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Keller, Marjorie -; May, W. TheodoreOccupational Health Content in Baccalaureate Nu. sing

Education.Public Health Service (DHE. Cincinnati, Ohio.

PHS-Pub-217671126p.Superintendent of Docum nts, U.S. Government PrintingOffice, Washington, D.C. 20402 (HE 20.2802N93; S/N1716-0002; $1.25)

MF-$0.65 HC-$6.58Achievement Tests; Bachelors Degrees; *conceptualSchemes; *content Analysis; Course Content;*Curriculum Evaluation; Educational Research; *HealthOccupations Education; Inservice Education; MastersDegrees; *Nursing

A 4-year project was conducted at the'University of

Tennessee College of Nursing to identify occupat onal health nursing

content essential in baccalaureate education for professional

nursing. In the process of determining content, a review of relevant

literature was male, and a theoretical framework was developed which

consisted of an integration of Leavell and Clark's levels of

prevention approach to health care, and Maslow's hierarchy of needs

personality theory. This theoretical combination resulted in 25

categories, each labeled with a level of prevention and basic human

need. Within each category, competencies needed by a nurse in

occupational health care were identified, and corresponding academic

content was identified and delineated into educational levels(baccalaureate, graduate, and inservice). The theoretical framework

was then utilized to assess the content of one baccalaureate nursing

program. Data were collected by observing classes over a 3-year

period, and a content analysis was conducted. Findings revealed th t

the theoretical framework provides a method for structuring the

curriculum desired and that the methodology can be applied to all

aspects of the nursing curriculum. In addition to content analysis

items for an achievement test were developed and a standardization

process was started. (SB)

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f

Occupational Health Contentin Baccalaureate Nursing Education

Marjorie J. Keller, R.N., B.S. N. , M.S.Assistant Professor of Nursing

andPrincipal Investigator

The University of Tennessee College of Nursing

in association with

W. Theodore May, Ph. D.Associate Professor, Department of Psychiatry

The University of Tennessee College of Medicine

The work upon which this publication is based was performedpursuant to Contract No. PH-86-64-66-106 and PH 86-66-179with the U.S. Public Health Service, Department of Health,Education, and Welfare. Contract Project Officer: MissMary Louise Brown, Chief Nurse, Bureau of OccupationalSafety and Health, Public Health S ervice, Department of Health,Education, and Welfare.

U.S. DF:PARTMENT OF HEALTH, EDUCATION, AND WELFAREPublic Health Service

National Institute for Occupational Safety and Health

Cincinnati. Ohio U$. DEPARTMENT OF HEALTH,EDUCATION & WELFAREOFFICE OF EDUCATION

THIS DOCUMENT HAS BEEN REPRO-DUCED EXACTLY AS RECEIVED FROMTHE PERSON OR ORGANIZATION ORIG-INATING IT. POINTS OF VIEW OR OPIN-IONS STATED DO NOT NECESSARILYREPRESENT OFFICIAL OFFICE OF EDU-CATION POSITION OR POLICY.

Public Health Service Publication No. 2176Reprinted 1971

For sale by the Superintendent of Documents, U.S. Government Printing Office ashin- on, D.C. 20402 - Price $1.25tock Number 1716-0002

ii

FOREW ORD

Nursing leaders have long recognized the significance andcontribution, both real and potential, of occupational health nursingas part of the nursing force in this country. In 1963 an ad hoccommittee phi-pointed the need for clarification of the essentialsof occupational health nursing in relation to the baccalureatenursing curriculum. Steps initiated by the committee led to thestudy herein described.

The project was conducted with an open and investigativeapproach. Its course was influenced throughout by the dynamicnature of nursing itself and the significant changes occurring inthe health field during the years of its activation. These influencesare reflected in the delineation of the role of the occupational healthnurse and in the resulting framework for curriculum study anddes ign

The focus of the project as completed extends beyond theoccupational health setting. As interest and conviction have grownregarding the scope and significance of comprehensive healthplanning and care, so nursing, with other health professions, hasmoved from restricted settings into broad community focus.

This then is the base, in education and service, from whichthis study is derived. And this is the core, with its changingconcepts of health and health practice, which has shaped itsmethodology and findings.

The project is itself a beginning step, reflecting as it pro-gressed the changing currents of our time in professional educationand service. It is our hope and belief that the framework andmethodology, and the subsequent fthdings and recommendations,will form a sound base for continuing study and implementationdestined to strengthen both nursing education and nursina practice.

Julia Dupuy SmithProject DirectorProfessor of Public Health NursinCollege of NursingThe University of Tennessee

(*Now retired)

iii

PREFACE

This manual presents a methodology for identifying specificcontent in a curriculum. It further presents the utilization of thismethodology in delineating the occupational health nursing contentin baccalaureate nursing education and suggests its application tograduate education. The process and content should be of valueto individuals concerned with nursing education and nursingpractice.

In each chapter the processes involved are clearly described,and the relation between process and content is delineated. Atheoretical framework is presented utilizing an integration of atheory from public health and a theory from psychology. Pertinentliterature is reviewed, competencies and content for occupationalhealth nursing are identified, and realistic immediate and longterm recommendations for leaders in nursing education and forpracticing occupational health nurses are made.

Ruth Neil Murry, DeanCollege of NursingThe University of Temlessee

ACKNOWLEDGMENTS

The Principal Investigator acknowledges with appreciation the

cooperation, assistance, and patience of The University of Tennessee

College of Nursing faculty and students. Speciax acknowledgment

goes to Dean Ruth Neil Murry; Julia D. Smith, ?roject Director;W. T. May, Ph. D. Research Consultant; and the members of the Fac-

ulty Advisory Committee, Mary Morris, Margaret Ann Newman, and

Ruth Bryce. Spec ial Recognition goes to the secretarial personnel in-

volved in the typing and clerical dccails necessary to complete the

project

Appreciation is also expressed to the staff of the Mooney

Memorial Library at The University of Tennessee Medical Units

for their unfailing cooperation. Valuable assistance was also pro-

vided by the librarians at Southwestern-at-Memphis, Memphis State

University, and Memphis and Shelby County Public Libraries.

Particular acknowledgment is made for the contributions of

Mary Louise Brown, Chief Nurse, Occupational Health Program,

who served as Project Officer. Without her interest, efforts, and

support there would not have been a project. The contributions of

Jane Lee andRuthReilschneider, Nurse Consultants, and Lorice Ede,

Program Editor, of the Occupational Health Program in reviewing

and making recommendations regarding the content are gratefully

acknowledged.

In addition, the project personnel and Faculty Advisory Committee

wish to recognize the interest and assistance of the members of the

project's ad hoc Occupational Health Committee: Betty Byers, Anita

Harris, Jean S. Felton, M.D., and Harold Magnuson, M.D.; and the

members of the project's ad hoc Nurse Educators Committee: Ruth

Bryce, Mary Morris, Margaret Shetland, and Catherine Tinkham.v_.

ACKNOWLEDGMENTS (Continued)

Credit goes to E. E. Cureton, Ph D for his encouragementand consultation in the standardization of the achievement test inoccupational health nursing. Acknowledgment is extended to theNational League for Nursing Testing Service and EducationalTesting Service, Incorporated, for their Lnstruction in item writing.

