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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., McGill 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 p r e s e n t i n g t h i s t h e s i s in p a r t i a l f u l f i l m e n t o f the r e q u i r e m e n t s f o r an advanced degree at the U n i v e r s i t y o f B r i t i s h Co lumb i a , I a g ree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s tudy . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y purposes may be g r a n t e d by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s . It i s u n d e r s t o o d that c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i thout my w r i t t e n p e r m i s s i o n . Department o f N U R S I N G  The U n i v e r s i t y o f B r i t i s h Co lumbia 20 75 Wesbrook Place Vancouver, Canada V6T 1W5 Date 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 perceptions 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, expectations o f the teacher and the i n d i v i d u a l ' s ideas of 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 of s i x t y - f o u r student nurses from three b a s i c nursing educa-t i o n programs were s e l e c t e d . These students, 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 experiences. The data were c o l l e c t e d by the researcher 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 noting 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 schools. 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 of 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' choice o f responses supports many o f the f i n d i n g s revealed 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 s t r e s s . 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 i i 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 that teachers d i d perceive 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 negative c r i t i c i s m . 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 of perceptions r e l a t e d to c l i n i c a l l e a r n i n g experiences. 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 perceptions may give the teacher i n s i g h t i n t o the meaning of events to the l e a r n e r . Students i n a l l three schools 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 i i i TABLE OF CONTENTS CHAPTER PAGE I. INTRODUCTION 1 The Purpose of the-Study 3 Assumptions of the Study 4 L i m i t a t i o n s of the Study 4 D e f i n i t i o n o f Terms 4 Overview of the Remainder of the Study 5 I I . REVIEW OF RELATED LITERATURE 6 Int r o d u c t i o n 6 ' Learning Needs of I n d i v i d u a l s 7 The Role of Perception i n D e f i n i n g I n d i v i d u a l Needs 9 The I n d i v i d u a l ' s S e l f Concept as an Influence i n D e f i n i n g Needs 10 Past Learning Experiences 12 The Need f o r Knowledge of Past Learning Experiences 12 The E f f e c t s of Past Learning Experiences on the I n d i v i d u a l ... 13 Student Expectations of the Teacher 14 Summary 20 I I I . METHOD 22 In t r o d u c t i o n 22 Population of the Study 22 Development of the Tool 23 The P i l o t Study 24 Re v i s i o n of the Tool -25 C o l l e c t i o n of Data 25 A n a l y s i s of Data 26 i v CHAPTER PAGE IV. FINDINGS, ANALYSIS AND INTERPRETATION 28 . Introdu c t i o n 28 Responses to Questions Related to Past Learning Experiences . . 28 Responses to Questions Related to Student Expectations o f the teacher 38 Responses to Questions Related to the I n d i v i d u a l Needs of the student . 44 Summary 53 V. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS 54 Substantive 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 Questionnaire sent to Schools of Nursing ... 76 C Percentage Responses to Items on Questionnaires 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 Al 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 VII Responses to Questions BI and B2 39 VIII Responses to Questions B3, B4 and B5 40 IX Responses to Questions B6 and B7 43 X Responses to Questions B8 and B9 45 XI Responses to Questions CI, 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 CHAPTER I INTRODUCTION The numbers of 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 increased during the past y e a r s . The use of 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 contact in order to develop knowledge of c l i e n t experiences has been viewed as important i n developing an understanding of the r o l e of the nurse as a he 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 of 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 of 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 . D i s s a t i s -f a c t i o n with nursing i n the c l i n i c a l area may be one of 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 described 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 nursing programs. ' ' Reasons given f o r with-drawal i n c l u d e : (1) d i s l i k e f o r nursing, (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 nursing courses, (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 courses, and (6) d i f f i c u l t y with c l i n i c a l theory courses. ^"Withdrawal o f Students," American Journal of Nursing, Vol.51 (May, 1951), 342-343. 2 Barbara C. Rottkamp, " A t t r i t i o n Rates i n Basic Baccalaureate 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 Drop-outs," Nursing Forum, Vol.13 No.l, 1974. 2 These st u d i e s appear to support the idea that nursing experiences viewed as negative experiences may lead to a t t r i t i o n . Student perceptions of 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 perception as i t a f f e c t s behavior. He suggests that i f the perception i s one of t h r e a t the per-4 ceptual f i e l d i s narrowed and new perceptions or l e a r n i n g are decreased. Perception 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 self-esteem. Super s work suggests that i n choosing an occupation the i n d i v i d u a l chooses a means of implementing a s e l f c o n c e p t . 6 Lack of congruence between expectations and r e a l i t y may lead to withdrawal. K i b r i c k , i n a study on the e f f e c t of s e l f and r o l e perception of dropouts i n schools of n u r s i n g , has supported t h i s i d e a . I f 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 expectations of 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 that s p e c i a l demands, not n e c e s s a r i l y included 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 of View," Journal of Abnormal and S o c i a l Psychology, Vol.47, 662-673. ^Stanley Coopersmith, The Antecedents of Self-Esteem, (San F r a n c i s c o : W. H. Freeman and Company, 1967). c D. E. Super,"Vocational Adjustment; Implementing a S e l f Concept," Occupations, Vol.30 (November, 1951), 92. 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 perceived 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 of t h i s study i s to develop a tool which w i l l gather data of student perceptions 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 of student per-ceptions of 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 of past l e a r n i n g experiences; the student's expecta-t i o n s of the teacher; and, the student's ideas of 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 fo r c e d choice questions which reveal a p i c t u r e of the past experiences of the i n d i v i d u a l . These ideas, 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 at which they are revealed and may a l t e r or disappear i n a sho r t time. Perceptions give c l u e s to ideas and ac t i o n s but must be recognized as r e q u i r i n g constant v a l i d a t i o n . Past l e a r n i n g experiences, expectations of 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 Perception," 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 . I I . ASSUMPTIONS OF THE STUDY The f o l l o w i n g three assumptions guided development of the study: - student l e a r n i n g i n the 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 experiences. - student perceptions o f the expectations o f the teacher may d i f f e r from the teacher's own ex 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 t h e i r l e a r n i n g a b i l i t y . I I I . 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 only 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 s e t t i n g . Nursing Student - a student e n r o l l e d i n a ba s i c nursing education program preparatory 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 three nursing programs i n the B r i t i s h Columbia lower mainland were, i n the m a j o r i t y , midway through t h e i r b a s i c nursing education. Past Learning Experiences - t h i s r e f e r s to 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 occurred p r i o r to answering the study questions. 5 Perception - the i n t e g r a t i o n o f sensory impressions of events i n the external world as a f u n c t i o n o f nonconscious expectations d e r i v e d from past experiences and ser v i n g as a b a s i s f o r f u r t h e r meaningful motivated a c t i o n . ^ Personal Learning Needs - t h i s r e f e r s to the ideas which the student has of the f a c t o r s perceived i n the environment, i n other people, or 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 of the l i t e r a t u r e p e r t a i n i n g to l e a r n i n g needs of i n d i v i d u a l s , the e f f e c t of 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 expectations of the teacher. Selected 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 are i n c l u d e d . Chapter III d i s -cusses the research design, and a n a l y s i s o f the 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, con 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 In 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 perceptions of 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 expectations of the teacher These three areas are discuss 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 in 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 nursing l i t e r a t u r e which examined f a c t o r s which could i n f l u e n c e student's perceptions o f c l i n i c a l l e a r n i n g 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 interviewed students to gather information r e l a t e d to personal goals asking questions 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 Learner," The Journal  of Nursing Education, (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 revealed the perceptions 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 of nursing revealed many student a t t i t u d e s and ideas. LEARNING NEEDS OF INDIVIDUALS Recognition 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 of 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 experiences. C a r r o l l b e l i e v e s that 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 . ^ In t h e i r d i s -c u s s i o n the authors r a i s e the point that the time spent in 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 tasks 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 o b j e c t i v e s . C a r r o l l ' s model, from general education, d e s c r i b e s four 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 of 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 Basic  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 Learning," 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 Applied to Nursing Education," 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 def ic 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 fai lures. 