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Student’s perceptions of clinical experiences Pinkham, Judith Mary 1976

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STUDENT'S PERCEPTIONS OF CLINICAL EXPERIENCES by JUDITH MARY PINKHAM B.N., M c G i l l U n i v e r s i t y , 1970 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in the School of Nursing We accept t h i s t h e s i s as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1976  In  presenting  an  advanced  the I  Library  this  degree shall  f u r t h e r agree  for  scholarly  by h i s of  this  written  at make  that  thesis  freely  may It  is  University  British  of  Columbia,  British  by  for  gain  Columbia  shall  the  that  not  requirements I  agree  r e f e r e n c e and copying  t h e Head o f  understood  NURSING  of  of  for extensive  permission.  of  fulfilment  available  be g r a n t e d  financial  20 75 W e s b r o o k P l a c e V a n c o u v e r , Canada V6T 1W5  Date  it  permission  purposes  for  in p a r t i a l  the U n i v e r s i t y  representatives.  Department The  thesis  of  be a l l o w e d  or  that  study.  this  thesis  my D e p a r t m e n t  copying  for  or  publication  without  my  i  ABSTRACT STUDENT'S PERCEPTIONS OF CLINICAL EXPERIENCES JUDITH MARY PINKHAM Student's f e e l i n g s , ideas and understandings of t h e i r experiences when l e a r n i n g to nurse have r e c e i v e d very l i t t l e a t t e n t i o n as i n d i c a t e d by the nursing l i t e r a t u r e .  The purpose of t h i s study was to develop a tool  which would gather data of the student's p e r c e p t i o n s of her c l i n i c a l l e a r n i n g experiences.  The type of tool s e l e c t e d f o r development was a q u e s t i o n n a i r e .  The questions were d e r i v e d from three s p e c i f i c areas: past l e a r n i n g e x p e r i ences, e x p e c t a t i o n s o f the teacher and the i n d i v i d u a l ' s ideas o f her own l e a r n i n g needs i n the c l i n i c a l s e t t i n g . A sample o f s i x t y - f o u r student nurses from three b a s i c n u r s i n g educat i o n programs were s e l e c t e d . These s t u d e n t s , midway through t h e i r programs, had a l l had c l i n i c a l l e a r n i n g e x p e r i e n c e s .  The data were c o l l e c t e d by the  r e s e a r c h e r who administered the q u e s t i o n n a i r e .  A l l students who were asked  to v o l u n t e e r d i d so, a l l questions were completed by each group of students. The data r e s u l t s were compiled n o t i n g i n d i v i d u a l responses as well as s i m i l a r i t i e s and d i f f e r e n c e s between s c h o o l s .  No s i g n i f i c a n t d i f f e r e n c e s were  noted i n the responses between the three d i f f e r e n t nursing programs.  A  s i m i l a r i t y o f responses was noted f o r the m a j o r i t y of questions across the three s c h o o l s .  The students' c h o i c e o f responses supports many o f the f i n d i n g s  r e v e a l e d i n the l i t e r a t u r e review.  A s p e c i f i c preference f o r a small c l a s s  s i z e and the l e c t u r e - d i s c u s s i o n method of i n s t r u c t i o n was e v i d e n t .  Students  expressed a p o s i t i v e f e e l i n g toward c l i n i c a l e v a l u a t i o n , but i n d i c a t e d t h a t r e c e i v i n g a c l i n i c a l e v a l u a t i o n from a teacher caused them a high degree of stress.  F i f t y - f o u r per cent of the students supported past f i n d i n g s which  ii  suggest t h a t students b e l i e v e they most o f t e n r e c e i v e feedback from the teacher when they have performed u n s a t i s f a c t o r i l y .  The m a j o r i t y of students  b e l i e v e d t h a t teachers d i d p e r c e i v e themselves as c o u n s e l o r s .  One-third of  the students i n d i c a t e d they thought teachers avoided g i v i n g d i r e c t n e g a t i v e criticism.  Another o n e - t h i r d b e l i e v e d t h i s might happen but had not person-  a l l y experienced i t . I n d i v i d u a l responses to the questions i n d i c a t e d a wide v a r i e t y o f p e r c e p t i o n s r e l a t e d to c l i n i c a l l e a r n i n g e x p e r i e n c e s .  Although the tool may  give an i n d i c a t i o n of trends i n student's ideas and f e e l i n g s , i t i s p r i m a r i l y designed to be used with i n d i v i d u a l students.  Knowledge of the i n d i v i d u a l ' s  p e r c e p t i o n s may g i v e the teacher i n s i g h t i n t o the meaning of events to the learner.  Students i n a l l t h r e e s c h o o l s gave p o s i t i v e support f o r the c o l l e c -  t i o n and use of these data i n attempting to improve i n d i v i d u a l t e a c h i n g / l e a r n i n g experiences i n the c l i n i c a l area.  85 pages  iii  TABLE OF CONTENTS CHAPTER  PAGE  I.  1  II.  INTRODUCTION The Purpose o f the-Study  3  Assumptions o f the Study  4  L i m i t a t i o n s o f the Study  4  D e f i n i t i o n o f Terms  4  Overview of the Remainder o f the Study  5  REVIEW OF RELATED LITERATURE Introduction ' Learning Needs o f I n d i v i d u a l s The Role o f Perception i n D e f i n i n g I n d i v i d u a l Needs  III.  6 6 7 9  The I n d i v i d u a l ' s S e l f Concept as an I n f l u e n c e i n D e f i n i n g Needs  10  Past Learning Experiences  12  The Need f o r Knowledge o f Past Learning Experiences  12  The E f f e c t s o f Past Learning Experiences on the I n d i v i d u a l . . .  13  Student Expectations o f the Teacher  14  Summary  20  METHOD  22  Introduction  22  P o p u l a t i o n o f the Study  22  Development o f the Tool  23  The P i l o t Study  24  R e v i s i o n o f the Tool  -25  C o l l e c t i o n o f Data  25  A n a l y s i s o f Data  26  iv  CHAPTER IV.  PAGE  FINDINGS, ANALYSIS AND INTERPRETATION  28  . Introduction  28  Responses to Questions Related to Past Learning Experiences . .  28  Responses t o Questions R e l a t e d t o Student E x p e c t a t i o n s o f t h e teacher  38  Responses to Questions Related to the I n d i v i d u a l Needs o f the student Summary V.  SUMMARY, CONCLUSIONS AND RECOMMENDATIONS  .  44 53 54  S u b s t a n t i v e Conclusions and Recommendations  55  Methodological Conclusions and Recommendations  58  Summary  59  BIBLIOGRAPHY  60  APPENDIXES  64  A  Questionnaire  67  B  Cover L e t t e r f o r Q u e s t i o n n a i r e sent t o Schools o f Nursing . . .  76  C  Percentage Responses to Items on Q u e s t i o n n a i r e s by each P a r t i c i p a t i n g School  78  LIST OF TABLES TABLE  PAGE  I  Responses to Questions A l and A2  29  II  Responses to Questions A3 and A4  30  III  Responses to Questions A5 and A6  32  IV  Responses to Questions A7 and A8  33  V  Responses to Questions A9 and AIO  35  VI  Responses to Questions A l l and A12  37  Responses to Questions BI and B2  39  Responses to Questions B3, B4 and B5  40  IX  Responses to Questions B6 and B7  43  X  Responses to Questions B8 and B9  45  Responses to Questions C I , C2 and C3  47  XII  Responses to Questions C4 and C5  50  XIII  Responses to Questions C6 and C7  51  XIV  Responses to Questions C8 and C9  52  VII VIII  XI  CHAPTER I INTRODUCTION The numbers o f students from the h e a l t h care p r o f e s s i o n s u t i l i z i n g community c l i n i c a l resources has i n c r e a s e d d u r i n g the past y e a r s .  The  use o f c l i n i c a l f a c i l i t i e s to provide the student with e a r l y c l i e n t c o n t a c t in o r d e r to develop knowledge o f c l i e n t experiences has been viewed as important i n developing an understanding o f the r o l e o f the nurse as a h e a l t h care p r o f e s s i o n a l . Due to the l a r g e numbers o f students i n c l i n i c a l areas the a l l o t t e d time must be used to i t s optimum advantage.  The a b i l i t y o f nursing students  to u t i l i z e t h i s l e a r n i n g time i s complicated by many v a r i a b l e s .  Dissatis-  f a c t i o n with nursing i n the c l i n i c a l area may be one o f these f a c t o r s . Three s t u d i e s , done i n 1951, 1968 and 1974, have each d e s c r i b e d d i s s a t i s f a c t i o n with nursing courses as a major reason given by nursing 1 2 3 students who withdrew from n u r s i n g programs. ' ' drawal i n c l u d e :  Reasons given f o r w i t h -  (1) d i s l i k e f o r n u r s i n g , (2) d i s s a t i s f a c t i o n with nursing  f a c u l t y , (3) f a i l u r e i n classwork, (4) disappointment i n the n u r s i n g c o u r s e s , (5) d i f f i c u l t y i n succeeding i n c l i n i c a l p r a c t i s e c o u r s e s , and (6) d i f f i c u l t y with c l i n i c a l theory c o u r s e s . ^"Withdrawal o f Students," American Journal o f Nursing, Vol.51 (May, 1951), 342-343. 2 Barbara C. Rottkamp, " A t t r i t i o n Rates i n B a s i c B a c c a l a u r e a t e Nursing Programs," Nursing Outlook, (June, 1968), 45. 3 Michael H. M i l l e r , "A Follow-up of F i r s t Year Nursing Student Dropouts," Nursing Forum, Vol.13 No.l, 1974.  2 These s t u d i e s appear to support the idea t h a t n u r s i n g experiences viewed as negative experiences may l e a d to a t t r i t i o n . Student perceptions o f c l i n i c a l experiences do i n f l u e n c e behavior. Combs has w r i t t e n e x t e n s i v e l y on the r o l e o f p e r c e p t i o n as i t a f f e c t s behavior.  He suggests t h a t i f the p e r c e p t i o n i s one o f t h r e a t the per4  ceptual f i e l d i s narrowed and new p e r c e p t i o n s or l e a r n i n g are decreased. P e r c e p t i o n of events and t h e i r meaning to the i n d i v i d u a l a l s o play a major r o l e i n developing the s e l f concept.  Coopersmith has pointed out  the s i g n i f i c a n t d i f f e r e n c e s i n the e x p e r i e n t i a l worlds and s o c i a l behavior 5  of persons who d i f f e r i n s e l f - e s t e e m .  Super s work suggests t h a t i n  choosing an occupation the i n d i v i d u a l chooses a means o f implementing a self concept.  6  Lack of congruence between e x p e c t a t i o n s and r e a l i t y may l e a d to withdrawal.  K i b r i c k , i n a study on the e f f e c t o f s e l f and r o l e p e r c e p t i o n  of dropouts i n schools o f n u r s i n g , has supported t h i s i d e a . If a student i n the program f a i l s to a d j u s t or continue i n the program i t may be due to not o n l y e x p e c t a t i o n s o f the p r e s c r i b e d r o l e i n terms of performance and behavior but because the student's p e r s o n a l i t y and a t t r i b u t e s are such t h a t s p e c i a l demands, not n e c e s s a r i l y i n c l u d e d i n the p r e s c r i b e d r o l e , are made which the A. W. Combs, " I n t e l l i g e n c e from a Perceptual P o i n t o f View," Journal of Abnormal and S o c i a l Psychology, Vol.47, 662-673. ^ S t a n l e y Coopersmith, The Antecedents of S e l f - E s t e e m , F r a n c i s c o : W. H. Freeman and Company, 1967). c  D. E. Super,"Vocational Adjustment; Occupations, Vol.30 (November, 1951), 92.  Implementing  (San  a S e l f Concept,"  3  nursing school i s u n w i l l i n g or unable to meet, or s p e c i a l needs i n the student are foremost which the school cannot meet. 7  Knowledge of student's p e r c e i v e d needs i s b e l i e v e d to be important i n planning experiences which can best develop student p o t e n t i a l .  The  purpose o f t h i s study i s to develop a tool which w i l l gather data o f student p e r c e p t i o n s to f a c i l i t a t e implementing t h i s b e l i e f i n the t e a c h i n g / l e a r n i n g process. I.  THE PURPOSE OF THE STUDY  This e x p l o r a t o r y study i s designed to gather data o f student perc e p t i o n s o f c l i n i c a l experiences i n three s p e c i f i c areas.  These are: the  student's perceptions o f past l e a r n i n g e x p e r i e n c e s ; the student's expectat i o n s o f the teacher; and, the student's ideas o f personal l e a r n i n g needs. The study focuses on the student's i d e a s , f e e l i n g s and understandings asking f o r c e d c h o i c e questions which reveal a p i c t u r e of the past experiences o f the individual.  These i d e a s , f e e l i n g s and understandings are c o n s t a n t l y i n f l u e n c e d  by events i n the environment.  They r e f l e c t only the moment i n time a t which  they are r e v e a l e d and may a l t e r or disappear i n a s h o r t time.  Perceptions  give c l u e s t o ideas and a c t i o n s but must be recognized as r e q u i r i n g constant validation. Past l e a r n i n g e x p e r i e n c e s , e x p e c t a t i o n s o f the teacher and i n d i v i d u a l l e a r n i n g needs were three areas s e l e c t e d f o l l o w i n g a review of the l i t e r a t u r e and d i s c u s s i o n s with student nurses.  Not a l l students may have experienced  problems r e l a t e d to these s e l e c t e d areas.  Space on the q u e s t i o n n a i r e f o r  Anne K. K i b r i c k , "Dropouts i n Schools of Nursing: The E f f e c t of S e l f and Role P e r c e p t i o n , " Nursing Research, Vol.12 No.3 (Summer 1963), 140-149.  4 the student to share her own ideas i s a suggestion to overcome t h i s l i m i t a t i o n when the tool i s used i n p r a c t i s e . II.  ASSUMPTIONS OF THE STUDY  The f o l l o w i n g three assumptions guided development o f the study: - student l e a r n i n g i n t h e c l i n i c a l area i s i n f l u e n c e d by past l e a r n i n g e x p e r i e n c e s . - student p e r c e p t i o n s o f the e x p e c t a t i o n s o f the teacher may d i f f e r from the teacher's own e x p e c t a t i o n s . - students have unique i n d i v i d u a l needs which i n f l u e n c e their learning a b i l i t y . III.  LIMITATIONS OF THE STUDY  The study was l i m i t e d by the type o f data c o l l e c t e d , i e . student p e r c e p t i o n s , and the f a c t t h a t o n l y three s p e c i f i c t o p i c areas were questioned. VI.  DEFINITION OF TERMS  C l i n i c a l Experience - the events a student experiences i n the c l i n i c a l setting. Nursing Student - a student e n r o l l e d i n a b a s i c nursing education program p r e p a r a t o r y to nurse r e g i s t r a t i o n (R.N.).  Students s e l e c t e d from t h r e e  nursing programs i n the B r i t i s h Columbia lower mainland were, i n t h e m a j o r i t y , midway through t h e i r b a s i c nursing e d u c a t i o n . Past Learning Experiences - t h i s r e f e r s t o t e a c h i n g / l e a r n i n g experiences in the student's nursing education which have o c c u r r e d p r i o r to answering the study q u e s t i o n s .  5 P e r c e p t i o n - the i n t e g r a t i o n o f sensory impressions o f events i n the external world as a f u n c t i o n o f nonconscious e x p e c t a t i o n s d e r i v e d from past experiences and s e r v i n g as a b a s i s f o r f u r t h e r meaningful  motivated  action.^ Personal Learning Needs - t h i s r e f e r s t o the ideas which the student has of the f a c t o r s perceived i n the environment,  i n other people, o r w i t h i n  h e r s e l f which can a s s i s t her to l e a r n . OVERVIEW OF THE REMAINDER OF THE STUDY The study i s organized i n the f o l l o w i n g way. Chapter II c o n s i s t s of a s e l e c t e d review o f the l i t e r a t u r e p e r t a i n i n g t o l e a r n i n g needs o f i n d i v i d u a l s , the e f f e c t o f past l e a r n i n g experiences o f the i n d i v i d u a l , and student e x p e c t a t i o n s o f the teacher.  