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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 in the School of Nursing \Ie accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA April , 1973 In presenting th i s thesis i n p a r t i a l fu l f i lment of the requirements fo r an advanced degree at the Univer s i ty of B r i t i s h Columbia. I agree that the Library s h a l l make i t f ree ly ava i lab le for reference and study. I further agree that permission for extensive copying of th i s thes i s for scholar ly purposes may be granted by the Head of my Department or by his representat ives . It i s understood that copying or pub l i ca t ion of t h i s thes is for f i n a n c i a l gain s h a l l not be allowed without my wri t ten permission. Department of Nursing The Univer s i ty of B r i t i s h Columbia Vancouver 8, Canada Date A p r i l 15, 1973 i ABSTRACT This descr ip t ive study was done to provide information on the number of hours and c l i n i c a l experience students received during nursing education which might equip them with s k i l l s required for mental retardat ion nurs ing . Registered Nurses Associat ions for each province as s i s ted i n the study by providing l i s t s of nursing schools i n t h e i r province . Of the 142 nursing schools having a graduating class i n 1969, 1^0 were s tudied. The urgency of the problem was shown when i t was noted that an estimated 3 percent of the population of Canada were mentally retarded. Several commissions have been done on t h i s top ic i n the past decade i n Canada. Some studies of th i s general nature have been done i n the United States. Review of the l i t e r a t u r e ind ica ted that no previous studies had been done on t h i s topic i n Canada. A questionnaire was constructed to obtain data r e l a t i n g to placement of mental retardat ion experience, hours of theory and c l i n i c a l experience provided and the year of nursing education i n which the experience occurred. Questionnaires were mailed to the schools , completed by them, and returned. It was found that diploma schools tended to provide between 0 to 8 hours of theory and c l i n i c a l experience i n i i mental re tardat ion whereas un iver s i ty schools tended to offer up to 12 hours of experience. Most nursing education i n mental re tardat ion occurred i n ped ia t r i c s or p s y c h i a t r i c programs or i n combinations of these and other courses. Mental re tardat ion nursing education tended to occur i n the next to the las t year of the program for a l l schools . Many schools , however, ind ica ted that mental re tardat ion experience was not included i n the school curriculum at a l l . It appeared that very l i t t l e theory and c l i n i c a l experience i n mental re tardat ion was being given students enro l l ed i n nursing schools i n Canada. The r e l a t i v e lack of planned c l i n i c a l experience with retarded i n d i v i d u a l s was s u r p r i s i n g . Several problems and l imi t a t ions 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 for data c o l l e c t i o n . The data had to be c o l l e c t e d i n two phases from two di f ferent sources, home schools and a f f i l i a t e schools , to obtain accurate data. Studies could be done to focus a t tent ion on current problems i n nursing the mentally retarded, re la ted to the need for i n c l u s i o n of theory and c l i n i c a l experience i n the curriculum of nursing schools . Studies, could also be done to determine time al lotment, placement and s p e c i f i c mental re tardat ion content i n current nursing programs. Qual i tat ive studies could be done to show the poss ible effect of s t a f f knowledge of mental re tardat ion on the care provided to mentally retarded pa t i ent s . This study was an attempt to show the need for review of nursing education programs i n r e l a t i o n to the i n c l u s i o n of mental re tardat ion theory and c l i n i c a l experience i n the curriculum of nursing schools . i v TABLE OF CONTENTS Page ABSTRACT i LIST OF TABLES v i i i ACKNOWLEDGMENTS x Chapter 1. NURSING EDUCATION IN MENTAL RETARDATION . . . 1 THE NURSING PROBLEM 1 Statement of the Problem 3 D e f i n i t i o n of Terms Used 3 Mental Retardation 3 Ins t ruc t ion 4 C l i n i c a l Experience 4 Canadian School of Nursing 4 URGENCY AND IMPORTANCE OF THE PROBLEM . . . 4 Recognition of the Problem 5 Extent of the Problem 9 Mental re tardat ion i n B r i t i s h Columbia 9 Implications for Nursing Education . . 11 PURPOSE OF THE STUDY 12 Primary Objective 12 Contributory Objectives 12 REVIEW OF EARLIER STUDIES AND ARTICLES CONCERNING MENTAL RETARDATION CONTENT IN NURSING EDUCATION 13 Limitat ions of Previous Studies 17 V Chapter Page OVERVIEW OF RESEARCH DESIGN 17 Population 17 Conduct of the Study 17 Questionnaire 18 SUMMARY 18 2. 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 Pretest 23 DATA COLLECTION, PHASE I 24 DATA COLLECTION, PHASE II 25 SUMMARY 27 3. ANALYSIS OF THE DATA 28 D i s t r i b u t i o n of Nursing Schools by-' Length of Program 29 D i s t r i b u t i o n of Nursing Schools by Community Sett ing 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 . . . 43 DATA COMPARISON FOR EASTERN AND WESTERN SCHOOLS 46 v i Chapter Page DATA CHANGES DUE TO INCORPORATING AFFILIATION DATA 50 SUMMARY 53 4. 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 imita t ions i n Conducting the Study 60 Comments from respondents 6 l IMPLICATIONS AND CONCLUSIONS 62 Recommendations 63 BIBLIOGRAPHY 65 APPENDIXES 67 A. Questionnaire 67 B. Let ter of Introduction to the Study 70 C. Follow-up Let ter 72 D. Questionnaire, French Trans l a t ion 7^ E . Le t te r of Introduction to the Study, French Trans l a t ion 77 F . Follow-up L e t t e r , French Trans l a t ion 79 G. Introductory L e t t e r , D i r e c t o r , School of Nursing, Univer s i ty of B r i t i s h Columbia, Vancouver, B.C 8 l H. Le t te r of Request to A f f i l i a t e Schools of Nursing 83 v i i Chapter Page I. L e t t e r to Home Nursing School V e r i f y i n g A f f i l i a t i o n Data 85 v i i i LIST OF TABLES Table Page 1. Nursing Schools Included 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 . 21 2. D i s t r i b u t i o n of Schools of Nursing i n Canada for 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 Single and Grouped Course Placement for Theory, C l i n i c a l Experience andAobservation i n Mental Retardation 31 3. Percentage of Nursing Schools i n Canada that Provide Mental Retardation Theory, C l i n i c a l Experience and Observation i n Single Courses or i n Combined Courses 33 4. D i s t r i b u t i o n of Univer s i ty Schools of Nursing i n Canada by Hours A l l o t t e d to Mental Retardation Theory, C l i n i c a l Experience and Observation 3.7 5. 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 Retardation Theory, C l i n i c a l Experience and Observation 39 6. 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 to Mental Retardation Theory, C l i n i c a l Experience and Observation . . . . 4 l 7. 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 to Mental Retardation Theory, C l i n i c a l Experience and Observation 42 8. D i s t r i b u t i o n of Schools of Nursing i n Canada for 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 Retardation 44 ix Table Page 9 . D i s t r i b u t i o n of Schools of Nursing i n Canada for 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 Retardation Theory for Eastern and Western Schools 47 10. D i s t r i b u t i o n of Schools of Nursing i n Canada for 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 Retardation C l i n i c a l Experience for Eastern and Western Schools 48 11. D i s t r i b u t i o n of Schools of Nursing i n Canada for 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 Retardation Observation for Eastern and Western Schools 49 12. 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 Retardation Theory, C l i n i c a l Experience and Observation (Phase I Data Only) 51 13. 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 Retardation Theory, C l i n i c a l Experience and Observation for 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 to members of the Thesis Committee, p a r t i c u l a r l y Mrs. Sharon Ogden, for the support and assistance given during preparation of the t h e s i s . Members of the Committee were: Mrs. Sharon Ogden, Ass is tant Professor , Chairman 1972-73, Mrs. Jeanne Hurd, Lecturer , Chairman 1970-71, Miss Margaret S t reet , Associate Professor, Mrs. Nancy Forbes, Lecturer , Miss Jess ie McCarthy, Assistant; Professor , Department of Health Care and Epidemiology, Faculty of Medicine, Mrs. Helen E l f e r t , Ass i s tant Professor. This study was supported i n part by the B r i t i s h Columbia Mental Retardation Assoc ia t ion who provided f i n a n c i a l assistance and c l e r i c a l help during the pre l iminary part of the work. Assistance was given i n the preparat ion of questionnaires and form l e t t e r s , typing and mai l ing mater ia l s , for which the Assoc ia t ion provided s tat ionery supplies and postage. The author i s g ra te fu l for the assistance given by t h i s organizat ion . Chapter 1 NURSING EDUCATION IN MENTAL RETARDATION Profes s iona l nursing has grown beyond the stage where the prov i s ion of p h y s i c a l care and comfort i s the only concern of nurses, the pa t i en t ' s mental and s o c i a l heal th i s of equal concern today. Nurses are becoming aware of the need to provide spec i a l nursing care for pat ients with s p e c i a l problems. One of the major concerns of society today i s the problem'of mental r e ta rda t ion . Nurses are looking at the menta l^re tarded to determine what s p e c i a l nursing problems they may present. Nursing educators are taking a c loser look at the preparation students receive to equip them with the s k i l l s necessary to provide care to these pat ients with s p e c i a l needs. THE NURSING PROBLEM There are many new approaches i n providing care for the mentally retarded, there i s a growing awareness of the 1 2 inadequacy of services presently provided"'' and there i s d i s s a t i s f a c t i o n with present methods of implementing t h i s se rv ice . The outlook fo r the mentally retarded has changed, many lead busy useful l i v e s , many of them have regular employment, many have s p e c i a l health needs. Nurses usual ly accept the r e s p o n s i b i l i t y of providing service wherever there i s an area of recognized need. Recognition of the problem, however, i s not enough, nurses must be able to analyse the problem to determine contr ibut ing f ac tor s , and they must be able to i n i t i a t e therapeutic nursing act ion directed at reso lv ing the problem. In order to have the kind and depth of knowledge necessary to provide t h i s care, nursing students must receive t h i s i n s t r u c t i o n i n t h e i r basic program. Observation of nurses working with mentally retarded ch i ldren i n a large i n s t i t u t i o n prompted the present study. While observing the care provided to these pat ients i t became obvious that the basic t r a i n i n g of the nurses g iv ing th i s care var ied widely. It seemed poss ible that the preparation a student nurse receives for work i n t h i s area could affect her a t t i tude toward these pa t ient s , as we l l as 1 Nancy J . Patterson, "A Guide for Integrating Mental Retardation Content i n t o the Basic Curriculum" (unpublished Master 's t h e s i s , Univer s i ty of Washington, 1968), p. 1. 2 The Commission on Emotional and Learning Disorders i n C h i l d r e n , One M i l l i o n Chi ldren (Toronto: L. Crainford for the Commission, 1970), p . 9. 