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 sat is -faction was the subject o f a study by Fox. 1 6 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 ab i l i t y to learn". ' ' , J I b i d . , 179. 1 6 Fox, et a l . , Satisfying and Stressful Situations in Basic Programs  in Nursing Education, p.194. ^Kellogg, "Individualizing Teaching of Students," p.14. 9 K e l l o g g 1 s assessment i s c a r r i e d out 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 -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 to assess the 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 sciences have a l s o studied the i n d i v i d u a l and h i s needs foc 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 de s c r i b e s the growing trend toward viewing behavior 18 as a f u n c t i o n o f p e r c e p t i o n . 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 the 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 of the i n d i v i d u a l i s seen as dependent on h i s per c e p t i o n s , i f these are 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 of 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 of h i s perceptions p o s s i b l e to him at.a given 19 moment". In examining f a c t o r s which l i m i t perception Combs has include d physio-l 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 Arthur Combs, " I n t e l l i g e n c e from a Perceptual Point of View," Journal of 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 or negative, depending on previous experiences. 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 are perceived vary with the events taking p l a c e . Negative perceptions that are 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 of 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 of 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 pe 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 perceive new ideas and l e a r n i n g may be decreased. Combs and Syngg have elaborated 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 of good teaching i s i n the a b i l i t y to chal 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 that teachers must be s e n s i t i v e to the impact upon t h e i r charges of what they do and say, f o r the d i s t i n c t i o n between challenge and t h r e a t l i e s not i n what the teacher thinks 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 f i e l d . These i n c l u d e information from the i n d i v i d u a l himself and in 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 Carl Roger's d e f i n i t i o n - the s e l f concept or s e l f s t r u c t u r e may be thought of as an Arthur W. Combs and Donald Syngg, I n d i v i d u a l Behavior - A Per- ceptual Approach to Behavior. (New York: Harper and Row P u b l i s h e r s , 1959). 2 1 I b i d . , 389. 11 organized c o n f i g u r a t i o n of perceptions of the s e l f which are admissible to awareness. It i s composed of such elements as the perceptions 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 perceived as a s s o c i a t e d with experiences and o b j e c t s ; and goals and i d e a l s which are perceived as having p o s i t i v e or negative valence.22 The r o l e o f perceptions i s important i n determining the s e l f concept. S. I. Hayakawa has s t a t e d that the s e l f concept i s the fundamental d e t e r -23 minant of our p e r c e p t i o n s , t h e r e f o r e our behavior. The s e l f concept comes from personal experiences, from i n f a n c y on, and from personal evalua-t i o n s . He suggests that 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 perceive i t . The f a c t of 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 at 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 t h r e a t . The importance of f i n d i n g out the meaning of 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 of persons of high and 24 low self-esteem. The person with a low self-esteem l a c k s t r u s t i n them-selves and i s apprehensive about expressing ideas. 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. A person with a high self-esteem i s s o c i a l , independent and o f t e n c r e a t i v e . They can examine external issues 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 intuit ive thinking is 25 fostered by the development of self confidence and courage in the student". 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 terature did not reveal other art ic les which suggested a similar step to gain knowledge of past learning experiences of students. p c Jerome S. Bruner, The Process of Education. (Cambridge: Harvard University Press, 1966), p.65. 2 6 Metz, "Knowing the Learner," p.3-9. 2 7 I b i d . , 6. 28 Bruner, The Process of Education, p.49 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 of high, medium and low academic 29 a c h i e v e r s . He d e s c r i b e s the work of previous researchers who have sug-gested that s c h o l a s t i c performance tends to be c o n s i s t e n t with the i n d i v i -dual 's self-assessment. 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 of high, medium and low achi e v i n g students. There was consensus among the students as to the q u a l i t i e s of the id e a l student. T h i s student was involved 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 of these q u a l i t i e s than the other two groups. The achievement 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 ac 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 students. 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 that there i s a d i f f e r e n c e i n the s e l f p erception of students who are high a c h i e v e r s and 30 those who are not. This study revealed that the low a c h i e v i n g student l a c k s the goals and mot i v a t i o n to lead him to higher achievement. 3 Goldberg has studie d the e f f e c t s of f e a r of f a i l u r e on the i n d i v i d u a l . He studie d some of the consequences of 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 a l u a t i o n of self-esteem. He found t h a t a person with low self-esteem " A . V. E v e r e t t , "The S e l f Concept of High, Medium and Low A c h i e v e r s " , The A u s t r a l i a n Journal of Education, Vol.15 No.3 (October, 1971), 319-324. 3 0R. 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 of C l i n i c a l Psychology, Vol.27, (1971), 188. 3 1 C a r l o s Goldberg, "Some E f f e c t s of Fear o f F a i l u r e i n the Academic S e t t i n g " , Journal of Psychology, Vol.84-85 (1973). 14 whose s e l f pe rcept i on i s c l o s e l y l i n k e d to academic achievement may view f a i l u r e as an i n d i c a t i o n of h i s t rue a b i l i t y . Th i s leads to a c on t i nua l f e a r of f a i l u r e even though the i n d i v i d u a l may have succe s s fu l expe r i ence s . Goldberg concludes tha t the f ea r of f a i l u r e person has a low se l f - e s t eem and i s dependent on ex te rna l c r i t e r i a f o r a d e f i n i t i o n of s e l f . His m o t i -v a t i on and goals to ach ieve are lowered to avo id the p o s s i b i l i t y of f a i l i n g . 32 Kates has a l so s tud ied f a i l u r e avo idance. His study suggests tha t succes s fu l problem s o l v i n g i s dependent on an i n t e g r a t i o n o f p e r s o n a l i t y f a c t o r s , the kinds of demands made by the t a s k , and the environmental con-d i t i o n s i n which the task i s a t tempted. Pe rv in has developed the idea of the match o f an i n d i v i d u a l w i th h i s 33 environment i n o rder to ach ieve optimum performance and s a t i s f a c t i o n . He views a " b e s t - f i t " of i n d i v i d u a l w i t h h i s environment as showing i t s e l f i n high performance, s a t i s f a c t i o n and l i t t l e s t r e s s ; a " l a c k of f i t " r e s u l t s i n poor performance, d i s s a t i s f a c t i o n and s t r e s s to the i n d i v i d u a l . The l i t e r a t u r e reviewed i n t h i s s e c t i o n has focused on the need to have knowledge of the i n d i v i d u a l ' s past l e a r n i n g expe r i ence s . S tud ies r e -viewed show the e f f e c t s of past l e a r n i n g exper iences in shaping the i n d i v i -dual ' s s e l f concept. . STUDENT EXPECTATIONS OF THE TEACHER Student expec ta t i on s of the teacher appear to revea l themselves most ocS. L. Kates and Win. T . Ba r r y , " F a i l u r e Avoidance and Concept A t t a i n -ment", Journa l of P e r s o n a l i t y and Soc i a l Psychology, Vo l .15 No.l (May, 1970), 21-27. 33 L. A. P e r v i n , "Performance and S a t i s f a c t i o n as a Funct ion o f I n d i -v idua l -Env i ronment F i t " , P s ycho l og i ca l B u l l e t i n , Vo l .69 No.l (1968), 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 of 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 discussed 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 defined e v a l u a t i o n as "a continuous process of c o l l e c t i n g 34 data to be used as a basis f o r applying a set of standards. She d e s c r i b e s a general trend in 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 s k i l l s . 