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1 69-16,176 RANDALL, Joyce Lorraine, A STUDY OF THE EMERGENCE AND DEVELOPMENT OF AN ASSOCIATE DEGREE NURSING CURRICULUM AT LANSING COMMUNITY COLLEGE, LANSING, MICHIGAN. Michigan State University, Ph. D., 1969 Education, general University Microfilms, Inc., Ann Arbor, Michigan ^ JOYCE LORRAINE RANDALL 1969 ALL RIGHTS RESERVED i i

2 A STUDY OF THE EMERGENCE AND DEVELOPMENT OF AN ASSOCIATE DEGREE NURSING CURRICULUM AT LANSING COMMUNITY COLLEGE, LANSING, MICHIGAN By Joyce L orraine Randall A THESIS Submitted to Michigan State U niversity in p a rtia l fulfillm ent of the requirem ents for the degree of DOCTOR OF PHILOSOPHY College of Education 1969

3 ABSTRACT A STUDY OF THE EMERGENCE AND DEVELOPMENT OF AN ASSOCIATE DEGREE NURSING CURRICULUM AT LANSING COMMUNITY COLLEGE, LANSING, MICHIGAN By Joyce L orraine Randall The purpose of this study was to collect and analyze em pirical and descriptive evidence concerning the planning phase of a curriculum for an associate degree nursing program. This study developed from a previous study conducted by the author on the need and feasibility of establishing a tw o-year nursing program at the Lansing Community College. The resu lts of the first study clearly documented such a need. The study and recom m endations w ere accepted by the Board of T rustees, the A dm inistration and faculty, and the Advisory Council of the Lansing Community College. The present study is a com pilation of an account of the em ergence and development of the curriculum of the Lansing Community College A ssociate D egree Nursing P ro g ram. This study was developed due to the encouragem ent given m e by my doctoral

4 Joyce L orraine Randall com m ittee and my professional colleagues to supplem ent the e a rlie r study by additional exploration, analysis, description, and proposals. It w as felt that this study would benefit community college adm inistra to rs, faculty, and nurse educators contemplating the estab lish m ent of an associate degree nursing program. L iteratu re was reviewed which presented views of general and nursing educators which would contribute to the understanding and background knowledge n ecessary fo r the planning of a new c u r riculum. The are a s included in the review w ere the function of education, values and beliefs, the learning p ro cess, curriculum theory, determ ination of educational objectives, guides to the se lection of learning experiences, ch ara cte ristic s of a discipline, social fo rces which contribute to the need fo r change in education, the p ro cess of organizing content, the re-education of teach ers, ch ara c te ristic s of a new tw o-year nursing program, and an experim ental audio-tutorial system s approach to learning. These p artic u lar are a s w ere chosen to a ssist the nurse educator, faced with the problem of developing a new curriculum, in recognizing the various concepts of curriculum planning which m ust be studied in depth p rio r to the selection of subject m aterial. The review of the national, State of M ichigan, and Lansing Community College requirem ents for establishing the new nursing

5 Joyce Lorraine Randall program indicated the need for careful planning of the curriculum in o rd er to m eet all of th ese requirem ents. The re su lts of the survey of educational facilities at the Lansing Community College gave evidence that a nursing program could use these facilities with careful planning. It was im portant to note that the approval from the M ichigan Board of N ursing would be based on the fact that new facilities would be available in the n ear future. According to the re su lts of the hospital surveys which w ere conducted, there a re many excellent clinical facilities available for selected learning experiences fo r students. It was also noted that the community is rich in related h ealth -serv ice agencies which are not adequately utilized in existing nursing education program s. M eetings w ere held throughout the study with ad m in istrato rs and faculty of the Lansing Community College and with the N urse Education Consultant from the M ichigan Board of N ursing. The purpose of these m eetings was to determ ine the a re a s for investigation and to discuss and draw conclusions from the resu lts of the investigations. This group was called the N urse Study Group. The philosophy and purpose of the college and the general philosophy of associate degree nursing program s w ere studied.

6 Joyce Lorraine Randall D iscussion of the N urse Study G roup led to the selection of g eneral education co u rses which would m eet the proposed objectives of the nursing program. Nursing co u rses w ere proposed and these w ere combined with the general education courses to form ulate the proposed curriculum pattern for the asso ciate degree nursing p ro gram at the Lansing Community College. Conclusions which w ere draw n w ith regard to the purpose of the study w ere: 1. The N urse Study Group was in accord that the d isc u s sions on g en eral education and the new tw o-year nursing program s contributed greatly to the understanding and the planning of the curriculum. 2. The support and assistan ce given throughout the study, by the A dm inistrators and faculty of the Lansing Community College, contributed to the su ccess of the curriculum planning sessio n s. 3. It was found that health agencies are all increasing in size, the population continues to in crease, n u rses a re expected to assum e m o re responsibility, and few er n u rses a re being graduated from schools of nursing. 4. It w as established, by the N ursing Study Group, that national, state, and college requirem ents for

7 Joyce Lorraine Randall establishing an asso ciate degree nursing program w ere ra th e r broad and general and could be m et a t the Lansing Community College without difficulty. 5. The survey of educational facilities at the Lansing Comm unity College gave evidence of lim ited facilities at present but plans presented for the n e a r future assured very good facilities. 6. The survey of clinical facilities of the four m a jo r hospitals in the a re a indicated that excellent learning experiences could be selected fo r students. It was also noted that extrem e care m ust be taken in planning and scheduling these facilities due to the num ber of students that would be on the w ards at certain periods. 7. The philosophies of the Lansing Community College and the proposed nursing program w ere studied. It was determ ined, by the N urse Study Group, that the nursing program could become an in tegral p art of the college since the philosophies w ere com parable. 8. Specific objectives w ere form ulated fo r the asso ciate degree nursing program. These w ere based on the probable needs of the nursing students and on the needs of the community.

8 Joyce Lorraine Randall 9. Eight m eetings of the N urse Study Group resulted in the final selection of appropriate g en eral education courses, and nursing education co u rses w ere proposed. A c u r riculum p attern evolved from these m eetings. R ecom m endations of the study include: 1. It is highly recom m ended that nursing faculty be appointed a t least six months p rio r to the opening of an associate degree nursing program. Nursing faculty would benefit from a ll of the planning sessions and should participate in a ll planning. 2. Studies should be conducted to determ ine the need for inclusion of a y ear o r less of chem istry, and if chem is try should be included in an integrated science course. 3. The nursing faculty appointed fo r th is program should develop the philosophy and objectives with the d ire c to r of the program. 4. C areful planning w ill be n ecessary fo r use of the clinical facilities due to use by other schools of nursing. 5. Evaluation techniques should be developed at the sam e tim e that definite objectives a r e form ulated. 6. Continuous evaluation should take place in o rd er that the curriculum be continuously im proved.

9 Joyce Lorraine Randall 7. F o rm al agreem ents should be made between the college and the health agencies which will be utilized for s tu dent experience. 8. F o rm al agreem ents should contain a statem ent that all instruction of nursing students would be by college faculty. 9. Scholarships fo r students should be investigated. 10. A recru itm en t program should be organized for the people of the com m unity. This study was focused upon the em ergence and development of a curriculum p attern fo r the Lansing Community College. It is hoped that the study will contribute to the background knowledge and understanding of other educators who may be attem pting to develop a new associate degree nursing program in a community college setting.

10 ACKNOWLEDGMENTS I would like to acknowledge the assista n ce and encouragem ent given me by the m em bers of m y D octoral Guidance Com m ittee: D r. W alter E. F reem an, D r. Vernon H icks, D r. David Smith, and D r. Edward Schuler. I p articularly wish to ex p ress my deep a p p reciation to D r. Troy L. S tearns, C hairm an of my D octoral Com m ittee, fo r his continuous encouragm ent, support and guidance throughout, a ll phases of my doctoral program. The w rite r is also indebted to P resid en t Philip J. Ganon, of the L ansing Com m unity C ollege, fo r the opportunity given to conduct this study as the appointed d ire c to r of the associate degree nursing program. A ppreciation is also extended to the a rts and science faculty for th e ir many valuable suggestions and support. I am also m ost grateful fo r the assista n ce of M iss M ildred Seyler, fo rm e r N ursing Education Consultant for the Michigan Board of Nursing. T his study would not have been c a rrie d to com pletion w ithout the encouragem ent rendered by m y colleagues, friends, and fam ily. I owe p a rtic u la r gratitude to my daughter, Sharon, and to

11 m y th ree sons, R ichard, C raig, and R obert, fo r th e ir understanding and w holehearted support.

12 TABLE OF CONTENTS Page ACKNOW LEDGM ENTS... iii CHAPTER I. INTRODUCTION TO THE STUDY... 1 In tro d u ctio n... 1 Statem ent of the P ro b le m... 3 Significance of the S t u d y... 5 Scope and Overview of the S tu d y... 7 D e lim ita tio n s... 8 Definition of T e r m s... 8 H isto rical Background fo r the S tu d y II. REVIEW OF RELATED LITERATURE In tro d u ctio n Section I S elected Studies in th e A rea of Education 16 Section I I Selected Studies in the A rea of N ursing E ducation--t w o-year P r o g r a m s S u m m a ry III. METHODOLOGY AND PROCEDURES In tro d u c tio n Sources of D a t a P ro ced u res for Data C o lle c tio n S u m m a ry v

13 CHAPTER IV. Page BASIC DETERMINANTS OF A NURSING CURRICULUM In tro d u c tio n Community Need and F e a s ib ility National and Regional R e q u ire m e n ts State and College R e q u ire m e n ts Survey of Educational F acilities at the Lansing Community College Survey of C linical F acilities at Lansing A rea H o s p i t a l s S u m m a ry V. AN EMERGING CURRICULUM P L A N In tro d u c tio n "Philosophy and P urpose of the Lansing Com munity C o l l e g e Philosophy and P urpose of the A ssociate D egree N ursing P r o g r a m G eneral Education C o u r s e s N ursing Education C o u r s e s The C urriculum P a t t e r n S u m m a ry VI. SUMMARY, CONCLUSIONS, RECOMMENDA TIONS AND SUGGESTIONS FO R FURTHER S T U D Y S u m m a ry C o n c lu sio n s R e c o m m e n d a tio n s Suggestions for F u rth e r S tu d y APPENDIX A. STA TE-BY-STATE GROWTH O F ASSOCIATE DEGREE NURSING PROGRAM S B. ASSOCIATE DEGREE NURSING PROGRAMS BY HIGHER EDUCATION ACCREDITING R E G IO N S vi

14 APPENDIX Page C. 10-YEAR GROWTH PATTERN ASSOCIATE DEGREE PROGRAMS IN NURSING-- NUMBER OF PROGRAM S/ TO D. NURSE TRAINING ACT OF E. LANSING COMMUNITY COLLEGE QUESTION NAIRE F. CLINICAL SURVEY F O R M S G. GENERAL EDUCATION COURSE D ESCRIP TIONS BIBLIOGRAPHY 118

15 CHAPTER I INTRODUCTION TO THE STUDY Introduction In D ecem ber, 1965, the A m erican N urses A ssociation published a position paper on N ursing Education in the A m erican Journal of N ursing. The purpose of the paper was to rep o rt to m em bers of the profession on a tw o-year study m ade by nursing lead ers and by educators on the nature and scope of nursing p ra c tice and the type and quality of education needed by nursing p ractitio n ers. The im m ediate effect of the rep o rt on the nursing profession was to bring into the open the controversy concerning the many levels of nursing education--one y ear, two y ear, three y ear, and four y ear p ro g ram s. The report also brought recognition of the rapid rise nationally in the num ber of tw o-year asso ciate degree nursing program s. The recom m endations m ade by the A m erican N urses A ssociation in the report w ere: 1. The education fo r a ll those who are licensed to practice nursing should take place in institutions of higher education. 1

16 2 2. M inimum p rep aratio n for beginning professional nursing p ractice at the p resent tim e should be baccalaureate degree education in nursing. 3. M inimum p rep aratio n for beginning technical nursing p ra c tice at the p resent tim e should be asso ciate degree education in nursing. (27:107) One of the m ost co n tro v ersial statem ents in the rep o rt was one which predicted that in the n ear future th e re would be only two levels of nursing education for the undergraduate student: the four- y ear b accalaureate nursing degree earned in a fo u r-y ear university or college and the tw o-year asso ciate nursing degree earned in a two- y ear com munity college. In essen ce the re p o rt was official professional recognition of the m o re than 200 asso ciate degree nursing p ro g ram s already established in com munity o r junior colleges a c ro ss the nation. Though an attem pt was m ade in the rep o rt to define " p ro fessional" and "technical" nursing p ractice, the authors made no referen ce to changes in the curriculum which would ultim ately p ro duce n u rses at these two educational lev els. The effect was not one ' of reassu ra n ce to the lead ers and d ire c to rs of the tw o-year associate degree p ro g ram s since they w ere com m itted to establishing a c u r riculum which would produce the "technical" n u rse. The controversy over the definition of "professional" and "technical" n u rse continues at p resen t. A ssistance is being given in in terp retatio n by lead ers in education, psychology, sociology, business, labor, and industry.

17 3 A study of the existing asso ciate degree nursing program s by the professional accrediting agency--the National League for N ursing--gave evidence that th ere w ere alm ost as m any differences in the tw o-year nursing curriculum s as th ere w ere pro g ram s. (35:23) Statem ent of the Problem The purpose of this study was to analyze the n ecessary steps involved in the pre-planning phase of a curriculum fo r a relatively new program in professional nursing education. The underlying problem which gave ris e to the need fo r this analysis is the rapid growth of community colleges accom panied by rapid growth of associate degree nursing program s in these colleges. Due to this rapid growth in num ber of program s, it has becom e nearly im possible to obtain the serv ice of qualified nursing d ire c to rs. The term "qualified" m eaning with adm inistrative and teaching experience in nursing education and experience in planning, directing, and evaluating a nursing education program in an institution of higher education. In a m eeting with Michigan d ire c to rs of asso ciate degree nursing p rogram s it was found that seven out of eleven d ire c to rs attending w ere appointed a month p rio r to the opening of the school y ear with the hope that a curriculum could be planned in tim e for the firs t te rm o r se m ester. W here th is situation has occurred it should also be

18 4 noted that college officials have been re a listic enough to allow the d ire c to rs to attend w orkshops and conferences which would a s s is t in this "on-the-job" training. This study em phasized the need for p re planning of the curriculum and d escrib es the im plem entation of a planned curriculum for the A ssociate D egree N ursing P rogram to be established in Lansing Community College, Lansing, M ichigan. The p resen t study was preceded by a tw o -y ear study, ( ), by the author, to determ ine the need and feasibility of establishing a tw o-year nursing program at Lansing Community College. The resu lts of the firs t study clearly docum ented the need and feasibility fo r the establishm ent of a tw o-year nursing program. The study and recom m endations w ere accepted by the Board of T ru stees, the A dm inistration and Faculty, and the A dvisory Council of the Lansing Community College. The specific dim ensions for which data w ere collected for the firs t study included the com m unity's im m ediate need for n u rses, the num ber of n u rses employed and the num ber of budgeted vacancies, the num ber of high school graduates who m ight e n te r the n u rsing field, the type and num ber of schools of nursing in the a rea and the num ber of graduates each year, the num ber of graduates rem aining in the a re a to work, the educational and clinical facilities that m ight be utilized, the financial support available and the num ber of av ailab le qualified faculty.