Appreciation is also expressed to the faculty and students ofschools of nursing taking part in the testing aspect of the project.These included _Fiac ific Lutheran University, University of Wyoming,University of Iowa, University of Texas, Florida State University,Texas Woman's University, Indiana University, Northeast LouisanaState College, San Diego State College, California State College atLong Beach, Tuskeege Institute, College of St. Teresa, Universityof Tennessee, Marymount College, Anila College, Duke University,University of Maryland, Goshen College, Brigham Young University,Northwestern State College, Ohio State University, University ofWashington, Arizona State University, Catholic University ofAmerica, GustavAis Adolphus College, and University of Californiaat San Francisco.

Thanks are due to :thany other groups and individuals, toonu emus to mention, who contributed knowingly and unknowingly.

M. Keller

viii

THE THREE BEST THINGSWORK

Let me but do my work from day to day,In field or forest, at desk or loom,In roving market-place or tranquil room;

Let me but find it in my heart to say,When vagrant wishes beckon me astray,"This is my work; my blessing, not my doom;"Of all who live, I am the only one by whom

"This work can best be done in the right way."

Then shall I see it not too great, nor small,To suit my spirit and to prove my powers;Then shall I cheerful greet the labouring hours,

And cheerful turn, when long shadows fallAt eventide, to play and love and rest,Because I know for me my work is best.

Henry Van Dyke(1852-1933)

The Poems of Henry Van Dyke. New York: Charlesuoted by permissionlcrn.ner s Tons,

of the publisher.

CONTENTS

CHAPTER PAGE

Introduction 1

II Review of the Literature . . . . .. . . .. . ....... . . . .... . 7

Education... . .. .. . ........... ... ....... . ..... .. .. . 0 00 7

Nursing 8

Occupational Health Nursing ...................... 0900 00 11

III 'Theoretical Framework... ... . .... .... . .. . .. ..... .. . .... 17Levels of Prevention... .. . ...... . . . ... ..... .. 0000000000 17Hierarchy of Needs ................... . ...... 0 0000.0 09 18

The Integrated Theoretical Model 19

IV Methodology . , , . . 25Development of Competencies and Content 25

Competencies .. . .... .. ...... .......... ...... .. . .. . 29Content , , , i __ . --.. . 30

Validation of Competencies and Content . . 31Utilization of the Methodology... ...... - - - ... 400 32

V Data Analysis_ 00000_ 0_ __ 39Methods. of Analysis.... . . .. ... . . 0000000000.0 39Qualitative Comparison . .. 44Quantitative Comparison ....... .. . . .. .... 44

VI Delineation of Occupational Health Content forProfessional Nursing.... ..... ............ .. .......... . 47.

VII The Achievement Test in Occupational Health Nursing.... 75Development . 75Assessment 77Status 81

VIII Findings .. 000099 . 0 . #000009 . 0 . 0000 . 0000 . 90 0000000 33Theoretical Framework ......................... 660660 . 83

A Methodology for 'Analyzing a Nursing Curriculum_ ... 0.09 85Use of Methodology in Changing the Occupational

Health Nursing Component of BaccalaureateCurricula_ , i _ _ . - . .. _ - , 1±77#90 86

Use. of Methodology in Developing GraduatePrograms _in Octupational H ealth Nursing . ... 009 0 0 0 0000 87

Achievement. Test in Occupational Health Nursing .. ... .... . 87Suggested Learning Experiences for Professional

Nursing Students M.the Work Setting ...... .. .. .. . ... ... 87xi

CO-i--TENTS

CHAPTER PAGE

IX Reco mendations.... 91Immediate Recommendations .. ........ 91Long-Range Recommendations 92

X Summary 95

APPENDIXA History of Education for Occupational Health Nursing:

Mary Louise Brown 99

Rationale for The University of Tennessee College oNursing Curriculum Mary L. Morris 440 113

First Attempt in Fitting Functions and Responsibilitiesof Professional Nurse in Occupational Health intothe Theoretical Framework ........ ........ . . .. . 115

Competencies and Suggested Nursing Actions of theProfessional Nurse in Occupational Health 117

The University of Tennessee College of Nursing404 ............... 4004444 ... 4444 123

xii

10

CHAPTER I

INTRODUCTION

In July 1963, an ad hoc committee, composed of representatives of

the National League for Nursing (NLN) and the Occupational HealthProgram* of the Public Health Service, met to explore ways andmeans for more adequate integration of occupational health nursingcontent into the baccalaureate curriculum. It was the consensus of

this group of nurses that the purpose of the discussion was

not an attempt to make a specialty of occupational healthnursing but rather an attempt to identify content in occu-pational health in relation to the basic curriculum. It isbelieved that in the basic content there is much that isapplicable to the industrial setting or to the nursing of theemployed adult. There is also content from occupationalhealth nursing possibly not presently included that wouldcontribute to the preparation of professional nurses inbaccalaureate programs. (1)

The committee recommended the initiation of a project to test threehypotheses:

1 There is content in occupational health nursing that providesan essential contribution to the preparation of professionalnurses in a baccalaureate program.

2 This content can be identified and taught on a baccalaureatelevel.

This instruction can be evaluated.

It was further recommended that the project be carried out at two

NLN-accredited collegiate schools of nursing in colleges oruniversities having a department of occupational health or publichealth in the medical school and that the persons selected to conductthe project have faculty appointment with freedom to develop theproject. (2)

*The Occupational Health Program is now the National Institute _ r Oc-cupational Safety and Health, Public Health Service, U.S. Departmentof Health, Education, and Welfare.

1

C apter I - In roduction

At a meeting on Februa y 27, 1964, the following general approachwas suggested:

Review, identify, and organize current concepts andlearning experiences in the literature regarding occupationalhealth.

2 Review and iden ify content .and learning experiences withInthe objectives of current school curriculum.

Determine methods of modifying and implementing occupationalhealth components in the program.

4 Help faculty try out and implement the above.

5 Evaluate the project program. (2)

The University of Tennessee College of Nursing and the Boston CollegeSchool of Nursing were selected by the Occupational Health Programof the U.S. Public Health Service as sites at which to conduct thisproject. Each school was to work independently in developing anappreach and in carrying on the project. The Boston College project,which started in September 1964, was planned for one year. TheUniversity of Tennessee project was continued for four and one-halfyears, commencing in February 1965.

This manual is based on the philosophy, approach, methodology, andfindings of the project as pursued at The University of TennesseeCollege of Nursing. A Faculty Advisory Committee for consultation inthe planning and evaluating phases consisted of the incumbent faculty, thechairman of the research committee, and the instructor for the course inscientific methods in nursing. The Dean of the College, the Project Director,and the Principal Investigator met with the Faculty Advisory Committeeas needed. Each visit by the Project Officer included a meeting withthis group. As the project progressed, consultations were held witha committee of occupational health experts and a committee of nurseeducators.

The 1963 ad hoc committee was motivated by historical and existingdevelopments in the fields of occupational health nursing and profession-al nursing education. Their original concerns were influenced byperhaps more significant changes in health concepts, legislation, andplanning than have occurred in any similar timespan in recent history.In particular, a more comprehensive concept of health and the necessityfor change in the delivery of health care services are clearly manifestedin the planning for comprehen % th care for individuals and familiesin their normal environment.

ee ppeti .

health nursing.

