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A survey of Canadian schools of nursing to determine the instruction and clinical experience provided… Pearen, Elsie I. E. 1973

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A SURVEY OP CANADIAN SCHOOLS OF NURSING TO DETERMINE THE INSTRUCTION AND CLINICAL EXPERIENCE PROVIDED IN MENTAL RETARDATION  by ELSIE I . E. PEAREN B.S.N., University of Washington, 1963 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n the School of Nursing  \Ie accept t h i s thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1973  In p r e s e n t i n g requirements  this  of the  f o r an advanced degree at the U n i v e r s i t y of  B r i t i s h Columbia. freely  thesis i n p a r t i a l fulfilment  available  I agree that f o r reference  the L i b r a r y s h a l l make and study.  I further  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 copying of t h i s t h e s i s  it  agree for  s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e s . that  copying or p u b l i c a t i o n of t h i s  It  is  understood  thesis for  financial  g a i n s h a l l not be allowed without my w r i t t e n p e r m i s s i o n .  Department of  Nursing  The U n i v e r s i t y of B r i t i s h Columbia Vancouver 8, Canada  Date  April  15, 1973  i  ABSTRACT T h i s d e s c r i p t i v e study was done t o p r o v i d e i n f o r m a t i o n on the number of hours and c l i n i c a l  experience  students r e c e i v e d during n u r s i n g education which might equip them w i t h s k i l l s nursing.  r e q u i r e d f o r mental r e t a r d a t i o n  R e g i s t e r e d Nurses A s s o c i a t i o n s f o r each p r o v i n c e  a s s i s t e d i n the study by p r o v i d i n g l i s t s in their province. graduating  of n u r s i n g  schools  Of the 142 n u r s i n g schools having a  c l a s s i n 1969,  1^0 were s t u d i e d .  The urgency  of the problem was shown when i t was noted that an estimated mentally  3 p e r c e n t of the p o p u l a t i o n of Canada were retarded.  S e v e r a l commissions have been done on t h i s t o p i c i n the past decade i n Canada.  Some s t u d i e s of t h i s  nature have been done i n the U n i t e d S t a t e s . literature  general  Review of the  i n d i c a t e d t h a t no p r e v i o u s s t u d i e s had been done  on t h i s t o p i c i n Canada. A q u e s t i o n n a i r e was c o n s t r u c t e d t o o b t a i n data r e l a t i n g t o placement of mental r e t a r d a t i o n  experience,  hours of theory and c l i n i c a l experience p r o v i d e d and the year of n u r s i n g e d u c a t i o n i n which the experience Questionnaires  were m a i l e d t o the s c h o o l s ,  occurred.  completed by  them, and r e t u r n e d . I t was found that  diploma schools tended t o p r o v i d e  between 0 t o 8 hours of theory and c l i n i c a l experience i n  ii mental r e t a r d a t i o n whereas u n i v e r s i t y schools offer  up t o 12 hours of e x p e r i e n c e .  Most n u r s i n g e d u c a t i o n  i n mental r e t a r d a t i o n o c c u r r e d i n p e d i a t r i c s programs  tended t o  or p s y c h i a t r i c  or i n combinations of these and other  courses.  Mental r e t a r d a t i o n n u r s i n g e d u c a t i o n tended t o occur i n the next t o the l a s t year of the program f o r a l l Many s c h o o l s ,  schools.  however, i n d i c a t e d t h a t mental r e t a r d a t i o n  experience was not i n c l u d e d i n the s c h o o l c u r r i c u l u m at It  all.  appeared t h a t very l i t t l e theory and c l i n i c a l  experience i n mental r e t a r d a t i o n was being g i v e n e n r o l l e d i n n u r s i n g schools i n Canada.  students  The r e l a t i v e  lack  of planned c l i n i c a l experience with r e t a r d e d i n d i v i d u a l s was  surprising. S e v e r a l problems and l i m i t a t i o n s were encountered  i n conducting the study, p a r t i c u l a r l y concerning data c o l l e c t i o n and the t o o l used f o r data c o l l e c t i o n .  The data  had t o be c o l l e c t e d i n two phases from two d i f f e r e n t home schools and a f f i l i a t e Studies  schools,  sources,  t o o b t a i n accurate  c o u l d be done t o focus  data.  a t t e n t i o n on c u r r e n t  problems i n n u r s i n g the m e n t a l l y r e t a r d e d ,  r e l a t e d t o the  need f o r i n c l u s i o n of theory and c l i n i c a l experience i n the c u r r i c u l u m of n u r s i n g s c h o o l s .  Studies, c o u l d a l s o be done  t o determine time a l l o t m e n t , placement and s p e c i f i c mental r e t a r d a t i o n content i n c u r r e n t n u r s i n g programs. Qualitative effect  s t u d i e s c o u l d be done t o show the  of s t a f f  possible  knowledge of mental r e t a r d a t i o n on the  provided to mentally retarded  patients.  care  T h i s study was an attempt t o show the need review of n u r s i n g e d u c a t i o n programs  i n r e l a t i o n to  i n c l u s i o n of mental r e t a r d a t i o n theory and c l i n i c a l experience  i n the c u r r i c u l u m of n u r s i n g  schools.  for the  iv  TABLE OF CONTENTS Page ABSTRACT  i  LIST OF TABLES  viii  ACKNOWLEDGMENTS  x  Chapter 1.  NURSING EDUCATION IN MENTAL RETARDATION . . . THE NURSING PROBLEM  1 1  Statement of the Problem  3  Definition  3  of Terms Used  Mental R e t a r d a t i o n  3  Instruction  4  C l i n i c a l Experience  4  Canadian School of Nursing  4  URGENCY AND IMPORTANCE OF THE PROBLEM . . .  4  R e c o g n i t i o n of the Problem  5  Extent  9  of the Problem  Mental r e t a r d a t i o n Implications  i n B r i t i s h Columbia  f o r Nursing Education  . .  9 11  PURPOSE OF THE STUDY  12  Primary O b j e c t i v e  12  Contributory Objectives  12  REVIEW OF EARLIER STUDIES AND ARTICLES CONCERNING MENTAL RETARDATION CONTENT IN NURSING EDUCATION Limitations  of Previous  Studies  13 17  V  Chapter  Page OVERVIEW OF RESEARCH DESIGN  17  Population  17  Conduct of the Study  17  Questionnaire  18  SUMMARY 2.  18  CONDUCT OF THE STUDY  19  THE RESEARCH DESIGN  19  The Sample  20  The Questionnaire  21  Problems and l i m i t a t i o n s  of the  Questionnaire  22  The P r e t e s t  3.  23  DATA COLLECTION, PHASE I  24  DATA COLLECTION, PHASE II  25  SUMMARY  27  ANALYSIS  OF THE DATA  28  D i s t r i b u t i o n of Nursing Schools by-' Length of Program D i s t r i b u t i o n of Nursing Schools by  29  Community S e t t i n g  29  PLACEMENT IN THE CURRICULUM  30  HOURS OF THEORY, CLINICAL EXPERIENCE AND OBSERVATION  34  D i s t r i b u t i o n of Hours  3$  YEAR OF THEORY AND CLINICAL EXPERIENCE DATA COMPARISON FOR EASTERN AND WESTERN SCHOOLS  . . .  43 46  vi Chapter  4.  Page DATA CHANGES DUE TO INCORPORATING AFFILIATION DATA  50  SUMMARY  53  SUMMARY, CONCEESXOMS,,RECOMMENDATIONS FOR FURTHER STUDY . .  55  URGENCY AND RECOGNITION OF THE PROBLEM . . .  56  REVIEW OF THE LITERATURE  57  CONDUCT OF THE STUDY  57  RESULTS OF THE STUDY  59  Problems and L i m i t a t i o n s i n Conducting the Study  60  Comments from respondents  6l  IMPLICATIONS AND CONCLUSIONS Recommendations  62 63  BIBLIOGRAPHY  65  APPENDIXES  67  A.  Questionnaire  67  B.  L e t t e r of I n t r o d u c t i o n t o the Study  70  C.  Follow-up L e t t e r  72  D.  Questionnaire,  7^  E.  L e t t e r of I n t r o d u c t i o n t o the Study, French  French T r a n s l a t i o n  Translation  77  F.  Follow-up L e t t e r ,  G.  I n t r o d u c t o r y L e t t e r , D i r e c t o r , School of N u r s i n g , U n i v e r s i t y of B r i t i s h Columbia, Vancouver, B.C L e t t e r of Request t o A f f i l i a t e Schools of Nursing  H.  French T r a n s l a t i o n  79  8l 83  vii Chapter I.  L e t t e r t o Home Nursing School V e r i f y i n g A f f i l i a t i o n Data  Page 85  viii  LIST OF TABLES Table 1.  2.  3.  4.  5.  6.  7.  8.  Page Nursing Schools Included i n the Study by Length of Program and Number of Schools Participating .  21  D i s t r i b u t i o n of Schools of Nursing i n Canada f o r U n i v e r s i t y , Three Year Diploma, Two and O n e - h a l f Year Diploma and Two Year Diploma Programs by S i n g l e and Grouped Course Placement f o r Theory, C l i n i c a l Experience andAobservation i n Mental Retardation  31  Percentage of Nursing Schools i n Canada t h a t Provide Mental R e t a r d a t i o n Theory, C l i n i c a l Experience and Observation i n S i n g l e Courses or i n Combined Courses  33  D i s t r i b u t i o n of U n i v e r s i t y Schools of Nursing i n Canada by Hours A l l o t t e d t o Mental R e t a r d a t i o n Theory, C l i n i c a l Experience and Observation  3.7  D i s t r i b u t i o n of Three Year Diploma Schools of Nursing i n Canada by Hours A l l o t t e d t o Mental R e t a r d a t i o n Theory, C l i n i c a l Experience and Observation  39  D i s t r i b u t i o n of Two and One-half Year Diploma Schools of Nursing i n Canada by Hours A l l o t t e d t o M e n t a l R e t a r d a t i o n Theory, C l i n i c a l Experience and Observation . . . .  4l  D i s t r i b u t i o n of Two Year Diploma Schools of Nursing i n Canada by Hours A l l o t t e d t o Mental R e t a r d a t i o n T h e o r y , C l i n i c a l Experience and Observation  42  D i s t r i b u t i o n of Schools of Nursing i n Canada f o r U n i v e r s i t y , Three Year Diploma, Two and One-half Year Diploma, and Two Year Diploma Programs by Year of Theory, C l i n i c a l Experience and Observation i n Mental R e t a r d a t i o n  44  ix Table 9.  10.  11.  12.  13.  Page D i s t r i b u t i o n of Schools of Nursing i n Canada f o r U n i v e r s i t y , Three Year Diploma, Two and One-half Year Diploma, and Two Year Diploma Programs by Grouped Hours of Mental R e t a r d a t i o n Theory f o r E a s t e r n and Western Schools  47  D i s t r i b u t i o n of Schools of Nursing i n Canada f o r U n i v e r s i t y , Three Year Diploma, Two and One-half Year Diploma, and Two Year Diploma Programs by Grouped Hours of Mental R e t a r d a t i o n C l i n i c a l Experience f o r E a s t e r n and Western Schools  48  D i s t r i b u t i o n of Schools of Nursing i n Canada f o r U n i v e r s i t y , Three Year Diploma, Two and One-half Year Diploma, and Two Year Diploma Programs by Grouped Hours of Mental R e t a r d a t i o n Observation f o r E a s t e r n and Western Schools  49  D i s t r i b u t i o n of Three Year Diploma Schools of Nursing i n Canada by Hours A l l o t t e d t o Mental R e t a r d a t i o n Theory, C l i n i c a l Experience and Observation (Phase I Data Only)  51  D i s t r i b u t i o n of Three Year Diploma Schools of Nursing i n Canada by Hours A l l o t t e d to Mental R e t a r d a t i o n Theory, C l i n i c a l Experience and Observation f o r Change i n Data When A f f i l i a t i o n Data i s Included . .  52  X  ACKNOWLEDGMENTS The  author i s  indebted t o members of the T h e s i s  Committee, p a r t i c u l a r l y Mrs. Sharon Ogden, f o r the and  assistance given during preparation  of the  support  thesis.  Members of the Committee were: Mrs.  Sharon Ogden, A s s i s t a n t  Mrs.  Jeanne Hurd, L e c t u r e r , Chairman 1970-71,  Miss Margaret S t r e e t , Mrs.  Nancy F o r b e s ,  Professor,  Associate  Chairman 1972-73,  Professor,  Lecturer,  Miss J e s s i e McCarthy, Assistant; P r o f e s s o r , Department of H e a l t h Care and E p i d e m i o l o g y , F a c u l t y of M e d i c i n e , Mrs.  Helen E l f e r t , A s s i s t a n t  Professor.  T h i s study was supported i n p a r t  by the B r i t i s h  Columbia Mental R e t a r d a t i o n A s s o c i a t i o n who p r o v i d e d f i n a n c i a l a s s i s t a n c e and c l e r i c a l help during the preliminary part  of the work.  Assistance  the p r e p a r a t i o n of q u e s t i o n n a i r e s and m a i l i n g m a t e r i a l s , stationery for  supplies  was g i v e n i n  and form l e t t e r s ,  typing  f o r which the A s s o c i a t i o n p r o v i d e d  and p o s t a g e .  the a s s i s t a n c e g i v e n by t h i s  The author i s organization.  grateful  Chapter 1  NURSING EDUCATION IN MENTAL RETARDATION  Professional  n u r s i n g has grown beyond the  stage  where the p r o v i s i o n of p h y s i c a l care and comfort  is  only concern of n u r s e s , the p a t i e n t ' s mental and  social  health is  of equal concern today.  of the need t o p r o v i d e s p e c i a l with s p e c i a l  n u r s i n g care f o r  concerns  problem'of mental r e t a r d a t i o n . mental^retarded they may p r e s e n t .  patients  of s o c i e t y  Nurses  are  today i s  the  l o o k i n g at  the  t o determine what s p e c i a l n u r s i n g Nursing educators are t a k i n g a  look at the p r e p a r a t i o n  special  are becoming aware  problems.  One of the major  the s k i l l s  Nurses  the  students r e c e i v e  necessary to p r o v i d e  problems closer  t o equip them with  care t o these p a t i e n t s with  needs.  THE NURSING PROBLEM  There are many new approaches i n p r o v i d i n g care the m e n t a l l y r e t a r d e d ,  there  is  1  for  a growing awareness of the  2 inadequacy of s e r v i c e s dissatisfaction service.  p r e s e n t l y provided"'' and there  w i t h present  is  methods of implementing t h i s  The outlook f o r the m e n t a l l y r e t a r d e d has  many l e a d busy u s e f u l  l i v e s , many of them have  employment, many have s p e c i a l h e a l t h Nurses u s u a l l y accept s e r v i c e wherever there i s  changed,  regular  needs.  the r e s p o n s i b i l i t y  of p r o v i d i n g  an area of r e c o g n i z e d need.  R e c o g n i t i o n of the problem, however, i s not enough, nurses must be able t o analyse the problem t o determine c o n t r i b u t i n g factors,  and they must be able t o i n i t i a t e  therapeutic  n u r s i n g a c t i o n d i r e c t e d at r e s o l v i n g the problem.  In order  t o have the k i n d and depth of knowledge necessary t o p r o v i d e this  care,  n u r s i n g students must r e c e i v e t h i s i n s t r u c t i o n i n  t h e i r b a s i c program. Observation of nurses working with m e n t a l l y  retarded  c h i l d r e n i n a l a r g e i n s t i t u t i o n prompted the present While observing the care p r o v i d e d t o these p a t i e n t s became obvious that this  it  the b a s i c t r a i n i n g of the nurses g i v i n g  care v a r i e d w i d e l y .  p r e p a r a t i o n a student could affect  study.  It  seemed p o s s i b l e  nurse r e c e i v e s  her a t t i t u d e  that  the  f o r work i n t h i s  toward these p a t i e n t s ,  area  as w e l l  as  1  Nancy J . P a t t e r s o n , "A Guide f o r I n t e g r a t i n g Mental R e t a r d a t i o n Content i n t o the B a s i c C u r r i c u l u m " (unpublished M a s t e r ' s t h e s i s , U n i v e r s i t y of Washington, 1968), p. 1. 