19 5 The p resent study is a com pilation of an account of the em ergence and developm ent of th e Lansing Community College A ssociate D egree N ursing P ro g ram. This study developed due to the encouragem ent given m e by m y docto ral com m ittee and my p ro fessional colleagues to supplem ent the e a rlie r study by additional exploration, analysis, description, and proposals. It was felt that th is study would benefit com munity college ad m in istrato rs, faculty, and n u rse educators contem plating the establishm ent of an asso ciate degree nursing program. Specific data for this study w ere collected on national and state requirem ents fo r accreditation, curriculum requirem ents of the M ichigan Board of N ursing, philosophy and purpose of asso ciate degree nursing program s and the philosophy and purpose of the Lansing Community College, curriculum pro g ram s fo r asso ciate degree nursing cu rren tly in use in Michigan, specific educational and clinical facilities available in the Lansing are a, and course content in general education co u rses at the Lansing Community College that m ight contribute to o r becom e a part of the nursing education curriculum. Significance of the Study It was significant that a prelim in ary search of the lite ra tu re revealed no study which d escrib es o r analyzes the em ergence of a

20 6 curriculum pattern fo r this new type of nursing program related to the health needs of the com munity and which w ill utilize the nursing serv ices provided. It was hoped that this study would contribute to the background knowledge and understanding of other nurse educators who may be attem pting to develop a new nursing curriculum in a com m unity college settin g. The scope of any proposed curriculum in the p ara-m ed ical field poses problem s when one considers the rapid advances in science and m edicine. Scientific knowledge m ust be utilized on a b asis fo r both professional and technical nursing education. N urse educators ag ree, "The p rim ary aim of nursing education is to p ro vide an environm ent in which the nursing student can develop selfdiscipline, intellectual curiosity, the ability to think clearly, and acquire the knowledge n ecessary for practice. " (35:21) T his study attem pted to show that the Lansing Community College offered the potential fo r an educational environm ent n ecessary for the growth and effectiveness of the associate degree nursing program in achieving th is aim. The im portance of the present study is the planning and the im plem entation of a tw o-year nursing curriculum at the Lansing Community College. This curriculum w ill provide the scientific

21 7 base, the technical skills and the opportunity to develop sk ills, along with the evolving theory needed by the practicing n u rse. Scope and O verview of the Study The study was lim ited to the pre-planning phase of the c u r riculum for the A ssociate D egree Nursing P ro g ram to be established a t the L ansing Com m unity C ollege, L ansing, M ichigan. C hapter Two combined a review of related lite ra tu re in the field of education and in the m ore specific a re a of nursing education and tw o-year nursing program s. C hapter T hree is a descriptive account of m ethods and p ro cedures utilized a s a b asis for p relim in ary planning of the nursing curriculum. C hapter F our is a presentation of the basic determ inants of the nursing curriculum. C hapter Five is an account of how the data w ere analyzed and d escrib es the specific curriculum for the tw o-year nursing p ro gram at the Lansing Community College. C hapter Six contains a sum m ary, conclusions which w ere drawn from the analysis of the data, recom m endations, and suggestions fo r fu rth e r re se a rc h in the a rea of pre-planning for a tw o-year nursing curriculum.

22 8 D elim itations I This study w ill be confined to an analysis of the steps leading to the em ergence and developm ent of a c u r riculum plan fo r a new A ssociate D egree N ursing P ro gram. II This study w ill be confined to the T ri-county a re a (Clinton, Eaton, and Ingham Counties of M ichigan), with Lansing Community College, Lansing, Michigan, a s the focal point. D efinition of T erm s The A ssociate D egree N ursing P rogram : (Length--tw o y ears). Defined by the M ichigan Board of N ursing as: "A program in nursing leading to an associate degree, is conducted by an educational unit in nursing (departm ent o r division) that is an in teg ral part of a com m unity o r junior college and is organized and controlled in the sam e way as sim ila r units in the institution. " A ssociate D egree N ursing C urriculum : Defined by the National League fo r N ursing, 1967: "R efers to course content, instruction, and sequential arrangem ent of co u rses leading to the asso ciate degree in n u rsin g."

23 9 The Diploma P rogram : (L ength--three y ears). Defined by the Michigan Board of N ursing as: "A program leading to a diplom a in nursing is conducted by a single-purpose school under the control of a hospital o r other authority. " The B accalaureate D egree P rogram : (L ength--m ay be four o r five y ears). Defined by the M ichigan Board of N ursing as: "A program in nursing leading to a baccalaureate degree is conducted by an educational unit in nursing (departm ent, division, school o r college) that is an in tegral part of sen io r college o r university and is organized and controlled in the sam e way as sim ila r units in the in s titution. " N ursing Laboratory: Defined by the National League fo r N ursing, 1967: "Includes the hospital(s), other com munity agencies, an d /o r the laboratory a re a s within the college plant that are designated fo r students' planned learning a c tiv itie s." P re-planning Phase: A one-y ear period of study previous to the establishing of an A ssociate D egree N ursing P ro g ram in a Community College. This study to include the need and feasibility for

24 10 such a program ; the educational and clinical facilities available; the selection of qualified faculty; the provision of an adequate budget; and the o v erall curriculum planning. P ro fessio n al Nursing: Defined by the A m erican N urses A ssociation, 1955, as: "The p ractice of professional nursing m eans the perform ance for com pensation of any act in the observance, care, and counsel of the ill, injured, o r infirm, o r in the m aintenance of health o r prevention of illn ess of others, o r in the su p e r vision and teaching of other personnel, o r in the ad m in istration of m edications and treatm en ts as p rescrib ed by a licensed physician o r dentist; requiring substantial sp ecialized judgm ent and sk ill and based on knowledge and application of the principles of biological, physical, and social science. The foregoing shall not be deem ed to include acts of diagnosis o r p rescrip tio n of therapeutic o r co rrectiv e m easu res. " Technical N urse: Defined by the National League fo r N ursing, 1967: "A reg istered nurse with an associate degree licensed for the practice of nursing who c a rrie s out nursing and other therapeutic m easu res with a high degree of skill, using

25 11 p rin cip les from an ever*expanding body of science. The technical nurse p erfo rm s nursing functions with patients who a re under the supervision of a physician an d /o r professional n u rse and a s s is ts in planning the day-to-day care of patients, evaluating the patien ts' physical and em otional reactions to therapy, taking m easu res to alleviate d is tre s s, using tr e a t m ent m odalities with knowledge and precision, and su p e r vising o th er w orkers in the technical asp ects of care. " T echnical N ursing: The A m erican Journal of N ursing, D ecem ber, 1965: "N ursing p ractice which is unlim ited in depth but lim ited in scope. Its com plexity and extent a re trem endous. It m ust be rendered, under the direction of professional nurse p ractitio n e rs, by persons who are selected with and educated within the system of higher education.... Education fo r th is p ractice req u ires attention to scientific laws and to scientific principles with em phasis on skill. It is education which is technically oriented and scientifically founded, but not p rim arily concerned with evolving theory. " P ra c tic a l N ursing: (P ro g ram length--approxim ately one y ear. V aries nationally from ten months to eighteen m o n th s.) Defined by State of

26 12 M ichigan N ursing P ra ctic e Act of 1967 as: "P ra c tic e of p ra c tic a l nursing m eans the perform ance fo r com pensation of acts in the care, treatm en t o r observation of the ill, injured o r infirm, o r for the m aintenance of the health o r the prevention of illn ess of o th ers, perform ed in accordance with education and p rep aratio n which has provided the p ra c titio n er with a le s s e r degree of specialized sk ill, knowledge, education o r training than that required to p ractice as a reg istered n u rse. A licensed p ra ctical nurse sh all perform such acts only under the direction of a reg istered nurse o r licensed physician o r dentist. " H isto rical Background for the Study In 1949 the N ational League of N ursing Education proposed to the A m erican A ssociation of Ju n io r Colleges that a com m ittee be form ed to study ways in which junior colleges could p articip ate in nursing education. In 1952 the nursing organization w as reorganized and was nam ed the N ational League fo r N ursing. At this tim e p ro vision w as m ade within the League for a D epartm ent of Diploma and A ssociate D egree P ro g ram s. U nder the auspices of the A m erican A ssociation of Junior Colleges and the National League fo r N ursing an experim ental program was conducted, under the direction of M ildred L. Montag,

27 13 P ro fe sso r of N ursing Education, T each ers College, Columbia U niversity. This experim ent, the "C ooperative R esearch P ro je ct in Ju n io r and Community Colleges for N ursing, " resulted in an en tirely new type of program in nursing education--the tw o-year asso ciate degree program. M ontag's book, Community College Education fo r N ursing, is a rep o rt of this five y e a r project--( ). The rep o rt was published in The Cooperative R esearch P ro ject included eight participating schools: five tw o-year ju n io r colleges, two foury e a r institutions of higher education, and one hospital school of nursing. These schools w ere a ssiste d in developing nursing p ro g ram s that would p rep are a nurse graduate who could qualify for licen su re as a reg istered n u rse, and as a graduate of the seven collegiate program s could m eet the colleges' requirem ents for an asso ciate degree. The rep o rt stated that the unique c h a ra c te ristic s of these seven collegiate asso ciate degree nursing program s w ere: 1) they w ere not diplom a program s transplanted into college settings; 2) they w ere not truncated o r diluted baccalaureate degree program s; 3) they w ere an en tirely new type of nursing program. (13:v) It w as also noted in the rep o rt that the asso ciate degree nursing program s adhered to a g en e ra l philosophy fo r these p ro gram s but each differed in specific statem ents of philosophy acco rd ing to the college in which it was integrated.

28 14 By 1959 the num ber of asso ciate degree nursing program s had grown to 48. Today th ere a re approxim ately 215 program s; the m ajority a re being conducted within com munity colleges. The com m unity college h as been called the fastest growing collegiate e n te rp rise in A m erica today. Leading educators feel that its m a jo r purpose rem ains unchanged--providing essen tial se rv ic es to m eet the community* s needs.

29 CHAPTER II REVIEW OF RELATED LITERATURE Introduction This study utilized both g en eral education and nursing education concepts of curriculum planning proposed by le ad ers in these a re a s. The review of related lite ra tu re included basic philosophies, definitions, and values and beliefs of the authors. E m phasis is on fairly cu rren t inquiry in these a re a s. Selection of related re se arch was m ade on the b asis of providing an overview of the m ajo r facto rs in curriculum developm ent. The firs t section of lite ra tu re viewed as appropriate for th is study was focused on the general a re a of education; the second section dealt with studies in the a re a of nursing education--tw o-year p ro g ram s. Specific a re a s which a re reviewed in th is chapter are: The function of education, the learning p ro cess, curriculum theory, determ ination of educational objectives, guides used in the selection of learning experiences, c h a ra c te ristic s of a discipline, social forces contributing to a change in education, the p ro cess of 15

30 16 organizing content, re-education of teach ers, the c h a ra c te ristic s of the new tw o-year nursing p ro g ram s, and an experim ental audiotu to rial system s approach to learning. These a re a s w ere chosen to a s s is t the college ad m in istrato r and faculty, and the n u rse educator, faced with the problem of developing a new nursing curriculum, in recognizing the various concepts of curriculum planning which m ust be studied p rio r to selection of subject m aterial. Section I Selected Studies in the A rea of Education Saylor has voiced the opinion of educators when he stated that th ere is a larg e body of sk ills, knowledge, attitudes, ap p reciations, ways of working, and ways of behaving that should be learned in common by all. (17:55) He also stated that education m ust p r i m a rily seek c h a ra c te r and behavior, all-round c h a ra c te r of a kind to lead to p ro p er behavior leading to a w ell-adjusted personality. Education m ust be concerned with the developm ent of the total personality including behavior, attitudes, ch aracte r, value p attern s, and human relatio n s. Saylor postulated that curriculum decisions a re philosophical d ecisio n s--th ey rep resent a choice of values. (17:82)

31 17 One of the m ajo r issu e s in education today is the lack of em phasis on values in the developm ent of a curriculum. C arpenter, in a discussion of th is issu e, w rites, "It is even possible that th ere can be n eith er intellectual integrity nor freedom unless we in sist upon c ritic a l thinking about our own attitudes tow ards the discoveries of our tim es, and unless we know how to re-exam ine our own lives in the light of the values to which we give p rio rity." (5:xv) Saylor quotes Huston Smith as making the following statem ent, "That th ere is a lo stn ess, and anxiousness, a bew ilderm ent in contem porary life which the a rts ex p ress and sta tistic s on... delinquency, divorce, insanity, and alcoholism... co n firm." (17:1) Smith is fu rth e r quoted in answ er to the question of the function of education, "It has the m eans by which the adult generation tra n sm its to the oncoming generation the in tern al equipment it deem s n ecessary for the good life--know ledge, sk ills, appreciations, and m otivations. " (17:2) C arp en ter feels that the A m erican college does not see it as its task to fu rth e r hum an v irtu es as a whole. It re s tric ts its responsibility to in tellectual v irtu es. Intellectual attitude analyzed yields in te l lectual v irtu es such as: a. Intellectual honesty: the determ ination, in so far as possible, to keep personal bias from distorting o n e 's vision of things. b. Scope of knowledge. O ther things being equal, a rich and v aried stock of inform ation renders life m ore in terestin g and com petent.

32 18 c. D ialectical agility, o r "sh arp n ess" as we say. Not only should m inds be inform ed; they should be able to work with th e ir inform ation nim bly, skillfully, and in an o rd erly fashion. d. A esthetic sensitivity. These, C arp en ter stated, a re the values colleges as institutions really believe in. O ther values which she discussed w ere diligence, m o ral honesty, and academ ic freedom. (5:4) It w as fu rth e r stated that the general feeling among faculties w as that v irtu es of this so rt w ere not the re sp o n sib ility of the college. It w as pointed out: a. Enlightm ent view of m a n --re aso n is the key to the good life. F re e the mind of superstition and ignorance and it w ill prove capable of discerning the good and persuading the re st of the self to follow it. b. The belief that a ll values a re relative. Anthropology* s doctrine of cultural relativism, philosophy's em otive theory of value, psychology's d isco v eries about conditioning, and e x iste n tia lism 's th esis that existence precedes essence have combined to create an im p ressio n in the academ ic mind that values a re a rb itra ry in the sense that th ere being no universally valid standards by which to judge b e tte r from w orse. Such a view reduces the urgency of value instruction. c. The Cult of objectivity--the le ss education gets entangled with p referen ces and em otion--the b etter it w ill be able to perform its appointed task. d. D ivision of labor--(doubt that the place to nuture values is in the college). Value concerns d istra c t from tru th (home and church should look a fte r m o ral values). e. R espect fo r autonom y--students should be free to shape th e ir own values--should have freedom, individuality, autonom y, and subjective self-h o o d. (5:6) S tratem ey er claim s that any curriculum design stem s from a se t of values--fundam ental beliefs relating to the type of citizen d esired and the p art to be played by the school in h is development.