2

ac groun e ucaiönor ôcOuaTiähal

Chapter In o uction

(7 8 9 10 11)As writers from various health disciplines ' " have noted, healthcare encompasses more than the traditional preoccupation with thecultivation of sound health habits and the detection of diagnosabledisease entities. The health of the individual and the family mustreflect a well-integrated dynamic balance of physical, psychological,socio-economic, and spiritual factors.

To implement the concept of comprehensive health care there is needfor health professionals who understand, accqpt, and practice promotionof health as well as prevention of disease. (12) Every individual, atany given moment is somewhere on the health-illness continuum; andthe ideal state is to be at the health end, vertical and active. But theworker can apparently be vertical and active and yet be the host ofa latent disease process. Promotion of health for the worker as wellas for the general public includes making the well person a morefully-functioning individual, thereby preventing the completion of theepidemiologic triad (host, agent, and environment) leading to adiseased state.

Technological and social changes in our society are bringing aboutnew ways for the delivery of health care. Since these changes directlyaffect nursing practice and nursing education, nurses must expand theirrole to meet the challenges.

it is imperative that knowledge and utilization of human ecology be madean integral part of comprehensive health planning and care. (ii) Ecologicalfactors, be they from the natural environment, the family, work, school,or community, must be assessed in terms of promotion of or interfer-ence with health. As for the labor force, the increasing population ofthe United States means an increasing number of employees. Projectedfigures indicate that the employee population by the year 2000 willincrease by about 42 million (or about 50 percent) over the present f gure of80 million. (14)

The work setting has been influenced and will continue to be influencedby increasing automation, computerization, unionization, and work-forcemobility, and by decreasing hours at work per week. These all influencehealth. Exposure to new chemical and biological hazards will preSentother problems. Kahn and Weiner have,projected 100 significant techno-logical innovations by the year 2000 (141)

The culturally-different and minority sectors of our population willhave greater numbers in the work force. These individuals bringmulti-faceted health problems to the work setting; for example, poornutrition, high incidence of chronic and infectious illness, and differentpatterns of social and emotional living. (15,16)

Chapter I - Introduction

In the light of the multiplicity of these changes, nursing mustreassess its role as a member of the community healthcare teams. Theseteams will include members representing more than the traditional healthp-rofessions (17 3 18 19) Certainto be included are the consumers ofhealth care services - the indigenous population either at the worksetting or in residential areas. Nurses must be aware of all changesthat affect health. Particularly, in a work-oriented society suchas ours, the influences on health of factors in and out of the worksetting cannot be neglected. Probably every interaction between nurseand the identified patient is influenced ari. some respect by a workenvironment.

In several western countries an emerging awakening of Lnterest in"other than hospital" nursing may be noted in nursing students.Their job preference is towards practice in the comrnunity,(20,21,22,23)and more and more they are beginning to seek positions that involvepractice in community health.

The curriculum evaluation and the course content discussed in thismanual reflect the trends outlined above in the health field and thelabor force.

REFERENCES

1 Minutes from meeting in New York City, July 10, 1963. Attendedby Chairman Rita Kelleher, Dorothy Benning, Mary LouiseBrown, Irene Courtney, and Margaret Shtland.

2 Notes of meeting taken by Julia D. Smith at Washington, D.C.,February 27, 1964. Attended by Chairman Rita Kelleher,Dorothy Benning, Mary Louise Brown, Josephine Cipolla,Jean Grey, Lucy Kennedy, Laura Resengael, Julia D. Smith.

Community Health Nursing, Newsletter, Division on Practice,American Nurses' Association, April, 1968, 3

4 Dunn, Halbert L. High-Level Wellness. Arlin on, Va.R .W. Beatty, inc., 19 6 a

5 Mann, George 3. Future Hospitals Will Go Where the People A e,Modern Hospital 110:84-89, June 1968.

Hilleboe, Herman E. Public Health in the United States in the1970's, American Journal of Public Health 57:1588-1610,Septemb

Chapter ntroduction

7 Hirsch, Sidney, and Abraham Lurie. Social Work Dimensions inShaping Medical Care Philosophy and Practice, Social Work14:75-79, April 1969.

8 Felton, Jean Spencer. Care, Compassion and Confrontation TheCorrectives in The Occupational Mental Health of the Future,Journal of Occupational Medicine 10:331-343 July 1968.

9 Lotzkar, Stanley. Dentistry in Health Care Facilities: The PublicHealth Viewpoint, The Journal of the American DentalAssociation 77111-

10 Branagan, Charles A.Jr. Community Health Care System -Pharmacy's Role, Journal of the American PharmaceuticalAssociation NS9: 6-8-=-Z-9 7-2, Peruary

11 Caplan, Gerald. Principles of Preventive Psychiat y. New York:Basic Books, -IncT,---196-4.

12 Leaven, Hugh Rodman and E. Gurney Clark. Preventive Medicinefor the Doctor in his Community. 3rd edition.Thr-YaFF

c a oo ompany, 65.

13 Hanlon, John J. An Ecological View of Public Health, AmericanJournal of Public Health 59: 4-11, January 1969.

14 Kahn, Herman and Anthony J. Weiner. The Year 2000 - A Frame orkfor Speculation on the Next Thirty- ee ears.TNFTVITFMfllan COT, 1967, p. -195-496.

15 Poverty and Health in the United States A Bibliography ofs rac s. e or e ca an ea esearcsissociation

(37-17ev=rk City, 1968.

16 Winick, Myron and Pedro Rosso. The Effect of Severe EarlyMalnutrition on Cellular Growth of Human Brain, PediatricResearch 3:181-184, March 1969.

17 Geiger, H. Jack. Health Center in Mississippi, Hospital Prac ice4:68-81, February 1969.

18 Barry, Mildred C. and Ce Al G. Sheps. A New Model for CommunityHealth Planning, Arne can Journal of Public Health 59: 226-236,February 1969.

Burnis, Joan B. and William C. Ackerly. College Student Volun-teers in a Child Guidance Clinic, Social Casework 50:282-286,May 1969.

5

Chap er I Introduction

20 Mussallem, Helen D. The Changing Role of the Nurse, AmericanJournal of Nursing 69:514-517, March 1969.

21 Olson, Edith V. Health Manpower Needed: A Shake-up in theStatus Quo, American Journal of Nursing 68:1491-1495, July 1968.

22 Reinkemeyer, Sister Agnes M. It Won't Be Hospital Nursing,American journal of Nursing 68:1936-1940, September 1968.

Davis, Fred, F. L. Olesen, and E. W. Whittaker. Problems andIssues Ln Collegiate Nursing Education. The Nursing Profession:Five Sociological Essays. New York: Jo ni ey an oils, ne.

6

ChAPTER IIREVIEW OF THE LITERATURE

Education

Various conceptual models have been developed for viewing andorganizing the curriculum content of educational programs. Somemodels are based on educational objectives; some, on content. Tyler'sapproach for analyzing and interpreting the curriculum content andinstruction, which is based on the objectives of the program, divides theobjectives into two dimensions: behavior and content. (A He identifiesseven components of the behavioral aspect: (1) understanding of im-portant facts and principles, (2) familiarity with dependable sources ofinformation, (3) ability to interpret data, (4) ability to apply principles,(5)ability to study and report results of study, (6) broadness andmaturity of interests, and (7) nature of social attitudes. Content isidentified in operational terms as a part of the objective. Accomplish-ment of objectives is evaluated in terms of behavioral outcomes.