2 The Commission on Emotional and L e a r n i n g D i s o r d e r s i n C h i l d r e n , One M i l l i o n C h i l d r e n (Toronto: L . C r a i n f o r d for the Commission, 1970), p . 9.  3 her a b i l i t y t o care f o r them. Murray and Barnard contend t h a t n u r s i n g programs  i n the past  basic  gave only cursory a t t e n t i o n t o the need f o r  i n c l u s i o n of content r e l a t i v e  t o developmental  commonly a s s o c i a t e d w i t h mental r e t a r d a t i o n .  deviations Little  emphasis had been g i v e n t o the need f o r p r o v i s i o n of l e a r n i n g experiences beginning s k i l l s  which would equip b a s i c students w i t h  i n this  area.  They suggested t h a t  might be r e l a t e d t o the t e a c h e r ' s experience  in this  special  field.  this  l a c k of knowledge and  3  Statement of the Problem It  is  the purpose  of t h i s  study t o attempt  to  determine whether or not nurse educators i n Canadian n u r s i n g schools  are p r e p a r i n g nurses t o g i v e s e r v i c e  retarded patient  t o the m e n t a l l y  i n the home, s c h o o l , h o s p i t a l ,  and i n the  community by p r o v i d i n g l e a r n i n g experiences  to  students  which w i l l equip them w i t h beginning s k i l l s  t o care f o r  the  retarded. Definition  of Terms Used  Mental Retardation. retardation  as  "sub-average g e n e r a l  which o r i g i n a t e s  3  R i c k Heber defines intellectual  mental functioning  d u r i n g the developmental p e r i o d and i s  B. L o u i s e Murray and Kathryn E . B a r n a r d , "The Nursing S p e c i a l i s t i n Mental R e t a r d a t i o n , " Nursing C l i n i c s of North A m e r i c a , V o l . I , No. 4, e d . Kathryn E . Barnard ( P h i l a d e l p h i a : W.B. Saunders Company, December, 1 9 6 6 ) , p. 634.  associated, w i t h impairment i n adaptive Instruction. 5 lesson, precept.  behaviour.".  4  h  Webster d e f i n e s i n s t r u c t i o n as  C l i n i c a l Experience.  This i s  the p r a c t i c a l  c a t i o n of b a s i c t h e o r e t i c a l knowledge i n p r o v i d i n g  (la)  applipatient  care.^ Canadian School of N u r s i n g . Canada having a graduating, trains  c l a s s i n 1969 that teaches  students i n p r e p a r a t i o n  examinations  f o r nurse  Any i n s t i t u t i o n i n  f o r w r i t i n g the  or  qualifying  registration.  URGENCY AND IMPORTANCE OP THE PROBLEM  The problem of mental r e t a r d a t i o n  is  not new.  Davens suggested t h a t the problem was one of such and extent as t o r e q u i r e seeking  a solution.  organized  is  community a c t i o n i n  The. causes are m u l t i p l e , he f e l t ,  present m u l t i p l e o p p o r t u n i t i e s that i t  character  a c h r o n i c problem,  for prevention.  and  He suggested  lifelong in duration,  and may  4  Rick Heber, " M o d i f i c a t i o n s i n the Manual on Terminology and C l a s s i f i c a t i o n i n M e n t a l R e t a r d a t i o n , " American J o u r n a l of Mental D e f i c i e n c y , 1960-61, p . 499. Webster's Seventh New C o l l e g i a t e D i c t i o n a r y , ( S p r i n g f i e l d : G. and C. Merriam Company, 19W), p . 438.  6 Nursing  Jean E . Schweer, C r e a t i v e Teaching i n C l i n i c a l ( S a i n t L o u i s : The C. V . Mosby Company, 19bb), p.  41.  5 affect  families  economically,  skills  of many p r o f e s s i o n a l  socially  and c u l t u r a l l y .  The  people both w i t h i n and outside  the f i e l d of h e a l t h are r e q u i r e d i n p r o v i d i n g s e r v i c e . l a r g e segment of the p o p u l a t i o n i s  affected,  either  or i n d i r e c t l y , i n p r o v i d i n g care or i n r e l a t i o n s h i p 7 patients.  A  directly t o the  R e c o g n i t i o n of the Problem In r e c o g n i t i o n of the g r a v i t y  of the problem a  federal-provincial  conference  on mental r e t a r d a t i o n  i n Ottawa, Canada,  October 19-22, 1964,  sponsored  was h e l d  by the  M i n i s t e r of N a t i o n a l H e a l t h and W e l f a r e , the Honourable Judy LaMarsh.  T o p i c s d i s c u s s e d at the conference  of h e a l t h , w e l f a r e ,  *  e d u c a t i o n and v o c a t i o n a l t r a i n i n g and  employment a p p l i c a b l e recommendations  i n c l u d e d aspects  t o the m e n t a l l y r e t a r d e d .  resulting  from t h i s  conference  8  are  Some listed  below.  7 Edward Davens, "Role of a State H e a l t h Department i n Mental R e t a r d a t i o n , " i n New F r o n t i e r s i n Mental R e t a r d a t i o n , (presented at C l i n i c a l D i r e c t o r ' s Mental R e t a r d a t i o n Conference, June 5, 6, 7, 1966, A s i l o m a r , C a l i f o r n i a ) , C h i l d r e n ' s Bureau, Department of H e a l t h E d u c a t i o n and W e l f a r e , (Washington: Government P r i n t i n g O f f i c e , 1966), pp. 18-19.  8  Harvey W. Adams et a l ( e d s . ) , MentaI R e t a r d a t i o n i n Canada (Report F e d e r a l - P r o v i n c i a l Conference, Ottawa, Canada. Ottawa: Department of N a t i o n a l H e a l t h and W e l f a r e , October 1 9 - 2 2 ^ 1 9 6 4 ) , p. 1.  There i s  1.  need f o r a spectrum  r e t a r d e d throughout  life,  of s e r v i c e s f o r  the  from i n f a n c y t o o l d age,  in a l l  9 areas of work and There i s  2.  leisure.  a need f o r a d d i t i o n a l q u a l i f i e d p e r s o n n e l  work w i t h the m e n t a l l y r e t a r d e d .  to  Some measures which can be  taken t o p r o v i d e these needed h e a l t h workers are t r a i n i n g programs f o r those working i n t h i s approaching t r a i n i n g i n s t i t u t i o n s  in-service  field,  and  t o ensure the i n c l u s i o n of  t h i s k i n d of m a t e r i a l i n the c u r r i c u l u m . 1 0 It  3.  is  recommended " t h a t a l l r e l e v a n t  educational  agencies concerned w i t h h e a l t h e d u c a t i o n . . . g i v e r e c o g n i t i o n t o the t e a c h i n g identification,  treatment  of the problems  specific  of p r e v e n t i o n ,  and care of the m e n t a l l y  re-  tarded."11 The 1964 conference the need f o r f u r t h e r mentally retarded. set .  served t o focus a t t e n t i o n on  action i n providing services for As a r e s u l t  a n a t i o n a l commission was  up i n 1966 whose primary t a s k was .  . t o engage i n a comprehensive,  problem and p o s s i b l e s o l u t i o n s parents f e l t  .  .  12  Ibid.,  p.  . expressed . .  250.  10  up a  committee  nationwide study  to i t . "  no m e d i c a l person was prepared t o  9  " t o set  a totality  . frustration  'stay with'  Ibid.  of the  I t was noted t h a t  "no one viewed the c h i l d as  and "many parents  the  11  . .  .",  because  their  I b i d . , p . 255.  The Commission on Emotional and Learning D i s o r d e r s i n C h i l d r e n , One M i l l i o n C h i l d r e n (Toronto: L . C r a i n f o r d f o r the Commission, 1 9 7 0 ) , p . 9 .  problem."  13  treatment  Since m e d i c a l education g i v e s high p r i o r i t y  of p h y s i c a l and acute c o n d i t i o n s "  .  w i t h emotional or l e a r n i n g d i s o r d e r s and the since  t h e i r condition is  receive  to  . . children retarded,  r a r e l y e i t h e r acute or p h y s i c a l ,  low p r i o r i t y and scant a t t e n t i o n  from most h e a l t h  personnel. Some recommendations  applicable  to nursing  education i n the area of mental r e t a r d a t i o n by the Commission are 1.  Postnatal  child's  t h a t were made  listed.  care should i n c l u d e an assessment of  emotional s t a t u s and l e a r n i n g  the  abilities.  A p p r o p r i a t e t r a i n i n g should be p r o v i d e d f o r doctors  and  15 nurses t o make t h i s 2.  possible.  Educational institutions  c u r r i c u l u m of d o c t o r s , theoretical  should i n c l u d e as p a r t  nurses and other h e a l t h  and p r a c t i c a l  t r a i n i n g i n the  of the  personnel,  developmental  d i s o r d e r s of c h i l d h o o d and adolescence. In the U n i t e d S t a t e s , the P r e s i d e n t ' s on Mental R e t a r d a t i o n meets y e a r l y .  Committee  In 1971 a new approach  t o the problem was suggested based on the i d e a that societal  conditions  d a t i o n and s o c i e t a l 13 15  often are the agents that cause r e t a r conditions  I b i d . , p.  164.  Ibid.,  175.  often p r o v i d e a s e t t i n g i n 14  I b i d . , p.  157.  I b i d . , p.  176.  16 p.  8 which r e t a r d a t i o n can t h r i v e .  17  Some suggestions made by  the Committee f o l l o w . 1.  There should be e d u c a t i o n a l r e s t r u c t u r i n g of some  d i s c i p l i n e s i n the s o c i a l and b i o l o g i c a l s c i e n c e s , should be brought t o g e t h e r each d i s c i p l i n e i s  they  so the center of concern f o r  the whole human being w i t h i n h i s  environment. 2.  A comprehensive c u r r i c u l u m and academic program should  be developed by u n i v e r s i t i e s devoted t o human e c o l o g y .  i n a new k i n d of  college  Environmental s e r v i c e s  governmental h e a l t h s e r v i c e s  and  should share and coordinate  t h e i r knowledge of human ecology i n an e f f o r t  to attain a  19 d e c i s i v e r e d u c t i o n i n mental r e t a r d a t i o n . To summarize, p u b l i c and p r o f e s s i o n a l  groups  are  becoming i n c r e a s i n g l y aware of the problem of mental r e t a r d a t i o n i n our s o c i e t y  and of the impact of  this  problem on the c o u n t r y ' s s o c i o - e c o n o m i c - c u l t u r a l l i f e . Many measures are being d i s c u s s e d effort  and i n t r o d u c e d i n an  t o prevent the problem or r e h a b i l i t a t e the m e n t a l l y  r e t a r d e d t o the g r e a t e s t extent If  possible.  U . S . Department of H e a l t h and W e l f a r e , P r e s i d e n t ' s Committee on Mental R e t a r d a t i o n , M.R. 71 E n t e r i n g the E r a of Human E c o l o g y , No. ( P . S . ) 72-7.  18 19  I b i d . , p.  9.  I b i d . , p.  9.  9 Extent  of the Problem Canada, w i t h a p o p u l a t i o n of  estimate)  20  has  an estimated  630,000  21,061,000 (1969 mentally  retarded,  21 approximately  three percent  of the  population.  Mental r e t a r d a t i o n i n B r i t i s h Columbia. of  At the end  1969 the number of m e n t a l l y r e t a r d e d i n d i v i d u a l s  with the R e g i s t r y  listed  f o r Handicapped C h i l d r e n and A d u l t s i n  7,789  B r i t i s h Columbia was  and of these  2,062  were i n  22 institutions.  For the year 1970-71 the average number of  patients i n residence was approximately  $8,168,889.00  at Woodlands S c h o o l , New Westminster,  1,280  and the cost of care was  for that year.  S c h o o l , T r a n q u i l l e , B. C , approximately, new f a c i l i t y  F o r the same year T r a n q u i l l e  had an average of 579 p a t i e n t s ,  the cost of care being  $3,787,785.00. 2 3  A  f o r the mentally r e t a r d e d was opened i n  20  Bureau of S t a t i s t i c s , Canada, The Canada Year Book 1970-71, Ottawa, 1 9 7 l ) » p. 242. 21 I b i d . , p.  396.  22  B r i t i s h Columbia, Department of H e a l t h S e r v i c e s and H o s p i t a l Insurance, R e g i s t r y f o r Handicapped C h i l d r e n and A d u l t s , Annual Report 1969, ( V i c t o r i a , 1969), p. 20.  23  B r i t i s h Columbia, Department of H e a l t h S e r v i c e s and H o s p i t a l Insurance. Mental H e a l t h Branch, Annual Report 1971, ( V i c t o r i a ) 1971), P , L 9 0 .  Saanich, Vancouver I s l a n d , i n October,  1971  w i t h accomo-  2k  d a t i o n f o r t h r e e hundred p a t i e n t s . In 1970  the P r o v i n c i a l Department of Education  was  faced w i t h the task of p r o v i d i n g f a c i l i t i e s and s t a f f t o 25 26 accomodate both educable and t r a i n a b l e mentally r e t a r d e d which i n c l u d e d 3,726 educable and 957 t r a i n a b l e mentally  retarded.  27  In a d d i t i o n the B r i t i s h  Mental R e t a r d a t i o n A s s o c i a t i o n e n r o l l e d 476  Columbia  trainable  m e n t a l l y r e t a r d e d i n t h e i r p r e s c h o o l and workshop  28  facilities.  Many m i l d l y r e t a r d e d c h i l d r e n were  i n t e g r a t e d i n t o the s c h o o l system, however the number was  not  exact  available.  24 I b i d . , p. L l 6 . 25 An educable mentally r e t a r d e d c h i l d . . . r e t a r d e d who can p r o f i t from academic m i l d l y r e t a r d e d - IQ g e n e r a l l y from 50 t o 75" i n Teaching the M e n t a l l y Retarded, e d i t e d by A t l a n t a , 1965, p. 184. 11  is a education; as d e f i n e d Bensberg,  26  A t r a i n a b l e m e n t a l l y r e t a r d e d r e f e r s to ". . . those i n the g e n e r a l IQ range of 30 t o 49 who can b e n e f i t from t r a i n i n g mainly i n the s e l f - c a r e and s o c i a l areas r a t h e r than i n academic s u b j e c t s , " I b i d . , p. 189. 27  B r i t i s h Columbia, Department of E d u c a t i o n , B r i t i s h Columbia P u b l i c School Annual Report 1970-71, . V i c t o r i a ; , 1971.) , p. C87. ;  28 Ibid.,  C56.  11 In summaryj  a problem of t h i s enormity,  involving  such s i g n i f i c a n t numbers of i n d i v i d u a l s i n our s o c i e t y demands expert a t t e n t i o n .  T h i s a t t e n t i o n i n c l u d e s expert  n u r s i n g care. I m p l i c a t i o n s f o r Nursing E d u c a t i o n . such enormity  A problem of  n e c e s s a r i l y i n v o l v e s nurses who may care f o r  these i n d i v i d u a l s i n the h o s p i t a l , c l i n i c , home or i n a community s e t t i n g .  institution,  In a d d i t i o n , they w i l l be  i n v o l v e d i n c o u n s e l l i n g and p r o v i d i n g guidance in  t o workers  o f f i c i a l and n o n - o f f i c i a l agencies who work with the  mentally retarded.  A nurse's p r e p a r a t i o n and t r a i n i n g  should be such that she w i l l q u a l i f y t o g i v e t h i s guidance  care,  and support. In the past nurse educators  have viewed the r o l e  of n u r s i n g schools i n p r e p a r i n g students t o work with mental r e t a r d a t e s w i t h v a r i e d r e a c t i o n s .  In her study  Goward noted t h a t although r e t a r d a t i o n was i n c l u d e d i n the c u r r i c u l u m of one n u r s i n g s c h o o l , an a s s o c i a t e degree s c h o o l , i t was f e l t  t h a t a thorough understanding  of t h i s  s p e c i a l t y was beyond the present t e c h n i c a l l e v e l of 29 education."  However, some c o n c l u s i o n s i n t h i s  study  29 Mary H. Goward, "A Study of R e t a r d a t i o n Content Taught i n S e l e c t e d New England Schools o f Nursing," (unpublished Master's t h e s i s . Boston U n i v e r s i t y School of Nursing, Massechusetts, 1965), p. 10.  