33 19 She lis ts the following a s c ritic a l facto rs in curriculum developm ent: 1. need to consider the nature of society and of le a rn e r 2. recognition of what has m eaning fo r the le a rn e r 3. concern for s o c ie ty 's b asic values. (20:86) A sim ila r statem ent made by Saylor is that the m ost im portant influence in shaping the curriculum of any school is the cu ltu ral p attern and value system of the society that estab lish es and supports the school. He fu rth e r stated that teach ers and all educato r s should: 1. understand thoroughly the basic social aim s and values which the A m erican people accept 2. assum e an active role in helping citizens them selves m ore thoroughly analyze and understand these values 3. seek a broad base of decision-m aking so that m inority opinion and the views of p re ssu re groups o r vested in te re st groups a re not m istakenly assum ed to be the voice of the people. (17:81) A statem ent of values is m ade in the book Schools fo r the Sixties as follows: "E very society is d irected and sustained by a core oi values which rep resen ts its id eals, its stan d ard s, and its norm s of what is d e s ira b le." (18:7) The National Com m ittee reporting in this book also states that the following values are vital as c rite ria for a s s e s s ing p resen t p ractices and as guides to future im provem ent of our schools: 1. R espect for the w orth and dignity of every individual 2. Equality of opportunity fo r all children 3. Encouragem ent of variability

34 21 In the 1957 Yearbook of the N ational Education A ssociation, curriculum developm ent is described a s, "Identification and analysis of the problem, developm ent of new insights and p ersp e ctiv e s--a n analysis of needs which req u ires reorientation of the conceptions and attitudes regarding what is im portant in learning and te ach in g." (17:62) This rep o rt fu rth er stated, The p ersisten t problem of a ll education is sim ply the problem of influencing the behavior of individuals in d esired ways to the resu lt of educational experiences. Education is concerned with learning. Any knowledge which enables us to understand how hum an beings develop and le arn is basic knowledge in curriculum study and developm ent. Education is so cial in its nature and s e t ting. Studies of the role of the school in the com m unity and in society, of the nature of p ersisten t p ro b lem s of living, and of norm ative behavior, illu stra te studies suggested by the social n a tu re of education. (17:85) In Foundations of C urriculum Planning and Developm ent Hugh B. Wood stated, The m ost p ractical method of determ ining educational objectives for m odern education is the n eeds-cen tered m ethod, which is based on analysis and introspection. A ll needs a re individual because they concern the individual, e ith e r as a single person o r as a m em b er of a group. But we m ust recognize and deal with the b asic needs of the com munity... and those of the b ro ad er w orld o rd er, as w ell as those of the individual h im self-- always m indful of th e ir various in te rre la tio n sh ip s--th e re is a danger of over em phasis of self to the d etrim en t of the social w elfare. (21:84) The philosophy of learning m ust be considered when planning any curriculum. K ilpatrick sum m arizes a philosophy of learning in the following four principles:

35 22 1. L earning h as taken place when any p art o r aspect of the ongoing experience rem ains with one to come back la te r at the appropriate tim e into the life p ro cess to help shape that p ro cess. 2. I learn what I live and I learn it as I accept it to live by it. 3. A nything--a thought, an attitude, a bodily m ovem ent has been learned in the degree that it th erefo re tends to get back into life at the right tim e to play th ere its appropriate part learn anything ih the degree that I live it, in the degree that I count it im portant fo r m e to know and use it, and fu rth e r in the degree that I understand it and can fit it in with what I already know and believe. (19:95) The basic principles of learning as recom m ended by Hugh B. Wood a re described as the n atu ral p ro cess of the hum an organism interacting in its environm ent: a) Learning is the resu lt of the constant efforts of the organism to m aintain a norm al equilibrium and balance; b). The im m ediate environm ent, together with one1s past experiences, provides the source of a ll new m eanings- - the ric h e r the environm ent, the g re a te r, m ore significant, and ric h e r the m eanings; c) A ll learning is based on the ability of the le a rn e r to 1) a s s o ciate the values o r learnings of previous experiences, with new situations in which they are pertinent, 2) create new responses o r p attern s of behavior to fit the new situations, and 3) incorporate o r integrate the resulting values in the organism fo r subsequent use; d) L earning is active, not passive; the le a rn e r m ust be active m entally, em otionally, physiologically, an d /o r physically if learning is to take place--know ledge, concepts, principles, attitudes, sk ills, ap p reciatio n s all types of learn in g s-- em erge from, and a re the product of, an experience, e ith e r actual o r v icarious. (21:99) C rite ria to be used as guides to the selection of learning experiences are given by Wood:

36 23 1. A learning experience should satisfy a recognized need. (Goals and purposes of the le a rn e r are attained) 2. A learning experience should be appropriate to the m atu rity and understanding of the le arn er. 3. A learning experience should build toward consistent, continuing and dynam ic goals. (L e arn er m ust recognize long-term o r life-tim e goals) 4. A learning experience should be based on social values. (E xperiences based on socially accepted goals) 5. A learning experience p referably should be positive. (Negative experiences m ay have a strong learning value but a re a th reat to individual and so cial w elfare) 6. A learning experience should be re a listic. (L ittle re a l learning takes place in a rtific ia l situations) 7. A learning experience should be efficient. (Maximum amount of learning should take place in the least am ount of tim e, effo rt, and expense) 8. A learning experience should not be lim ited by artific ial b a r r ie r s such as the four w alls of the classro o m, subjectm a tte r lines... etc. (Reach out into the community fo r Experiences) 9. A learning experience should involve total behavior.. (M ental, m uscular, em otional activity) 10. A learning experience should be feasible of accom plishm ent. (21:114) B asically, education has three m ajo r purposes; the tr a n s m issiv e, the adaptive, and the developm ental. These purposes are described by Inlow as tran sm issio n of the past, adaptive to sk ills, knowledge and em otional adjustm ent, and developm ental guidance tow ard growth and m aturity. Inlow also stated, Along the p ro cess dim ension, we conceive curriculum as including such efforts of educational personnel as the following: (1) determ ining educational goals; (2) tran slatin g goals into the substance of learning; (3) selecting and employing instructional m ethods designed to m ake learning effective and econom ical; and (4) evaluating how w ell any educational echelon has achieved its predeterm ined goals. Along the product dim ension, we conceive curriculum as including the tangible m anifestations of

37 24 educational planning and im plem entation. Illu strativ e a re statem ents of goals; the tangible re su lts of in stru ctio n... and in stru m en ts and profiles of evaluation. (11:7) Inlow a lso proposed, Education, w ithin the fram ew ork of approved cu ltu ral values, firs t carves out its operational goals and then im plem ents them by selecting content from the trad itio n al disciplines, from the em erging disciplines, and from the on-going so cial o rd er. (11:23) A w ell-designed curriculum should relate both to the present and to the future; it should rew ard students not only with im m e diate but with delayed benefits; it should reveal specific evidences of m astery while p ro g ressin g down a path of long-term developm ent. (11:26) A ccording to Inlow, "a discipline p o ssesse s th ree c h a ra c te r istics: it consists of knowledge and concepts that em anate from and relate, to a given life area; it consists of dem onstrable and describable m ethods of discovering and validating knowledge and hypotheses w ithin that life area; and it is ev e r evolving. " (11:9) The fundam ental purpose of a discipline is described by Inlow, "To develop in individuals disciplined thinking and disciplined attitudes, with the outcome a disciplined way of life. " (11:18) In Schools fo r the Sixties, the National Education A sso ciation' s rep o rt of the project on instruction, it is stated, The purpose which runs through and strengthens a ll other educational purposes - -the common thread of ed u catio n --is the development of the ability to think. The ability to think rationally, to use reason and evidence in solving problem s and m aking decisions, extends o n e 's control over the environm ent. W here im m ediate control is beyond the individual, the ability

38 25 to u n d erstan d and follow the reasoning behind events and confusing issu e s brings som e order to b ear on situations in which people m ay otherw ise re tre a t into apathy o r react destructively w ith blind em otion. (18:iii) In The E m erging C urriculum, Inlow defined thinking as, "A quality to be released, not one to be injected into a learn in g - - organism. " He fu rth e r stated, "Thinking (problem solving) m ay be taught in these th ree ways: 1) by a te ach e r rem oving the blockages which stand in the way of thinking, 2) by a te a c h e r's stim ulating an environm ent of learning, and 3) by a te a c h e r's helping a le a rn e r to proceduralize h is thinking. " (11:99) Q uestions which the curriculum planner m ust be concerned with a re raised by Inlow: Is the curriculum in its totality extensive enough and flexible enough to relate to the uniqueness of each student? Does the curriculum have the sanction of such agencies of assessm en t as the state, the federal governm ent, and the professional groups? Does it have unity? Does it lend itself to system atized in s tru c tion? Does it lead to fu rth e r learning? A re curriculum content and curriculum organization in harm ony? (11:27) In Role of S upervisor and C urriculum D irecto r in a Clim ate of Change, Ole Sand stated, "The aim s of education should serv e as a guide fo r making decisions about c u rric u la r organization as w ell as a guide for making decisions about a ll other asp ects of the in s tru c tional p ro g ra m." (16:39) Sand also proposed an analysis of the fo rc e s w hich shape education: a) analyzing three kinds of d ata-so u rc es that a re b ases for decisions--including societal fo rces causing change,

39 26 knowledge of the human being as a le a rn e r and the accum ulated body of organized knowledge about the world and man; b) screening the data from these so u rces against the values and educational aim s which society se ts fo r education; c) identifying im portant kinds of decision; and d) determ ining what can be and what should be. (16:31) Two approaches discussed by Van T il and quoted by Inlow are: E ducators m ay accept the tendencies of the tim es in which they find them selves and develop school program s which reflect all prevalent social forces. O r educators m ay appraise the ten dencies of the tim es and develop school program s through which the le a rn e rs can reflect upon and shape social forces. The second approach conceives the school as an instrum ent fo r the im p ro v em en t of individuals and so ciety. (11:16) Sharp cautioned that the curriculum w orker cannot presum e to change eith er individuals o r society in accordance with h is views no m a tte r how right he may think him self to be. He suggested the following as so u rces of data to be used in curriculum development: "Sociology and anthropology w ill yield clues to the nature of the society; child developm ent has data on the nature of the young; social psychology, m ental hygiene, and psychology of learning a ll provide insights into the nature of the p ro cess of integration, while educational philosophy and the h isto ry of education can clarify the role of the sch o o l." (19:16) The rep o rt of the project on instruction by the National Education A ssociation, 1963, contains se v eral recom m endations for

40 27 decision-m aking levels in education. T hese levels a re described as: I II Ill Societal level and educational d ecisio n s--th is level would include school board m em b ers, state leg islato rs, and fed eral officials. D ecisions m ade at th is level would include special p ro g ram s for the handicapped, funds for closed circuit TV, financing of lev els of education, school lands, rights of m inority groups, etc. Institutional level and educational decisions--w ould include ad m in istrato rs and te ach e rs and would include the making of decisions on specific c u rric u la r sequences and relating of various subject-fields. Instructional level and educational d ecisio n s--th ese d ecisions would be m ade by teach ers and would include daily in stru ctio n al decisions, units of work, selection of m a teria ls, and the setting up of learning situations. (18:13) In the 1963 NEA rep o rt the following is given as a reco m m endation on deciding what to teach and ways of achieving balance: The school can provide and m aintain a curriculum which is appropriately balanced fo r each student by offering a co m p rehensive program of studies, m aking e a rly and continuous assessm en t of individual potentialities and achievem ents, and providing individualized p ro g ram s based on careful counseling. To avoid the im balance that can re su lt from lim iting financial support to certain selected subjects and se rv ic es, general financial support should be provided fo r the to tal program. This applies to local, state, and fed eral support. (18:47) A nother recom m endation given in the above rep o rt sets a b asis fo r selecting content: Content earn s its place in the curriculum by its contribution to the achievem ent of educational objectives. The establishm ent of the objectives. The establishm ent of the objectives should, th erefo re, precede any effort to determ ine content of the in stru ctio n al program and to determ ine relative em phasis to be placed on various asp ects of the program. (18:50) In a discussion of decision-m aking, Doll suggested:

41 28 As soon a s objectives have been accepted, m eans of evaluating th e ir achievem ent should be sought.... Tim e gaps develop between form ulation of objectives and th e ir evaluation process is ch a ra cte ristic ally sh o rt-circu ited by moving d irectly to the experiences through which objectives m ay be achieved. As soon as the objectives are clear, then, the m eans of th e ir evaluation should be considered, and these m eans w ill in tu rn suggest learning experiences. (8:24) Doll has also m ade suggestions on the utilization of the various disciplines in curriculum building. His reference to the contribution of psychology is a s follows: Psychology b e a rs upon four facets of curriculum im provem ent: the objectives we establish for and with le a rn e rs, the m eans we use in gauging the attainm ent of these objectives, and the ways in which we organize educational experiences, and the kinds of experiences we utilize to achieve the objectives. (8:21) F u rth e r recom m endations from the NEA 1963 report em phasized the above points: Since the re a l purpose of education is to bring about d esired changes in the behavior of students--changes in thinking, feeling, and actin g --statem en ts of objectives should indicate specifically the kinds of behavior sought. Each curriculum a re a should be under continuous study and evaluation and should be reviewed periodically. One purpose of such review is to determ ine w hether recent findings in the academ ic disciplines a re, o r should be, reflected in the instructional program. The review should u tilize the knowledge and sk ills of the teacher, the school ad m in istrato r, the sch o lar in the academ ic d isc i plines, the scholar in the profession of teaching, and the lay citizen, each contributing his special com petence to the total ta sk. (18:51) The p ro cess of organizing content also req u ires m ajor decisions. D ecisions m ust be made on the arrangem ent of learnings

42 29 in sequence so that one learning builds upon another. In considering these decisions the above rep o rt stated: In m aking [these] decisions, one deals with the curriculum v ertically. T here a re also problem s of arranging learnings so that they support one another. In making these decisions, one view s the curriculum horizontally. (48:58) In School fo r the Sixties it is also recom m ended: In each c u rric u la r area, the v ertic al organization of subject m a tte r should take account of: a) the logical stru ctu re of the subject; b) the difficulty of m a te ria l a s related to the students' intellectual m aturity; c) the relation of the field to o th er fields. (48:67) The content of the curriculum m ust be organized in such a way that students m ay be guided tow ard a m atu re utilization and organization of th e ir knowledge. The above rep o rt stated, "Helping le a rn e rs see in terrelatio n sh ip s and achieve unity from the d iv ersity of knowledge is basic to any organization of content. " (48:58) Ralph W. T y ler suggested the following questions with reference to an a re a of learning proposed for inclusion in the in stru c tional program : 1. Is it learning that is based substantially upon bodies of organized knowledge, such as the a rts and scien ces? 2. Is it learning of complex and difficult things that req u ires organization of experience and distribution of p ractice over long periods of tim e? 3. Is it learning in which the essen tial facto rs m ust be brought specially to the attention of the le a rn e r? 4. Is it an experience that cannot be provided d irectly in the ordinary activ ities of daily living? 5. Is it learning that req u ires a m ore stru ctu red experience than is usually available in life outside the schools?