Bloom and Krathwohl use a taxonomy of educational objectives as, meansfor organizing objectives, behaviors, and evaluation techniques. 3)

Objectives are classified as cognitive (related to recall and to solvingan intellectual problem), affective (related to a feeling tone, emotion,or attitude), and psychomotor (related to a motor skill or to neuro-muscular coordination). The cognitive is further divided into knowledge,comprehension, application, analysis, synthesis, and evaluation. Theaffective is divided into receiving, responding, valuing, organizing, and intenalizing with behavior change. The psychomotor domain is not yetsub-divided. Values of this system include clarification of objectives,adaptability to developing evaluation tools, and adaptability toevaluating educational programs.

Maccia developed a scheme called SIGGS an organization of Set,Information,Graph, and General Systems theories. (4) It has been usedto develop general propositions 'about education. No relevant literatureevaluating the use of this model was found.

Chickering used the dimensions of student development based ondevelopmental tasks, needs, and student typplogies. (5) Specificaspects of student development thus identified were the developmentof competence, autonomy, identity, purpose, and integrity; themangement of emotions; and the freeing.of interpersonal relationships.

7

Chapter II - Review of the Lite atu e

Mayhew suggested the use of a two-way chart for conceptualizingcurricula. He proposed two dimensions, one consisting of thesubstantive areas, and the other of the skills, traits, and attitudesnecessary in utilizing the substantive materials. He described thevalue of this concept as follows:

If the collegiate curriculum can be visualized as this two-way chart with the divisions of human knowledge extendingalong the horizontal axis, the skills, traits, approachesand attitudes along the vertical axis, then it is possible toplot the most important curricula matters which should beoffered. By describing a curriculum concept in such form,we can readily expose where imbalances and omissionsoccur.

This construct may be viewed as the first step in thinkingabout either a college-wide curriculum or the offerings ofa division or department, or even the construction of a singlecourse. Once the framework is established it provides thelimits within which the courses can be built, added or sub-tracted...The chart provides a curricular medium whichimposes quite definite, quite stringent, and quite severelimitations within which the creative energies of the facultymust operate. The faculty should always have the right toput anything it wants into the curriculum, but within sufficientlimitations ... (6)

Other conceptual models for education generally have been developedand described, (7, 8) but the thread that runs through the literature isthat there exists a definite need for an organized approach to thesystematic identification of the content and objectives of an educationalprogram.

Nursing

Nursing education also has had established its need for theories ormodels on which to base curriculum construction. Attempts in de-veloping such a theory in a scientific manner are underway Interestednurses and non-nurses have presented various approaches.(9, 10, 11)

Gunter suggests the need for a theoretical framework composed of threeparts: (I) a theory of the organism, (2) a theory of medicine, and (3)a theory of interpersonal relations. (12) She also suggests that thecombination of such theories specifically applied to nursing will providethe uniqueness necessary to separate nursing from other functionMgareas.

8

hapte II Revie o the Lite a ure

King has identified the levels of operation for nursing as (1) theindividual, (2) the group, and (3) society. (13) She suggests thatthese be integrated into curriculum structure.

In the past few years many approaches for identifying and organizingvarious nursing curriculum contend ireas have been developed. In

1961 the National League for Nurs,ag established a sub-committeeon Maternal and Child Nursing Content to develop a process foridentifying essential content in nursing. Their methodology includedidentifying a nursing problem from which the essential content neededto resolve the problem would be determined. The two aspects of thecontent were specific information and the frame of reference fornursing action. This group defined essential content as "the knowledgethat a graduate from that type of program needs in order to assumethe nursing role for which that program prepares its graduates." (14)

No literature was found evaluating the use of this approach.

The Baccalaureate Seminar of the Western Council on Higher Educationfor Nursing conducted a study to develop an approach for identifyingcontent essential to baccalaureate programs in nursing. The selectedapproach identified four perimeters for the containment of essentialcontent: (1 ) philosophy of baccalaureate education in nursing, (2)characteristics of the graduate of a baccalaureate program in nursing,(3) characteristics of today's college-bound high school graduate, and

(4) implications for the faculty who will be teaching today's college-bound high school graduate. Essential content within these perimetersmight be based on (1) nursing needs (physical, environmental, emotional,instructional, coordination of service) and (2) the background factorsfrom the biophysical and psychosocial sciences. Based on this frame-work, essential content was described in six statements:

1 Learning experiences in identifying physical andenvironmental needs are essential in all clinicalsettings.

2 Learning experiences related to emotional needs,needs for instruction and information, and forcoordination of patient services should be empha-sized strongly in all clinical settings.

Learning experiences in communicating and know-ledge of the value and effect of communicationbetween individuals and/or groups are essentialthroughout the total program.

4 Knowledge and learning experiences related to growthand development throughout the life continuum areessential to human interaction.

Chap-e.- II - Revie of the L :erature

5 Knowledge of social forces influencing individual and/orgroup behavior is essential for identification and evaluationof nursing needs.

6 Learning experiences which provide opportunity todevelop independent thought and action in the identi- (15)fication and evaluation of nursing needs are essential.

The Western Council on Higher Education for Nursing also conductedanotherpnoject to clarify and delineate nursing content at the graduatelevel.(16.1r(18,19) However, over the years, this became a project ofdetermining approaches only. Each speciality area selected a generaltheoretical framework which was used to approach the developmentof content in that specific area. Community health nursing selectedParsons' theory of action; medical-surgical nursing, the nursingprocess and related patient and ilhiess characteristics; psychiatricnursing, nurse-patient interaction; and maternal-child health nursing,the concepts of pattern maintenance, pattern functioning, coping, andvulnerabilities to stress and crisis.

Sand used the school objectives as the framework for a curriculumstudy at the University of Washington.(20) The,objectives were separatedinto Tyler's two components, behavior and content. Categoriesidentified in the behavioral component included (1) uriderstanding offacts and principles, (2) critical thinking, (3) controlled and coordi-nated motor activities, (4) attitudes, (5) interests and appreciations,(6) communication skills, and (7) habits. Areas of content included (1) thenurse as a person and as a citizen (2) the body of scientific and culturalknowledge, (3) the agency and those it serves, (4) the nursing care of thepatient, and (5) the nurse's heritage and responsibilities. An importantresult of this study was the recognition of the problems associated withcurriculum and student evaluation.

A decision-making model utilizing the problem-solving processconstituted the theoretical orientation for the curriculum developmentat the University of California. This model provided both a "consistentand systematic way of thinking about nursing interventions" and acommon way of organizing the knowledge of the curriculum. (21) Onecourse organized within this framework combined three theories in theorganization of content:Simon'sdefinition of organizational behaviorof employees, Getzel's theory on administration as a hierarchy of sub-ordinate (superordiaate relationships with a social system), andPeplau's experimental learning process theory. (22)

Thus, at the present stage of theory development in nursing education,a variety of approaches are being considerpd and assessed.

