summary, C o n c l u s i o n s , I m p l i c a t i o n s , and Recommendations Summary T h i s r e s e a r c h r e p r e s e n t s an i n v e s t i g a t i o n i n t o the c o m p l e x i t i e s of e d u c a t i o n a l d i r e c t i o n f o r n u r s i n g . The r e s e a r c h problem emerged from a r e v i e w of the b a c c a l a u r e a t e e n t r y t o p r a c t i c e i s s u e and the s u r r o u n d i n g c o n t r o v e r s y over t h e i n t e n t and e f f e c t of u n i v e r s i t y e d u c a t i o n f o r nur s e s . As s t a t e d i n the i n t r o d u c t i o n t o t h i s r e s e a r c h , the r a t i o n a l e f o r p u r s u i n g b a c c a l a u r e a t e e d u c a t i o n f o r n u r s e s has been d i f f i c u l t t o d e s c r i b e . In o r d e r t o more c l e a r l y d e f i n e the r a t i o n a l e , t h e e f f e c t s of - b a c c a l a u r e a t e e d u c a t i o n i n n u r s i n g must be i n v e s t i g a t e d . S p e c i f i c a l l y , t h e problem t h a t was i n v e s t i g a t e d i n t h i s r e s e a r c h i s c o n t a i n e d i n the f o l l o w i n g q u e s t i o n : Do b a c c a l a u r e a t e g r a d u a t e s d i f f e r from d i p l o m a g r a d u a t e s i n t h e i r l e v e l of i n t e l l e c t u a l and e t h i c a l development? T h i s r e s e a r c h e r was i n t e r e s t e d i n the meaning of u n i v e r s i t y e d u c a t i o n , a l o n g w i t h i t s r e l a t e d i s s u e s , f o r n u r s e s and n u r s i n g . The s t u d y was founded i n p h i l o s o p h i c a l s t a t e m e n t s about the m i s s i o n of u n i v e r s i t y e d u c a t i o n i n g e n e r a l ( C a r n e g i e F o u n d a t i o n , 1977) and i n the m i s s i o n of u n i v e r s i t y e d u c a t i o n f o r n u r s e s (CNA, 1988). 90 I n i t i a l r e a d i n g s and r e v i e w of the l i t e r a t u r e r e v e a l e d v a s t e f f o r t s by t h e o r e t i c i a n s and r e s e a r c h e r s w i t h i n t h e d i s c i p l i n e s of e d u c a t i o n and n u r s i n g on the s u b j e c t a r e a . The g o a l s of u n i v e r s i t y e d u c a t i o n i n c l u d e d more th a n i m p a r t i n g s p e c i a l i z e d knowledge. The development of i n t e l l e c t u a l competence, moral and s o c i a l r e a s o n i n g , and b r e a d t h of p e r s p e c t i v e a r e c o n s i d e r e d t o be more i m p o r t a n t v a l u e s of e d u c a t i o n , p a r t i c u l a r l y u n i v e r s i t y e d u c a t i o n . - The c o g n i t i v e l y mature, educated i n d i v i d u a l shows: a t o l e r a n c e f o r d i v e r s i t y and u n c e r t a i n t y i n the w o r l d ; p r o p e n s i t y f o r s e l f e d u c a t i o n ; r e l i a n c e on an i n t e r n a l l o c u s of c o n t r o l ; an a b i l i t y t o make judgments; a commitment t o a p r o f e s s i o n ; and an a b i l i t y t o use c r i t i c a l r e a s o n i n g i n problem s o l v i n g . T h e o r i e s of e d u c a t i o n grounded i n t h i s d e v e l o p m e n t a l p e r s p e c t i v e have been w e l l d e v e l o p e d (Dewey, 1965, P i a g e t , 1950, P e r r y , 1970). The c o n s t r u c t of i n t e l l e c t u a l and e t h i c a l development as put f o r t h by P e r r y r e p r e s e n t s c u r r e n t t h i n k i n g on a d u l t c o g n i t i v e development. In a d d i t i o n , c o n s i d e r a b l e e f f o r t has r e s u l t e d i n measurement and assessment t o o l s which have allowed, o p e r a t i o n a l i z a t i o n of the c o n s t r u c t and i t s use i n r e s e a r c h and p r a c t i c e . The t h e o r e t i c a l framework chosen f o r t h i s s t u d y was d e v e l o p e d t h r o u g h r i g o r o u s p h e n o m e n o l o g i c a l r e s e a r c h 91 ( P e r r y , 1970). T h e t h e o r y c o n t a i n s p r o p o s i t i o n a w h i c h l i n k e s s e n t i a l components o f u n i v e r s i t y u ndergraduate e d u c a t i o n i n a l o g i c a l , c l e a r m a n n e r . T h e q u a n t i t a t i v e r e s e a r c h r e p o r t e d i n t h i s s t u d y e v o l v e d from the p r o p o s i t i o n s w i t h i n t h i s t h e o r y . T h i s r e s e a r c h demonstrated an e f f e c t i v e r e l a t i o n s h i p between q u a l i t a t i v e r e s e a r c h , t h e o r y c o n s t r u c t i o n , and q u a n t i t a t i v e i n v e s t i g a t i o n of p r o p o s i t i o n s w i t h i n the the o r y . - The t h e o r e t i c a l framework a l l o w e d l i n k i n g of c o n c e p t s i m p o r t a n t t o n u r s i n g e d u c a t i o n . These i n c l u d e l e v e l of e d u c a t i o n , autonomy, s e l f d i r e c t e d n e s s , p r o f e s s i o n a l i s m , commitment, c r i t i c a l t h i n k i n g , c l i n i c a l judgment, and moral r e a s o n i n g . T h e r e f o r e the t h e o r e t i c a l framework used i n the s t u d y was a p p r o p r i a t e , and the r e s e a r c h d e s i g n r e f l e c t e d t he s t a t e of knowledge i n the f i e l d . With t h i s background i n mind, t h e l e v e l of i n t e l l e c t u a l and. e t h i c a l development of a group of p r a c t i s i n g d i p l o m a and b a c c a l a u r e a t e - p r e p a r e d n u r s e s was measured and compared. P a r t i c i p a n t s were s e l e c t e d randomly t h r o u g h the RNABC r e g i s t r y and t h e d a t a g a t h e r i n g t o o l was m a i l e d t o two hundred nurses. P e r t i n e n t v a r i a b l e s such as 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 , age, and p l a c e of employment were i d e n t i f i e d . Some of t h e s e v a r i a b l e s were c o n t r o l l e d t h r o u g h sample 92 s e l e c t i o n and some were i d e n t i f i e d i n c o n s t r u c t i o n of the demographic d a t a sheet. P e r r y p o s i t i o n s of i n t e l l e c t u a l and e t h i c a l development were a s s e s s e d t h r o u g h r a t e d r e s p o n s e s on the Measure of E p i s t e m o l o g i c a l R e f l e c t i o n (MER). A l t h o u g h the r e t u r n r a t e was poor r e s u l t i n g i n s m a l l sample s i z e , the d a t a g e n e r a t e d from t h i s q u e s t i o n n a i r e were i n f o r m a t i v e . S t a t i s t i c a l a n a l y s i s of d a t a r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e between groups of d i p l o m a and b a c c a l a u r e a t e p r e p a r e d n u r s e s on the v a r i a b l e of i n t e l l e c t u a l and e t h i c a l development. However, a s i g n i f i c a n t d i f f e r e n c e was found i n the mean s c o r e s of a group of n u r s e s who had o t h e r u n i v e r s i t y l e v e l c r e d i t and a group who had not t a k e n u n i v e r s i t y l e v e l c r e d i t o u t s i d e of n u r s i n g . There was no c o r r e l a t i o n between s c o r e s on the MER and the v a r i a b l e s of age and e x p e r i e n c e . The remainder of t h i s c h a p t e r w i l l i n c l u d e c o n c l u s i o n s drawn from the d a t a and s t a t i s t i c a l a n a l y s e s . I m p l i c a t i o n s f o r n u r s i n g p r a c t i c e , e d u c a t i o n , and f u r t h e r r e s e a r c h w i l l be d i s c u s s e d w i t h i n the background of the l i t e r a t u r e r e v i e w and g u i d i n g c o n c e p t u a l framework. C o n c l u s i o n s The c e n t r a l purpose of t h i s s t u d y was t o determine 93 i f t h e r e was a d i f f e r e n c e between groups of p r a c t i s i n g d i p l o m a and b a c c a l a u r e a t e n u r s e s on the v a r i a b l e of i n t e l l e c t u a l and e t h i c a l development. In a n a l y s i s of f i n d i n g s , the v a r i a b l e of i n t e l l e c t u a l and e t h i c a l development, as i t r e l a t e s t o p a r t i c i p a t i o n i n u n i v e r s i t y l e v e l c o u r s e s o u t s i d e of the n u r s i n g program was a l s o examined. The c o r r e l a t i o n between the c e n t r a l v a r i a b l e as measured by s c o r e s on the MER and age and n u r s i n g e x p e r i e n c e was a l s o determined. C o n c l u s i o n s w i l l be l i s t e d f i r s t and i m p l i c a t i o n s of f i n d i n g s w i l l f o l l o w . C o n c l u s i o n s i n t h i s r e s e a r c h s h o u l d be c o n s i d e r e d w i t h c a u t i o n u n t i l t he s t u d y can be r e p l i c a t e d w i t h l a r g e r samples. 1. Most n u r s e s i n t h i s s t u d y sample s c o r e d a t P e r r y p o s i t i o n s two and t h r e e , w h i l e o n l y two of 29 re s p o n d e n t s s c o r e d a t P e r r y p o s i t i o n f o u r . Nurses i n p o s i t i o n two v i e w t h e w o r l d i n p o l a r terms from a d u a l i s t i c p e r s p e c t i v e . P o s i t i o n t h r e e n u r s e s b e g i n t o ac c e p t m u l t i p l e s o u r c e s of knowledge, some of which i s known and some unknown. The w o r l d i s viewed i n a t o m i s t i c terms and an advanced system of e v a l u a t i n g and making judgments has not yet developed. 2. There was no e v i d e n c e i n t h i s sample t o s u p p o r t the h y p o t h e s i s t h a t b a c c a l a u r e a t e n u r s i n g e d u c a t i o n c o n t r i b u t e s t o h i g h e r l e v e l s of i n t e l l e c t u a l and e t h i c a l 94 development of p r a c t i s i n g n u r s e s any more e f f e c t i v e l y t han does d i p l o m a e d u c a t i o n . 3. There was a r e l a t i o n s h i p between p a r t i c i p a t i o n i n u n i v e r s i t y l e v e l c r e d i t c o u r s e s o u t s i d e of the b a s i c n u r s i n g program and c o g n i t i v e development. The r e l a t i o n s h i p between l e v e l of i n t e l l e c t u a l and e t h i c a l development and p a r t i c i p a t i o n i n o t h e r u n i v e r s i t y c r e d i t c o u r s e s o u t s i d e of the b a s i c n u r s i n g program was d i s c o v e r e d s e r e n d i p i t o u s l y . T h e r e f o r e , t h e r e l a t i o n s h i p s h o u l d be c o n s i d e r e d c a r e f u l l y because the s t u d y was not d e s i g n e d t o f u l l y examine t h i s concept. 