12 were that  a m a j o r i t y of n u r s i n g schools  do r e c o g n i z e  r e t a r d a t i o n as a problem of which nurses should be aware, 31 and i n which they should have some competency. noted i n her study that b a c c a l a u r e a t e schools  30  Patterson  "The p h i l o s o p h i e s of most  of n u r s i n g do not p r o v i d e f o r the  i n c l u s i o n of a s p e c i a l t y basic nursing  such as mental r e t a r d a t i o n i n the 32 curriculum." PURPOSE OP THE STUDY  Primary O b j e c t i v e The primary o b j e c t i v e  of t h i s d e s c r i p t i v e  was t o determine the i n s t r u c t i o n and c l i n i c a l students were r e c e i v i n g i n Canadian schools  study  experience  of n u r s i n g t o  a s s i s t them i n meeting the needs of the m e n t a l l y r e t a r d e d , as  applied to nursing.  C o n t r i b u t o r y Obj e c t i v e s 1.  To determine the hours of i n s t r u c t i o n i n mental  r e t a r d a t i o n now being g i v e n i n n u r s i n g schools  30 31 32  Ibid.,  p.  9.  Ibid.,  p.  13.  Patterson,  op. c i t . , p .  2.  i n Canada.  13 2.  To determine the courses  i n the c u r r i c u l u m which  i n c l u d e i n s t r u c t i o n i n mental r e t a r d a t i o n . 3.  To determine the hours of c l i n i c a l experience i n  mental r e t a r d a t i o n now being g i v e n i n n u r s i n g schools  in  Canada. 4.  To determine the courses  i n the c u r r i c u l u m which  i n c l u d e c l i n i c a l experience i n mental r e t a r d a t i o n . 5.  To determine i n what year of the program  students  are r e c e i v i n g i n s t r u c t i o n and c l i n i c a l experience  in  mental r e t a r d a t i o n .  REVIEW OP EARLIER STUDIES AND ARTICLES CONCERNING MENTAL RETARDATION CONTENT IN NURSING EDUCATION  S e v e r a l s t u d i e s and a r t i c l e s  have been w r i t t e n  r e l a t i n g t o the p r e p a r a t i o n of n u r s i n g students w i t h the r e t a r d e d .  t o work  Most of these s t u d i e s have been done  i n the U n i t e d S t a t e s .  A review of a v a i l a b l e  studies  follows. Mary Goward has done a study r e v i e w i n g the i n s t r u c t i o n i n mental r e t a r d a t i o n p r o v i d e d i n New England schools of diploma schools  of n u r s i n g .  selected  Random sampling was done  of n u r s i n g and p r a c t i c a l n u r s i n g  schools  i n s i x New England s t a t e s .  A l l 11  schools  i n the area were i n c l u d e d .  Out of 50  receiving questionnaires,  27 r e p l i e d .  collegiate schools  Curriculum content  and c l i n i c a l experience r e l a t i n g t o r e t a r d a t i o n were the major areas of i n v e s t i g a t i o n , but other aspects of  t e a c h i n g the r e t a r d e d were a l s o i n c l u d e d . cooperating,  about t h r e e - f o u r t h s  i n the undergraduate  Of the  schools  did include retardation  curriculum.  Lecture was the most  commonly used t e a c h i n g method, and the Department of M a t e r n a l and C h i l d H e a l t h most f r e q u e n t l y c a r r i e d the responsibility  for t h i s teaching.  A few programs i n c l u d e d  such t e a c h i n g techniques as group d i s c u s s i o n , or v o l u n t a r y student p r o j e c t s .  field  The author observed  trips that  n u r s i n g educators were becoming aware of r e t a r d a t i o n as an area of need w i t h which nurses therefore  a greater  should have some competency,  number of n u r s i n g schools w i l l probably  include i n s t r u c t i o n i n this  area i n the near  Another study presented a guide f o r  future.  33  integrating  mental r e t a r d a t i o n content i n t o the b a s i c n u r s i n g curriculum.  Recognizing t h a t n u r s i n g students  i n basic  programs needed more i n s t r u c t i o n i n t h i s area i f they were t o f u n c t i o n adequately i n n u r s i n g mental r e t a r d a t e s , P a t t e r s o n d e v i s e d a method t o i n c l u d e the t r a i n i n g i n the b a c c a l a u r e a t e  program without changing the s c h o o l  philosophy or without making major changes curriculum.  34  33  Goward, op. c i t . , p . 13.  34  Patterson,  op. c i t . , p . 3.  i n the  15 In another a r t i c l e Vevang, et " i t was the o p i n i o n of our f a c u l t y p r e p a r i n g the student  adequately  al,  stated  that  that we were not  t o work with the m e n t a l l y  r e t a r d e d persons she might encounter i n p u b l i c h e a l t h n u r s i n g , i n p e d i a t r i c n u r s i n g , as an o f f i c e  nurse and as  35 a c i t i z e n i n her community."  Pennington found that  using the course i n p u b l i c h e a l t h n u r s i n g was experience families  the  best s u i t e d f o r p r e p a r i n g students t o work with  who have r e t a r d e d  children.  The growing involvement of n u r s i n g i n the of mental r e t a r d a t i o n was noted by Adams. many nurses f e l t  k i n d of n u r s i n g .  She b e l i e v e d good  n u r s i n g care of the i n d i v i d u a l who i s  r e t a r d e d must i n v o l v e p r i n c i p l e s a l l nursing.  She found t h a t  n u r s i n g the m e n t a l l y r e t a r d e d was a  strange or d i f f e r e n t and e f f e c t i v e  field  She f e l t  and processes b a s i c  to  the t e a c h e r ' s behaviour i n p r e p a r i n g  nurses t o care f o r the r e t a r d e d was of great  importance.  37  35  B e v e r l y Vevang, P h y l l i s Leonard and L o u i s a P i e r s o n , "Experience i n Mental R e t a r d a t i o n f o r B a s i c Nursing S t u d e n t s , " Nursing Forum, V o l . V I , No. 2, 1967,  pp. 183-194. 36  Mavis Pennington, "Nursing Students Work w i t h the M e n t a l l y R e t a r d e d , " Nursing Outlook, May, 1968, pp. 38-39.  37  Martha Adams, " P r o f e s s i o n a l E d u c a t i o n of Nurses t o Care f o r C h i l d r e n who are R e t a r d e d , " I n t e r n a t i o n a l J o u r n a l of Nursing S t u d e n t s , V o l . I l l (Pergamon P r e s s , 1966), pp. lbl-190.  16  Lange and Whitney r e c o g n i z e d that profession  has accepted  a responsibility  the n u r s i n g for i d e n t i f y i n g  n u r s i n g f u n c t i o n i n the p r e v e n t i o n and treatment retardation.  To accomplish t h i s ,  of mental  an o p p o r t u n i t y must be  p r o v i d e d students t o l e a r n about mental r e t a r d a t i o n b a s i c n u r s i n g program.  in a  In her a r t i c l e Anderson suggested  t h a t the u n i v e r s i t y a f f i l i a t e d  center w i l l provide a m u l t i -  d i s c i p l i n a r y team and a comprehensive program f o r  students  l e a r n i n g t o meet the needs of mental r e t a r d a t e s and t h e i r 39  families. 1  In an a r t i c l e  e n t i t l e d "The Nursing S p e c i a l i s t  in  Mental R e t a r d a t i o n , " Murray and Barnard found there was an increased for  awareness that  necessary  the p r o v i s i o n of s k i l l e d care t o the mentally  A g r e a t shortage e x i s t s adequately and  special preparation is  of p e r s o n n e l who can cope  with the problems presented by these c h i l d r e n  their families.  prepare  retarded.  They suggest a n u r s e ' s t r a i n i n g should  her t o work toward p r e v e n t i o n of r e t a r d a t i o n ,  as 4,  w e l l as i n c a s e f i n d i n g ,  and management  of the  retardation.  38  S i l v i a Lange and L i n d a Whitney, "Teaching Mental R e t a r d a t i o n N u r s i n g , " Nursing Outlook, A p r i l , 1 9 6 6 , pp. 5 8 - 6 0 .  39  E d i t h Anderson, " N u r s i n g i n the U n i v e r s i t y A f f i l i ated Center f o r the M e n t a l l y R e t a r d e d , " a b s t r a c t i n Mental R e t a r d a t i o n A b s t r a c t s , V o l . V I , No. 2 ( A p r i l / J u n e 19o971 p . 333. 40  Murray and B a r n a r d ,  op. c i t . ,  pp. 6 3 1 - 6 3 2 .  Limitations  of Previous  Previous  Studies  s t u d i e s have not shown c l e a r l y  specific  preparation  nursing.  No e a r l i e r  of nurses f o r mental  is  studies,  apparently  being g i v e n n u r s i n g students i n the  U n i t e d States although i t tues. of n u r s i n g s t a f f important  retardation  s t u d i e s were found i n Canada.  In summarizing the l i t e r a t u r e some p r e p a r a t i o n  the  appears t o be l i m i t e d .  towards mental r e t a r d a t i o n  Attiare  i n p r o v i d i n g care t o these i n d i v i d u a l s ,  it  seems  ICWERVIEW OF RESEARCH DESIGN  The study was conducted i n two phases, Phase I concerned the. c o l l e c t i o n and a n a l y s i s of data from the o r i g i n a l n u r s i n g schools c o n t a c t e d . c o l l e c t i o n of d a t a from a f f i l i a t i n g of the  Phase I I  included  schools and a n a l y s i s  combined d a t a .  Population One hundred f o r t y u n i v e r s i t y and diploma schools of n u r s i n g i n Canada having a graduating were i n c l u d e d i n the Conduct of the  class i n  1969  study.  Study  Since i t was not known which schools met the c r i t e r i a f o r i n c l u s i o n i n the s t u d y ,  the names and  addresses of a l l Canadian schools of n u r s i n g i n e x i s t e n c e i n 1968 were obtained from p r o v i n c i a l r e g i s t e r e d n u r s e s '  associations.  Questionnaires  asking the respondents they had a graduating  were m a i l e d t o 191 s c h o o l s ,  t o complete the q u e s t i o n n a i r e c l a s s i n 1969.  l a t e r sent t o a f f i l i a t i n g  Questionnaires  if were  schools.  Questionnaire A q u e s t i o n n a i r e was c o n s t r u c t e d and a French t r a n s l a t i o n was p r o v i d e d .  Pretesting  of the  questionnaire  was done at the U n i v e r s i t y of B r i t i s h Columbia and i n a local  hospital.  SUMMARY  The problem concerned p r e p a r a t i o n students  are  r e c e i v i n g i n Canadian n u r s i n g schools t o equip them f o r working w i t h m e n t a l l y r e t a r d e d i n d i v i d u a l s .  The need f o r  the study has been shown by o u t l i n i n g the extent  of the  problem of r e t a r d a t i o n i n Canada and B r i t i s h Columbia. Other developments i n the f i e l d this  of n u r s i n g e d u c a t i o n i n  area have been shown by a review of the  literature.  The proposed method of conducting the study was and the o b j e c t i v e s  listed.  c o n s i d e r e d i n Chapter 2.  stated  Conduct of the study w i l l be  Chapter 2  CONDUCT OP THE STUDY  T h i s study p r e s e n t s an assessment of the number of hours of p r e p a r a t i o n nurses were g i v e n t o work w i t h the m e n t a l l y r e t a r d e d and the placement of t h i s i n the c u r r i c u l u m .  The i n f o r m a t i o n needed was  n u m e r i c a l so a q u e s t i o n n a i r e was s e l e c t e d be used f o r c o l l e c t i o n of the data page 6 7 ) .  (see  experience largely  as the t o o l t o  Appendix A ,  Development of the q u e s t i o n n a i r e  and the method  used i n the c o l l e c t i o n of data w i l l be d i s c u s s e d  in this  chapter.  THE RESEARCH DESIGN  This i s  a d e s c r i p t i v e study comparing the  c u r r i c u l u m of s e l e c t e d  schools  of n u r s i n g i n Canada i n  r e l a t i o n t o the number of hours of theory and c l i n i c a l experience n u r s i n g students  receive i n preparation  work with the m e n t a l l y r e t a r d e d .  for  Placement of the t r a i n i n g  i n the c u r r i c u l u m was a l s o measured.  Data was c o l l e c t e d  from an o r i g i n a l u n c o n t r o l l e d s o u r c e ,  the n u r s i n g  p r o v i d i n g the n u r s i n g e d u c a t i o n .  19  schools  b  20  Nursing schools having a graduating c l a s s i n 1969 were s e l e c t e d as the sample t o be s t u d i e d out of a l l Canadian n u r s i n g schools i n o p e r a t i o n that y e a r .  A tool  was c o n s t r u c t e d f o r q u a n t i t a t i v e measurement of the  data.  Comparison of d a t a was expected t o i n d i c a t e whether or not the l e n g t h of the s c h o o l program or the g e o g r a p h i c a l l o c a t i o n of the s c h o o l i n f l u e n c e d the  data.  The Sample Questionnaires page  and l e t t e r s  (see  Appendix B,  70) e x p l a i n i n g the study were m a i l e d t o 191 schools  i n Canada.  Second and t h i r d l e t t e r s  page 72) were sent when necessary questionnaire. replied. eligible  (see  Appendix C,  t o ensure r e t u r n of the  A t o t a l of 95 percent of the  Of the 180 q u e s t i o n n a i r e s  schools  r e t u r n e d , 38 were not  f o r i n c l u s i o n i n the study due t o f a i l u r e t o meet  the c r i t e r i o n "having a g r a d u a t i n g c l a s s i n 1969".  One  s c h o o l t h a t had a combined p s y c h i a t r i c and diploma n u r s i n g program was not i n c l u d e d because of d i f f i c u l t y it  i n placing  i n one of the f o u r s c h o o l groupings by l e n g t h of program.  One s c h o o l sent a r e p l y i n too l a t e t o be i n c l u d e d i n the study s i n c e data was a l r e a d y being a n a l y s e d . One hundred f o r t y n u r s i n g schools i n Canada were finally  s e l e c t e d f o r i n c l u s i o n i n the study s i n c e they had  met the c r i t e r i o n ,  "having a graduating c l a s s i n 1 9 6 9 , " and  they had r e t u r n e d completed q u e s t i o n n a i r e s . schools  16 were u n i v e r s i t y s c h o o l s ,  diploma s c h o o l s ,  Of these  108 were t h r e e year  6 were two and o n e - h a l f year diploma  21 schools,  and 10 were two year diploma schools  (see Table  1).  Each p r o v i n c e had some n u r s i n g schools i n c l u d e d i n the study.  Table 1 Nursing Schools I n c l u d e d i n the Study by Length of Program and Number of Schools P a r t i c i p a t i n g  Length of Program  Number of Schools  Pour Year U n i v e r s i t y Nursing Schools  16  Three Year Diploma N u r s i n g Schools  108  Two and One-half Year Diploma Nursing Schools  6  Two Year Diploma N u r s i n g Schools  10  T o t a l N u r s i n g Schools  140  The Questionnaire The t o o l used i n the s t u d y , s e l e c t e d i n the hope that questions accurate part  a q u e s t i o n n a i r e , was  a c a r e f u l l y devised l i s t  would p r o v i d e f a i r l y e x t e n s i v e  and reasonably  i n f o r m a t i o n r e q u i r i n g a minimum of e f f o r t  of the respondents.  I t was f e l t  of  on the  the i n f o r m a t i o n  c o u l d be c o l l e c t e d q u i c k l y from a large number of n u r s i n g schools w i t h minimal expense. Information r e q u i r e d t o complete the study i n c l u d e d (l)  course placement,  (2) hours of t h e o r y ,  clinical  experience and o b s e r v a t i o n , and (3) y e a r ( s ) of t r a i n i n g i n  22 which mental r e t a r d a t i o n experience  occurred.  The  q u e s t i o n n a i r e was c o n s t r u c t e d t o p r o v i d e t h i s i n f o r m a t i o n . Problems and l i m i t a t i o n s of the  questionnaire.  Problems encountered i n completing the q u e s t i o n n a i r e were many.  