43 30 6. Is it learning that req u ires reexam ination and in terp retatio n of experience? (10:47) S h a rp 's m ain th e sis is, "The curriculum develops basically a s the resu lt of the developm ent of te a c h e rs' p erso n alities. " He fu rth e r stated the problem a s, "Helping to reorganize the experience of m any te ach e rs who have been conditioned, train ed, and successful in the use of trad itio n al m ethods and v a lu e s." (19:8) In Teaching in a W orld of Change, A nderson proposed: The nature of the task s w ill depend on the te a c h e r's sk ill as a clinical o b serv er of each pupil and a s a diagnostician of each p u p il's needs. He is, in a sense, a student of le a rn e rs --a professional sch o lar of children. This diagnostic relationship which resem b les that of a physician to a young patient, se rv e s as the principle b asis fo r the te a c h e r's educational planning and decisions. The te a c h e r has certain knowledge, sk ills, insights, and attitudes and it is his responsibility to pass these on eith er in a didactic fashion o r in som e in d irect o r subtle way. The teach er m ust also have a special com m itm ent to the knowledge he is to teach. (2:16) A nderson also discussed team teaching as a m eans of utilizing the experience and talen ts of the teach er who has been su c cessful in the u se of trad itio n al m ethods. He defines team teaching as, "A form al type of cooperative staff organization in which a group of te ach e rs accepts the responsibility for planning, carrying out, and evaluating an educational program, o r som e m ajo r portion of a p ro gram, fo r an aggregate of p u p ils." (2:83) A nderson does not propose that a ll teach ers have the n ecessary qualifications for the role of team lead er. He lis ts these qualifications as:

44 31 1. A bove-average to su p erio r talents as a classroom teacher. 2. A p a rtic u la r teaching strength. 3. Unusual ability in curriculum planning a) analysis of instructional problem s and procedures b) diagnosis and evaluation of pupil behavior 4. S tills associated with group leadership and a sound understanding of group dynam ics. 5. A bility to assum e responsibilities associated with a le a d e r's ro le. (2:86) Sharp proposed the following as advice to the curriculum planner: "In working through h is relationship with the staff, the curriculum w orker should place consistent and continuous em phasis upon the human and individual asp ects of problem s rath e r than upon th e ir official and institutional a s p e c ts." (19:iii) Section II Selected Studies in the A rea of N ursing E ducation--t w o-year P ro g ram s M ontag's rep o rt described the su ccess of the Cooperative R esearch P ro ject in establishing seven collegiate level program s. The in creased need fo r term inal-education program s and the success of these seven program s combined to encourage community colleges to plan im m ediately to institute this new program fo r n u rs- In 1958 the National League for N ursing published, through the League Exchange, a report developed at a workshop on associate degree program s at the U niversity of California. The report,

45 32 "P re lim in ary Steps in E stablishing an A ssociate D egree P ro g ram in N ursing in the Ju n io r College, " confined itse lf to a discussion of questions as to the needs of a com m unity and the basic facto rs in beginning a program. Q ualifications of the n u rse d ire c to r and faculty w ere discussed a s w ere problem s of curriculum developm ent and evaluation of available teaching facilities. (36:12) A rep o rt published by K atherine Cafferty, through the League Exchange, in 1960, described the a d m in is tra to r's duties and responsib ilities in organizing the program, and the various problem s which m ust be faced in in terp retin g the program to personnel, new faculty, and to the surrounding com m unity. (23:20-22). In O ctober 1961, the D epartm ent of Diploma and A ssociate D egree P ro g ram s of the N ational League for N ursing published a lis t and a discussion of "C h a ra cte ristic s of C ollege-c ontrolled P ro g ram s in N urse Education Leading to an A ssociate D e g re e." The identifiable c h a ra c te ristic s of this college controlled program w ere listed as: 1. The program is controlled, financed, and adm inistered by the college in the way that o th er program s in the college a re controlled, financed, and adm inistered. 2. This collegiate pattern m akes it possible fo r the n u rsin g - program to utilize the o v e r-a ll standards and policies of the college; the educational leadership of the institution, the adm inistration, and the faculty; the in terd iscip lin ary c u r riculum com m ittees; and the student personnel program. 3. P olicies and procedures pertaining to faculty personnel apply to the nursing faculty in the sam e way as to a ll other faculty m em bers. 4. The nursing faculty plans, organizes and im plem ents the nursing co u rses, and the nursing in stru c to rs select,

46 33 supervise, and evaluate a ll learning experiences, including those in the clinical p ractice a rea. 5. By m eans of w ritten agreem ents with h o sp itals and other agencies in the com munity, the college provides fo r clinical facilities essen tia l to the learning of nursing. 6. Students m eet the req u irem ents of the college and its nursing program for adm ission, continuation of study, and g rad u a tion. They sh a re in the resp o n sib ilities and privileges of the to ta l student body. (24:2) A nother publication of the N ational League fo r N ursing which is v ery helpful in understanding th is type of program is "Guiding P rin cip le s for Ju n io r College P articip atio n in Education for N ursing, " published in D ecem ber, In th is rep o rt guiding principles a re established and differentiation is m ade between the com munity college controlled asso ciate degree nursing program and the instruction provided by the college fo r students of hospital controlled schools of nursing. (30:6) At a biennial convention in Cleveland, Ohio, A pril, 1961, the N ational League fo r the N ursing D epartm ent of Diploma and A ssociate D egree N ursing P ro g ram s prep ared statem ents for c u r rent pro g ram s in nursing. The asso ciate degree program is described in the statem ents as a program which: P rovides a m eans of co rrelatin g the philosophy and standards of nursing education with those of g en eral education. The o v era ll standards and policies of the specific college apply to the program in nursing as w ell as to the o th er types of program s w ithin the college. A ll sh are in (1) the educational leadership and adm inistration of the college, (2) the cooperative resp o n sibility of the whole faculty and the curriculum com m ittees concerned with various fields of study in the college, (3) the benefits of the student personnel program.

47 34 The purpose of the program s, a s defined in the N ational League sta tem en ts: The asso ciate degree program is designed to fulfill the educational needs of qualified high school graduates who (1) want to p rep are fo r nursing in a relatively short tim e, (2) want to study in a m ulti-purpose collegiate institution w here they sh are resp o n sib ilities, priv ileg es, intellectual and so cial experiences with other students. A survey study conducted by the N ational League for N u rsing of a ll associate degree nursing program s was published in G eneral ch a ra c te ristic s of these program s w ere included in the study, R eport on A ssociate D egree P ro g ram s in N ursing. The rep o rt ex p ressed feelings of n u rse educators: P erh ap s no aspect of asso ciate degree program s in nursing has stim ulated m ore in te re st among nursing educators than have th e ir curriculum s. To those who, for y ears, have been revising "old" curriculum s, som etim es making considerable changes but still conforming to the traditional mold, the v ery thought of a fre sh s ta rt in curriculum -building has been an exciting one. (37:10) The above rep o rt dealt stric tly with course content without referen ce to present day values and beliefs, function of education, o r the m ajo r task s of curriculum developm ent. In C urriculum Developm ent, by Amy F ran ces Brown, the m any facto rs related to planning a new curriculum w ere discussed. Brown related, "Values include aesthetic qualities, id eals, objects, and activ ities which le a rn e rs a re expected to develop loyalty to o r in te re st in as a part of the educational p ro g ram."

48 35 Brown explained the above statem en t: An exam ple would be reg ard fo r the dignity and w orth of every individual. This would be an organizing elem ent which m ight have been introduced firs t at hom e, o r school, o r church. V alues becom e increasingly im portant to the n u rse as she studies the ethical basis fo r behavior and applies what she le arn s to every facet of h e r nursing experience. V alues appear to be the organizing elem ents which relate to such objectives as the developm ent of attitudes, in te re sts, and appreciations. F rom th is value of the essen tial (inherent) dignity and w orth of every individual stem se v e ra l p ractices which m ust be u n d erstood in o rd e r to provide good m edical and nursing care to the individual p a tie n ts. (4:254) Brown suggested a lis t of values categorized under these headings: attitudes tow ard self, attitudes toward o th ers, attitudes tow ard social groups to which one belongs, and intellectual and aesth etic values. She also stated, "A cceptance of the dem ocratic tenets does not req u ire that our resp ect fo r the individual and our resp ect fo r his right to his own beliefs m ust also be accom panied by resp ect fo r the p artic u lar beliefs he h o ld s." (4:255) The T ylerian rationale of curriculum developm ent was quoted by Brown as, "The four m ajo r task s of curriculum developm ent are: (1) form ulation of educational goals, (2) selection of learning experiences by which students m ay attain these goals, (3) effective and efficient organization of these learning experiences, and (4) evaluation of the extent to which the goals have been atta in e d." (4:94) The firs t three of these goals m ust form the b asis fo r the pre-planning stages of the curriculum. The fourth g o al--ev alu atio n --

49 36 m ust be planned with the nursing faculty responsible fo r the in stru c tion of students. The form ulation of educational goals fo r the associate degree nursing program m ay be achieved by a combined effort of the college faculty in various disciplines and the nursing d irecto r o r curriculum planner. (Community colleges in general cannot envision the n ecessity of appointing the nursing faculty for the pre-planning phase due to the o v er-all cost of the new nursing prog ram --though the ideal situation would be the inclusion of the faculty in all phases of planning.) One of the basic principles offered by Brown in selection of learning experiences fo r students is, "The student m ust have the experiences which give the student opportunities to practice the kinds of behavior and to deal with the kinds of content im plied by the objectives of in stru ctio n." (4:220) E xcerpts from the d issertatio n of Dorothy T. White are contained in a study published by the League Exchange in The d issertatio n is titled A bilities Needed by T eachers of N ursing in Community C olleges, and problem s are discussed from the point of view of the ad m in istrato r v ersu s the point of view of the in stru cto r. F o r exam ple: the chief adm in istrato rs and the nurse ad m in istrato rs see as the m a jo r problem of the nurse faculty a lack of knowledge in

50 37 the actual teaching m ethods and inability in in terp e rso n al relations. The nurse in stru c to rs, on the contrary, identify th e ir problem s as lack of c rite ria fo r the selection of learning experiences and in secu rity in the classroom. (40:35) The lack of c rite ria for selecting learning experiences may be due to the lack of knowledge of the learning p ro cess. It m ay also be due to lack of organization of learning experiences. T y ler stated,... "The p rim ary educational function of organization is to relate the various learning experiences which together com prise the curriculum so as to produce the m axim um cum ulative effect in attaining the objectives of the school." T y ler also proposed that if the experiences provided build upon e a rlie r experiences, th ere w ill be g re a te r depth and breadth in the development of the concepts and sk ills. (4:48) A new approach to education as described by M ary E. Jensen prom oted the audio-tutorial m ethod. Jensen stated, "O akland Community College is dedicated to the application of a su p e r vised, self-in stru ctio n, audio-tutorial method of instruction to achieve the best possible student learning and p erfo rm a n c e." Oakland College su b scrib es to the philosophy that conventional methods of teaching a re basically teach er-o rien ted and that students play a passive role in the learning p ro cess. The college th erefo re has em barked on a system s approach to learning which actively involved the student in the learning pro cess.

51 38 Jen sen described the sy stem s approach as the utilization of m any and varied techniques to accom plish the stated objectives. She stated that the approach dem anded that a ll te rm in al perform ances and specifications be detailed and w ritten in behavioral te rm s identifying the student perform ance at the com pletion of the course. The term in al perform ance and the specifications m ust be form ulated p rio r to offering the course. These a re the detailed descriptions of the "need to know" and "need to do" elem ent of p erfo rm an ce the behaviors the student w ill be expected to dem onstrate at the com pletion of the course. The courses in nursing under the sy stem s approach are set up as g en eral assem bly sessio n s (G. A. S.) and sm all assem bly sessio n s (o r S. A. S.). Jen sen reported a weekly schedule as follows: 1. G. A. S hour, once a week, attended by all students. 2. S. A. S. --h e ld as specified and as needed in each course. 3. L ab o ra to ry --fo r large enrollm ent co u rses, open from 8 a.m p.m., M onday-friday; not open fo r as many h ours in sm aller-en ro llm en t co u rses. Students arran g e th e ir own laboratory h o u rs. N ursing students a re assigned to specific days fo r clinical (hospital) laboratory experience. 4. T estin g --m ajo rity of w ritten te sts a re given in G. A. S. O ral testing m ay be done in laboratory o r S. A. S. Oakland Community College conducted a workshop fo r the college faculty p rio r to the im plem entation of the system s approach. C onsultants from the Instructional M aterials D ivision of Litton Industries had a prom inent role in the w orkshop. Jensen reported

52 39 that p rereq u isite readings w ere required of the faculty before beginning the detailed analysis of the system s approach. T hree of the required readings w ere: P reparin g Instructional O bjectives, by M ager, Why the Instructional System s A pproach, by C orrigan and Kaufman, and An Integrated Approach to L earning, by S. N. P o stle - w ait. (32:42-43) N ursing educators need to be constantly aw are of the changing role of the n u rse and of the so cietal fo rces which contribute to th is change. H enderson m ade the following statem ent, "To what extent nursing can and should control its own destiny is a philosophical question... to deny the existence of conditions conducive to change seem s to m e to deny the lessons of h isto ry." (31:12) The changing role of the nurse should be em phasized throughout the two- y e a r nursing curriculum with p a rtic u la r em phasis given in the nursing sem in ar and post-conference discussions in o rd e r to p re p are the graduate nurse to m eet and accept change. H enderson p ro posed the following as goals tow ard which we m ight work: 1. An understanding of our tim es. The developm ent of nurse philosophers and statesm en, effective citizens who see nursing in relation to other serv ices. 2. N urse participation in planning health se rv ices o r in policy m aking at national, state, and local levels. P ossibly the initiation of new and m ore effective in terd iscip lin ary planning bodies. 3. Development of a stro n g e r professional organization M arriag e of education and serv ice so that students will see practiced the kind of nursing they a re taught.

53 40-5. P lacem ent of a ll nursing education program s within the country* s educational system. This m eans seeking le g islation fo r support of public nursing schools and developing endowments fo r private nursing schools. 6. L ast, and m ost im portant, a recognition by n u rses them selves and by society of the n u rse p ractitio n er equal to that accorded the nurse ad m in istra to r and teach er. (31:43) Sum mary The selection of related lite ra tu re presented views of g en eral and nursing educators which contribute to the understanding and the planning of a curriculum. The a re a s discussed w ere values and beliefs, the function of education, the learning p ro cess, c u r riculum theory, determ ination of educational objectives, guides to the selection of learning experiences, c h a ra c te ristic s of a discipline, so cial forces which contribute to the need fo r change in education, the p ro cess of organizing content, the re-education of te ach e rs, c h a ra c te ristic s of a new nursing tw o-year program, an experim ental au dio-tutorial system s approach to learning, and the changing role of the n u rse. These p a rtic u la r a re a s w ere chosen to a s s is t the nurse educator, faced with the problem of developing a new curriculum, in recognizing the various concepts of curriculum planning which m ust be studied in depth p rio r to the selection of subject m aterial.

54 CHAPTER III METHODOLOGY AND PROCEDURES Introduction A tentative proposal of the present study was outlined, in b rie f form, at a m eeting on O ctober 11, 1965, which was attended by the P resid en t of the Lansing Community College, H ospital A d m in istrato rs, D irecto rs of N ursing Service and the D irecto rs of N ursing Education of the g re a te r Lansing a re a. This group p re viously acted in an advisory capacity for the need and feasibility study. The group had no fu rth e r suggestions for the study but asked that they be kept inform ed of the p ro g ress m ade and offered to a s sist in any way they could. A m eeting was held on D ecem ber 10, 1965,' with the P resid en t and the A dm inistrative Council of the college. The p u r pose of this m eeting w as to acquaint the council with the proposal for the study and to explain asso ciate degree nursing program s in general. The council m em bers (Deans of each departm ent in the 41

55 42 college) w ere enthusiastic about the proposed study and agreed to discu ss the proposal in departm ental m eetings. Following this in itial discussion of the proposal at d ep a rtm ental m eetings, a reg u lar schedule of m eeting was planned with departm ent heads and faculty who would be p rim arily concerned with the planning of an asso ciate degree nursing program. The N ursing Education Consultant from the M ichigan Board of N ursing was included in these weekly m eetings. O thers included in these m eetings w ere the D irecto r of the L earning R esource C enter, the D irecto r of the A udio-visual C enter, the R eg istrar, and the D irecto r of Counseling at the L ansing Com m unity College.. Separate conferences w ere held with M iss M ildred Seyler, * the N ursing Education Consultant from the M ichigan Board of N u rsing. T hese conferences w ere valuable in presenting steps which should be considered when a program of this nature is being considered fo r a community college. C urrent lite ra tu re on the a s s o ciate degree program s was explored and discussed. P roblem s, which o th er com munity colleges had faced, and are facing, in establishing th is type of program w ere also explored. D r. M ildred Montag, P ro fe sso r of Nursing Education, T eachers College, Columbia U niversity, also served as a consultant by m eans of telephone group conferences.