4. There was no c o r r e l a t i o n between the v a r i a b l e s of age and n u r s i n g e x p e r i e n c e and t h e i n t e l l e c t u a l and e t h i c a l l e v e l of p r a c t i s i n g n u r s e s . I m p l i c a t i o n s f o r N u r s i n g P r a c t i c e I m p l i c a t i o n s f o r n u r s i n g p r a c t i c e i n t h i s s t u d y a r i s e from the r e l a t i o n s h i p between e d u c a t i o n and p r a c t i c e . E d u c a t i o n e x i s t s and changes t o s e r v e the p r o f e s s i o n ' s p r e s e n t and f u t u r e p r a c t i c e needs. H e a l t h c a r e p r o f e s s i o n a l s r e q u i r e g e n e r a l i z e d i n t e l l e c t u a l s k i l l s so t h a t t h e y may f u l f i l l a v a r i e t y of independent r o l e s w i t h i n a c h a n g i n g h e a l t h c a r e system. Nurses, w o r k i n g i n a v a r i e t y of s e t t i n g s , p r e s e n t l y f u l f i l l an un c o u n t a b l e number of c h a n g i n g r o l e s . S p e c i a l i z e d t r a i n i n g f o r a f i n i t e , d e f i n a b l e number of f u n c t i o n s and 95 r o l e s i s no l o n g e r adequate p r e p a r a t i o n f o r n u r s e s of the p r e s e n t or f u t u r e . Of g r e a t e s t importance t o n u r s e s i n t h e s e r o l e s i s the a b i l i l t y t o t h i n k i n a p e r c e p t i v e , independent, and c r i t i c a l manner, and t o communicate tho u g h t s i n such a manner. A u n i v e r s i t y e d u c a t i o n i s seen t o be the a p p r o p r i a t e p r e p a r a t i o n f o r the development of t h e s e s k i l l s . T h i s purpose r e p r e s e n t s the most c o m p e l l i n g argument i n s u p p o r t of the r e q u i r e m e n t f o r b a c c a l a u r e a t e p r e p a r a t i o n p r i o r t o nurse r e g i s t r a t i o n . However, the a s s u m p t i o n t h a t u n i v e r s i t y e d u c a t i o n i n c u l c a t e s h i g h e r o r d e r i n t e l l e c t u a l s k i l l s i s y e t t o be e m p i r i c a l l y s u p p o r t e d . The purpose of t h i s r e s e a r c h was t o d e t e r m i n e i f t h e s e h i g h e r o r d e r i n t e l l e c t u a l s k i l l s c o u l d be c o n s i d e r e d t o be a d i f f e r e n t i a t i n g outcome of d i p l o m a and b a c c a l a u r e a t e n u r s i n g e d u c a t i o n . The argument t h a t u n i v e r s i t y n u r s i n g e d u c a t i o n f o s t e r s i n t e l l e c t u a l and e t h i c a l m a t u r i t y more e f f e c t i v e l y t h a n d i p l o m a programs was not s u p p o r t e d i n t h i s r e s e a r c h . The CNA statement a t the b e g i n n i n g of t h i s paper e x e m p l i f i e s the r e l a t i o n s h i p between h i g h e r e d u c a t i o n and n u r s i n g p r a c t i c e . I t s t a t e s t h a t n u r s e s need a u n i v e r s i t y e d u c a t i o n so t h a t t h e y are b e t t e r p r e p a r e d t o d e a l w i t h "changes i n the p r a c t i c e of n u r s i n g w i t h an emphasis on t h e o r y based p r a c t i c e , a r e s e a r c h 96 o r i e n t a t i o n t o p r a c t i c e , the e f f e c t s of t e c h n o l o g i c a l advances, the importance of h e l p i n g r e l a t i o n s h i p s , e t h i c a l i s s u e s and community based n u r s i n g c a r e " (1988, p. 12). The r e l a t i o n s h i p between each of t h e s e a r e a s and c o g n i t i v e development w i l l be d i s c u s s e d i n the f o l l o w i n g paragraphs. Theory-Based P r a c t i c e The development of n u r s i n g t h e o r y and a unique body of n u r s i n g knowledge, w i t h a g u i d i n g c o n c e p t u a l framework can be r e g a r d e d as e s s e n t i a l t o t h e autonomous p r o f e s s i o n a l p r a c t i c e of n u r s i n g . N u r s i n g r e q u i r e s i n d i v i d u a l s who have the a b i l i t y t o use as w e l l as c o n t r i b u t e t o t h e e x p a n s i o n of n u r s i n g knowledge and n u r s i n g t h e o r y . Absence of t h e o r i e s and c o n c e p t u a l frameworks which d e s c r i b e the unique f u n c t i o n of n u r s i n g and t h e b o u n d a r i e s of n u r s i n g ' s sphere of p r a c t i c e p e r m i t s wide v a r i a t i o n s i n approaches t o n u r s i n g p r a c t i c e and n u r s i n g e d u c a t i o n . C o n s t r u c t i v e a l l i a n c e of n u r s i n g e d u c a t i o n , n u r s i n g p r a c t i c e , and n u r s i n g r e s e a r c h depends upon an a b i l i t y t o a r t i c u l a t e the m i s s i o n and b o u n d a r i e s of the domain of n u r s i n g . Ve can s p e c u l a t e t h a t t h e more mature c o g n i t i v e l e v e l of n u r s e s , and c o l l e c t i v e i n t e l l e c t u a l s t r e n g t h of the p r o f e s s i o n w i l l p o s i t i v e l y a f f e c t the development and i m p l e m e n t a t i o n of n u r s i n g t h e o r y , models, and n u r s i n g 97 r e s e a r c h . The i n t e r a c t i o n between i n t e l l e c t u a l and e t h i c a l m a t u r i t y of n u r s e s and the development of n u r s i n g knowledge and t h e o r y i s s y m b i o t i c . In a d d i t i o n t o the p o s i t i v e e f f e c t of c o g n i t i v e m a t u r i t y of i n d i v i d u a l s on expanding n u r s i n g knowledge, the i m p l e m e n t a t i o n of n u r s i n g frameworks i n c u r r i c u l a and p r a c t i c e s e t t i n g s may enhance the c o g n i t i v e development of s t u d e n t s and p r a c t i t i o n e r s . Q u e s t i o n s f o r f u r t h e r s t u d y c o u l d i n c l u d e : Do s t u d e n t s who a r e p r o d u c t s of c u r r i c u l a based on a c o n c e p t u a l framework f o r n u r s i n g show h i g h e r l e v e l s of i n t e l l e c t u a l and e t h i c a l m a t u r i t y ? Does i m p l e m e n t a t i o n of and commitment t o a n u r s i n g framework i n the h e a l t h c a r e s e t t i n g promote i n t e l l e c t u a l and e t h i c a l development of the n u r s e s who p r a c t i c e t h e r e ? F u r t h e r s t u d y of r e c e n t g r a d u a t e s and the r e l a t i o n s h i p between t h e o r y - b a s e d p r a c t i c e and i n t e l l e c t u a l and e t h i c a l development would a l l o w f u r t h e r e x p l o r a t i o n of t h i s i s s u e . The r e s t r i c t e d f i n d i n g s of t h i s s t u d y do not c o n t r i b u t e s i g n i f i c a n t l y t o e m p i r i c a l s u p p o r t o f t h e t h e o r e t i c a l i d e a s . R e search O r i e n t a t i o n t o P r a c t i c e A r e s e a r c h o r i e n t a t i o n t o n u r s i n g p r a c t i c e r e q u i r e s an i n q u i r i n g mind and a view of knowledge as u n c e r t a i n but d e f i n a b l e i n c o n t e x t . T h i s v iew of knowledge i s 98 congruent w i t h h i g h e r p o s i t i o n s on the P e r r y s c a l e . The a b i l i t y t o conduct and use r e s e a r c h i n p r a c t i c e r e q u i r e s h i g h e r i n t e l l e c t u a l s k i l l s and an a b i l i t y t o s e l e c t i v e l y a p p l y knowledge i n c o n t e x t . E x p a n s i o n of n u r s i n g knowledge and development of sound n u r s i n g i n t e r v e n t i o n s based on a s c i e n t i f i c f o u n d a t i o n depend upon the g e n e r a t i o n of r e s e a r c h and r e s e a r c h i d e a s a t t h e c a r e g i v i n g l e v e l . An o b j e c t i v e of b a c c a l a u r e a t e e d u c a t i o n i s t o p r e p a r e n u r s e s who have the i n t e l l e c t u a l s k i l l s n e c e s s a r y t o c o n t r i b u t e t o and use n u r s i n g r e s e a r c h . T e c h n o l o g i c a l Change The t h i r d a r e a i d e n t i f i e d by the CNA as n e c e s s i t a t i n g u n i v e r s i t y p r e p a r a t i o n i n c l u d e s the t e c h n o l o g i c a l advances i n h e a l t h c a r e which g r e a t l y a f f e c t n u r s i n g p r a c t i c e . The e f f e c t s of t e c h n o l o g i c a l change i n h e a l t h c a r e have been w e l l documented (Cooper, 1980, Urbano, Jahns, and Urbano, 1988). I t has been p o s t u l a t e d t h a t n u r s e s who do not c o n t i n u e l e a r n i n g w i l l become o b s o l e s c e n t i n p r a c t i c e (Cooper, 1980). Thus, the p r e p a r a t i o n of n u r s e s who have the s k i l l s and m o t i v a t i o n t o pursue f u r t h e r l e a r n i n g i s an i m p o r t a n t g o a l of n u r s i n g s c h o o l s . Oddi (1986), i n s t u d y i n g s e l f - d i r e c t e d l e a r n i n g , d e s c r i b e d t h r e e d i m e n s i o n s of p e r s o n a l i t y c h a r a c t e r i s t i c s which d e t e r m i n e the 99 p r o p e n s i t y f o r s e l f - e d u c a t i o n and l i f e l o n g l e a r n i n g : p r o a c t i v e d r i v e v e r s u s r e a c t i v e d r i v e ; c o g n i t i v e openness v e r s u s d e f e n s i v e n e s s ; and commitment t o l e a r n i n g v e r s u s apathy or a v e r s i o n t o l e a r n i n g . These c h a r a c t e r i s t i c s c o u l d be d e v e l o p e d i n a c u r r i c u l u m which enhances c o g n i t i v e development. T h i s would be p a r t i c u l a r l y i m p o r t a n t i n l i g h t of the f a c t t h a t , i n t h i s s t u d y , i t was found t h a t e x p e r i e n c e a l o n e does not a f f e c t c o g n i t i v e l e v e l . A l t h o u g h i t was not examined i n t h i s s t u d y , t h e r e may be a r e l a t i o n s h i p between c o n t i n u i n g e d u c a t i o n and i n t e l l e c t u a l and e t h i c a l development. Perhaps s t u d y i n g t h e r e l a t i o n s h i p between 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 and c o g n i t i v e development would be u s e f u l . Do h i g h e r l e v e l s of c o g n i t i v e development p r e d i s p o s e an i n d i v i d u a l t o pursue l i f e l o n g l e a r n i n g o r c o n t i n u i n g e d u c a t i o n ? Does c o n t i n u i n g e d u c a t i o n s i g n i f i c a n t l y promote c o g n i t i v e growth where e x p e r i e n c e a l o n e might not? H e l p i n g R e l a t i o n s h i p s The f o u r t h a r e a i d e n t i f i e d by the CNA i n the e n t r y t o p r a c t i c e i s s u e i s the r e l a t i o n s h i p between h i g h e r e d u c a t i o n and the i n c r e a s i n g i mportance of i n t e r p e r s o n a l h e l p i n g s k i l l s r e q u i r e d i n n u r s i n g p r a c t i c e . The importance of h e l p i n g r e l a t i o n s h i p s has a l s o been 100 r e l a t e d t o c o g n i t i v e development i n t h i s s t u d y , e s p e c i a l l y as i t r e l a t e s t o the e f f e c t s of a l i b e r a l e d u c a t i o n . I t i s r e c o g n i z e d t h a t n u r s e s s h o u l d c a r e f o r each c l i e n t w i t h i n the c o n t e x t of t h a t i n d i v i d u a l ' s unique s i t u a t i o n . T h i s r e q u i r e s p r o f e s s i o n a l judgment, t o l e r a n c e of o t h e r s , and a broad p e r s p e c t i v e . E t h i c a l i s s u e s The a b i l i t y t o d e a l w i t h e t h i c a l i s s u e s i s c l o s e l y r e l a t e d t o c o g n i t i v e development ( K e t e f i a n , 1981). The r e l a t i o n s h i p between l o g i c a l r e a s o n i n g and e t h i c a l o r moral r e a s o n i n g was demonstrated i n the l i t e r a t u r e r e v i e w . Community-Based H e a l t h Care The f i n a l a r e a i d e n t i f i e d by the CNA as n e c e s s i t a t i n g h i g h e r e d u c a t i o n f o r n u r s e s i n c l u d e s t h e p r o j e c t e d changes i n h e a l t h c a r e d e l i v e r y i n t h e f u t u r e . The n u r s i n g p r o f e s s i o n and the h e a l t h c a r e s y s t e m r e q u i r e n u r s e s w i t h broadened p e r s p e c t i v e s and c r e a t i v e v i s i o n s . The d e l i v e r y of h e a l t h c a r e i n Canada i s h i g h l y i n s t i t u t i o n a l i z e d and f u t u r i s t s p r e d i c t a d r a s t i c s h i f t f r o m t r a d i t i o n a l methods of h e a l t h c a r e d e l i v e r y . Community-based n u r s i n g c a r e , w i t h i t s many p o s s i b l e avenues, i s an a c c e p t a b l e a l t e r n a t i v e , but autonomous f l e x i b l e n u r s e s w i l l be r e q u i r e d t o f u l f i l l c h a n g i n g r o l e s . 