The respondents  had d i f f i c u l t y i n determining t h a t  mental r e t a r d a t i o n t h e o r y , c l i n i c a l experience v a t i o n occurred i n a s p e c i f i c  course,  time a l l o t t e d t o t h i s e x p e r i e n c e , year the experience  and obser-  i n stating  the exact  and i n g i v i n g the exact  occurred.  In many cases the experience was unplanned and took p l a c e i n c i d e n t a l l y or as  o p p o r t u n i t y presented and  might not apply t o a l l s t u d e n t s .  In many r e p l i e s  it  was  noted that the time was an approximation or average and i t could vary w i d e l y . impossible)  T y p i c a l comments were " d i f f i c u l t  t o answer,"  this experience,"  " o n l y some of the students  or "none g i v e n (at  Some schools  this  (or  have  time)".  organized t h e i r programs around a core  c u r r i c u l u m or they i n t e g r a t e d the subject matter i n t o the t o t a l curriculum. courses.  They were unable t o i s o l a t e  One correspondent suggested that i t  specific is  the k i n d  of experience and the guidance g i v e n at the time the student  i s undergoing the experience t h a t i s  important,  r a t h e r than the number of hours p r o v i d e d f o r mental retardation instruction.  It  is  i n t e r e s t i n g t o note  i n some i n t e g r a t e d programs they were unable t o i n which courses  the content was g i v e n .  that  specify  23  The format limitations. 1.  of the q u e s t i o n n a i r e presented  Some l i m i t a t i o n s are  definite  listed.  The i n f o r m a t i o n requested was scanty and d i d not  p r o v i d e enough data t o a c c u r a t e l y determine the mental r e t a r d a t i o n content of the 2.  curriculum.  There was l i m i t e d awareness on the part  of p a t t e r n s  of the author  of change i n n u r s i n g e d u c a t i o n i n Canada.  Many schools had i n t e g r a t e d t h e i r programs.  Some  l i s t e d on the q u e s t i o n n a i r e were no longer taught specific  s u b j e c t s but were now p a r t  of a core  courses as  curriculum.  Not a l l schools had d i f f i c u l t y completing the questionnaire.  A few s c h o o l s ,  complete the q u e s t i o n n a i r e  however, were unable  as d e s i g n e d .  to  These schools were  c a t e g o r i z e d under not r e c o r d e d . The  Pretest Questionnaires  were p r e t e s t e d  i n two l o c a l a r e a s .  T h i s t e s t took the form of a survey and c r i t i q u e of the questionnaire.  F i f t e e n graduate n u r s i n g students  enrolled  i n the degree program, S c h o o l of N u r s i n g , U n i v e r s i t y of B r i t i s h Columbia, Vancouver, B . C . , assessed the questionnaire.  Approximately ten r e g i s t e r e d nurses  l o c a l h o s p i t a l a l s o assessed the t o o l .  difficulties  i n completing the q u e s t i o n n a i r e ,  they were asked f o r suggestions t o improve the t o o l . questionnaires  were r e t u r n e d .  the q u e s t i o n n a i r e  as a r e s u l t  a  Nurses were asked  t o comment on the c l a r i t y of the t o o l , any they might a n t i c i p a t e  at  and All  No changes were r e q u i r e d i n of the p r e t e s t .  24  DATA COLLECTION,  Questionnaires schools  were m a i l e d t o a l l Canadian n u r s i n g  having a graduating  students were e l i g i b l e nurse r e g i s t r a t i o n  PHASE I  c l a s s i n 1969 whose  t o w r i t e q u a l i f y i n g examinations  i n t h e i r province.  were completed by one or more members faculty,  teaching s t a f f  translation  graduating  The  for  questionnaires  of the n u r s i n g  or a d m i n i s t r a t i v e  staff.1  A French  was done f o r a l l m a t e r i a l t o be submitted  to  2  n u r s i n g schools questionnaire  s i t u a t e d i n French speaking  areas.  see Appendix D, page 74, f o r l e t t e r  Appendix E , page 77,  f o r follow-up l e t t e r  (For see  see Appendix F ,  page 79)• An i n t r o d u c t o r y l e t t e r  from the D i r e c t o r , School of  N u r s i n g , U n i v e r s i t y of B r i t i s h Columbia (see page 8 l ) , was m a i l e d w i t h the q u e s t i o n n a i r e . letter  o u t l i n i n g the g e n e r a l purpose  included  (see  Appendix G, An explanatory  of the study was  also  Appendix B, page 70 ) .  1  Those completing q u e s t i o n n a i r e s i n c l u d e d D i r e c t o r s of N u r s i n g , A s s i s t a n t or A s s o c i a t e D i r e c t o r s of N u r s i n g , D i r e c t o r s of Nursing E d u c a t i o n , L e c t u r e r s , P r o f e s s o r s i n the U n i v e r s i t y ' s Nursing Department and A d m i n i s t r a t i v e s t a f f . 2  French t r a n s l a t i o n was done by Miss M a r i e - C l a i r e Delahaye, s t u d e n t , School of N u r s i n g , U n i v e r s i t y of B r i t i s h Columbia, Vancouver, B . C . , 1969-70. Miss Delahaye was a graduate nurse from F r a n c e .  DATA COLLECTION, PHASE I I When t h e a v a i l a b l e d a t a had been assembled, t a b u l a t e d and a n a l y s e d , t h e r e was  found t o be  insufficient  i n f o r m a t i o n t o complete the study s a t i s f a c t o r i l y . schools i n d i c a t e d that t h e i r students or more courses  affiliated  such as o b s t e t r i c s , p e d i a t r i c s ,  p s y c h i a t r y and d a t a r e g a r d i n g the hours of provided students for  on a f f i l i a t i o n had  i n c l u s i o n on the q u e s t i o n n a i r e .  Many for  one  and  experience  seldom been a v a i l a b l e Enquiry  showed t h a t  68 n u r s i n g s c h o o l s , most of them t h r e e y e a r d i p l o m a s c h o o l s i n E a s t e r n Canada, u t i l i z e d a f f i l i a t e s c h o o l s .  A  few  s c h o o l s were a b l e t o p r o v i d e the d a t a f o r these  affiliations  but some s c h o o l s i n d i c a t e d t h a t t h i s i n f o r m a t i o n c o u l d be i n v a l i d because d e t a i l e d r e p o r t s were not a v a i l a b l e r e g a r d i n g the hours of t h e o r y and c l i n i c a l e x p e r i e n c e students i n a f f i l i a t i n g f u r t h e r d a t a was  schools.  given  I t became obvious t h a t  needed which c o u l d o n l y be o b t a i n e d  the a f f i l i a t e s c h o o l s . d a t a c o l l e c t i o n was  from  A c c o r d i n g l y , a second phase of  undertaken.  P r o v i n c i a l Nurses' A s s o c i a t i o n s s u p p l i e d a l i s t 35 a f f i l i a t e s c h o o l s t h a t p r o v i d e d o b s t e t r i c , p e d i a t r i c p s y c h i a t r i c experience i n c l u d e d i n the study.  t o s t u d e n t s from n u r s i n g The  same q u e s t i o n n a i r e ,  sent t o the 35 a f f i l i a t e s c h o o l s .  together 83)  These s c h o o l s were  asked t o complete the q u e s t i o n n a i r e f o r a f f i l i a t e only.  and  schools  w i t h a l e t t e r of e x p l a n a t i o n (see Appendix H, page was  of  Completed q u e s t i o n n a i r e s were r e t u r n e d from  students 33  s c h o o l s , two schools d i d not r e p l y . A copy of the completed q u e s t i o n n a i r e r e c e i v e d from the a f f i l i a t e  s c h o o l was then sent t o the home s c h o o l  asking f o r s u b s t a n t i a t i o n  of the new d a t a .  P e r m i s s i o n was  requested t o i n c o r p o r a t e the new d a t a i n t o t h a t o r i g i n a l questionnaire  (see  letter).  65 percent of the schools  As a r e s u l t ,  Appendix I ,  page  on the  85  for granted  p e r m i s s i o n t o use the new data and approved the r e s u l t i n g changes i n d a t a .  The data had already been i n c l u d e d by  21 percent of the schools and 14 percent of the schools d i d not r e p l y . T a b u l a t i o n and a n a l y s i s was again done.  Diffi-  c u l t i e s were encountered due t o the time l a g between Phase I and Phase II  of the s t u d y , which amounted t o  approximately one year and e i g h t months.  A number of three  year diploma s c h o o l programs had been phased out i n the i n t e r v a l and no f u r t h e r i n f o r m a t i o n could be obtained from these s c h o o l s . schools,  The c u r r i c u l u m had been changed i n some  subject matter had been i n t e g r a t e d and was being  p r e s e n t e d through a core c u r r i c u l u m r a t h e r than as  specific  courses. The assembled data was t a b u l a t e d ,  analysed and  i n t e r p r e t e d i n r e l a t i o n t o the i n c l u s i o n of mental r e t a r d a t i o n i n the c u r r i c u l u m of Canadian schools Specific  of n u r s i n g .  areas analysed were placement of t h i s  experience  and hours a l l o t t e d t o the experience i n the s c h o o l curriculum.  27 SUMMARY  Phase I and Phase II cussed i n t h i s  chapter.  of the study have been d i s -  There has a l s o been d i s c u s s i o n  of the t o o l used f o r data c o l l e c t i o n and methods used i n data c o l l e c t i o n .  Problems encountered i n assembling  f o r conduct of the study have a l s o been reviewed.  data  Chapter 3  ANALYSIS OF THE DATA  A n a l y s i s of the data i n c l u d e d a review of the data f o r mental r e t a r d a t i o n placement i n the hours of t h e o r y 1 and c l i n i c a l e x p e r i e n c e ,  curriculum,  and placement  by year of t r a i n i n g i n which the experience was g i v e n . 'A; comparison of the d a t a was done f o r four  different  types  of n u r s i n g education programs i n v o l v e d i n the  study  (see  Table 1,  page 21).  As noted e a r l i e r , the study was conducted i n two phases.  Unless otherwise s t a t e d the data d i s c u s s e d i n -  cludes a l l data obtained from both Phase I and Phase of the s t u d y .  II  A l l t a b l e s c o n t a i n e d data from both  Phase I and Phase I I  of the study except Table 12  (page 51 ) which contains Phase I data f o r Three Year Diploma S c h o o l s .  Table 5 (page 39) contains Phase I and  II  schools.  data f o r these  1  Although the word " i n s t r u c t i o n " was used on the q u e s t i o n n a i r e " t h e o r y " w i l l be used i n p l a c e of i n s t r u c t i o n throughout Chapter 3 s i n c e i t seems t o more adequately express the d a t a .  28  29 D i s t r i b u t i o n o f Nursing Schools' by Length' o f Program Of the l40 n u r s i n g schools i n c l u d e d i n the 16 were u n i v e r s i t y degree s c h o o l s . s c h o o l s had f o u r year programs, year program.  F o r purposes  study,  F i f t e e n of these  and one s c h o o l had a f i v e  of s i m p l i f i c a t i o n , data  from  the f i v e year u n i v e r s i t y s c h o o l was i n c l u d e d w i t h t h a t the four year s c h o o l s . change i n d a t a ,  of  Where t h i s made any s i g n i f i c a n t  an e x p l a n a t i o n was g i v e n .  D i s t r i b u t i o n o f Nursing Schools' by Community' S e t t i n g Diploma schools u t i l i z e d three d i f f e r e n t community s e t t i n g s f o r t h e i r programs, h o s p i t a l s c h o o l s , t e c h n i c a l institutes  and r e g i o n a l or. community c o l l e g e s .  Included  i n the study were 108 t h r e e y e a r diploma s c h o o l s ,  100 9f  these were h o s p i t a l schools and 8 were r e g i o n a l or community, c o l l e g e schools 2 C.E.G.E.P.  program.  (7-Queb.ec schools were i n the  The number, of these schools that were  h o s p i t a l , t e c h n i c a l o r c o l l e g e schools i s not known). The two and o n e - h a l f year programs, were a l l h o s p i t a l s c h o o l s .  6 i n number,  Of the 10 two year diploma  schools,. 3 were based i n t e c h n i c a l i n s t i t u t e s , 4 r e g i o n a l or community, c o l l e g e s , community 2 Quebe c.  used  and 2 d i d not s p e c i f y  the  setting.  C o l l e g e s d'Enseignement G e n e r a l et  Professionel,  30  PLACEMENT IN THE CURRICULUM  Placement of mental r e t a r d a t i o n theory and c l i n i c a l experience i n the c u r r i c u l u m was expected occur most f r e q u e n t l y i n courses  such as  to  obstetrics,  p e d i a t r i c s , p s y c h i a t r y and p u b l i c h e a l t h .  A category  " o t h e r " was i n c l u d e d on the q u e s t i o n n a i r e f o r placement of  courses not The  listed.  first  s e c t i o n of the q u e s t i o n n a i r e  requested  the f o l l o w i n g data " F o r your 1969 graduating c l a s s please i n d i c a t e the c o u r s e ( s ) t h a t i n c l u d e mental r e t a r d a t i o n instruction".  The f o u r t h and seventh s e c t i o n s  q u e s t i o n n a i r e requested s i m i l a r i n f o r m a t i o n f o r experience and o b s e r v a t i o n r e s p e c t i v e l y  (see  on the clinical  Appendix A ,  page 6 7 ) . Courses were l i s t e d f o r t a b u l a t i n g purposes  based  on apparent trends i n placement of mental r e t a r d a t i o n theory and c l i n i c a l experience i n the c u r r i c u l u m . single  The  courses most f r e q u e n t l y u t i l i z e d were l i s t e d .  Combinations of courses also o u t l i n e d . modate courses  u t i l i z e d f o r t h i s experience were  A category  " o t h e r " was i n c l u d e d t o acco-  not l i s t e d on the q u e s t i o n n a i r e such as  b i o l o g y , b i o c h e m i s t r y , e n d o c r i n o l o g y , and p s y c h o l o g y , Table 2 shows the d i s t r i b u t i o n of n u r s i n g schools  for  placement of mental r e t a r d a t i o n theory and c l i n i c a l experience i n the  curriculum.  etc.  Table 2 Distribution of Schools of Nursing in Canada for University, Three Year Diploma, Two and One-half Xear Diploma and Two Year Diploma Programs by Single and Grouped Courss Placement for Theory, Clinical Experience and Observation in Mental Retardation 8,  University Schools  Three Year Diplcr-.n Schools  Tvo & One-half Y e a r Diploma Schools  ; Two  Year Diploma Schools  Number of Schools  V a  m •r-i CL> CJ • r i  o G>  Single Courses Pediatrics PsychiatryOb ste trie s Public Health  t-*  •ri  •ri rH  O  f.  <i>  p>  S  ft,0o y:  •  • rH  CO  •P  0  £-.  W  1  O  o  •ri +> cC  2 3 1. 1  rH  cC  ro  O  cj •ri  >>  O  c •H  10  o  O  rH  E-  o  o -ri  •ri  ft  •ri  ft  fCJl  A^  C 3  Lid  TotSJL  6 11 2  -  27 21 1 3  42 46 3 3  9  —  1  1 1  1 2  1 1  -  2  2  ' —  - - -  2  -2  —  -  _  1  4  7  — Pediatrics & Psychiatry Pediatrics, Psychiatry 1 and Obstetrics Pediatrics, Psychiatry, Obstetrics, Public Health 2 Pediatrics and other 8 combinations Other 3  2  1  3  18  26  8  52  _  -  1  2  17  17  2  36  2  1  -  3  3  -,i  3  1  6 5  3 4  17 12  41 10  11 31  5 41  57 82  2 1  1 4  16  16  108  108  108  6  6  _  Grouped Courses  0  Total Schools a  16  .-0  2  1 3 7  1 2  4 1  6 4  52 53 3 10  _  1  1  58  - 2 - 2 - - - 6 2  5  10  10  1 7 3 10  42 7 84 111  10  Schools having a graduating class in 1969  k Pediatrics with genetics (listed 5 tiaes), with biochemistry, and other combinations of courses listed above ° Other includes NR (not recorded) and courses or combinations of courses not listed above with Pediatrics excluded. Genetics was listed 33 times in combination with other courses.  