56 43 Sources of Data The data collected fo r the p resen t study cam e from a v ariety of so u rces. The in itial source was basic data collected fo r the exploratory need and feasibility study conducted fo r the Lansing Community College This data is discussed in this chapter under the heading "P ro ced u res fo r D ata C ollection." O ther so u rces in the g re a te r Lansing area: Interview s w ere held with the four H ospital A dm inistra to rs, the four D irecto rs of N ursing and twenty Head N urses to determ ine the clinical a re a s which m ight be utilized in each of the four a rea hospitals fo r the best clinical learning experience for the asso ciate degree nursing student. Interview s w ere held with staff n u rses in the four are a hospitals to determ ine th e ir understanding of the philosophy and objectives of the new asso ciate degree n u rs ing program s. M eetings w ere then scheduled, according to clinical division, for groups of staff n u rses so that common questions about the program could be discussed. Interview s w ere held with the d ire c to rs of the following community health agencies: The V isiting N urses

57 44 A ssociation, Public H ealth N ursing D ivision-ingham County Public H ealth D epartm ent, M ental H ealth C linic, Child Guidance C linic, Spartan Day N ursery, R ehabilitation C enter, and the M onticello and P ro v in cial N ursing H om es. T hese interview s w ere held to determ ine how these com m unity health agencies could p articip ate in the asso ciate degree nursing program by providing field observational experience fo r the student n u rses. Inform al discussions w ere also held with som e of the staff m em bers of these agencies. C onferences w ere held with the N ursing Education Consultant from the M ichigan Board of N ursing to investigate the steps which would need to be followed to m eet the requirem ents of the Board to establish an asso ciate degree nursing program. C onferences w ere held with D r. M ildred Montag, founder of the asso ciate degree nursing program s and P ro fe sso r of N ursing Education, Columbia U niversity. T hese conferences w ere held via Bell Telephone Conference System. The purpose of the conferences was to have the guidance of D r. Montag in selecting science co u rses fo r the curriculum.

58 45 C onferences w ere also held with two m em bers of the N ational League fo r N ursing A ccreditation visiting team. T hese conferences w ere held to review the developm ent of the curriculum. Interview s w ere held with the d ire c to rs of the two schools of nursing and the d ire c to r of the p ractical nursing center to determ ine the days and hours these students w ere using the clinical facilities in the four a re a hospitals and how, with planning, a new nursing program could also utilize these facilities. Inform al discussions w ere also held with the nursing faculty and students of these schools to explain the philosophy and purpose of the asso ciate degree nursing program. Group m eetings w ere held with A dm inistrative officials and faculty m em bers of the Lansing Community College relative to educational facilities available and general education co u rses offered which m ight be considered for the new nursing curriculum. A ssociate D egree N ursing P ro g ram s reviewed w ere those in operation in M ichigan--at D elta College, U niversity C enter; F lint Community Ju n io r College,

59 46 Flint; Henry F ord Community College, D earborn; Highland P ark Community College, Highland P ark, D etroit; Kellogg Community College, Battle C reek; Macomb County Community College, W arren; Petoskey Community College, Petoskey; P o rt Huron Ju n io r C ollege, P o rt Huron; N orthw estern Michigan College, T ra v erse City; and Schoolcraft Community College, Livonia. Surveys of the four m ajo r hospitals in the Lansing a re a w ere conducted to determ ine clinical facilities fo r stu dents in the a re a of m edical-su rg ical, o b stetrics, p ed iatrics and psychiatric nursing. A review was m ade of w ritten requirem ents for a school of nursing from the National League for N ursing, M ichigan League for Nursing, M ichigan Board of N u rsing, State Board of Education, and requirem ents for an associate degree at the Lansing Community College. P ro ced u res fo r Data Collection The need and feasibility study conducted fo r the Lansing Community College from was reviewed with the N ursing Education Consultant from the M ichigan Board of N ursing. It was

60 47 determ ined that surveys of clinical and educational facilities be made for purposes of the p resen t study and that the recom m endations of the f ir s t study be review ed. The recom m endations w ere: 1. The en tire college faculty be m ade aw are of the philosophy and objectives of the asso ciate degree nursing program. 2. Investigate the need fo r an A dvisory Council. 3. The Michigan Board of N ursing Education C onsultant's se rv ic es be requested fo r the pre-planning phase of the program. 4. Appointment of the D irecto r fo r one y e a r previous to the adm ission of students to the program. 5. Appointment of nurse faculty m em bers at least six months previous to the adm ission of students to allow tim e fo r planning. 6. Academ ic appointm ents fo r the D irecto r and faculty to allow tim e fo r advanced study. 7. Check with the National League for N ursing and the M ichigan Board of N ursing fo r approval of the use of the Lansing G eneral O steopathic H ospital for clinical experiences. 8. Investigate scholarships available for students entering this program.

61 48 9. An application be m ade fo r a grant under the N urse Training Act of 1964 to provide funds fo r building and fo r curriculum planning fo r the A ssociate D egree P ro gram. (Appendix D) 10. The N urse D irecto r and faculty m eet with other D irecto rs of A ssociate D egree N ursing P ro g ram s in Michigan to determ ine the course of action in planning fo r the P sy ch iatric N ursing Course. 11. The M edical Society, hospital and other health agency personnel be given detailed inform ation of the philosophy and objectives of this program. (48:45) These recom m endations w ere discussed with the P resid en t and adm inistrative council of the college; the outcome of these d iscussions was that the w rite r was appointed N urse D irecto r of the A ssociate D egree Nursing P rogram with one y ear available fo r planning p rio r to the opening of the program. The adm inistrative council did not consider it advisable to appoint nurse faculty fo r the planning period due to the estim ated cost of the program. Catalogs, brochures, and other published m a te rials w ere reviewed on the Michigan A ssociate D egree Nursing P ro g ram s, and v isits w ere m ade to each of the colleges previously noted. D iscussions w ere held with the faculty of each program on curriculum

62 pattern s, m ethods of teaching and evaluation, and problem s encountered in establishing and im plem enting the program s. Surveys w ere conducted at the four m ajo r hospitals in Lansing to determ ine clinical facilities and at the Lansing Community College to ap p raise the educational facilities. Summary Schmidt has stated, "The quality of adm inistrative support appears to be the hidden facto r that influences the successful estab lishm ent of asso ciate degree nursing program s in community co lleg es." (38:84) It is im portant to note that each stage of developm ent fo r this program was discussed with adm inistrative officials of the college. Quality of support from adm inistration is dependent upon full aw areness of problem s and possible solutions--one of the m ajo r beginning resp o n sib ilities of the N urse D irecto r. It is equally im portant that faculty im m ediately concerned with the planning of the program be kept fully inform ed of a ll developm ents. As stated, th is was accom plished through form al and in form al group m eetings and conferences. The recom m endations, from the need and feasibility study, which w ere pertinent to this phase of planning w ere investigated.

63 50 Surveys w ere m ade of clinical and educational facilities and the inform ation com piled fo r the study.

64 CHAPTER IV BASIC DETERMINANTS OF A NURSING CURRICULUM In troduction The in creased demand fo r nursing serv ic e is due to both an in c re ase in population and to social changes which have resulted in an in c re a se in the se rv ic es which n u rses a re expected to perform. The num ber of n u rses needed for the future can only be estim ated. A projection, published by the National League for Nursing, suggests a need of 700, 000 fo r 1970 in the United States. The Michigan Board of N u rsin g rep o rt stated, P ro g ram s in nursing education leading to reg istratio n a re p ro vided in hospital schools, in com munity colleges and u n iv ersities. D espite the existence of these program s the supply of reg istered n u rses is not keeping pace with the population in Michigan. Based on the population to be served, M ichigan ranks 27th among the 50 states in reg istered nurse supply. M ost alarm ing is M ichigan's downward trend in the num ber of reg istered n u rses p e r 100, 000 people to be served while the national average has shown a steady gain. An additional source of reg istered n u rses is being developed as a resu lt of the participation in nursing education by an increasing num ber of community colleges. The 2 -y e a r nursing program s in com munity colleges have experienced a dram atic 51

65 52 growth and expansion in the p ast y ears and a re the fastest growing type of nursing education today. (41:20) The need fo r n u rses in the g re a te r Lansing a re a is discussed under "Com m unity Need and F easibility" in th is chapter. The requirem ents to be m et in establishing an asso ciate degree nursing program a re reviewed on the national, state, and local level, and included in the plans fo r establishing the new p ro gram. These requirem ents a re also discussed in this chapter. The surveys of clinical and educational facilities a re analyzed and suggestions a re m ade a s to p ro p er use of the facilities within the plan for this program. Community Need and F easib ility In the exploratory study dealing with the need and feasibility of a tw o-year nursing program for the Lansing a re a, the question was asked, "Is th ere a re a l need fo r m ore n u rses in the g re a te r Lansing a re a? " Since em ployers a re the best indicators of need, and fo r the purposes of the p resen t study, interview s w ere held with the cu rren t adm in istrato rs and d ire c to rs of nursing serv ice in the four hospitals in Lansing. The above question elicited the following answ ers as indications of need: 1. The rise in population continues to su rp ass e a rlie r p ro jections.

66 53 2. H ospital expansion pro g ram s a re being studied continually and a re being revised to m eet the m ost im m ediate needs of the com munity. 3. T here is a shortage of n u rses today--how w ill expanded facilities be staffed? (The d ire c to rs of nursing serv ices listed 61 R. N. budgeted position v acan cies.) 4. The num ber of graduates from the two schools of n u rs ing in the a re a is much too sm all to m eet the need fo r general duty n u rses. a. The m ajority of graduates from the baccalaureate program en ter teaching, public health, ad m in istrative o r other su p erv iso ry positions upon graduation. b. The m ajority of graduates from the diplom a p ro gram eith er rem ain at the hospital w here they a re trained, retu rn to th e ir home area, o r en ter p o sitions in other health agencies. 5. Due to the rise in population, a la rg e r percentage of "new" doctors open p ractices, nursing hom es in crease in num ber, the Public Health D epartm ent, V isiting N urse A ssociation, and Red C ro ss a ll anticipate needs for an in crease in s ta ff--a ll utilizing the serv ices of the R. N.

67 54 When these sam e em ployers w ere asked how an associate degree program m ight help to alleviate som e of the above problem s, th ere was a g eneral consensus on the following points: 1. Students train ed in th e ir home a re a m ight rem ain afte r graduation. a. Student could be m a rried and live at hom e. b. M ore m ale students m ight en ter the profession. c. Students generally m ight enjoy a com bination of cam pus and home so cial life. 2. The cost of such a program would be shared by the student and the com m unity--and not be reflected in higher cost to patients. N urse educators have been aw are of, and concerned with, the lim ited num ber of graduates from schools of nursing. It is obvious that an in creased num ber of n u rses m ust be prepared, and it is equally evident that the asso ciate degree nursing program may be a p artial solution to the problem of a shortage of n u rses in L ansing, M ichigan. Many students enrolled as freshm en at the Lansing Com m unity College have not selected m ajo r a re a s for study and a re listed as non-preference students. Would ah asso ciate degree p ro gram a ttra c t these students? A ccording to d ire c to rs of other

68 55 pro g ram s in M ichigan, the. num ber of applicants exceeds the num ber which can be adm itted. A nother question which is raised frequently: W ill th is p ro gram, if instituted in the local com munity college^ d etra ct students from the two existing schools of nursing? Montag* s point would apply to this question when she sta tes, "C ertain individuals who m ight otherw ise not have been attracted to o r able to attend another type of nursing school found these pro g ram s p artic u larly d esirab le and a c c e s s ib le." (13:340) High school graduates and high school counselors raised the question: What advantages a re th e re to the student in a tw o-year college nursing program? L ite ra tu re from the League Exchange lis ts the advantages as: 1. Schooling is directed by education-centered institutions ra th e r than by serv ice-cen tered hospitals. 2. T here are b e tter facilities fo r general.education. 3. T here is le ss duplication and repitition with resultant reduction in tim e needed to com plete the training. 4. T here is b e tter d irect-lin e com m unication between the com munity college and high school counselors than is possible between high schools and hospitals. (24:2) National and Regional H equirem ents The National League fo r N ursing, D epartm ent of A ssociate D egree P ro g ram s, published a revised edition of the " C rite ria for the Evaluation of Educational P ro g ram s in N ursing Leading to an

69 56 A ssociate D egree" in This publication lis ts c rite ria which a re requirem ents to be followed in establishing a new program. "The organization, the adm inistration, and the policies of the unit in nursing a re in accord with the g en eral policies that govern the organization and the adm inistration of other units in the college that offer program s of com parable type and academ ic le v e l." (26:10) listed as c rite ria : Under organization and adm inistration the following a re I. The organization and the adm inistration of the unit in n u rs ing a re com parable to those of other units within the college with resp ect to: A. R elationships with the adm inistrative authorities. B. R elationships with o th er units. C. P riv ileg es, resp o n sib ilities, and policies. D. R epresentation on cen tral councils, com m ittees, and o th er agencies of the faculty. E. Publicity and recruitm ent. F. L ong-term planning. II. The college adm inistration provides fo r the reso u rces and the facilities needed by the unit in nursing to achieve its purpose. A. F inancial support to im plem ent the objectives of the unit in nursing is assu red, with provision fo r the budget and its operation m ade in accordance with college policy. B. T here a re contracts o r agreem ents covering the use of any p art of the facilities of another agency o r in stitu tion. 1. Such contracts o r agreem ents a re initiated by the college, a re in w ritten form, and a re periodically reviewed by the p arties thereto. 2. Such contracts o r agreem ents ensure that the faculty m em bers have control of the students and freedom to teach and guide them and to select the patients assigned for nursing laboratory experiences in consultation with the appropriate m em bers of the agency staff but unham pered by obligations to provide nursing serv ice. (26:5)

70 57 The section on curriculum developm ent and program of in stru ctio n provides the following guidelines: The curriculum reflects the philosophy and the objectives of the program in nursing. It is developed and revised by the faculty in nursing in accordance with college policy. I. The nursing program is developed to fulfill the stated objectives, the college requirem ents fo r the asso ciate degree, and the state requirem ents fo r eligibility to w rite the State Board T est Pool Exam ination. A. The objectives of each nursing course reflect the purposes of the program and a re periodically reviewed by the faculty in nursing. B. The curriculum includes the a re a s in nursing, natural sciences, social sciences, and the hum anities. II. The nursing curriculum dem onstrates the generally accepted pattern fo r asso ciate degree education and is co n sisten t w ith the college policy. (26:11) The above c rite ria fo r evaluation of associate degree n u rs ing program s w ere studied and discussed with the N urse Study Group and the adm inistrative council of the Lansing Community College. It was agreed that these requirem ents could be m et. State and College Requirem ents At the sta te lev el, the M ichigan B oard of N ursing has published a booklet, Minimum Standards and Educational C rite ria fo r Schools of P ro fessio n al N ursing in M ichigan, 1964, which lists the following as requirem ents for the curriculum of an asso ciate degree program in nursing: A. The curriculum shall be consistent in quality with other asso ciate degree program s in the college:

71 58 1. The program should be planned within the college calendar and m eet the requirem ents for an asso ciate degree. 2. T here should be a reasonable balance between general and nursing education co u rses. 3. The nursing curriculum shall be organized to help the student develop knowledge, sk ills, and attitudes which a re essen tial fo r beginning p ractice as a nurse. 4. P rep aratio n insuring nursing com petencies should be provided through selected and supervised experiences. 5. C redit hours fo r lectu re and clinical experience shall be consistent with the existing college pattern. 6. The ratio of students to in stru c to r in clinical experience should not exceed 10:1. B. The study, developm ent, im p lem en tatio n, and evaluation of the nursing curriculum sh all be the responsibility of the nursing faculty and the college adm inistration: 1. Studies in nursing of a sta tistical, experim ental, and follow-up nature, should be conducted by the d e p a rtm ent in the college charged with th is responsibility in cooperation with the nursing departm ent; and, 2. Cooperative planning, problem solving and evaluation between the nursing and college faculty and the nursing departm ent and cooperating agencies a re essen tial for the effective conduct of the p ro g ra m. (33:35-36) E ligibility to w rite the state board exam inations is dependent upon the successful com pletion of a nursing education program which has the approval of the M ichigan Board of N ursing. The application to take the exam inations is m ade following the com pletion date, and m ust be signed by the d ire c to r of the program and m ust be notarized. The M ichigan State Board of Education also req u ires that a course in P o litical Science (or equivalent) be included in the c u rric ulum.