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 discussed by 35 H e s l i n . She recognizes that 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 of 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 of other q u a l i t i e s empha-s i z e s t h i s p o i n t . 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 e v a l u a t i o n s l e s s o f t e n than any other type of 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 of 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 hat 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 of 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 of t h e o r e t i c a l knowledge of c l a s s -room examinations, but t h i s type of 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 in C l i n i c a l Nursing (Saint L o u i s : C. V. Mosby Company, 1972), p.240. 35 P. H e s l i n , "Evaluating 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 in Basic Programs i n  Nursing Education, p. 201. 3 7 I b i d . 1 Fox's study included 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 the student's great need f o r t h i s p o s i t i v e reinforcement. He c i t e s i n c i d e n t s that stated 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 that the student i s most of t e n s i n g l e d out only when doing something i n c o r r e c t l y . Olesen has examined both teachers' and students' ideas of 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 or 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 in 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 ex-ample, 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 respon-s i b i l i t y , f i r s t as teacher, but e q u a l l y importantly, as counselor.39 The true meaning of the e v a l u a t i v e comments may become c l e a r to the student only when a f i n a l grade i s g i v e n , or 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 and i n d i v i d u a l d i s c u s s i o n s . 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 Jylbid. 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 recounting of t h e i r impressions of 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 could gauge f a c u l t y ,~ perception 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 con-41 ference from the student's viewpoint. An o p i n i o n a i r e revealed many d i s -s a t i s f a c t i o n s with the conference. 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 the experience, the a v a i l a b i l i t y of 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 ex-perience. The students d i d f e e l that the conference stimulated them to do be 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 provide time f o r sharing o f information about the 43 student's progress i n an nonthreatening an atmosphere as p o s s i b l e . He a l s o s t a t e s : 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 that 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, main-t 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 auto-c r a t i c , f o r the i n s t r u c t o r never needs defend her evaluations.44 I b i d . , 158. S i s t e r Dolores Calamari, "Factors that Influence E v a l u a t i o n Con-ferences 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 Basic Programs  i n Nursing Education, p.202. 43 Lawrence Litwack, et a l . Counseling, 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 I b i d . 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 others and has l i s t e d four 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 of the r e c i p i e n t , (3) the strength 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 disapproval i s g i v e n . He concludes: "Findings of the study tend to support the general view that s e l f - c o n c e p t i o n s are learned and that the e v a l u a t i v e r e a c t i o n s of others 46 play a s i g n i f i c a n t part i n the l e a r n i n g process." D i f f e r i n g expectations 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 expectations 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 baccalaureate nursing students i n nursing courses, 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 nursing 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 of the f a c u l t y . On the other, she con-s 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 personnel. The r e s u l t i n g c o n t r a d i c t i o n s in the student's mind seem to be one of 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 of t h e i r program.^8 4 3 R i c h a r d Videbeck, "Self-Conception and the Reaction of Others," Sociometry, Vol.23, (1960), 351-359. 4 6 I b i d . , 359. ^^Litwack, et a l . Counseling, E v a l u a t i o n and Student Development, p. 141. I b i d . 19 S t e i n has studied 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 in the academic, 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 . The students s t u d i e d revealed awareness of tensions i n the c l i n i c a l area between teacher and s t a f f e x p e c t a t i o n s . Three authors reviewed made suggestions which could reduce the gap between teacher and student e x p e c t a t i o n s . Mauksch has suggested that students should share i n the s e l e c t i o n 50 o f c l i n i c a l l e a r n i n g experiences. This 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 independent judgement. The concept of s e l f d i r e c t i o n i s emphasized. Litwack has discussed the view o f Kramer (1967) which supports t h i s 51 idea . The need f o r help i n developing a greater 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 of having students p a r t i c i p a t e i n s e l e c t i n g t h e i r own l e a r n i n g experiences. Wiedenbach focused on the need f o r the student to see and to be able 52 to c h a l l e n g e the e v a l u a t i o n . This author d i s c u s s e s the need f o r the teacher to show she recognizes that the meaning to the student o f the behavior e v a l u -ated may be d i f f e r e n t from i t s meaning to the teacher. " " R . S t e i n , "The Student Nurse", Nursing Research, Vol.18 No.5 (S ptember-October, 1969), 436-439. 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 . Counseling, 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: Springer P u b l i s h i n g Company, 1969), p.52. 20 The importance of the development and maintenance of e f f e c t i v e two-way communication i s seen as an important means to make student and teacher expectations 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 perception 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 perception 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 -r a t u r e . 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 reveal a growing awareness of the need f o r t h i s information 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 of perception 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 of 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 self-esteem and in reducing motivation and attainment of g o a l s . Knowledge of the l e a r n e r ' s perception of h i s academic a b i l i t y i s suggested as important f o r the teacher to understand his motivation 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 perception o f h i s a b i l i t y . 21 The student's expectations of the teacher most often appear in 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 expectations with respect to c l i n i c a l performance are well documented in the l i t e r a t u r e . Suggestions to improve congruency of expectations 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 imple-ment 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 devised to gather data on students' perceptions of c l i n i c a l experiences. 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 perceptions of student nurses i n three nursing 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 in c o l l e c t i n g the data. In planning the survey these steps were fo 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 basis f o r the study; second, the population 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 nursing 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 -c i p a t e . The student groups, randomly s e l e c t e d , were each composed of high, 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 year h o s p i t a l school of n u r s i n g ; a f o u r year baccalaureate program at a u n i v e r s i t y ; and, a two year community c o l l e g e program. The t o t a l number of students from each school was 20, 25 and 19 r e s -p e c t i v e l y . 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 of e x p l o r a t o r y research appears to lend i t s e l f to the use of q u e s t i o n n a i r e s , interviews and o b s e r v a t i o n s . The emphasis i s on the d i s -covery of 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 of the tool was i n three phases: review of the l i t e r a t u r e to develop the content o f the questions; 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 ide a s ; and, ideas suggested by the researcher's personal experience i n teaching nursing. 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 of the student's perception o f the degree o f s el 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 perceives from n u r s i n g . Other questions used ideas of 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 experiences, eg., the student's perception 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 area, and, the type o f feedback r e c e i v e d from the teacher. G. C. Helmstader, Research Concepts i n Human Behavior, (New York: Appleton-Century-Crofts, 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 experiences, student expectations of 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 choice was presented i n a L i k e r t - t y p e s c a l e - 57 o f f i v e answers. 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 of misunderstanding or ambiguity, to o b t a i n an idea of the length of time r e -quired 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 in d i s c u s s i n g the merits of the ideas on which the questions were to be based. The ideas, opinions and f e e l i n g s expressed revealed very d i f f e r e n t personal experiences as students. T h i s f a c t gave the researcher clues to the p o s s i b l e perceptions of other students. A sample of 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 of 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 C O randomly s e l e c t e d sample of the questions. 