32 R e f e r r i n g t o Table 2 , four g e n e r a l areas appear  to  be the areas i n which most of the theory and c l i n i c a l experience o c c u r r e d .  When the experience was g i v e n i n one  course o n l y , p s y c h i a t r y was mentioned by most schools schools),  whereas p e d i a t r i c s was l i s t e d by 5 2 s c h o o l s .  O b s t e t r i c s and p u b l i c h e a l t h were a l s o u t i l i z e d as courses.  (53  R e f e r r i n g t o Table 2 a g a i n ,  it  single  can be seen  that  almost a l l n u r s i n g schools presented mental r e t a r d a t i o n theory and c l i n i c a l experience i n more than one course. Table 3 i l l u s t r a t e s  the percentage  of times courses  were  presented s i n g l y or i n combination with other courses.  The  s m a l l number of two year and two and o n e - h a l f year diploma schools i n c l u d e d i n the study may have had a l i m i t i n g effect  on the d i s t r i b u t i o n of data f o r these  schools.  P e d i a t r i c s was the course u t i l i z e d most f r e q u e n t l y i n combination with other courses  for this  P u b l i c H e a l t h was used more f r e q u e n t l y as  experience. a single  course  i n the u n i v e r s i t y programs than i n three year diploma programs.  P u b l i c H e a l t h apparently r e c e i v e d l i t t l e  atten-  t i o n i n two and two and o n e - h a l f year diploma schools of n u r s i n g f o r mental r e t a r d a t i o n e x p e r i e n c e .  The large  number of t h r e e year diploma schools u t i l i z i n g of p e d i a t r i c s ,  obstetrics  combinations  and p s y c h i a t r y may have been due  i n part t o the a f f i l i a t i o n program, s i n c e these are common areas f o r  affiliation.  G e n e t i c s was l i s t e d by schools n a t i o n w i t h other courses  3 3 times i n combi-  f o r mental r e t a r d a t i o n placement.  Table 3 Percentage of Nursing Schools in Canada* that Provide Mental Retardation Theory, C l i n i c a l Experience and Observation in Single Courses or in Combined Courses Theory Single Course School  Combined Courses  Percent of Schools  Clinical Experience Single Course  Combined Courses  Percent of Schools  Observation Single Course  Combined Courses  Percent of Schools  University Schools  12  88  12  88  44  56  Three Year Diploma Schools  18  82  21  79  48  52  100  17  83  33  67  80  30  70  50  50  Two and One-half Year Diploma Schools Two Year Diploma Schools  20  * Schools having a graduating class in 1969  P e d i a t r i c s was i n c l u d e d i n 32 of these combinations.  Bio-  chemistry was l i s t e d i n combination with other courses by eight  schools. To summarize, mental r e t a r d a t i o n t h e o r y ,  experience and o b s e r v a t i o n were presented most i n combinations of two or more c o u r s e s .  clinical  frequently  Pediatrics  seemed  t o be the course most f r e q u e n t l y used i n these combinations In c o n t r a s t ,  p u b l i c h e a l t h seemed t o be an area where there  was minimal i n c l u s i o n of mental r e t a r d a t i o n  experience.  HOURS OP THEORY, CLINICAL EXPERIENCE AND OBSERVATION  I t was expected that hours a l l o t t e d t o mental r e t a r d a t i o n t h e o r y , c l i n i c a l experience and o b s e r v a t i o n would i n d i c a t e the extent curriculum. it  of t h i s experience i n the  As mentioned e a r l i e r , many respondents  found  d i f f i c u l t t o s p e c i f i c a l l y i s o l a t e hours of mental r e -  t a r d a t i o n theory and c l i n i c a l experience from other experience. For t a b u l a t i n g purposes  hour c a t e g o r i e s were  set  up i n increments of flour hours from 0 through 20, i . e . 3.99 h o u r s ,  4.00 t o 7.99 h o u r s , e t c .  (see  Table 4 ) .  0 to Res-  pondents were asked t o show the time i n minutes and hours i n the v a r i o u s A , page 6 7 ) .  c a t e g o r i e s on the q u e s t i o n n a i r e  (see  Appendi  The purpose was t o a l l o w space f o r e n t e r i n g  hours of theory and c l i n i c a l experience  as w e l l  a d d i t i o n a l minutes of time g i v e n t o the  subject.  as  O c c a s i o n a l l y the r e q u e s t , as s t a t e d , was m i s i n t e r p r e t e d and minutes were taken t o mean h o u r s , r e s t a t e d as minutes, 1 hour would be entered a l s o as  60 minutes.  I t was  i.e.  obvious  where t h i s had o c c u r r e d and the data was taken t o mean the s t a t e d number of h o u r s . In some cases the e n t i r e p e r i o d p r o v i d e d f o r  student  t r a i n i n g i n an area was g i v e n as when the e n t i r e p e r i o d f o r p s y c h i a t r i c experience was g i v e n . c l i n i c a l experience the s c h o o l seeking schools  exceeded  When hours of theory or  50 h o u r s ,  l e t t e r s were sent  c l a r i f i c a t i o n of the time allotment  to  (six  exceeded 50 h o u r s ) . The s e l e c t i o n of 50 hours as the time p e r i o d assigned  t o theory and c l i n i c a l e x p e r i e n c e , was requested  beyond which c l a r i f i c a t i o n  from n u r s i n g s c h o o l s ,  was based on the  U n i v e r s i t y of B r i t i s h Columbia, School of Nursing allotment of hours f o r mental r e t a r d a t i o n e x p e r i e n c e . had a f i v e year p r o j e c t  underway i n which the s c h o o l was  i n t e g r a t i n g mental r e t a r d a t i o n school c u r r i c u l a .  This u n i v e r s i t y  content i n t o the n u r s i n g  T h i s was a j o i n t e f f o r t  between the  B r i t i s h Columbia Mental R e t a r d a t i o n I n s t i t u t e and the School of N u r s i n g . The approximately 50 hours a l l o t t e d t o mental r e t a r d a t i o n theory and c l i n i c a l experience  in this  was used as a g u i d e l i n e and c l a r i f i c a t i o n was from schools experience  i f the time a l l o t t e d t o mental  school  requested  retardation  exceeded 50 hours i n any a r e a .  Letters  were sent t o the s i x  schools who had  36 exceeded 50 hours of experience clarification from f i v e  i n any area asking  of the time a l l o t m e n t .  of the s c h o o l s .  R e p l i e s were r e c e i v e d  In most c a s e s , the hours  were f o r the e n t i r e p e r i o d of p s y c h i a t r i c , pediatric  affiliation,  stated  obstetric  or  and the breakdown f o r mental  r e t a r d a t i o n experience was not a v a i l a b l e . t a l l i e d as  for  These cases were  "not r e c o r d e d " f o r hours but the course u t i l i z e d  f o r the experience was entered as g i v e n .  At other  times,  the experience took p l a c e w i t h i n an i n s t i t u t i o n c a r i n g mental r e t a r d a t e s and p s y c h i a t r i c p a t i e n t s , number of hours designated  and the  as p s y c h i a t r i c theory or  experience w i t h m e n t a l l y r e t a r d e d p a t i e n t s The problem of i s o l a t i n g f o r mental r e t a r d a t i o n experience  specific  for  large clinical  was confirmed. periods  of time  e l i c i t e d such responses  as  "an approximation or average, v a r i e d w i d e l y , v a r i e d w i t h available  opportunities"  and " d i f f i c u l t  answer".  These items were t a l l i e d as  (or i m p o s s i b l e )  OP (as  presents),  ID ( i n c i d e n t a l ) , NG (none g i v e n ) ,  recorded),  c a t e g o r i z i n g them as a c c u r a t e l y  to  opportunity or NR (not  as  possible.  D i s t r i b u t i o n of Hours D i s t r i b u t i o n of hours w i l l be d i s c u s s e d following  section.  T h i s was thought t o be an area that  would i n d i c a t e the extent i n the c u r r i c u l u m .  of mental r e t a r d a t i o n  experience  U n i v e r s i t y schools tended t o i n c l u d e  theory and c l i n i c a l experience  i n mental r e t a r d a t i o n  throughout the hour c a t e g o r i e s 0 t o 20 hours schools).  i n the  Few s c h o o l s were l i s t e d as  (94 percent  "not r e c o r d e d " i n  of  37 Table 4 D i s t r i b u t i o n of U n i v e r s i t y Schools of Nursing i n Canada3" by Hours A l l o t t e d t o Mental R e t a r d a t i o n T h e o r y , C l i n i c a l Experience and Observation  Theory  Hours  Clinical Experience Percentage  of  Observation  Schools  0-3  12.50  6.25  12.50  4-7  25.00  12.50  56.25  8-11  18.75  18.75  6.25  12  - 15  18.75  6.25  16  - 19  6.25  6.25  12.50  12.50  20 -  6.25  0P b  IDC-  _  -  NGd-  -  6.25  NR e -  6.25  T o t a l Schools  100.00  Schools  a  OP (as  ID (incidental) d NG (none given) C  e  NR  (not  25.00  18.75  100.00  100.00  having a graduating opportunity  recorded)  6.25  presents)  c l a s s i n 1969  38 u n i v e r s i t y schools can be seen t h a t  (6 p e r c e n t ) .  R e f e r r i n g t o Table 4 i t  13 percent of u n i v e r s i t y schools p r o v i d e d  theory and c l i n i c a l experience i n the 20 hour  category.  Observation occurred most f r e q u e n t l y w i t h i n the 2 t o 6 hour p e r i o d (70 p e r c e n t ) . Three year diploma schools u t i l i z e d most of the hour c a t e g o r i e s 0 t o 20 f o r student experience i n the t h r e e areas.  R e f e r r i n g t o Table 5, i t  can be seen that  only 7  percent of t h r e e y e a r diploma schools u t i l i z e d NR, NG, I D , or OP c a t e g o r i e s f o r t h e o r y , whereas 55 percent were  listed  i n these c a t e g o r i e s f o r c l i n i c a l experience and 30 percent for  observation.  In d i s c u s s i n g the schools j o i n t l y 27  percent e n t e r e d "as experience.  opportunity presents"  The reason f o r t h i s  for  clinical  c o u l d have been t h a t i n  many schools the o p p o r t u n i t y t o work w i t h and observe  the  m e n t a l l y r e t a r d e d occurs only i n c i d e n t a l l y when one of these patients  happens t o be a d m i t t e d .  "Not r e c o r d e d " was h i g h  i n a l l three areas but p a r t i c u l a r l y h i g h i n experience  (17 p e r c e n t )  most of the s c h o o l s . of schools  It  clinical  and o b s e r v a t i o n (15 p e r c e n t ) , is  for  i n t e r e s t i n g t o note the number  l i s t e d i n the 20 hour category f o r the three  areas of e x p e r i e n c e . Two and o n e - h a l f and two year diploma schools appeared t o have a narrower d i s t r i b u t i o n of hours (0 t o 8 hours) but the l i m i t e d number of these s c h o o l s i n the study p o s s i b l y accounted f o r t h i s  factor.  Only three  different  hour groupings were used f o r theory i n two and o n e - h a l f  39 Table 5 D i s t r i b u t i o n of Three Year Diploma Schools of Nursing i n Canada3- by Hours A l l o t t e d t o Mental R e t a r d a t i o n T h e o r y , C l i n i c a l Experience and Observation  Theory  Hours  Clinical Experience Percentage  of  Observation  Schools  0 - 3  28.71  7.4l  38.89  4 - 7  36.11  4.63  14.82  8 - 11  12.04  9.26  11.11  12 - 15  3.70  2.78  1.85  16 -  7.40  1.85  0.93  20 -  4.63  19.44  3.70  0Pb-  -  26.85  9.26  IDC-  -  8.33  1.85  NGd-  0.93  2.78  2.78  NR e -  6.48  16.67  14.81  100.00  100.00  19  100.00  T o t a l Schools a  Schools  ^OP C  ID  (as  having a graduating opportunity presents)  (incidental)  NG (none e  NR  (not  given) recorded)  c l a s s i n 1969  40 year schools grouping,  (see  Table 6 ) ,  50 percent u t i l i z e d a 2 hour  33 percent used a 6 houre;group, and 17 percent  u t i l i z e d the 8 hour grouping f o r a l l a r e a s . experience was g i v e n by 50 percent under "as  opportunity presents".  these schools  listed  Clinical  of the two year  schools  Another 30 percent  c l i n i c a l experience under "not  of re-  corded" . Two year schools u t i l i z e d the 0 t o 8 hour c a t e g o r i e s also,  f o r t h e o r y , c l i n i c a l experience  Table 7 ) . schools  and o b s e r v a t i o n  (see  In the area of t h e o r y , 20 percent of these  listed  "not r e c o r d e d " , under c l i n i c a l  experience  30 percent entered "none g i v e n " , and f o r o b s e r v a t i o n 30 percent "not  listed  "as  o p p o r t u n i t y p r e s e n t s " and 10 percent  recorded". G e n e r a l l y there were fewer e n t r i e s  opportunity p r e s e n t s " ,  under  " i n c i d e n t a l " , "none g i v e n " and  "not r e c o r d e d " f o r a l l schools i n the areas of o b s e r v a t i o n  i n the area of theory than  and c l i n i c a l e x p e r i e n c e .  o p p o r t u n i t y p r e s e n t s " and "not r e c o r d e d " were frequently  "as  f o r c l i n i c a l experience  "As  listed  and o b s e r v a t i o n .  On r e v i e w i n g the t r e n d f o r a l l s c h o o l s ,  theory was  g i v e n most f r e q u e n t l y i n the hour c a t e g o r i e s of 2 h o u r s , 4 h o u r s , 6 hours and 8 h o u r s , i n that experience was entered by most schools category,  f o l l o w e d by "as  order.  Clinical  i n the "not r e c o r d e d "  opportunity p r e s e n t s " ,  20 h o u r s ,  "none g i v e n " and 8 or 6 hour c a t e g o r i e s s u c c e s s i v e l y . sequence of hours f o r o b s e r v a t i o n was 2 h o u r s , "none r e c o r d e d " and 6 h o u r s .  4 hours,  The  41 Table 6 D i s t r i b u t i o n of Two and One-half Year Diploma Schools Nursing i n Canada3- by Hours A l l o t t e d t o Mental R e t a r d a t i o n T h e o r y , C l i n i c a l Experience and Observation  Theory  Hours  Clinical Experience Percentage  of  of  Observation  Schools  0 - 3  50.00  50.00  4 -  33.33  16.67  8 - 11  -  16.67  12 - 15  -  _  16.67  -  20 -  -  -  0Pb-  -  -  IDC-  -  -  NGd-  -  -  16 -  7  19  NR e T o t a l Schools  100.00  Schools  a  OP (as C  ID  (incidental)  d  NG  (none  e  NR  (not  given) recorded)  -  -  100.00  16.66  100.00  100.00  having a graduating, c l a s s i n 1969 opportunity presents)  _  42 Table 7 D i s t r i b u t i o n of Two Year Diploma Schools of Nursing i n Canada 3 , by Hours A l l o t t e d t o Mental R e t a r d a t i o n T h e o r y , C l i n i c a l Experience and Observation Theory  Clinical Experience Percentage  Hours  of  Observation  Schools  0 - 3  40.00  -  40.00  4 - 7  30.00  10.00  20.00  8 - 11  10.00  10.00  -  12 - 15  -  -  -  16 - 19  -  -  -  20 -  -  -  -  0Pb-  -  50.00  30.00  IDC-  -  -  -  NGd-  -  -  -  NRe-  20.00  30.00  10.00  T o t a l Schools 100.00  100.00  100.00  a  Schools  b  0P  C  ID  (as  having a graduating opportunity presents)  (incidental)  d  NG  (none  e  NR (not  given) recorded)  c l a s s i n 1969  43 In summary, the 2 t o 8 hour c a t e g o r i e s were used by the g r e a t e s t number of schools i n p r o v i d i n g experience i n mental r e t a r d a t i o n f o r s t u d e n t s .  