10

Chapter II Review of the LIterature

Occupational Health Nursing

Several projects related to integration of occupational health nursingcontent into a nursing curriculum have been conducted by nurses. In1949-51 Smith conducted a survey at Yale University School of Nursing

to study the curriculum content with respect to occupatio, alhealth in order to determine areas and scope of integratwithin the curriculum; to find new methods of weaving itthroughout the various courses and activities into clinicalnursing; to explore possibilities for enrichment of the pre-sent content; and to aid in locating additional hospital andcommunity facilities for teaching purposes in occupationalhealth. (23

She determined through conferences with the dean and faculty, reviewsof course outlines, and visits to classes and clinical experience areasutilized for student learning that content related to occupational healthwas adequately integrated into that specific curriculum.

Brown described ways in which the knowledge and understandingsneeded by the nurse in industry differ from those needed in otherareas of nursing practice.k24) She advocated provision of learningexperiences for students through course integration of theseidentified differences.

In 1955 Ditchfield stated that 'probably the largest amount of curriculumcontent essential to the preparation of the nurse for the field ofoccupational health nursing is content that is also essential to allfields of nursing. "(25) She recognized that the first problem was notthat of integrating occupational health nursing content into the curri-culum, but rather the identification of content basic to all nursing,including content specific to the understanding of occupational healthnurs ing.

In 1957 an NLN-AAIN Conference Committee prepared a ide forincluding occupational health nursing in the curriculum. ( ) Thesixteen principles developed bythis gr'oup were used in formulating ameans of evaluating the occupational health nursing content. The guideincluded evaluative statements for assessing application of principlesin the area of occupational health; attitudes, understanding, andabilities basic to general practice in occupational health nursing; andsuggested methods of acquiring the necessary understanding and ability.

Henriksen in 1959 thund that the professional curricula in six collegiateschools of nursing did prepare nurses for beginning positions in occu-pational health nursing, but that the occu ational health aspects of ahealth problem were underdeveloped. (27 ) The methodology used to

11

Chapter II Revie of the Lte a iu e

reach this conclusion Mcluded questionnaires concerning nursingactivities in occupational health that were given to practicing occupa-tional health nurses, occupational health physicians, and employersand employees. A faculty checklist of abilities was then developedfrom the responses to the questionnaires. The faculty was asked toevaluate their curriculum in the following content areas: organizationand program planning, employee benefits, employee services, recordsand reports, health services, safety, community relations and parti-cipation in professional activities. A second check list of understandingsand abilities based on representative functions of the occupationalhealth nurses was also used by the faculty in evaluating curriculumcontent.

A workshop was held in 1962 by occupational health nurses and nursingeducators to develop ways of providing opportunities for nursingstudents to gain fundamental understandings about the health of theadult worker. Specific goals of the workshop were:

1 Increased understanding of the need and potential forproviding basic nursing students with fundamental con-cepts concerning the health of the working person.

2 Identification of areas in the basic curriculum whichmay provide students with learning experiences relatedto occupational health, and

Identification of occupational health resources,within the school and the community, and ways inwhich they may be utilized to enrich the students'knowledge and understanding of occupational health. (28)

A project was conducted at Boston College by Summers 'to identifythe occupational health components in baccalaureate nursing educationand to determine whether there was a need to strengthen them. "(29)A checklist of eighteen major subject areas was developed and wasused by the faculty to assess curriculum content. Tabulation of resultsshowed that twenty-nine items (fifty-six percent) on the checklist werenot considered to be included in the curriculum.

In spite of these efforts, there have apparently been no studies thatutilize a theoretical framework as a criterion for the occupationalhealth content data to be collected by means of a study of the nursingeducation process.

12

Chapter II Revie of the Lite ature

REFERENCES

Tyler, Ralph W. Basic Principles of Curriculum and Instruction- Syllabus for E ucation

_icago esicago: nivers Y 0-

2 Bloom, Benjamin S. (ed.) Taxonomy of Educational Objectivesthe Classification of Eogn WO Do

uca lona oa s - an socam. iêw 'o av c ay c., 1956.

Krathwohl, David R., Benjamin S. Bloom, and Bertram B. Masia.Taxonomy of Educational Objectives The Classification of

4 Maccia, Elizabeth S., et al. An Educational Theory Model(SIGGS) An Integration of eo y orma=ion

ap enera y e s eory.o rae IfliversiLy u eau o

Servi e, 1966.

_eory0 urn. us,

uea'ióna esearch andio:

5 Chickering, Arthur W. The Young Adult - A Conceptual Framework.Project on Student eve_ optnen a o eges.Vermont: Goddard College, 1967.

6 Mayhew, Lewis B. The Collegiate Curriculum - An Approach toAnalysiS. SREB YonograpEducation Board, 1967.

ern egional

Verduin, John R. Jr. Conceptual Models in Teachers EducationAn Approach to Teac mg an Learning. as ing on,

erican A ssoctation o o eges of Teacher Education,1967.

8 Gage, N. L. (ed. ) Handbook of Research on Teaching - A Projectof the American u a -iona esearc ASsoOla on. icago:

an c a y an o.,

9 Symposium on Theory Development in Nursing, Nursing Research17:196-227, May-June, 1968.

10 Rogers, Martha E. Educational Revolution in Nu sing. New York:

The Macmillan

11 Fox, David J. A Proposed Model for Identifying Research Areasin Nursing, Nursing Research 13:29-36, Wiriter, 1964.

13

Chapter II - Review of the Literature

12 Gunter, Laurie M. .Notes on Theoretical Framework for NursingResearch, Nursing Research 11:29, Fall, 1962.

13 King, Imogene M. A Conceptual Frame of Reference NursingNursin_g Research 17:27, January-February 1968.

Subcommittee on Maternal and Child Nursing Content. A Processfor Identifying Essential Content in Nursing. New York

a iOna eague o tits _g, nc.,

15 Pair, Nana Tiller, et al. The Report of One Approach to theIdentification of Essentia on en rn acca aurea, e °grams

ursin-g. ou :ora o: es ern7 n ei-s a e o kission1775IFITi Education, February, 1967.

16 Ford, Loretta, et al. Defining Clinical Content Graduate NursingPrograms Commum y a ursmg. ou .er, o orasoWstern interstate Commission lor ITigher Education,February, 1967.

17 Lewis, Lucile, et al. Defining Clinical Content Graduate NursingPrograms Medica

es ern n ër a e ommiion o1967.

urgica er, o ora o:er Education, February,

18 Fujiki, Sumiko, et al. Defining Clinical Content-GraduateNursing. Programs-

eS ern n ers -a e 5miiisstdni oi iger Education,February, 1967.

19 Highley, Betty L. Defining Clinical Content Graduate NursingProgram Maternal_ an-d 2tiild Health Nursmg. -Moulder,CTDIorado-: Wes-fth-ti Interstate-Commission for HigherEducation, February, 1967.

20 Sand, Ole. Curriculum Study inYork: na s ons

asic Nursing Education. New

21 McDonald, Frederick J. and Mary T. Harms. A.TheoreticalModel for an Experimental Curriculum, Nursing Outlook14:48-51, August 1966.

22 Dietrich, Betty J. and Doris I. Miller. Nursing. Leadership- A Theoretical Framework, Nursing Outlook 14:52-55,August 1966.

14

Chapter II Revie ite atu e

23 Smith, Emily Myrtle. Occupa ional Health Integration in the

Yale University Schoo ursmg urricuu pp aisalovem. e

'oe, C- eague xe ange

_iona eague or ursmg Education, 1952, p.6.