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 of Asking Questions, ( P r i n c e t o n , New Jersey: P r i n c e t o n U n i v e r s i t y Press, 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 in the terminology of the questions. 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 revealed 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 ten to f i f t e e n minutes. T h i s seemed acce 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 of nursing were contacted by telephone, then mailed 60 a cover l e t t e r to set up the appointment f o r the c o l l e c t i o n o f the data. The researcher v i s i t e d each of the schools and administered the ques-t i o n n a i r e to the three groups of student nurses. P r i o r to a d m i n i s t e r i n g the qu e s t i o n n a i r e the researcher shared with the students some personal experiences i n 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 of 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 occurred with academically weak students who had been the o b j e c t of 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, frequent checks to see that they were aware of 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 researcher to p o s t u l a t e that there may have been events i n these students' past experiences, expectations 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 refused 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 of the f i n d i n g s would be sent to the schools only 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 of the questions were compiled f o r each of the p a r t i c i p a t i n g s c h o o l s . 6 ^ The responses were examined to see i f students from the three d i f f e r e n t types of nursing programs revealed s i m i l a r or d i s s i m i l a r perceptions o f c l i n i c a l experiences. T h i s was i n l i n e with the purpose of the study which was to develop a t o o l with which to gather student's perceptions of c l i n i c a l experiences. The content v a l i d i t y of 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 with, 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 of perceptions 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 of answers across the three types of nursing programs. CHAPTER IV FINDINGS, ANALYSIS AND INTERPRETATION INTRODUCTION The purpose of 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 perceptions of 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 of 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 to volunteer completed the q u e s t i o n n a i r e . No questions were unanswered, the response was 100 per cent. RESPONSES TO QUESTIONS RELATED TO PAST LEARNING EXPERIENCES The f i r s t f o u r questions 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 of i n s t r u c t i o n , and 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 rea. As shown i n Tables I and II the responses across the three programs rev e a l e d that 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 cent. F i f t y per cent of the students stated 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 included 19 of 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 of 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 Al AND A2 A l . The s i z e of c l a s s I f e e l most comfortable i n i s : Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) , 60.0 25.0 68.4 51.6 1 0 - 2 0 , 12.0 45.0 31 .6 28.1 12.0 10.0 - 7.9 2 0 - 5 0 16.0 20.0 - 12.5 over 50 Total 100.0 100.0 100.0 100.1 A2. The method of 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 School A (N=25) Responses i n a School B b (N=20) Per Cent School C c (N=19) To t a l (N=64) . . . 5.0 - 1.6 20.0 10.0 15.8 15.7 , , , 4.0 - - 1.6 68.0 80.0 84.2 76.6 8.0 5.0 - 4.7 Total 100.0 100.0 100.0 100.2 a S c h o o l A bSchool B c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . = 3 year b a s i c nursing education program i n a h o s p i t a l school o f nursing. = 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 Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 15. ,0 5, .2 6.2 . . . . 8 .0 40. .0 31, .5 25.0 . . . . 12 .0 15. .0 26, .3 17.1 . . . . 76 .0 30, .0 37, .0 50.0 . . . . 4 .0 1.6 Total 100 .0 100, .0 100 .0 99.9 A4. 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 as: Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) , 5.0 5.2 3.1 f a s t , 56.0 75.0 63.1 64.0 28.0 15.0 26.3 23.4 16.0 5.0 5.2 9.3 very slow Tota l 100.0 100.0 99.8 99.8 a S c h o o l A bSchool B c S c h o o l C = 4 year basic nursing education program i n a u n i v e r s i t y . = 3 year basic nursing education program i n a h o s p i t a l school of nu r s i n g . = 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 s e t t i n g . In general these responses revealed 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 preference f o r the l e c t u r e then d i s c u s s i o n method of i n s t r u c t i o n . The responses to the questions r e l a t e d to perceptions of l e a r n i n g a b i l i t y r evealed that the m a j o r i t y of students had found c l i n i c a l educational experiences "demanding". The m a j o r i t y of the students described 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 included 17 of the 25 u n i -v e r s i t y students. F o r t y - s i x per cent of 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 included the m a j o r i t y of the hos-p i t a l and community c o l l e g e students. The expression of the meaning o f t h i s behavior i n d i c a t e d that 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 hat they enjoyed t h i s experience. 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 questions Al and A2, Table I. The next group of questions, 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 stated t h a t t h e i r 32 TABLE III 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 Response Categories School A a School B b School C c Total (N=25) (N=20) (N=19) (N=64) 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 30.0 42.1 48.4 l i s t e n , speak o c c a s i o n a l l y 32.0 60.0 52.7 46.9 none o f these -l i s t e n , say l i t t l e - 10.0 5.2 4.7 never p a r t i c i p a t e Total 100.0 100.0 99.9 100.0 A6. My behavior i n a d i s c u s s i o n group means: Response Categories I enjoy d i s c u s s i o n groups I sometimes f e e l l i k e p a r t i c i p a t i n g . none o f these I have d i f f i c u l t y expressing myself . I d i s l i k e d i s c u s s i o n groups Responses i n Per Cent School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 72.0 60.0 63.1 65.7 16.0 15.0 26.3 18.8 4.0 10.0 - 4.7 8.0 15.0 10.6 11.0 100.0 100.0 100.2 To t a l 100.0 a S c h o o l A = bSchool B = c S c h o o l C = 4 year basic nursing education program i n a u n i v e r s i t y . 3 year b a s i c nursing education program i n a h o s p i t a l school o f nursing. 2 year b a s i c nursing 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 de s c r i b e d as: Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 8. ,0 20.0 9.3 52, .0 65.0 31 .5 50.0 28, .0 5.0 31 .5 21.9 4, .0 10.0 37 .0 15.7 8, .0 • - 3.1 Total 100, .0 100.0 100 .0 100.0 A8. The s i t u a t i o n which would cause me the most s t r e s s would be: Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) c a r i n g f o r a p a t i e n t I have nursed before - - - -24.0 30.0 15.8 23.4 20.0 20.0 10.6 17.1 nursing assignment d i s c u s s i o n with 8.0 20.0 10.6 12.5 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 30.0 63.1 46.9 T o t a l 100.0 100.0 100.1 99.9 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 . bSchool B = 3 year b a s i c nursing education program i n a h o s p i t a l school of nursing. c S c h o o l C = 2 year basic 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 is 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 of responses. Equal numbers of these students i n d i c a t e d the " p o s i t i v e " , or "un c e r t a i n " response while 7 of 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 revealed that " r e c e i v i n g c l i n i c a l evalua-t i o n from teacher" caused 46.9 per cent of the students s t r e s s . "Caring f o r a new p a t i e n t " was the second choice causing 23.4 per cent of the students s t r e s s . In general 59.3 per cent of 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 choices 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 " , " u n c e r t a i n " 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 teacher", 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 of 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 of 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 of the 64 students s t a t e d that none of the given responses were a p p r o p r i a t e f o r t h e i r experience. In general the m a j o r i t y of 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 of the t o t a l s i t u a t i o n . 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 th i n k I have been most f r e q u e n t l y judged on: Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) my knowledge of t o t a l p a t i e n t 44.0 35.0 21.0 34.3 what the teacher saw me do . . . . 48.0 55.0 57.9 53.1 8.0 10.0 21.0 12.5 what agency s t a f f saw me do ... . - - - -what I t o l d the teacher I could do - - - -T o t a l 100.0 100.0 99.9 99.9 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 teacher: Response Categories when I d i d very well when I d i d s a t i s f a c t o r i l y none of these when I d i d u n s a t i s f a c t o r i l y . . . . when I f a i l e d Responses i n Per Cent. School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 8.0 35.0 10.6 17.1 12.0 30.0 21.0 20.3 16.0 - 5.2 7.2 64.0 35.0 63.1 54.7 99.9 99.3 Total 100.0 100.0 a S c h o o l A bSchool B c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . = 3 year basic nursing education program i n a h o s p i t a l school o f nursing. = 2 year b a s i c nursing education program i n a community c o l l e g e . 