The 20 hour category  used f r e q u e n t l y f o r c l i n i c a l e x p e r i e n c e , c a t e g o r i e s of "as  was  as were the  o p p o r t u n i t y p r e s e n t s " and "not r e c o r d e d " .  YEAR OP THEORY AND CLINICAL EXPERIENCE  The v a r i a t i o n i n year of placement can be seen on Table 8.  R e f e r r i n g t o Table 1 (page 21)  t h a t programs  f o r n u r s i n g schools  varied considerably i n length. studied,  it  can be seen  i n c l u d e d i n the  study  Of the 16 u n i v e r s i t y  15 had f o u r y e a r programs.  One s c h o o l w i t h a  year program was i n c l u d e d with the f o u r year group. year diploma schools were h o s p i t a l schools  five  Three  s t u d i e d numbered 108 and 101 of these and 7 schools were organized under  the C . E . G . E . P . 3 program.  A l l 6 two and o n e - h a l f year diploma'  schools were h o s p i t a l s c h o o l s . schools,  schools  Of the 10 two year diploma  3 provided t r a i n i n g i n t e c h n i c a l i n s t i t u t e s ,  u t i l i z e d r e g i o n a l or community c o l l e g e s , h o s p i t a l based and 2 schools  4  1 program was  d i d not r e c o r d t h i s i n f o r m a t i o n .  Respondents were asked t o show the year of the program i n which mental r e t a r d a t i o n experience was g i v e n f o r  3 Quebec.  C o l l e g e s d'Enseignement G e n e r a l et P r o f e s s i o n e l ,  Table 8 Distribution of Schools of Nursing in Ganadaa for University, Three Year Diploma, Two and One-half Year Diploma, and Two Year Diploma Programs by Year of Theory, Clinical Experience and Observation in Mental Retardation Theory  Clinical Experience  Observation  Number of Schools Year of Program 1 2 3  4  2 and « or 3 Not recorded Other f combinations Total Schools  Univ. 3 I r . ° 2£Yr. 2 Y r . U n i v J 3 l r . c 2 i Y r . d 2 Y r . Univ,^ 3 I r . ° 2i Y r . 2 Y r . b  d  1 43  25 8  1  8  26  1  16  108  6  5  3  e  mm  1 1 2 3 1  _  e  1 2 1 1 6  35  5  5  4  10  16  108  4  5  —  —  —  mm  6  26 37  1  *1  6  2  1 2 1  4  5  5  20 28  1 1  1  1  4  «•  2  16  108  6  10  10  2  3 1  43  11  _  Schools having a graduating class in 1969 University Schools,  Three Year Diploma Schools,  1 6  -  4 _  5  d  Two and Qne-Jialf Year Diploma Schools  •Two Year Diploma Schools f Other combinations includes any other combinations of 1, 2, 3, 4 and 5  e  45  each course  l i s t e d on the q u e s t i o n n a i r e .  There may have  been some v a r i a t i o n i n data due t o d i f f e r e n c e s l e n g t h of the n u r s i n g e d u c a t i o n programs. c l i n i c a l experience years  i n the  Theory and  could be g i v e n i n any one of the 4  i n the u n i v e r s i t y s c h o o l , whereas they could only be  g i v e n i n the f i r s t schools.  or second year of two year diploma  In a d d i t i o n , some schools  more than one y e a r , e g .  o f f e r e d experience i n  one u n i v e r s i t y s c h o o l gave mental  r e t a r d a t i o n experience i n the t h i r d and f o u r t h years t h e i r program. variations  Categories  were set up t o  i n program s c h e d u l e s ,  of  acconroo'dafeethese  as noted i n Table 8 .  Two year and two and o n e - h a l f year schools tended t o present  the g r e a t e r  part  of mental r e t a r d a t i o n  i n the second year of t r a i n i n g .  experience  C l i n i c a l experience was  minimal i n two and o n e - h a l f year s c h o o l s .  One of these  schools gave c l i n i c a l experience i n the second year but 5 schools  l i s t e d t h i s experience under "not r e c o r d e d " . Although n e a r l y a l l three year diploma schools  o f f e r e d t h e o r y , c l i n i c a l experience  and o b s e r v a t i o n i n a l l  t h r e e years  occurred i n the second  year.  of t r a i n i n g , most of i t  Many of the a f f i l i a t i o n experiences  were underway  during the second year of t r a i n i n g i n these s c h o o l s , f a c t o r which may have had a d i r e c t b e a r i n g on the number of schools  listed in this  noted t h a t the experience  category.  third.  years  eg.  large  Many schools  could take p l a c e i n e i t h e r the  second or t h i r d year of the program, or i t two d i f f e r e n t  a  first  c o u l d occur i n  and second or second and  Most i n s t r u c t i o n and c l i n i c a l experience occurred i n the t h i r d year of the u n i v e r s i t y programs.  \Oftly two  u n i v e r s i t y s c h o o l s gave t h i s experience i n more than one year ( t h i r d and f o u r t h y e a r s ) . As w i t h other d a t a ,  the "not r e c o r d e d " category  was mentioned f r e q u e n t l y i n one or more areas f o r a l l types  of s c h o o l s .  In most s c h o o l s , mental r e t a r d a t i o n  experience was g i v e n i n the next t o the l a s t year of nursing education.  DATA COMPARISON FOR EASTERN AND WESTERN NURSING SCHOOLS  It  seemed p o s s i b l e  that the l o c a t i o n of n u r s i n g  schools i n c l u d e d i n the study might have an e f f e c t Accordingly, eastern  on d a t a .  schools were separated by l o c a t i o n i n t o  and western schools and the d a t a was analysed i n  r e l a t i o n t o d i s t r i b u t i o n of hours a l l o t t e d t o mental r e t a r d a t i o n experience.  Tables 9, 10 and 11 p r o v i d e a  comparison of data by l o c a t i o n of  schools.  The e a s t e r n area had no two and o n e - h a l f year diploma s c h o o l s .  D i s t r i b u t i o n f o r grouped hours tended t o  be f a i r l y e q u a l i n e a s t e r n It  and western schools  otherwise.  can be concluded that g e o g r a p h i c a l l o c a t i o n of n u r s i n g  schools has l i t t l e e f f e c t provided  students.  on mental r e t a r d a t i o n  experience  Table 9 Distribution of Schools of Nursing in Canada8- for University, Three Year Diploma, Two and One-half Year Diploma, and Two Year Diploma Programs by Grouped Hours of Mental Retardation Theory for Eastern and Western Schools THEORY Percentage of Schools University Schools Grouped Hours 0-8 10 - 20 Other" Total  Eastern  b  Western0  Three Year Diploma Schools  Two and One-half Year Diploma Schools  Eastern*3 Western0  Eastern  53.85 38.46 7.69  33.33 33.33 33.34  69.66 23.60 6.74  84.21 5.26 10.53  100.00  100.00  100.00  100.00  —  Western0 83.33 16.67  -  100.00  Two Year Diploma Schools Eastern 3 Western0  -  -  83.33  75.00  16.67  25.00  100.00  100.00  Schools having a graduating class in 1969 ^Eastern includes schools from Newfoundland, P . E . I . , New Brunswick, Nova Scotia, Quebec, Ontario Western includes schools from Manitoba, Saskatchewan, Alberta, British Columbia ^Other includes OP (as opportunity presents), ID (incidental), NG (none giyen), NR (not recorded)  Table 10 Distribution of Schools of Nursing i n Canada for University, Three Year Diploma, Two and Ona-half Year Diploma, and Two Y«ar Diploma Programs by Grouped Hours of Mental Retardation Clinical Experience for Eastern and Western Schools CLINICAL EXPERIENCE Percentage of Schools University Schools Grouped Hours  Eastern  38.46  0.8 10 - 20 0ther d  30.77 30.77  100.00  Total  b  Western  33.34 66.66 100.00  c  Three Year Diploma Schools Eastern  b  Western 10.53  14.61  32.58 52.81  26.31 63.16  100.00  100.00  c  Two and One-half Year Diploma Schools b c Eastern Western  -  Two Year Diploma Schools Eastern  b  Western  100,00  » 100.90  50.00  100.00  100.00  100.00  0  50.00 —  Schools having a graduating class in 1969 ^Eastern includes schools from Newfoundland, P . E . I . , New Brunswick, Nova Scotia, Quebec, Ontario °Western includes schools from Manitoba, Saskatchewan, Alberta, British Columbia d  0ther includes OP (as opportunity presents), ID (incidental), NG (none given), NR (not recorded)  Table 11 Distribution of Schools of Nursing in Ganadaa for University, Three Year Diploma, Two and Gne-half Year Diploma, and Two Year Diploma Programs by Grouped Hours of Mental Retardation Observation for Eastern and Western Schools OBSERVATION Percentage of Schools University Schools Grouped Hours  b Eastern  0-8 10 - 20 Other"  61.54 7.69 30.77  100.00  100.00  100.00  Total a  c Western  Three Year Diploma Schools Eastern13 Western0 61.80 10.11 28.09  63.16 5.26 31.58  100.00  100.00  Two and One-half Year Diploma Schools  Two Year Diploma Schools  b Eastern"  o Western  -  83.33  50.00  75.00  16.67  50.00  25.00  100.00  100.00  100.00  Eastern*5 Western0  Schools having a graduating class in 1969  ^Eastern includes from Newfoundland, P . E . I . , New Brunswick, Nova Scotia, Quebec, Ontario °Westem includes schools from Manitoba, Saskatchewan, Alberta, British Columbia °tither includes OP (as opportunity presents), ID (incidental),  NG (none given), NR (not recorded)  50 DATA CHANGES DUE TO INCORPORATING AFFILIATION DATA  The e f f e c t affiliating  of i n c o r p o r a t i n g data r e c e i v e d from  schools i n t o the data obtained on the o r i g i n a l  q u e s t i o n n a i r e was p a r t i c u l a r l y n o t i c e a b l e f o r s c h o o l s and f o r three year diploma schools  of n u r s i n g .  the 51* t h r e e year diploma schools u t i l i z i n g 14 were s i t u a t e d i n O n t a r i o ,  14 i n Quebec,  eastern Of  affiliations, 3 i n Prince  Edward I s l a n d and 3 i n Newfoundland, Nova S c o t i a p r o v i d e d 10 a f f i l i a t i o n s 4 affiliations. affiliated  and both New Brunswick and A l b e r t a had Only 1 two and o n e - h a l f year s c h o o l  and data from t h i s  r e c e i v e d from the home s c h o o l .  s c h o o l d i d not a l t e r  U n i v e r s i t y and two year  diploma schools had no a f f i l i a t i o n s , of B r i t i s h Columbia and Saskatchewan, determined i n t h i s  that  nor d i d the p r o v i n c e s as f a r  as  could be  study.  I n t e g r a t i n g data from a f f i l i a t i n g schools  altered  some of the o r i g i n a l data f o r three year diploma schools considerably.  Many schools  o r i g i n a l l y l i s t e d i n the "not  r e c o r d e d " category were e l i m i n a t e d from t h a t p l a c e d i n s p e c i f i c hour c a t e g o r i e s .  category and  A considerable  change was noted i n theory s i n c e many of the hour groupings were i n c r e a s e d , eg.  the t a l l y f o r 2 hours i n c r e a s e d from  21 percent t o 26 percent f o r three year diploma s c h o o l s . At times an hour grouping became l e s s when data had t o be t r a n s f e r r e d t o a more s u i t a b l e hour c a t e g o r y , decreased from 7 percent t o 3 percent 13).  (see  eg.  0 hours  Tables 12 and  51 Table 12 D i s t r i b u t i o n of Three Year Diploma Schools of n u r s i n g i n Canada 3 by Hours A l l o t t e d t o Mental R e t a r d a t i o n T h e o r y , C l i n i c a l Experience and Observation (Phase I Data Only) Clinical Experience  Theory  Hours  Percentage  of  Observation  Schools  0 - 3  27.78  4.62  24.07  4 - 7  28.71  1.86  13.89  8 - 11  10.18  0.93  9.26  12 - 15  4.63  1.86  1.86  16 -  5.55  1.85  0.93  19  20 -  -  16.67  3.70  OPb-  -  27.78  9.26  IDC-  -  7.4l  I.85  NGd-  -  3.70  2.78  NRe-  -  33.32  32. 40  100.00  100.00  T o t a l Schools  100.00  a  Schools  b  0P  C  ID  ( as  having a graduating opportunity presents)  (incidental)  NG (none' given) e  NR (not  recorded)  c l a s s i n 1969  Table 13 Distribution of Three Year Diploma Schools of Nursing in Canada* by Hours Allotted to Mental Retardation Theory, Clinical Experience and Observation for Change i n Data When Affiliation Data i s Included Theory  Clinical Experience  Obserration  Percentage of Schools Hours 02~  46-  81012-  14-  Phase I  7.41  20.37  14.82  13.89 5.55 4.63 2.78 1.85 3.70 1.85 4.63  Phase I & II  Phase I  2.78 25.93 20.37 15.74 4.63 1.85 1.85 3.70 3.70 4.63  1613200PIDNGNR-  18.52  0.93 6.48  Total  100.00  100.00  1.85 2.77 0.93 0.93 0.93  2.78 4.63 0.93 3.70 1.85  0.93 0.93 1.85  0.93 1.85 1.85  -  7.41  7.41  Phase I 5.55 18.52 8.33 5.55  7.41 1.85 0.93 0.93 —  12.96 25.93  9.26  5.56 8.33 2.78 _  1.85 —  72.22  8.33 2.78 16.67  46.30  100.00  100.00  100.00  100.00  —  16.66  19.44  —  —  —  —  mm  —  Schools having a graduating class in 1969  26.85  0.93 3.70  Phase I & II  0.93 3.70 9.26 1.85 2.78 U.81  —  —  —  Phase I & II  —  Categories "incidental",  such as  "as  opportunity  "none g i v e n " , and "not r e c o r d e d " remained h i g h  f o r c l i n i c a l experience and o b s e r v a t i o n , found i t  present",  since many schools  d i f f i c u l t t o i s o l a t e hours of mental r e t a r d a t i o n  theory and experience  from the broader program.  I n c o r p o r a t i n g data from a f f i l i a t i n g  schools  data from t h r e e year diploma schools i n e a s t e r n particularly.  this  Canada  The category i n which the g r e a t e s t  occurred was "not r e c o r d e d " s i n c e many schools category were t r a n s f e r r e d t o s p e c i f i c  Table 13 i l l u s t r a t e s  the e f f e c t  hour  altered  change  listed in categories.  of i n c o r p o r a t i n g t h i s  data.  SUMMARY  Chapter 3 has p r o v i d e d an a n a l y s i s  of data i n  r e l a t i o n t o placement of mental r e t a r d a t i o n n u r s i n g educ a t i o n i n the c u r r i c u l u m of n u r s i n g schools i n Canada, having a graduating  c l a s s i n 1969.  experience have a l s o been d i s c u s s e d .  Hours and year of L o c a t i o n of the  n u r s i n g s c h o o l a p p a r e n t l y had l i t t l e e f f e c t programs s t u d i e d . schools  on n u r s i n g  I n c o r p o r a t i n g data from a f f i l i a t i n g  a l t e r e d the data f o r t h r e e year diploma schools i n  the study t o a c o n s i d e r a b l e  extent.  D i s c u s s i o n of t o t a l s f o r a l l types  of schools  v e a l s that theory i n v o l v i n g from 2 t o 8 hours appeared  reto  be the most f r e q u e n t l y used time p e r i o d f o r mental retardation nursing education.  "Not r e c o r d e d " was  f r e q u e n t l y i n a l l areas of experience while "as  listed  opportunity  54  p r e s e n t s " had a h i g h count f o r c l i n i c a l experience observation.  The time, category  i n c l i n i c a l experience due, i n p a r t ,  and  20 hours o c c u r r e d f r e q u e n t l y  and o b s e r v a t i o n which may have been  t o o p p o r t u n i t y f o r extensive  mental r e t a r d a t e s d u r i n g  affiliation.  contact  with  Chapter 4  SUMMARY, CONCLUSIONS, RECOMMENDATIONS FOR FURTHER STUDY  H e a l t h care i n Canada has where a t t e n t i o n  advanced t o the  stage  can be focussed on the u n d e r p r i v i l e g e d and  i n d i v i d u a l s w i t h s p e c i a l problems i n our s o c i e t y . mentally retarded fession  are  one such group.  