24 Brown, Mary Louise. Integrating Occupational Health Nursing inthe Basic Curriculum. Nursing Outlook 2:316-18, June 1954.

25 Ditchfield, Alda L. Problems that Integrating Occupational HealthNursing, into the Basic Nursing Program, Will Present to

the Nurse Educator. Paper presented at the National Leaguefor Nursing Convention, St. Louis, Missouri, May 4, 1955.

26 National League for Nursing American Association of IndustrialNurses Conference Committee. Guide for Evaluating andTeaching Occupational Health Nursing oncep e eague

ona eague or Nursing, 1957.xc_ ange

27 Henriksen, Heide L. Curriculum Study of the Occupational HealthAspects of Nursing Afl ve ure in oopera ion. eporo an ouca_iona rojec m .x o egia_e c oos of Nursingin Minnesota, Sponsored by The American Journal of NursingCo. and The Minnesota League for Nursing. U S.A. : 1959.

28 Report of Workshop on Occupational Health Nursing for.the Student

urse ImverS y as in on, ea e as n on, uy

271, 56, 1962.

29 Su mers, Virginia M. An Occupational Health Nursing Study,Nursing Outlook 15:64-66, July 1967.

15

CHAPTER IIITHEORETICAL FRAMEWORK

Occupational health nursing is in the same transition that is affectingall nursing. With emphasis shifting from emergency care of occupa-tional diseases and injuries to promotion and maintenance of health,a different type of theoretical framework from those discussed inChapter II seemed essential for assessment of occupational healthnursing content in a baccalaureate program.

Leave 11 and Clark's levels of prevention(l) and Maslow's hierarchyof needs systems(2) were selected as being adaptable to a curriculumstudy and as providing implications for defining the competencies ofthe professional nurse in occupational health.

Levels of Prevention

Leave 11 and Clark identified three levels of prevention: primary(health promotion and specific protection), secondary (early diagnosisand prompt treatment and disability limitation), and tertiary(rehabilitation).

Health promotion relates to furthering the general health and well-beingof an individualT Specific activities directed to this goal by the healthprofessionals in industry include educating in health habits; promotingadequate nutrition adjusted to the developmental phase of life; fosteringhealthy personality development; defining and promoting adequate housing,recreation, and suitable working conditions; counseling in marriage,sex education, and genetics; and conducting periodic selective examinations.

Specific protection is concerned with the health professional's activitiesin con ro isease-producing conditions before the individual isaffected. Attention is given as individually needed in such areas asspecific immunizations, personal hygiene practices, specific nutrientsto bolster diets, and recommendations of job assignments permittingavoidance of allergens and protection from carcinogens in addition, pro-fessional activities are directed toward the broader environmental areas thataffect the individual as a member of the group, such as environmentalsanitation, occupationsl disease hazard prevention, and safety practices.

Early diagnosis and prompt treatment as defined by Leavell and Clarkare in en e

1 to cure and prevent disease processes,

2 to prevent the sp ead of communicable diseases,

17

Chapter In - Theoretical Fra ework

_o prevent complications and sequelae, and

4 to shorten the period of disability. (1)

The achievement of these goals in early diagnosis requires individualand mass case-finding measures, screening .measures, and selectiveexaminations. Prompt treatment of injuries and disease so disclosedmust follow.

Disability limitation focuses on preventing or delaying the consequencesFraU irT1TEEMTEriced disease process. Two aspects of this level areidentified as (1) adequate treatment to arrest the disease process andprevention of further complications and sequelae and (2) provision offacilities to limit disability and avoid preventable death.

Rehabilitation has as its mains objective TTto return the affected11-7-diTirdifaTTUa useful Ave in society and make maximum use of hisremaining abilities. "C 1) To accomplish this objective Leavell andClark identified such activities as (1) the provision of hospital andcommunity facilities for retraining and educating the individual formaximum use of remaining capacities, (2) the education of the publicand industry to utilize the rehabilitated for as full employment aspossible, (3) selective placement, (4) work therapy in hospitals, and(5) the use of the sheltered workshop technique.

Activities specifically directed toward occupational health for eachlevel were identified and have been used as the basis for assigning thespecific competencies of the occupational health nurse. (See Chart I)

Hierarchy of Needs

In his hierarchical theory of human motivation Maslow(2) identified sixbasic human needs: physiological, safety or protection, love andbelongingness, esteem, self-actualization, and aesthetic. For thepurposes of this study the aesthetic needs have not been consideredsince they have yet to be explored more completely.

Maslow's presentation of a general growth-oriented personality theorywas evolved through studying self-fulfilled, ergo very healthy, individuals.Since his original formulations, a variety of elaborations and applica-tions have evolved. The most relevant one, for this study, is hishighly provocative hypotheses-forwarding hook, Eupsychian Management. (3)

Although a number of writers have been concerned with the differencesbetween growth-motivation and deficiency-motivation (Gordon Allport,Eric Fromm, Kurt Goldstein, and Carl Rogers,among others), it isMaslow's theory Of self-actualization which outlines the most compre-hensive statement of human motives and need levels. This is presented

18

2.

Chapter III Theoretical F ame

in the form of a system of hierarchical prepotencies from lowest to

highest level in human development. Maslow's theoretical orientationis one in which physiological needs are the most potent; however,once these needs are reasonably satisfied, more psychologically-oriented needs (security, safety, etc.) become more pronounced. Assafety is consistently gratified, belonging and love-needs as well asesteem needs emerge more strongly as motivating forces. Only afterthese needs are fulfilled, may self-actualization become manifest.

A sharp distinction is made in this theoretical system between growthand deficiency motivation. Accordingly, the first four levels in theneed hierarchy (physiological, safety, love, and esteem) are characterizedby some significant deficiency, similar perhaps to a nutritionaldeficiency. The necessity of satisfying these basic needs producestension, which is experienced as being unpleasant. A prolongedperiod of deprivation or lack of gratification leads to physical illnessand psychological or emotional disturbances of one kind or another.In the growth-motivated self-actualizing individual, on the other hand,this "need" state is desired rather than rejected and defended against.Satisfaction at these higher levels involves more than a simple tensionreduction. Actually, with satisfaction, desire increases rather thandecreases. The gratification of growth-motives produces health,whereas satisfaction in deficiency areas serves only to prevent diseaseor illness.Actually, in his later writings, Maslow(4) has indicated that the motiva-tional nature of the self-actualization tendency is by no means clear, andhe described this state as meta-motivation or unmotivated. In a way,this need for self-actualization is never fully realized, as is possiblewith deficiency motivation. Instead, individual growth and self-fulfillmentis a continuing life-long process. It is developing, ongoing, emerging,and becoming.