101 Changes i n n u r s i n g p r a c t i c e i n c l u d i n g i n c r e a s i n g emphasis on t h e o r y - b a s e d p r a c t i c e , a r e s e a r c h o r i e n t a t i o n t o p r a c t i c e , t h e e f f e c t s of t e c h n o l o g i c a l advances, the importance of h e l p i n g r e l a t i o n s h i p s , e t h i c a l i s s u e s and community-based n u r s i n g c a r e as d e s c i b e d i n the above pa r a g r a p h s have been used t o i l l u s t r a t e t he r e l a t i o n s h i p between t h e n a t u r e of n u r s i n g p r a c t i c e and e d u c a t i o n a l r e q u i r e m e n t s f o r e n t r y t o the p r o f e s s i o n . The f o r e g o i n g p a r a g r a p h s i l l u s t r a t e an i d e a l a l i g n m e n t of n u r s i n g e d u c a t i o n and p r a c t i c e . Another a s p e c t t o t h e e d u c a t i o n - p r a c t i c e r e l a t i o n s h i p i s the r e c i p r o c a l congruence where the c l i n i c a l work s e t t i n g p r o v i d e s t h e new grad u a t e w i t h t h e o p p o r t u n i t y t o use s k i l l s d e v e l o p e d i n t h e e d u c a t i o n a l s e t t i n g . C h a r a c t e r i s t i c s of the p r a c t i c e s i t u a t i o n , which i n c l u d e a h i e r a r c h i c a l s t r u c t u r e where many d e c i s i o n s about n u r s i n g c a r e f o r c l i e n t s a r e made by s u p e r i o r s and p h y s i c i a n s , can be seen as i n c o m p a t i b l e w i t h t h e e d u c a t i o n a l p r e p a r a t i o n of the p r o f e s s i o n a l nurse. Sheahan (1972) s t a t e s t h a t " t h e p r o f e s s i o n a l nurse who p r a c t i c e s i n a h o s p i t a l s e t t i n g w i l l p r o b a b l y f u n c t i o n w e l l below her p r o f e s s i o n a l c a p a c i t y , a t a semi p r o f e s s i o n a l o r t e c h n i c a l l e v e l , f o r a t t h a t l e v e l , by d e f i n i t i o n , one works under the s u p e r v i s i o n of o t h e r s " (p. 442). Kramer (1970) a l s o a d d r e s s e s t h e 102 p r o f e s s i o n a l - b u r e a u c r a t i c c o n f l i c t . She found t h a t b a c c a l a u r e a t e - p r e p a r e d n u r s e s e x p e r i e n c e h i g h i n t e n s i t y -c o n f l i c t and r o l e d e p r i v a t i o n , and a d e c r e a s e i n p r o f e s s i o n a l v a l u e s . Thus, some p r a c t i c e s e t t i n g s c o u l d a l l o w r e g r e s s i o n or a t l e a s t s t a g n a t i o n o f i n t e l l e c t u a l s k i l l s . Where g r a d u a t e s of o t h e r u n i v e r s i t y - b a s e d d i s c i p l i n e s may meet the o p p o r t u n i t y t o grow and b u i l d upon t h e i r broad e d u c a t i o n a l bases, b a c c a l a u r e a t e n u r s i n g g r a d u a t e s w o r k i n g i n the h o s p i t a l s e t t i n g may f a c e r e g r e s s i o n and s t a g n a t i o n . T h i s a s p e c t may have i m p l i c a t i o n s f o r the c u r r e n t i s s u e s of j o b s a t i s f a c t i o n and r e t e n t i o n of n u r s e s i n a c u t e c a r e h o s p i t a l s . As s t a t e d i n c o n c l u s i o n number 1, n u r s e s p r a c t i s i n g i n the h o s p i t a l s e t t i n g a t t a i n e d s i m i l a r l e v e l s of c o g n i t i v e m a t u r i t y r e g a r d l e s s of 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 . The impact of t h e p r a c t i c e s e t t i n g on the v a r i a b l e of i n t e l l e c t u a l and e t h i c a l development r e q u i r e s f u r t h e r i n v e s t i g a t i o n . F u t u r e r e s e a r c h might examine the i n t e l l e c t u a l and e t h i c a l l e v e l s o f n u r s e s w o r k i n g i n a v a r i e t y of s e t t i n g s , or compare n u r s i n g g r a d u a t e s t o g r a d u a t e s of o t h e r p r o f e s s i o n a l programs. I m p l i c a t i o n s f o r N u r s i n g E d u c a t i o n The f i n d i n g s of t h i s s t u d y a r e most i m p o r t a n t l y r e l a t e d t o i m p l i c a t i o n s f o r n u r s i n g e d u c a t i o n . The r e s e a r c h r e s u l t s do not i n t h e m s e l v e s o f f e r f u r t h e r 103 s u p p o r t f o r t h e e n t r y t o p r a c t i c e p o s i t i o n . T h i s i s c o n s i s t e n t w i t h o t h e r r e s e a r c h a t t e m p t s t o d e s c r i b e the v a l u e o f b a c c a l a u r e a t e e d u c a t i o n (McCloskey, 1983). S t u d y i n g the i s s u e t h r o u g h t h e t h e o r e t i c a l a pproach used i n t h i s r e s e a r c h , can, however, o f f e r f u r t h e r i n s i g h t s as t o how n u r s i n g s t u d e n t s g a i n the knowledge, s k i l l s , and v a l u e s n e c e s s a r y t o p r a c t i c e n u r s i n g . The P e r r y t h e o r y of i n t e l l e c t u a l and e t h i c a l development demonstrates how i n d i v i d u a l s g a i n h i g h e r o r d e r i n t e l l e c t u a l s k i l l s t h r o u g h u n i v e r s i t y e d u c a t i o n . In the p r e v i o u s s e c t i o n , the r e l a t i o n s h i p between i n t e l l e c t u a l s k i l l s and t h e c o m p l e x i t i e s of p r e s e n t and f u t u r e n u r s i n g p r a c t i c e were i l l u s t r a t e d . In t h i s way t h e t h e o r y of i n t e l l e c t u a l and e t h i c a l development o f f e r s a framework which h e l p s t o c l a r i f y what knowledge, s k i l l s , and v a l u e s a r e n e c e s s a r y t o p r a c t i c e n u r s i n g . The t h e o r y of i n t e l l e c t u a l and e t h i c a l development c o u l d be u s e f u l i n a s s e s s i n g the d e v e l o p m e n t a l l e v e l of s t u d e n t s who e n t e r n u r s i n g , and i n measuring t h e i r g a i n s i n c o g n i t i v e development a t i n t e r v a l s t h r o u g h o u t the c u r r i c u l u m . S e c o n d l y , t h e t h e o r y c o u l d h e l p c l a r i f y c u r r i c u l u m g o a l s w i t h i n the c o g n i t i v e development r e a l m and e v a l u a t i o n of achievement of t h e s e g o a l s . T h i r d l y , i t has i m p l i c a t i o n s f o r d e s i g n i n g t e a c h i n g s t r a t e g i e s 104 which promote c o g n i t i v e growth. Student Assessment With i n c r e a s i n g e d u c a t i o n a l c o s t s and the h i g h a t t r i t i o n r a t e s i n n u r s i n g programs, s e l e c t i o n and r e t e n t i o n of a p p l i c a n t s has r e c e i v e d c l o s e r a t t e n t i o n . T h i s has renewed a s e a r c h f o r assessment t o o l s which can p r e d i c t s u c c e s s i n n u r s i n g programs. K i s s i n g e r and Mujas (1982) conducted a l o n g i t u d i n a l s t u d y of 201 n u r s i n g s t u d e n t s and found t h a t " f o u r c h a r a c t e r i s t i c s can p r e d i c t s u c c e s s i n u s i n g the n u r s i n g p r o c e s s . These ar e v e r b a l a b i l i t y , v o c a b u l a r y knowledge, c o n v e r g e n t t h i n k i n g a b i l i t y , and f i e l d independent p e r c e p t u a l s t y l e " <p. 53). H i g h e r l e v e l s of i n t e l l e c t u a l and e t h i c a l development which a l l o w i n d i v i d u a l s t o t o l e r a t e a m b i g u i t y , and a p p l y knowledge i n an u n c e r t a i n and r e l a t i v i s t i c environment may be r e l a t e d t o s u c c e s s i n n u r s i n g s c h o o l . A s s e s s i n g c o g n i t i v e l e v e l of i n d i v i d u a l s e n t e r i n g n u r s i n g would a l s o p r o v i d e i n s i g h t f u l d e v e l o p m e n t a l i n f o r m a t i o n f o r i n s t r u c t o r s . From a d i f f e r e n t p e r s p e c t i v e , V a l i g a q u e s t i o n s whether n u r s i n g a t t r a c t s people who p r e f e r e x t e r n a l d i r e c t i o n and a u t h o r i t y . R e s e a r c h s t u d i e s which compare e n t r a n t s t o d i f f e r e n t f a c u l t i e s may h e l p t o p r o f i l e the i n d i v i d u a l who chooses n u r s i n g . In a s t u d y of s i m i l a r d e s i g n , Boughn (1988) found t h a t n u r s i n g s t u d e n t s s c o r e d 105 s i g n i f i c a n t l y lower on an autonomy s c a l e t h a n f e m a l e s i n n o n - t r a d i t i o n a l f a c u l t i e s . She c o n c l u d e s t h a t , i n o r d e r t o a t t r a c t c a p a b l e s t u d e n t s , n u r s i n g must compete w i t h o t h e r d i s c i p l i n e s where t h e r e i s o p p o r t u n i t y f o r a more autonomous p r o f e s s i o n a l r o l e . Assessment of c o g n i t i v e l e v e l a t v a r i o u s p o i n t s t h r o u g h o u t the c u r r i c u l u m would a l s o be h e l p f u l i n d e t e r m i n i n g the e f f e c t of p a r t i c u l a r c o n t e n t o r e x p e r i e n c e s on c o g n i t i v e development. L e v e l s of i n t e l l e c t u a l and e t h i c a l development can be c h a r t e d l o n g i t u d i n a l l y t o d etermine which c u r r i c u l u m components enhance g r e a t e s t g a i n s i n c o g n i t i v e development. Do t h e g r e a t e s t g a i n s o c c u r i n y e a r one, two, t h r e e , o r f o u r ? What a r e the components of the c u r r i c u l u m i n y e a r s of g r e a t e s t g a i n ? Can g a i n s be r e l a t e d t o i n c l u s i o n of e l e c t i v e s or l i b e r a l a r t s ; s p e c i f i c c l i n i c a l e x p e r i e n c e s ; e t h i c s and i s s u e s c o u r s e s ; or o p p o r t u n i t i e s f o r independent s t u d y ? C u r r i c u l u m P l a n n i n g N u r s i n g s c h o o l p h i l o s o p h i e s ( M a l a s p i n a , Camosun, U n i v e r s i t y of B r i t i s h Columbia, and the U n i v e r s i t y of V i c t o r i a ) c o n t a i n s t a t e m e n t s about h i g h e r o r d e r c o g n