3 her a b i l i t y to care for them. Murray and Barnard contend that i n the past basic nursing programs gave only cursory a t tent ion to the need for i n c l u s i o n of content r e l a t i v e to developmental deviations commonly associated with mental re ta rda t ion . L i t t l e emphasis had been given to the need for prov i s ion of s p e c i a l learning experiences which would equip basic students with beginning s k i l l s i n t h i s area. They suggested that t h i s might be re l a ted to the teacher ' s lack of knowledge and 3 experience i n t h i s f i e l d . Statement of the Problem It i s the purpose of t h i s study to attempt to determine whether or not nurse educators i n Canadian nursing schools are preparing nurses to give service to the mentally retarded pat ient i n the home, school , h o s p i t a l , and i n the community by providing learning experiences to students which w i l l equip them with beginning s k i l l s to care for the retarded. D e f i n i t i o n of Terms Used Mental Retardation. Rick Heber defines mental re tardat ion as "sub-average general i n t e l l e c t u a l functioning which or ig inates during the developmental per iod and i s 3 B. Louise Murray and Kathryn E . Barnard, "The Nursing Spec i a l i s t i n Mental Retardat ion , " Nursing C l i n i c s  of North America, V o l . I , No. 4, ed. Kathryn E . Barnard (Phi lade lphia : W.B. Saunders Company, December, 1966), p. 634. 4 h associated, with impairment i n adaptive behaviour . " . In s t ruc t ion . Webster defines i n s t r u c t i o n as ( la) 5 lesson, precept . C l i n i c a l Experience. This i s the p r a c t i c a l a p p l i -cat ion of bas ic t h e o r e t i c a l knowledge i n providing pat ient care.^ Canadian School of Nursing. Any i n s t i t u t i o n i n Canada having a graduating, class i n 1969 that teaches or t r a i n s students i n preparation for wr i t ing the qua l i fy ing examinations for nurse r e g i s t r a t i o n . URGENCY AND IMPORTANCE OP THE PROBLEM The problem of mental re tardat ion i s not new. Davens suggested that the problem was one of such character and extent as to require organized community act ion i n seeking a s o l u t i o n . The. causes are m u l t i p l e , he f e l t , and present mul t ip le opportunit ies for prevent ion. He suggested that i t i s a chronic problem, l i f e l o n g i n durat ion , and may 4 Rick Heber, "Modif icat ions i n the Manual on Terminology and C l a s s i f i c a t i o n i n Mental Retardat ion , " American Journal of Mental Def ic iency , 1960-61, p. 499. Webster's Seventh New Col leg ia te D ic t ionary , ( S p r i n g f i e l d : G. and C. Merriam Company, 19W), p. 438. 6 Jean E . Schweer, Creat ive Teaching i n C l i n i c a l  Nursing (Saint Louis : The C. V. Mosby Company, 19bb), p. 41. 5 affect famil ies economically, s o c i a l l y and c u l t u r a l l y . The s k i l l s of many pro fe s s iona l people both wi th in and outside the f i e l d of heal th are required i n providing serv ice . A large segment of the populat ion i s a f fected, e i ther d i r e c t l y or i n d i r e c t l y , i n providing care or i n re l a t ionsh ip to the 7 pat ient s . Recognition of the Problem In recogni t ion of the grav i ty of the problem a f e d e r a l - p r o v i n c i a l conference on mental re tardat ion was held i n Ottawa, Canada, October 19-22, 1964, sponsored by the M i n i s t e r of Nat ional Health and Welfare, the Honourable Judy LaMarsh. Topics discussed at the conference included aspects of hea l th , welfare, education and voca t iona l t r a i n i n g and * 8 employment appl icable to the mentally retarded. Some recommendations r e s u l t i n g from th i s conference are l i s t e d below. 7 Edward Davens, "Role of a State Health Department i n Mental Retardat ion , " i n New Front ier s i n Mental  Retardat ion, (presented at C l i n i c a l D i r e c t o r ' s Mental Retardation Conference, June 5, 6, 7, 1966, Asi lomar, C a l i f o r n i a ) , Ch i ld ren ' s Bureau, Department of Health Education and Welfare, (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 (eds . ) , MentaI Retardation  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 Nat ional Health and Welfare, October 19-22^1964), p. 1. 1. There i s need for a spectrum of services for the retarded throughout l i f e , from infancy to old age, i n a l l 9 areas of work and l e i s u r e . 2. There i s a need for add i t iona l q u a l i f i e d personnel to work with the mentally retarded. Some measures which can be taken to provide these needed health workers are in- se rv ice t r a i n i n g programs for those working i n t h i s f i e l d , and approaching t r a i n i n g i n s t i t u t i o n s to ensure the i n c l u s i o n of t h i s k ind of mater i a l i n the c u r r i c u l u m . 1 0 3. I t i s recommended "that a l l relevant educational agencies concerned with health educa t ion . . . g ive s p e c i f i c recogni t ion to the teaching of the problems of prevent ion, i d e n t i f i c a t i o n , treatment and care of the mentally re-t a r d e d . " 1 1 The 1964 conference served to focus a t tent ion on the need for further ac t ion i n providing services for the mentally retarded. As a r e su l t a na t iona l commission was set up i n 1966 whose primary task was "to set up a committee . . . to engage i n a comprehensive, nationwide study of the problem and poss ible solut ions to i t . " It was noted that parents f e l t "no one viewed the c h i l d as a t o t a l i t y . . . " , and "many parents . . . expressed . . . f r u s t r a t i o n because no medical person was prepared to 'stay wi th ' t h e i r 9 10 11 I b i d . , p. 250. I b id . I b i d . , p . 255. 12 The Commission on Emotional and Learning Disorders i n C h i l d r e n , One M i l l i o n Chi ldren (Toronto: L . Crainford for the Commission, 1970), p. 9. 13 problem." Since medical education gives high p r i o r i t y to treatment of p h y s i c a l and acute condit ions" . . . ch i ld ren with emotional or learning disorders and the retarded, since t h e i r condit ion i s r a re ly e i ther acute or p h y s i c a l , receive low p r i o r i t y and scant a t tent ion from most health personnel . Some recommendations appl icable to nursing education i n the area of mental re tardat ion that were made by the Commission are l i s t e d . 1. Postnata l care should include an assessment of the c h i l d ' s emotional status and learning a b i l i t i e s . Appropriate t r a i n i n g should be provided for doctors and 15 nurses to make t h i s pos s ib le . 2. Educat ional i n s t i t u t i o n s should include as part of the curriculum of doctors , nurses and other health personnel , t h e o r e t i c a l and p r a c t i c a l t r a i n i n g i n the developmental disorders of childhood and adolescence. In the United States , the Pres ident ' s Committee on Mental Retardation meets yea r ly . In 1971 a new approach to the problem was suggested based on the idea that s o c i e t a l condit ions often are the agents that cause r e t a r -dation and s o c i e t a l conditions often provide a se t t ing i n 13 14 I b i d . , p. 164. I b i d . , p . 157. 15 16 I b i d . , p. 175. I b i d . , p . 176. 8 17 which re tardat ion can t h r i v e . Some suggestions made by the Committee fo l low. 1. There should be educat ional re s t ruc tur ing 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 sc iences , they should be brought together so the center of concern for each d i s c i p l i n e i s the whole human being wi th in his environment. 2. A comprehensive curriculum and academic program should be developed by u n i v e r s i t i e s i n a new kind of col lege devoted to human ecology. Environmental services and governmental health services should share and coordinate t h e i r knowledge of human ecology i n an e f for t to a t t a in a 19 dec i s ive reduct ion i n mental re ta rda t ion . To summarize, pub l i c and profes s iona l groups are becoming increas ing ly aware of the problem of mental re tardat ion i n our society and of the impact of t h i s problem on the country's socio-economic-cultural l i f e . Many measures are being discussed and introduced i n an e f for t to prevent the problem or r e h a b i l i t a t e the mentally retarded to the greatest extent pos s ib le . I f U.S . Department of Health and Welfare, Pres ident ' s Committee on Mental Retardation, M.R. 71 -Entering the Era of Human Ecology, No. (P.S . ) 72-7. 18 I b i d . , p. 9. 19 I b i d . , p. 9. 9 Extent of the Problem Canada, with a population of 21,061,000 (1969 20 estimate) has an estimated 630,000 mentally retarded, 21 approximately three percent of the populat ion. Mental re ta rda t ion i n B r i t i s h Columbia. At the end of 1969 the number of mentally retarded ind iv idua l s l i s t e d with the Registry for Handicapped Chi ldren and Adults i n B r i t i s h Columbia was 7,789 and of these 2,062 were i n 22 i n s t i t u t i o n s . For the year 1970-71 the average number of pat ients i n residence at Woodlands School , New Westminster, was approximately 1,280 and the cost of care was $8,168,889.00 for that year . For the same year Tranqui l l e School , T r a n q u i l l e , B. C , had an average of 579 pa t ient s , approximately, the cost of care being $3,787,785.00 . 2 3 A new f a c i l i t y for the mentally retarded 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 Health Services and Hosp i ta l Insurance, Registry for Handicapped Chi ldren and Adul 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 Health Services and Hosp i ta l Insurance. Mental Health Branch, Annual  Report 1971, ( V i c t o r i a ) 1971), P, L 9 0 . Saanich, Vancouver Island, i n October, 1971 with accomo-2k dation for three hundred patients. In 1970 the P r o v i n c i a l Department of Education was faced with the task of providing f a c i l i t i e s and s t a f f to 25 26 accomodate both educable and trainable mentally retarded which included 3,726 educable and 957 trainable 27 mentally retarded. In addition the B r i t i s h Columbia Mental Retardation Association enrolled 476 trainable mentally retarded i n t h e i r preschool and workshop 28 f a c i l i t i e s . Many mildly retarded children were integrated i n t o the school system, however the exact number was not available. 24 Ibid., p. Ll6. 25 An educable mentally retarded c h i l d i s a 11. . . retarded who can p r o f i t from academic education; mildly retarded - IQ generally from 50 to 75" as defined i n Teaching the Mentally Retarded, edited by Bensberg, Atlanta, 1965, p. 184. 26 A trainable mentally retarded refers to ". . . those i n the general IQ range of 30 to 49 who can benefit from t r a i n i n g mainly i n the self-care and s o c i a l areas rather than i n academic subjects," Ibid., p. 189. 27 B r i t i s h Columbia, Department of Education, B r i t i s h Columbia Public School Annual Report 1970-71, .Victoria;, 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 individuals i n our society demands expert attention. This attention includes expert nursing care. Implications f o r Nursing Education. A problem of such enormity necessarily involves 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 , i n s t i t u t i o n , home or i n a community setting. In addition, they w i l l be involved i n counselling and providing guidance to workers i n 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 preparation 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 to give t h i s care, guidance and support. In the past nurse educators have viewed the role of nursing schools i n preparing students to work with mental retardates with varied reactions. In her study Goward noted that although retardation was included i n the curriculum of one nursing school, an associate degree school, i t was f e l t that a thorough understanding of t h i s specialty was beyond the present tec h n i c a l l e v e l of 29 education." However, some conclusions i n th i s study 29 Mary H. Goward, "A Study of Retardation Content Taught i n Selected New England Schools of Nursing," (unpublished Master's t h e s i s . Boston University School of Nursing, Massechusetts, 1965), p. 10. 12 were that a majority of nursing schools do recognize 30 retardat ion as a problem of which nurses should be aware, 31 and i n which they should have some competency. Patterson noted i n her study that "The philosophies of most baccalaureate schools of nursing do not provide for the i n c l u s i o n of a spec ia l ty such as mental re tardat ion i n the 32 basic nursing cur r i cu lum. " PURPOSE OP THE STUDY Primary Objective The primary objective of th i s descr ipt ive study was to determine the i n s t r u c t i o n and c l i n i c a l experience students were rece iv ing i n Canadian schools of nursing to a s s i s t them i n meeting the needs of the mentally retarded, as appl ied to nurs ing . C ontributory Obj ect ives 1. To determine the hours of i n s t r u c t i o n i n mental re tardat ion now being given i n nursing schools i n Canada. 