The five needs selected are oriented first toward health equilibrium andsubsequently towards personal growth and positive health. They relateto the whole individual in a dynamic manner throughout the total lifespan. For purposes of this project specific common human needs foreach broad area have been itemized. (See Chart II)

The Integrated Theoretical Model

The resultant framework that has been developed from the meshLrigof the two described theories is composed of twenty-five categories,each labeled with one level of prevention and one need. These categoriesrange from "Health Promotion-Physiological" to "Rehabilitation-Self-Actualization." (See Chart III)

19

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Chapter III - Theoretical Frame o k

REFERENCES

1 Leavell, HughRodmanand E. Gurney Clark. Preventive Medicinefor the Doctor in His Community - An Ep

ion lv, YOrElakiston Division, 1965.

aemiôogic pproac

oo o pany

2 Maslow, Abraham H. Motivation and Personality. New York: Harperand Row, Publishers,

Maslow, Abraham H. Eupsychian Manage ent: A Journal. Home-wood, Illinois: R c a n 'win, nc an _e orsey Press,1965.

4 Maslow, A.H. Some Basic Propositions of a Growth and Self-Actualization Psychology. Perceiving, behaving, becoming:a new focus for education, (ed rt ur CoIJ.C. "narbotik of-the A-ssociation for Supervision andCurriculum Development, 1962.

in

23

on,

CHAPTER IVMETHODOLOGY

This chapter presents the methodology used in The University ofTennessee Project as a prototype for a methodology that can be modifiedto the needs of the particular curriculum being restructured.

A number of factors influenced the decision to utilize an open andevolving approach to choice of design and methodology. Thesewere: (1) the span of time allotted, (2) the abilities and interests of

the project personnel, (3) the consultation services available, (4) theinterest of the faculty in supporting a research study, and (5)theapparent need for further de-rielopment of a systematic approach to astudy of the nursing curriculum.

The primary pu poses of the project were

1 To identify that knowledge from occupational health nursingwhich is essential for professional nursing education andpractices, and

2 To develop a methodology for identifying given content areaswithin a course of study. (1)

A secondary purpose was to develop a methodology for determiningwhether a specific baccalaureate program did include the contentnecessary to prepare an individual for a beginning position inoccupational health nursing. The 1963 ad hoc committee and laterthe Faculty Advisory Committee had agreed that initial planning shou dbe focused on studying the existing course content in a systematicmanner before considering possible changes.

Development of Competencies and Content

Although the functions and responsibilities of the occupational healthnurse are welTegfabiTshed-F cc-71nWicies and content needed bythe professional nurse to function m occuPational bea1111 have neverbeen identified. In this project, first priority was given to identifyingthe competencies and content in a systematic manner.

ee Appendix B foiNursing curriculum.

-atioiiàeo±T e Un.ve si y o Tennessee Co ege of

Chapter IV - Methodology

A role model for the professional nurse in industry was formulatedwithin the proposed theoretical framework. In developing this role,the assumption was made that all professional nurses learned duringtheir academic experiences certain basic concepts, principles, skills,and techniques:

1 Pri ciples and skills of communication;

2 Concepts of human growth and development;

Principles from physical and behavioral sciences, i.e., anatomyand physiology, microbiology, biochemistry, physics, sociology,anthropology, psychology;

4 Principles on which technical nursing skills are developed; andthe performance of skills of technical nursing, e. g. , taking vital signs,administration of medications, hygienic and comfort skills;

5 General medical and nursing techniques applicable to commonpatho-physiology.

In addition, the following criteria were used in developing the competenciesand content necessary for the full functioning of a professional nurseas a worker in occupational health:

2

1 Competencies to be stated in general terms and to includethose which in all probability will be needed for an extended ti ein the future;

2 Statements of specific skills, functions, and bits of knowledge(sOme of which can and hopefully will change) to be avoided.

Content to be prepared for use by nurse educators at theprofessional nursing level (the baccalaureate graduate);

4 Competencies to be broad in scope to provide for progressivechange;

5 Competenc es to be identified or stated in terms of what could'be done;

6 Occupat onal health nursing co- petencies to be expressed interms of the nursing process. (2 3, 4)

4

Chapter Methodology

All aspects of the work setting were considered and the followingcomponents deduced:

Employee - receiver of

Environment - receiver of

(as professionalNu se (as employee)doer/giver of

- receiver of

knowledgeunderstandingsskills

knowledgeunderstandingsskills

Knowledgeunderstandingsskills

Successive schematic diagrams were used to clarify thinking in thedevelopment of the competencies and content: These are shown inSection A, 9, and C on page 28.

27

NeedSystem

LeVels of Prevention:

Complete picture ofoccupational health

nurse(Expert level)

Baccalaureate,level

fGraduate

levelIn-Service-

suIP-Levels of Prevention

NeedSystem

NeedSystem' ,

Role of occupational healthnurse

owledgeunderstandingss killsfunctions - responsibilities

Work - specific knowledgeunderstandingsskills


nurs e

Role of occupationalhealth nurse Content needed to perform

as occupational healthnurse

2 8


nurs e

Chap _er IV - Methodology

This approach was sufficiently broad to permit identification of thoseconcepts equanursing.. mce e exper eve ee I amlurriler 1 a no yetbeen identified and/or organized, it was necessary to complete this levelin order to determine what beginning nurses in occupational health, orprofessional nurses in general, should kmow about occupational health

nursing.

A detailed account of the steps involved in the development of a projectedoccupational health nursing role model (competencies and content) follows.

Competencies

Based on the func ions and responsibilities of the expert occupationalhealth nurse practitioner as stated by the ANA(5) and the AAIN(6) and onthe observations, reflections, and experience of the Principal Investigator,a preliminary listing of the components of nursing in occupationalhealth was made. These components are:

Nursing of employed adultsmergency care

Conthming nursing careHealth educationHealth counselingHealth maintenanceAbsentee controlCommunity activitiesEnvironmental relationships

Nursing and the work environmentu vey an ana ysis o p an

Structure of business organization and managementIndustrial relationsSafety/industrial hygieneDisaster planningTypes of occupational health nursing programsRecords and reportsAdministration of nursing serviceDevelopment of special programs

Nursing and the welfare pf the employeeocia egis a ion

Effect of industrial revolutionsEmployee benefits

The relevance of these functions and responsibilities was evaluated in the

light of available documentations.(7, 8, 9, 10, 11, 12)

29


The first step in the systematic development of the competencies wasto fit the identified functions and responsibilities into the theoreticalframework. (See Appendix C). After many revisions and subsequentdiscussion with the project's ad hoc Occupational Health Committee, thisapproach was discarded since a greater depth and breadth was necessary todefine adequately and clearly the role of the professional nurse in eachtheoretically-derived category.

There evolved a framework of competencies of the professional nursein occupational health in terms of the nursing process. This processencompasses the steps in comprehensive nursing care; and these stepsare applicable to any individual on the health-illness continuum. Thecompetencies, stated in terms of on-the-job behaviors, were cast intothe described framework.

Specific nursing actions for each competency were then suggested. (SeeAppendix _D for competencies and suggested nursing actions for theprofessional nurse in occupational health.) The identified occupationalhealth nursing competencies and suggested nursing actions are obviouslynot all-inclusive of professional nursing activities.

Content

In identifying content, the Principal Investigator used her experiences,observations, and conversations with health professionals as resources,as well as a broad range of nursing and non-nursing periodicals andpublications. Pertinent subject areas researched included health, nursing,medicine, sociology, psychology, government, community organization,personnel administration, social work, environment, ecology, rehabili-tation and toxicology.