36 Question AIO sought information 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 during c l i n i c a l experiences. F i f t y - f o u r per cent of the students stated 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 ixteen of the 25 u n i v e r s i t y students, and 12 of the 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 u n s a t i s f a c t o r i l y . T h is 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 of "when I d i d very 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 question 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 the teacher, i n the c l i n i c a l area, 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 to 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 during c l i n i c a l e v a l u a t i o n . In question A l l 59.3 per cent of the s t u -dents i n d i c a t e d that 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 the teacher's judgement was most important. These responses were c o n s i s t e n t across the three schools. Question A12 showed that 62.5 per cent o f the 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 to 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 of 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. TABLE VI RESPONSES TO QUESTIONS A l l AND Al 2 37 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 con-sidered to be the most important was: Response Categories •School A (N=25) Responses i n a School B b (N=20) Per Cent School C c (N=19) Total (N=64) my own ... . . 44.0 54.0 73.7 59.3 - 5.2 1 .5 - - -. . 52.0 30.0 21.0 36.0 . . 4.0 5.0 - 3.1 Total 100.0 100.0 99.9 99.9 Al2..In 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 Response Categories School A a School B D School C c Total (N=25) (N=20) (N=19) (N=64) 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 40.0 21.0 29.7 where I stand i n r e l a t i o n to my — 8.0 5.0 10.6 7.9 how w e l l / p o o r l y the teacher thinks I am l e a r n i n g to nurse 64.0 55.0 68.4 62.5 the agency s t a f f l i k e d / d i s l i k e d me - - - -Total 100.0 100.0 100.0 100.1 aSchool A = bSchool B = cSchool C = 4 year basic nursing education program i n a u n i v e r s i t y . 3 year basic nursing education program i n a h o s p i t a l school of nursing. 2 year basic nursing education program i n a community c o l l e g e . 38 In general these two questions reveal that the m a j o r i t y of 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 of t h e i r nursing appears to 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 Th i s group of questions seeks to i d e n t i f y information about the s t u -dent's expectations of 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 regarding the use of 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 counselor, 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 of the students f e l t they were well known as an i n d i v i d u a l , while 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 across 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, only 7 of the 25 students. Question B2 revealed that 67.1 per cent of the students f e l t f a i r l y r e laxed 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 of 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 questions 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 revealed that 53.1 per cent of the students thought t h a t course o b j e c t i v e s were most useful 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 Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=l9) 01=64) well known as an i n d i v i d u a l 28.0 60.0 52, .7 45, .3 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 56.0 25.0 21, .0 36, .0 none o f these - -one of many students . . . 16.0 15.0 21, .0 17, .1 - - 5, .2 1, .5 Total 100.0 100.0 99, .9 99, .9 B2. 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 Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) very r e l a x e d 25.0 10.6 11.0 68.0 65.0 68.4 67.1 12.0 - - 4.7 20.0 10.0 21.0 17.1 very i l l a t ease Tota l 100.0 100.0 100.0 99.9 a S c h o o l A = bSchool B = c S c h o o l C = 4 year basic nursing education program i n a u n i v e r s i t y . 3 year b a s i c nursing education program i n a h o s p i t a l school o f nursing. 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 useful f o r : Response Categories a guide f o r my own progress. . . t e l l me the school's expectations none of these give d i r e c t i o n to the teacher. . t e l l agency s t a f f what to expect Responses i n Per Cent School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 8.0 50.0 15.8 23.4 64.0 50.0 42.1 53.1 12.0 - 10.6 7.9 16.0 _ 31.6 15.6 Total 100.0 100.0 100.1 100.0 B4. In my opinion 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 ev a l u a t i n g c l i n i c a l performance: Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 68.0 60 0 63 1 64.0 28.0 25 0 26 3 26.6 5 .0 5 2 3.1 perhaps, but not i n my experience. 4.0 10 .0 5 .2 6.2 - -T o t a l 100.0 100.0 99.8 99.9 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 . bSchool B = 3 year b a s i c nursing education program i n a h o s p i t a l school of nursing. 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 . 41 TABLE VIII (continued) RESPONSES TO QUESTION B5 B5. In my op i n i o n teachers' 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 a K p Response Categories School A School B School C T o t a l (N=25) (N=20) (N=19) (N=64) 8, .0 10, .6 6.2 48, .0 55. .0 42, .1 48.4 16, .0 10. .0 31, .6 18.8 perhaps, but not i n my experience . 24, .0 30, .0' 10, .6 21,9 never i n my experience 4, .0 5. ,0 5, .2 4.7 Total 100, ,0 100, ,0 100, .1 100.0 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 . ^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 nursing. School C = 2 year b a s i c nursing education program i n a community c o l l e g e . 42 f o r 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 of 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 gain an understanding of the school's e x p e c t a t i o n s . Question B4 revealed that 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 -c a l performance. Twenty-six per cent of 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 that 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 of the students b e l i e v e d that 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 that 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 perceive the teacher's counseling 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 that 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 sai d t h i s could happen while 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 c r i t i c i s m : Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 8 .0 5, .0 21 .0 11 .0 12 .0 35, .0 21 .0 21 .9 8 .0 15, .0 5 .2 9 .3 perhaps, but not i n my experience 44 .0 15, .0 31 .6 31 .2 never i n my experience 28 .0 30, .0 21 .0 26 .6 Total 100 .0 100, .0 99 .8 100 .0 B7. In my experience teachers may perceive themselves as h e l p f u l c o u n s e l l o r s as well as teachers: Responses i n Per Cent Response Categories School A a School B b School C c Total (N=25) (N=20) (N=19) (N=64) 24 .0 55, .0 15 .8 31. 2 56 .0 40, .0 52 .6 50. 0 5 .2 1. 5 perhaps, but not i n my experience 20 .0 5, .0 15 .8 14. 0 never i n my experience 10 .6 3. 1 Total 100 .0 100, ,0 100 .0 99. 8 a S c h o o l A bSchool B c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . = 3 year b a s i c nursing education program i n a h o s p i t a l school of nursing. = ,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 highest number of any of the responses. In question 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 question "do teachers per-c e i v e themselves as h e l p f u l counselors as well as teachers?" G e n e r a l l y the students seemed to f e e l t h at teachers do perceive them-selves 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 revealed that 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 of 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 only from d i r e c t o b s e r v a t i o n . These responses were con-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 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 of student achievement. The responses to question 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 teacher. T h i s was evident 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 information about teacher behaviors that students value, 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 think teachers most'often a c q u i r e t h e i r knowledge of student achievement: Responses in Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) from d i r e c t o bservation and d i s c u s s i o n with the student . . . . 80.0 15.0 78.9 59.3 from d i r e c t o bservation o n l y . . . . 16.0 85.0 15.8 37.5 none of these - - -from agency s t a f f . . . . 4.0 - - 1.5 from what student t e l l s teacher . . - 5.2 1 .5 Total 100.0 100.0 99.9 99.8 B9. 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: Responses i n Per Cent Response Categories School A a School 1 B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 80.0 84.2 84.3 my classmates' o p i n i o n . . . ... 4.0 - ' - 1.5 none of these . . . 4.0 15.0 15.8 11.0 ... 4.0 5.0 - 3.1 agency s t a f f ' s o p i n i o n . . . . . . - - -Total 100.0 100.0 100.0 99.9 a S c h o o l A = bSchool B = c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . 3 year b a s i c nursing education program i n a h o s p i t a l school of nursing. 2 year basic 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 question on Table XI asked the student to i d e n t i f y the people she f e e l s most at ease with in the c l i n i c a l a rea. Forty per cent of the students wished the teacher "to be a v a i l a b l e when I request help", while 39 per cent of the students d e s i r e d that the teacher " t r i e s to understand me as a person". The answers across 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 in 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 question C2 37.5 per cent o f the t o t a l sample de-s i r e d that the teacher be able to "ask thought provoking questions" while 36 per cent d e s i r e d the teacher to be able to "answer que s t i o n s " . Of the three schools nearly 70 per cent of 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 questions. In both the other programs the m a j o r i t y of the students d e s i r e d that the teacher could answer questions. Question C3 revealed 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. This 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 that peers and p a t i e n t s are people with whom students f e e l most at ease i n the c l i n i c a l s e t t i n g . 