traditionally  concerns i t s e l f  problems wherever they may o c c u r . retarded i s  The  The n u r s i n g p r o w i t h the  health  Nursing of the mentally  one such area r e c e i v i n g a t t e n t i o n  from nurse  educators. While working w i t h m e n t a l l y r e t a r d e d p a t i e n t s i n a l a r g e i n s t i t u t i o n i n Canada, the v a r i a t i o n i n q u a l i t y  of  n u r s i n g care p r o v i d e d these p a t i e n t s became apparent. was thought t h a t  a study attempting  p r e p a r a t i o n nurses r e c e i v e  t o determine  during t h e i r nursing  t o work w i t h these i n d i v i d u a l s might be Accordingly a descriptive  i n c l u s i o n of mental r e t a r d a t i o n experience  i n nursing  the education  pertinent.  study was undertaken r e l a t i n g  the c u r r i c u l a of n u r s i n g schools  education. 55  It  i n Canada and to the theory and c l i n i c a l  to  56  URGENCY AND RECOGNITION OF THE PROBLEM  In 1969 the urgency of the mental  retardation  problem i n Canada was such t h a t approximately percent  of the p o p u l a t i o n ^ were d i r e c t l y  three  affected.  B r i t i s h Columbia had 7,789 m e n t a l l y r e t a r d e d l i s t e d w i t h the R e g i s t r y  individuals  f o r Handicapped C h i l d r e n and  A d u l t s and 2,062 of them were i n i n s t i t u t i o n s 2 retarded.  The P r o v i n c i a l Department  provided f a c i l i t i e s classes.  for  the  of E d u c a t i o n  f o r 4,683 r e t a r d a t d s i n  special  The B r i t i s h Columbia R e t a r d a t i o n  Association provided f a c i l i t i e s children.  for a further  An u n i d e n t i f i e d number of m i l d l y  c h i l d r e n were i n t e g r a t e d  476 of these retarded  i n t o the p u b l i c s c h o o l system.  1 Bureau of S t a t i s t i c s , Canada, The Canada Year Book 1970-71, (Ottawa, 1971), p . 396. 2  B r i t i s h Columbia, Department of H e a l t h S e r v i c e s and H o s p i t a l Insurance, R e g i s t r y f o r Handicapped C h i l d r e n and A d u l t s , Annual Report 1969, ( V i c t o r i a , 1969), p . 20. 3 B r i t i s h Columbia, Department of E d u c a t i o n , B r i t i s h •Columbia Pub l i e School Annual Report 1970-71, ( V i c t o r i a , 1971), p . C87. 4 I b i d . , C56.  57 R e c o g n i t i o n of the extent when two major conferences t o study the problem.  of the problem was shown  were h e l d w i t h i n the past decade  A F e d e r a l - P r o v i n c i a l Conference was  h e l d i n 1964,^ and i n 1970 there was a Commission on Emotional and Learning D i s o r d e r s  in Children.^  mendation coming out of these conferences special training for professional and educators) i n p r e p a r a t i o n  A recom-  was t o p r o v i d e  personnel  (medical,  f o r working i n t h i s  nursing  field.  REVIEW OF THE LITERATURE  Review of the l i t e r a t u r e  showed t h a t  several  studies  have been done r e l a t i n g t o the p r e p a r a t i o n nurses are g i v e n as  students f o r work i n the f i e l d of mental  The l i t e r a t u r e  suggested t h a t  accept the r e s p o n s i b i l i t y work i n t h i s  field.  retardation.  the n u r s i n g p r o f e s s i o n  f o r adequately  needs t o  preparing s t a f f  to  However, no s t u d i e s were found con-  c e r n i n g mental r e t a r d a t i o n n u r s i n g education i n Canada.  CONDUCT OF THE STUDY  The study was conducted i n two phases.  The sample  5  Harvey W. Adams et a l ( e d s . ) , Mental R e t a r d a t i o n i n Canada. (Report F e d e r a l - P r o v i n c i a l Conference, Ottawa, Canada. Ottawa: Department of N a t i o n a l H e a l t h and W e l f a r e , October 19-22, 1964), p. 1. 6 The Commission on Emotional and L e a r n i n g D i s o r d e r s i n C h i l d r e n , One M i l l i o n C h i l d r e n (Toronto: L . C r a i n f o r d f o r the Commission, 1970), p . 9.  58 s e l e c t e d was Canadian n u r s i n g schools having a g r a d u a t i n g c l a s s i n 1969. n u r s i n g students  Data t h a t  could i n d i c a t e the p r e p a r a t i o n  r e c e i v e d i n c l u d e d course placement  for  mental r e t a r d a t i o n theory and c l i n i c a l experience i n the c u r r i c u l u m , time allotment f o r t h i s e x p e r i e n c e , and the year of n u r s i n g education i n which t h i s p r e p a r a t i o n took place.  A q u e s t i o n n a i r e was used f o r data c o l l e c t i o n . A l l P r o v i n c i a l R e g i s t e r e d Nurses ' A s s o c i a t i o n s were  contacted to obtain l i s t s  of Canadian n u r s i n g s c h o o l s .  The  sample was 140 n u r s i n g schools having a graduating, c l a s s i n 1969.  A 95 percent r e t u r n r a t e was obtained from these  schools f o r m a i l e d q u e s t i o n n a i r e s . When data from Phase I of the study had been r e viewed, i n f o r m a t i o n obtained was found t o be incomplete i n some a r e a s .  Many n u r s i n g schools used a f f i l i a t e  f o r experience i n p a r t i c u l a r areas such as obstetrics  and p s y c h i a t r y .  schools  pediatrics,  Records of time a l l o t t e d t o  theory and c l i n i c a l experience from these schools were often incomplete.  A c c o r d i n g l y Phase II  and a f f i l i a t i n g  of the study was undertaken  schools were asked t o complete the same  q u e s t i o n n a i r e sent t o the o r i g i n a l s c h o o l s , necessary  data f o r a f f i l i a t i n g  t o p r o v i d e the  students.  Permission t o use the data and v e r i f i c a t i o n of the new f i n d i n g s was requested from the parent s c h o o l s .  Out of  the 68 n u r s i n g schools u t i l i z i n g a f f i l i a t i n g h o s p i t a l s student data,  experience,  65 percent a u t h o r i z e d use  for  of the new  21 percent i n d i c a t e d t h a t the data had a l r e a d y been  59 i n c l u d e d and 14 percent d i d not r e p l y .  A time l a g of  approximately one year and e i g h t months occurred between Phase I and Phase I I  of the study.  The. combined data was  t a b u l a t e d and a n a l y s e d .  RESULTS OP THE STUDY  Information was obtained from u n i v e r s i t y s c h o o l s , h o s p i t a l schools and community or r e g i o n a l c o l l e g e of n u r s i n g .  schools  U n i v e r s i t y s c h o o l s presented a degree on  completion of the course and h o s p i t a l and j u n i o r c o l l e g e s c h o o l s presented a diploma on g r a d u a t i o n .  Diploma schools  had three y e a r , two and o n e - h a l f year and two year n u r s i n g programs. On r e v i e w i n g the time allotment f o r theory and c l i n i c a l e x p e r i e n c e , the h o s p i t a l and r e g i o n a l or community c o l l e g e diploma schools u s u a l l y p r o v i d e d between 0 and 8 h o u r s , whereas u n i v e r s i t y schools tended t o o f f e r up t o 12 hours of e x p e r i e n c e .  Most of the experience o c c u r r e d i n  the second year of the program i n h o s p i t a l and r e g i o n a l or community c o l l e g e  s c h o o l s , whereas i t  occurred most  f r e q u e n t l y i n the t h i r d year of education i n the u n i v e r s i t y schools.  Data from e a s t e r n and western schools was  examined.  There d i d not appear t o be an a p p r e c i a b l e  d i f f e r e n c e i n data from the two a r e a s . In u n i v e r s i t y schools t h e r e was a tendency t o  60 present mental r e t a r d a t i o n  theory w i t h i n the framework of  the b i o l o g i c a l or b e h a v i o u r a l science, c o u r s e s . experience  f r e q u e n t l y was arranged  with p r o v i s i o n made f o r f a m i l y  i n community s e t t i n g s  contact.  Most n u r s i n g education i n mental  retardation  o c c u r r e d w i t h i n the framework of p e d i a t r i c s programs.  C l i n i c a l experience  Clinical  or p s y c h i a t r i c  was f r e q u e n t l y g i v e n i n  more than one course and the combination of courses most f r e q u e n t l y used was p e d i a t r i c s  and p s y c h i a t r y .  Problems and L i m i t a t i o n s i n Conducting the  Study  A number of problems were encountered i n conducting the s t u d y .  A list  of some of the problems  encountered  follows. 1.  The q u e s t i o n n a i r e  trends  d i d not r e f l e c t  i n nursing school c u r r i c u l a .  grams were i n t e g r a t e d , distinguishing these 2.  In schools  the respondents  specific  current  where p r o -  had d i f f i c u l t y i n  courses and a l l o t t i n g time  for  courses.  Data should have been more s p e c i f i c ,  could too e a s i l y  be m i s i n t e r p r e t e d  interpreted i n several 3.  some of the  as phrased  or some of i t  was q u a n t i t a t i v e  i n nature  y e a r s , hours and courses i n which mental experience quality  occurred.  c o u l d be  ways.  Another l i m i t a t i o n concerned the type of data  The data requested  it  collected.  and i n v o l v e d  retardation  No p r o v i s i o n was made t o show the  of the l e a r n i n g  experience.  4.  The time lag of one year and e i g h t months  between Phase I and Phase II the data c o l l e c t e d .  (approximately)  of the study may have  affected  Many r e g i o n a l or community c o l l e g e two  year n u r s i n g programs were being i n t r o d u c e d and the t r a d i t i o n a l three year diploma programs were being phased When a d d i t i o n a l d a t a , requested,  such as a f f i l i a t i o n d a t a ,  out.  was  some of the schools had been c l o s e d and no  f u r t h e r data was  available.  Comments from respondents.  The r e s e a r c h t o o l ,  u n f o r t u n a t e l y , p r o v i d e d many o p p o r t u n i t i e s f o r m i s i n t e r p r e t a t i o n or f o r v a r i e d i n t e r p r e t a t i o n of requests f o r P o s s i b l y because of t h i s many respondents  data.  offered  suggestions or c r i t i c i s m s i n r e l a t i o n t o the  questionnaire.  The most f r e q u e n t l y o c c u r r i n g c r i t i c i s m of the t o o l concerned d i f f i c u l t y i n i s o l a t i n g mental r e t a r d a t i o n theory and c l i n i c a l experience questionnaire,  for. courses  as  l i s t e d on the  and with time a l l o t m e n t f o r these  courses.  One s c h o o l , a two year s c h o o l , s t a t e d w i t h  regret  t h a t they had t o discontinue, c l i n i c a l experience i n mental r e t a r d a t i o n due t o time l i m i t a t i o n s i n t h e i r program. S t i l l another s c h o o l noted t h a t mental r e t a r d a t i o n experience was t o be i n c l u d e d i n the c u r r i c u l u m the f o l l o w i n g year as  a result  subject following r e c e i p t  of i n t e r e s t  aroused i n t h i s  of the q u e s t i o n n a i r e .  One  respondent noted t h a t t h i s was a study t h a t needed d o i n g . In another s c h o o l an attempt was being made t o prevent the a s s o c i a t i o n  of mental r e t a r d a t i o n and p s y c h i a t r y .  62 IMPLICATIONS AND CONCLUSIONS  The m a j o r i t y c l i n i c a l experience  of n u r s i n g schools and o b s e r v a t i o n  i n mental  i n t h e i r n u r s i n g e d u c a t i o n programs. c l i n i c a l experience  and o b s e r v a t i o n  gave some t h e o r y , retardation  The i n c l u s i o n of i n the c u r r i c u l u m  tended t o be i n c i d e n t a l r a t h e r than p l a n n e d , as by the frequent "as  l i s t i n g i n the c a t e g o r i e s of "not  opportunity p r e s e n t s " ,  very l i t t l e  theory and c l i n i c a l experience  retardation  is  study,  i n mental  The data i m p l i e s that many schools  not have a s t r u c t u r e d p l a n f o r p r e s e n t i n g t h i s I t would c e r t a i n l y seem that  a planned and  approach t o n u r s i n g e d u c a t i o n i n t h i s  and the time allotment education programs.  The r e l a t i v e  experience.  area would be  f o r t h i s experience  i n nursing  i s p o s s i b l e that  of the m e n t a l l y  observation  clinical  surprising.  The data a l s o i m p l i e s that many schools make p r o v i s i o n f o r o b s e r v a t i o n  useful  placement  l a c k of planned  w i t h r e t a r d e d i n d i v i d u a l s was  do  structured  so t h a t nurse educators c o u l d be aware of the  It  that  being g i v e n t o students e n r o l l e d i n n u r s i n g  i n Canada.  experience  recorded"  and " i n c i d e n t a l " .  It would seem, based on data from t h i s  schools  evidenced  do not retarded.  of mental r e t a r d a t e s may  be of l i m i t e d value i n l e a r n i n g t o care f o r these p a t i e n t s , particularly i f possible.  c l i n i c a l experience  It would seem t h a t  increasingly  important.  with them i s  observation  not  then would be  63 Nursing e d u c a t i o n i n mental r e t a r d a t i o n tends t o be i n c l u d e d w i t h i n a narrow range  of programs and  I t would seem that e x t e n s i o n of t h i s i n l i n e w i t h the r e a l i t i e s three-fourths  coverage would be more  of our s o c i e t y .  of n u r s i n g schools  experiences.  Although over  do i n c l u d e some theory and  c l i n i c a l experience i n mental r e t a r d a t i o n i n the  curriculum,  i t would seem t h a t t h i s t o p i c i s being s l i g h t e d or ommitted i n a number of s c h o o l s .  I t was noted with  considerable  concern t h a t there would appear t o be many n u r s i n g g r a d u a t i n g without having r e c e i v e d any measurable in this  students experience  area.  Recommendations Should another study of t h i s nature be undertaken i t is (2)  recommended that  (1)  a l l data be c o l l e c t e d at  one t i m e ,  a more adequate t o o l f o r measurement be d e v i s e d ,  s m a l l e r p o p u l a t i o n be chosen f o r  (3)  a  study.  Recommendations f o r f u r t h e r s t u d i e s i n t h i s f i e l d g i v e n i n the f o l l o w i n g 1.  A study t o focus  are  list.  a t t e n t i o n on current problems i n  n u r s i n g the m e n t a l l y r e t a r d e d i n Canada, r e l a t e d t o the need f o r i n c l u s i o n of theory and c l i n i c a l experience i n the c u r r i c u l u m of n u r s i n g 2.  schools.  A study t o determine the time a l l o t m e n t , placement and  specific  content of mental r e t a r d a t i o n i n current n u r s i n g  programs. 3.  A qualitative  staff  study t o show the p o s s i b l e  effect  of  knowledge of mental r e t a r d a t i o n on the care p r o v i d e d  to mentally retarded p a t i e n t s . this  A study, c l o s e l y r e l a t e d  c o u l d be done t o show the p o s s i b l e  attitudes  effect  of  to  staff  toward mental r e t a r d a t i o n on the care p r o v i d e d t  mentally retarded  patients.  