S e l e c t e d a r t i c l e s and s t u d i e s  from n u r s i n g , education and psychology a r e i n c l u d e d . Chapter I I I d i s cusses the research d e s i g n , and a n a l y s i s o f t h e data.  Chapter IV d i s -  cusses the f i n d i n g s , a n a l y s i s , and i n t e r p r e t a t i o n and Chapter V i n c l u d e s the summary, c o n c l u s i o n s and recommendations.  P h i l i p Babcock Grove, ed., Webster's D i c t i o n a r y - 3rd New I n t e r national D i c t i o n a r y ( S p r i n g f i e l d , Massachusetts: G.& G. Merriam Company, 1971), 1675.  CHAPTER II  REVIEW OF RELATED LITERATURE INTRODUCTION L i t e r a t u r e r e l a t e d to the student's p e r c e p t i o n s o f c l i n i c a l experiences was c l a s s i f i e d i n t o three general areas as f o l l o w s : 1  Learning needs of i n d i v i d u a l s  2  Past l e a r n i n g experiences  3  Student e x p e c t a t i o n s o f the teacher  These three areas are d i s c u s s e d i n t h i s chapter.  The t o p i c s have  been broken down i n t o s e c t i o n s which examine each of these broad areas i n more d e t a i l . There have been a few s t u d i e s and a r t i c l e s i n the n u r s i n g l i t e r a t u r e which examined f a c t o r s which c o u l d i n f l u e n c e student's p e r c e p t i o n s o f c l i n i c a l learning experiences. Metz and McCleary have looked at past l e a r n i n g experiences and have g developed a tool to gather t h i s data.  Kellogg has i n t e r v i e w e d students to  gather i n f o r m a t i o n r e l a t e d to personal g o a l s asking q u e s t i o n s i n an i n t e r view which gave a p i c t u r e of i n d i v i d u a l needs E d i t h A. Metz and C. M. McCleary, "Knowing the L e a r n e r , " The Journal of Nursing E d u c a t i o n , (January, 1970), 3-9. ^ C a r o l y n Jo K e l l o g g , " I n d i v i d u a l i z i n g Teaching o f Students," The Journal of Nursing Education, Vol.14 No.3 (August, 1975), 14.  7 Fox's study of s t r e s s e s and s a t i s f a c t i o n s i n nursing education r e v e a l e d the p e r c e p t i o n s of student n u r s e s . ^  Olesen's s o c i o l o g i c a l study c a r r i e d 12 out i n a school o f nursing r e v e a l e d many student a t t i t u d e s and i d e a s . LEARNING NEEDS OF INDIVIDUALS R e c o g n i t i o n of the d i f f e r e n c e s and s i m i l a r i t i e s i n l e a r n i n g needs o f i n d i v i d u a l students has been acknowledged by teachers but has not a l ways been a major c o n s i d e r a t i o n i n planning l e a r n i n g e x p e r i e n c e s .  Carroll  b e l i e v e s t h a t a student's a b i l i t y to l e a r n w i l l be higher i f the teaching 13 i s i n accord with the student's a b i l i t i e s .  C a r r o l l ' s l e a r n i n g model has  been a p p l i e d to nursing education by Wolf and Q u i r i n g . ^ cussion  In t h e i r d i s -  the authors r a i s e the p o i n t t h a t the time spent i n determining  behavioral o b j e c t i v e s , and i n sequencing the l e a r n i n g t a s k s has l e f t l i t t l e time f o r examining the means to a s s i s t students to achieve the l e a r n i n g objectives.  C a r r o l l ' s model, from general e d u c a t i o n , d e s c r i b e s f o u r v a r i a b l e s  which i n f l u e n c e l e a r n i n g : a p t i t u d e ; a b i l i t y to understand i n s t r u c t i o n s ; q u a l i t y o f i n s t r u c t i o n ; o p p o r t u n i t y f o r l e a r n i n g , and perseverence. " D a v i d J . Fox, et a l . S a t i s f y i n g and S t r e s s f u l S i t u a t i o n s i n B a s i c Programs i n Nursing Education, Teachers C o l l e g e Columbia U n i v e r s i t y . ( 1 9 6 4 ) . 12 V i r g i n i a Olesen and E l v i W. Whittaker, The S i l e n t Dialogue (San F r a n c i s c o : Jossey-Boss Inc., 1968). — 13 J . B. C a r r o l l , "A Model of School L e a r n i n g , " Teachers C o l l e g e Record, Vol.64 (May, 1963), 723-733. 14 V. C. Wolf and J . Q u i r i n g , " C a r r o l l ' s Model A p p l i e d to Nursing E d u c a t i o n , " Nursing Outlook, Vol.19 No.3 (March, 1971), 176-179.  8  These variables have been reviewed by Wolf and Quiring using nursing education practises to raise questions and give suggestions.  In summary  the authors state: In view of the nursing manpower d e f i c i t and the increasing need for continuing education programs, nursing educators cannot afford to use instructional strategies that produce avoidance tendencies due to deficient or inferior mastery of the learning tasks associated with nursing or to the frustrations from accumulated f a i l u r e s . The instructional method must produce learners who continue to seek learning and gain satisfaction through their successful mastery of new knowledge and behaviors relevant to learning.^ 5  Gaining the knowledge o f factors which account for stress or s a t i s faction was the subject o f a study by F o x .  16  This study o f satisfying and  stressful situations in learning to nurse revealed that the satisfactions come mainly from the student's nursing experiences while the stresses come from the educational aspects o f the nursing program.  Fox suggests  that modifying the stresses by examining and revising the educational aspects o f the program is indicated. He suggests that any revision must be done with the knowledge o f the student's short and long range goals, and the social and cultural setting in which they operate. Kellogg agrees with this view.  Writing in the Journal of Nursing  Education she states: "An assessment of the student which recognizes the student as an individual and which highlights some o f the outside pressures helps pinpoint the student's needs which may affect her a b i l i t y to learn".''  , J  I b i d . , 179.  F o x , et a l . , Satisfying and Stressful Situations in Basic Programs in Nursing Education, p.194. 16  ^ K e l l o g g , "Individualizing Teaching of Students," p.14.  9 K e l l o g g s assessment i s c a r r i e d o u t i n a s t r u c t u r e d i n t e r v i e w where i n f o r 1  mation r e l e v a n t to the student's personal goals i s shared. These three authors appear to agree on the need t o assess t h e student as an i n d i v i d u a l with s p e c i f i c needs.  T h e i r emphasis i s on using t h i s  information to improve l e a r n i n g outcomes. Authors i n the behavioral s c i e n c e s have a l s o s t u d i e d the i n d i v i d u a l and h i s needs f o c u s i n g a t t e n t i o n on the r o l e o f perception i n d e f i n i n g needs. >  THE ROLE OF PERCEPTION IN DEFINING INDIVIDUAL NEEDS Arthur Combs d e s c r i b e s the growing trend toward viewing 18 as a f u n c t i o n o f p e r c e p t i o n .  behavior  The i n d i v i d u a l ' s behavior i s viewed, not so  much as the r e s u l t o f p h y s i c a l s t i m u l u s , but as a f u n c t i o n o f t h e meaning o f the events to which he i s exposed.  In Comb's a r t i c l e h i s a t t e n t i o n i s  d i r e c t e d to the nature o f i n t e l l i g e n c e as viewed from a perceptual frame of r e f e r e n c e .  The behavior o f the i n d i v i d u a l i s seen as dependent on h i s  p e r c e p t i o n s , i f these a r e adequate the behavior w i l l be a p p r o p r i a t e .  Using  t h i s idea Combs s t a t e s : "The i n t e l l i g e n c e o f an i n d i v i d u a l w i l l be dependent upon the r i c h n e s s and v a r i e t y o f h i s perceptions p o s s i b l e t o him a t . a given 19 moment". In examining f a c t o r s which l i m i t p e r c e p t i o n Combs has i n c l u d e d physiol o g i c a l f a c t o r s , environmental  f a c t o r s , the i n d i v i d u a l ' s goals and v a l u e s ,  c u l t u r a l e f f e c t s , the s e l f concept, and t h r e a t .  T h i s author sees goals and  A r t h u r Combs, " I n t e l l i g e n c e from a Perceptual Point o f View," Journal o f Abnormal and S o c i a l Psychology, Vol.47 (1952), 662-673. 19 I b i d . , 663.  10 values as e i t h e r p o s i t i v e o r n e g a t i v e , depending on previous e x p e r i e n c e s . Major goals and values remain r e l a t i v e l y s t a b l e but f l u c t u a t i o n s i n how these goals a r e p e r c e i v e d vary with the events t a k i n g p l a c e . Negative p e r c e p t i o n s t h a t a r e viewed as a t h r e a t a l s o have a d i r e c t e f f e c t on behavior.  Threat i s seen to have a r e s t r i c t i v e e f f e c t causing  narrowing o f the perceptual f i e l d i n what i s c a l l e d "tunnel v i s i o n " . Combs d e s c r i b e s the phenomona o f i n d i v i d u a l s who f e e l threatened drawing back, c l i n g i n g to o l d p e r c e p t i o n s . The threatened i n d i v i d u a l reduces h i s a b i l i t y to p e r c e i v e new ideas and l e a r n i n g may be decreased. Combs and Syngg have e l a b o r a t e d on these ideas i n a book c a l l e d 20 I n d i v i d u a l Behavior. R e l a t i n g t h e i r ideas to education the authors w r i t e : The genius o f good t e a c h i n g i s i n the a b i l i t y to c h a l l e n g e students without t h r e a t e n i n g them. To do t h i s e f f e c t i v e l y means t h a t teachers must be s e n s i t i v e to the impact upon t h e i r charges o f what they do and say, f o r the d i s t i n c t i o n between c h a l l e n g e and t h r e a t l i e s not i n what t h e teacher t h i n k s he i s doing - but i n what the students p e r c e i v e him to be d o i n g . ' 2  The authors suggest techniques f o r e x p l o r i n g an i n d i v i d u a l ' s p e r c e p t i v e field.  These i n c l u d e i n f o r m a t i o n from t h e i n d i v i d u a l h i m s e l f and i n f e r e n c e s  from observed behavior.  THE INDIVIDUAL'S SELF CONCEPT AS AN INFLUENCE IN DEFINING NEEDS Wylie, w r i t i n g i n her book The S e l f Concept, has used C a r l Roger's d e f i n i t i o n - the s e l f concept o r s e l f s t r u c t u r e may be thought o f as an  A r t h u r W. Combs and Donald Syngg, I n d i v i d u a l Behavior - A Perceptual Approach to Behavior. (New York: Harper and Row P u b l i s h e r s , 1959). 21  I b i d . , 389.  11 organized c o n f i g u r a t i o n o f p e r c e p t i o n s of the s e l f which are a d m i s s i b l e to awareness. It i s composed o f such elements as the p e r c e p t i o n s of one's c h a r a c t e r i s t i c s and a b i l i t i e s ; the percepts and concepts of the s e l f i n r e l a t i o n to others and to the environment; the value q u a l i t i e s which are p e r c e i v e d as a s s o c i a t e d with experiences and o b j e c t s ; and g o a l s and i d e a l s which are p e r c e i v e d as having p o s i t i v e or negative valence.22 The r o l e o f p e r c e p t i o n s i s important i n determining the s e l f concept. S. I. Hayakawa has s t a t e d t h a t the s e l f concept i s the fundamental 23 minant o f our p e r c e p t i o n s , t h e r e f o r e our behavior.  deter-  The s e l f concept  comes from personal e x p e r i e n c e s , from i n f a n c y on, and from personal e v a l u a tions.  He suggests t h a t people t r y to p r o t e c t and enhance t h e i r s e l f concept  as they p e r c e i v e i t . The f a c t o f d i f f e r e n t goals i s a r e a l one and the f e e l i n g t h a t another i s imposing t h e i r own goals r e s u l t s i n a f e e l i n g of threat.  The importance o f f i n d i n g out the meaning o f events to the other  person i s e s s e n t i a l i n f a c i l i t a t i n g  communication.  The behavior o f people r e v e a l s t h e i r s e l f concept. Coopersmith has d e s c r i b e d c l e a r l y the d i f f e r e n c e s i n the behavior o f persons of high and 24 low s e l f - e s t e e m .  The person with a low s e l f - e s t e e m l a c k s t r u s t i n them-  s e l v e s and i s apprehensive about e x p r e s s i n g i d e a s . These persons l i s t e n r a t h e r than d i s c u s s , they may appear s e l f - c o n s c i o u s and preoccupied with personal problems. and o f t e n c r e a t i v e .  A person with a high s e l f - e s t e e m i s s o c i a l ,  independent  They can examine e x t e r n a l i s s u e s as they are not pre-  occupied with s e l f and can d i s c u s s r a t h e r than j u s t l i s t e n i n a group. " R u t h C. Wylie, The S e l f Concept. (London: U n i v e r s i t y of Nebraska Press, 1974), p.9. 23 S. I. Hayakawa, Symbol, Status and P e r s o n a l i t y . (New York: Harcourt, Brace and World Inc., 1958T 24 S. Coopersmith, The Antecedents of Self-Esteem, (San F r a n c i s c o : W. H. Freeman and Company, 1967).  12 Bruner has stated that " . . .  effective i n t u i t i v e thinking is  fostered by the development of self confidence and courage in the student".  25  He agrees with Coopersmith that the insecure person may not have enough confidence to take risks."  PAST LEARNING EXPERIENCES THE NEED FOR KNOWLEDGE OF PAST LEARNING EXPERIENCES Metz and McCleary, writing in the Journal of Nursing Education, have suggested that characteristics of the learner may well be the most useful 26 indicator of the effectiveness of the teaching/learning process.  They  discuss the need for educators to increase their efforts in identifying student characteristics before deciding on the types of learning experiences. The role of past learning in shaping individual learning patterns, attitudes toward education, and personal motivation was recognized by the authors who 27 developed a questionnaire to collect this information from students.  The  authors discuss the need for educational programs to recognize individual differences.  Bruner has stated that " . . .  at i t s best a learning episode 28  reflects what has gone before i t and permits one to generalize beyond i t " . The review of the nursing l i t e r a t u r e did not reveal other a r t i c l e s which suggested a similar step to gain knowledge of past learning experiences pc  of students. Jerome S. Bruner, The Process of Education. (Cambridge: Harvard University Press, 1966), p.65. 26  Metz, "Knowing the Learner," p.3-9.  28  Bruner, The Process of Education, p.49  2 7  I b i d . , 6.  13 THE EFFECTS OF PAST LEARNING EXPERIENCES ON THE INDIVIDUAL In a study done i n A u s t r a l i a , E v e r e t t has attempted to provide a d e s c r i p t i v e p i c t u r e of the s e l f concept o f high, medium and low academic 29 achievers.  He d e s c r i b e s the work o f previous r e s e a r c h e r s who have sug-  gested t h a t s c h o l a s t i c performance dual 's self-assessment.  tends t o be c o n s i s t e n t with the i n d i v i -  E v e r e t t ' s study of f i f t y - n i n e female c o l l e g e  students revealed d i s t i n c t d i f f e r e n c e s i n the s e l f concepts o f high, medium and low a c h i e v i n g students.  There was consensus among the students as to  the q u a l i t i e s o f the ideal student.  T h i s student was i n v o l v e d i n d i s c u s s i o n ,  enjoyed pursuing knowledge, and possessed i n i a t i v e .  The high a c h i e v i n g  students possessed more o f these q u a l i t i e s than the other two groups. achievement  The  r e l a t e d concept, examinations, was a s s o c i a t e d with a n x i e t y and  f r u s t r a t i o n i n the medium and low a c h i e v i n g students, and seen as r e l a t i n g to ambition and competition by the high a c h i e v i n g s t u d e n t s . In a s i m i l a r study by B a i l e y the r e s u l t s supported the idea t h a t there i s a d i f f e r e n c e i n the s e l f p e r c e p t i o n of students who a r e high a c h i e v e r s and 30 those who are not.  T h i s study r e v e a l e d t h a t the low a c h i e v i n g student l a c k s  the goals and m o t i v a t i o n to lead him to higher  achievement. 