i t i v e a b i l i t i e s s u ch as c r i t i c a l t h i n k i n g , moral r e a s o n i n g , s e l f - d i r e c t e d l e a r n i n g , c r e a t i v e t h i n k i n g , and problem s o l v i n g . These i d e a l s o f t e n remain as 106 p h i l o s o p h i c a l s t a t e m e n t s because of the d i f f i c u l t y i n imple m e n t i n g them i n any p r e c i s e i n t e n t i o n a l way th r o u g h the c u r r i c u l u m . I t has a l s o been d i f f i c u l t t o measure and e v a l u a t e such c h a r a c t e r i s t i c s i n gr a d u a t e s . A l t h o u g h purpose s t a t e m e n t s and g o a l s among n u r s i n g c u r r i c u l a a r e s i m i l a r , t he c u r r i c u l u m d e s i g n s t o meet thes e common g o a l s v a r y g r e a t l y . C u r r i c u l u m p l a n n e r s and e d u c a t o r s e x p r e s s v a r y i n g i d e a s about the ways i n which s t u d e n t s g a i n the knowledge, s k i l l s , and v a l u e s n e c e s s a r y t o p r a c t i c e n u r s i n g . The d i f f i c u l t y i n c l e a r l y d e s c r i b i n g the ways i n which s t u d e n t s d e v e l o p and demonstrate h i g h e r o r d e r c o g n i t i v e s k i l l s may e x p l a i n some of the d i v e r s i t y i n c u r r i c u l u m p l a n s which e v o l v e from s i m i l a r p h i l o s o p h i e s and g o a l s . The P e r r y scheme b r i n g s more p r e c i s e meaning t o c o g n i t i v e d e v e l o p m e n t a l g o a l s . T h i s c l a r i t y a l l o w s f a c u l t y t o a c h i e v e consensus around i m p l e m e n t a t i o n of p l a n s t o a c h i e v e c o g n i t i v e development, and a l l o w s s t u d e n t s t o have a c l e a r e r u n d e r s t a n d i n g of e x p e c t a t i o n s r e g a r d i n g t h e i r c o g n i t i v e growth. A l l n u r s i n g c u r r i c u l a have a common purpose: t o prepare i n d i v i d u a l s f o r n u r s i n g p r a c t i c e and r e g i s t r a t i o n . P e r u s a l of d e s c r i p t i o n s of d i p l o m a programs i n B r i t i s h Columbia r e v e a l s d i v e r s i t y i n e n t r a n c e r e q u i r e m e n t s , l e n g t h of the program, c o u r s e 107 s e l e c t i o n , course content, and c l i n i c a l experiences. There are a l s o post-RN b a c c a l a u r e a t e programs and a g e n e r i c b a c c a l a u r e a t e program. In North America, b a c c a l a u r e a t e programs can be f o u r or f i v e y e ars i n length, f o l l o w i n t e g r a t e d c u r r i c u l u m designs, one p l u s three designs, or two p l u s two designs, and c o n t a i n v a r y i n g numbers of e l e c t ! v e s or l i b e r a l a r t s and s c i e n c e s c r e d i t s . Many arguments have been put f o r t h t o support the v a r y i n g c u r r i c u l u m designs which have been apparent i n nu r s i n g e d u c a t i o n both i n the past and present. Montag (1959) s u c c e s s f u l l y promoted the a s s o c i a t e degree two year diploma program i n the U n i t e d S t a t e s f o r p r e p a r a t i o n of t e c h n i c a l nurses. She e n v i s i o n e d d i f f e r e n t e d u c a t i o n a l p r e p a r a t i o n and p r a c t i c e r o l e s f o r t e c h n i c a l and p r o f e s s i o n a l nurses. The r e a l i t i e s of the h o s p i t a l s e t t i n g d i d not a l l o w c l e a r and d e f i n i t e d e l i n e a t i o n of these two r o l e s , and the o r i g i n a l i n t e n t of the t e c h n i c a l - p r o f e s s i o n a l dichotomy was l o s t . In a d d i t i o n , t h e fundamental d e s i r e t o a l l o w upward m o b i l i t y and advancement f o r nurses at a l l l e v e l s f o s t e r e d t h e p o p u l a r i t y of the ladder concept i n the 1960's and 1970*s. Although the t e c h n i c a l - p r o f e s s i o n a l dichotomy d i d not r e c e i v e as much a t t e n t i o n i n Canada, two year c o l l e g e - b a s e d diploma programs arose l e a d i n g t o 108 a s i m i l a r conglomeration of e d u c a t i o n a l pathways i n nursing. D e c i s i o n s which l e d to the e v o l u t i o n of t e c h n i c a l nursing, e n t r y and e x i t p o i n t s i n programs, and the ladder concept, have c r e a t e d a v a r i e t y of ro u t e s i n n u r s i n g e d u c a t i o n which s t i l l e x i s t today. P r a c t i s i n g nurses i n B r i t i s h Columbia are graduates of a wide v a r i e t y of programs. T h i s conglomeration of e d u c a t i o n a l pathways i n n u r s i n g i s the legacy of u n c l e a r d i r e c t i o n i n the past. As s t r a t e g i e s t o achieve the bac c a l a u r e a t e e n t r y t o p r a c t i c e p o s i t i o n are implemented, e f f e c t s of the h i s t o r y of n u r s i n g e d u c a t i o n and d i r e c t i o n s f o r the f u t u r e are r e c e i v i n g c l o s e r a t t e n t i o n . The b a c c a l a u r e a t e e n t r y t o p r a c t i c e p o s i t i o n has prompted a demand f o r more post-RN b a c c a l a u r e a t e programs. When diploma RN's r e t u r n f o r b a c c a l a u r e a t e e d u c a t i o n they are e s s e n t i a l l y o b t a i n i n g upper l e v e l u n i v e r s i t y p r e p a r a t i o n which i s b u i l t upon a narrow, s p e c i a l i z e d and t e c h n i c a l base. C r i t i c s of a r t i c u l a t i o n between diploma and b a c c a l a u r e a t e programs b e l i e v e t h a t upper l e v e l b a c c a l a u r e a t e e d u c a t i o n should b u i l d upon a broad, g e n e r a l l i b e r a l a r t s base (Gallop, 1984, Bullough, 1979). While opponent arguments t o a r t i c u l a t i o n appear e d u c a t i o n a l l y sound, r e a l i t y i n bac c a l a u r e a t e n u r s i n g e d u c a t i o n today suggests t h a t RN's 109 r e t u r n i n g f o r the b a c c a l a u r e a t e degree make up a l a r g e number of s u c c e s s f u l n u r s i n g degree graduates. Richardson <1986), i n a response to G a l l o p ' s a r t i c l e , p r e s e n t s a case f o r a r t i c u l a t i o n as one mechanism f o r a c h i e v i n g b a c c a l a u r e a t e e n t r y t o p r a c t i c e i n Canada. She s t a t e s t h a t a r t i c u l a t i o n i s a d e s i g n d e c i s i o n to meet present needs and does not need to be a p r e s c r i p t i o n f o r the f u t u r e . A l s o p e r t i n e n t i n t h i s i ssue i s the study by Lawler and Rose (1987), c i t e d e a r l i e r i n t h i s r esearch, which concluded t h a t "the ADN who r e t u r n s to s c h o o l t o earn the BSN i s a more p r o f e s s i o n a l product than e i t h e r the g e n e r i c BSN or ADN graduate" (p- 22). In a d d i t i o n to the v a r i e t y of e d u c a t i o n a l programs and pathways l e a d i n g to nurse r e g i s t r a t i o n , t here can be c o n s i d e r a b l e d i v e r s i t y w i t h i n one type of program. For example, T o r r e s and Stanton (1982) d e s c r i b e t h r e e c u r r i c u l u m d e s i g n s which can be used i n g e n e r i c b a c c a l a u r e a t e programs (p. 56). The f i r s t i s a b u i l d i n g d e s i g n where year one and two of the program c o n s i s t of g e n e r a l u n i v e r s i t y support and e l e c t i v e courses, a l l n u r s i n g content i s d e l i v e r e d i n the f i n a l two years. The second d e s i g n i s a p r o g r e s s i v e d e s i g n where students r e c e i v e a l a r g e p o r t i o n of g e n e r a l e d u c a t i o n and support courses and a l e s s e r amount of n u r s i n g content i n t h e i r 110 f i r s t year. The gen e r a l content p r o g r e s s i v e l y decreases u n t i l the f o u r t h year while the n u r s i n g content p r o g r e s s i v e l y i n c r e a s e s t o the f o u r t h year. Advantages of the p r o g r e s s i v e d e s i g n were d e s c r i b e d e a r l i e r i n t h i s chapter i n the s e c t i o n on l i b e r a l education. The t h i r d c u r r i c u l u m d e s i g n presented by T o r r e s and Stanton i s a p a r a l l e l d e s i g n where st u d e n t s r e c e i v e a p r o p o r t i o n a t e amount of n u r s i n g and g e n e r a l content c o n c u r r e n t l y throughout the f o u r years. Another d e s i g n r e c e i v i n g g r e a t e r a t t e n t i o n i s the post b a c c a l a u r e a t e n u r s i n g program where a gen e r a l b a c c a l a u r e a t e degree i s r e q u i r e d p r i o r t o e n t e r i n g a n u r s i n g program. T h i s e d u c a t i o n a l pathway i s s i m i l a r t o t h a t i n d e n t i s t r y , law, medicine, and some s o c i a l work programs where p r o f e s s i o n a l e d u c a t i o n b u i l d s upon a g e n e r a l a r t s and s c i e n c e base. T o r r e s and Stanton present advantages and disadvantages of each design. C u r r i c u l u m p l a n n e r s choose a d e s i g n based on the r e s t r i c t i o n s of the u n i v e r s i t y s e t t i n g and t h e i r own e d u c a t i o n a l assumptions. Research on the e f f e c t i v e n e s s of each d e s i g n i s not a v a i l a b l e , so that p l a n n e r s must make d e c i s i o n s on a t h e o r e t i c a l b a s i s . The P e r r y theory p r o v i d e s a framework from which t o view and c l a r i f y c u r r i c u l u m g o a l s which r e f e r t o higher order c o g n i t i v e s k i l l s of concept attainment, problem s o l v i n g , d e c i s i o n making, c r i t i c a l t h i n k i n g , and 111 c l i n i c a l judgment ( R e i l l y and Oermann, 1985, p. 146). The t h e o r y of i n t e l l e c t u a l and e t h i c a l development may o f f e r d i r e c t i o n f o r c u r r i c u l u m development, i m p l e m e n t a t i o n , and e v a l u a t i o n , w i t h i n the c o g n i t i v e domain. The r e s u l t s of t h i s s t u d y and the r e s e a r c h by V a l i g a (1982) and F r i s c h (1987, 1990) i n d i c a t e t h a t c o g n i t i v e development s h o u l d be f o s t e r e d i n a more e f f e c t i v e way i f t h e s e c u r r i c u l u m g o a l s and p h i l o s o p h i c a l s t a t e m e n t s a r e t o be r e a l i z e d . N u r s i n g c u r r i c u l a undergo f r e q u e n t r e v i s i o n s and changes w i t h o u t the b e n e f i t of broad c u r r i c u l u m r e s e a r c h upon which t o base d e c i s i o n s . The t h e o r i z i n g around th e e f f e c t s of a l i b e r a l e d u c a t i o n i s one example where debate c o n t i n u e s w i t h o u t t h e b e n e f i t of e m p i r i c a l r e s e a r c h . F u t u r e r e s e a r c h might i n c l u d e comparison of g r a d u a t e s f rom d i f f e r e n t c u r r i c u l a ; t h i s might h e l p t o measure e f f