BIBLIOGRAPHY BOOKS, PERIODICALS AND ARTICLES Adams, Harvey W. et a l . M e n t a l / R e t a r d a t i o n Tn Canada. Report F e d e r a l - P r o v i n c i a l Conference, Ottawa, Canada. (Ottawa: Department of N a t i o n a l H e a l t h and W e l f a r e , October 19-22, 1964). Adams, Martha. " P r o f e s s i o n a l Education of Nurses t o Care f o r C h i l d r e n who are Retarded,"' I n t e r n at T o n a l 'Journal of Nursing Students. Pergamon P r e s s , 1966, V o l I I I , pp. 181-190. Anderson, E d i t h H. "Nursing E d u c a t i o n i n the U n i v e r s i t y A f f i l i a t e d Center f o r the M e n t a l l y R e t a r d e d , " a b s t r a c t i n Mental R e t a r d a t i o n A b s t r a c t s . V o l . V I , No. 2, ( A p r i l - J u n e 1969). Bensberg, Gerard J . (ed). Teaching the Mentally' Retarded. A t l a n t a : Southern Regional Education Board, 1965. Davens,  Edward. "Role of a State H e a l t h Department i n Mental R e t a r d a t i o n , " New F r o n t i e r s i n M e n t a l R e t a r d a t i o n . C h i l d r e n ' s Bureau, Department of H e a l t h , Education and Welfare. (Washington: Government P r i n t i n g O f f i c e , 1966), pp. 18-19.  Heber, R i c k . " M o d i f i c a t i o n s i n the Manual on Terminology and C l a s s i f i c a t i o n i n Mental R e t a r d a t i o n , " American J o u r n a l of Mental D e f i c i e n c y , fo;60-"61-.. !.': Lange,  S i l v i a and L i n d a Whitney. "Teaching Mental N u r s i n g , " Nursing O u t l o o k . A p r i l , 1966.  Retardation  Murray, B. Louise and Kathryn E . Barnard. "The Nursing S p e c i a l i s t i n Mental R e t a r d a t i o n , " Nursing C l i n i c s of North America S e r i e s , e d . Kathryn E . B a r n a r d , V o l . I , No. *n P h i l a d e l p h i a : W.B. Saunders Company, December, 1966. Pennington, M a v i s . "Nursing Students Work w i t h the M e n t a l l y R e t a r d e d , " ' Nursing' Outlook. May, 1968, pp. 38-39. Schweer,  J e a n . E . ' C r e a t i v e Teaching i n C l i n i c a l N u r s i n g . S a i n t L o u i s : The C . V . Mosby Company, 1968.  65  Vevang, B e v e r l e y , P h y l l i s Leonard, and Louis P i e r s o n , "Experience i n Mental R e t a r d a t i o n f o r B a s i c Nursing S t u d e n t s . " Nursing Forum. V o l . V I , No. 2 1967, pp. 183-194. Webster's Seventh New C o l l e g i a t e D i c t i o n a r y . G. and C. Merriam Company, 1967"  Springfield:  OTHER SOURCES B r i t i s h Columbia. Department of E d u c a t i o n . ' B r i t i s h Columbia P u b l i c S c h o o l Annual Report 1970-71. V i c t o r i a , 1971. B r i t i s h Columbia. Department of H e a l t h S e r v i c e s and H o s p i t a l Insurance. Mental H e a l t h Branch. Annual Report 1971. V i c t o r i a , 1971. B r i t i s h Columbia. Department of H e a l t h S e r v i c e s and H o s p i t a l Insurance. R e g i s t r y f o r Handicapped C h i l d r e n and A d u l t s . ' Annua:! Report 1969. V i c t o r i a , 1969, p . 20. Canada,  Bureau of S t a t i s t i c s . The Canada Year Book 1970-71. Ottawa, 1971.  Commission on Emotional and Learning Disorders i n C h i l d r e n One M i l l i o n C h i l d r e n . T o r o n t o : L. C r a i n f o r d f o r the Commission, 1970. Goward, Mary H. "A Study of R e t a r d a t i o n Content Taught i n S e l e c t e d New England Schools of N u r s i n g . " Boston: Boston U n i v e r s i t y School of N u r s i n g , 1964-1965. P a t t e r s o n , Nancy J . "A Guide f o r I N t e g r a t i n g Mental R e t a r d a t i o n Content i n t o the B a s i c C u r r i c u l u m . " Unpublished M a s t e r ' s T h e s i s , U n i v e r s i t y of Washington, 1968. U.S.  Department of H e a l t h and Welfare. President's Committee on Mental R e t a r d a t i o n . M.RY '71 E n t e r i n g the E r a of Human E c o l o g y , No. I P . S . )  72-7  Appendix A QUESTIONNAIRE  67  ( V  School o f N u r s i n g :  Your program Is (check one  Address:  U n i v e r s i t y program  Length o f program  years  .Diploma program...  Length o f program  years  Number o f students tn 1 6? Q  Tl  graduating class  For your 198? g r a d u a t i n g c l a s s p l e a s e I n d i c a t e "By" a check (J) the c o u r s e ( s ) t h a t Include mental retardation Instruction.  Check I or more  f.  (*0:  For" each course checked show time In minutes/hours o f i n s t r u c t i o n i n mental . retardation.  Biochemistry  .minutes........hours  Genetics  .minutes  hours  O b s t e t r i c Pursing  .minutes  hours  P e d i a t r i c Murslng  .minutes  hours  P s y c h i a t r i c Nursing...  .minutes  hours  P u b l i c Health N u r s i n g .  .minutes  hours  For each c o u r s e checked show year of.program t n which c o u r s e was given.  Remarks:  * l . For your 1^6° g r a d u a t i n g d o s s p l e a s e I n d i c a t e by n check ( ) the c o u r s e ( s ) i n which the student worked d i r e c t l y w i t h m e n t a l l y retarded p a t i e n t s .  Check 1 or more  For each c v i r s c checked show time In mlnutos/bours o f d i r e c t c l i n i c a l experience.  O b s t e t r i c Nursing  .minutes  hours  P e d i a t r i c Nursing  .mi nutes  hours  P s y c h l a t r t c Nursing...,  .minutes  hours  P u b l i c H e a l t h Nursing..  .minutes  .hours  Other ( p l e a s e s p e c i f y ) .  .minutes  hours  Remarks:  For each course checked show year o f program In which d i r e c t c l i n i c a l experience o c c u r r e d .  cr\ co  School of Nurstng  T.  For your I 1 f < 9 qraduatlng class nlease Indicate by a check («0 the coursc(s) In which c l t n l c o l experience consisted of observation only of mentally retarded patients.  Check 1 or more  ~W. For each course checked show time In minutes/hours of observation.  Obstetric Nursing  • minutes  Pediatric  .minutes  Nursing......  hours hours  Nursing...,  • ulnutes  hours  Publ1c HPOIth Nursing.,  .ulnutes  hours  Other (olease soeclfy),  .nlnutes  hours  Psychiatric  Remarks:  F i l l e d out by Tltle(s) Date  9.  For each course checked show year of program In which observation occurred.  Appendix B LETTER OP INTRODUCTION TO THE STUDY  70  Appendix C FOLLOW-UP LETTER  72  73  January 22,  1970.  I am a student at the U n i v e r s i t y of B r i t i s h Columbia, Vancouver, B. C , e n r o l l e d i n the second year of the Master of Science i n Nursing program. P r e p a r a t i o n of a t h e s i s i s a requirement of the course. My t h e s i s i s e n t i t l e d "A Survey of Canadian Schools of Nursing t o Determine the I n s t r u c t i o n and C l i n i c a l Experience Provided i n Mental R e t a r d a t i o n . " In order t o complete my study, I w i l l need i n f o r mation from a l l the s c h o o l s of n u r s i n g i n Canada, i n c l u d i n g u n i v e r s i t y s c h o o l s , and two and three year diploma s c h o o l s . Approximately three weeks ago I sent you a l e t t e r and q u e s t i o n n a i r e r e q u e s t i n g i n f o r m a t i o n I need t o complete my study. Since I have not heard from you I am w r i t i n g again i n the hope t h a t I can get your k i n d c o o p e r a t i o n i n comp l e t i n g and r e t u r n i n g the q u e s t i o n n a i r e , as a good response r a t e i s necessary i f my study i s t o be s u c c e s s f u l . I f your reason f o r not r e t u r n i n g the q u e s t i o n n a i r e i s t h a t you do not have a 1969 g r a d u a t i n g c l a s s , would you p l e a s e i n d i c a t e t h i s i n a l e t t e r or on the q u e s t i o n n a i r e and r e t u r n i t t o me. Report of the study w i l l not I d e n t i f y i n d i v i d u a l schools of n u r s i n g by name. I t i s my hope t h a t the i n f o r m a t i o n you send w i l l a s s i s t i n f u r t h e r i n g n u r s i n g education i n Canada. Thank you f o r your c o o p e r a t i o n . Yours t r u l y ,  (Mrs.) E l s i e Pearen  Appendix D QUESTIONNAIRE, FRENCH TRANSLATION  74  Ecole de  Type de programme  ciences Infirmieres:.............  Adresse  Universite  Nombre d'Studiantes dans l a Promotion 1969.  Ecole de base  1. Pour votre promotion 1969, indlquez d'un t r a i t („') l a (les) partie(s) du programme comprenant 1'arri6ration.  • Pointez j(l)icl. I  •Biochiraie....  2. Indiquez chaque f o i s 3. Indiquez chaque f o i s en le nombre d'heures/minutes quelle annle du programme consacrSes a 1'arriSration • l e cours a ete donnS me tit ale .minutes . . ,., .tjeur as..  Genetlque  .minutes,.....heures.  Obstfitrique  .minutes......heures,  Pediatric  .minutes ......heures.  Psychiatrie  .minutes ......heures.  Saute Publique....  .minutes ......heures.  Divers (Precisez),  .minutes......heures.  Remarques 4. Pour l a promotion 1969, indiquez d'un t r a i t le(s) cours dans lequel l ' e tudiante a t r a v a i l l e directement avec des arrifires mentaux  r Pointez • i c i (1)  .minutes......heures. ,  Sante Publique................... Psychiatrie........................... Divers (Precisez) Remarquos:  6. Indiquez chaque fois en quelle annSe du programme a eu l i e u 1*experience pratique.  ,  ObstStrique. Pediatr ie  l5. Indiquez chaque fois 'le nombre de minutes/hevr es d'experience pratique.  i ..  I  .1.....  1.....  .minutes ...... .heures ...!, .minutes. .... .heures. minutes......heures minutes  heures  1  i  Ecole d'Inflrmieres  7. Pour votre promotion 1969 ,indiquez| Pointez par un t r a i t (J) l e cours pour lequel lci(l) l'cxperience pratique a consists dans | l a seule observation d'arrier£s men- ; taux. J  8. Indiquez chaque f o i s l e nombre de minutes/heures d'observacion.  9. Indlquez chaque f o i s en quelle ann£e du programme cette observation a eu l i e u .  I  .minutes........heures.  Obstetrique Pediatr ie  !>*••  .minutes  .minutes........heures.  Psychiatr ie Sante Publ ique Divers (Pr€cisez)  heures.  I  .minutes  , .heures,  I......minutes  heures.  f  Remarque8:  Rempli par:..  ,,  Titrea professionnels Date:  —J  Appendix E LETTER OP INTRODUCTION TO THE STUDY, FRENCH TRANSLATION  77  Appendix F FOLLOW-UP LETTER, FRENCH TRANSLATION  79  Appendix G INTRODUCTORY LETTER, DIRECTOR, UNIVERSITY  SCHOOL OP NURSING,  OP BRITISH COLUMBIA, VANCOUVER, B . C .  81  Appendix H LETTER OF REQUEST TO AFFILIATE SCHOOLS OF NURSING  83  84 March 6, 1971.  Dear Last y e a r , while e n r o l l e d i n the second year of a M . S . N , program at U n i v e r s i t y of B r i t i s h Columbia, I undertook a t h e s i s concerning the t r a i n i n g of student nurses i n the f i e l d of mental r e t a r d a t i o n . I enclose a copy of the l e t t e r that was sent t o Canadian schools of n u r s i n g t h a t met the c r i t e r i a f o r i n c l u s i o n i n the study. I was unable t o complete my t h e s i s due t o i n s u f f i c i e n t data. I hope t o complete i t t h i s year but I r e q u i r e additional information. As you know, many n u r s i n g schools use a f f i l i a t i n g schools f o r t h e i r s t u d e n t s ' experience i n P e d i a t r i c s , O b s t e t r i c s and P s y c h i a t r y , the areas where Theory, C l i n i c a l Experience or Observation of the m e n t a l l y r e t a r d e d c o u l d and f r e q u e n t l y would take p l a c e . Many of the "home" schools were unable t o complete my q u e s t i o n n a i r e concerning the theory and t r a i n i n g i n mental r e t a r d a t i o n g i v e n students at the a f f i l i a t i n g s c h o o l ; they d i d not keep d e t a i l e d records of t h i s k i n d of e x p e r i e n c e . My t h e s i s w i l l be more complete and accurate i f you w i l l supply t h i s i n f o r m a t i o n f o r n u r s i n g schools i n c l u d e d i n my study that a f f i l i a t e at your i n s t i t u t i o n . I enclose a q u e s t i o n n a i r e f o r your use and a l i s t of schools i n your p r o v i n c e t h a t are i n c l u d e d i n my study (please note that one of the c r i t e r i a f o r i n c l u s i o n was "having a graduating c l a s s i n 1969"). Would you p l e a s e complete the q u e s t i o n n a i r e f o r your s c h o o l (as an a f f i l i a t i n g s c h o o l ) , g i v i n g the average h o u r s , y e a r , e t c . t h a t c o u l d best be a p p l i e d t o a l l schools l i s t e d t h a t a f f i l i a t e with y o u . ( I f one or more schools vary widely from the average p l e a s e g i v e data s e p a r a t e l y f o r that s c h o o l ) . Please p l a c e a check mark beside the n u r s i n g schools on the e n c l o s e d l i s t t h a t a f f i l i a t e at your s c h o o l and t o whom the average s t a t i s t i c a l data a p p l y . Would you r e t u r n the q u e s t i o n n a i r e and the s c h o o l l i s t i n the enclosed stamped, addressed envelope. A f t e r r e c e i v i n g t h i s i n f o r m a t i o n I w i l l contact the home s c h o o l f o r v e r i f i c a t i o n of t o t a l counts (from both home and a f f i l i a t i n g s c h o o l s ) before u s i n g the data i n my study. Thank you f o r your c o o p e r a t i o n . Yours t r u l y , (Mrs.) E l s i e Pearen  Appendix  I  LETTER TO HOME NURSING SCHOOL VERIFYING AFFILIATION DATA  85  86 J u l y 14,  1971.  Dear Last y e a r , while e n r o l l e d i n the second year of the M . S . N , program at the U n i v e r s i t y of B r i t i s h Columbia, Vancouver, B . C . , I undertook a t h e s i s e n t i t l e d "A Survey of Canadian Schools of Nursing t o Determine the I n s t r u c t i o n and C l i n i c a l Experience P r o v i d e d i n Mental R e t a r d a t i o n " . Your n u r s i n g s c h o o l met the c r i t e r i a f o r i n c l u s i o n i n my study and a q u e s t i o n n a i r e was sent t o you which you completed. I r e q u i r e a d d i t i o n a l i n f o r m a t i o n t o complete my s t u d y , however, r e l a t i v e t o t r a i n i n g students r e c e i v e u i n mental r e t a r d a t i o n at a f f i l i a t i n g n u r s i n g schools i n the f i e l d s of P e d i a t r i c s , O b s t e t r i c s and P s y c h i a t r y . A l i s t of n u r s i n g schools and t h e i r a f f i l i a t i o n s was obtained from the R e g i s t e r e d Nurses A s s o c i a t i o n f o r each p r o v i n c e , and the same q u e s t i o n n a i r e was sent t o them, a p p l i c a b l e t o a f f i l i a t i n g students o n l y . Information obtained from ( p r o v i n c e ) . . a f f i l i a t i n g schools (some of i t a p p l i c a b l e t o your t r a i n i n g program) i s as f o l l o w s : P s y c h i a t r i c experience Instruction/Theory C l i n i c a l Experience Ob s e r v a t i on  at  hours hours hours  Hospital  O b s t e t r i c experience at Ins t r u c t i on/The ory C l i n i c a l Experience Observation  hours hours hours  Hospital  P e d i a t r i c experience at Instruction/Theory C l i n i c a l Experience Ob s e r v at i on  Hospital hours hours h our s  A copy of your completed q u e s t i o n n a i r e i s e n c l o s e d . Please i n d i c a t e the f o l l o w i n g on the q u e s t i o n n a i r e and return:  87  - has the above ( a p p l i c a b l e ) data already been i n c l u d e d i n the t o t a l s g i v e n on your q u e s t i o n n a i r e ? - what ( i f any) of the above data should be added t o the t o t a l s g i v e n on your q u e s t i o n n a i r e ? Your c o o p e r a t i o n w i l l be a p p r e c i a t e d and w i l l add t o the accuracy of my study. Yours  truly,  (Mrs.) E l s i e Pearen  

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