30 I b i d . , p. 9. 31 I b i d . , p. 13. 32 Patterson, op. c i t . , p. 2. 13 2. To determine the courses i n the curriculum which include i n s t r u c t i o n i n mental re ta rda t ion . 3. To determine the hours of c l i n i c a l experience i n mental re tardat ion now being given i n nursing schools i n Canada. 4. To determine the courses i n the curriculum which include c l i n i c a l experience i n mental re ta rda t ion . 5. To determine i n what year of the program students are rece iv ing i n s t r u c t i o n and c l i n i c a l experience i n mental r e t a rda t ion . REVIEW OP EARLIER STUDIES AND ARTICLES CONCERNING MENTAL RETARDATION CONTENT IN NURSING EDUCATION Several studies and a r t i c l e s have been wri t ten r e l a t i n g to the preparat ion of nursing students to work with the retarded. Most of these studies have been done i n the United States. A review of ava i lab le studies fo l lows. Mary Goward has done a study reviewing the i n s t r u c t i o n i n mental re tardat ion provided i n selected New England schools of nurs ing . Random sampling was done of diploma schools of nursing and p r a c t i c a l nursing schools i n s ix New England states . A l l 11 co l l eg i a te schools i n the area were inc luded . Out of 50 schools rece iv ing quest ionnaires , 27 r e p l i e d . Curriculum content and c l i n i c a l experience r e l a t i n g to retardat ion were the major areas of i n v e s t i g a t i o n , but other aspects of teaching the retarded were also inc luded . Of the schools cooperating, about three-fourths did include re tardat ion i n the undergraduate curr iculum. Lecture was the most commonly used teaching method, and the Department of Maternal and C h i l d Health most frequently ca r r i ed the r e s p o n s i b i l i t y for t h i s teaching. A few programs included such teaching techniques as group d i scuss ion , f i e l d t r i p s or voluntary student pro jec t s . The author observed that nursing educators were becoming aware of re tardat ion as an area of need with which nurses should have some competency, therefore a greater number of nursing schools w i l l probably 33 include i n s t r u c t i o n i n th i s area i n the near future. Another study presented a guide for integra t ing mental re tardat ion content in to the basic nursing curr iculum. Recognizing that nursing students i n basic programs needed more i n s t r u c t i o n i n th i s area i f they were to function adequately i n nursing mental retardates , Patterson devised a method to include the t r a i n i n g i n the baccalaureate program without changing the school philosophy or without making major changes i n the 34 curriculum. 33 Goward, op. c i t . , p. 13. 34 Patterson, op. c i t . , p. 3. 15 In another a r t i c l e Vevang, et a l , stated that " i t was the opinion of our facul ty that we were not preparing the student adequately to work with the mentally retarded persons she might encounter i n publ ic heal th nurs ing , i n p e d i a t r i c nurs ing , as an of f ice nurse and as 35 a c i t i z e n i n her community." Pennington found that using the course i n publ ic heal th nursing was the experience best su i ted for preparing students to work with famil ies who have retarded c h i l d r e n . The growing involvement of nursing i n the f i e l d of mental re tardat ion was noted by Adams. She found that many nurses f e l t nursing the mentally retarded was a strange or d i f ferent kind of nurs ing . She bel ieved good and e f fec t ive nursing care of the i n d i v i d u a l who i s retarded must involve p r i n c i p l e s and processes basic to a l l nurs ing . She f e l t the teacher ' s behaviour i n preparing 37 nurses to care for the retarded was of great importance. 35 Beverly Vevang, P h y l l i s Leonard and Louisa P ier son , "Experience i n Mental Retardation for Basic Nursing Students ," Nursing Forum, V o l . V I , No. 2, 1967, pp. 183-194. 36 Mavis Pennington, "Nursing Students Work with the Mentally Retarded," Nursing Outlook, May, 1968, pp. 38-39. 37 Martha Adams, "Profes s iona l Education of Nurses to Care for Chi ldren who are Retarded," In ternat iona l  Journal of Nursing Students, V o l . I l l (Pergamon Press , 1966), pp. lbl-190. 16 Lange and Whitney recognized that the nursing profess ion has accepted a r e s p o n s i b i l i t y for i d e n t i f y i n g nursing function i n the prevention and treatment of mental r e ta rda t ion . To accomplish t h i s , an opportunity must be provided students to learn about mental re tardat ion i n a basic nursing program. In her a r t i c l e Anderson suggested that the un iver s i ty 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 for students learning to meet the needs of mental retardates and t h e i r 39 f ami l i e s . 1 In an a r t i c l e e n t i t l e d "The Nursing Spec i a l i s t i n Mental Retardat ion , " Murray and Barnard found there was an increased awareness that s p e c i a l preparat ion i s necessary for the prov i s ion of s k i l l e d care to the mentally retarded. A great shortage exis t s of personnel who can cope adequately with the problems presented by these ch i ldren and t h e i r f ami l i e s . They suggest a nurse 's t r a i n i n g should prepare her to work toward prevention of re ta rda t ion , as 4, wel l as i n casef inding, and management of the re ta rda t ion . 38 S i l v i a Lange and Linda Whitney, "Teaching Mental Retardation Nurs ing , " Nursing Outlook, A p r i l , 1 9 6 6 , pp. 5 8 - 6 0 . 39 Edi th Anderson, "Nursing i n the Univer s i ty A f f i l i -ated Center for the Mentally Retarded," abstract i n Mental Retardation Abstract s , V o l . V I , No. 2 (Apri l / June 19o971 p. 333. 40 Murray and Barnard, op. c i t . , pp. 6 3 1 - 6 3 2 . Limitat ions of Previous Studies Previous studies have not shown c l e a r l y the s p e c i f i c preparation of nurses for mental re tardat ion nurs ing . No e a r l i e r studies were found i n Canada. In summarizing the l i t e r a t u r e s tudies , apparently some preparat ion i s being given nursing students i n the United States although i t appears to be l i m i t e d . A t t i -tues. of nursing s t a f f towards mental re tardat ion are important i n providing care to these i n d i v i d u a l s , i t 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 analys is of data from the o r i g i n a l nursing schools contacted. Phase II included c o l l e c t i o n of data from a f f i l i a t i n g schools and analysis of the combined data. Population One hundred forty u n i v e r s i t y and diploma schools of nursing i n Canada having a graduating class i n 1969 were included i n the study. Conduct of the Study Since i t was not known which schools met the c r i t e r i a for i n c l u s i o n i n the study, the names and addresses of a l l Canadian schools of nursing i n existence i n 1968 were obtained from p r o v i n c i a l reg i s tered nurses' as soc ia t ions . Questionnaires were mailed to 191 schools , asking the respondents to complete the questionnaire i f they had a graduating class i n 1969. Questionnaires were l a t e r sent to a f f i l i a t i n g schools . Questionnaire A questionnaire was constructed and a French t r a n s l a t i o n was provided. Pretest ing of the questionnaire was done at the Univer s i ty of B r i t i s h Columbia and i n a l o c a l h o s p i t a l . SUMMARY The problem concerned preparat ion students are rece iv ing i n Canadian nursing schools to equip them for working with mentally retarded i n d i v i d u a l s . The need for the study has been shown by o u t l i n i n g the extent of the problem of re tardat ion i n Canada and B r i t i s h Columbia. Other developments i n the f i e l d of nursing education i n th i s area have been shown by a review of the l i t e r a t u r e . The proposed method of conducting the study was stated and the objectives l i s t e d . Conduct of the study w i l l be considered i n Chapter 2. Chapter 2 CONDUCT OP THE STUDY This study presents an assessment of the number of hours of preparation nurses were given to work with the mentally retarded and the placement of t h i s experience i n the curr iculum. The information needed was l a rge ly numerical so a questionnaire was selected as the t o o l to be used for c o l l e c t i o n of the data (see Appendix A, page 6 7 ) . Development of the questionnaire and the method used i n the c o l l e c t i o n of data w i l l be discussed i n t h i s chapter. THE RESEARCH DESIGN This i s a descr ip t ive study comparing the curriculum of se lected schools of nursing i n Canada i n r e l a t i o n to the number of hours of theory and c l i n i c a l experience nursing students receive i n preparation for work with the mentally retarded. Placement of the t r a i n i n g i n the curriculum was a lso measured. Data was co l l ec ted from an o r i g i n a l uncontrol led source, the nursing schools providing the nursing education. 19 b 20 Nursing schools having a graduating class i n 1969 were selected as the sample to be studied out of a l l Canadian nursing schools i n operation that year. A t o o l was constructed for quant i ta t ive measurement of the data. Comparison of data was expected to indica te whether or not the length of the school program or the geographical loca t ion of the school inf luenced the data. The Sample Questionnaires and l e t t e r s (see Appendix B, page 70) expla ining the study were mailed to 191 schools i n Canada. Second and t h i r d l e t t e r s (see Appendix C, page 72) were sent when necessary to ensure return of the quest ionnaire . A t o t a l of 95 percent of the schools r e p l i e d . Of the 180 questionnaires returned, 38 were not e l i g i b l e for i n c l u s i o n i n the study due to f a i l u r e to meet the c r i t e r i o n "having a graduating class i n 1969". One school that had a combined p s y c h i a t r i c and diploma nursing program was not included because of d i f f i c u l t y i n p lac ing i t i n one of the four school groupings by length of program. One school sent a reply i n too late to be included i n the study since data was already being analysed. One hundred forty nursing schools i n Canada were f i n a l l y se lected for i n c l u s i o n i n the study since they had met the c r i t e r i o n , "having a graduating class i n 1969," and they had returned completed quest ionnaires . Of these schools 16 were un iver s i ty schools , 108 were three year diploma schools , 6 were two and one-half year diploma 21 schools , and 10 were two year diploma schools (see Table 1). Each province had some nursing schools included i n the study. Table 1 Nursing Schools Included 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 Univers i ty Nursing Schools 16 Three Year Diploma Nursing Schools 108 Two and One-half Year Diploma Nursing Schools 6 Two Year Diploma Nursing Schools 10 T o t a l Nursing Schools 140 The Questionnaire The t o o l used i n the study, a quest ionnaire , was selected i n the hope that a care fu l ly devised l i s t of questions would provide f a i r l y extensive and reasonably accurate information requi r ing a minimum of e f fort on the part of the respondents. It was f e l t the information could be c o l l e c t e d quickly from a large number of nursing schools with minimal expense. Information required to complete the study included ( l ) course placement, (2) hours of theory, c l i n i c a l experience and observation, and (3) year(s) of t r a i n i n g i n 22 which mental re tardat ion experience occurred. The questionnaire was constructed to provide t h i s information. Problems and l i m i t a t i o n s of the quest ionnaire . Problems encountered i n completing the questionnaire were many. The respondents had d i f f i c u l t y i n determining that mental re tardat ion theory, c l i n i c a l experience and obser-vat ion occurred i n a s p e c i f i c course, i n s ta t ing the exact time a l l o t t e d to t h i s experience, and i n g iv ing the exact year the experience occurred. In many cases the experience was unplanned and took place i n c i d e n t a l l y or as opportunity presented and might not apply to a l l students. In many rep l i e s i t was noted that the time was an approximation or average and i t could vary widely. T y p i c a l comments were " d i f f i c u l t (or impossible) to answer," "only some of the students have th i s experience, " or "none given (at th i s t ime) " . Some schools organized t h e i r programs around a core curriculum or they integrated the subject matter in to the t o t a l curr iculum. They were unable to i so l a te s p e c i f i c courses. One correspondent suggested that i t i s the kind of experience and the guidance given at the time the student i s undergoing the experience that i s important, rather than the number of hours provided for mental re tardat ion i n s t r u c t i o n . It i s i n t e r e s t i n g to note that i n some integrated programs they were unable to specify i n which courses the content was g iven. 23 The format of the questionnaire presented de f in i te l i m i t a t i o n s . Some l i m i t a t i o n s are l i s t e d . 