3  Goldberg has s t u d i e d the e f f e c t s o f f e a r o f f a i l u r e on the i n d i v i d u a l . He s t u d i e d some of the consequences o f a f e a r of f a i l u r e when i t i s r e l a t e d to a d e v"aAl.u a tV.i o nE v of e s t e eS me.l f Concept He found o tfh aHigh, t a person low As ce hl if e- ve es rt es e" m, e r e ts et l, f -"The Medium with and Low The A u s t r a l i a n Journal o f Education, Vol.15 No.3 (October, 1971), 319-324. R . B a i l e y , " S e l f Concept D i f f e r e n c e s i n Low and High A c h i e v i n g Students", Journal o f C l i n i c a l Psychology, Vol.27, (1971), 188. 30  C a r l o s Goldberg, "Some E f f e c t s o f Fear o f F a i l u r e i n the Academic S e t t i n g " , Journal o f Psychology, Vol.84-85 (1973). 3 1  14  whose s e l f p e r c e p t i o n i s c l o s e l y l i n k e d t o academic achievement may view f a i l u r e as an i n d i c a t i o n o f h i s  true a b i l i t y .  This  l e a d s to a c o n t i n u a l  f e a r o f f a i l u r e even though the i n d i v i d u a l may have s u c c e s s f u l  experiences.  Goldberg c o n c l u d e s t h a t t h e f e a r o f f a i l u r e person has a low s e l f - e s t e e m and i s dependent on e x t e r n a l c r i t e r i a f o r a d e f i n i t i o n o f s e l f .  His m o t i -  v a t i o n and g o a l s to a c h i e v e a r e lowered to a v o i d the p o s s i b i l i t y o f f a i l i n g . 32 Kates has a l s o s t u d i e d f a i l u r e a v o i d a n c e . successful  problem s o l v i n g  H i s study s u g g e s t s t h a t  i s dependent on an i n t e g r a t i o n o f  personality  f a c t o r s , the k i n d s o f demands made by the t a s k , and the e n v i r o n m e n t a l ditions  con-  i n which the t a s k i s a t t e m p t e d . P e r v i n has developed the i d e a o f the match o f an i n d i v i d u a l w i t h 33  environment  his  i n o r d e r t o a c h i e v e optimum performance and s a t i s f a c t i o n .  views a " b e s t - f i t " o f i n d i v i d u a l w i t h h i s environment as showing high p e r f o r m a n c e , s a t i s f a c t i o n and l i t t l e  stress;  poor p e r f o r m a n c e , d i s s a t i s f a c t i o n and s t r e s s  itself  He in  a " l a c k of f i t " r e s u l t s  in  to the i n d i v i d u a l .  The 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 has f o c u s e d on the need to have knowledge o f the i n d i v i d u a l ' s  past l e a r n i n g experiences.  viewed show the e f f e c t s o f p a s t l e a r n i n g e x p e r i e n c e s dual 's  self  i n shaping  Studies the  re-  indivi-  concept. . STUDENT EXPECTATIONS OF THE TEACHER  Student e x p e c t a t i o n s o f t h e t e a c h e r appear to r e v e a l themselves  most  S. L. Kates and Win. T . B a r r y , " F a i l u r e A v o i d a n c e and Concept A t t a i n m e n t " , J o u r n a l o f P e r s o n a l i t y and S o c i a l P s y c h o l o g y , V o l . 1 5 No.l (May, 1970), 21-27. oc  33  L. A. P e r v i n , " P e r f o r m a n c e and S a t i s f a c t i o n as a F u n c t i o n o f I n d i v i d u a l - E n v i r o n m e n t F i t " , P s y c h o l o g i c a l B u l l e t i n , V o l . 6 9 No.l ( 1 9 6 8 ) , 56-68.  15 f r e q u e n t l y when an e v a l u a t i o n o f l e a r n i n g experiences takes p l a c e .  When  successes and f a i l u r e s are d i s c u s s e d both teacher and student may hear f o r the f i r s t time the d i f f e r e n c e s i n t h e i r i n d i v i d u a l e x p e c t a t i o n s . Schweer has d e f i n e d e v a l u a t i o n as "a continuous process o f c o l l e c t i n g 34 data to be used as a b a s i s f o r a p p l y i n g a set of standards. She d e s c r i b e s a general trend i n the purpose of e v a l u a t i o n toward determining i n d i v i d u a l student growth i n developing c l i n i c a l  skills.  The d i f f i c u l t y of o b j e c t i v e l y c o l l e c t i n g t h i s data i s d i s c u s s e d by 35 Heslin.  She recognizes t h a t the e v a l u a t o r brings her own needs, f e e l i n g s  and biases to the e v a l u a t i o n task.  The d e s c r i p t i o n given o f the teacher  who  values neatness and o r g a n i z a t i o n to the e x c l u s i o n o f other q u a l i t i e s emphasizes this point. Fox has w r i t t e n e x t e n s i v e l y of student's perceptions of the e v a l u a t i o n 36 process.  In h i s a n a l y s i s of i n c i d e n t s l e a d i n g to s t r e s s or s a t i s f a c t i o n  Fox d e s c r i b e s how the students wrote about the formal c l i n i c a l  evaluations  l e s s o f t e n than any other type o f e v a l u a t i o n . He s t a t e s : From the a n a l y s i s o f the i n c i d e n t s w r i t t e n about the c l i n i c a l e v a l u a t i o n s , students seemed to f e e l t h a t they were evaluated s o l e l y on what they could do, and seldom on t h e i r knowledge or understanding o f the t o t a l c l i n i c a l s i t u a t i o n . Students d i d w r i t e about the e v a l u a t i o n o f t h e o r e t i c a l knowledge o f c l a s s room examinations, but t h i s type o f e v a l u a t i o n seemed to have l i t t l e r e l a t i o n s h i p to c l i n i c a l e v a l u a t i o n . 3 7  34 Jean E. Schweer, C r e a t i v e Teaching i n C l i n i c a l Nursing /( S a i n t L o u i s : C. V. Mosby Company, 1972), p.240. 35 P. H e s l i n , " E v a l u a t i n g C l i n i c a l Performance," Nursing Outlook, V o l . 11 No.5 (May, 1963), 345. » 36 Fox, et a l . S a t i s f y i n g and S t r e s s f u l S i t u a t i o n s i n Basic Programs i n Nursing Education, p. 201. 3 7  Ibid.  1 Fox's study i n c l u d e d student's responses to informal e v a l u a t i o n , i e . , casual comments about t h e i r c l i n i c a l a b i l i t y .  S a t i s f a c t i o n v/as very high  when informal comments were p o s i t i v e . Fox r a i s e s questions regarding student's g r e a t need f o r t h i s p o s i t i v e reinforcement.  the  He c i t e s i n c i d e n t s  that s t a t e d the student thought she had done a poor job u n t i l t o l d by another person that she had done w e l l .  He wonders i f s a t i s f a c t i o n from  p r a i s e i s an i n d i c a t i o n t h a t the student i s most o f t e n s i n g l e d out o n l y when doing something i n c o r r e c t l y . Olesen has examined both teachers' and students' ideas o f e v a l u a t i o n She d e s c r i b e s the v i e w o f teachers that a student's e r r o r s i n knowledge o r performance should be pointed out to her.  The manner i n which t h i s i s done  must not cause the student undue s t r e s s . Olesen w r i t e s : Negative c r i t i c i s m s are worded i n such a manner that the reader i s l e f t with the assumption t h a t the r e q u i r e d norm o f behavior or a t t i t u d e i s a l r e a d y present i n the student i n a submerged f a s h i o n and merely needs to e x e r t i t s e l f . For example, the student i s not d e s c r i b e d as " d i s o r g a n i z e d " , but r a t h e r as "seems to be working toward b e t t e r o r g a n i z a t i o n " . The i n s t r u c t o r s are o b v i o u s l y mindful o f t h e i r dual respons i b i l i t y , f i r s t as teacher, but e q u a l l y i m p o r t a n t l y , as counselor.39 The true meaning o f the e v a l u a t i v e comments may become c l e a r to the student o n l y when a f i n a l grade i s g i v e n , o r a f i n a l e v a l u a t i o n conference i s h e l d . Olesen d e s c r i b e s the student's p e r c e p t i o n o f these conferences individual discussions. They had become aware t h a t what they s a i d i n conferences and i n i n d i v i d u a l d i s c u s s i o n s with the i n s t r u c t o r s formed some o f the data on which the i n s t r u c t o r s based t h e i r e v a l u a t i o n s . Very  Olesen, The S i l e n t Dialogue, p.159. 39 Jy  lbid.  and  17 q u i c k l y the " e v a l u a t i o n " , the f a c u l t y r e c o u n t i n g o f t h e i r impressions o f student behavior and progress on s e l e c t e d and d i f f e r i n g v a r i a b l e s , assumed a s i g n i f i c a n t place as the most important c r i t e r i o n by which the students c o u l d gauge f a c u l t y ,~ p e r c e p t i o n o f t h e i r successes or f a i l u r e s as f l e d g l i n g nurses. Calamari has a l s o examined the e f f e c t i v e n e s s o f the e v a l u a t i o n con41 f e r e n c e from the student's viewpoint. s a t i s f a c t i o n s with t h e c o n f e r e n c e .  An o p i n i o n a i r e r e v e a l e d many d i s -  Among them the need f o r o b j e c t i v e s and  requirements o f the c l i n i c a l course before beginning t h e experience, the a v a i l a b i l i t y o f anecdotal notes, and the need to review c l i n i c a l e v a l u a t i o n s p r i o r to the conference were c i t e d as ways to improve t h i s e v a l u a t i o n experience.  The students d i d f e e l t h a t the conference s t i m u l a t e d them to do  b e t t e r as a r e s u l t o f l e a r n i n g where they could improve. Fox has c i t e d the e v a l u a t i o n conference as a s t r e s s f u l experience 42 f o r the students he s t u d i e d . Litwack has reviewed the l i t e r a t u r e r e l a t e d to e v a l u a t i o n conferences, and d i s c u s s e s the need to p r o v i d e time f o r s h a r i n g o f i n f o r m a t i o n about the 43 student's progress i n an nonthreatening an atmosphere as p o s s i b l e .  He  also states: It i s e s s e n t i a l f o r s t u d e n t - f a c u l t y communication t h a t an open, v a l i d , f a i r and c o n s i s t e n t e v a l u a t i o n system be developed, maint a i n e d , and safeguarded. Without i n d i v i d u a l conferences a t r e g u l a r i n t e r v a l s , e v a l u a t i o n tends to become biased and autoc r a t i c , f o r the i n s t r u c t o r never needs defend her e v a l u a t i o n s . 4 4 I b i d . , 158. S i s t e r Dolores C a l a m a r i , " F a c t o r s t h a t I n f l u e n c e E v a l u a t i o n Conf e r e n c e s i n C l i n i c a l Experience", The Journal o f Nursing Education, Vol.7 No.4 (November, 1968), 12-14. 42 Fox, e t a l . S a t i s f y i n g and S t r e s s f u l S i t u a t i o n s i n B a s i c Programs in Nursing Education, p.202. 43 Lawrence Litwack, e t a l . C o u n s e l i n g , E v a l u a t i o n and Student Development ( P h i l a d e l p h i a : W. B. Saunders, 1972), p.160. 4 4  Ibid.  18 Videbeck has r e l a t e d the development of the s e l f concept to the 45 e v a l u a t i v e comments of o t h e r s and has l i s t e d f o u r i n f l u e n c i n g f a c t o r s . These are:  the number of times the other c o n s i s t e n t l y approves or d i s -  approves of the i n d i v i d u a l . w i t h r e f e r e n c e to the s p e c i f i c q u a l i t i e s i n review, (2) how a p p r o p r i a t e or q u a l i f i e d the e v a l u a t i o n i s i n the o p i n i o n o f the r e c i p i e n t , (3) the s t r e n g t h of m o t i v a t i o n of the i n d i v i d u a l , and (4) the i n t e n s i t y with which the approval or d i s a p p r o v a l i s g i v e n . concludes:  He  "Findings o f the study tend to support the general view t h a t  s e l f - c o n c e p t i o n s are learned and t h a t the e v a l u a t i v e r e a c t i o n s of o t h e r s 46 play a s i g n i f i c a n t p a r t i n the l e a r n i n g p r o c e s s . " D i f f e r i n g e x p e c t a t i o n s between students and f a c u l t y are one of the many problems t h a t i n f l u e n c e student e x p e c t a t i o n s of the teacher.  Litwack  has reviewed the l i t e r a t u r e and d i s c u s s e s Bohan (1967) who found no s i g n i f i c a n t r e l a t i o n s h i p between the grades of b a c c a l a u r e a t e nursing students in nursing c o u r s e s , and the students' performance as p r o f e s s i o n a l nurses 47 as measured by s e l f and s u p e r v i s o r y e v a l u a t i o n s .  C o n f l i c t i n g expectations  between n u r s i n g education and nursing s e r v i c e may c o n t r i b u t e to the d i s c r e pancy f e l t by the student. Litwack s t a t e s : On the one hand, she i s evaluated by what she f e e l s are the i d e a l i s t i c standards o f the f a c u l t y . On the o t h e r , she cons t a n t l y views around her i n the c l i n i c a l area the wide d i v e r gence i n techniques, p r a c t i s e s and a t t i t u d e s used or expressed by s t a f f nurses and s u p e r v i s o r y p e r s o n n e l . The r e s u l t i n g c o n t r a d i c t i o n s i n the student's mind seem to be one o f the main c o n t r i b u t i n g f o r c e s to the d i s i l l u s i o n m e n t students f r e q u e n t l y f e e l a t some stage o f t h e i r program.^8 R i c h a r d Videbeck, " S e l f - C o n c e p t i o n and the Reaction o f Others," Sociometry, Vol.23, (1960), 351-359. 4 3  4 6  I b i d . , 359.  ^^Litwack, et a l . C o u n s e l i n g , E v a l u a t i o n and Student Development, p. 141. Ibid.  19 S t e i n has s t u d i e d t h i s same phenomena using a q u e s t i o n n a i r e to gather data to reveal the development o f student a t t i t u d e s i n the 49 p r o f e s s i o n a l and c l i n i c a l areas of a student's l i f e .  academic,  The students s t u d i e d  r e v e a l e d awareness of t e n s i o n s i n the c l i n i c a l area between teacher and staff expectations. Three authors reviewed made suggestions which c o u l d reduce the gap between teacher and student e x p e c t a t i o n s . Mauksch has suggested t h a t students should share i n the s e l e c t i o n 50 of c l i n i c a l learning experiences.  T h i s o p p o r t u n i t y i s viewed as p r o v i d i n g  an o p p o r t u n i t y to make d e c i s i o n s , take i n i t i a t i v e and develop judgement.  independent  The concept of s e l f d i r e c t i o n i s emphasized.  Litwack has d i s c u s s e d the view o f Kramer (1967) which supports t h i s 51 idea.  The need f o r help i n d e v e l o p i n g a g r e a t e r f e e l i n g of r e s p o n s i b i l i t y  toward her own l e a r n i n g i s seen as an outcome o f having students p a r t i c i p a t e in s e l e c t i n g t h e i r own l e a r n i n g e x p e r i e n c e s . Wiedenbach focused on the need f o r the student to see and to be a b l e 52 to c h a l l e n g e the e v a l u a t i o n .  T h i s author d i s c u s s e s the need f o r the teacher  to show she r e c o g n i z e s t h a t the meaning to the student o f the behavior e v a l u ""R. S t e i n , "The Student Nurse", Nursing Research, Vol.18 No.5 ated may be d i f f e r e n t1969), from 436-439. i t s meaning to the t e a c h e r . (September-October, 50 Ingeborg C. Mauksch, "Lets L i s t e n to the Students", Nursing Outlook, Vol.20 No.2 (February, 1972), 103-107. 51 Litwack, et a l . C o u n s e l i n g , E v a l u a t i o n and Student Development, p. 149. 52 E. Wiedenbach, Meeting the R e a l i t i e s i n C l i n i c a l Teaching (New York: S p r i n g e r P u b l i s h i n g Company, 1969), p.52.  20  The importance of the development and maintenance o f e f f e c t i v e two-way communication i s seen as an important means to make student and teacher e x p e c t a t i o n s more congruent.  SUMMARY The authors c i t e d express concern and i n t e r e s t i n the many f a c t o r s which can i n f l u e n c e student p e r c e p t i o n and p o s s i b l y l e a r n i n g . The v a r i a b l e s which i n f l u e n c e p e r c e p t i o n are numerous and vary with each i n d i v i d u a l . The three areas chosen - i n d i v i d u a l needs, past l e a r n i n g experiences, and s t u dent expectations of the teacher, appear to be well documented i n the l i t e rature. Learning needs of i n d i v i d u a l s are beginning to be recognized as important by nurse educators.  