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 point s c a l e . These questions 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 that are most important to me in the c l i n i c a l area are: Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) t r i e s to understand me as a person 32.0 60.0 26.3 39.0 16.0 • - 5.2 7.9 8.0 - 21.0 9.3 a v a i l a b l e when I request help . . 40.0 40.0 42.1 40.7 4.0 - 5.2 3.1 Total 100.0 100.0 99.8 100.0 C2. The teaching 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 area: Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) asks thought provoking questions . 28.0 20.0 68.4 37.5 40.0 50.0 15.8 36.0 28.0 15.0 10.6 18.8 knows way around c l i n i c a l area . . - - 5.2 1.5 informs agency s t a f f o f o b j e c t i v e s 4.0 15.0 - 6.2 To t a l 100.0 100.0 100.0 100.0 a S c h o o l A bSchool B c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . = 3 year b a s i c nursing education program i n a h o s p i t a l school of nursing. = 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 able to act the way I f e e l with: Responses i n Per Cent Response Categories School A a School B b School C c Total (N=25) (N=20) (N=19) (N=64) p a t i e n t s 28.0 30.0 36.9 31.2 60.0 70.0 57.9 62.5 none of these 4.0 - - 1 .5 agency s t a f f 4.0 - 5.2 1.3 teacher 4.0 - - 1 .5 Total 100.0 100.0 100.0 100.0 a S c h o o l A = bSchool B = c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . 3 year basic nursing education program i n a h o s p i t a l school of nursing. 2 year b a s i c nursing education program i n a community c o l l e g e . 49 Question C4, as shown on Table XII looked at the amount of s e l f -support in the nurse r o l e f o r the student at t h i s time. Sixty-eight per cent of the students indicated they thought they did " f a i r l y w e l l " at being the sort of nurse they l i k e d to think of themselves as being. Twenty per cent stated they were "unsure". This was s i m i l a r across the three schools. Question C5, Table XII, asked the student to rate the degree of socia l support she perceived in the nurse r o l e . F i f t y - f i v e per cent stated that other persons thought they did " f a i r l y w e l l " at being the sort of nurse the student l i k e d to think she was. F i f t e e n per cent indicated others thought the student did "very w e l l " with 21.9 per cent i n d i c a t i n g the response "unsure". These responses were very consistent across the three schools. Generally the students perceived a moderate degree of s e l f and socia l support in the nurse r o l e . Questions C6 and C7 as shown in Table XIII examined the amount of i n t r i n s i c and e x t r i n s i c rewards the students perceived in t h e i r nursing. C6 revealed that 92.2 per cent of the students received e i t h e r a "great deal of pleasure", or moderate pleasure in doing the things they did as nurses. C7 which asked students to rate the e x t r i n s i c rewards they got from t h e i r nursing revealed that 67.1 per cent received "moderate rewards". Seventeen per cent of the students perceived " c o n s i s t e n t l y high rewards" while 9.3 per cent i n d i -cated "very l i t t l e rewards". Generally the students appeared to gain more i n t r i n s i c than e x t r i n s i c rewards from t h e i r nursing. Table XIV shows the responses to questions C8 and C9, which examined the student's commitment to nursing and her investment of time, energy and resources. 50 TABLE XII RESPONSES TO QUESTIONS C4 AND C5 C4. How well do I do at being the s o r t of nurse I l i k e to think of myself as being? Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 4.0 15.0 5.2 7.9 60.0 70.0 78.9 68.8 32.0 10.0 15.8 20.3 4.0 5.0 - 3.1 very p o o r l y Tot a l 100.0 100.0 99.9 100.1 C5. How well do o t h e r s , on the average, t h i n k I do a t being the s o r t of nurse I l i k e to think of myself as being? Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) 8.0 20.0 21.0 15.7 56.0 60.0 52.7 56.2 20.0 20.0 26.3 21.9 16.0 - - 6.2 very poorly Tot a l 100.0 100.0 100.0 100.0 a S c h o o l A = bSchool B = c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . 3 year basic nursing education program i n a h o s p i t a l school o f nursing. 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 things I do as a nurse? Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) great deal of pleasure . . . . . . 32.0 50.0 52.7 43.8 moderate pleasure . . 52.0 50.0 42.1 48.4 - - 4.7 small amount of pleasure . . . . . 4.0 - 5.2 3.1 no pleasure Total 100.0 100.0 100.0 100.0 C7. How much do I get out of doing the things I do as a nurse? Response Categories School A a (N=25) Responses i n School B b (N=20) Per Cent School C c (N=19) Total (N=64) c o n s i s t e n t l y high rewards . . . . 4.0 30.0 21.0 17.1 72.0 60.0 68.4 67.1 8.0 5.0 5.2 6.2 very l i t t l e rewards 16.0 5.0 .5.2 9.3 - - - -T o t a l 100.0 100.0 99.8 99.7 School A = 4 year basic 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 of nursing. School C = 2 year basic nursing education program i n a community c o l l e g e . TABLE XIV RESPONSES TO QUESTIONS C8 AND C9 52 C8. How deeply have I staked myself on being the s o r t of nurse I l i k e to t hink of myself as being? Responses i n Per Cent Response Categories School A a School B b School C c Total (N=25) (N=20) (N=19) (N=64) 32.0 50.0 57.9 45.3 60.0 45.0 36.9 48.4 4.0 5.0 5.2 4.7 4.0 - - 1.5 - - - -T o t a l 100.0 100.0 100.0 99.9 C9. How much time, energy, and resources have I put i n t o being the s o r t o f nurse I l i k e to th i n k of myself as being? Responses i n Per Cent Response Categories School A a School B b School C c T o t a l (N=25) (N=20) (N=19) (N=64) a great deal of time, energy, and 48.0 50.0 57.9 51.6 a moderate amount o f time, energy 48.0 45.0 42.1 45.3 - - - -a small amount of time, energy, 4.0 5.0 - 3.1 very l i t t l e time, energy, or - - - -Total 100.0 100.0 100.0 100.0 a S c h o o l A bSchool B c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . = 3 year b a s i c nursing education program i n a h o s p i t a l school of nursing. = 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 that 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 nursing. Question C9 revealed a s i m i l a r d i v i s i o n between a great 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 r e s p e c t i v e l y . G e n e r a l l y the students appear committed to the r o l e of the nurse and have invested l a r g e amounts of time, energy, and resources to meet t h i s g o a l . SUMMARY It i s d i f f i c u l t to summarize trends from so wide a range of 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 of 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 in 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 experiences. The t o o l was designed to give 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 experiences. Responses of "unsure", " u n c e r t a i n " , or "none of 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 choices 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 . In some instances the questions may have been unclear and a r e v i s i o n may be necessary. CHAPTER V SUMMARY, CONCLUSIONS AND RECOMMENDATIONS It was the purpose of t h i s study to gather data of student's per-ceptions i n three s p e c i f i c areas: 1 student's perceptions of past l e a r n i n g experiences 2 student's expectations o f the teacher 3 student's ideas of personal l e a r n i n g needs The researcher developed a q u e s t i o n n a i r e which asked students to reveal ideas, 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 s e t t i n g . 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 researchers studying the experiences of 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 several young nurses. The researcher'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 three basic nursing education programs on the Lower Mainland of B r i t i s h Columbia. These included twenty-five 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 a r ea. They were a l l n e a r l y midway through t h e i r b a s i c nursing education. 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 administered by the r e s e a r c h e r . A l l questions 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 across 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 nd i v i dua l ' s perception is unstable, the s i m i l a r i t y of response across schools may give an ind icat ion of the frequency of s imi la r experiences. SUBSTANTIVE CONCLUSIONS AND RECOMMENDATIONS The students ' choice of responses support many of the f indings and ideas which have been stated in the l i t e r a t u r e . The fol lowing are several examples to support th i s statement. A spec i f i c preference for class s ize and method of in s t ruct ion could be u t i l i z e d in planning learning experiences. This i s discussed by Wolf and CO Quiring. The pos i t ive feel ings revealed about c l i n i c a l evaluation could be queried by Fox, but the stress of receiv ing the c l i n i c a l evaluation would be 64 supported by his f ind ings. The stress of caring for a new patient i s also documented in Fox's study. 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 un sa t i s f a c to r i l y . ' This idea is supported by the responses to Question AIO. An example in the l i t e r a t u r e , which was of interest to the researcher, was Olesen's idea that students may not be able to pick up the negative Wolf and Quir ing, " C a r r o l l ' s Model Applied to Nursing Education," p. 176. 64 Fox, et a l . Sat i s fy ing and Stressful S ituations in Basic Programs  in Nursing Education, p. 202 . 65 Litwack, et a l . Counseling, Evaluation and Student Development, p. 150. 66 Fox, et a l . Sat i s fy ing and Stressful S ituations in Basic Programs  in Nursing Education, p. 202 . 56 67 c r i t i c i s m i n the teacher's comments. T h i s i n a b i l i t y to hear the negative comments was postulated to be a r e s u l t of the very s u b t l e wording o f the c r i t i c i s m . Olesen suggested i t i s the teacher's perception of 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 d i r e c t l y . Two questions, B6 and B7, Table IX were developed to t e s t out t h i s idea. The m a j o r i t y of the students did t h i n k teachers thought of them-selves as counselors while nearly 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 that can be drawn from the students' responses give the f e e l i n g t h at events i n the l e a r n i n g experiences of 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 taking place today. An examination of 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 experiences. T h i s pattern 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 experiences, r e a l i s t i c or u n r e a l i s t i c expectations of the teacher, and i n d i v i d u a l needs which may or may not be able 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 of a student's experiences, from her p o i n t of view, a s s i s t educators to plan to meet i n d i v i d u a l l e a r n i n g needs? Do teachers not need t h i s know-ledge to e f f e c t i v e l y bring about changes i n behavior which w i l l i n d i c a t e l e a r n i n g ? 