1. The information requested was scanty and d id not provide enough data to accurately determine the mental re tardat ion content of the curr iculum. 2. There was l imi ted awareness on the part of the author of patterns of change i n nursing education i n Canada. Many schools had integrated t h e i r programs. Some courses l i s t e d on the questionnaire were no longer taught as s p e c i f i c subjects but were now part of a core curriculum. Not a l l schools had d i f f i c u l t y completing the quest ionnaire . A few schools , however, were unable to complete the questionnaire as designed. These schools were categorized under not recorded. The Pretest Questionnaires were pretested i n two l o c a l areas. This test took the form of a survey and c r i t i q u e of the quest ionnaire . F i f teen graduate nursing students enro l led i n the degree program, School of Nursing, Univers i ty of B r i t i s h Columbia, Vancouver, B . C . , assessed the quest ionnaire . Approximately ten reg i s tered nurses at a l o c a l h o s p i t a l a lso assessed the t o o l . Nurses were asked to comment on the c l a r i t y of the t o o l , any d i f f i c u l t i e s they might ant ic ipa te i n completing the quest ionnaire , and they were asked for suggestions to improve the t o o l . A l l questionnaires were returned. No changes were required i n the questionnaire as a r e su l t of the pre tes t . DATA COLLECTION, PHASE I 24 Questionnaires were mailed to a l l Canadian nursing schools having a graduating class i n 1969 whose graduating students were e l i g i b l e to write qua l i fy ing examinations for nurse r e g i s t r a t i o n i n t h e i r province. The questionnaires were completed by one or more members of the nursing f a c u l t y , teaching s t a f f or administrat ive s t a f f . 1 A French t r a n s l a t i o n was done for a l l mater i a l to be submitted to 2 nursing schools s i tuated i n French speaking areas. (For questionnaire see Appendix D, page 74, for l e t t e r see Appendix E , page 77, for follow-up l e t t e r see Appendix F , page 79)• An introductory l e t t e r from the D i r e c t o r , School of Nursing, Univer s i ty of B r i t i s h Columbia (see Appendix G, page 8 l ) , was mailed with the quest ionnaire . An explanatory l e t t e r o u t l i n i n g the general purpose of the study was also included (see Appendix B, page 70 ) . 1 Those completing questionnaires included Directors of Nursing, Ass i s tant or Associate Directors of Nursing, Directors of Nursing Educat ion, Lecturers , Professors i n the U n i v e r s i t y ' s Nursing Department and Administrat ive s ta f f . 2 French t r a n s l a t i o n was done by Miss Mar ie -Cla i re Delahaye, student, School of Nursing, Univers i ty of B r i t i s h Columbia, Vancouver, B . C . , 1969-70. Miss Delahaye was a graduate nurse from France. DATA COLLECTION, PHASE I I When the a v a i l a b l e data had been assembled, t a b u l a t e d and analysed, there was found to be i n s u f f i c i e n t 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 . Many schools i n d i c a t e d that t h e i r students a f f i l i a t e d f o r one or more courses such as o b s t e t r i c s , p e d i a t r i c s , and p s y c h i a t r y and data regarding the hours of experience provided students on a f f i l i a t i o n had seldom been a v a i l a b l e f o r i n c l u s i o n on the q u e s t i o n n a i r e . Enquiry showed that 68 nursing schools, most of them three year diploma schools i n Eastern Canada, u t i l i z e d a f f i l i a t e schools. A few schools were able t o provide the data f o r these a f f i l i a t i o n s but some schools i n d i c a t e d that t h i s i n f o r m a t i o n could 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 -garding the hours of theory and c l i n i c a l experience given students i n a f f i l i a t i n g schools. I t became obvious that f u r t h e r data was needed which could only be obtained from the a f f i l i a t e schools. A c c o r d i n g l y , a second phase of data c o l l e c t i o n was 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 of 35 a f f i l i a t e schools that provided o b s t e t r i c , p e d i a t r i c and p s y c h i a t r i c experience t o students from nursing schools i n c l u d e d i n the study. The same q u e s t i o n n a i r e , together w i t h a l e t t e r of explanation (see Appendix H, page 83) was sent t o the 35 a f f i l i a t e schools. These schools 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 students only. Completed questionnaires were returned from 33 schools , two schools d id not r e p l y . A copy of the completed questionnaire received from the a f f i l i a t e school was then sent to the home school asking for substant iat ion of the new data. Permission was requested to incorporate the new data in to that on the o r i g i n a l questionnaire (see Appendix I , page 85 for l e t t e r ) . As a r e s u l t , 65 percent of the schools granted permission to use the new data and approved the r e s u l t i n g changes i n data. The data had already been included by 21 percent of the schools and 14 percent of the schools d id not r e p l y . Tabulat ion and analys i s was again done. D i f f i -c u l t i e s were encountered due to the time lag between Phase I and Phase II of the study, which amounted to approximately one year and eight months. A number of three year diploma school programs had been phased out i n the i n t e r v a l and no further information could be obtained from these schools . The curriculum had been changed i n some schools , subject matter had been integrated and was being presented through a core curriculum rather than as s p e c i f i c courses. The assembled data was tabulated, analysed and interpreted i n r e l a t i o n to the i n c l u s i o n of mental re ta r -dation i n the curriculum of Canadian schools of nurs ing. Spec i f i c areas analysed were placement of th i s experience and hours a l l o t t e d to the experience i n the school curr iculum. SUMMARY 27 Phase I and Phase II of the study have been d i s -cussed i n th i s chapter. There has also been discuss ion of the t o o l used for 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 data for conduct of the study have also been reviewed. Chapter 3 ANALYSIS OF THE DATA Analys is of the data included a review of the data for mental re tardat ion placement i n the curr iculum, hours of t h e o r y 1 and c l i n i c a l experience, and placement by year of t r a i n i n g i n which the experience was g iven. 'A; comparison of the data was done for four d i f ferent types of nursing education programs involved 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 stated the data discussed i n -cludes a l l data obtained from both Phase I and Phase II of the study. A l l tables contained data from both Phase I and Phase II of the study except Table 12 (page 51 ) which contains Phase I data for Three Year Diploma Schools. Table 5 (page 39) contains Phase I and II data for these schools . 1 Although the word " i n s t r u c t i o n " was used on the questionnaire "theory" w i l l be used i n place of i n s t r u c t i o n throughout Chapter 3 since i t seems to more adequately express the data. 28 29 D i s t r i b u t i o n of Nursing Schools' by Length' of Program Of the l40 nursing schools included i n the study, 16 were u n i v e r s i t y degree schools . F i f t een of these schools had four year programs, and one school had a f ive year program. For purposes of s i m p l i f i c a t i o n , data from the f ive year un iver s i ty school was included with that of the four year schools . Where t h i s made any s i g n i f i c a n t change i n data, an explanation was g iven. D i s t r i b u t i o n of Nursing Schools' by Community' Sett ing Diploma schools u t i l i z e d three d i f ferent community sett ings for t h e i r programs, h o s p i t a l schools , t e c h n i c a l i n s t i t u t e s and reg iona l or. community co l leges . Included i n the study were 108 three year diploma schools , 100 9f these were h o s p i t a l schools and 8 were reg iona l or community, col lege schools (7-Queb.ec schools were i n the 2 C . E . G . E . P . program. The number, of these schools that were h o s p i t a l , t e c h n i c a l or col lege schools i s not known). The two and one-half year programs, 6 i n number, were a l l h o s p i t a l schools . 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 used reg iona l or community, co l leges , and 2 did not specify the community s e t t i n g . 2 Colleges d'Enseignement General et Pro fe s s ione l , Quebe c. PLACEMENT IN THE CURRICULUM 30 Placement of mental re tardat ion theory and c l i n i c a l experience i n the curriculum was expected to occur most frequently i n courses such as o b s t e t r i c s , p e d i a t r i c s , psychiatry and pub l i c hea l th . A category "other" was included on the questionnaire for placement of courses not l i s t e d . The f i r s t sect ion of the questionnaire requested the fol lowing data "For your 1969 graduating class please indicate the course(s) that include mental re tardat ion i n s t r u c t i o n " . The fourth and seventh sections on the questionnaire requested s i m i l a r information for c l i n i c a l experience and observation respect ive ly (see Appendix A, page 6 7 ) . Courses were l i s t e d for tabulat ing purposes based on apparent trends i n placement of mental re tardat ion theory and c l i n i c a l experience i n the curriculum. The s ingle courses most frequently u t i l i z e d were l i s t e d . Combinations of courses u t i l i z e d for th i s experience were also o u t l i n e d . A category "other" was included to acco-modate courses not l i s t e d on the questionnaire such as b io logy , biochemistry, endocrinology, and psychology, e tc . Table 2 shows the d i s t r i b u t i o n of nursing schools for placement of mental re tardat ion theory and c l i n i c a l experience i n the curr iculum. Table 2 Distribution of Schools of Nursing in Canada8, 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 University Three Year Diplcr-.n Tvo & One-half ; Two Year Diploma Schools Schools Y e a r Diploma Schools Schools Number of Schools Single Courses V o a • r i r-i m +> • • r H • CL> cC ro CJ • r i p> >> cj • r i f . r H • r i o <i> S CO O c G> • r i ft • P •H r H y: ,0 0 r H t-* O W o £-. E- o 10 O cC o O - r i .-0 o • r i ft f l A CJ ^ • r i ft C 3 Lid O TotSJL Pediatrics Psychiatry-Ob ste trie s Public Health Grouped Courses Pediatrics & Psychiatry Pediatrics, Psychiatry and Obstetrics Pediatrics, Psychiatry, Obstetrics, Public Health Pediatrics and other combinations Other0 1 2 3 6 9 27 42 1 1 1 1 4 6 52 - — 1 . 