A r t i c l e s i n the nursing l i t e r a t u r e r e v e a l  a growing awareness o f the need f o r t h i s i n f o r m a t i o n i n planning l e a r n i n g experiences.  Authors i n psychology and s o c i o l o g y studying i n d i v i d u a l needs  examined the r o l e o f p e r c e p t i o n i n d e f i n i n g these needs f o r the i n d i v i d u a l . The development of the s e l f concept i s c l o s e l y r e l a t e d to the i n d i v i d u a l ' s p e r c e p t i o n , the meaning o f events to each i n d i v i d u a l shapes h i s behavior. Past l e a r n i n g experiences have a marked a f f e c t on the i n d i v i d u a l ' s perception of himself.  The s t u d i e s c i t e d show the a f f e c t of f a i l u r e i n  r e i n f o r c i n g a low s e l f - e s t e e m and i n reducing m o t i v a t i o n and attainment of goals.  Knowledge of the l e a r n e r ' s p e r c e p t i o n o f h i s academic a b i l i t y i s  suggested as important f o r the teacher to understand  h i s m o t i v a t i o n and  goal s e t t i n g . Actual academic achievement may be s t r o n g l y i n f l u e n c e d by the l e a r n e r ' s p e r c e p t i o n o f h i s a b i l i t y .  21  The student's e x p e c t a t i o n s of the teacher most o f t e n appear i n d i s cussions r e l a t i n g to e v a l u a t i o n . D i f f e r i n g s t u d e n t - f a c u l t y e x p e c t a t i o n s with r e s p e c t to c l i n i c a l performance are well documented i n the l i t e r a t u r e . Suggestions to improve congruency of e x p e c t a t i o n s focus on the need to improve and f a c i l i t a t e two-way communication between f a c u l t y and students. Knowledge of student perceptions may be a f i r s t step i n planning to implement changes and improve the i n d i v i d u a l ' s l e a r n i n g experiences.  CHAPTER III METHOD .  INTRODUCTION.  For t h i s study a q u e s t i o n n a i r e was d e v i s e d to gather data on s t u d e n t s ' p e r c e p t i o n s of c l i n i c a l e x p e r i e n c e s .  A q u a n t i t a t i v e r e p r e s e n t a t i o n of the  p e r c e p t i o n s of student nurses i n three n u r s i n g programs was used to give an i n d i c a t i o n of student's i d e a s , f e e l i n g s and understandings of t h e i r c l i n i c a l 53 experiences.  A d e s c r i p t i v e survey method was used i n c o l l e c t i n g the data.  In planning the survey these steps were f o l l o w e d : f i r s t , a review of the l i t e r a t u r e was c a r r i e d out to e s t a b l i s h a b a s i s f o r the study; second, the p o p u l a t i o n was s e l e c t e d ; t h i r d , the type of tool to be used was s e l e c t e d , developed, p r e t e s t e d and r e v i s e d ; and f i n a l l y , the data were c o l l e c t e d and presented. POPULATION OF THE STUDY Student nurses, e n t e r i n g the f i n a l h a l f of t h e i r n u r s i n g program, who had had v a r i e d l e a r n i n g experiences i n the c l i n i c a l area were s e l e c t e d to p a r t i cipate.  The student groups, randomly s e l e c t e d , were each composed of h i g h ,  medium and low a c h i e v i n g students.  These students were from three types of  nursing education programs: a three y e a r h o s p i t a l school of n u r s i n g ; a f o u r y e a r b a c c a l a u r e a t e program at a u n i v e r s i t y ; and, a two y e a r community c o l l e g e program. pectively.  The t o t a l number of students from each school was 20, 25 and 19 r e s The t o t a l sample of students p a r t i c i p a t i n g was  64.  Eleanor W. Treece and James W. Treece, J r . , Elements of Research i n Nursing, ( S a i n t L o u i s : The C. V. Mosby Company, 1973), p.76.  23 DEVELOPMENT OF THE TOOL The d e c i s i o n to use a q u e s t i o n n a i r e was made f o l l o w i n g a review o f the l i t e r a t u r e r e l a t e d to e x p l o r a t o r y d e s c r i p t i v e r e s e a r c h .  The non-experi-  mental design o f e x p l o r a t o r y research appears to lend i t s e l f to the use o f q u e s t i o n n a i r e s , i n t e r v i e w s and o b s e r v a t i o n s .  The emphasis i s on the d i s -  covery o f new i n s i g h t s , f a c t s and r e l a t i o n s h i p s . The r e s u l t s may lead not to e s t a b l i s h e d c o n c l u s i o n s but to what Helmstader terms an " e m p i r i c a l l y 54 developed hypothesis". The development o f the tool was i n three phases: review o f the l i t e r a t u r e t o develop the content o f the q u e s t i o n s ; d i s c u s s i o n with three recent ( l e s s than s i x months) graduates to gather new i d e a s ; and, ideas suggested by the r e s e a r c h e r ' s personal experience i n t e a c h i n g n u r s i n g . Several questions were adapted from McCall's work on r o l e i d e n t i t i e s . These questions gather data o f the student's p e r c e p t i o n o f the degree o f s e l support, s o c i a l support, i n t r i n s i c and e x t r i n s i c g r a t i f i c a t i o n s , commitment 56 and investment which she p e r c e i v e s from n u r s i n g .  Other questions used  ideas o f authors who r a i s e d questions about the p o s s i b i l i t y o f f a c t o r s which could i n f l u e n c e c l i n i c a l e x p e r i e n c e s , eg., the student's p e r c e p t i o n o f her a b i l i t y to l e a r n i n the c l i n i c a l a r e a , and, the type o f feedback r e c e i v e d from the t e a c h e r . G. C. Helmstader, Research Concepts i n Human Behavior, (New York: A p p l e t o n - C e n t u r y - C r o f t s , 1970), p. 50. 55 George J . McCall and J . L. Simmons, I d e n t i t i e s and I n t e r a c t i o n s , (New York: The Free Press, 1966), p.264-267. 56 Appendix A, Questions C 4-9, p. 73-74.  24 The questions were d i v i d e d i n t o three areas: past l e a r n i n g e x p e r i e n c e s , student e x p e c t a t i o n s o f the teacher, and i n d i v i d u a l l e a r n i n g needs.  The  d i r e c t i o n s asked the respondents to s e l e c t the answer which best r e f l e c t s her personal experience. -The c h o i c e was presented i n a L i k e r t - t y p e s c a l e o f- f i v e answers. 57  THE PILOT STUDY The p r e t e s t i n g was conducted f o r the purpose o f a s s e s s i n g areas o f misunderstanding  or ambiguity, to o b t a i n an idea o f the length of time r e -  q u i r e d to complete the q u e s t i o n n a i r e , and to o b t a i n comments f o r improving the q u e s t i o n n a i r e . In the e a r l y development of the tool the three new graduates acted as a panel of experts i n d i s c u s s i n g the m e r i t s o f the ideas on which the questions were to be based.  The i d e a s , o p i n i o n s and f e e l i n g s expressed  r e v e a l e d very d i f f e r e n t personal experiences as students.  T h i s f a c t gave  the r e s e a r c h e r c l u e s to the p o s s i b l e p e r c e p t i o n s o f other students. A sample o f 8 students a l s o p a r t i c i p a t e d i n an assessment o f the content v a l i d i t y o f the q u e s t i o n n a i r e .  Using the random probe  technique  developed by Schuman, each student was asked to e x p l a i n the meaning o f a CO  randomly s e l e c t e d sample o f the q u e s t i o n s .  T h i s sample of students  was  r e p r e s e n t a t i v e of the other students who p a r t i c i p a t e d i n the study. Stanley L. Payne, The A r t o f Asking Questions, ( P r i n c e t o n , New J e r s e y : P r i n c e t o n U n i v e r s i t y P r e s s , 1951), p.94. 58 Howard Schuman, "The Random Probe: A Technique f o r E v a l u a t i n g the V a l i d i t y of Closed Questions", American S o c i o l o g i c a l Review, Vol.31 (1966), 218-222.  25 REVISION OF THE TOOL Based on the p i l o t study a few changes were made i n the terminology o f the q u e s t i o n s .  For example, question C-2 item one was changed from 59  "asks c h a l l e n g i n g q u e s t i o n s " , to "asks thought provoking q u e s t i o n s " . The content v a l i d i t y probe r e v e a l e d no questions whose i n t e n t was unclear. The time r e q u i r e d f o r completing the q u e s t i o n n a i r e was from t e n to f i f t e e n minutes.  T h i s seemed a c c e p t a b l e .  No f u r t h e r changes were i n d i c a t e d on the b a s i s of the p i l o t study. COLLECTION OF DATA The three schools o f nursing were contacted by telephone, then mailed 60 a cover l e t t e r to s e t up the appointment  f o r the c o l l e c t i o n o f the data.  The r e s e a r c h e r v i s i t e d each o f the schools and administered the quest i o n n a i r e to the three groups o f student nurses.  P r i o r to a d m i n i s t e r i n g the  q u e s t i o n n a i r e the r e s e a r c h e r shared with the students some personal  experiences  in teaching nursing which had l e d to the development o f t h i s study. The examples used d e s c r i b e d experiences from e v a l u a t i o n conferences i n which students had become upset and angry when d i s c u s s i n g t h e i r attainment o f the l e a r n i n g g o a l s .  T h i s most f r e q u e n t l y o c c u r r e d with a c a d e m i c a l l y weak  students who had been the o b j e c t o f d i s c u s s i o n and concern.  E f f o r t s to a s s i s t  these students to understand the goals o f the experience, f r e q u e n t checks to see t h a t they were aware o f the teacher's e x p e c t a t i o n s , and almost constant Appendix A, p. 72  Appendix B, p. 76  26 feedback and d i s c u s s i o n throughout the c l i n i c a l experience d i d not l e a d to the d e s i r e d l e a r n i n g outcome.  In the conference these students were o f t e n  unhappy s t a t i n g , "no one ever t o l d me I was doing p o o r l y " . These experiences l e d the r e s e a r c h e r to p o s t u l a t e t h a t there may have been events i n these students' past e x p e r i e n c e s , e x p e c t a t i o n s o f the teacher or i n d i v i d u a l needs which reduced t h e i r a b i l i t y to r e c e i v e , or attend t o , the teacher's comments.  Knowledge of these f a c t o r s appeared to be one p o s s i b l e  way to gain an understanding of the experiences of the l e a r n e r . A b r i e f d e s c r i p t i o n o f the type of questions asked and the p o s s i b l e f u t u r e uses of t h i s type of data i n improving t e a c h i n g / l e a r n i n g experiences was i n c l u d e d . The students' p a r t i c i p a t i o n was requested, no students r e f u s e d to complete the q u e s t i o n n a i r e . The students were made aware t h a t the data would be used o n l y by the r e s e a r c h e r , the q u e s t i o n n a i r e and general summary o f the f i n d i n g s would be sent t o the schools o n l y i f d e s i r e d by the f a c u l t y .  ANALYSIS OF THE DATA The responses to each o f the questions were compiled f o r each o f the participating schools. ^ 6  The responses were examined to see i f students from  the three d i f f e r e n t types of n u r s i n g programs r e v e a l e d s i m i l a r or d i s s i m i l a r perceptions of c l i n i c a l experiences.  T h i s was i n l i n e with the purpose o f  the study which was to develop a tool with which to gather student's p e r c e p t i o n s of c l i n i c a l e x p e r i e n c e s . The content v a l i d i t y o f the questions may p o s s i b l y be i n d i c a t e d by the a b i l i t y of the students to i d e n t i f y w i t h , and answer each of the q u e s t i o n s .  Appendix C, p. 78  27 R e l i a b i l i t y o f p e r c e p t i o n s i s very d i f f i c u l t to measure with any accuracy. The responses were examined f o r c o n s i s t e n c y o f answers a c r o s s the t h r e e types o f nursing programs.  CHAPTER IV FINDINGS, ANALYSIS AND  INTERPRETATION  INTRODUCTION The purpose o f t h i s study, to develop a q u e s t i o n n a i r e to gather data of student's p e r c e p t i o n s o f c l i n i c a l experiences, does not lend i t s e l f to a n a l y s i s i n the s t a t i s t i c a l sense.  The students' responses have been compiled  showing answers by school and t o t a l sample.  D i f f e r e n c e s , and s i m i l a r i t i e s bet-  ween the three d i f f e r e n t types o f b a s i c nursing education have been noted. S i x t y - f o u r q u e s t i o n n a i r e s were completed by the respondents i n the three b a s i c nursing education programs.  In each school a l l students who were  asked t o v o l u n t e e r completed the q u e s t i o n n a i r e . No q u e s t i o n s were unanswered, the response was 100 per c e n t .  RESPONSES TO QUESTIONS RELATED TO PAST LEARNING  EXPERIENCES  The f i r s t f o u r q u e s t i o n s asked the student to i n d i c a t e the s i z e o f c l a s s , method o f i n s t r u c t i o n , and her a b i l i t y t o l e a r n i n the c l i n i c a l a r e a . As shown i n Tables I and II the responses across the three programs r e v e a l e d t h a t 79.1 per cent of the students p r e f e r r e d a small c l a s s s i z e , with the l e c t u r e then d i s c u s s i o n method s e l e c t e d by 76.6 per c e n t .  F i f t y per cent o f the  students s t a t e d they had found past l e a r n i n g experiences i n the c l i n i c a l area "sometimes demanding", t h i s number i n c l u d e d 19 o f the 25 u n i v e r s i t y students. Twenty-five per cent o f the t o t a l sample s t a t e d these experiences had been "sometimes easy", the m a j o r i t y o f these students were i n the h o s p i t a l and community c o l l e g e programs.  S i x t y - f o u r per cent o f the students d e s c r i b e d  t h e i r a b i l i t y to l e a r n i n the c l i n i c a l s e t t i n g as " f a s t " , 23 per cent  29 TABLE I RESPONSES TO QUESTIONS A l AND A2  Al.  The s i z e o f c l a s s I f e e l most comfortable i n i s : Responses i n Per Cent School A School B School C (N=19) (N=20) (N=25)  Response C a t e g o r i e s  10-20  a  , ,  20-50 over 50 Total  A2.  60.0 12.0 12.0 16.0  25.0 45.0 10.0 20.0  68.4 31 .6  100.0  100.0  100.0  a  , , ,  Total  c  Total (N=64) 51.6 28.1 7.9 12.5  -  Responses i n Per Cent School B School C School A (N=20) (N=19) (N=25) b  20.0 4.0 68.0 8.0  5.0 10.0 80.0 5.0  100.0  100.0  . . .  b  c  100.1  The method o f i n s t r u c t i o n I f e e l most comfortable with i s :  Response C a t e g o r i e s  a  b  15.8  84.2  100.0  c  Total (N=64) 1.6 15.7 1.6 76.6 4.7 100.2  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year basic nursing education program i n a community c o l l e g e .  30 TABLE II RESPONSES TO QUESTIONS A3 AND A4  A3.  In the past my educational experiences i n the c l i n i c a l s e t t i n g have seemed: Responses i n Per Cent School A School B School C (N=19) (N=20) (N=25)  Response C a t e g o r i e s  a  . . . .  . . . .  . . . .  Total  A4.  . . . .  8.0 12.0 76.0 4.0 100 .0  b  c  Total (N=64)  15.,0 40..0 15..0 30,.0  5,.2 31,.5 26,.3 37,.0  6.2 25.0 17.1 50.0 1.6  100,.0  100 .0  99.9  I would d e s c r i b e my a b i l i t y to l e a r n i n the c l i n i c a l s e t t i n g a s : Responses i n Per Cent School A School B School C (N=20) (N=19) (N=25)  Response C a t e g o r i e s  a  ,  c  Total (N=64)  56.0 28.0 16.0  5.0 75.0 15.0 5.0  5.2 63.1 26.3 5.2  3.1 64.0 23.4 9.3  100.0  100.0  99.8  99.8  ,  fast  b  very slow Total a  b  c  S c h o o l A = 4 year basic nursing education program i n a u n i v e r s i t y . S c h o o l B = 3 year basic n u r s i n g education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year basic nursing education program i n a community c o l l e g e .  