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 assumptions Olesen, The S i l e n t Dialogue, p. 159. 57 which have prompted the study. These are: (1) knowledge of a l e a r n e r ' s perceptions gives the teacher g r e a t e r information on which to plan, c a r r y out and evaluate 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 teaching s t r a t e g i e s becoming b e t t e r able to l e a r n in the c l i n i c a l area. It would appear important that before the q u e s t i o n n a i r e i s admini-stered students are aware of the use the teacher intends to make of the data. An element of 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 per-c e p t i o n s , p o s i t i v e and negative, of past experiences. If the students f e e l f r e e to r i s k t h e i r r e a l f e e l i n g s , the teacher has v a l u a b l e information with which to plan i n d i v i d u a l l e a r n i n g experiences. 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 point of view - information to be respected and held i n confidence. The use the teacher makes of t h i s information 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 safe to r i s k again. The teacher should share with each student her ideas f o r the use of the information c o l l e c t e d . D i s c u s s i o n to see that a student's ideas have not changed i s important. I n d i v i d u a l maturation, new experiences, 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 of events has a l t e r e d . The researcher would recommend that teachers administer 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 of 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 during an e v a l u a t i o n conference. When students are aware that 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 l e a r n i n g g o a l s . This i n f o r m a t i o n , when contrasted 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 the 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 escribed i n t h i s study i s only 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 education. METHODOLOGICAL CONCLUSIONS AND RECOMMENDATIONS In developing the q u e s t i o n n a i r e the researcher was aware that 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 neutral response, eg. " u n c e r t a i n " , "unsure", was given the lowest number of responses i n 73.3 per cent o f the questions. T h i s f i n d i n g appears to i n d i c a t e that i n the m a j o r i t y of ques t i o n s , the responses given d i d have meaning i n terms of the student's own experience. A blank space could be provided at the end o f the q u e s t i o n n a i r e when the t o o l i s used i n p r a c t i s e . T h i s space would provide the student a place i n which to expand her answers i f d e s i r e d , and a l s o give examples of 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 que 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 develop-ment 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 volunteer p a r t i c i p a t i o n . In each group, students approached the researcher a f t e r they had answered the questions to o f f e r support f o r the use of 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 useful to teachers i n improving c l i n i c a l l e a r n i n g experiences. SUMMARY A q u e s t i o n n a i r e to gather data on student's perceptions of c l i n i c a l experiences was administered to s i x t y - f o u r students i n three b a s i c nursing education programs. The data revealed s i m i l a r experiences in l e a r n i n g to nurse i n the three 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 in the l i t e r a t u r e r e l a t e d to perceptions of c l i n i c a l e v a l u a t i o n , the r o l e of the teacher, and the type of feedback students r e c e i v e from the teacher i n the c l i n i c a l a rea. Data r e l a t e d to i n d i v i d u a l needs and past l e a r n i n g experiences was a l s o c o l l e c t e d . 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Mosby Company, 1972. 61 Treece, Eleanor W. and Treece, James W., J r . Elements of Research i n  Nursing. S a i n t L o u i s : The C. V. Mosby Company, 1973. Wiedenbach, E. Meeting the R e a l i t i e s i n C l i n i c a l Teaching. New York: Springer P u b l i s h i n g Company, 1969. Wylie, Ruth C. The S e l f Concept. London: U n i v e r s i t y of Nebraska Press, 1974. B. PERIODICALS B a i l e y , R. " 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 of C l i n i c a l Psychology, V o l . 27 (1971), 188-192. B r u n e i i k , Helen. "The Empathy Inventory." Nursing Outlook, (June, 1967), 42-45. Calamari, S i s t e r Dolores. "Factors t h a t Influence E v a l u a t i o n Conferences i n C l i n i c a l Experience." The Journal of Nursing Education, V o l . 7 No. 4 (November, 1968), 12-14. C a r r o l l , J . B. "A Model of School Learning." Teachers C o l l e g e Record, V o l . 64 (May, 1963), 723-733. Combs, A r t h u r W. " I n t e l l i g e n c e from a Perceptual Point o f View." Journal  of Abnormal and S o c i a l Psychology, V o l . 47 (1952), 662-673. E v e r e t t , A. V. "The S e l f Concept of High, Medium and Low A c h i e v e r s . " The  A u s t r a l i a n Journal of Education, V o l . 15 No. 3 (October, 1971), 319-324. F l i t t e r , H. "How to Develop a Questionnaire." Nursing Outlook, V o l . 8 No. 10 (October, 1960), 566-568. Goldberg, C a r l o s . "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 of P s y c h i a t r y , V o l . 84-85 ( J u l y , 1973), 324-326. H e s l i n , P. " 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), 345-347. Kates, S. L. and Barry, Wm. T. " F a i l u r e Avoidance and Concept Attainment." Journal of P e r s o n a l i t y and S o c i a l Psychology, V o l . 15 No. 1 (May, 1970), 21-27. 62 Kellogg, Carolyn Jo. " I n d i v i d u a l i z i n g Teaching of Students." The Journal of Nursing Education, V o l . 14 No. 3 (August, 1975), 14-16. K i b r i c k , Anne K. "Dropouts i n Schools of Nursing: The E f f e c t o f 'Self and Role Perception." Nursing Research, V o l . 12 No. 3 (Summer, 1963), 140-149. Mauksch, Ingeborg C. "Lets L i s t e n to the Students." Nursing Outlook, V o l . 20 No. 2 (February, 1972), 103-107. Metz, E d i t h A. and McCleary, C. M. "Knowing the Learner." The Journal  of Nursing Education, (January, 1970), 3-9. Perv i n , L. A. "Performance S a t i s f a c t i o n as a Function of 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 of Nursing Education, (August, 1973), 21-27. Redman, Barbara K. "Nursing Teacher Perceptiveness of 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 Basic Baccalaureate Nursing Programs," Nursing Outlook, (June, 1968), 45-49. Schuman, Howard. "The Random Probe: A Technique f o r Eva 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, V o l . 18 No. 5 (September-October, 1969), 436-439. Super, D. E. "Vocational Adjustment: Implementing a S e l f Concept." Occupations, V o l . 30 (November, 1951), 92-95. Videbeck, Richard. "Self-Conception and the Reaction of Others." Sociometry, V o l . 23 (1960), 351-359. "Withdrawal of Students." American Journal of Nursing, V o l . 51 (May, 1951), 342-343. 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 re p o r t of a f i v e year 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 are designed to gather information i n three areas: past l e a r n i n g experiences, expectations 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 ques-t i o n s ask f o r information 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. 67 .J 1. The s i z e o f c l a s s I f e e l most c o m f o r t a b l e i n i s - l e s s t h a n 10 - 1 0 - 2 0 - no p r e f e r e n c e - 2 0 - 5 0 - o v e r 50 2. The method o f i n s t r u c t i o n I f e e l m o s t c o m f o r t a b l e w i t h i s : - 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 g r o u p - no p r e f e r e n c e - l e c t u r e t h e n d i s c u s s i o n - l e c t u r e 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 i n t h e c l i n i c a l s e t t i n g h a v e seemed: - a l w a y s e a s y - s o m e t i m e s e a s y - u n c e r t a i n - s o m e t i m e s d e m a n d i n g - v e r y d e m a n d i n g 4. I w o u l d d e s c r i b e my a b i l i t y t o l e a r n i n t h e c l i n i c a l s e t t i n g a s : - v e r y f a s t - f a s t - u n c e r t a i n - s l o w - v e r y s l o w In a d i s c u r e s e m b l e s : s s i o n g r o u p my b e h a v i o r most c l o s e l y ( ) - 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 ( ) - l i s t e n , s p e a k 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 , s a y l i t t l e ( ) - n e v e r p a r t i c i p a t e My b e h a v i o r i n a d i s c u s s i o n g r o u p means: ( ) - I e n j o y d i s c u s s i o n g r o u p s ( ) - I s o m e t i m e s f e e l 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 h a v e 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 g r o u p s My f e e l i ngs a b o u t c l i n i c a l e v a l u a t i o n c a n be d e s -c r i b e d a s : ( ) - v e r y p o s i t i v e ( ) - p o s i t i v e ( ) - u n c e r t a i n ( ) - n e g a t i v e ( ) - v e r y n e g a t i v e T h e s i t u a t i o n w h i c h w o u l d c a u s e me t h e most s t r e s s w o u l d be: ( ) - c a r i n g f o r a p a t i e n t I h a v e n u r s e d b e f o r e ( ) - 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 ( ) - n u r s i n g a s s i g n m e n t d i s c u s s i o n w i t h t e a c h e r ( ) - 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 f r o m t e a c h e r 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 have b e e n most f r e q u e n t l y j u d g e d o n : ( ) - 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 ( ) - what t h e t e a c