1 11 21 46 — 1 1 2 1 2 1 4 53 - _ - _ 2 - 1 3 3 2 1 4 7 3 3 10 — 2 1 3 18 26 8 52 _ - 2 2 ' — _ 1 1 58 1 - 1 2 17 17 2 36 2 - - 2 - 2 - 2 42 2 1 - 3 3 -,i 3 1 - - 1 - - - - 7 8 6 3 17 41 11 5 57 2 1 3 6 1 7 84 3 5 4 12 10 31 41 82 1 4 2 7 2 5 3 10 111 Total Schools 16 16 16 108 108 108 6 6 10 10 10 a 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 Referr ing to Table 2, four general areas appear to be the areas i n which most of the theory and c l i n i c a l experience occurred. When the experience was given i n one course only , psychiatry was mentioned by most schools ( 5 3 schools ) , whereas ped i a t r i c s was l i s t e d by 52 schools . Obstetr ics and pub l i c heal th were a lso u t i l i z e d as s ingle courses. Referr ing to Table 2 again, i t can be seen that almost a l l nursing schools presented mental retardat ion 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 ingly or i n combination with other courses. The small number of two year and two and one-half year diploma schools included 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 for these schools . Ped ia t r i c s was the course u t i l i z e d most frequently i n combination with other courses for th i s experience. Publ ic Health was used more frequently as a s ingle course i n the un iver s i ty programs than i n three year diploma programs. Publ ic Health apparently received l i t t l e at ten-t i o n i n two and two and one-half year diploma schools of nursing for mental re tardat ion experience. The large number of three year diploma schools u t i l i z i n g combinations of p e d i a t r i c s , obs te tr ics and psychiatry may have been due i n part to the a f f i l i a t i o n program, since these are common areas for a f f i l i a t i o n . Genetics was l i s t e d by schools 33 times i n combi-nation with other courses for mental re tardat ion placement. Table 3 Percentage of Nursing Schools in Canada* that Provide Mental Retardation Theory, Clinical Experience and Observation in Single Courses or in Combined Courses Theory Clinical Experience Observation Single Combined Course Courses Single Course Combined Courses Single Course Combined Courses School Percent of Schools Percent of Schools Percent of Schools University Schools 12 88 12 88 44 56 Three Year Diploma Schools 18 82 21 79 48 52 Two and One-half Year Diploma Schools 100 17 83 33 67 Two Year Diploma Schools 20 80 30 70 50 50 * Schools having a graduating class in 1969 Pedia t r i c s was included i n 32 of these combinations. B io -chemistry was l i s t e d i n combination with other courses by eight schools . To summarize, mental re tardat ion theory, c l i n i c a l experience and observation were presented most frequently i n combinations of two or more courses. Ped ia t r i c s seemed to be the course most frequently used i n these combinations In contras t , pub l i c heal th seemed to be an area where there was minimal i n c l u s i o n of mental re tardat ion experience. HOURS OP THEORY, CLINICAL EXPERIENCE AND OBSERVATION It was expected that hours a l l o t t e d to mental re tardat ion theory, c l i n i c a l experience and observation would ind ica te the extent of t h i s experience i n the curr iculum. As mentioned e a r l i e r , many respondents found i t d i f f i c u l t to s p e c i f i c a l l y i s o l a t e hours of mental re-tardat ion theory and c l i n i c a l experience from other experience. For tabulat ing purposes hour categories were set up i n increments of flour hours from 0 through 20, i . e . 0 to 3.99 hours, 4.00 to 7.99 hours, e t c . (see Table 4) . Res-pondents were asked to show the time i n minutes and hours i n the various categories on the questionnaire (see Appendi A, page 6 7 ) . The purpose was to allow space for entering hours of theory and c l i n i c a l experience as w e l l as a d d i t i o n a l minutes of time given to the subject . Occasional ly the request, as s ta ted , was mis interpreted and minutes were taken to mean hours, restated as minutes, i . e . 1 hour would be entered a lso as 60 minutes. It was obvious where t h i s had occurred and the data was taken to mean the stated number of hours. In some cases the ent i re per iod provided for student t r a i n i n g i n an area was given as when the ent i re per iod for p s y c h i a t r i c experience was g iven. When hours of theory or c l i n i c a l experience exceeded 50 hours, l e t t e r s were sent to the school seeking c l a r i f i c a t i o n of the time allotment (six schools exceeded 50 hours) . The s e l ec t ion of 50 hours as the time per iod assigned to theory and c l i n i c a l experience, beyond which c l a r i f i c a t i o n was requested from nursing schools , was based on the Univer s i ty of B r i t i s h Columbia, School of Nursing allotment of hours for mental re tardat ion experience. This un iver s i ty had a f ive year project underway i n which the school was in tegra t ing mental re tardat ion content in to the nursing school c u r r i c u l a . This was a j o i n t e f fort between the B r i t i s h Columbia Mental Retardation Ins t i tu te and the School of Nursing. The approximately 50 hours a l l o t t e d to mental re tardat ion theory and c l i n i c a l experience i n t h i s school was used as a guidel ine and c l a r i f i c a t i o n was requested from schools i f the time a l l o t t e d to mental re tardat ion experience exceeded 50 hours i n any area. Letters were sent to the s ix schools who had 36 exceeded 50 hours of experience i n any area asking for c l a r i f i c a t i o n of the time al lotment. Replies were received from f ive of the schools . In most cases, the hours stated were for the ent i re per iod of p s y c h i a t r i c , obs te t r i c or p e d i a t r i c a f f i l i a t i o n , and the breakdown for mental re tardat ion experience was not a v a i l a b l e . These cases were t a l l i e d as "not recorded" for hours but the course u t i l i z e d for the experience was entered as g iven. At other times, the experience took place within an i n s t i t u t i o n caring for mental retardates and p s y c h i a t r i c pa t ient s , and the large number of hours designated as p s y c h i a t r i c theory or c l i n i c a l experience with mentally retarded pat ients was confirmed. The problem of i s o l a t i n g s p e c i f i c periods of time for mental re tardat ion experience e l i c i t e d such responses as "an approximation or average, var ied widely , var ied with ava i lab le opportuni t ies " and " d i f f i c u l t (or impossible) to answer". These items were t a l l i e d as OP (as opportunity presents ) , ID ( i n c i d e n t a l ) , NG (none g iven) , or NR (not recorded) , categor iz ing them as accurately as pos s ib le . 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 discussed i n the fol lowing sec t ion . This was thought to be an area that would indicate the extent of mental retardat ion experience i n the curr iculum. Univers i ty schools tended to include theory and c l i n i c a l experience i n mental re tardat ion throughout the hour categories 0 to 20 hours (94 percent of school s ) . Few schools were l i s t e d as "not recorded" i n 37 Table 4 D i s t r i b u t i o n of Univer s i ty Schools of Nursing i n Canada3" by Hours A l l o t t e d to Mental Retardation Theory, C l i n i c a l Experience and Observation Theory C l i n i c a l Observation Experience Hours Percentage of Schools 0 - 3 12.50 6.25 12.50 4 - 7 25.00 12.50 56.25 8 - 1 1 18.75 18.75 6.25 12 - 15 18.75 6.25 16 - 19 6.25 6.25 20 - 12.50 12.50 0P b- 6.25 6.25 IDC- _ -N G d - - 6.25 NR e - 6.25 25.00 18.75 T o t a l Schools 100.00 100.00 100.00 a Schools having a graduating class i n 1969 OP (as opportunity presents) C ID ( inc identa l ) d NG (none given) eNR (not recorded) 38 u n i v e r s i t y schools (6 percent) . Referr ing to Table 4 i t can be seen that 13 percent of un iver s i ty schools provided theory and c l i n i c a l experience i n the 20 hour category. Observation occurred most frequently within the 2 to 6 hour per iod (70 percent) . Three year diploma schools u t i l i z e d most of the hour categories 0 to 20 for student experience i n the three areas. Referr ing to Table 5, i t can be seen that only 7 percent of three year diploma schools u t i l i z e d NR, NG, ID, or OP categories for theory, whereas 55 percent were l i s t e d i n these categories for c l i n i c a l experience and 30 percent for observation. In discuss ing the schools j o i n t l y 27 percent entered "as opportunity presents" for c l i n i c a l experience. The reason for th i s could have been that i n many schools the opportunity to work with and observe the mentally retarded occurs only i n c i d e n t a l l y when one of these pat ients happens to be admitted. "Not recorded" was high i n a l l three areas but p a r t i c u l a r l y high i n c l i n i c a l experience (17 percent) and observation (15 percent) , for most of the schools . It i s in te re s t ing to note the number of schools l i s t e d i n the 20 hour category for the three areas of experience. Two and one-half and two year diploma schools appeared to have a narrower d i s t r i b u t i o n of hours (0 to 8 hours) but the l imi ted number of these schools i n the study poss ib ly accounted for t h i s f ac tor . Only three d i f fe rent hour groupings were used for theory i n two and one-half 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 to Mental Retardation Theory, C l i n i c a l Experience and Observation Theory C l i n i c a l Observation Experience Hours Percentage of Schools 0 - 3 28.71 7 . 4 l 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 - 19 7.40 1.85 0.93 20 - 4.63 19.44 3.70 0 P b - - 26.85 9.26 I D C - - 8.33 1.85 N G d - 0.93 2.78 2.78 NR e - 6.48 16.67 14.81 T o t a l Schools 100.00 100.00 100.00 a Schools having a graduating class i n 1969 ^OP (as opportunity presents) C ID ( inc identa l ) NG (none given) eNR (not recorded) 40 year schools (see Table 6) , 50 percent u t i l i z e d a 2 hour grouping, 33 percent used a 6 houre;group, and 17 percent u t i l i z e d the 8 hour grouping for a l l areas. C l i n i c a l experience was given by 50 percent of the two year schools under "as opportunity presents" . Another 30 percent of these schools l i s t e d c l i n i c a l experience under "not r e -corded" . Two year schools u t i l i z e d the 0 to 8 hour categories a l so , for theory, c l i n i c a l experience and observation (see Table 7) . In the area of theory, 20 percent of these schools l i s t e d "not recorded" , under c l i n i c a l experience 30 percent entered "none g i v e n " , and for observation 30 percent l i s t e d "as opportunity presents" and 10 percent "not recorded" . Generally there were fewer entr ies under "as opportunity presents" , " i n c i d e n t a l " , "none g iven" and "not recorded" for a l l schools i n the area of theory than i n the areas of observation and c l i n i c a l experience. "As opportunity presents" and "not recorded" were l i s t e d frequently for c l i n i c a l experience and observation. On reviewing the trend for a l l schools , theory was given most frequently i n the hour categories of 2 hours, 4 hours, 6 hours and 8 hours, i n that order. C l i n i c a l experience was entered by most schools i n the "not recorded" category, followed by "as opportunity presents" , 20 hours , "none g iven" and 8 or 6 hour categories success ive ly . The sequence of hours for observation was 2 hours, 4 hours, "none recorded" and 6 hours. 41 Table 6 D i s t r i b u t i o n of Two and One-half Year Diploma Schools of Nursing i n Canada3- by Hours A l l o t t e d to Mental Retardation Theory, C l i n i c a l Experience and Observation Theory C l i n i c a l Observation Experience Hours Percentage of Schools 0 - 3 50.00 50.00 4 - 7 33.33 16.67 8 - 11 - 16.67 12 - 15 - _ _ 16 - 19 16.67 -20 - - - -0P b - - -I D C - - - -N G d - - -NR e - 100.00 16.66 T o t a l Schools 100.00 100.00 100.00 a Schools having a graduating, class i n 1969 OP (as opportunity presents) C ID ( inc identa l ) dNG (none given) eNR (not recorded) 42 Table 7 D i s t r i b u t i o n of Two Year Diploma Schools of Nursing i n Canada3 , by Hours A l l o t t e d to Mental Retardation Theory, C l i n i c a l Experience and Observation Theory C l i n i c a l Observation Experience Hours Percentage of 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 - - - -0P b - - 50.00 30.00 I D C - - - -N G d - - - -NR e - 20.00 30.00 10.00 T o t a l Schools 100.00 100.00 100.00 a Schools having a graduating class i n 1969 b 0P (as opportunity presents) C ID ( inc identa l ) dNG (none given) eNR (not recorded) 43 In summary, the 2 to 8 hour categories were used by the greatest number of schools i n providing experience i n mental re tardat ion for students. The 20 hour category was used frequently for c l i n i c a l experience, as were the categories of "as opportunity presents" and "not recorded" . 