31 s t a t i n g they were " u n c e r t a i n " of t h e i r a b i l i t y to l e a r n i n the c l i n i c a l setting. In general these responses r e v e a l e d a s p e c i f i c preference f o r a small c l a s s s i z e , i e . , not'over 20, and a p r e f e r e n c e f o r the l e c t u r e then d i s c u s s i o n method o f i n s t r u c t i o n .  The responses to the q u e s t i o n s r e l a t e d  to p e r c e p t i o n s o f l e a r n i n g a b i l i t y r e v e a l e d t h a t the m a j o r i t y of students had found c l i n i c a l e d u c a t i o n a l experiences "demanding". The m a j o r i t y of the students d e s c r i b e d t h e i r a b i l i t y to l e a r n in the c l i n i c a l area as " f a s t " . Questions A5 and A6 asked the respondent to i n d i c a t e the behavior most o f t e n seen i n a d i s c u s s i o n group and to i n d i c a t e the meaning of t h i s behavior.  As shown i n Table III 48.4 per cent of the students i n d i c a t e d  a c t i v e p a r t i c i p a t i o n i n group d i s c u s s i o n s , t h i s i n c l u d e d 17 o f the 25 u n i v e r s i t y students.  F o r t y - s i x per cent o f the students i n d i c a t e d the r e -  sponse " l i s t e n , speak o c c a s i o n a l l y " , t h i s i n c l u d e d the m a j o r i t y o f the hosp i t a l and community c o l l e g e students.  The e x p r e s s i o n o f the meaning o f t h i s  behavior i n d i c a t e d t h a t 65.7 per cent o f the students enjoyed group d i s c u s s i o n s , no students i n d i c a t e d a d i s l i k e of group d i s c u s s i o n s . In general the m a j o r i t y of the students p a r t i c i p a t e d a c t i v e l y i n d i s c u s s i o n groups i n d i c a t i n g t h a t they enjoyed t h i s e x p e r i e n c e .  The i n d i c a t e d  behavior o f the students i n small groups and t h e i r enjoyment of t h i s method o f i n s t r u c t i o n supports the responses to q u e s t i o n s A l and A2, T a b l e I. The next group of q u e s t i o n s , A7 through A12 focuses on the student's experiences with c l i n i c a l e v a l u a t i o n . Table IV shows the students' responses to questions A7 and A8.  Question A7 asked the student to i n d i c a t e her f e e l i n g s  about c l i n i c a l e v a l u a t i o n . F i f t y per cent of the students s t a t e d t h a t t h e i r  32 TABLE I I I RESPONSES TO QUESTIONS A5 AND A6  A5.  In a d i s c u s s i o n group my behavior most c l o s e l y resembles: Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s  a  c o n s i s t e n t a c t i v e p a r t i c i p a t i o n . . . 68.0 l i s t e n , speak o c c a s i o n a l l y 32.0 none o f these l i s t e n , say l i t t l e never p a r t i c i p a t e Total  A6.  100.0  42.1 52.7  48.4 46.9  10.0  5.2  4.7  100.0  99.9  100.0  Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Total  c  Total (N=64)  30.0 60.0  a  I enjoy d i s c u s s i o n groups 72.0 I sometimes f e e l l i k e p a r t i c i p a t i n g . 16.0 4.0 none o f these I have d i f f i c u l t y e x p r e s s i n g myself . 8.0 I d i s l i k e d i s c u s s i o n groups  b  c  My behavior i n a d i s c u s s i o n group means:  Response C a t e g o r i e s  a  b  100.0  b  c  Total (N=64)  60.0 15.0 10.0 15.0  63.1 26.3 10.6  65.7 18.8 4.7 11.0  100.0  100.0  100.2  -  S c h o o l A = 4 year basic n u r s i n g education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 y e a r b a s i c n u r s i n g education program i n a community c o l l e g e .  33 TABLE IV RESPONSES TO QUESTIONS A7 AND A8  A7.  My f e e l i n g s about c l i n i c a l e v a l u a t i o n can be d e s c r i b e d a s : Responses i n Per Cent School A School B School C (N=19) (N=25) (N=20)  Response C a t e g o r i e s  a  20.0 65.0 5.0 10.0  8.,0 52,.0 28,.0 4,.0 8,.0 Total  A8.  -  100.0  100 .0  Responses i n Per Cent School B School C School A (N=19) (N=20) (N=25) a  Total  c  9.3 50.0 21.9 15.7 3.1  31 .5 31 .5 37 .0  100.0  100,.0  c a r i n g f o r a p a t i e n t I have nursed before 24.0 20.0 nursing assignment d i s c u s s i o n with 8.0 r e c e i v i n g c l i n i c a l e v a l u a t i o n from 48.0  b  •  Total (N=64)  c  The s i t u a t i o n which would cause me t h e most s t r e s s would be:  Response C a t e g o r i e s  a  b  100.0  b  c  Total (N=64)  -  -  -  30.0 20.0  15.8 10.6  23.4 17.1  20.0  10.6  12.5  30.0  63.1  46.9  100.1  99.9  100.0  S c h o o l A = 4 year b a s i c n u r s i n g \ e d u c a t i o n program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  34 f e e l i n g s about c l i n i c a l e v a l u a t i o n were " p o s i t i v e " .  T h i s response was con-  s i s t e n t between the u n i v e r s i t y and h o s p i t a l s c h o o l s . The c o l l e g e students had a wider v a r i e t y o f responses.  Equal numbers o f these students i n d i c a t e d  the " p o s i t i v e " , o r " u n c e r t a i n " response while 7 o f the 19 students had "negative" f e e l i n g s toward c l i n i c a l e v a l u a t i o n . Question A8 asked the students which c l i n i c a l s i t u a t i o n would cause them the most s t r e s s . The responses r e v e a l e d t h a t " r e c e i v i n g c l i n i c a l e v a l u a t i o n from teacher" caused 46.9 per cent o f the students s t r e s s . "Caring f o r a new p a t i e n t " was the second c h o i c e causing 23.4 per cent o f the students s t r e s s . In general 59.3 per cent o f the students i n d i c a t e d p o s i t i v e f e e l i n g s about c l i n i c a l e v a l u a t i o n . The community c o l l e g e students had the l e a s t p o s i t i v e f e e l i n g s , t h e i r c h o i c e s were n e a r l y e q u a l l y d i v i d e d between the responses " p o s i t i v e " , "uncertain" or "negative". The two c l i n i c a l s i t u a t i o n s which g e n e r a l l y caused the g r e a t e s t s t r e s s to the students were " r e c e i v e a c l i n i c a l e v a l u a t i o n from a t e a c h e r " , and " c a r i n g f o r a new p a t i e n t " . Table V shows the responses to questions A9 and AIO.  Question A9 asked  the student to i n d i c a t e which o f the responses she thought she had been most f r e q u e n t l y judged on during c l i n i c a l e v a l u a t i o n . F i f t y - t h r e e per cent o f the students i n d i c a t e d they f e l t they had been judged on what the teacher had seen them do, with 34.3 per cent i n d i c a t i n g they were judged on t h e i r knowledge o f the t o t a l p a t i e n t s i t u a t i o n .  E i g h t o f the 64 students s t a t e d t h a t none o f the  given responses were a p p r o p r i a t e f o r t h e i r e x p e r i e n c e . In general the m a j o r i t y o f students b e l i e v e d they had been evaluated on what the teacher had seen them do r a t h e r than on knowledge o f the t o t a l situation.  35 TABLE V RESPONSES TO QUESTIONS A9 AND AIO  A9.  In past c l i n i c a l e v a l u a t i o n s I t h i n k I have been most f r e q u e n t l y judged on: Responses i n Per Cent School A School B School C (N=20) (N=19) (N=25)  Response C a t e g o r i e s  a  my knowledge o f t o t a l p a t i e n t what the teacher saw me do  ....  what agency s t a f f saw me do . . . . what I t o l d the teacher I c o u l d do Total  b  c  Total (N=64)  44.0 48.0 8.0  35.0 55.0 10.0  21.0 57.9 21.0  34.3 53.1 12.5  -  -  -  -  99.9  99.9  100.0  100.0  -  A10. In my past c l i n i c a l experiences I most f r e q u e n t l y r e c e i v e d feedback from the t e a c h e r : Responses i n Per Cent. School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s  when when none when when  a  I d i d very well I did satisfactorily o f these I did unsatisfactorily . . . . I failed Total  b  8.0 12.0 16.0 64.0  35.0 30.0  100.0  c  Total (N=64)  35.0  10.6 21.0 5.2 63.1  17.1 20.3 7.2 54.7  100.0  99.9  99.3  -  a  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y .  b  S c h o o l B = 3 year b a s i c n u r s i n g education program i n a h o s p i t a l school o f n u r s i n g .  c  S c h o o l C = 2 year b a s i c n u r s i n g education program i n a community c o l l e g e .  36 Question AIO sought i n f o r m a t i o n from the student i n d i c a t i n g when the student had r e c e i v e d feedback from the teacher d u r i n g c l i n i c a l  experiences.  F i f t y - f o u r per cent o f t h e students s t a t e d they had r e c e i v e d feedback most f r e q u e n t l y when they performed u n s a t i s f a c t o r i l y .  Seventeen per cent s t a t e d  t h i s feedback came most o f t e n when the student had done very w e l l , with 20.3 per cent i n d i c a t i n g they r e c e i v e d feedback when they d i d s a t i s f a c t o r i l y . S i x t e e n o f the 25 u n i v e r s i t y students, and 12 o f t h e 19 c o l l e g e students i n d i cated they r e c e i v e d feedback from the teacher most o f t e n when they had done unsatisfactorily.  T h i s was a d i f f e r e n t response from the h o s p i t a l students  who were n e a r l y e q u a l l y d i v i d e d between the responses o f "when I d i d v e r y w e l l " , "when I d i d s a t i s f a c t o r i l y " , and "when I d i d u n s a t i s f a c t o r i l y " . G e n e r a l l y the responses to q u e s t i o n AIO i n d i c a t e d students f e l t t h a t they most f r e q u e n t l y r e c e i v e d feedback from t h e teacher, i n t h e c l i n i c a l a r e a , when they had done u n s a t i s f a c t o r i l y . Table VI shows the responses t o questions A l l and A12 which focused on the student's r a t i n g o f her c l i n i c a l performance and the meaning o f the feedback r e c e i v e d d u r i n g c l i n i c a l e v a l u a t i o n . In q u e s t i o n A l l 59.3 per cent o f t h e s t u dents i n d i c a t e d t h a t t h e i r own judgement was the most important i n r a t i n g t h e i r c l i n i c a l performance.  T h i r t y - s i x per cent i n d i c a t e d they b e l i e v e d t h e teacher's  judgement was most important.  These responses were c o n s i s t e n t a c r o s s the three  schools. Question A12 showed t h a t 62.5 per cent o f t h e students b e l i e v e d t h a t c l i n i c a l e v a l u a t i o n t o l d them how w e l l , or how p o o r l y , the teacher thought they were l e a r n i n g t o nurse.  Twenty-nine per cent f e l t t h a t the c l i n i c a l e v a l u a t i o n  was an i n d i c a t i o n o f the f i t between the l e a r n i n g experience and the student's a b i l i t y to nurse.  37  TABLE VI RESPONSES TO QUESTIONS A l l AND Al 2  A l l . In the past when r a t i n g my own c l i n i c a l performance the judgement I cons i d e r e d to be the most important was: Responses i n Per Cent •School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s my own  ...  a  . .  44.0  b  54.0  Total  Total (N=64)  73.7 5.2  59.3 1 .5  52.0 4.0  30.0 5.0  21.0 -  36.0 3.1  100.0  100.0  99.9  99.9  . . . .  c  -  -  A l 2 . . I n the past c l i n i c a l e v a l u a t i o n s have t o l d me: Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s  a  there was a good/bad f i t between the l e a r n i n g experience and my a b i l i t y  28.0  D  c  Total (N=64)  40.0  21.0  29.7  8.0  5.0  10.6  7.9  64.0  55.0 -  68.4  62.5 -  100.0  100.0  where I stand i n r e l a t i o n to my —  how w e l l / p o o r l y the teacher t h i n k s I am l e a r n i n g to nurse the agency s t a f f l i k e d / d i s l i k e d me Total a  b  c  100.0  -  100.1  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  38 In general these two questions r e v e a l t h a t the m a j o r i t y o f students appear to r a t e t h e i r own judgement as most important when e v a l u a t i n g t h e i r c l i n i c a l performance.  The teacher's assessment o f t h e i r nursing appears t o  be viewed as a major outcome o f the c l i n i c a l e v a l u a t i o n .  RESPONSES TO QUESTIONS RELATING TO STUDENT EXPECTATIONS OF THE TEACHER T h i s group o f questions seeks to i d e n t i f y i n f o r m a t i o n about the s t u dent's e x p e c t a t i o n s o f the teacher.  These i n c l u d e questions d e a l i n g with  i n t e r p e r s o n a l r e l a t i o n s between the student and f a c u l t y , ideas r e g a r d i n g the use o f course o b j e c t i v e s , and the i n s t r u c t o r as a c o u n s e l o r , as well as teacher. Table VII shows the responses to questions Bl and B2.  Question BI  asked the students to i n d i c a t e how well they were known as i n d i v i d u a l s i n past c l i n i c a l experiences.  F o r t y - f i v e per cent o f the students f e l t they were well  known as an i n d i v i d u a l , w h i l e 36 per cent f e l t they had o c c a s i o n a l l y been t r e a t e d as an i n d i v i d u a l .  A d i f f e r e n c e noted a c r o s s schools was the few number  of u n i v e r s i t y students who f e l t they were well known, o n l y 7 o f the 25 students. Question B2 r e v e a l e d t h a t 67.1 per cent of the students f e l t f a i r l y r e l a x e d while 17.1 per cent f e l t i l l a t ease i n t h e i r i n t e r p e r s o n a l r e l a t i o n s h i p s with teachers. G e n e r a l l y the students i n a l l schools f e l t they were known as i n d i v i d u a l s , a f e e l i n g that may account f o r the high number o f students f e e l i n g f a i r l y r e l a x e d i n t h e i r i n t e r p e r s o n a l r e l a t i o n s with t h e i r t e a c h e r s . Table VIII shows the responses to three q u e s t i o n s which asked the students to i n d i c a t e t h e i r ideas r e l a t e d to course o b j e c t i v e s . Question B3 r e v e a l e d t h a t 53.1 per cent o f the students thought t h a t course o b j e c t i v e s were most u s e f u l  39 TABLE VII RESPONSES TO QUESTIONS BI AND B2  BI.  In my past c l i n i c a l experiences I f e l t I was: Responses i n Per Cent School A School B School C (N=25) (N=20) (N=l9)  Response C a t e g o r i e s  a  well known as an i n d i v i d u a l o c c a s i o n a l l y t r e a t e d as an i n d i v i d u a l none o f these one o f many students . . . Total  B2.  b  28.0 56.0  60.0 25.0  -  -  16.0  15.0  -  -  100.0  100.0  c  Total 01=64)  52,.7 21,.0  45,.3 36,.0  21,.0 5,.2  17,.1 1,.5  99,.9  99,.9  In my i n t e r p e r s o n a l r e l a t i o n s h i p s with teachers I f e l t : Responses i n Per Cent School A School B School C (N=20) (N=25) (N=19)  Response C a t e g o r i e s  a  very r e l a x e d 68.0 12.0 20.0  b  c  Total (N=64)  25.0 65.0  10.6 68.4  -  -  10.0  21.0  11.0 67.1 4.7 17.1  100.0  100.0  99.9  very i l l a t ease Total a  b  c  100.0  S c h o o l A = 4 year basic n u r s i n g education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  40 TABLE VIII RESPONSES TO QUESTIONS B3 AND B4  B3.  In my o p i n i o n the course o b j e c t i v e s are most u s e f u l f o r : Responses i n Per Cent School A School B School C (N=19) (N=20) (N=25)  Response C a t e g o r i e s  a  b  a guide f o r my own p r o g r e s s . . . t e l l me t h e school's e x p e c t a t i o n s none o f these give d i r e c t i o n to the t e a c h e r . . t e l l agency s t a f f what to expect  8.0 64.0 12.0 16.0  50.0 50.0 -  Total  100.0  100.0  B4.  _  15.8 42.1 10.6 31.6  23.4 53.1 7.9 15.6  100.1  100.0  Responses i n Per Cent School A School B School C (N=19) (N=20) (N=25) a  68.0 28.0 perhaps, but not i n my e x p e r i e n c e .  