e c t i v e n e s s of one d e s i g n over another. T e a c h i n g S t r a t e g i e s The P e r r y scheme has become the b a s i s of e x p e r i m e n t a l r e s e a r c h where t e a c h i n g i n t e r v e n t i o n s were s p e c i f i c a l l y d e v e l o p e d t o enhance development t o h i g h e r p o s i t i o n s (Knefelkamp, 1974, Stephenson and Hunt, 1977, Widdick, 1975). These r e s e a r c h e r s p l a n n e d l e a r n i n g e x p e r i e n c e s f o r s t u d e n t s which i n c l u d e d exposure t o d i v e r s i t y , p r e s e n t a t i o n of more t h a n one p e r s p e c t i v e on 112 i s s u e s , and c h a l l e n g e s t o encourage s t u d e n t s t o advance t o m u l t i p l i s t i c and r e l a t i v i s t i c l e v e l s of t h i n k i n g . These r e s e a r c h s t u d i e s u t i l i z e d e x p e r i m e n t a l d e s i g n s where P e r r y p o s i t i o n s were measured b e f o r e and a f t e r i m p l e m e n t a t i o n of a t e a c h i n g i n t e r v e n t i o n d e s i g n e d t o enhance c o g n i t i v e development. These s t u d i e s , which were p r e s e n t e d i n the l i t e r a t u r e r e v i e w , o f f e r r e s e a r c h models f o r f u r t h e r s t u d y i n t o t h e e f f e c t i v e n e s s of t e a c h i n g s t r a t e g i e s . Only one n u r s i n g s t u d y used a s i m i l a r d e s i g n . F r i s c h (1990) measured the p o s i t i o n on the P e r r y s c a l e of n u r s i n g s t u d e n t s b e f o r e and a f t e r a s t u d e n t exchange e x p e r i e n c e . She found t h a t an i n t e r n a t i o n a l s t u d e n t exchange was an i n t e r v e n t i o n which enhanced the c o g n i t i v e development of n u r s i n g s t u d e n t s . In p l a n n i n g t e a c h i n g methods t o promote c o g n i t i v e m a t u r i t y i t i s i m p o r t a n t t o c o n s i d e r the l e v e l of the s t u d e n t s i n the group. S t u d e n t s w i l l be h a p p i e r and more s a t i s f i e d w i t h i n s t r u c t i o n i f i t i s congruent w i t h t h e i r b e l i e f s about the r o l e of the i n s t r u c t o r , peers, and l e a r n e r s i n p u r s u i n g e d u c a t i o n and the n a t u r e of knowledge, t r u t h and v a l u e s . These can be a s s e s s e d u s i n g t h e MER. I f t h e f a c u l t y b e l i e v e t h a t l e a r n i n g i n c l u d e s the development of i n c r e a s i n g l y complex c o g n i t i v e a b i l i t i e s , t h en l e a r n i n g i n t h i s r e a l m can be more c o n c r e t e l y and 113 s p e c i f i c a l l y d e f i n e d as a c h i e v i n g ' h i g h e r p o s i t i o n s on the P e r r y s c a l e . The way i n which s t u d e n t s a c h i e v e h i g h e r p o s i t i o n s w i l l be the f a c u l t y ' s frame of r e f e r e n c e f o r e x p l a i n i n g how l e a r n i n g i n t h i s r e a l m i s a c h i e v e d . The p r o c e s s of change was b r i e f l y d e s c r i b e d i n c h a p t e r I I and i s i l l u s t r a t e d here i n F i g u r e 1. I f the s t u d e n t f a c e s new knowledge or e x p e r i e n c e i n the environment which cannot be h a n d l e d by e x i s t i n g c o g n i t i v e s t r u c t u r e s , c o g n i t i v e d i s s o n a n c e r e s u l t s . S t u d e n t s can a l t e r t h e i r c o g n i t i v e s t r u c t u r e s t o i n t e g r a t e the new knowledge or e x p e r i e n c e . T h i s accommodation, or m o d i f i c a t i o n of i n t e r n a l p a t t e r n s of u n d e r s t a n d i n g t o f i t the new r e a l i t y , r e s u l t s i n p r o g r e s s i o n t o the next s t a g e of c o g n i t i v e development. C o g n i t i v e d i s s o n a n c e which cannot be accommodated r e s u l t s i n a l t e r n a t i v e s t o growth. A c h i e v i n g new p o s i t i o n s and a l t e r n a t i v e s t o growth a r e i l l u s t r a t e d i n F i g u r e 2. P e r r y d e s c r i b e s t h e s e a l t e r n a t i v e s t o growth i n the f o l l o w i n g way: T e m p o r i z i n g . The s t u d e n t d e l a y s i n some P o s i t i o n f o r a y e a r , e x p l o r i n g i t s i m p l i c a t i o n s or e x p l i c i t l y h e s i t a t i n g t o t a k e the next s t e p . Escape. The s t u d e n t e x p l o i t s the o p p o r t u n i t y f o r detachment o f f e r e d by the s t r u c t u r e s of P o s i t i o n s Figure 1. PROCESS OF CHANGE IN DEVELOPMENTAL POSITION C o n f l i c t u a l knowledge/ Experience processed ^~ " to be congruent with Basic Position Reaffirmation of Position Knowledge/Experience congruent with Basic Position BASIC POSITION Knowledge/ Experience NEW POSITION PERSON IN CONFLICT Integration of knowledge/experience Re-evaluation of basic position Knowledge/ experience in c o n f l i c t with Basic Position -^-Overwhelming >Escape Retreat -> Temporize Copied without permission Cordts (1977) Unpublished paper Found in Valiga (1983) \ 115 A c h i e v i n g N e w P o s i t i o n s a n d A l t e r n a t i v e s t o G r o w t h NEW P O S I T I O N I n t e g r a t i o n o f k n o w l e d g e / e x p e r i e n c e R e - e v a l u a t i o n o f B a s i c P o s i t i o n P E R S O N I N C O N F L I C T • > O v e r whe 1 m i n g — • E s c a p e - ^ R e t r e a t - > T e m p o r i z e B A S I C P O S I T I O N K n o w l e d g e / E x p e r i e n e e i n c o n f l i c t w i t h B a s i c P o s i t i o n K n o w l e d g e / E x p e r i e n c e 116 4 and 5 t o deny r e s p o n s i b i l i t y t h r o u g h p a s s i v e or o p p o r t u n i s t i c a l i e n a t i o n . R e t r e a t . The s t u d e n t e n t r e n c h e s i n the d u a l i s t i c , a b s o l u t i s t i c s t r u c t u r e s of P o s i t i o n 2 or 3. A p e r s o n i n c o n f l i c t might a l s o b l o c k p e r c e p t i o n of new knowledge or e x p e r i e n c e so t h a t i n s i g h t which a l l o w s r e - e v a l u a t i o n of B a s i c P o s i t i o n does not o c c u r . I f the s t u d e n t f a c e s new knowledge or e x p e r i e n c e i n the environment which i s congruent w i t h e x i s t i n g c o g n i t i v e s t r u c t u r e s , the s t u d e n t can r e a f f i r m the B a s i c P o s i t i o n or c u r r e n t l e v e l of development. No new l e a r n i n g or change o c c u r s i n a s i t u a t i o n s uch as t h i s . R e a f f i r m a t i o n of p o s i t i o n i s i l l u s t r a t e d i n F i g u r e 3. 117 F i g u r e 3 : R e a f f i r m a t i o n of P o s i t i o n Knowledge/Experience E x p e r i e n c e A dilemma o c c u r s where, i f s t u d e n t s a r e not f a c e d w i t h a c h a l l e n g e , l e a r n i n g and change do not occur. On the o t h e r hand i f the s t u d e n t s a r e f a c e d w i t h knowledge and e x p e r i e n c e u n s u i t a b l e f o r t h e i r l e v e l , or t o o much of a c h a l l e n g e , t h e y cannot a t t a i n New P o s i t i o n s . Stephenson and Hunt (1977) have proposed a " d u a l i s t i c c u r r i c u l u m i n t e r v e n t i o n " which combines c h a l l e n g e and s u p p o r t t o h e l p s t u d e n t s i n d u a l i s m move t o new p o s i t i o n s . F i g u r e 4 i l l u s t r a t e s e lements of c h a l l e n g e and s u p p o r t which can be used w i t h d u a l i s t i c s t u d e n t s t o enable them t o move t o more m u l t i p l i s t i c and r e l a t i v i s t i c ways of t h i n k i n g . . 118 F i g u r e 4 D u a l l s t i c C u r r i c u l u m I n t e r v e n t i o n D i v e r s i t y «- L i t e r a t u r e w i t h paradox I n t e r d i s c i p l i n a r y c o u r s e C h a l l e n g e s I n s t r u c t i o n a l p rocedure E x p e r l e n t i a l L e a r n i n g D u a 1 i s t i c Students Degree of S t r u c t u r e In C l a s s E x p e r i e n c e (Role p l a y a c r i s i s ) Out of C l a s s C o n c r e t e (Conduct an I n t e r v i e w ) S t r u c t u r e d i n s t r u c t i o n Assignments d e f i n e d High l e v e l s of A u t h o r i t y S u p p o r t s .Pe r s o n a l Atmosphere S e l f D i s c l o s u r e / M o d e l i n g Take c a r e of maintenance I n d i v i d u a l C o n f e r e n c e s T h i s b a l a n c e of c h a l l e n g e and s u p p o r t a l s o j u s t i f i e s a h u m a n i s t i c approach t o e d u c a t i o n . T e a c h i n g s t r a t e g i e s t o enhance c o g n i t i v e development can be used i n the c l a s s r o o m , seminar and c l i n i c a l p r a c t i c u m s . 119 The c l i n i c a l l e a r n i n g environment p r o v i d e s a r i c h a r ena f o r c o g n i t i v e growth. N u r s i n g , as a h u m a n i s t i c i n t e r a c t i v e s c i e n c e s e r v i n g c l i e n t s of a l l backgrounds w i t h v a r y i n g needs, i s an i n h e r e n t l y i n e x a c t and r e l a t i v i s t i c d i s c i p l i n e . W i th a l l of our p o l i c i e s and pr o c e d u r e s , and i n t o l e r a n c e of m i s t a k e s , we may p o r t r a y n u r s i n g as an e x a c t d u a l i s t i c s c i e n c e t o new s t u d e n t s . V a l i g a (1982) s t a t e s : Perhaps nurse e d u c a t o r s attempt t o o e n t h u s i a s t i c a l l y t o emphasize the s e r i o u s n a t u r e of n u r s i n g and f a i l t o h e l p s t u d e n t s r e c o g n i z e t h a t n u r s i n g i s an i m p e r f e c t d i s c i p l i n e . Indeed, d e s p i t e a l l t h e s t u d i e s of human b e i n g s conducted by p s y c h o l o g i s t s , s o c i o l o g i s t s , b i o l o g i s t s , a n t h r o p o l o g i s t s , and n u r s e s , we s t i l l c o n c l u d e t h a t each p e r s o n i s a unique i n d i v i d u a l whose needs and b e h a v i o r s cannot be p r e d i c t e d p r e c i s e l y , i f t h e y can be p r e d i c t e d a t a l l . Thus, u n c e r t a i n t y and a m b i g u i t y a r e i r r e d u c i b l e i n n u r s i n g , and s t u d e n t s must be a s s i s t e d t o d e v e l o p ways t o manage such u n c e r t a i n t y and a m b i g u i t y and d i v e r s i t y . (p. 217) I t i s t h i s d i f f e r e n c e between how we v i e w and t e a c h n u r s i n g and the a m b i g u i t y p r e s e n t i n p r a c t i c e s i t u a t i o n s t h a t F r i s c h r e f e r s t o as she d e v e l o p s a new and 120 i n t e r e s t i n g p e r s p e c t i v e of r e a l i t y shock. A new g r a d u a t e who has been encouraged t o view the n u r s i n g s i t u a t i o n i n d u a l i s t i c r i g h t - w r o n g terms w i l l have t r o u b l e w i t h the p r o f e s s i o n a l r o l e which r e q u i r e s independent judgment i n a r e l a t i v i s t i c w o r l d . S t u d e n t s who have the o p p o r t u n i t y t o d e v e l o p r e