72 59 The procedure fo r receiving approval from the Michigan Board of N ursing to estab lish an asso ciate degree nursing program was not established during the tim e this study w as being conducted. Steps suggested by the N u rse E ducation C onsultant w ere followed: The d ire c to r of the nursing program subm itted a proposal to the M ichigan Board of N ursing which described in detail a ll proposed asp ects of the curriculum, proposed budget, proposed faculty, p ro posed date of adm ission of students, and num ber of students to be enrolled in the firs t class. This proposal was approved by the M ichigan Board of N ursing. Conferences w ere then held with the Consultant on each a re a of the p ro p o sal--th ese conferences w ere also attended by the adm inistrative officials of the college. Approval of the program is given by the board a fte r the program is in o p eration. Any change? in the curriculum m ust be approved by this board. The requirem ents for an A ssociate D egree to be m et at the Lansing Community College w ere: 1. Com plete a tw o-year course of study adapted to needs, in te re sts, and capacities, and conform to a plan acceptable to the College. The course of study should: (a) be suitable fo r tra n sfe r to adm it the student to the level of upperdivision work in a fo u r-y ear college of h is choice; o r (b) form a program of study to be com pleted at the end of two y e a rs at the Lansing Community College. 2. M aintain a m inim um grade point average of E arn tow ard graduation at le ast 30 cred its in attendance at Lansing Community College. 4. F ile with the R e g is tra r's Office a petition for graduation one te rm preceding the term of graduation.

73 60 5. Satisfy all g en e ra l and specific requirem ents of Lansing Community College including fulfillm ent of a ll financial obligations. 6. Be in attendance at the com m encem ent ex e rcise of his class u n less a petition of basence is approved by the P resid en t. 7. Have the approval of the faculty and the Board of T ru stees. A ssociate deg rees a re granted to all who m eet the graduation requirem ents. (44:9) The asso ciate degree nursing program could m eet the above requirem ents with the exception of 1. (a). Survey of Educational F acilities at the i Lansing Community College The educational facilities at Lansing Community College could be utilized for a beginning class of n u rses. However, p ro jected enrollm ent figures pointed out the possibility of crowded c la s s room s in the n e a r future. The addition of a probable cla ss of forty nursing students would create heavy teaching loads in the A rts and Sciences D epartm ent and would require additional faculty. Proposed building plans, which m ay be utilized in the n ear future, include plans fo r a professional nursing program. Included in these plans a re lectu re-d em o n stratio n room s, classro o m s, m u ltipurpose room s, and faculty office space. The following points are recom m endations which should be used as a guide for new program s from the U. S. D epartm ent of Education, Health and W elfare study, N ursing Educational F a c ilitie s:

74 61 A. To provide flexibility fo r future expansion, it is reco m m ended that: 1. L ecture room s be planned to accom m odate the m axim um enrollm ent projected. 2. The num ber of sm a lle r classro o m s be sufficient to p erm it scheduling additional sections of a class as enrollm ents and faculty in c re a se. 3. Teaching m ethods commonly used th at w ill influence the arc h itectu ra l planning include dem onstration within the classroom and m onitoring of dem onstrations by clo sed -circu it television. The arch itect should be inform ed of plans fo r projecting film s, video tapes and slid es, and the use of tape recordings and other audiovisual aids. B. Space R equirem ents for Teaching: L ecture-dem onstration ro o m --th e room should be designed for film and slide projection. The am phitheater design with tie red seat«> in c re a se s visability of d em o n strations. N um ber of se ats should be determ ined according to the la rg e st projected figure on enrollm ent. C lassro o m s--o n e large classro o m that can be p a rtitioned o r two sm a lle r classro o m s should be provided for sm all lecture discussion groups. M ultipurpose ro o m --th is room should be designed to hold p ediatric and adult hospital units. The firs t y e a r class could be divided into four sections fo r supervised laboratory p ractice. This room should also be scheduled for independent study by the individual student (p ra c tic e techniques). Conference ro o m s--th ese sm all room s a re essen tial fo r the p riv acy needed fo r counseling and evaluative conferen ces for students. P re - and P ost-conference d isc u s sions of patient care a re usually held in conference room s allocated within the hospital o r other health agency. L ib ra ry --th e college lib ra ry should contain referen ces and periodicals which a re specifically designated in a section allocated fo r study in view of in creased enrollm ent. C. Faculty Space P riv acy is a fundam ental requirem ent fo r faculty offices. Each office should accom m odate only one faculty m em b er. If locker space is provided, it can be om itted fro m faculty lounge. 2. A conference room is needed fo r faculty m eetin g s, conferences and work groups.

75 62 3. A dm inistrative space includes offices for the d ire c to r and h e r se c re ta ry. It also provides a lobby reception a re a for v isito rs and space fo r clerk -ty p ists as w ell as for storing supplies. 4. Lounges fo r the faculty as w ell as fo r m ale and fem ale stu dents and v isito rs a re required. L ockers w ill be needed fo r changing from s tre e t clothes to uniform s. 5. Supporting sp a ce includes provisions for storage of educational m edia such as anatom ical m odels, film s, p ro jecto rs, and tape re c o rd e rs. (34:10-13) The proposed building plans for Lansing Community C ollege the Health Sciences building--w ere approved by the Board of T ru stees. The plans included one section on the firs t floor of the science building, which utilized the above guidelines fo r the asso ciate degree nursing program. Survey of C linical F a cilities at Lansing A rea H ospitals F o r the purpose of the p resent study, the hospitals in the Lansing a re a w ere rev isited and a survey conducted to determ ine the clinical a re a s which m ight be utilized for student learning experiences. It was also a suggestion of the N urse Study Group that the understanding and attitudes of hospital personnel, toward an asso ciate degree nursing program, be determ ined while conducting the survey. The N ational League fo r N ursing has, in num erous a rtic le s, stre s se d the significant asp ects to be considered in the selection of clinical agencies. One of these aspects is the a re a of the "in tan g ib le,"

76 63 the values, beliefs, attitudes of the personnel in the agency, which m ay be directed tow ard asso ciate degree nursing education. The League has suggested a serio u s exploration, of the questions of attitudes tow ard a college centered type of educational program, be conducted p rio r to any definite decision on the selection of an agency fo r use for student learning experiences. The d esire to include the asso ciate degree program should be accepted by the nursing serv ice personnel, the agency adm inistratio n, the Board of T ru stees, and the m edical board. It has been stated by the N ursing League that the m ore groups and individuals that become in terested and inform ed of the degree program, the g re a te r the possibility of understanding its purposes and plan of operation. The hospitals surveyed w ere Edward W. Sparrow H ospital, Ingham M edical H ospital, Lansing G eneral H ospital, and St. Law rence H ospital. A ll of the clinical a re a s and serv ice a re a s w ere observed in each hospital. A form was com pleted fo r each hospital showing total bed capacity, patient capacity in specific a r e a s - - M edical-surgical, N ursery, O b stetrics, P ed ia trics, Rehabilitation,. and Intensive C are. (Appendix F) The form also lis ts a ll serv ice a re a s offered in each hospital since students w ere to be assigned to these a re a s on a rotation schedule. O ther inform ation gathered and

77 64 recorded on the survey form was the projected in c re ase of facilities p rio r to and including 1968; the num ber of professional nurse s tu dents and p ractical nurse students utilizing the a re a s for experience, and the staffing p attern showing the cu rren tly employed num ber of R egistered N urses, Licensed P ra c tic a l N urses and N urse A ides. (N urse Aides are train ed on-the-job by the hospital for a th ree o r four week period and a s s is t the R egistered N urse o r Licensed P ra c tic a l N urse in giving patient c a r e.) During the period of tim e covered by the surveys (F eb ru ary - A pril, 1966), interview s w ere held with the d ire c to rs of nursing se rv ic e. Interview s w ere also held with head n u rses in the clinical a re a s--m e d ic a l, surgical, pediatrics and o b stetrics. In addition to the interview s, the day su p erv iso rs and head n u rses in the above clinical a re a s w ere asked to com plete a questionnaire. The q u estions w ere form ulated to a s sist in determ ining the attitude of this group tow ard an asso ciate degree nursing program. (A com posite of the answ ers is contained in the questionnaire--a ppendix E. ) E very w ard in each of the clinical a re a s, in each hospital, w as o b served and the following points checked: C leanliness of patient unit Good lighting and ventilation Sufficient space p er patient unit

78 65 U tility room s cen trally located Clean and unclean a re a s easily identifiable Supplies and equipment for patient care available on each w ard E m ergency tra y s and equipment checked by each shift of personnel N arcotics cupboards kept locked at all tim es when not in use N arcotics checked and signed for by each shift of personnel M edication a re a s--a m p le room fo r preparation of m edications D ietary d ep artm en t--in charge of a ll food serv ice and checking of tra y s W ard clerk s assigned to each ward M essenger serv ice system operating throughout the hospital Conference room available fo r each w ard T reatm ent room available fo r each ward A ll pertinent inform ation on the patient included on the Kardex W ard L ib rary on each unit--containing appropriate cu rren t inform ation on treatm en ts and drugs; a m edical dictionary, hospital policies and procedure m anuals,

79 66 fire and d is a s te r m anuals, and textbook on related clinical care of patients P hysicians o rd e rs noted by head nurse Com plete charting of care given patient recorded on each patient ch art by professional personnel on each shift The resu lts of the survey and observation of the clinical a re a s produced evidence of a good v ariety of clinical learning experiences available for new nursing students in the four a re a hospitals. A reas which did not m eet standards required by the N ational League for N ursing w ere discussed with the hospital ad m in istrato r, d ire c to r of nursing serv ice, and a re a su p erv iso r. It appeared evident that the a re a s which w ere in question could m eet the requirem ents with a m inim um of change. F o r exam ple--the w ard lib ra rie s a ll needed to have updated m a te rials and inform ation available to w ard staff and nursing students. It was also noted that both professional and p ractical n u rs ing students utilize the clinical a re a s between the hours of 8:00 a.m. and noon--m onday through F rid ay. It th erefo re would be n ecessary to schedule m eetings with the D irecto rs of N ursing Service and the D irecto rs of the schools of nursing to form ulate a plan fo r cooperative use of these facilities. It was also evident that additional stu dents could be accom m odated during the afternoon o r early evening hours since the other schools do not schedule these hours.

80 67 Interview s which w ere held with the adm inistrative level in each hospital provided the following inform ation: 1. A d m in istrato rs had a v ery good understanding of the philosophy and objectives of the asso ciate degree n u rs ing program. 2. A d m inistrators expressed w illingness to m ake any n ecessary changes on the w ards to m eet the re q u ire m ent standards set by the nursing school accreditation body--n ational League for N ursing. 3. A d m in istrato rs proposed plans fo r inform ing a ll n u rsing staff and personnel of the philosophy and objectives of the asso ciate degree nursing program. 4. A d m in istrato rs proposed that faculty office space, conference and classro o m s, and student locker space would be m ade available fo r the new nursing program. 5. One of the d irecto rs of nursing serv ice advised that the recruitm ent program be geared to the older women, as w ell as the high school graduate. The other d irecto rs, when questioned in interview, agreed with the prom o- tion of th is idea since the "older" student might be expected to rem ain and serv e the community afte r g raduation. i

81 68 6. The hospital a d m in istra to rs w ere a ll v ery enthusiastic about the plan to develop an asso ciate degree nursing program in the Lansing area. Head n u rses w ere in agreem ent about a definite shortage of n u rses in the Lansing a re a. These n u rses also agreed that they have lim ited knowledge about the asso ciate degree program and th erefo re a re ra th e r skeptical about the type of graduates that m ay be produced. A ll w ere w illing to work with the students and in stru c to rs to provide the best possible learning experiences. F u rth e r study should be m ade by the A dm inistrator of the College and the D irecto r of the A ssociate D egree N ursing P rogram into the possible use of the O steopathic H ospital fo r student clinical experience. Approval for use of these facilities m ust be obtained from the Michigan Board of N ursing and from the National League for N ursing. O ther health agencies C ontacts w ere m ade and discussions w ere held with other health agencies in the Lansing are a. The purpose of these m eetings w as to d iscuss the nature and philosophy of the asso ciate degree nursing program and to determ ine how these agencies could p a rtic i pate in the program.

82 69 The agencies visited w ere the V isiting N urses A ssociation, Adult M ental H ealth Clinic, Child Guidance Clinic, N ursing Hom es, Ingham County Public H ealth--n ursing D ivision, four physicians' o ffices--g en eral p ractice, th ree physicians' offices p ediatricians, Lincoln School--m entally disturbed children, Spartan N ursery, and the R ehabilitation C enter. The personnel in these agencies appeared to be very in terested in assistin g with the learning experiences fo r students, and arran g em en ts w ere m ade for la te r m eetings which would include the n u rsin g faculty. Sum m ary Inform ation reviewed from the study on the need and fe a s i bility of establishing an asso ciate degree nursing program in Lansing, M ichigan, appeared to indicate that a tw o-year nursing program would be a p a rtia l solution to presen t and future needs of the com m unity for an in creased num ber of reg istered n u rses. P rospective em ployers explained the shortage of R.N.' s as being due to, (1) the rapid rise in population, (2) the n ecessary expansion of hospital facilities which then m ust be staffed by a g re a te r num ber of n u rses, (3) the n ecessary expansion of other health agencies which require nursing serv ice, (4) the lim ited num ber of students graduated from the two existing schools of nursing, and

83 70 (5) the nation-w ide shortage which reduces the potential num ber of n u rses that m ight be expected to move to this community from other a re a s. The review of the N ational, State, and the L ansing C om m unity College requirem ents indicated the need for careful planning of the curriculum in o rd e r to m eet a ll of these requirem ents. The re su lts of the survey of educational facilities at Lansing Community College gave evidence that a nursing program could use these facilities with careful planning, and that approval from the M ichigan Board of N ursing would be based on the fact that new facilities would be available in the n ear future. A ccording to the resu lts of the hospital surveys, there w ere m any excellent clinical facilities available for selected le a rn ing experiences fo r students. Many of the hospital units w ere not being used by o th er nursing p ro g ram s, p articu larly on the afternoon schedules. The Lansing Community is rich in related h ealth -serv ice agencies which w ere not adequately utilized in the two existing n u rs ing education p ro g ram s. A thorough study and investigation should be m ade on the utilization of these agencies within the associate degree nursing program. These arrangem ents should be m ade only when nursing faculty a re available and can be included in the planning.