4.0  b  60 0 25 0 5 .0 10 .0  63 1 26 3 5 2 5 .2  Total  b  c  Total (N=64)  In my o p i n i o n i n d i v i d u a l teachers have d i f f e r e n t personal c r i t e r i a f o r e v a l u a t i n g c l i n i c a l performance:  Response C a t e g o r i e s  a  c  100.0  c  Total (N=64) 64.0 26.6 3.1 6.2 -  100.0  99.8  99.9  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y . S c h o o l B = 3 y e a r b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c n u r s i n g education program i n a community c o l l e g e .  41 TABLE VIII ( c o n t i n u e d ) RESPONSES TO QUESTION B5  B5.  In my o p i n i o n t e a c h e r s ' personal e v a l u a t i o n c r i t e r i a d i f f e r from s t a t e d course o b j e c t i v e s : Responses i n Per Cent p School A School B School C (N=25) (N=20) (N=19) a  Response C a t e g o r i e s  perhaps, but not i n my experience . never i n my experience Total  8,.0 48,.0 16,.0 24,.0 4,.0 100,,0  K  Total (N=64)  55..0 10..0 30,.0' 5.,0  10,.6 42,.1 31,.6 10,.6 5,.2  6.2 48.4 18.8 21,9 4.7  100,,0  100,.1  100.0  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y . ^School B = 3 year b a s i c n u r s i n g education program i n a h o s p i t a l school o f n u r s i n g . School C = 2 year b a s i c nursing education program i n a community c o l l e g e .  a  42 for i n d i c a t i n g the school's e x p e c t a t i o n s .  Of these students 16 of the 25  u n i v e r s i t y students i n d i c a t e d t h i s response.  Twenty-three per cent o f the  t o t a l sample i n d i c a t e d the response "a guide f o r my own progress, while  15.6  per cent chose "give d i r e c t i o n to the teacher". G e n e r a l l y the m a j o r i t y of the students appeared to use the o b j e c t i v e s to g a i n an understanding o f the school's e x p e c t a t i o n s . Question B4 r e v e a l e d t h a t 64 per cent of the students b e l i e v e d t h a t i n d i v i d u a l teachers do have d i f f e r e n t personal c r i t e r i a f o r e v a l u a t i n g c l i n i cal performance.  Twenty-six per cent o f the students i n d i c a t e d they b e l i e v e d  that t h i s could happen "sometimes". Across the three schools the m a j o r i t y of students b e l i e v e d t h a t teachers do have personal c r i t e r i a f o r e v a l u a t i n g c l i n i c a l performance. Question B5 sought to d i s c o v e r i f the students b e l i e v e d t h a t the teacher's personal c r i t e r i a d i f f e r e d from the s t a t e d course o b j e c t i v e s .  The  f i n d i n g s showed t h a t 48.4 per cent o f the students b e l i e v e d t h a t t h i s occurred "sometimes".  Twenty-one per cent i n d i c a t e d the response "perhaps, but not i n  my experience", while 18.8 per cent i n d i c a t e d "unsure".  The responses were  c o n s i s t e n t across the three s c h o o l s . G e n e r a l l y students d i d appear to f e e l t h a t the teacher's personal c r i t e r i a may d i f f e r o c c a s i o n a l l y from the s t a t e d course o b j e c t i v e s . Table IX shows the r e s u l t s o f two questions which attempted to d i s c o v e r i f students p e r c e i v e the teacher's c o u n s e l i n g f u n c t i o n 'as i n t e r f e r i n g with her teaching r o l e .  Question B6 showed t h a t 31.2 per cent o f the students f e l t the  teacher might avoid g i v i n g d i r e c t negative c r i t i c i s m but had not d i r e c t l y experienced t h i s .  Twenty-one per cent said t h i s could happen w h i l e 26.6 per cent  s a i d they had never experienced i t . Of the i n d i v i d u a l schools 11 o f the 25  43 TABLE IX RESPONSES TO QUESTIONS B6 AND B7  B6.  In my experience teachers may avoid g i v i n g students d i r e c t negative criticism: Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s  a  perhaps, but not i n my experience never i n my experience Total  B7.  5,.0 35,.0 15,.0 15,.0 30,.0  21 .0 21 .0 5 .2 31 .6 21 .0  11 .0 21 .9 9 .3 31 .2 26 .6  100 .0  100,.0  99 .8  100 .0  Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Total  c  Total (N=64)  8 .0 12 .0 8 .0 44 .0 28 .0  a  perhaps, but not i n my experience never i n my experience  b  c  In my experience teachers may p e r c e i v e themselves as h e l p f u l c o u n s e l l o r s as well as t e a c h e r s :  Response C a t e g o r i e s  a  b  b  24 .0 56 .0  55,.0 40,.0  20 .0  5,.0  100 .0  100,,0  c  Total (N=64)  15 .8 52 .6 5 .2 15 .8 10 .6  31. 2 50. 0 1. 5 14. 0 3. 1  100 .0  99. 8  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = ,2 year b a s i c nursing education program i n a community c o l l e g e .  44 u n i v e r s i t y students chose the response, "perhaps but not i n my experience". T h i s was the h i g h e s t number o f any of the responses. In q u e s t i o n B7 81.2 per cent of the students s e l e c t e d the responses "very d e f i n i t e l y " , or "sometimes" i n answer to the q u e s t i o n "do teachers perc e i v e themselves as h e l p f u l counselors as well as t e a c h e r s ? " G e n e r a l l y the students seemed to f e e l t h a t teachers do p e r c e i v e thems e l v e s as counselors as well as t e a c h e r s . T h i s idea does not appear to have i n t e r f e r e d with the teacher's g i v i n g the students d i r e c t negative c r i t i c i s m as i s i n f e r r e d i n the l i t e r a t u r e . Table X shows the responses to the l a s t two questions i n t h i s s e c t i o n . Question B8 r e v e a l e d t h a t 59.3 per cent of the students b e l i e v e d that teachers most o f t e n a c q u i r e knowledge o f student achievement through d i r e c t o b s e r v a t i o n and d i s c u s s i o n with the student.  T h i r t y - s e v e n per cent b e l i e v e d  t h i s knowledge came o n l y from d i r e c t o b s e r v a t i o n . These responses were cons i s t e n t a c r o s s the t h r e e s c h o o l s . G e n e r a l l y students appeared to b e l i e v e t h a t teachers observe students and d i s c u s s with them when seeking knowledge o f student  achievement.  The responses to q u e s t i o n B9 showed t h a t students depended on t h e i r own o p i n i o n i n d e c i d i n g i f an i n s t r u c t o r has value as a t e a c h e r .  T h i s was  e v i d e n t i n 84.3 per cent of the responses, an o v e r a l l general response.  RESPONSES TO QUESTIONS RELATED TO THE INDIVIDUAL NEEDS OF THE STUDENT The questions i n t h i s f i n a l s e c t i o n seek i n f o r m a t i o n about teacher behaviors t h a t students v a l u e , the people students f e e l a t ease with i n the l e a r n i n g environment, and knowledge of the value f o r the i n d i v i d u a l o f her nursing r o l e .  45 TABLE X RESPONSES TO QUESTIONS B8 AND B9  B8.  I t h i n k teachers most'often a c q u i r e t h e i r knowledge o f student achievement: Responses in Per Cent School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s  from with from none from from  a  d i r e c t o b s e r v a t i o n and d i s c u s s i o n the student .... 80.0 d i r e c t observation only . . . . 16.0 o f these agency s t a f f .... 4.0 what student t e l l s teacher . . Total  B9.  b  15.0 85.0  a  my classmates' o p i n i o n . . . . . . none o f these . . . ... agency s t a f f ' s o p i n i o n . . . . . . Total  c  -  5.2  1.5 1 .5  99.9  99.8  Responses i n Per Cent School A School 1B School C (N=25) (N=20) (N=19) b  80.0  b  59.3 37.5  -  100.0  Total (N=64)  For me d e c i d i n g whether an i n s t r u c t o r has value as a teacher depends on:  Response C a t e g o r i e s  a  78.9 15.8  -  100.0  c  4.0 4.0 4.0  -  15.0 5.0 -  100.0  100.0  84.2 '  -  15.8 -  100.0  c  Total (N=64) 84.3 1.5 11.0 3.1  99.9  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  46 Table XI shows the students' responses to two questions r e l a t i n g to teacher behavior and a b i l i t y .  A t h i r d q u e s t i o n on Table XI asked the student  to i d e n t i f y the people she f e e l s most a t ease with i n the c l i n i c a l a r e a . F o r t y per cent of the students wished the teacher "to be a v a i l a b l e when I request h e l p " , while 39 per cent o f the students d e s i r e d t h a t the teacher " t r i e s to understand me as a person".  The answers a c r o s s the schools  are evenly d i v i d e d between these two responses. The teaching a b i l i t y most d e s i r e d i n the c l i n i c a l area was a l s o d i v i d e d between two responses.  In q u e s t i o n C2 37.5 per cent o f the t o t a l sample de-  s i r e d t h a t the teacher be a b l e to "ask thought provoking q u e s t i o n s " w h i l e 36 per cent d e s i r e d the teacher to be a b l e to "answer q u e s t i o n s " .  Of the t h r e e  schools n e a r l y 70 per cent o f the community c o l l e g e students d e s i r e d the teacher to be able to ask thought provoking q u e s t i o n s .  In both the o t h e r  programs the m a j o r i t y o f the students d e s i r e d t h a t the teacher c o u l d answer questions. Question C3 r e v e a l e d t h a t students f e e l most f r e e to a c t the way they f e e l with t h e i r classmates.  T h i s answer was i n d i c a t e d by 62.5 per cent o f the  students with " p a t i e n t s " r e c e i v i n g 31.2 per cent of the responses. G e n e r a l l y these answers support the l i t e r a t u r e which s t a t e s t h a t peers and p a t i e n t s are people with whom students f e e l most a t ease i n the c l i n i c a l setting.  These responses were c o n s i s t e n t across the three s c h o o l s .  The f i n a l s i x questions asked students to r a t e t h e i r r o l e i d e n t i t y on 62 a f i v e p o i n t s c a l e . These q u e s t i o n s have been adapted from McCall's work. M c C a l l , I d e n t i t i e s and I n t e r a c t i o n s , p. 264-265.  47 TABLE XI RESPONSES TO QUESTIONS CI AND C2  CI.  Teacher behaviors t h a t a r e most important to me i n the c l i n i c a l area a r e : Responses i n Per Cent School A School B School C (N=20) (N=19) (N=25)  Response C a t e g o r i e s  a  t r i e s to understand me as a person  a v a i l a b l e when I request help . . Total  C2.  26.3 5.2 21.0 42.1 5.2  -  40.0 -  100.0  100.0  Total (N=64) 39.0 7.9 9.3 40.7 3.1  99.8  Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  knows way around c l i n i c a l area . . informs agency s t a f f o f o b j e c t i v e s Total  c  •  a  asks thought provoking questions .  b  60.0  c  100.0  The t e a c h i n g a b i l i t y I most d e s i r e i n the c l i n i c a l a r e a :  Response C a t e g o r i e s  a  32.0 16.0 8.0 40.0 4.0  b  28.0 40.0 28.0 4.0 100.0  b  20.0 50.0 15.0 15.0 100.0  68.4 15.8 10.6 5.2 100.0  c  Total (N=64) 37.5 36.0 18.8 1.5 6.2 100.0  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  48 TABLE XI (continued) RESPONSES TO QUESTION C3  C3.  In the c l i n i c a l area I f e e l most a b l e to act the way I f e e l with: Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s  a  patients none o f these agency s t a f f teacher Total a  b  c  b  28.0 60.0 4.0 4.0 4.0  30.0 70.0  100.0  100.0  -  36.9 57.9  c  Total (N=64)  -  31.2 62.5 1 .5 1.3 1 .5  100.0  100.0  -  5.2  S c h o o l A = 4 year b a s i c n u r s i n g education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  49  Q u e s t i o n C4, as shown on T a b l e XII looked a t the amount o f s e l f support  i n the nurse r o l e f o r the student a t t h i s time.  cent o f t h e s t u d e n t s  indicated  the s o r t o f nurse they l i k e d stated  they were "unsure". Question  support  they thought  they d i d " f a i r l y w e l l " a t being  to t h i n k o f themselves  as b e i n g .  Twenty per c e n t  T h i s was s i m i l a r a c r o s s t h e t h r e e s c h o o l s .  C5, T a b l e X I I , asked  t h e student to r a t e the degree o f s o c i a l  she p e r c e i v e d i n the nurse r o l e .  o t h e r persons  thought  student l i k e d  t o t h i n k she was.  Fifty-five  per c e n t s t a t e d t h a t  they d i d " f a i r l y w e l l " a t being t h e s o r t o f nurse the  the student d i d "very w e l l " with These responses  S i x t y - e i g h t per  Fifteen  per cent i n d i c a t e d  21.9 per c e n t i n d i c a t i n g  others  thought  t h e response  "unsure".  were v e r y c o n s i s t e n t a c r o s s the t h r e e s c h o o l s .  G e n e r a l l y the s t u d e n t s p e r c e i v e d a moderate degree o f s e l f and s o c i a l support  i n the nurse Questions  role.  C6 and C7 as shown i n T a b l e X I I I examined the amount o f  i n t r i n s i c and e x t r i n s i c rewards t h e s t u d e n t s p e r c e i v e d i n t h e i r n u r s i n g .  C6  r e v e a l e d t h a t 92.2 per cent o f t h e s t u d e n t s r e c e i v e d e i t h e r a " g r e a t deal o f p l e a s u r e " , o r moderate p l e a s u r e i n doing t h e t h i n g s they d i d as n u r s e s . which asked revealed  students to r a t e the e x t r i n s i c rewards they g o t from  t h a t 67.1 per c e n t r e c e i v e d "moderate rewards".  t h e i r nursing  Seventeen per c e n t  o f t h e s t u d e n t s p e r c e i v e d " c o n s i s t e n t l y high rewards" w h i l e 9.3 per c e n t cated  "very l i t t l e  resources.  t o g a i n more i n t r i n s i c  than  extrinsic  t h e i r nursing.  T a b l e XIV shows the responses the s t u d e n t ' s  indi-  rewards".  G e n e r a l l y the s t u d e n t s appeared rewards from  C7  t o q u e s t i o n s C8 and C9, which examined  commitment to n u r s i n g and her investment  o f time, energy and  50 TABLE XII RESPONSES TO QUESTIONS C4 AND C5  C4.  How well do I do a t being the s o r t o f nurse I l i k e to t h i n k o f myself as being? Responses i n Per Cent School A School B School C (N=20) (N=19) (N=25)  Response C a t e g o r i e s  a  b  c  Total (N=64)  4.0 60.0 32.0 4.0  15.0 70.0 10.0 5.0  5.2 78.9 15.8 -  7.9 68.8 20.3 3.1  100.0  100.0  99.9  100.1  very p o o r l y Total  C5.  How well do o t h e r s , on t h e average, t h i n k I do a t being t h e s o r t o f nurse I l i k e to t h i n k o f myself as being? Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s  a  b  c  Total (N=64)  8.0 56.0 20.0 16.0  20.0 60.0 20.0 -  21.0 52.7 26.3 -  15.7 56.2 21.9 6.2  100.0  100.0  100.0  100.0  very p o o r l y Total a  b  c  S c h o o l A = 4 year b a s i c n u r s i n g education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  51 TABLE XIII RESPONSES TO QUESTIONS C6 AND C7  C6.  How much do I enjoy doing the t h i n g s I do as a nurse? Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s g r e a t deal o f pleasure moderate pleasure  a  .... . . . .  small amount o f pleasure . . . . . no pleasure Total  C7.  b  32.0 52.0  50.0 50.0  52.7 42.1  -  4.0  -  100.0  100.0  c  Total (N=64)  5.2  43.8 48.4 4.7 3.1  100.0  100.0  How much do I get out o f doing the t h i n g s I do as a nurse? Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  Response C a t e g o r i e s  c o n s i s t e n t l y high rewards  a  ....  very l i t t l e rewards Total  4.0 72.0 8.0 16.0 100.0  b  30.0 60.0 5.0 5.0 100.0  c  Total (N=64)  21.0 68.4 5.2 .5.2 -  17.1 67.1 6.2 9.3 -  99.8  99.7  School A = 4 year b a s i c nursing education program i n a u n i v e r s i t y . School B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . School C = 2 year b a s i c nursing education program i n a community c o l l e g e .  52  TABLE XIV RESPONSES TO QUESTIONS C8 AND C9  C8.  How deeply have I staked myself on being the s o r t o f nurse I l i k e to t h i n k o f myself as being? Responses i n Per Cent School A School B School C (N=20) (N=19) (N=25)  Response C a t e g o r i e s  a  32.0 60.0 4.0 4.0  Total  C9.  -  -  Total (N=64) 45.3 48.4 4.7 1.5  -  100.0  100.0  a  a moderate amount o f time, energy  a small amount o f time, energy, very l i t t l e time, energy, o r Total  c  57.9 36.9 5.2  Responses i n Per Cent School A School B School C (N=25) (N=20) (N=19)  a g r e a t deal o f time, energy, and  b  50.0 45.0 5.0  c  99.9  How much time, energy, and r e s o u r c e s have I put i n t o being t h e s o r t o f nurse I l i k e to t h i n k o f myself as being?  Response C a t e g o r i e s  a  100.0  b  b  c  Total (N=64)  48.0  50.0  57.9  51.6  48.0  45.0  42.1  45.3  -  -  -  -  4.0  5.0  -  3.1  -  -  -  -  100.0  100.0  100.0  100.0  S c h o o l A = 4 y e a r b a s i c nursing education program i n a u n i v e r s i t y . S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g . S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  53 Responses to C8 reveal t h a t 93.7 per cent of the students were e i t h e r very s t r o n g l y , or moderately committed  to n u r s i n g .  Question C9  revealed a s i m i l a r d i v i s i o n between a g r e a t deal of time, energy and a moderate amount. These f i g u r e s were 51.6 per cent and 45.3 per cent respectively. G e n e r a l l y the students appear committed  to the r o l e o f the nurse  and have i n v e s t e d l a r g e amounts of time, energy, and resources to meet this goal.  SUMMARY It i s d i f f i c u l t to summarize trends from so wide a range o f q u e s t i o n s . The m a j o r i t y of responses from the three d i f f e r e n t programs i n b a s i c nursing education r e v e a l e d a high degree o f s i m i l a r i t y .  Most questions were answered  by the s e l e c t i o n of two o f the f i v e p o s s i b l e responses.  In some i n s t a n c e s ,  however, the responses i n d i c a t e d a wider v a r i e t y of e x p e r i e n c e s . The tool was designed to g i v e the i n d i v i d u a l student an o p p o r t u n i t y to express her e x p e r i e n c e s .  Responses o f "unsure", " u n c e r t a i n " , or "none o f  these", are as important i n understanding an i n d i v i d u a l student's experience as are the other p o s s i b l e responses.  These c h o i c e s could guide the teacher  in asking the student to express more f u l l y the meaning of t h i s c h o i c e . some i n s t a n c e s the q u e s t i o n s may have been u n c l e a r and a r e v i s i o n may necessary.  be  In  CHAPTER V SUMMARY, CONCLUSIONS AND RECOMMENDATIONS It was the purpose of t h i s study to gather data o f student's perc e p t i o n s i n three s p e c i f i c areas: 1  student's p e r c e p t i o n s o f past l e a r n i n g experiences  2  student's e x p e c t a t i o n s o f the teacher  3  student's ideas o f personal l e a r n i n g needs  The r e s e a r c h e r developed a q u e s t i o n n a i r e which asked students to r e v e a l i d e a s , f e e l i n g s , and understandings by i n d i c a t i n g which of f i v e responses best s u i t e d her own personal experience i n the c l i n i c a l  setting.  Both the questions and responses were developed a f t e r a l i t e r a t u r e review.  The questions and responses r e f l e c t f i n d i n g s of other r e s e a r c h e r s  studying the experiences o f student nurses, and by t h i s r e s e a r c h e r ' s informal d i s c u s s i o n s with s e v e r a l young nurses.  The r e s e a r c h e r ' s own experience i n  teaching nursing a l s o provided ideas which were i n c l u d e d . The sample of student nurses was s e l e c t e d from t h r e e b a s i c n u r s i n g education programs on the Lower Mainland o f B r i t i s h Columbia.  These i n c l u d e d  t w e n t y - f i v e students from a f o u r year b a s i c program i n a u n i v e r s i t y , twenty students from a three year h o s p i t a l program, and nineteen students from a two year community c o l l e g e program. The t o t a l sample o f students was s i x t y - f o u r . The students s e l e c t e d had a l l had past l e a r n i n g experiences i n the c l i n i c a l area.  They were a l l n e a r l y midway through t h e i r b a s i c n u r s i n g e d u c a t i o n . A l l students volunteered to p a r t i c i p a t e .  Each student completed  the  q u e s t i o n n a i r e a d m i n i s t e r e d by the r e s e a r c h e r . A l l q u e s t i o n s were answered by each student, a 100 per cent response.  The student's responses were compiled  in an e f f o r t to examine the c o n s i s t e n c y of answers a c r o s s the three s c h o o l s .  55 While i t v/as recognized that the r e l i a b i l i t y of an i n d i v i d u a l ' s perception i s unstable, the s i m i l a r i t y of response across schools may give an i n d i c a t i o n of the frequency of s i m i l a r experiences.  SUBSTANTIVE CONCLUSIONS AND RECOMMENDATIONS The students' choice of responses support ideas which have been stated in the l i t e r a t u r e .  many of the f i n d i n g s and The f o l l o w i n g are several  examples to support t h i s statement. A s p e c i f i c preference f o r c l a s s s i z e and method of i n s t r u c t i o n could be u t i l i z e d in planning learning experiences.  This i s discussed by Wolf and  CO  Quiring.  The p o s i t i v e f e e l i n g s revealed about c l i n i c a l evaluation could be  queried by Fox, but the stress of r e c e i v i n g the c l i n i c a l evaluation would be supported by his f i n d i n g s . documented in Fox's study.  64  The stress of caring f o r a new p a t i e n t i s also Both Litwack and Fox suggest that i t i s apparent  that students perceive they get feedback from the teacher only when they do  65 66 unsatisfactorily.  '  This idea i s supported by the responses to Question AIO.  An example in the l i t e r a t u r e , which was of i n t e r e s t to the researcher, was Olesen's  idea that students may not be able to pick up the negative  Wolf and Q u i r i n g , " C a r r o l l ' s Model Applied to Nursing  p. 176. 64  Fox, et a l . S a t i s f y i n g and S t r e s s f u l in Nursing Education, p. 2 0 2 .  65  p. 150.  Litwack, et a l .  Education,"  S i t u a t i o n s in Basic  Programs  Counseling, Evaluation and Student Development,  66 Fox, et a l . S a t i s f y i n g and S t r e s s f u l i n Nursing Education, p. 2 0 2 .  S i t u a t i o n s in Basic  Programs  56 c r i t i c i s m i n the teacher's comments.  67  T h i s i n a b i l i t y to hear the negative  comments was p o s t u l a t e d to be a r e s u l t o f the very s u b t l e wording o f the criticism.  Olesen suggested i t i s the teacher's p e r c e p t i o n o f h e r s e l f as a  counselor which i n t e r f e r e d ' w i t h her a b i l i t y to express c r i t i c a l comments directly.  Two q u e s t i o n s , B6 and B7, Table IX were developed to t e s t out  t h i s i d e a . The m a j o r i t y o f the students d i d t h i n k teachers thought of thems e l v e s as counselors while n e a r l y o n e - t h i r d f e l t t h i s could happen, but had not occurred i n t h e i r own experience. The c o n c l u s i o n s t h a t can be drawn from the s t u d e n t s ' responses g i v e the f e e l i n g t h a t events i n the l e a r n i n g experiences o f student nurses have not changed very much i n the past ten y e a r s .  T h i s r a i s e s questions about the  q u a l i t y of i n d i v i d u a l i n s t r u c t i o n t a k i n g p l a c e today.  An examination o f the  responses from each i n d i v i d u a l may reveal a p a t t e r n o f e x p e r i e n c e s .  This  p a t t e r n may i n d i c a t e p o s i t i v e or negative past l e a r n i n g e x p e r i e n c e s , r e a l i s t i c or u n r e a l i s t i c e x p e c t a t i o n s of the t e a c h e r , and i n d i v i d u a l needs which may or may not be a b l e to be met w i t h i n the l e a r n i n g environment.  Would not t h i s  knowledge o f a student's e x p e r i e n c e s , from her p o i n t o f view, a s s i s t educators to p l a n to meet i n d i v i d u a l l e a r n i n g needs?  Do t e a c h e r s not need t h i s know-  ledge to e f f e c t i v e l y b r i n g about changes i n behavior which w i l l i n d i c a t e learning?  The r e a l i t y i n l e a r n i n g to nurse i s the meaning o f the experience  to the l e a r n e r . Learning which w i l l l a s t longer than the length o f a student's school years must have meaning f o r the student as an i n d i v i d u a l . Recommendations f o r the f u t u r e use o f the tool a r i s e from two  Olesen, The S i l e n t Dialogue, p. 159.  assumptions  57 which have prompted the study.  These a r e :  (1)  knowledge of a l e a r n e r ' s  p e r c e p t i o n s g i v e s the teacher g r e a t e r i n f o r m a t i o n on which to p l a n , c a r r y out and e v a l u a t e teaching s t r a t e g i e s and l e a r n i n g outcomes, and (2)  the  student w i l l b e n e f i t from i n d i v i d u a l i z e d t e a c h i n g s t r a t e g i e s becoming b e t t e r a b l e to l e a r n i n the c l i n i c a l a r e a . It would appear important t h a t before the q u e s t i o n n a i r e i s adminis t e r e d students are aware o f the use the teacher intends to make o f the d a t a . An element o f t r u s t i s e s s e n t i a l i f students are to share openly t h e i r perc e p t i o n s , p o s i t i v e and n e g a t i v e , of past e x p e r i e n c e s .  I f the students f e e l  f r e e to r i s k t h e i r real f e e l i n g s , the teacher has v a l u a b l e i n f o r m a t i o n with which to plan i n d i v i d u a l l e a r n i n g e x p e r i e n c e s .  She w i l l have a p i c t u r e of  the student's experiences from an i n d i v i d u a l p o i n t o f view - i n f o r m a t i o n to be respected and held i n c o n f i d e n c e .  The use the teacher makes of t h i s  i n f o r m a t i o n i s c r u c i a l i n c r e a t i n g an environment i n which i t w i l l be s a f e to r i s k again.  The teacher should share with each student her ideas f o r the use  of the i n f o r m a t i o n c o l l e c t e d . not changed i s important.  D i s c u s s i o n to see t h a t a student's ideas have  I n d i v i d u a l maturation, new e x p e r i e n c e s , and changes  in values and g o a l s , a l l i n f l u e n c e p e r c e p t i o n .  It i s important to check with  the student to see i f her p e r c e p t i o n o f events has a l t e r e d . The r e s e a r c h e r would recommend t h a t teachers a d m i n i s t e r t h i s type o f tool a t r e g u l a r i n t e r v a l s . The value o f the tool i n s e r v i n g to improve t e a c h i n g / l e a r n i n g experiences can be assessed d u r i n g an e v a l u a t i o n conference.  When students are aware t h a t  the teacher has used t h e i r ideas to t r y to f a c i l i t a t e l e a r n i n g , t h e i r e v a l u a t i o n i s an important comment.  For the teacher an e v a l u a t i o n of the teaching s t r a -  t e g i e s which she has arranged to s u i t i n d i v i d u a l l e a r n i n g needs i s e s s e n t i a l .  58  The teacher may note the speed and ease with which students have met the learning goals.  T h i s i n f o r m a t i o n , when c o n t r a s t e d with past experiences  may a s s i s t the teacher to evaluate her teaching i n t e r v e n t i o n s . Teaching s t r a t e g i e s based on knowledge o f the i n d i v i d u a l appear t o have a higher p o t e n t i a l f o r meeting t h e i n d i v i d u a l ' s own needs as a l e a r n e r . The data c o l l e c t i o n d e s c r i b e d i n t h i s study i s o n l y a beginning step i n t r y i n g to improve the t e a c h i n g / l e a r n i n g process i n nursing e d u c a t i o n .  METHODOLOGICAL CONCLUSIONS AND RECOMMENDATIONS In developing the q u e s t i o n n a i r e the r e s e a r c h e r was aware t h a t not a l l the students would have had experiences which would f i t i n t o the s e l e c t i o n o f responses.  The most n e u t r a l response, eg. " u n c e r t a i n " , "unsure", was given  the lowest number o f responses i n 73.3 per cent o f the q u e s t i o n s .  This finding  appears to i n d i c a t e t h a t i n t h e m a j o r i t y o f q u e s t i o n s , t h e responses given d i d have meaning i n terms o f t h e student's own experience. A blank space could be provided a t the end o f the q u e s t i o n n a i r e when the tool i s used i n p r a c t i s e . T h i s space would provide t h e student a p l a c e i n which to expand her answers i f d e s i r e d , and a l s o g i v e examples o f more a p p r o p r i a t e answers i f the given responses do not match her experience.  T h i s idea should  have perhaps been used when the c u r r e n t data was c o l l e c t e d . T h i s would have given ideas f o r question r e v i s i o n s and suggestions f o r new q u e s t i o n s . In a d m i n i s t e r i n g the q u e s t i o n n a i r e the p r i o r d i s c u s s i o n o f i t s development and o b j e c t i v e appeared very e f f e c t i v e i n s o l i c i t i n g v o l u n t e e r p a r t i c i p a t i o n . In each group, students approached  the r e s e a r c h e r a f t e r they had answered t h e  questions to o f f e r support f o r the use o f t h i s t o o l .  They appeared to b e l i e v e  59  the data they had shared could be u s e f u l to teachers i n improving  clinical  learning experiences.  SUMMARY A q u e s t i o n n a i r e to gather data on student's p e r c e p t i o n s o f c l i n i c a l experiences was administered to s i x t y - f o u r students i n t h r e e b a s i c nursing education programs.  The data r e v e a l e d s i m i l a r experiences i n l e a r n i n g to  nurse i n the t h r e e d i f f e r e n t b a s i c nursing programs.  The data c o l l e c t e d  supported f i n d i n g s i n the l i t e r a t u r e r e l a t e d to p e r c e p t i o n s o f c l i n i c a l e v a l u a t i o n , the r o l e o f the t e a c h e r , and the type o f feedback students r e c e i v e from the teacher i n the c l i n i c a l a r e a .  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"Performance S a t i s f a c t i o n as a Function o f I n d i v i d u a l Environment F i t . " P s y c h o l o g i c a l B u l l e t i n , V o l . 69 No. 1 (1968), 56-58. Q u i r i n g , J u l i a D. " U t i l i z i n g Questioning S t r a t e g i e s i n Nursing Education." The Journal o f Nursing Education, (August, 1973), 21-27. Redman, Barbara K. "Nursing Teacher P e r c e p t i v e n e s s o f Student A t t i t u d e s . " Nursing Research, V o l . 17 No. 1 (January-February, 1965), 59-63. Rottkamp, Barbara C. " A t t r i t i o n Rates i n B a s i c Baccalaureate Nursing Programs," Nursing Outlook, (June, 1968), 45-49. Schuman, Howard. "The Random Probe: A Technique f o r E v a l u a t i n g the V a l i d i t y of Closed Questions." American S o c i o l o g i c a l Review, V o l . 13 (1966), 218-222. S t e i n , R. "The Student Nurse." Nursing Research, (September-October, 1969), 436-439.  V o l . 18 No. 5  Super, D. E. " V o c a t i o n a l Adjustment: Implementing a S e l f Concept." Occupations, V o l . 30 (November, 1951), 92-95. Videbeck, R i c h a r d . " S e l f - C o n c e p t i o n and the Reaction o f Others." V o l . 23 (1960), 351-359. "Withdrawal o f Students." 342-343.  American Journal o f Nursing,  Sociometry,  V o l . 51 (May, 1951),  Wolf, V. C. and Q u i r i n g , J u l i a A. " C a r r o l l ' s Model A p p l i e d to Nursing Education." Nursing Outlook, V o l . 19 No. 3 (March, 1971), 176-179.  Wood, V i v i a n . E v a l u a t i o n of Student Nurse C l i n i c a l Performance - A Problem that Won't Go Away." I n t e r n a t i o n a l Nursing Review, V o l . 19 No. 4 (1972), 336-343.  