l a t i v i s t i c r e a s o n i n g s k i l l s w i l l be b e t t e r equipped t o d e a l w i t h the r e a l i t i e s of the c l i n i c a l s i t u a t i o n . The r e s e a r c h i n t h i s s t u d y does not o f f e r c o n c l u s i v e d i r e c t i o n f o r n u r s i n g e d u c a t i o n because of the l i m i t a t i o n s of the f i n d i n g s . T h i s r e s e a r c h r e p r e s e n t s an i n i t i a l i n v e s t i g a t i o n i n t o the c o m p l e x i t i e s of the r e l a t e d c o n c e p t s w i t h i n c o g n i t i v e development t h e o r y and n u r s i n g e d u c a t i o n . The f i n d i n g s of the s t u d y i n c o m b i n a t i o n w i t h o t h e r l i t e r a t u r e and e x t e n s i o n s of the t h e o r e t i c a l framework do, however, p r o v i d e a b a s i s f o r many avenues of f u r t h e r r e s e a r c h . I m p l i c a t i o n s f o r F u t u r e Research R e s e a r c h i n t o the r e l a t i o n s h i p between i n t e l l e c t u a l and e t h i c a l development and c o n c e p t s such as p r o f e s s i o n a l i s m ( V a l i g a , 1982), and s e 1 f - d i r e c t e d n e s s and r o l e of a u t h o r i t y (Shaw-Berget, 1988) has a l r e a d y begun. Re s e a r c h t o f u r t h e r t h e s e e f f o r t s and i n v e s t i g a t e r e l a t i o n s h i p s w i t h o t h e r c o n c e p t s such as c r i t i c a l t h i n k i n g , moral r e a s o n i n g , d e c i s i o n - m a k i n g , and 121 autonomy would c o n t r i b u t e t o our u n d e r s t a n d i n g of the r o l e of e d u c a t i o n i n p r o m o t i n g t h e s e a b i l i t i e s . L o n g i t u d i n a l s t u d i e s of s t u d e n t s upon g r a d u a t i o n , and a t i n t e r v a l s t h e r e a f t e r would promote our u n d e r s t a n d i n g of the r e l a t i o n s h i p between e x p e r i e n c e , e d u c a t i o n , and c o g n i t i v e development. I n f o r m a t i o n r e g a r d i n g the enhancement, r e g r e s s i o n , o r s t a b i l i z a t i o n of c o g n i t i v e l e v e l f o l l o w i n g g r a d u a t i o n would be h e l p f u l . C u r r i c u l u m r e s e a r c h where c o g n i t i v e l e v e l i s a s s e s s e d t h r o u g h o u t the program and upon g r a d u a t i o n would be i m p o r t a n t f o r f u t u r e c u r r i c u l u m d e c i s i o n s i n n u r s i n g e d u c a t i o n . Comparing g r a d u a t e s from d i f f e r e n t programs, which use d i f f e r e n t c u r r i c u l a might a l s o p r o v i d e i n t e r e s t i n g r e s u l t s . A l s o , many s t u d e n t s e n t e r i n g n u r s i n g now a r e mature s t u d e n t s who o f t e n have a p r e v i o u s degree o r u n i v e r s i t y c o u r s e s i n o t h e r f a c u l t i e s . A s s e s s i n g the development of t h e s e s t u d e n t s and f o l l o w i n g t h e i r c a r e e r p a t h s a f t e r g r a d u a t i o n might p r o v i d e u s e f u l i n f o r m a t i o n . R e s e a r c h i n t o t r a d i t i o n a l and i n n o v a t i v e t e a c h i n g s t r a t e g i e s d e s i g n e d t o enhance c o g n i t i v e development w i l l add t o our knowledge about the e f f e c t i v e n e s s of n u r s i n g e d u c a t i o n . E x p e r i m e n t a l r e s e a r c h d e s i g n s where l e v e l s of c o g n i t i v e development a r e measured b e f o r e and 122 a f t e r an i n t e r v e n t i o n or e x p e r i e n c e may a l s o h e l p t o c o r r o b o r a t e i n c l u s i o n of p a r t i c u l a r components i n a c o u r s e . A l t h o u g h the e n t r y t o p r a c t i c e p o s i t i o n i s g a i n i n g s u p p o r t , the v a l u e of b a c c a l a u r e a t e e d u c a t i o n f o r n u r s e s i s s t i l l t o be c l e a r l y d emonstrated t o a l l n u r s e s and the p u b l i c . Any e f f o r t s which h e l p t o c l a r i f y the n a t u r e of h i g h e r e d u c a t i o n ' s c o n t r i b u t i o n t o n u r s i n g p r a c t i c e w i l l s t r e n g t h e n the e n t r y t o p r a c t i c e p o s i t i o n . Summary In p r o m o t i n g the e n t r y t o p r a c t i c e p o s i t i o n , the Canadian Nurses A s s o c i a t i o n s t a t e d t h a t b a c c a l a u r e a t e e d u c a t i o n s h o u l d f o s t e r the development of a b i l i t i e s r e q u i r e d f o r p r o f e s s i o n a l p r a c t i c e . B a c c a l a u r e a t e e d u c a t i o n s h o u l d a s s i s t i n the development of a b r e a d t h of knowledge, b u i l d i n t e l l e c t u a l power, and a s s i s t i n the c r e a t i o n of a c o h e r e n t scheme of v a l u e s (CNA, 1988, p.12). The r e s e a r c h p r e s e n t e d here was an e f f o r t t o f u r t h e r the s e a r c h f o r d i f f e r e n t i a t i o n between the e f f e c t s of b a c c a l a u r e a t e and d i p l o m a e d u c a t i o n i n n u r s i n g . To t h i s end, the r e s e a r c h proceeded t o t e s t the a s s u m p t i o n s i n the CNA s t a t e m e n t s on t h e b a c c a l a u r e a t e e n t r y t o p r a c t i c e i s s u e as p r e s e n t e d i n the b e g i n n i n g pages of t h i s s t u d y . The f i n d i n g s i n t h i s s t u d y do not o f f e r f u r t h e r s u p p o r t f o r the b a c c a l a u r e a t e 123 e n t r y t o p r a c t i c e p o s i t i o n . However the numbers of s u b j e c t s i n the s t u d y d i c t a t e j u d i c i o u s c o n s i d e r a t i o n of the r e s u l t s . T h i s f i n a l c h a p t e r p r e s e n t e d a summary of the t h e o r e t i c a l background and the r e s e a r c h p r o c e s s used i n the s t u d y . The i m p l i c a t i o n s of the c o n c l u s i o n s , f o r n u r s i n g p r a c t i c e , e d u c a t i o n , and r e s e a r c h , were a n a l y s e d . The r e l a t i o n s h i p s between c o g n i t i v e m a t u r i t y and p r a c t i c e i s s u e s such as t h e o r y - b a s e d p r a c t i c e , r e s e a r c h o r i e n t a t i o n t o p r a c t i c e , t e c h n o l o g i c a l change, h e l p i n g r e l a t i o n s h i p s , e t h i c a l i s s u e s , and community-based h e a l t h c a r e were demonstrated. I m p l i c a t i o n s of the P e r r y t h e o r y f o r n u r s i n g e d u c a t i o n i n the a r e a s of s t u d e n t assessment, c u r r i c u l u m p l a n n i n g , and f o r m u l a t i n g t e a c h i n g s t r a t e g i e s were a n a l y s e d . T h i s r e s e a r c h f u r t h e r s i n v e s t i g a t i o n s i n t o i n t e l l e c t u a l and e t h i c a l development i n n u r s i n g e d u c a t i o n c o nducted by V a l i g a (1982) and F r i s c h (1986, 1990). I t r e v e a l s numerous q u e s t i o n s f o r f u r t h e r r e s e a r c h i n t o t h i s a r e a of n u r s i n g e d u c a t i o n . A p r o f e s s i o n a l n u rse must be e d u c a t i o n a l l y p r e p a r e d t o d e a l w i t h the c o m p l e x i t i e s of a p l u r a l i s t i c w o r l d . T h e o r e t i c a l f o u n d a t i o n s and r e s e a r c h which c o n t r i b u t e t o a b e t t e r u n d e r s t a n d i n g of development w i t h i n the c o g n i t i v e domain i n n u r s i n g e d u c a t i o n a r e needed so t h a t 124 s t u d e n t s can be w e l l p r e p a r e d f o r n u r s i n g p r a c t i c e . 125 Archambault, R. <1964'). J o h n Dewey o n E u u c a t i o n : S e l e c t e d V r i t i n g s , H e w Y o r k : R a n d o m H o u s e . B a i l e y , J . T . , McDonald, F. J . , & C l a u s , K. E. ( 1 9 7 0 ) . E v a l u a t i o n o f t h e d e v e l o p m e n t of c r e a t i v e b e h a v i o r i n a n e x p e r i m e n t a l n u r s i n g p r o g r a m . N u r s i n g R e s e a r c h , 19(2), 100-107. Bauwens, E. E., & Gerhard, G. G. (1987). The use of t h e W a t s o n - G l a s e r c r i t i c a l t h i n k i n g a p p r a i s a l t o p r e d i c t s u c c e s s i n a b a c c a l a u r e a t e n u r s i n g program. 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(1982). P r o f e s s i o n a l autonomy among s e n i o r n u r s i n g s t u d e n t s i n di p l o m a , a s s o c i a t e degree, and b a c c a l a u r e a t e n u r s i n g programs. N u r s i n g Research, 31_(5) , 311-313. Mustapha, S. L. , & S e y f e r t , J . A. (1989). Moral r e a s o n i n g i n c o l l e g e s t u d e n t s : I m p l i c a t i o n s f o r n u r s i n g e d u c a t i o n . J o u r n a l of N u r s i n g E d u c a t i o n , 2 8 ( 3 ) , 107-111. N i c k e r s o n , R. S. (1981) Thoughts about t e a c h i n g t h i n k i n g . E d u c a t i o n a l L e a d e r s h i p , 39 (1),21-24. Oddi, L. F. (1988). Comparison of s e l f - d i r e c t e d l e a r n i n g s c a r e s among gr a d u a t e s t u d e n t s i n n u r s i n g , a d u l t e d u c a t i o n , and law. J o u r n a l of C o n t i n u i n g  E d u c a t i o n i n N u r s i n g . 19.(4), 178-181. Pardue, S. F. (1987). D e c i s i o n - m a k i n g s k i l l s and c r i t i c a l t h i n k i n g a b i l i t y among a s s o c i a t e degree, d i p l o m a , b a c c a l a u r e a t e , and master' s - p r e p a r e d nurses. J o u r n a l of N u r s i n g E d u c a t i o n , 26_(9) , 354-361. P e r r y , V. G. (1981). C o g n i t i v e and e t h i c a l growth: The 132 making of meaning. In A.V. C h i c k e r i n g <Ed. ) . The  Modern American C o l l e g e <pp.76-116). San F r a n c i s c o : J ossey-Bass. P e r r y , W. G. (1970). Forms of I n t e l l e c t u a l and E t h i c a l Development i n the C o l l e g e Years: A Scheme. New York: H o l t , R i n e h a r t , and Winston, Inc. Pesut, D. J. (1988). S e I f - p e r c e i v e d c r e a t i v i t y of p r a c t i c i n g r e g i s t e r e d nurses. The J o u r n a l of C o n t i n u i n g E d u c a t i o n i n N u r s i n g . 19_(3) , 100-102. P i a g e t , J . (1950). The P s y c h o l o g y of I n t e l l i g e n c e . H a r c o u r t : Brace. Reed, P. G. (1987). L i b e r a l a r t s and p r o f e s s i o n a l n u r s i n g e d u c a t i o n : I n t e g r a t i n g knowledge and wisdom. Nurse E d u c a t o r , 12_(4) , 37-40. R e i l l y , D. E. & Oermann, M. H. (1985). The C l i n i c a l F i e l d : I t s Use i n N u r s i n g E d u c a t i o n . Norwalk: A p p l e t o n - C e n t u r y - C r o f t s . R i c h a r d s o n , S. (1986). A r t i c u l a t i o n and b a c c a l a u r e a t e e n t r y t o p r a c t i c e : The Canadian c o n t e x t . N u r s i n g Papers. 18.