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. Referring to Table 1 (page 21) i t can be seen that programs for nursing schools included i n the study var ied considerably i n length. Of the 16 un iver s i ty schools s tudied , 15 had four year programs. One school with a f ive year program was included with the four year group. Three year diploma schools studied numbered 108 and 101 of these were h o s p i t a l schools and 7 schools were organized under the C . E . G . E . P . 3 program. A l l 6 two and one-half year diploma' schools were h o s p i t a l schools . Of the 10 two year diploma schools , 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 , 4 u t i l i z e d reg iona l or community co l leges , 1 program was h o s p i t a l based and 2 schools did not record t h i s information. Respondents were asked to show the year of the program i n which mental re tardat ion experience was given for 3 Colleges d'Enseignement General et Quebec. Pro fe s s ione 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 Univ. b 3 I r . ° 2£Yr.d 2 Yr. e UnivJ 3 3 l r . c 2iYr . d 2 Yr. e Univ,^ 3 I r . ° 2 i Yr. d 2 Yr. e 1 1 mm *1 2 1 1 2 1 43 4 5 1 35 1 4 2 43 2 6 3 1 5 — — 2 6 - 4 11 1 4 2 _ — 1 _ 3 _ 2 and « or 3 3 25 1 1 26 1 20 1 Not recorded 1 8 mm 6 37 5 5 5 28 1 1 Other f combinations 8 26 1 5 5 4 - 1 4 «• 2 Total Schools 16 108 6 10 16 108 6 10 16 108 6 10 Schools having a graduating class in 1969 University Schools, Three Year Diploma Schools, 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 45 each course l i s t e d on the quest ionnaire . There may have been some v a r i a t i o n i n data due to dif ferences i n the length of the nursing education programs. Theory and c l i n i c a l experience could be given i n any one of the 4 years i n the un iver s i ty school , whereas they could only be given i n the f i r s t or second year of two year diploma schools . In a d d i t i o n , some schools offered experience i n more than one year, eg. one un iver s i ty school gave mental re tardat ion experience i n the t h i r d and fourth years of t h e i r program. Categories were set up to acconroo'dafeethese var ia t ions i n program schedules, as noted i n Table 8 . Two year and two and one-half year schools tended to present the greater part of mental re tardat ion experience i n the second year of t r a i n i n g . C l i n i c a l experience was minimal i n two and one-half year schools . 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 recorded". Although nearly a l l three year diploma schools offered theory, c l i n i c a l experience and observation i n a l l three years of t r a i n i n g , most of i t occurred i n the second year. 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 schools , a factor which may have had a d i rec t bearing on the large number of schools l i s t e d i n th i s category. Many schools noted that the experience could take place i n e i ther the second or t h i r d year of the program, or i t could occur i n two d i f fe rent years eg. f i r s t and second or second and t h i r d . 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 schools gave t h i s experience i n more than one year ( t h i r d and fourth years ) . As with other data, the "not recorded" category was mentioned frequently i n one or more areas for a l l types of schools . In most schools , mental re tardat ion experience was given i n the next to the l a s t year of nursing education. DATA COMPARISON FOR EASTERN AND WESTERN NURSING SCHOOLS It seemed poss ib le that the loca t ion of nursing schools included i n the study might have an effect on data. According ly , schools were separated by loca t ion in to eastern and western schools and the data was analysed i n r e l a t i o n to d i s t r i b u t i o n of hours a l l o t t e d to mental re-tarda t ion experience. Tables 9, 10 and 11 provide a comparison of data by loca t ion of schools . The eastern area had no two and one-half year diploma schools . D i s t r i b u t i o n for grouped hours tended to be f a i r l y equal i n eastern and western schools otherwise. It can be concluded that geographical l oca t ion of nursing schools has l i t t l e ef fect on mental re tardat ion experience provided students. 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 Three Year Two and One-half Year Two Year Diploma Schools Diploma Schools Diploma Schools Grouped Hours b Eastern Western0 Eastern*3 Western0 Eastern Western0 Eastern3 Western0 0 - 8 53.85 33.33 69.66 84.21 83.33 83.33 75.00 10 - 20 38.46 33.33 23.60 5.26 — 16.67 - -Other" 7.69 33.34 6.74 10.53 - - 16.67 25.00 Total 100.00 100.00 100.00 100.00 100.00 100.00 100.00 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 in 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 Grouped Hours University Schools b c Eastern Western Three Year Diploma Schools b c Eastern Western Two and One-half Year Diploma Schools b c Eastern Western Two Year Diploma Schools b 0 Eastern Western 0 . 8 10 - 20 0therd 38.46 30.77 30.77 33.34 66.66 14.61 32.58 52.81 10.53 26.31 63.16 - 100,00 - 50.00 » — 100.90 50.00 Total 100.00 100.00 100.00 100.00 - 100.00 100.00 100.00 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 d0ther 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 Grouped Hours University Schools b c Eastern Western Three Year Diploma Schools Eastern13 Western0 Two and One-half Year Diploma Schools b o Eastern" Western Two Year Diploma Schools Eastern*5 Western0 0 - 8 10 - 20 Other" 61.54 7.69 30.77 100.00 61.80 10.11 28.09 63.16 5.26 31.58 - 83.33 16.67 50.00 75.00 50.00 25.00 Total 100.00 100.00 100.00 100.00 100.00 100.00 100.00 aSchools 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 ef fect of incorporat ing data received from a f f i l i a t i n g schools i n t o the data obtained on the o r i g i n a l questionnaire was p a r t i c u l a r l y noticeable for eastern schools and for three year diploma schools of nurs ing . Of the 51* three year diploma schools u t i l i z i n g a f f i l i a t i o n s , 14 were s i tuated i n Ontar io , 14 i n Quebec, 3 i n Prince Edward Is land and 3 i n Newfoundland, Nova Scot ia provided 10 a f f i l i a t i o n s and both New Brunswick and Alberta had 4 a f f i l i a t i o n s . Only 1 two and one-half year school a f f i l i a t e d and data from t h i s school d id not a l t e r that received from the home school . Univer s i ty and two year diploma schools had no a f f i l i a t i o n s , nor d id the provinces of B r i t i s h Columbia and Saskatchewan, as far as could be determined i n t h i s study. Integrat ing data from a f f i l i a t i n g schools a l tered some of the o r i g i n a l data for 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 recorded" category were e l iminated from that category and placed i n s p e c i f i c hour categories . A considerable change was noted i n theory since many of the hour groupings were increased, eg. the t a l l y for 2 hours increased from 21 percent to 26 percent for three year diploma schools . At times an hour grouping became less when data had to be t rans ferred to a more su i table hour category, eg. 0 hours decreased from 7 percent to 3 percent (see Tables 12 and 13). 51 Table 12 D i s t r i b u t i o n of Three Year Diploma Schools of nursing i n Canada 3 by Hours A l l o t t e d to Mental Retardation Theory, C l i n i c a l Experience and Observation (Phase I Data Only) Theory C l i n i c a l Observation Experience Hours Percentage of 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 - 19 5.55 1.85 0.93 20 - - 16.67 3.70 O P b - - 27.78 9.26 I D C - - 7 . 4 l I.85 N G d - - 3.70 2.78 NR e - - 33.32 32. 40 T o t a l Schools 100.00 100.00 100.00 a Schools having a graduating class i n 1969 b 0P ( as opportunity presents) C ID ( inc identa l ) NG (none' given) eNR (not recorded) 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 in Data When Affil iation Data i s Included Theory Clinical Experience Obserration Percentage of Schools Hours Phase I Phase I & II Phase I Phase I & II Phase I Phase I & II 0- 7.41 2.78 1.85 2.78 5.55 12.96 2~ 20.37 25.93 2.77 4.63 18.52 25.93 4- 14.82 20.37 0.93 0.93 8.33 9.26 6- 13.89 15.74 0.93 3.70 5.55 5.56 8- 5.55 7.41 0.93 1.85 7.41 8.33 10- 4.63 4.63 - 7.41 1.85 2.78 12- 2.78 1.85 0.93 0.93 0.93 _ 14- 1.85 1.85 0.93 1.85 0.93 1.85 16- 3.70 3.70 1.85 1.85 — — 13- 1.85 3.70 — — 0.93 0.93 20- 4.63 4.63 16.66 19.44 3.70 3.70 0P- — — — 26.85 - 9.26 ID- — — mm 8.33 — 1.85 NG- — 0.93 — 2.78 2.78 NR- 18.52 6.48 72.22 16.67 46.30 U.81 Total 100.00 100.00 100.00 100.00 100.00 100.00 Schools having a graduating class in 1969 Categories such as "as opportunity present" , " i n c i d e n t a l " , "none g i v e n " , and "not recorded" remained high for c l i n i c a l experience and observation, since many schools found i t d i f f i c u l t to i s o l a t e hours of mental re tardat ion theory and experience from the broader program. Incorporating data from a f f i l i a t i n g schools a l tered data from three year diploma schools i n eastern Canada p a r t i c u l a r l y . The category i n which the greatest change occurred was "not recorded" s ince many schools l i s t e d i n t h i s category were transferred to s p e c i f i c hour categories . Table 13 i l l u s t r a t e s the effect of incorporat ing th i s data. SUMMARY Chapter 3 has provided an analysis of data i n r e l a t i o n to placement of mental re tardat ion nursing edu-cat ion i n the curriculum of nursing schools i n Canada, having a graduating class i n 1969. Hours and year of experience have also been discussed. Location of the nursing school apparently had l i t t l e effect on nursing programs s tudied . Incorporating data from a f f i l i a t i n g schools a l tered the data for three year diploma schools i n the study to a considerable extent. Discuss ion of t o t a l s for a l l types of schools re-veals that theory invo lv ing from 2 to 8 hours appeared to be the most frequently used time per iod for mental re tardat ion nursing education. "Not recorded" was l i s t e d frequently i n a l l areas of experience while "as opportunity 54 presents" had a high count for c l i n i c a l experience and observation. The time, category 20 hours occurred frequently i n c l i n i c a l experience and observation which may have been due, i n par t , to opportunity for extensive contact with mental retardates during a f f i l i a t i o n . Chapter 4 SUMMARY, CONCLUSIONS, RECOMMENDATIONS FOR FURTHER STUDY Health care i n Canada has advanced to the stage where at tent ion can be focussed on the underpr iv i leged and i n d i v i d u a l s with s p e c i a l problems i n our soc ie ty . The mentally retarded are one such group. The nursing pro-fess ion t r a d i t i o n a l l y concerns i t s e l f with the heal th problems wherever they may occur. Nursing of the mentally retarded i s one such area rece iv ing a t tent ion from nurse educators. While working with mentally retarded pat ients i n a large 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 qua l i ty of nursing care provided these pat ients became apparent. It was thought that a study attempting to determine the preparation nurses receive during t h e i r nursing education to work with these i n d i v i d u a l s might be per t inent . Accordingly a descr ip t ive study was undertaken r e l a t i n g to the c u r r i c u l a of nursing schools i n Canada and to the i n c l u s i o n of mental re tardat ion theory and c l i n i c a l experience i n nursing education. 