h e r saw me do ( ) - none o f t h e s e ( ) - what a g e n c y s t a f f saw me do ( ) - what 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 f e e d b a c k f r o m t h e t e a c h e r : ( ) r 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 ( ) - none o f t h e s e ( ) - when I d i d u n s a t i s f a c t o r i l y ( ) - when I f a i l e d 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 most 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 ( ) - a g e n c y 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 and 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 t o n u r s e ( ) - 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 e x p e r i e n c e s I f e l t I was: ( ) - w e l l 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 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 t e a c h e r s I f e l t : ( ) - v e r y r e l a x e d ( ) - f a i r l y r e l a x e d ( ) - none o f t h e s e ( ) - i l l a t e a s e ( ) - v e r y i l l a t e a s e 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 f o r : ( ) - 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 ( ) - g i v e d i r e c t i o n t o t h e t e a c h e r ( ) - 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 p e r s o n a l 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 p e r f o r m a n c e ( ) - v e r y d e f i n i t e l y ( ) - s o m e t i m e s ( ) - u n s u r e ( ) - 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 c r i t e r i a d i f f e r f r o m s t a t e d c o u r s e o b j e c t i v e s : ( ) - v e r y d e f i n i t e l y ( ) - s o m e t i m e s ( ) - u n s u r e ( ) - 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 6. In my e x p e r i e n c e t e a c h e r s may a v o i d g i v i n g s t u d e n t s d i r e c t n e g a t i v e c r i t i c i s m : ( ) - v e r y d e f i n i t e l y ( ) - s o m e t i m e s ( ) - u n s u r e ( ) - 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 a s w e l l as t e a c h e r s : ( ) - v e r y d e f i n i t e l y ( ) - s o m e t i m e s ( ) - u n s u r e ( ) - 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 8. I t h i n k t e a c h e r s m ost o f t e n a c q u i r e t h e i r k n o w l e d g e o f s t u d e n t a c h i e v e m e n t : ( ) - f r o m 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 w i t h t h e s t u d e n t ( ) - f r o m d i r e c t o b s e r v a t i o n o n l y ( ) - none o f t h e s e ( ) - f r o m a g e n c y s t a f f ( ) - f r o m 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 an i n s t r u c t o r has 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 ( ) - o t h e r t e a c h e r s ' i d e a s ( ) - a g e n c y s t a f f ' s o p i n i o n 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 t o me i n t h e c l i n i c a l a r e a a r e : ( ) - t r i e s t o u n d e r s t a n d me as 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 T h e 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 t h e c l i n i c a l a r e a : ( ) - a s k s t h o u g h t p r o v o k i n g q u e s t i o n s ( ) - c a n a n s w e r 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 ( ) - i n f o r m s a g e n c y 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 I f e e l m o s t a b l e t o a c t t h e way I f e e l w i t h : ( ) - p a t i e n t s ( ) - c l a s s m a t e s ( ) - none o f t h e s e ( ) - a g e n c y s t a f f ( ) - t e a c h e r How w e l l do I do a t b e i n g t h e s o r t o f n u r s e I l i k e t o t h i n k o f m y s e l f as b e i n g ? ( ) - v e r y w e l l ( ) - f a i r l y w e l l ( ) - u n s u r e ( ) - p o o r l y ( ) - v e r y p o o r l y 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 a t b e i n g t h e s o r t o f n u r s e I l i k e t o t h i n k m y s e l f as b e i n g ? C ). - v e r y w e l l C I - f a i r l y w e l l ( ). - u n s u r e ( ) - p o o r l y ( } - v e r y p o o r l y How much do I e n j o y d o i n g t h e t h i n g s I do as a n u r s e ? ( ) - g r e a t d e a l o f p l e a s u r e C ) - m o d e r a t e p l e a s u r e C ) - u n s u r e ( ) - 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 t h e t h i n g s I do as a n u r s e ? ( ) - c o n s i s t e n t l y h i g h r e w a r d s ( ) - m o d e r a t e r e w a r d s ( ) - u n s u r e ( ) - v e r y l i t t l e r e w a r d s ( ) - no r e w a r d s 74 C. 8. How d e e p l y have 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 t o t h i n k o f m y s e l f a s b e i n g ? ( ) - v e r y s t r o n g c ommitment ( ) - m o d e r a t e l y c o m m i t t e d ( ) - u n s u r e ( ) - s m a l l c o m m i t m e n t ( ) - no commitment 9. How much t i m e , e n e r g y , and r e s o u r c e s have I p u t i n t o b e i n g t h e s o r t o f n u r s e I l i k e t o t h i n k o f m y s e l f a s 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 r e s o u r c e s ( ) - 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 ( } - u n s u r e ( ) - a s m a l l amount o f t i m e , e n e r g y , and r e s o u r c e s C ) - v e r y l i t t l e t i m e , e n e r g y , o r r e s o u r c e s 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 Columbia February, 1976 Dear Thank you f o r your i n t e r e s t i n my t h e s i s research during our recent 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 administer 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 that the student w i l l have had c l i n i c a l e xperiences. 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 , that i s , i n the past three or f o u r days. Since the questions ask f o r f e e l i n g s and under-standings 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 t o o l by seeing i f students answer questions 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 contact you at the end of 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 , S i n c e r e l y , / 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 Response Categories School A a School B b School C c T o t a l A 1 (N=25) (N=20) (N=19) (N=64) 1 60.0 25.0 68.4 51.6 2 12.0 45.0 31.6 28.1 3 12.0 10.0 - 7.9 4 16.0 20.0 - 12.5 5 - - - -2 1 (N=25) (N=20) 5.0 (N=19) (N=64) 1.6 2 20.0 10.0 15.8 15.7 3 4.0 - - 1.6 4 68.0 80.0 . 84.2 76.6 5 8.0 5.0 - 4.7 3 (N=25) (N=20) (N=19) (M=64) 1 - 15.0 5.2 6.2 2 8.0 40.0 31.5 25.0 3 12.0 15.0 26.3 17.1 4 76.0 30.0 37.0 50.0 5 4.0 - - 1.6 a S c h o o l A = bSchool B = c S c h o o l C = 4 year b a s i c nursing education program i n a u n i v e r s i t y . 3 year b a s i c nursing education program i n a h o s p i t a l school of nursing. 2 year basic nursing education program i n a community c o l l e g e . 79 Questionnaire Item Number Response Categories School A a School B b School C c T o t a l A 4 (N=25) (N=20) (N=19 (N=64) 1 - 5.0 5.2 3.1 2 56.0 75.0 63.1 64.0 3 28.0 15.0 26.3 23.4 4 16.0 5.0 5.2 9.3 5 - - - -5 (N-25) (N=20) (N=19) (N=64) 1 68.0 30.0 42.1 48.4 2 32.0 60.0 52.7 46.9 3 - - - -4 - 10.0 5.2 4.7 5 - -- - -6 (N=25) (N=20) (N=19) (N=64) 1 72.0 60.0 63.1 65.7 2 16.0 15.0 26.3 18.8 3 4.0 10.0 - 4.7 4 8.0 15.0 10.6 11.0 5 - - - -7 (N=25) (N=20) (N=19) (N=64) 1 8.0 20.0 - 9.3 2 52.0 65.0 31.5 50.0 3 28.0 5.0 31.5 21.9 4 4.0 10.0 37.0 15.7 5 8.0 _ _ 3.1 80 Questionnaire Item Number Response Categories School A a School B b School C c Total A 8 i (N=25) (N=20) (N=19) (N=64) i 2 24.0 30.0 15.8 23.4 3 20.0 20.0 10.6 17.1 4 8.0 20.0 10.6 12.5 5 48.0 30.0 63.1 46.9 9 (N=25) (N=20) (N=19) (N=64) 1 44.0 35.0 21 .0 34.3 2 48.0 55.0 57.9 53.1 3 8.0 10.0 21.0 12.5 4 - - - -5 - - - -10 (N=25) (N=20) (N=19) (N=64) 1 8.0 35.0 10.6 17.1 2 12.0 30.0 21.0 20.3 3 16.0 - 5.2 7.9 4 64.0 35.0 63.1 54.7 5 - - - -11 (N=25) (N=20) (N=19) (N=64) 1 44.0 65.0 73.7 59.3 2 - - 5.2 1.5 3 - - - -4 52.0 30.0 21.0 36.0 5 4.0 5.0 3.1 81 Questionnaire Item Number Response • Categories School A a School B b School C c T o t a l 12 (N=25) (N=20) (N=19) (N=64) 1 28.0 40.0 21 .0 29.7 2 - - - -3 8.0 5.0 10.6 7.9 4 64.0 - 55.0 68.4 62.5 5 - - - -B 1 (N=25) (N=20) (N=19) (N=64) 1 28.0 60.0 52.7 45.3 2 56.0 25.0 21.0 36.0 3 - - - -4 16.0 15.0 21.0 17.1 5 - - 5.2 1.5 2 (N=25) (N=20) (N=19) (N=64) 1 - 25.0 10.6 11.0 2 68.0 65.0 68.4 67.1 3 12.0 - - 4.7 4 20.0 10.0 21.0 17.1 5 - - - -3 (N=25) (N=20) (N=19) (N=64) 1 8.0 50.0 15.8 23.4 2 64.0 50.0 42.1 53.1 3 12.0 - 10.6 7.9 4 16.0 - 31.6 15.6 82 Questionnaire Item Number Response Categories School A a School Bb School C C T o t a l B 4 (N=25) (N=20) (N=19) (N=64) 1 68.0 60.0 63.1 64.0 2 28.0 25.0 26.3 26.6 3 - 5.0 5.2 3.1 4 5 4.0 10.0 5.2 6.2 5 (N=25) (N=20) (N=19) (N=64) 1 8.0 - 10.6 6.2 2 48.0 55.0 42.1 48.4 3 16.0 10.0 31.6 18.8 4 24.0 30.0 10.6 21.9 5 4.0 5.0 5.2 4.7 6 (N=25) (N=20) (N=19) (N=64) 1 8.0 5.0 21.0 11.0 2 12.0 35.0 21.0 21 .9 3 8.0 15.0 5.2 9.3 4 44.0 15.0 31.6 31.2 5 28.0 30.0 21.0 26.6 7 (N=25) (N=20) (N=19) (N=64) 1 24.0 55.0 15.8 31.2 2 56.0 40.0 52.6 50.0 3 - - 5.2 1.5 4 20.0 5.0 15.8 14.0 5 _ - 10.6 3.1 83 Questionnaire Item Number Response Categories School A a School B b School C c Total B 8 (N=25) (N=20) (N=19) (N=64) 1 80.0 15.0 78.9 59.3 2 16.0 85.0 15.8 37.5 3 - - - -4 4.0 - - 1.5 5 - - 5.2 1.5 9 (N=25) (N=20) (N=19) (N=64) 1 88.0 80.0 84.2 84.3 2 4.0 - - 1.5 3 4.0 15.0 15.8 11.0 4 4.0 5.0 - 3.1 5 - - - -C 1 (N=25) (N-20) (N=19) (N=64) 1 32.0 60.0 26.3 39.0 2 16.0 - 5.2 7.9 3 8.0 - 21.0 9.3 4 40.0 40.0 42.1 40.7 5 4.0 - 5.2 3.1 2 (N=25) (N=20) (N=19) (N=64) 1 28.0 20.0 68.4 37.5 2 40.0 50.0 15.8 36.0 3 28.0 15.0 10.6 18.8 4 - - 5.2 1.5 5 4.0 15.0 - 6.2 84 Questionnaire Item Number Response. Categories School A a School B b School C c T o t a l C 3 (N=25) (N=20) (N=19) (N=64) 1 28.0 30.0 36.9 31.2 2 60.0 70.0 57.9 62.5 3 4.0 - - 1.5 4 4.0 - 5.2 3.1 5 4.0 - - 1.5 4 (N=25) (N=20) (N=19) (N=64) 1 4.0 15.0 5.2 . 7.9 2 60.0 70.0 78.9 68.8 3 32.0 10.0 15.8 20.3 4 4.0 5.0 - 3.1 5 - - - -5 (N=25) (N=20) (N=19) (N=64) 1 8.0 20.0 21 .0 15.7 2 56.0 60.0 52.7 56.2 3 20.0 20.0 26.3 21.9 4 16.0 - _ 6.2 (N=25) (N=20) (N=19) (N=64) 1 32.0 50.0 52.7 43.8 2 52.0 50.0 42.1 48.4 3 12.0 - 4.7 4 4.0 - 5.2 3.1 85 Questionnaire Item Number Response Categories School A a School B b School C c T o t a l C 7 (N=25) (N=20) (N=19) (N=64) 1 4.0 30.0 21.0 17.1 2 72.0 60.0 68.4 67.1 3 8.0 5.0 5.2 6.2 4 5 16.0 5.0 5.2 9.3 8 (N=25) (N=20) (N=19) (N=64) 1 32.0 50.0 57.9 . 45.3 2 60.0 45.0 36.9 48.4 3 4.0 5.0 . 5.2 4.7 4 4.0 - - 1.5 5 - - - -9 (N=25) (N=20) (N=19) (N=64) 1 48.0 50.0 57.9 51.6 2 48.0 45.0 42.1 45.3 3 - - - -4 4.0 5.0 _ 3.1 

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