(3), 47-58. Rose, M. A. (1988). ADN vs BSN: The s e a r c h f o r d i f f e r e n t i a t i o n . N u r s i n g O u t l o o k , 3_6 (6) , 275-279. R u s s e l l , C. H. (1960). L i b e r a l E d u c a t i o n and N u r s i n g . New York: Teachers C o l l e g e , Columbia U n i v e r s i t y . S c h e i n , E. H. (1972). P r o f e s s i o n a l E d u c a t i o n : Some New 133 D i r e c t i o n s . New York: M c G r a w - H i l l . Shaw-Berget, D. M. (1988). S e l f - d i r e c t e d l e a r n i n g and i n t e l l e c t u a l development: The r o l e of a u t h o r i t y . In S e l e c t e d papers from the N a t i o n a l Conference on S t u d e n t - C e n t e r e d L e a r n i n g . B e l l i n g h a m : Western Washington U n i v e r s i t y . Sheahan, D. (1972). The game of the name: Nurse p r o f e s s i o n a l and nurse t e c h n i c i a n . N u r s i n g O u t l o o k , 20, 440-444. Spohn, R. R. (1962). The F u t u r e of E d u c a t i o n f o r P r o f e s s i o n a l P r a c t i c e . New York: American Nurses' A s s o c i a t i o n . Stephenson, B. W. & Hunt, C. (1977). I n t e l l e c t u a l and e t h i c a l development: A d u a l i s t i c c u r r i c u l u m i n t e r v e n t i o n f o r c o l l e g e s t u d e n t s . The C o u n s e l i n g  P s y c h o l o g i s t , 6 ( 4 ) , 39-42. S t u a r t , G. W. (1981). How p r o f e s s i o n a l i z e d i s n u r s i n g ? Image: The J o u r n a l of N u r s i n g S c h o l a r s h i p , 13(1), 18-23. S u l l i v a n , E. J . (1987). C r i t i c a l t h i n k i n g , c r e a t i v i t y , c l i n i c a l performance, and achievement i n RN s t u d e n t s . Nurse E d u c a t o r , 12^(2), 12-16. T a y l o r , M. B a x t e r . (1983). The development of the Measure of E p i s t e m o l o g i c a l R e f l e c t i o n . D i s s e r t a t i o n  A b s t r a c t s I n t e r n a t i o n a l , 44, 1065A. ( U n i v e r s i t y 134 M i c r o f i l m s No. DA 83-18,441) Tomlinson-Keasey, C. & Keasey, C. B. (1974). The m e d i a t i n g r o l e of c o g n i t i v e development i n moral judgment. C h i l d Development, 45, 291-298. T o r r e s , G. & S t a n t o n , M. (1982). C u r r i c u l u m P r o c e s s i n N u r s i n g : A Guide t o C u r r i c u l u m Development, Engelwood C l i f f s : P r e n t i c e H a l l . Touchton, J. G. , Wertheimer, L. C. , & C o r n f e l d , J . L. (1977). C a r e e r p l a n n i n g and d e c i s i o n - m a k i n g : A d e v e l o p m e n t a l approach t o the c l a s s r o o m . The C o u n s e l i n g P s y c h o l o g i s t . 6 ( 4 ) , 42-47. Urbano, M. T., Jahns, I. R., & Urbano, R. C. (1988). What r e a l l y m o t i v a t e s n u r s e s t o p a r t i c i p a t e i n mandatory p r o f e s s i o n a l c o n t i n u i n g e d u c a t i o n ? Journa1  of C o n t i n u i n g E d u c a t i o n i n N u r s i n g . 19_(1), 38-42. V a l i g a , T. M. (1983). C o g n i t i v e development: A c r i t i c a l component of b a c c a l a u r e a t e n u r s i n g e d u c a t i o n . Image:  The J o u r n a l of N u r s i n g S c h o l a r s h i p . 15(4), 115-119. V a l i g a , T. M. (1982). The c o g n i t i v e development and p e r c e p t i o n s about n u r s i n g as a p r o f e s s i o n of b a c c a l a u r e a t e n u r s i n g s t u d e n t s . U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n , Teachers C o l l e g e , Columbia U n i v e r s i t y . V o l i c i e r , B. J. (1984). M u l t i v a r i a t e S t a t i s t i c s f o r  N u r s i n g Research. New York: Grune & S t r a t t o n , Inc.. 135 Weir, G. <1932). Survey of N u r s i n g E d u c a t i o n i n Canada, Toronto: U n i v e r s i t y of To r o n t o P r e s s . Widdick, C. C. (1975). An E v a l u a t i o n of Developmental I n s t r u c t i o n i n a U n i v e r s i t y S e t t i n g . U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n , U n i v e r s i t y of Minnesota. Woolley, A. S. (1986). D e f i n i n g the p r o d u c t of b a c c a l a u r e a t e e d u c a t i o n . N u r s i n g and H e a l t h Care, 10, 199-201. APPENDIX A R e g i s t e r e d Nurses A s s o c i a t i o n of B r i t i s h Columbia G u i d e l i n e s f o r u s i n g the R e g i s t r y of P r a c t i s i n g Nurses i n B.C. f o r sample s e l e c t i o n / I 137 PROVIDING ACCESS TO RNABC MEMBERS CURRENT POLICIES: Names and addresses of members printed on mailing labels are released to B.C. educational Institutions, on request, for the purpose of distributing information about educational programs The mailing labels are provided at cost. The Executive Director has discretionary power to approve the release of data/from membership records', provided the followin criteria are merr^ =J a) No information which permits identification of individual members is released. b) Provision is made for review and approval by an agent of the Association of the interpretation of data in major studies which have implications for -the RNABC^A-^-^J /?•< c) The purpose of the project is not inconsistent with RNABC objects and positions. ACCESS FOR RESEARCH PURPOSES: Personal information about members is not released. If researchers or others with similar goals wish to contact RNABC members, we can help you by mailing information to them. Here's how i t ' s done. You Provide: A brief one page overview of your study, eg. objectives, methods, time-frame, etc. Specifications for your sample, eg. random sample of 200 R.N.s employed in B.C. acute care hospitals, or all R.N.s working in home care in B.C. (Information form attached.) A copy of information you plan to send to our members. Payment for costs involved. Stamped envelopes ready to be mailed -- we will put on the mailing labels. If you want reminders sent or plan to do a second mailing, you must order two sets of labels and number your questionnaires and envelopes. A copy of your completed study for the RNABC Library. 138 - 2 Select your sample from currently registered nurses in B.C. according to your specification. (Just a reminder not a l l B.C. R.N.s live here. If you want only B.C. residents, please specify.) A copy of the current registration renewal form 1s attached so you will know what categories can be selected. You must be specific about numbers, categories and geographic locations. Print mailing labels of the R.N.s selected for your sample. You will be billed for the cost of the labels (3-4 cents for each name printed.) Print a second set of labels i f you wish to do a second mailing to the same R.N.s or to send reminders. You must state the number of sets required with your ini t ia l request because i t may not be possible to duplicate your sample, particularly i f i t is a random sample. (Same charge as above.) Mail your information to the people in your sample, that i s , we put the mailing labels on your stamped, coded and sealed envelopes and put them in the mail. Envelopes should have return addresses so you will not do a second mailing to people when the first envelope was returned because the person has moved. If we are too busy to f i t this work into our regular routines, you will be charged approximately $15 an hour for this service. Do a second mailing to those you wish to receive more information or a reminder. (Same conditions as for first mailing.) Only i f required, stamp envelopes. Postage must be paid in advance. 139 Name: Address: Phone No.: Best Reached At (Time): Purpose Labels Required: REQUEST FOR MAILING LABELS No. of Sets of Labels Required: Sample of R.N.s*: Number: Place of Residence: Employment Status: Place of Employment: Employment Position: Primary Area of Responsibility: Specific Demographic: Other: * Please note, not al l categories listed may be relevant to your study. Indicate only those that are. >E COMPLETE SECTION BELOW ONLY IF ABOVE INFORMATION IS INCORRECT OR INCOMPLETE. IV- 3 f IR5T 3 M I D D L E C < - .0 J \ M r : t l l S ! . l i ' . j 5 140 S T R E E T A O O R E S S j T E L E P H O N E 4 6 P R O V I N C E 6 . . 5 N A M E ' S . 8 If your name has changed, please enclose a photocopy o l a legal change o f name document. ! P O S T A L C C O E 7 I S O C I A L I N S U R A N C E N O 9 ASE COMPLETE ALL ITEMS© THROUGH® BELOW. Th is will fac i l i tate p r o c e s s i n g of your reg is t ra t ion. S e e p a m p h l e t for more in format ion . ^ ' . r r e c o r d s S h o w s -.- s ^ f o r m a t i o n correct? 7ss"vCU YES N O ' J No correct below ? L O ' < E 0 N N U R S I N G : « 5 - i i a r 3 a s ; s C s s j a l . S e a s o n a l B a s i s 2?\ F — I E ' . ' P ' . O ' E D • N O T IN N U R S I N G Cj . w.ng E m p l o y m e n t i n N u r s i n g S o t s e e d i n g E m p l o y m e n t i n N u r s i n g ' . C T E M P L O Y E D 4 i S e e k i n g E m p l o y m e n t i n N u r s i n g TTl ' . c t s e e k i n g E m p l o y m e n t i n N u r s i n g 6 i [-•'• -s\ E m p l o y e d m N u r s i n g | v r A r e y o u e m p l o y e d b y m o r e t h a n o n e e r r . d o y e r ? N o f~] Y e s [ ~ ] H o w m a n y SO- ' . 'ARY E M P L O Y E R A g e n c y l n s t i t - i i i - ' n : C t y E m p l o y m e n t S t a t u s . P u l l - t ' m e • P a r t - t i m e • C a s u a l Q O a t e c o m m e n c e d p r e s e n t e m p l o y m e n t ; Yr: Mo: O T H E R E M P L O Y E R : A g e n c y / i n s t i t u t i o n i C t y - ' E m p l o y m e n t S t a t u s F u l l - t i m e • - a r t - t i m e O C a s u a l C3 O a t e c o m m e n c e d p r e s e n t e m p l o y m e n t ; Yr: Mo: A c t u a l h o u r s w o r k e d i n n u r s i n g m ' 9 8 6 H o u r s 26 28 30 26 28 30 3 7 I you are not employed in nursing and you wish to apply for NON-PRACTICING membership, please turn form over. Hew many hours did you work in NURSING in 1987? Full-time O (1500 hours will be recorded) or actual hours Have you completed a nursing refresher course in the past 5 years? NO • YES • It yes. when? Yr Ui ,cu new on maternity, disability, educational or other leave of absence from work? NO • YES • )c you held a current practicing/active membership n another Province/Territory? NO I l YFSi i if Yes where? Province/Territory 19 ; Registration Number 20 | Please attach photocopy of current membership card. =R£3Y APPLY FOR PRACTICING MEMBERSHIP 33 FEE S .Mo.. 43 . 31 IMPORTANT: PRINT YOUR REGISTRATION NUMBER ON BACK OF CHEQUE OR MONEY ORDER TO ENSURE CORRECT IDENTIFICATION OF PAYMENT. HAVE YOU COMPLETED ITEMS0THROUGH©? Amount Submitted S . X SIGNATURE late rcr /cur protection and convenience a Security Key Word is being added to your record. Ve suggest you select your mother's maiden name. See enclosed pamphlet. YOUR PERSONAL SECURITY WORD . 10 EDUCATION >LEASE REVIEW THE FOLLOWING SECTIONS CAREFULLY. 