55 URGENCY AND RECOGNITION OF THE PROBLEM 56 In 1969 the urgency of the mental re tardat ion problem i n Canada was such that approximately three percent of the population^ were d i r e c t l y af fected. B r i t i s h Columbia had 7,789 mentally retarded i n d i v i d u a l s l i s t e d with the Registry for Handicapped Chi ldren and Adults and 2,062 of them were i n i n s t i t u t i o n s for the 2 retarded. The P r o v i n c i a l Department of Education provided f a c i l i t i e s for 4,683 retardatds i n s p e c i a l c lasses . The B r i t i s h Columbia Retardation Associa t ion provided f a c i l i t i e s for a further 476 of these c h i l d r e n . An u n i d e n t i f i e d number of mi ld ly retarded ch i ldren were integrated i n t o the pub l i c school 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 Health Services and H o s p i t a l Insurance, Registry for Handicapped Chi ldren and Adul 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 Education, 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 Recognition of the extent of the problem was shown when two major conferences were held within the past decade to study the problem. A F e d e r a l - P r o v i n c i a l Conference was held i n 1964,^ and i n 1970 there was a Commission on Emotional and Learning Disorders i n C h i l d r e n . ^ A recom-mendation coming out of these conferences was to provide s p e c i a l t r a i n i n g for pro fe s s iona l personnel (medical, nursing and educators) i n preparat ion for working i n t h i s f i e l d . REVIEW OF THE LITERATURE Review of the l i t e r a t u r e showed that several studies have been done r e l a t i n g to the preparat ion nurses are given as students for work i n the f i e l d of mental re ta rda t ion . The l i t e r a t u r e suggested that the nursing profess ion needs to accept the r e s p o n s i b i l i t y for adequately preparing s ta f f to work i n th i s f i e l d . However, no studies were found con-cerning mental re tardat ion nursing 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 (eds . ) , Mental Retardation 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 Nat ional Health and Welfare, October 19-22, 1964), p. 1. 6 The Commission on Emotional and Learning Disorders i n Ch i ld ren , One M i l l i o n Chi ldren (Toronto: L. Crainford for the Commission, 1970), p. 9. 58 selected was Canadian nursing schools having a graduating class i n 1969. Data that could indica te the preparation nursing students received included course placement for mental re tardat ion theory and c l i n i c a l experience i n the curr iculum, time allotment for t h i s experience, and the year of nursing education i n which t h i s preparation took p lace . A questionnaire was used for data c o l l e c t i o n . A l l P r o v i n c i a l Registered Nurses 'Associat ions were contacted to obtain l i s t s of Canadian nursing schools . The sample was 140 nursing schools having a graduating, class i n 1969. A 95 percent return rate was obtained from these schools for mailed quest ionnaires . When data from Phase I of the study had been re-viewed, information obtained was found to be incomplete i n some areas. Many nursing schools used a f f i l i a t e schools for experience i n p a r t i c u l a r areas such as p e d i a t r i c s , obstetr ics and p sych ia t ry . Records of time a l l o t t e d to theory and c l i n i c a l experience from these schools were often incomplete. Accordingly Phase II of the study was undertaken and a f f i l i a t i n g schools were asked to complete the same questionnaire sent to the o r i g i n a l schools , to provide the necessary data for a f f i l i a t i n g students. Permission to use the data and v e r i f i c a t i o n of the new f indings was requested from the parent schools . Out of the 68 nursing schools u t i l i z i n g a f f i l i a t i n g hospi ta l s f o r student experience, 65 percent authorized use of the new data, 21 percent ind ica ted that the data had already been 59 included and 14 percent d id not r e p l y . A time lag of approximately one year and eight months occurred between Phase I and Phase II of the study. The. combined data was tabulated and analysed. RESULTS OP THE STUDY Information was obtained from univer s i ty schools , h o s p i t a l schools and community or reg iona l col lege schools of nurs ing . Univer s i ty schools presented a degree on completion of the course and h o s p i t a l and jun ior col lege schools presented a diploma on graduation. Diploma schools had three year, two and one-half year and two year nursing programs. On reviewing the time allotment for theory and c l i n i c a l experience, the h o s p i t a l and reg iona l or community college diploma schools usual ly provided between 0 and 8 hours, whereas u n i v e r s i t y schools tended to of fer up to 12 hours of experience. Most of the experience occurred i n the second year of the program i n h o s p i t a l and reg ional or community col lege schools , whereas i t occurred most frequently i n the t h i r d year of education i n the un iver s i ty schools . Data from eastern and western schools was examined. There did not appear to be an appreciable di f ference i n data from the two areas. In un iver s i ty schools there was a tendency to 60 present mental re tardat ion theory within the framework of the b i o l o g i c a l or behavioural science, courses. C l i n i c a l experience frequently was arranged i n community sett ings with prov i s ion made for family contact . Most nursing education i n mental re tardat ion occurred wi th in the framework of ped ia t r i c s or p s y c h i a t r i c programs. C l i n i c a l experience was frequently given i n more than one course and the combination of courses most frequently used was ped i a t r i c s and psychia t ry . Problems and Limitations i n Conducting the Study A number of problems were encountered i n conducting the study. A l i s t of some of the problems encountered fo l lows. 1. The questionnaire d id not r e f l e c t some of the current trends i n nursing school c u r r i c u l a . In schools where pro-grams were integra ted , the respondents had d i f f i c u l t y i n d i s t ingu i sh ing s p e c i f i c courses and a l l o t t i n g time for these courses. 2. Data should have been more s p e c i f i c , as phrased i t could too e a s i l y be mis interpreted or some of i t could be in terpre ted i n several ways. 3. Another l i m i t a t i o n concerned the type of data c o l l e c t e d . The data requested was quant i ta t ive i n nature and involved years , hours and courses i n which mental re tardat ion experience occurred. No prov i s ion was made to show the qua l i ty of the learning experience. 4. The time lag of one year and eight months (approximately) between Phase I and Phase II of the study may have affected the data c o l l e c t e d . Many reg iona l or community college two year nursing programs were being introduced and the t r a d i -t i o n a l three year diploma programs were being phased out. When a d d i t i o n a l data, such as a f f i l i a t i o n data, was requested, some of the schools had been closed and no further data was a v a i l a b l e . Comments from respondents. The research t o o l , unfortunately , provided many opportunit ies for mi s in te r -pre ta t ion or for var ied i n t e r p r e t a t i o n of requests for data. Poss ib ly because of th i s many respondents offered suggestions or c r i t i c i s m s i n r e l a t i o n to the quest ionnaire . The most frequently occurring c r i t i c i s m of the t o o l con-cerned d i f f i c u l t y i n i s o l a t i n g mental re tardat ion theory and c l i n i c a l experience for. courses as l i s t e d on the quest ionnaire , and with time allotment for these courses. One school , a two year school , stated with regret that they had to discontinue, c l i n i c a l experience i n mental re tardat ion due to 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 school noted that mental re tardat ion experience was to be included i n the curriculum the fol lowing year as a re su l t of in teres t aroused i n t h i s subject fol lowing rece ipt of the quest ionnaire . One respondent noted that th i s was a study that needed doing. In another school an attempt was being made to prevent the as soc ia t ion of mental re tardat ion and psychia t ry . IMPLICATIONS AND CONCLUSIONS 62 The majority of nursing schools gave some theory, c l i n i c a l experience and observation i n mental re tardat ion i n t h e i r nursing education programs. The i n c l u s i o n of c l i n i c a l experience and observation i n the curriculum tended to be i n c i d e n t a l rather than planned, as evidenced by the frequent l i s t i n g i n the categories of "not recorded" "as opportunity presents" , and " i n c i d e n t a l " . It would seem, based on data from t h i s study, that very l i t t l e theory and c l i n i c a l experience i n mental re tardat ion i s being given to students enro l l ed i n nursing schools i n Canada. The data implies that many schools do not have a s tructured plan for presenting t h i s experience. It would c e r t a i n l y seem that a planned and structured approach to nursing education i n t h i s area would be useful so that nurse educators could be aware of the placement and the time allotment for t h i s experience i n nursing education programs. The r e l a t i v e lack of planned c l i n i c a l experience with retarded i n d i v i d u a l s was s u r p r i s i n g . The data a lso implies that many schools do not make prov i s ion for observation of the mentally retarded. It i s poss ible that observation of mental retardates may be of l i m i t e d value i n learning to care for these pa t i en t s , p a r t i c u l a r l y i f c l i n i c a l experience with them i s not pos s ib l e . It would seem that observation then would be increas ing ly important. 63 Nursing education i n mental retardat ion tends to be included within a narrow range of programs and experiences. It would seem that extension of t h i s coverage would be more i n l i n e with the r e a l i t i e s of our soc ie ty . Although over three-fourths of nursing schools do include some theory and c l i n i c a l experience i n mental re tardat ion i n the curr iculum, i t would seem that t h i s top ic i s being s l i gh ted or ommitted i n a number of schools . It was noted with considerable concern that there would appear to be many nursing students graduating without having received any measurable experience i n t h i s area. Recommendations Should another study of t h i s nature be undertaken i t i s recommended that (1) a l l data be c o l l e c t e d at one t ime, (2) a more adequate t o o l for measurement be devised, (3) a smaller population be chosen for study. Recommendations for further studies i n t h i s f i e l d are given i n the fol lowing l i s t . 1. A study to focus a t tent ion on current problems i n nursing the mentally retarded i n Canada, re la ted to the need for i n c l u s i o n of theory and c l i n i c a l experience i n the curriculum of nursing schools . 2. A study to determine the time al lotment, placement and s p e c i f i c content of mental re tardat ion i n current nursing programs. 