84 CHAPTER V AN EMERGING CURRICULUM PLAN Introduction The national and state curriculum p attern s fo r asso ciate degree nursing program s w ere studied as background m a te ria l for the p resen t study. This chapter deals with the g en eral curriculum p attern s, the philosophy and purpose of the Lansing Community College, the philosophy of the proposed asso ciate degree nursing program, and the general education and nursing education co u rses which evolved into the curriculum pattern fo r the Lansing Community College A ssociate D egree N ursing P ro g ram. The general curriculum p attern s which w ere reported in the National League fo r N ursing 1961 rep o rt w ere found to have rem ained essen tially the sam e a s reported at the biennial convention in A pril, The rep o rt stated that the length of asso ciate degree program s varied from two academ ic y e a rs to two calendar y e a rs. In the m ajo rity of program s, this consisted of four se m e s te rs, o r six q u a rte rs, and one o r two su m m er sessio n s. This 71

85 7,2 v ariab ility in the length of program s is reflected in the num ber of cred its required fo r graduation. These requirem ents range from 64 to 126 cred its. In a study of 44 program s it w as noted that the m edian num ber of cred its was 77. C lass-h o u r credit, which includes independent study, was usually a ratio of 1:1. C redit fo r laboratory was justified when using a 3:1 ratio. G enerally, a fairly even balance was m aintained between the num ber of cred its in nursing co u rses and those in gen eral education. D istribution of the stu d e n t's clock-hour tim es w as usually one-third in g en eral education c la sse s and laborato ries and twoth ird s in nursing c lasse s and laboratory. G eneral education courses included H um anities, Com m unication Skills, B ehavioral Sciences, and P hysical and B iological Sciences. N ursing co u rses w ere divided into the four m ajo r a re a s of Fundam entals of N ursing, M aternal and Child H ealth, M edical-surgical N ursing, and P sy ch iatric Nursing. It was in terestin g to note that the g re a te st variation in the nursing courses was in the a re a of P sy ch iatric N ursing. The p ro g ram s range in this a re a from offering a th ree cred it course which provided two hours of class throughout one se m e ste r and a one-week sum m er workshop to a nine cred it course requiring tw enty-five hours of class and a tw elve-week laboratory. The variation is understandable when a check is made on th is problem in o th er types of nursing program s. Fully qualified

86 73 faculty a re not available and clinical facilities a re not alw ays within easy com muting distance fo r students. The National League 1961 rep o rt stated that P sy ch iatric N ursing was being taught in these ways: (1) including psychiatric nursing experience in m edicalsu rg ical nursing courses, (2) through sh o rt-te rm, intensive courses in psychiatric nursing, (3) through sem ester-len g th co u rses in which in stru ctio n is le ss concentrated. (37:11) A ccording to Montag, the pattern of general education co u rses should not be changed fo r nursing students, though som e n ecessary adjustm ents m ay need to be m ade in the biological and physical sciences. (13:212) One such a re a which needs fu rth e r investigation is the need fo r the inclusion of Inorganic and O rganic C hem istry in the nursing program. Some program s included C hem istry under the course titled "Integrated S ciences." This course introduced the student to the nature of m a tte r and energy, scientific m easurem ents, basic m echanics, and the fundam ental principles of Inorganic and O rganic C hem istry. The second half of this course dealt with a study of specific chem ical integrating system s of the body. Considered also w ere the stru c tu re s and functions of the skeletal, nervous, m uscular, circulatory, digestive, and rep ro ductive sy stem s. It would seem that the integration of so m any basic principles into one course would lead to m ere fam iliarity ra th e r than an understanding of the principles by the student.

87 74 G uidelines, proposed by the N ational League fo r N ursing, and discussed by n u rse educators at the 1967 biennial N. L. N. m e e t ings, provided the following inform ation on purpose and objectives of the asso cia te degree nursing program : Focusing on helping students gain d esired objectives, the n u rs ing faculty reduces repetitive p ractice in the clinical a re a to a d esire d m inim um by, (1) selecting learning experiences in te rm s of student needs and program objectives, and (2) a rra n g ing these experiences in nursing co u rses that closely relate theory, and p ractice. The asso ciate degree program is com plete for its own purpose and is not equivalent to the firs t two y ears of a b accalau reate nursing program. G raduates a re prep ared to give care to patients as beginning g en eral duty n u rses, drawing upon th e ir scientific knowledge and understanding of human behavior and needs. They a re p re pared to develop satisfacto ry relationships with people, to cooperate and sh are the responsibility fo r th e ir patients' w elfa re with o th er m em bers of the nursing and health staff, and to be self-d irectiv e in learning from experience as practicing n u rse s. G raduates of asso ciate degree nursing program s are eligible to take state exam inations fo r licen su re as reg istered n u rse s. (37:10-11) C urriculum p attern s which w ere studied, at the state level, w ere those cu rren tly in effect ( ) at the following M ichigan institutions of higher education: D elta College, U niversity C enter; F lint Com m unity Ju n io r College, Flint; H enry F o rd Community College, D earborn; Highland P ark Com munity College, Highland P ark, D etroit; Kellogg Com munity College, B attle C reek; Macomb County Com m unity College, W arren; P etoskey Community College, P etoskey; P o rt Huron Ju n io r College, P o rt Huron; N orthw estern

88 75 M ichigan College, T ra v erse City; and Schoolcraft Community C ollege, L ivonia. V ariations in the curriculum patterns w ere as g reat between these pro g ram s as they w ere at the national level. It was noted that constant study and evaluation was being c a rrie d on in all of th ese p ro g ram s. The faculty at H enry Ford Com munity College and at D elta College w ere involved in form al re se a rc h to determ ine the best use of au d io -tu to rial equipm ent in the nursing program. The faculty at D elta College also planned revisions of curriculum following the 1967 workshop on P sy ch iatric N ursing at Purdue Univ e rsity. One of the m ost notable changes would be the inclusion of principles of P sy ch iatric N ursing throughout the M edical-surgical nursing course. The integration would require a change in m ethods of teaching and in the assignm ent of student clinical experience. The change would also be a move tow ard m eeting the health needs of the com m unity. Philosophy and Purpose of the Lansing Com munity College The Lansing Community College is influenced by the com m unity to m eet the needs of business, industry, governm ent, and the in creasin g demand of students for higher education. It has a strong

89 76 individual-oriented approach which a ttra c ts students who m ight otherw ise not consider attem pting a college program. The philosophy is contained in the following statem en ts: The College staff, concerning itself with fundam ental q u estions regarding student and college resp o n sib ilities, has determ ined that: 1. The student w ill be aided in realizing his intellectual potential through an individualized approach to his education. Sm all classes and personal faculty guidance w ill aid the student in achieving th is objective. 2. The student m ust be encouraged to b ear responsibility for his educational goals and to pursue academ ic excellence to the lim its of his ability. 3. The student and the institution, aw are that the world is rapidly changing, culturally and technologically, m ust search diligently fo r the tru th concerning the h eritage of this republic and its roots in W estern civ i lization and other cultures as they p ertain to the dignity and freedom of m an. This search should enhance the student* s aw areness of his responsibility as a citizen of h is community, state, nation, and the w orld. 4. The student, w hatever his selected program of study, m ust gain fu rth er insight into his values as these values relate to him self and his fellow man. In accord with this philosophy Lansing Community College has m ade the statem ent that fulfilling and useful life can best be obtained through sound scholarship and training. The college lists the following o bjectives: 1. Contribute to good citizenship by helping students to u n d erstand dem ocratic p ro cesses. 2. P re p a re the student to m ake a contribution to the economic life of h is community. 3. Expose the student to our cultural, social, scientific, and sp iritu a l heritage out of which he m ay construct a satisfying and consistent world view by which to guide h is life. 4. F o ste r se lf-relia n ce on the p art of the student by encouraging him to think critic a lly in solving problem s.

90 77 5. Encourage the student to p articip ate in som e form of satisfying creativ e activity and in appreciating the creativ ity of o th ers. 6. Develop w ithin the student in creased understanding of the political and socio-econom ic problem s confronting our nation and the w orld contributing to a sense of social responsibility. 7. Help the student to understand h is relationship to his biological and physical environm ent so that he m ay b e tte r adjust to and im prove that environm ent. 8. Develop w ithin the student an appreciation and understanding of the contributions afforded by other id eas, races, and relig io n s. 9. Develop within students sk ills in w riting, speaking, reading, and listening which lead to im proved self-ex p ressio n and com m unication. (44:9) T hree m eetings w ere held with the ad m in istra to r of the college, the a r t s and scien ce faculty, the n u rsin g education consultant, and departm ent chairm an fo r the purpose of discussing the philosophy and purpose of the college and the philosophy and purpose of the asso ciate degree nursing program. The a re a s discussed w ere those reviewed in C hapter II: Review of Related L ite ra tu re in this study: the function of education, the learning p ro cess, values and b eliefs, determ ination of educational objectives, social forces which contribute to the need fo r change in education, guides to selection of learning experiences, the p ro cess of organizing content, the r e education of teach ers, and the c h a ra c te ristic s of a new tw o-year nursing program. It was the g e n era l consensus of the group that the philosophy and objectives of the college would p ertain and be acceptable to an

91 78 asso ciate degree nursing program. It was stated that a philosophy should be developed by the nursing faculty and d irec to r which would be in accord with the overall philosophy of the college. It was also stated that m ore specific objectives would be developed by the n u rsing faculty fo r the program. Philosophy and P urpose of the A ssociate D egree N ursing P ro g ram It was determ ined by the d ire c to r of the nursing program and the nursing education consultant that the general philosophy (as described in the introduction of th is chapter) should be followed until sufficient nursing faculty w ere available to evaluate the general philosophy and purpose changes. It was n ecessary to state specific objectives in o rd e r that these could be discussed with the a rts and science faculty to a s s is t in determ ining courses and content to be included in the curriculum. O bjectives w ere discussed with Janice O lsen, graduate student at T eachers College, Columbia U niversity, who was undertaking a study of objectives in associate degree n u rs ing p ro g ram s. O bjectives which evolved from the O lsen study w ere: 1. To in crease com petency in expressing thoughts clearly, speaking and w riting p recisely, and gaining understanding through listen in g, reading, and observ in g. 2. To develop fu rth er understanding of ethical values, and social, econom ic, and legal facto rs influencing the practice of nursing. 3. To grow in understanding and ability to develop personal relations that b e tte r enable one to becom e self-d irectiv e

92 79 and to m ake satisfacto ry fam ily, m a rita l, and professional adjustm ents. 4. To gain an understanding and appreciation of the physical and m ental health concepts of the in d iv id u al's needs and thei r inte rre latio n sh ip s. 5. To develop an understanding and ability to utilize basic m ental health concepts a s they apply to the n u rse, to h er patients and to the com munity. 6. To develop understanding of the patient as an individual, a m em ber of a fam ily and a w o rk er in the community. 7. To develop and use judgm ent in the application of principles of the biological and so cial sciences to nursing care including the prom otion of health. 8. To develop the ability to plan, adm inister, and evaluate nursing care (including rehabilitative aspects) of patients with varying nursing needs. To develop the ability to in te rp re t these needs. 9. To coordinate nursing care with the care of m edical and allied professional w o rkers. 10. To develop a basic understanding and ability to utilize available com munity reso u rces in the rehabilitation and care of patients To develop an understanding of the scope and the lim itations of the role of the professional nurse and tren d s which affect nursing. (47:11) These objectives w ere initially accepted fo r the new n u rs ing program by the a rts and science faculty, the nursing education consultant, and the d ire c to r of the nursing program. This group decided that the above objectives w ere those generally stated for o th er asso ciate degree program s in the O lsen study. It w as stated that these objectives should be reviewed and revised as needed by the nursing faculty. The above group held scheduled m eetings to determ ine the general education and nursing education co u rses for the nursing curriculum.

93 80 Following the acceptance of the above objectives the a rts and science faculty, the nursing education consultant, and the d ire c to r of the nursing program form ed a N urse Study Group to determ ine the g en eral education and nursing education co u rses fo r the nursing curriculum. G eneral Education C ourses The College of A rts and Sciences attem pts to confront the student with the full scope of m a n 's knowledge about him self and h is w orld. The curriculum is designed to stim ulate knowledge and understanding of past and p resen t cultural and social forces, and to acquaint the student with the ways in which these fo rces have been in terp reted, thus providing educational reso u rces whereby a student m ay b e tte r equip him self to m ake im portant cultural, social and econom ic contributions to society. Em phasis is given to individual growth and human developm ent and a d e sire to m ake available to all students intellectual training and knowledge that w ill add meaning, breadth, m otivation, and in te re st to th e ir lives re g ard le ss of vocational asp iratio n s. (44:30) The N ursing Study Group, a fte r a s e rie s of eight m eetings, selected the general education co u rses to be offered in the asso ciate degree nursing program. Long discussions w ere held and th ere was n ever unanim ous agreem ent on the co u rses included in the curriculum.

94 81 Each of the various disciplines represented felt that at least a sequence of th ree co u rses in th e ir a re a should be included in o rd e r to m eet the objectives of the program. Since this was im possible, the final decision was reached to offer: English 101, 102, 103; Speech 104; Social Science 101, 103; Psychology 201, 202, 205; Anatomy 201, 202; M icrobiology 203; and C hem istry 101, 102, 103. (Course D escription--a ppendix G) The study group reached the decision on these courses by considering requirem ents for the program and objectives of the college and of the asso ciate degree nursing program. It was suggested that the nursing faculty conduct a continuous evaluation study to determ ine w hether objectives would be m et by the courses offered in the curriculum. It was agreed, by the N urse Study Group, that students should be encouraged to elect courses in the hum anities w herever possible. N ursing Education C ourses The nursing education courses w ere planned with the a s s is tance of the nursing education consultant. An ideal sequence of co u rses would be such that a student would be exposed to the physical, psychological, sociological problem s of the norm al human.being from b irth through se n escen ce. R e alistic ally, one can only approach

95 82 th is type of sequence. The following course d escrip tio n s a re suggestions for d esirable content fo r the proposed nursing education courses. N ursing Education 101 and 102--F undam entals of N ursing This course should be designed to introduce the student to the profession of nursing. It would include histo ry, p ro fessional resp o n sib ilities, and the principles and related p rocedures which a re basic to the understanding of the physical and em otional needs of a ll individuals. Topics studies would be: O bservation of overt and covert needs and nursing intervention; personal and com m unity hygiene; com m unity health reso u rces; basic problem s related to nutrition, elim ination, the need for oxygen, fluid and electro ly te balance, m edical and su rg ical asep sis, adm inistra tio n of m edications, and rehabilitation. Selected clinical experiences would provide the student with the opportunities to identify and apply beginning sk ills in n u rs ing care. This course would cover two te rm s. Faculty teaching the course would determ ine the division of content and the clinical facilities to be utilized. N ursing Education 103--O b ste trics The course should be designed to help the student understand the norm al m aternity cycle. C linical experience

96 83 would be selected to provide the student with the opportunity to develop basic sk ills in giving c a re during labor, delivery, and the puerperium. U tilizing the b asic concepts presented in Fundam entals 1 and II, th is course would provide fu rth er understanding and sk ills in the nursing care of m others and newborn infants. N ursing Education 104--P e d iatric s Selected experiences would be provided for the student in observation and care of the w ell child em phasizing phases of growth and developm ent--as w ell as nursing care of the ill child. Pharm acology and diet therapy would be in te grated. N ursing Education 205 and 206--P h y sical and M ental Illn ess I and II These co u rses would be designed to give fu rth e r concepts of m edical-su rg ical-p sy chiatric problem s of the young adult and adult patient. Em phasis would be placed on the patient, his fam ily, and the com munity. Content would include dynam ics of observation, in terp erso n al relatio n ships of the n u rse and patient and nursing care problem s presented by the m entally and physically ill. N utrition and Pharm acology would be integrated in the firs t term. Selected clinical experience would be provided in the general

97 84 hospital and in a hospital fo r the m entally ill. Faculty teaching these courses would need sufficient background in both m ed ical-su rg ical nursing and psychiatric nursing. N ursing Education 207--S em inar The content would include discussions of professional ethics, tren d s in nursing, professional opportunities, and rese arch in nursing. Selected clinical experiences would provide the opportunity to develop a research design based on a nursing care problem. N ursing Education P racticu m The concepts, sk ills, and understanding n ecessary for com prehensive nursing care would be em phasized. P rin ciples of w ard m anagem ent and adm inistration would be introduced. Supervised clinical experience would be p ro vided during the second half of the te rm in the clinical a re a selected by the student. Specific content and m ethods of teaching would need to be studied and outlined by the nursing faculty. The objectives of each course and the evaluation techniques would also need to be developed. The C urriculum P attern The pattern of courses was arranged with the m ore difficult general'education courses being required the first three te rm s

98 85 during the period when the nursing co u rses would be le ss complex. The second y e a r courses in g en eral education do not have laboratory sections, a re considered le ss difficult, and would be offered at the tim e the nursing education co u rses become m ore complex. The N ursing Study Group accepted the suggestion of the d ire c to r that a "thread of learning" be followed throughout the p ro gram in the a re a of psychology. T herefore, psychology is offered in gen eral education co u rses the firs t th ree te rm s and is integrated and continued in the four rem aining te rm s, in the nursing education. co u rses. Anatomy and chem istry a re offered concurrently with the firs t nursing course. With the background knowledge and u n d erstanding of these courses the student would be b e tte r p rep ared to understand the th ird te rm of chem istry (organic), m icrobiology, and o b ste trics. Offering m icrobiology the th ird term would p rep are the student fo r the m ed ical-su rg ical asep sis section of p ed iatrics. English and speech courses would be offered during the firs t half of the second y e a r to p rep are the student fo r participation in the n u rs ing sem in ar. The integration of psychiatric nursing with m ed ical-su rg ical nursing would need carefu l study and evaluation. C linical ex p e riences would be provided in the psychiatric w ard of a gen eral hospital and in the m ental health clin ic s.