'he employment, education and other information on our files are given in the sections :e'c.vind'cated by an asterisk (•) or letter in the shaded column headed "F" (for file). If the ~!cr—ation is out of date or uncomplete please correct it by placing a check V) in the Ciymn marked "N" (for new). :r enmar/ employment check ONE only in each of A, B andC. B. P O S I T I O N PRESENT EMPLOYMENT IN NURSING elect one of the four main areas. Direct Patient Administration. Education or Research, then I D i r e c t o r I A s s o c i a t e ' A s s i s t a n t O i r e c t o r | 2 A I ;oi i 0 2 ' t h e most appropriate box i n that area. • S u p e r v i s o r • A s s i s t a n t S u p e r v i s o r | 0 3 ! j u q v A R E A C F R E S P O N S I B I L I T Y 25 F N | C l i n i c a l S p e c i a l i s t / C l i n i c i a n 0 4 : f P A T I E N T C A R E H e a d N u r s e ' A s s i s t a n t H e a d N u r s e 0 5 ! 11 S t a l l / G e n e r a l O u t y N u r s e 0 6 1 | C i r e cj C U . C R E R l O i C o m / O c c H e a l t h / H o m e C a r e N u r s e 0 7 i 2' N.VArjorn 131 i n s t r u c t o r / P r o l e s s o r [ OS j ! f . V e n t a i H e a l t h 1 4 \ C o n s u l t a n t ' C o u n s e l l o r 0 9 ; . ' • : s 151 | O t h e r n o t l i s t e d 8 8 : •r.z Zi-.rw.qy 161 C. P L A C E C F E M P L O Y M E N T 2 3 i F N v. - - ' . i -"ia l h . ; i i i A c u t e C a r e H o s p i t a l 0:. 1 ' i ' r i s - ' ' c a t s m " o ^ : j , c o m m u n i t y 13 | A c t i v a t i o n .-• R e h a b H o s p i t a l 0 2 ' | ! : it - : - t C a r * 19 E x t e n d e d C a r e H o s p i t a l 0 3 - i ••T = A r r f , I: ' P s y c h i a t r i c Hospital 0 4 : ; | j . c a t : n A c i n m i s l r a t i o n f 2 , i | L o n g T e r m C a r e F a c i l i t y / N u r s i n g H o m e 0 5 ! i j , if. c e s A . ^ - i . n . s l ' . i t i o n 2 2 H o m e C a r e / V ' S i t m g C a r e A g e n c y 0 6 i i • i j r r s t f i f e n 2 3 i C o m m u n i t y H e a l t h A g e n c y 0 7 . ! ! •" ~ N Cl B u s i n e s s ' i n d u s t r y 0 8 , i 1 . - 3 • V . 31 P h y s i c i a n s O f f i c e > F a m i l y P r a c t i c e U n i t 0 9 ; - g • I—-- ,-?•;> 3 2 ! ! E d u c a t i o n ' n s M u t i o n 1 0 ! * ; • - i : -."vs C . o n t s 1" i S e l l - e m p i o / e d 111 r a ^ ; - . . . r E d u c i f c n 1 3 3 1 1 O t h e r , n o t i . s t e d 3 3 | 1 . „ 1 i B A S I C N U R S I N G E D U C A T I O N 16 F N O i D l o m a B a c c a l a u r e a t e D e g r e e M a s t e r s D e g r e e 3 i P O S T B A S I C m e a n s e d u c a t i o n c o m p l e t e d A F T E R y o i o r i g i n a l n u r s i n g p r o g r a m w h i c h l e a d t o n u r s e r e g i s t r j t i o n . P l e a s e c h e c k o n l y h i g h e s t l e v e l c o m p l e t e d . P O S T B A S I C N U R S I N G E O U C A T I O N 2 1 ! F N N o n e of t h e l o l l o w m g 51 O o c t o r a t e 4 i M a s t e r ' s D e g r e e 3 ! P o s t B a s i c B a c c a l a u r e a t e D e g r e e 2 ; i P o s t B a s i c C e r t i f i c a t e / D i p l o m a | 1 I i O T H E R T H A N N U R S I N G 2 2 F N [ N o n e o l t h e f o l l o w i n g | D o c t o r a t e 4 ! M a s t e r ' s D e g r e e 3 ; B a c c a l a u r e a t e O e g r e e 2 ! C e r t i f i c a t e / D i p l o m a ! 1 1 C h e c k all boxes w h i c h are a p p r o p r i a t e . : C U R R E N T E N R O L L M E N T IN A N E D U C P R O G 3 2 F N i N o t C u r r e n t l y E n r o l l e d i n P r o g r a m E n r o l l e d i n N u r s i n g P r o g r a m N E n r o l l e d i n N o n - N u r s i n g P r o g r a m To! F u l l - T i m e S t u d e n t F j P a r t - T i m e S t u d e n t P : T Y P E O F P R O G R A M 3 2 ' N o n e of t h e f o l l o w i n g 1 5 1 ! D o c t o r a t e I4 ! M a s t e r s 3 1 B a c c a l a u r e a t e 2 1 141 APPENDIX B L e t t e r s t o P a r t i c i p a n t s APPENDIX C inographic Dat 145 DEMOGRAPHIC DATA 1. How many years have you been employed as a nurse' ( I f your employment has been p a r t time or s p o r a d i c , please estimate employment In f u l l time e q u i v a l e n t years.) 2. Your i n i t i a l n u r s i n g e d u c a t i o n was a ... H o s p i t a l diploma program C o l l e g e diploma program Generic b a c c a l a u r e a t e program 3. Have you ever e n r o l l e d i n a post b a s i c , or c o n t i n u i n g e d u c a t i o n n u r s i n g course? No Yes If Yes, please d e s c r i b e . 4. Do you p a r t i c i p a t e i n RNABC or BCNU a c t i v i t i e s ? No Yes If yes, i n what c a p a c i t y ? 5. Do you expect t o advance t o an a d m i n i s t r a t i v e p o s i t i o n w i t h i n the next f i v e years? No Yes 6. Do you have any u n i v e r s i t y or c o l l e g e l e v e l academic c r e d i t i n a d d i t i o n t o your b a s i c n u r s i n g education? No Yes. If yes, pl e a s e d e s c r i b e . 7. Please s t a t e the name and l o c a t i o n of the n u r s i n g s c h o o l t h a t you attended. 8. Please s t a t e your age. Completion of t h i s q u e s t i o n a i r e i n d i c a t e s your consent to p a r t i c i p a t e i n t h i s study. 146 APPENDIX D Measure of E p i s t e m o l o g i c a l R e f l e c t i o n 147 MEASURE OF EPISTEMOLOGICAL REFLECTION 1 INSTRUCTIONS: The q u e s t i o n n a i r e t h a t f o l l o w s has to do with your p e r s p e c t i v e on a number of concerns r e l a t e d t o l e a r n i n g . Each of the q u e s t i o n s on the f o l l o w i n g pages asks f o r your o p i n i o n or ch o i c e on a giv e n s u b j e c t , and the REASONS why you have t h a t p a r t i c u l a r p e r s p e c t i v e or opi n i o n . I am i n t e r e s t e d i n understanding your p e r s p e c t i v e as f u l l y as p o s s i b l e . Please g i v e as much d e t a i l as you can to d e s c r i b e how you f e e l about each question. F e e l f r e e to use the backs of pages i f you need more space. Code # ( o f f i c e use) Measure of Epistemological Reflection Page 2 Protocol # 148 THINK ABOUT THE LAST TIME YOU HAD TO MAKE A MAJOR DECISION ABOUT YOUR EDUCATION IN WHICH YOU HAD A NUMBER OF ALTERNATIVES (E.G., WHICH COLLEGE TO ATTEND, COLLEGE MAJOR, CAREER CHOICE, ETC.). WHAT WAS THE NATURE OF THE DECISION? WHAT ALTERNATIVES WERE AVAILABLE TO YOU? HOW DID YOU FEEL ABOUT THESE ALTERNATIVES? HOW DID YOU GO ABOUT CHOOSING FROM THE ALTERNATIVES? WHAT THINGS WERE THE MOST IMPORTANT CONSIDERATIONS IN YOUR CHOICE? PLEASE GIVE DETAILS. Measure of Epistemological Reflection Page 3 Protocol # 149 DO YOU LEARN BEST IN CLASSES WHICH FOCUS ON FACTUAL INFORMATION OR CLASSES WHICH FOCUS ON IDEAS AND CONCEPTS? WHY DO YOU LEARN BEST IN THE TYPE OF CLASS YOU CHOSE ABOVE? WHAT DO YOU SEE AS THE ADVANTAGES OF THE CHOICE YOU MADE ABOVE? WHAT DO YOU SEE AS THE DISADVANTAGES OF THE CHOICE YOU MADE ABOVE? IF YOU COULD GIVE ADVICE TO ANYONE ON HOW BEST TO SUCCEED IN COLLEGE COURSEWORK, WHAT KIND OF ADVICE WOULD YOU GIVE THEM? TALK ABOUT WHAT YOU BELIEVE IS THE KEY TO DOING WELL IN COLLEGE COURSES. Measure of Epistemological Reflection Page 4 Protocol # 150 DURING THE COURSE OF YOUR STUDIES, YOU HAVE PROBABLY HAD INSTRUCTORS WITH DIFFERENT TEACHING METHODS. AS YOU THINK BACK TO INSTRUCTORS YOU HAVE HAD, DESCRIBE THE METHOD OF INSTRUCTION WHICH HAD THE MOST BENEFICIAL EFFECT ON YOU. WHAT MADE THAT TEACHING METHOD BENEFICIAL? PLEASE BE SPECIFIC AND USE EXAMPLES. WERE THERE ASPECTS OF THAT TEACHING METHOD WHICH WERE NOT BENEFICIAL? IF SO, PLEASE TALK ABOUT SOME OF THE ASPECTS AND WHY THEY WERE NOT BENEFICIAL. WHAT ARE THE MOST IMPORTANT THINGS YOU LEARNED FROM THE INSTRUCTORS METHOD OF TEACHING? j . PLEASE DESCRIBE THE TYPE OF RELATIONSHIP WITH AN INSTRUCTOR THAT WOULD HELP YOU TO LEARN BEST AND EXPLAIN WHY. Measure of Epistemological Reflection Page 5 Protocol # 151 DO YOU PREFER CLASSES IN WHICH THE STUDENTS DO A LOT OF TALKING, OR WHERE STUDENTS DONT TALK VERY MUCH? WHY DO YOU PREFER THE DEGREE OF STUDENT INVOLVEMENT/ PARTICIPATION THAT YOU CHOSE ABOVE? WHAT DO YOU SEE AS THE ADVANTAGES OF YOUR PREFERENCE ABOVE? WHAT DO YOU SEE AT THE DISADVANTAGES OF YOUR PREFERENCE? WHAT TYPE OF INTERACTIONS WOULD YOU LIKE TO SEE AMONG MEMBERS OF A CLASS IN ORDER TO ENHANCE YOUR OWN LEARNING? Measure of Epistemological Reflection Page 6 Protocol # 152 SOME PEOPLE THINK THAT HARD WORK AND EFFORT WILL RESULT IN HIGH GRADES EST SCHOOL. OTHERS THINK THAT HARD WORK AND EFFORT ARE NOT A BASIS FOR HIGH GRADES. WHICH OF THESE STATEMENTS IS MOST LIKE YOUR OWN OPINION? IDEALLY, WHAT DO YOU THINK SHOULD BE USED AS A BASIS FOR EVALUATING YOUR WORK IN COLLEGE COURSES? WHO SHOULD BE INVOLVED IN THE EVALUATION YOU DESCRIBED ABOVE? PLEASE EXPLAIN WHY YOU THINK THE RESPONSE YOU SUGGESTED ABOVE IS THE BEST WAY TO EVALUATE STUDENTS' WORK IN COLLEGE COURSES. Measure of Epistemological Reflection Page 7 Protocol # 153 SOMETIMES DIFFERENT INSTRUCTORS GIVE DIFFERENT EXPLANATIONS FOR HISTORICAL EVENTS OR SCIENTIFIC PHENOMENA. WHEN TWO INSTRUCTORS EXPLAIN THE SAME THING DIFFERENTLY, CAN ONE BE MORE CORRECT THAN THE OTHER? WHEN TWO EXPLANATIONS ARE GIVEN FOR THE SAME SITUATION, HOW WOULD YOU GO ABOUT DECIDING WHICH EXPLANATION TO BELIEVE? PLEASE GIVE DETAILS AND EXAMPLES. CAN ONE EVER BE SURE OF WHICH EXPLANATION TO BELIEVE? IF SO, HOW? IF ONE CAN'T BE SURE OF WHICH EXPLANATION TO BELIEVE, WHY NOT? APPENDIX E R a t i n g S c o r e s on the Measure E p i s t e m o l o g i c a l R e f l e c t i o n 155 Appendix E R a t i n g S c o r e s on the Measure of  E p i s t e m o l o g i c a l R e f l e c t i o n Domain S u b j e c t 1 2 3 4 5 6 TPR 3 1.1.1 2.1.1 3.3.2 4.2.4 5.3.3 6.3.2 2.17 11 1.4.1 2.4.1 3.3.1 4.3.1 5.3.5 6.4.5 3.50 18 1.3.2 2.5.4 3.5.2 4.3.5 5.3.3 6.5.1 4.00 24 1.3.2 2.3.2 3.2.3 4.4.4 5.2.2 6.5.1 2.83 44 1.2.3 2.3.2 3.2.3 4.4.1 5.2.2 6.3.3 2.67 46 1.3.1 47 1.3.3 55 1.3.1 60 1.2.3 88 1.2.1 2.4.2 3.4.2 2.3.3 3.2.4 2.4.2 3.3.5 2.2.1 3.2.3 2.3.2 3.2.1 4.5.2 5.3.1 4.3.2 5.3.3 4.3.1 5.4.2 4.3.1 5.2.5 4.2.4 5.5.2 6.4.3 3.83 6.2.1 2. 67 6.3.2 3.33 6.3.2 2.33 6.3.2 2.83 100 1.3.1 101 1.3.1 106 1.4.6 118 1.3.2 122 1.2.2 2.3.2 3.3.3 2.3. 1 3.3.4 2.4.4 3.0.0 2.3.2 3.3.3 2.0.0 3.4.4 4.3.1 5.3.3 4.2.4 5.2.2 4.4.1 5.2.5 4.2.7 5.3.4 4.4.4 5.3.1 6.2.2 3. 00 6.3.2 2.67 6.3.2 3.40 6.2.1 2.67 6.3.2 3.20 156 Subj e c t 1 124 1.3.4 128 1.3.2 129 1.1.1 135 1.4.1 149 1.4.3 153 1.3.3 157 1.3.2 161 1.3.2 166 1.2.1 167 1.4.1 168 1.4.5 170 1.5.4 171 1.3.2 187 1.2.2 Appendix E ( c o n t i n u e d ) Domain 2 3 4 2.2.1 3.3.7 4.2.3 2.4.1 3.3.2 4.3.5 2.3.2 3.3.7 4.3.4 2.0.0 3.3.4 4.2.4 2.4.2 3.4.-4 4.4.1 2.3.1 3.1.1 4.3.1 2.2.1 3.3.7 4.2.4 2.2.1 3.4.4 4.5.1 2.3.1 3.2.2 4.2.1 2.4.2 3.3.7 4.2.4 2.2.1 3.2.2 4.3.3 2.0.0 3.4.1 4.5.2 2.3.1 3.4.4 4.2.2 2.3.3 3.3.4 4.2.4 5 6 TPR 5.3.5 6.2.1 2.50 5.2.2 6.3.2 3.00 5.3.5 6.2.1 2.50 5.3.2 6.0.0 3. 00 5.3.5 6.3.2 3.67 5.2.5 6.2.2 2.33 5.2.1 6.5.2 2. 67 5.5.1 6.5.2 4. 00 5.3.5 6.4.2 2.67 5.3.1 6.5.2 3. 50 5.3.5 6.2.3" 2. 67 5.3.4 6.2.3 3.80 5.2.2 6.5.1 3. 17 5.2.2 6.3.2 2. 67 TPR = T o t a l P r o t o c o l R a t i n g 

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