3. A q u a l i t a t i v e study to show the poss ible effect of s t a f f knowledge of mental re tardat ion on the care provided to mentally retarded pa t ient s . A study, c lose ly re l a ted to t h i s could be done to show the poss ible ef fect of s t a f f a t t i tudes toward mental re tardat ion on the care provided t mentally retarded pa t ient s . BIBLIOGRAPHY BOOKS, PERIODICALS AND ARTICLES Adams, Harvey W. et a l . Mental/Retardation 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 Nat ional Health and Welfare, October 19-22, 1964). Adams, Martha. "Profes s iona l Education of Nurses to Care for Chi ldren who are Retarded,"' Intern at Tonal 'Journal  of Nursing Students. Pergamon Press , 1966, V o l I I I , pp. 181-190. Anderson, Ed i th H. "Nursing Education i n the Univers i ty A f f i l i a t e d Center for the Mentally Retarded," abstract i n Mental Retardation Abstracts . V o l . V I , No. 2, (Apri l- June 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 Health Department i n Mental Retardat ion , " New Front ier s i n Mental Retardation. Ch i ld ren ' s Bureau, Department of Heal th , 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 ck . "Modif icat ions i n the Manual on Terminology and C l a s s i f i c a t i o n i n Mental Retardat ion , " American  Journal of Mental Def ic iency , fo;60-"61-.. !.': Lange, S i l v i a and Linda Whitney. "Teaching Mental Retardation N u r s i n g , " Nursing Outlook. A p r i l , 1966. Murray, B. Louise and Kathryn E . Barnard. "The Nursing S p e c i a l i s t i n Mental Retardat ion , " Nursing C l i n i c s of  North America Ser ie s , ed. Kathryn E . Barnard, 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, Mavis. "Nursing Students Work with the Mentally Retarded," ' Nursing' Outlook. May, 1968, pp. 38-39. Schweer, Jean. E . ' Creative Teaching i n C l i n i c a l Nursing. Saint Louis : The C .V. Mosby Company, 1968. 65 Vevang, Beverley, P h y l l i s Leonard, and Louis P ier son , "Experience i n Mental Retardation for Basic Nursing Students. " Nursing Forum. V o l . V I , No. 2 1967, pp. 183-194. Webster's Seventh New Col leg ia te Dic t ionary . S p r i n g f i e l d : G. and C. Merriam Company, 1967" OTHER SOURCES B r i t i s h Columbia. Department of Educat ion. ' B r i t i s h  Columbia Pub l i c School Annual Report 1970-71. V i c t o r i a , 1971. B r i t i s h Columbia. Department of Health Services and Hosp i ta l Insurance. Mental Health Branch. Annual Report 1971. V i c t o r i a , 1971. B r i t i s h Columbia. Department of Health Services and Hosp i ta l Insurance. Registry for Handicapped Chi ldren and Adul 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 Chi ldren One M i l l i o n C h i l d r e n . Toronto: L. Crainford for the Commission, 1970. Goward, Mary H. "A Study of Retardation Content Taught i n Selected New England Schools of Nurs ing . " Boston: Boston Univer s i ty School of Nursing, 1964-1965. Patterson, Nancy J . "A Guide for INtegrating Mental Retardation Content in to the Basic Curr icu lum." Unpublished Master 's Thes i s , Univers i ty of Washington, 1968. U.S . Department of Health and Welfare. Pres ident ' s Committee on Mental Retardat ion. M.RY '71 -Entering the Era of Human Ecology, No. IP.S.) 72-7 Appendix A QUESTIONNAIRE 67 ( V School of Nursing: Your program Is (check one (*0: Address: Univ e r s i t y program Length of program years Number of students tn 1Q6? graduating c l a s s .Diploma program... Length of program years Tl For your 198? graduating c l a s s please Indicate "By" a check (J) the course(s) that Include mental r e t a r d a t i o n I n s t r u c t i o n . Biochemistry Genetics O b s t e t r i c Pursing P e d i a t r i c Murslng P s y c h i a t r i c Nursing... P u b l i c Health Nursing. Remarks: *l. For your 1^6° graduating d o s s please Indicate by n check ( ) the course(s) i n which the student worked d i r e c t l y with mentally retarded p a t i e n t s . Check I or more Check 1 or more Ob s t e t r i c Nursing P e d i a t r i c Nursing P s y c h l a t r t c Nursing..., P u b l i c Health Nursing.. Other (please s p e c i f y ) . Remarks: f. For" each course checked show time In minutes/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 . .minutes........hours .minutes hours .minutes hours .minutes hours .minutes hours .minutes hours For each c v i r s c checked show time In mlnutos/bours of d i r e c t c l i n i c a l experience. .minutes hours .mi nutes hours .minutes hours .minutes .hours .minutes hours For each course checked show year of.program tn which course was given. For each course checked show year of program In which d i r e c t c l i n i c a l exper-ience occurred. 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 cltnlcol experience consisted of observation only of mentally retarded patients. Check 1 or more Obstetric Nursing Pediatric Nursing...... Psychiatric Nursing..., Publ1c HPOIth Nursing., Other (olease soeclfy), Remarks: ~W. For each course checked show time In minutes/hours of observation. • minutes hours .minutes hours • ulnutes hours .ulnutes hours .nlnutes hours 9. For each course checked show year of program In which observation occurred. Fi l led out by Tltle(s) Date Appendix B LETTER OP INTRODUCTION TO THE STUDY 7 0 Appendix C FOLLOW-UP LETTER 72 73 January 22, 1970. I am a student at the University of B r i t i s h Columbia, Vancouver, B. C , enrolled i n the second year of the Master of Science i n Nursing program. Preparation of a thesis i s a requirement of the course. My thesis i s e n t i t l e d "A Survey of Canadian Schools of Nursing to Determine the Instruction and C l i n i c a l Experience Provided i n Mental Retardation." In order to complete my study, I w i l l need i n f o r -mation from a l l the schools of nursing i n Canada, including university schools, and two and three year diploma schools. Approximately three weeks ago I sent you a l e t t e r and questionnaire requesting information I need to complete my study. Since I have not heard from you I am writing again i n the hope that I can get your kind cooperation i n com-ple t i n g and returning the questionnaire, as a good response rate i s necessary i f my study i s to be successful. I f your reason f o r not returning the questionnaire i s that you do not have a 1969 graduating c l a s s , would you please indicate t h i s i n a l e t t e r or on the questionnaire and return i t to me. Report of the study w i l l not Identify i n d i v i d u a l schools of nursing by name. It i s my hope that the information you send w i l l a s s i s t i n furthering nursing education i n Canada. Thank you f o r your cooperation. Yours t r u l y , (Mrs.) E l s i e Pearen Appendix D QUESTIONNAIRE, FRENCH TRANSLATION 74 Ecole de ciences Infirmieres:............. Adresse Nombre d'Studiantes dans l a Promotion 1969. Type de programme Universite Ecole de base 1. Pour votre promotion 1969, indlquez • Pointez d'un tra i t („') l a (les) partie(s) du pro- j ( l ) i c l . gramme comprenant 1'arri6ration. I •Biochiraie.... Genetlque Obstfitrique Pediatric Psychiatrie Saute Publique.... Divers (Precisez), 2. Indiquez chaque fois 3. Indiquez chaque fois en le nombre d'heures/minutes quelle annle du programme consacrSes a 1'arriSration • le cours a ete donnS me tit ale .minutes . . ,., .tjeur as.. .minutes,.....heures. .minutes......heures, .minutes ......heures. .minutes ......heures. .minutes ......heures. .minutes......heures. Remarques 4. Pour la promotion 1969, indiquez r Pointez d'un tra i t le(s) cours dans lequel l'e- • i c i (1) tudiante a travaille directement avec des arrifires mentaux , l5 . Indiquez chaque fois 'le nombre de minutes/hevr es d'experience pratique. ObstStrique. 6. Indiquez chaque fois en quelle annSe du program-me a eu lieu 1*experience pratique. .minutes......heures. Pediatr ie , i . . .minutes ...... .heures ...!, I i Sante Publique................... .1..... .minutes. .... .heures. Psychiatrie........................... 1..... minutes......heures 1 Divers (Precisez) minutes heures Remarquos: Ecole d'Inflrmieres 7. Pour votre promotion 1969 ,indiquez| par un trait (J) le cours pour lequel l'cxperience pratique a consists dans | la seule observation d'arrier£s men- ; taux. J I Pointez l c i ( l ) 8. Indiquez chaque fois le nombre de minutes/heures d'observacion. .minutes........heures. Obstetrique Pediatr ie !>*•• .minutes heures. Psychiatr ie Sante Publ ique .minutes........heures. I .minutes , .heures, f Divers (Pr€cisez) I......minutes heures. 9. Indlquez chaque fois en quelle ann£e du programme cette obser-vation a eu lie u . 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, SCHOOL OP NURSING, UNIVERSITY OP BRITISH COLUMBIA, VANCOUVER, B .C . 81 Appendix H LETTER OF REQUEST TO AFFILIATE SCHOOLS OF NURSING 83 84 March 6, 1971. Dear Last year, while enro l l ed i n the second year of a M.S .N, program at Univer s i ty of B r i t i s h Columbia, I undertook a thes 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 rda t ion . I enclose a copy of the l e t t e r that was sent to Canadian schools of nursing that met the c r i t e r i a for i n c l u s i o n i n the study. I was unable to complete my thes i s due to i n s u f f i c i e n t data. I hope to complete i t t h i s year but I require a d d i t i o n a l information. As you know, many nursing schools use a f f i l i a t i n g schools for t h e i r students' experience i n P e d i a t r i c s , Obstetr ics and Psychia try , the areas where Theory, C l i n i c a l Experience or Observation of the mentally retarded could and frequently would take p lace . Many of the "home" schools were unable to complete my questionnaire concerning the theory and t r a i n i n g i n mental re tardat ion given students at the a f f i l i a t i n g school ; they did not keep deta i led records of t h i s kind of experience. My thes i s w i l l be more complete and accurate i f you w i l l supply t h i s information for nursing schools included 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 questionnaire for your use and a l i s t of schools i n your province that are included i n my study (please note that one of the c r i t e r i a fo r i n c l u s i o n was "having a graduating class i n 1969"). Would you please complete the questionnaire for your school (as an a f f i l i a t i n g school ) , g iv ing the average hours, year, e t c . that could best be appl ied to a l l schools l i s t e d that a f f i l i a t e with you. ( I f one or more schools vary widely from the average please give data separately for that school ) . Please place a check mark beside the nursing schools on the enclosed l i s t that a f f i l i a t e at your school and to whom the average s t a t i s t i c a l data apply. Would you return the questionnaire and the school l i s t i n the enclosed stamped, addressed envelope. Af ter rece iv ing t h i s information I w i l l contact the home school for 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 schools) before using the data i n my study. Thank you for your cooperation. 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 Ju ly 14, 1971. Dear Last year, while enro l l ed i n the second year of the M.S.N, program at the Univer s i ty of B r i t i s h Columbia, Vancouver, B . C . , I undertook a thes i s e n t i t l e d "A Survey of Canadian Schools of Nursing to Determine the Ins t ruc t ion and C l i n i c a l Experience Provided i n Mental Retardat ion" . Your nursing school met the c r i t e r i a for i n c l u s i o n i n my study and a questionnaire was sent to you which you completed. I require a d d i t i o n a l information to complete my study, however, r e l a t i v e to t r a i n i n g students rece iveuin mental re tardat ion at a f f i l i a t i n g nursing schools i n the f i e l d s of P e d i a t r i c s , Obstetr ics and Psychia try . A l i s t of nursing schools and t h e i r a f f i l i a t i o n s was obtained from the Registered Nurses Assoc ia t ion for each province , and the same questionnaire was sent to them, appl icable to a f f i l i -at ing students only. Information obtained from (prov ince ) . . a f f i l i a t i n g schools (some of i t appl icable to your t r a i n i n g program) i s as fo l lows : P s y c h i a t r i c experience at Hosp i ta l Instruction/Theory hours C l i n i c a l Experience hours Ob servat i on hours Obstetr ic experience at Hospi ta l Ins t ruct i on/The ory hours C l i n i c a l Experience hours Observation hours P e d i a t r i c experience at Hosp i ta l Instruct ion/Theory hours C l i n i c a l Experience hours Ob s e r v at i on h our s A copy of your completed questionnaire i s enclosed. Please indicate the fo l lowing on the questionnaire and re turn : 87 - has the above (appl icable) data already been included i n the to ta l s given on your questionnaire? - what ( i f any) of the above data should be added to the to ta l s given on your questionnaire? Your cooperation w i l l be appreciated and w i l l add to the accuracy of my study. Yours t r u l y , (Mrs.) E l s i e Pearen 

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