99 86 C urriculum P atte rn F reshm an Y ear C redit Sophomore Y ear C redit F a ll T erm F a ll T erm P sy 201 Introduction 4 Eng 102 C om position 3 Cem 101 Inorganic 3 SS 103 P o litic a l Sci. 4 Ant 201 A natom y/ NE 205 Fhy. /M en tal Physiology 4 Illn ess 10 NE 101 F undam entals W inter T erm W inter T erm P sy 202 P erso n ality 3 Eng 103 Com position 3 Cem 102 Inorganic 3 Sph 1Q4 F undam entals 3 Ant 202 A natom y/ NE 206 Phy. /M en tal P hysiology 4 Illn e ss 10 NE 102 Fundam entals Spring T erm Spring T erm P sy 205 Hu. Grow th NE 207 N u rsin g and Dev. 3 Sem inar 5 Cem 103 O rganic 3 NE 208 N u rsin g Mic 203 M icrobiology 4 P racticu m 10 NE 103 O b stetrics Sum m er T erm Total Eng 101 C om position 3 SS 101 Sociology 4 G eneral Education 51 NE 104 P e d ia tric s 5 N ursing Education These co u rses a re a ll required for the A ssociate D egree N ursing.p rogram. E lective co u rses m ay be added with d e partm ental approval. P sy ---- Psychology Eng English Cem C h e m istry SS Social Science Ant ---- Anatomy M ic M icrobiology NE ---- N ursing E ducation Sph Speech

100 8? The nursing practicum would provide additional clinical experience and supervision in the a re a of the student* s choice. The nursing sem inar would provide the senio r student with the opportunity to spend som e tim e in reviewing and discussing any of the m ajo r clinical a re a s. Tim e would also be provided to discuss with guest le c tu re rs the job opportunities available fo r E. N. *s in various fields such as the arm ed se rv ic es, public health departm ents, visiting nurse associations, school nursing, and others which are not d irectly related to hospital nursing. The previous page gives the com plete listing of the total curriculum pattern fo r the A ssociate D egree N ursing P ro g ram at the L ansing Com m unity College. Summary The general statem ents concerning the philosophy of a s so ciate degree nursing program s reported by the N ational League of N ursing at the biennial m eeting in 1961 w ere reviewed in the in tro duction to this chapter. The N ursing study review of the philosophy and purpose of the Lansing Community College and the proposed objectives for this associate degree nursing program w ere d is cussed. A choice was m ade of g en eral education courses which would m eet these objectives and nursing education courses w ere

101 88 proposed, and from these course selections a curriculum p attern developed.

102 CHAPTER VI SUMMARY, CONCLUSIONS, RECOMMENDATIONS AND SUGGESTIONS FOR FURTHER STUDY Sum m ary This chapter contains a sum m ary of the data presented, conclusions draw n from the data, recom m endations fo r the N urse Study Group at the Lansing Community College and fo r other com munity college groups studying the pre-planning phase for a program of th is nature; suggestions fo r fu rth e r study a re also included. The purpose of this project w as to study the planning and developm ent activ ities n ecessary during the pre-planning phase fo r establishing an asso ciate degree nursing program at the Lansing Com m unity C ollege, L ansing, M ichigan. L iteratu re which could contribute to the understanding and the planning of a curriculum was selected from the a re a s of g eneral education and nursing education--tw o y e a r program s. This related 89

103 90 lite ra tu re was reviewed, and it w as proposed that the a re a s covered should be studied in depth p rio r to establishing a new curriculum. A previous study on the need and feasibility of an a s s o ciate degree nursing program at Lansing Com munity College was re-exam ined. The national, state, and college requirem ents for establishing a new nursing program w ere studied, and surveys of the educational and clinical facilities w ere m ade. M eetings w ere held throughout the study with ad m in istrato rs, college faculty, and the nurse education consultant to determ ine the a re a s for investigation and to draw conclusions fo r the re su lts of the investigations. This group w as called the N urse Study Group. The philosophy and purpose of the college and the g en eral philosophy of asso ciate degree nursing p ro g ram s was studied. D iscussion then led to general education co u rses which would m eet the proposed objectives of the nursing program. N ursing co u rses w ere then proposed. These co u rses, combined with the g eneral education courses, which would m eet the objectives of the college and the nursing program, form ulated the proposed curriculum pattern for the nursing program at the Lansing Community College. C onclusions The following conclusions can be draw n with reg ard to the p urpose of the study:

104 91 1. The N ursing Study Group gave evidence that the sem in ars which w ere held contributed g reatly to the understanding and the planning of the curriculum. 2. The support of the ad m in istra to rs of the college is essen tial if a successful asso ciate degree nursing p ro gram is to be established. 3. It was found that health agencies a re a ll in creasin g in size, the population continues to in crease, n u rses are expected to assum e m ore responsibility, and few er n u rses a re being graduated from schools of nursing. 4. It w as determ ined, by the N urse Study Group, that national, state, and college requirem ents fo r e sta b lishing an associate degree nursing program w ere ra th e r broad and gen eral and could be m et at Lansing Com munity College without difficulty. 5. The survey of educational facilities at the Lansing Community College gave evidence of lim ited facilities at p resen t but plans presented fo r the n ear future assu red very good facilities. 6. The survey of clinical facilities of the four m ajo r hospitals in the a rea indicated that excellent learning experiences could be selected for students. It w as also

105 92 noted that extrem e care m ust be taken in planning and scheduling these facilities due to the num ber of stu dents that would be on the w ards at certain periods. 7. The philosophies of the Lansing Community College and the proposed nursing program w ere studied. It was ' determ ined that the nursing p rogram could become an in te g ral p art of the college since the philosophies w ere com parable. 8. Specific objectives w ere form ulated fo r the associate degree nursing program. These w ere based on the probable needs of the nursing students and on the needs of the com m unity. 9. Eight m eetings of the N urse Study Group resulted in the final selection of appro p riate g en eral education courses and nursing education co u rses w ere proposed. A curriculum p attern evolved from th ese m eetings. Recom m endations 1. It is highly recom m ended that nursing faculty be appointed at least six m onths p rio r to the opening of an asso ciate degree nursing p rogram. Nursing faculty would benefit from all of the planning sessio n s and should p articip ate in all planning.

106 93 2. Studies should be conducted to determ ine the need fo r inclusion of a y e a r o r le ss of chem istry, and if chem is try should be included in an integrated science course. 3. The nursing faculty appointed fo r this program should develop the philosophy and objectives with the d ire c to r of the program. 4. C areful planning w ill be n ecessary fo r u se of the clin i cal facilities due to use by other schools of nursing. 5. Evaluation techniques should be developed at the sam e tim e that definite objectives a re form ulated. 6. Continuous evaluation should take place in o rd er that the c u rric u lu m be continuously im proved. 7. F o rm al agreem ents should be m ade between the college and the health agencies which w ill be utilized fo r stu dent experience. 8. F o rm al agreem ents should contain a statem ent that all in stru ctio n of nursing students would be by college faculty. 9. Scholarships for students should be investigated. 10. A recruitm ent program should be organized for the people of the com m unity.

107 94 Suggestions fo r F u rth e r Study Suggestions for fu rth e r study a re as follows: 1. A study should be conducted by the science departm ent and the nursing departm ent to determ ine the prin cip les which could be combined from anatom y, physiology, chem istry, and m icrobiology into an integrated science course fo r the nursing students. 2. A study should be m ade by the nursing faculty and d ire c to r on the use and participation of community health agencies in m eeting the objectives of the n u rs ing program. 3. A recru itm en t plan should be form ulated to inform and encourage the older age groups (20-45 y ears) in the com munity to consider the tw o-year nursing program as a c a re e r. 4. Investigation should be m ade fo r m ethods of assistin g nursing faculty who have not had the opportunity to teach in a com munity college o r in the tw o-year n u rs ing program. 5. F u rth e r study should be made in the potential u tiliz a tion of the audio-tutorial system s approach in the nursing program.

108 95 6. A follow-up study of graduates should be m ade to determ ine the effectiveness of the asso ciate degree nursing program.

109 APPENDICES

110 APPENDIX A STATE-BY-STATE GROWTH OF ASSOCIATE DEGREE NURSING PROGRAMS

111 APPENDIX A State-by-State Growth of Associate Degree Nursing Programs TOTAL ( * \» W H DAKOTA SOUTH DAKOTA ( D od) CO 0 5 o PUSHTO n tc o 2 VIROIN ISLANDS U lc O

112 APPENDIX B ASSOCIATE DEGREE NURSING PROGRAMS BY HIGHER EDUCATION ACCREDITING REGIONS

113 APPENDIX B Associate Degree Nursing Programs by Higher Education Accrediting Regions NORTHWEST-ALASKA m NUMBER OF AD NURSING PROGRAMS IN REGION ( )% OF NATIONAL TOTAL (281) NEMf ENGLAND MIDOLE STATES ) CO -a & w e st e r n GUAM HAWAII SOUTHERN MEXICO T 8 \ * MIDDLE STRJES DISTRICT OF COUJMMA CANALZONE PUERTO RICO VIRGIN ISLANDS

114 APPENDIX C 10-YEAR GROWTH PATTERN ASSOCIATE DEGREE PROGRAMS IN NURSING NUMBER O F PROGRAM S/ TO

115 98 APPENDIX C 10-Year Growth Pattern Associate Degree Programs in Nursing Number of Programs/ to NUMBER OF PROGRAMS

116 APPENDIX D NURSE TRAINING ACT O F 1964

117 99

118 100 U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Bureau of Health Manpower Division of Nursing NURSE TRAINING ACT o f 1964 Grants to help schools of nursing sharpen their teaching resources and improve their educational programs. The projects are making possible educational improvements that go far beyond the awards to individual schools. Many other schools are already becoming acquainted with better teaching methods resulting from the development of multimedia techniques. Content of specific courses, such as maternal and child health, is also being enriched and made more meaningful in relation to the responsibilities of modem day nursing. Of special and timely importance, this program is encouraging a cooperation among schools that is extending the effectiveness of the very limited supply of well qualified faculty. Awards have been made to 95 schools in 37 States and territories. Although a grant is awarded to a single school, any number of schools of all three types may take part in a particular project, including schools that are not accredited. Thus far, an additional 143 programs are benefiting from these grants by sharing directly in the projects. Of these programs, 64 are associate degree; 51 are baccalaureate; 28 are diploma. An estimated 33,000 nursing students are taking part in educational programs improved under this provision of the Nurse Training Act. 1 Over $7.4 million has been awarded for teaching improvement. Program Schools receivin g grants Funds awarded A ssociate degree $ 236,952 $ 199,904 Baccalaureate $1,436,348 $1,157,854 $2,373,785 D ip lo m a $ 553,216 $ 532,814 $ 945,144 Total $1,989,564 $1,927,620 $3,518,833 September 4, 1967

119 I 101 U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Ruruou of Health Manpower a Diviiion of Nunlng NURSE TRAINING ACT o f Loans of up to $1,000 per year repayable in 10 years with 50 percent forgiveness for 5 years full-time employment as a nurse. mmmmm More than 32,000 loans have been awarded to help nursing students. It is too soon, however, to document the program's effect on the increase in enrollment in nursing schools and on the number of nurses in active practice. During the fiscal year 1967, 655 nursing programs in 52 State* Puerto Rico, and the Virgin Islands received loan funds. Program A ssociate Degree Baccalaureate Diploma G raduate The average loan to a student has increased from $437 in 1965 to an estimated $680 in Program s Amount of loans , A ssociate Degree... $ 14,931 $ 265,177 N. A. Baccalaureate ,501 3,212,107 N.A. Diploma ,651 3,457,438 N. A. G raduate... 17, N.A. Total... $1,599,274 $6,952,359 $12,724, 155 J / Includes Federal capital plus institutional share (one-tenth) from the school. September / Allocated funds.

120 102 U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service bureau of Health Manpower a Division of Nursing NURSE TRAINING ACT o f M M : Matching grants of up to 66 2/3 percent for construction of new schools and major expansion of existing schools. Matching grants of up to 50 percent for replacement or rehabilitation of existing educational facilities. While most of the construction is in the beginning stages, more ' than 2,600 new first year places will result. The schools are showing ingenuity in planning new facilities that are both practical and adaptable to the opportunities of modem education. For example, one award is making possible an up-to-date teaching center that will be used jointly by three hospitals providing nursing education. Since the program began in fiscal year 1966, 71 schools in 29 States, Puerto Rico, and the Virgin Islands have received grants. It is significant that 62 of the awards have gone for replacement of obsolete buildings, thus maintaining student places that might otherwise be lost and providing settings in which quality education can occur. Nine new schools have received this Nurse Training Act support. During the first 2 years of operation, over $37.7 million has been awarded for construction. Program and awards Total A ssociate Degree No. of grants... Funds awarded... 8 $ 2.353,517 2 $ 585,864 6 $ 1,767,653 Baccalaureate No. of grants... Funds awarded $19,886,045 8 $4,907, $14,978,534 Diplom a No. of grants... Funds awarded $15,494, $5,559, $ 9,935,093 September 4, 1967

121 103- U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service bureau e f Health Manpower Q Division of Nursing NURSE TRAINING ACT of This is a broadly based program of support to schools and students of professional nursing intended to increase the numbers of practicing nurses and to improve the quality of education. Appropriations of $283 million over a 5-year period are authorized. (In thousands of dollars) ir T O V la X O li F iscal years Total Construction... Project grants... Formula grants... Traineeships... Loans to students. 2, , , , , , ,000 25, , , T otal... 17,100 42, , ,300 81, ,000 Public and nonprofit private associate degree, baccalaureate^ and diploma schools of nursing are eligible to apply provided they meet the requirements for educational quality contained in the legislation. For other than two provisions ~ the Professional Nurse Traineeship Program and Payments to Diploma Schools programs must be accredited by a body or bodies designated by the Commissioner of Education or have demonstrated that there is reasonable assurance they will meet accreditation standards within a specified time. Colleges and universities participating in the Professional Nurse Traineeship Program must have approved nursing programs that provide an academic degree in nursing for registered nurses. To be eligible for payments to diploma schools, nursing programs must be fully accredited. Schools E ligible to Participate in the Nurse Training Act: Septem ber 1967 Compared to January 1965 Type program January 1965 Septem ber 1967 Total number of schools Total eligible Total number of sch ools Total eligib le Diploma A ssociate D egree Baccalaureate Total , September