C. UNPUBLISHED MATERIALS Green, J . C. and Stone, J . C. "Teach Me and I w i l l be S i l e n t . " A r e p o r t o f a f i v e y e a r p r o j e c t i n development and use of t o o l s i n c u r r i c u l u m e v a l u a t i o n . Unpublished Manuscript. U n i v e r s i t y of San F r a n c i s c o , 1973. Hagarty, C a r o l e . "Nursing Students Career A t t i t u d e s Before and A f t e r C l i n i c a l Experience." Unpublished Masters T h e s i s , Marquette U n i v e r s i t y , Milwaukee, Wisconsin, 1969.  64  APPENDIXES  APPENDIX A QUESTIONNAIRE  APPENDIX A QUESTIONNAIRE TO GATHER DATA OF STUDENT'S PERCEPTIONS OF CLINICAL EXPERIENCES  These questions a r e designed to gather i n f o r m a t i o n i n three areas: past l e a r n i n g e x p e r i e n c e s , e x p e c t a t i o n s o f the teacher, and i n d i v i d u a l l e a r n i n g needs. The quest i o n s ask f o r i n f o r m a t i o n about your i d e a s , understanding, and f e e l i n g s . Please answer each question by s e l e c t i n g (v^ the answer t h a t best r e f l e c t s your personal experience.  1. The  size of c l a s s I feel -  I f e e l most  4.  in the  always easy sometimes easy uncertain sometimes demanding very demanding  I w o u l d d e s c r i b e my setting as: -  comfortable  p r e s e n t a t i o n s by s t u d e n t s d i s c u s s i o n group no p r e f e r e n c e l e c t u r e then d i s c u s s i o n lecture  3. In t h e p a s t my e d u c a t i o n a l e x p e r i e n c e s c l i n i c a l s e t t i n g have seemed: -  in is  l e s s t h a n 10 10-20 no p r e f e r e n c e 20-50 o v e r 50  2. T h e m e t h o d o f i n s t r u c t i o n w i th is: -  most c o m f o r t a b l e  a b i l i t y to l e a r n i n the  very fast fast uncertain slow very slow  clinical  67  .J  In a d i s c u s s i o n g r o u p resembles: ( ( ( ( ( My  ) ) ) ) )  -  behavior ( ( ( ( (  ) ) ) ) )  -  ) ) ) ) ) -  in a d i s c u s s i o n group  ) ) ) ) )  -  closely  means:  I enjoy d i s c u s s i o n groups I sometimes feel l i k e p a r t i c i p a t i n g none o f t h e s e I have d i f f i c u l t y e x p r e s s i n g m y s e l f I d i s l i k e d i s c u s s i o n groups clinical  e v a l u a t i o n c a n be  des-  very p o s i t i v e positive uncertain negative very negative  The s i t u a t i o n which would be: ( ( ( ( (  b e h a v i o r most  consistent active participation l i s t e n , speak o c c a s i o n a l l y none o f t h e s e l i s t e n , say l i t t l e never p a r t i c i p a t e  My f e e l i ngs a b o u t cribed as: ( ( ( ( (  my  w o u l d c a u s e me  the most s t r e s s  c a r i n g f o r a p a t i e n t I have nursed c a r i n g f o r a new p a t i e n t none o f t h e s e nursing assignment d i s c u s s i o n with r e c e i v i n g c l i n i c a l e v a l u a t i o n from  before  teacher teacher  69  In p a s t c l i n i c a l e v a l u a t i o n s I t h i n k I h a v e b e e n most f r e q u e n t l y judged on: ( ( ( ( (  ) ) ) ) )  -  my k n o w l e d g e o f t o t a l p a t i e n t s i t u a t i o n w h a t t h e t e a c h e r saw me do none o f t h e s e w h a t a g e n c y s t a f f saw me do w h a t I t o l d t h e t e a c h e r I c o u l d do  In my p a s t c l i n i c a l e x p e r i e n c e s I m o s t f r e q u e n t l y r e c e i v e d feedback from t h e t e a c h e r : ( ( ( ( (  ) ) ) ) )  r -  when when none when when  I d i d very well I did satisfactorily o f these I did unsatisfactorily I failed  In t h e p a s t when r a t i n g my own c l i n i c a l p e r f o r m a n c e t h e j u d g e m e n t I c o n s i d e r e d t o be t h e m o s t i m p o r t a n t was: ( ( ( ( (  ) ) ) ) )  -  my own my c l a s s m a t e s * none o f t h e s e my t e a c h e r ' s agency s t a f f  In t h e p a s t c l i n i c a l  e v a l u a t i o n s have t o l d  me:  ( ) - t h e r e was a g o o d / b a d f i t b e t w e e n t h e l e a r n i n g e x p e r i e n c e a n d my a b i l i t y t o n u r s e ( ) - w h e r e I s t a n d i n r e l a t i o n t o my c l a s s m a t e s ( ) - none o f t h e s e ( ) - how w e l l / p o o r l y t h e t e a c h e r t h i n k s I am l e a r n i n g to nurse ( ) - t h e a g e n c y s t a f f l i k e d / d i s l i k e d me.  In my p a s t c l i n i c a l  experiences  I felt  I was:  ( ) - w e l l known a s an i n d i v i d u a l ( ) - o c c a s i o n a l l y t r e a t e d as an i nd i v i d u a l ( ) - none o f t h e s e ( ) - o n e o f many s t u d e n t s ( ) - n o t known a t a l l In my i n t e r p e r s o n a l r e l a t i o n s h i p s w i t h I felt: ( ( ( ( (  teachers  ) - very relaxed ) - fairly relaxed ) - none o f t h e s e ) - i l l a t ease ) - very i l l a t ease  In my o p i n i o n t h e c o u r s e o b j e c t i v e s a r e m o s t u s e f u l for: ( ( ( ( (  ) ) ) ) )  -  a g u i d e f o r my own p r o g r e s s t e l l me t h e s c h o o l ' s e x p e c t a t i o n s none o f t h e s e give d i r e c t i o n to the teacher t e l l a g e n c y s t a f f what t o e x p e c t  In my o p i n i o n i n d i v i d u a l t e a c h e r s h a v e d i f f e r e n t personal c r i t e r i a f o r evaluating c l i n i c a l performance ( ( ( ( (  ) ) ) ) )  -  very d e f i n i t e l y sometimes unsure p e r h a p s , b u t n o t i n my e x p e r i e n c e n e v e r i n my e x p e r i e n c e  71 B.  5. In my o p i n i o n t e a c h e r s ' p e r s o n a l e v a l u a t i o n d i f f e r from s t a t e d course o b j e c t i v e s : ( ( ( ( ( 6.  ) ) ) ) )  -  very d e f i n i t e l y sometimes unsure p e r h a p s , b u t n o t i n my n e v e r i n my e x p e r i e n c e  In my e x p e r i e n c e t e a c h e r s may direct negative c r i t i c i s m : ( ( ( ( (  ) ) ) ) )  -  criteria  experience  avoid giving  students  very d e f i n i t e l y sometimes unsure p e r h a p s , b u t n o t i n my e x p e r i e n c e n e v e r i n my e x p e r i e n c e  7. In my e x p e r i e n c e t e a c h e r s may p e r c e i v e t h e m s e l v e s as h e l p f u l c o u n s e l l o r s as w e l l as t e a c h e r s : ( ( ( ( ( 8.  ) ) ) ) )  -  very d e f i n i t e l y sometimes unsure p e r h a p s , b u t n o t i n my e x p e r i e n c e n e v e r i n my e x p e r i e n c e  I t h i n k t e a c h e r s most o f t e n a c q u i r e t h e i r of student achievement: ( ) - from with ( ) - from ( ) - none ( ) - from ( ) - from  knowledge  d i r e c t o b s e r v a t i o n and d i s c u s s i o n the student direct observation only of these agency s t a f f what s t u d e n t t e l l s t e a c h e r  F o r me d e c i d i n g w h e t h e r a n i n s t r u c t o r h a s v a l u e as a t e a c h e r d e p e n d s o n : ( ( ( ( (  ) ) ) ) )  -  my own o p i n i o n my c l a s s m a t e s ' o p i n i o n none o f t h e s e other teachers' ideas agency s t a f f ' s opinion  T e a c h e r b e h a v i o r s t h a t a r e most i m p o r t a n t in the c l i n i c a l area a r e : ( ( ( ( (  ) ) ) ) )  -  t r i e s t o u n d e r s t a n d me a s a p e r s o n 1 i s t e n s t o me none o f t h e s e a v a i l a b l e when I r e q u e s t h e l p l e a v e s me a l o n e  The t e a c h i n g a b i l i t y area: ( ( ( ( (  ) ) ) ) )  -  ) ) ) ) )  -  I most d e s i r e i n t h e c l i n i c a l  asks thought provoking questions can answer q u e s t i o n s none o f t h e s e knows way a r o u n d c l i n i c a l a r e a informs agency s t a f f o f o b j e c t i v e s  In t h e c l i n i c a l a r e a way I f e e l w i t h : ( ( ( ( (  t o me  I feel  patients classmates none o f t h e s e agency s t a f f teacher  most a b l e to a c t t h e  How w e l l do I do a t b e i n g I l i k e to think o f myself ( ( ( ( (  ) ) ) ) )  -  the sort of as b e i n g ?  nurse  very well f a i r l y well unsure poorly very poorly  How w e l l do o t h e r s , on t h e a v e r a g e , t h i n k I do at being t h e s o r t o f nurse I l i k e to t h i n k myself as b e i n g ? C C ( ( (  ). I ). ) } -  very well f a i r l y well unsure poorly very poorly  How much do I e n j o y ( C C ( (  ) ) ) ) )  -  doing  the things  ) ) ) ) )  -  nurse?  great deal of pleasure moderate pleasure unsure s m a l l amount o f p l e a s u r e no p l e a s u r e  How much do I n e t o u t o f d o i n g nurse? ( ( ( ( (  I do a s a  the things  c o n s i s t e n t l y high rewards moderate rewards unsure very l i t t l e rewards no r e w a r d s  I do a s a  74 C.  8. How d e e p l y h a v e I s t a k e d m y s e l f on b e i n g t h e s o r t • o f n u r s e I l i k e to t h i n k o f m y s e l f as b e i n g ? ( ( ( ( (  ) ) ) ) )  -  v e r y s t r o n g commitment moderately committed unsure small commitment no c o m m i t m e n t  9. How much t i m e , e n e r g y , a n d r e s o u r c e s h a v e I p u t into being the s o r t of nurse I l i k e to t h i n k of m y s e l f as b e i n g ? ( ) - a g r e a t d e a l o f t i m e , e n e r g y , and resources ( ) - a m o d e r a t e amount o f t i m e , e n e r g y , and r e s o u r c e s ( } - unsure ( ) - a s m a l l amount o f t i m e , e n e r g y , and resources C ) - very l i t t l e time, energy, or resources  APPENDIX  B  COVER LETTER FOR QUESTIONNAIRE SENT TO SCHOOLS OF NURSING  76  APPENDIX B  COVER LETTER FOR QUESTIONNAIRE SENT TO SCHOOLS OF NURSING Vancouver, B r i t i s h February, 1976  Columbia  Dear Thank you f o r your i n t e r e s t i n my t h e s i s r e s e a r c h d u r i n g our r e c e n t telephone c o n v e r s a t i o n . Enclosed please f i n d a copy of my q u e s t i o n n a i r e . I would l i k e to a d m i n i s t e r the q u e s t i o n n a i r e to a group of twenty to t h i r t y students p r e f e r a b l y i n the f i n a l h a l f of t h e i r nursing program. The questions assume t h a t the student w i l l have had c l i n i c a l e x p e r i e n c e s . I f p o s s i b l e I would l i k e to avoid g i v i n g the q u e s t i o n n a i r e to students who have j u s t r e c e i v e d a c l i n i c a l e v a l u a t i o n , t h a t i s , i n the past t h r e e or f o u r days. S i n c e the q u e s t i o n s ask f o r f e e l i n g s and understandings a very recent e v a l u a t i o n may i n f l u e n c e the student's response. T h i s l a t t e r concern i s not a s e r i o u s matter. My main concern i s to e s t a b l i s h r e l i a b i l i t y o f the tool by seeing i f students answer q u e s t i o n s with s i m i l a r responses. The questions take approximately f i f t e e n minutes to answer. The students w i l l remain anonymous, the data w i l l be used o n l y by the r e searcher. Please f e e l f r e e to ask any questions you may have, I s h a l l c o n t a c t you a t the end o f the week o f February 23, 1976 to see i f you w i l l be w i l l i n g to p a r t i c i p a t e i n the study. Thank you f o r your a s s i s t a n c e ,  Sincerely, /s/  J u d i t h M. Pinkham  APPENDIX C PERCENTAGE RESPONSES TO ITEMS ON QUESTIONNAIRES BY EACH PARTICIPATING SCHOOL  78 APPENDIX C PERCENTAGE RESPONSES TO ITEMS ON QUESTIONNAIRE BY EACH PARTICIPATING SCHOOL  Questionnaire Item Number A  Response Categories  1 1 2 3 4 5 2 1 2 3 4 5  School A  1 2 3 4 5  School B  b  School C  (N=25) 60.0 12.0 12.0 16.0  (N=20) 25.0 45.0 10.0 20.0  -  -  (N=25)  (N=20) 5.0 10.0  (N=19)  -  -  20.0 4.0 68.0 8.0 (N=25)  3  a  8.0 12.0 76.0 4.0  80.0 5.0  (N=19) 68.4 31.6  -  15.8 . 84.2  -  (N=20) 15.0 40.0 15.0 30.0  (N=19) 5.2 31.5 26.3 37.0  -  -  c  Total (N=64) 51.6 28.1 7.9 12.5  (N=64) 1.6 15.7 1.6 76.6 4.7 (M=64) 6.2 25.0 17.1 50.0 1.6  a  S c h o o l A = 4 year b a s i c nursing education program i n a u n i v e r s i t y .  b  S c h o o l B = 3 year b a s i c nursing education program i n a h o s p i t a l school o f n u r s i n g .  c  S c h o o l C = 2 year b a s i c nursing education program i n a community c o l l e g e .  79  Questionnaire Item Number A  Response Categories  4  School A (N=25)  1 2 3 4 5 5 1 2 3 4 5  6 1 2 3 4 5 7 1 2 3 4 5  56.0 28.0 16.0  -  a  School B (N=20) 5.0 75.0 15.0 5.0  b  School C (N=19 5.2 63.1 26.3 5.2  c  Total (N=64) 3.1 64.0 23.4 9.3  -  -  -  (N-25) 68.0 32.0  (N=20) 30.0 60.0  (N=19) 42.1 52.7  (N=64) 48.4 46.9  -  -  -  -  10.0  5.2  4.7  -  -  (N=25) 72.0 16.0 4.0 8.0  (N=20) 60.0 15.0 10.0 15.0  (N=19) 63.1 26.3  (N=64) 65.7 18.8 4.7 11.0  -  -  -  -  (N=25) 8.0 52.0 28.0 4.0 8.0  (N=20) 20.0 65.0 5.0 10.0  (N=19)  _  _  (N=64) 9.3 50.0 21.9 15.7 3.1  --  10.6  31.5 31.5 37.0  80  Questionnaire Item Number A  8  Response Categories  School A  a  School B  b  School C  c  Total  (N=25)  (N=20)  (N=19)  (N=64)  2 3 4 5  24.0 20.0 8.0 48.0  30.0 20.0 20.0 30.0  15.8 10.6 10.6 63.1  23.4 17.1 12.5 46.9  1 2 3 4 5  (N=25) 44.0 48.0 8.0 -  (N=20) 35.0 55.0 10.0 -  (N=19) 21 .0 57.9 21.0 -  (N=64) 34.3 53.1 12.5  1 2 3 4 5  (N=25) 8.0 12.0 16.0 64.0 -  (N=20) 35.0 30.0  (N=19) 10.6 21.0 5.2 63.1 -  (N=64) 17.1 20.3 7.9 54.7 -  1 2 3 4 5  (N=25) 44.0 52.0 4.0  (N=20) 65.0 30.0 5.0  (N=19) 73.7 5.2 21.0  (N=64) 59.3 1.5 36.0 3.1  ii  9  10  11  -  35.0 -  -  81  Questionnaire Item Number  Response • Categories  School A  1 2 3 4 5  (N=25) 28.0 8.0 64.0 -  (N=20) 40.0 5.0 - 55.0 -  (N=19) 21 .0 -  (N=64) 29.7 -  10.6 68.4 -  7.9 62.5  1 2 3 4 5  (N=25) 28.0 56.0 16.0 -  (N=20) 60.0 25.0 15.0 -  (N=19) 52.7 21.0 21.0 5.2  (N=64) 45.3 36.0 -  1 2 3 4 5  (N=25) 68.0 12.0 20.0 -  (N=20) 25.0 65.0 10.0 -  (N=19) 10.6 68.4 21.0 -  (N=64) 11.0 67.1 4.7 17.1 -  1 2 3 4  (N=25) 8.0 64.0 12.0 16.0  (N=20) 50.0 50.0 -  (N=19) 15.8 42.1 10.6 31.6  (N=64) 23.4 53.1 7.9 15.6  12  B  1  2  3  a  School B  -  b  School C  c  Total  -  17.1 1.5  82  Questionnaire Item Number B  Response Categories  School A  a  School B  b  School C  C  Total  (N=25) 68.0 28.0 4.0  (N=20) 60.0 25.0 5.0 10.0  (N=19) 63.1 26.3 5.2 5.2  (N=64) 64.0 26.6 3.1 6.2  (N=20)  1 2 3 4 5  (N=25) 8.0 48.0 16.0 24.0 4.0  55.0 10.0 30.0 5.0  (N=19) 10.6 42.1 31.6 10.6 5.2  (N=64) 6.2 48.4 18.8 21.9 4.7  1 2 3 4 5  (N=25) 8.0 12.0 8.0 44.0 28.0  (N=20) 5.0 35.0 15.0 15.0 30.0  (N=19) 21.0 21.0 5.2 31.6 21.0  (N=64) 11.0 21 .9 9.3 31.2 26.6  (N=25) 24.0 56.0 20.0  (N=20) 55.0 40.0 5.0 -  (N=19) 15.8 52.6 5.2 15.8 10.6  (N=64) 31.2 50.0 1.5 14.0 3.1  4 1 2 3 4 5 5  6  7 1 2 3 4 5  _  -  83  Questionnaire Item Number B  Response Categories  School A  1 2 3 4 5  (N=25) 80.0 16.0 4.0 -  (N=20) 15.0 85.0 -  (N=19) 78.9 15.8 5.2  (N=64) 59.3 37.5 -  1 2 3 4 5  (N=25) 88.0 4.0 4.0 4.0 -  (N=20) 80.0 15.0 5.0 -  (N=19) 84.2 15.8 -  (N=64) 84.3 1.5 11.0 3.1 -  1 2 3 4 5  (N=25) 32.0 16.0 8.0 40.0 4.0  (N-20) 60.0 40.0 -  (N=19) 26.3 5.2 21.0 42.1 5.2  (N=64) 39.0 7.9 9.3 40.7 3.1  1 2 3 4 5  (N=25) 28.0 40.0 28.0 4.0  (N=20) 20.0 50.0 15.0 15.0  (N=19) 68.4 15.8 10.6 5.2 -  (N=64) 37.5 36.0 18.8 1.5 6.2  8  9  C  1  2  a  School B  -  b  School C  c  Total  1.5 1.5  84  Questionnaire Item Number C  Response. Categories  School A  1 2 3 4 5  (N=25) 28.0 60.0 4.0 4.0 4.0  (N=20) 30.0 70.0 -  (N=19) 36.9 57.9  -  -  1 2 3 4 5  (N=25) 4.0 60.0 32.0 4.0 -  (N=20) 15.0 70.0 10.0 5.0  (N=19) 5.2 . 78.9 15.8 -  -  -  1 2 3 4  (N=25) 8.0 56.0 20.0 16.0  (N=20) 20.0 60.0 20.0 -  (N=19) 21 .0 52.7 26.3  1 2 3 4  (N=25) 32.0 52.0 12.0 4.0  (N=20) 50.0 50.0  (N=19) 52.7 42.1  -  5.2  3  4  5  a  School B  b  School C  5.2  _  c  Total (N=64) 31.2 62.5 1.5 3.1 1.5 (N=64) 7.9 68.8 20.3 3.1 (N=64) 15.7 56.2 21.9 6.2  (N=64) 43.8 48.4 4.7 3.1  85  Questionnaire Item Number C  Response Categories  7 1 2 3 4 5 8 1 2 3 4 5 9 1 2 3 4  School A  a  School B  b  School C  c  Total  (N=25) 4.0 72.0 8.0 16.0  (N=20) 30.0 60.0 5.0 5.0  (N=19) 21.0 68.4 5.2 5.2  (N=64) 17.1 67.1 6.2 9.3  (N=25) 32.0 60.0 4.0 4.0  (N=20) 50.0 45.0 5.0  (N=19) 57.9 36.9 . 5.2  (N=64) . 45.3 48.4 4.7 1.5  -  -  -  (N=25) 48.0 48.0  (N=20) 50.0 45.0  (N=19) 57.9 42.1  (N=64) 51.6 45.3  -  -  -  -  4.0  5.0  _  3.1  -  

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