The academic content needed by the professional nurse (expert practi-tioner) was identified simultaneously with the nursing competenciesneeded tn occupational health. As the shift from functions and responsi-bilities to competencies occurred M the development of the project,the content took on the anticipated breadth. It became evident that theearlier formulation of academic content in terms of knowledge, under-standings, and abilities required modification. Discussion with the project's adhoc Occupational Health Committee led to the identification of principles,concepts, and broad areas of content. Each broad area of academiccontent was elaborated into appropriate component parts. Theseidentified components of each content area, although comprehensive,are not necessarily to be considered complete.

As the competencies in terms of the nursing process emerged, therelevant academic content in occupational health was identified foreach competency and was stated at the expert level of professionalnursing in occupational health.

3 0


In the spring of 1968, the project's ad hoc committee of NurseEducators and the project personnel delineated the levels of content forthree gradations of educational preparation-baccalaureate, graduate, andinservice. Subsequently, the Principal investigator re-organized theidentified academic content into the stated educational levels. The contentwas then reviewed independently by each member of the committee. Theacademic content for occupational health nursing thus derived is pre-sented in Chapter VI.

Validation of Competencies and Content

In 1965 the Faculty Advisory Committee rejected the use of a panel ofexperts as a means of validating the competencies and academic contentbecause of the time and difficulty involved in familiarizing such a panelwith the project.

The opinion of the Principal Investigator as nurse specialist withsuitable documentation would be considered decisive for questionableareas, particularly in view of the open-end character of the projectmaking it amenable to revision as necessary.

Extent .of Mention

The academic content was assigned a number indicating the "extentof mention" that might be spent on a given topic in a _class for pro-fessional students in nursing. The coding used for "extent of mention"was:

1- less than one sentence erely entioned)2- one to two sentences

three to five sentences4- over five sentences

In actuality, alte nat ve measures of coverage and weights m y besubstituted.

Subsequently, percentages were used to indicate the degree of coveragesuggested for each area of academic content. The following percentageswere used: (1) for content that was deemed primarily baccalaureatelevel and continuing through graduate level - 75 percent baccalaureateand 25 percent graduate; (2) for content that was introduced at-thebaccalaureate level, but was essentially graduate level 25 percentbaccalaureate and 75 graduate; (3) for content:that was introduded to alesser extent at the baccalaureate level and was primarily graduatelevel-10 percent baccalaureate level and 90 percent graduate level.

Chapter IV - ethodology

The suggested percentages (75-25, 25-75) were chosen to fit smoothlywith the assigned 1-2-3-4 "extent of mention" points. In order for alesser extent to be suggested) the 10-90 percentages were used. Considera-tion was given to suggesting more variations of degree of coverage, suchas 50-50, 67-33, or 33-67; but this specificity was not undertakenas its value was questionable.

The content at the inservice level was not assigned a percentage asthere appears to be little content in that area and its nature varieswith each work setting.

Utilization of the Methodology

Assessment of The University of Tennessee College of Nursingcurriculum content itself was deterxnined by the technique of contentanalysis as developed by.Berelson. Content analysis is "a researchtechnique for the objective, systematic, and quantitative descriptionof the manifest content of communications. "(13) This method can beused in evaluating content of a communication by cornparing it with(1) an a priori standard, (2) another body of content and (3) a non-contentsource-. TheTitandard in each case is developed by a person other thanthe one presenting the content. For the purposes of this project,evaluation of content by comparing one body of content with anotherwas found to be the most appropriate method.

The most important element in content analysis is the standard utilizedin making comparisons. The categories that are developed as the standard,according to Berelson, must be written in an analyzable form appropriatefor the content. The occupational health nursing competencies andcontent that have been stated within the theoretical framework of Leaven.and Clark and Maslow can and do constitute the standard ofcomparison for this project.

A systematic determination of what was presented to students wasessential to meet Berelson's second criteria for content analysis.Asking the faculty whether certain principles or selectedaspects of occupational health nursing were being presentedin their courses did not seem to be the most valid approach. Hence,the Faculty Advisory Committee decided that the best approach was forthe Principal Investigator to attend classes and observe selected learningexperiences. Due to the limitations of human energy and time onlynursing courses were studied. It was assumed that the nursing courseswould provide the opportunity for application of the knowledge taught inthe related courses. Admittedly, some occupational health nursingcontent may have been lost, but the experience of the Pr inc ipal Investigatorindicated that the decision was correct.

32

Chapter 11.7 Methodology

It was recognized that the data collected represented the course contentat a particular point in time and that the project was not.designed toevaluate faculty or course content adequacy. There was no discussionwith the faculty regarding what content might be added to selectedunits of study or what, content was identified until all data had been gathered

and analyzed. Nevertheless, the presence of thePrincipal Investigator

as creating an "experimenter effect" (14 15 16 17) was recognized Unavoid-

ably, the original design and the limitation of personnel necessitated an

unsystematic assessment of these variables. The Principal Investigatorattended one course during the summer session of 1965 to test thesuitability of the data collection techniques, and this experience indicated

the adequacy of the approach.

At the begimiing of each academic year the Principal Investigator wrote

the appropriate faculty chairman explaining how the data would be

collected and offered to meet with the faculty for that particular year

to answer any questions. The Principal Investigator attended meetingsof each year's faculty in order to be kept informed of plans andscheduling for the courses. She declined participation in the testingand evaluation aspects of the students' progress and the curriculumplanning.

The basic method of data collection for content analysis was auditing

the nursing classes and some clinical conferences of one class of

students (Class of 1968) for the three-year period of the program within

the College of Nursing. (See Appendix E for description of coursesoffered.) The courses audited over the three-year period were:

Sophomore YearNursing as a Social Force INursing of Children and Adults I and H

Junior YearNursing of Ch ldren and Adults HI, IV, V

Senior YearNursing of Children and Adults VI, VII, VIIINursing as a Social Force IIIPreventive Medicine 2 N

The related required courses taught within the Medical Units but

not audited included: anatomy and physiology, biochemistry,TEYsics, microbiology, anthropology, human growth and develop-

ment, scientific method in nursing, biostatistics, nutrition, and

pharmacology.

Chap e V - Me hodology

For nursing classes not attended the Principal Investigator obtainedtapes of the classes or the notes from one student of high caliber.About ninety percent of the target classes were audited by thePrthcipal Investigator. All handouts, the syllabi, films, and otheraudio-visual aids were noted and analyzed for content.

The Principal Investigator sat with the students in the classroom, butdid not participate in the teaching-learning process except when invitedby the instructor. Usually the questions directed to the PrincipalInvestigator were related to nursing, public health, or health care ingeneral, rather than to occupational health nursing.

Observations in the clinical area were started in the sophomore yearbut were discontinued after a few weeks. The reasons for omitting theseobservations were 1) an increase in student anxiety caused by thepresence of an additional observer, 2) the impossibility of observationof more than a very few student learning experiences, and 3) thedifficulty of being present when appropriate content could be observedor audited. It is acknowledged that some content may have been lost.

Class and clinical conference content material relevant to the theoreticalframework was recorded in written form in terms of broad categories,but details were noted when specific application to occupational healthnursing was evident.

The data were organized by courses and academic quarter, rather thanby speciality area in nursing, according to the organization of thecurriculum. At the completion of each course, the recorded contentfrom classes was coded on index cards (content information cards) underthe following headings: content data, course number, week, method ofinstruction, and "extent of mention." Each item of content was notedon a separate card.

"Extent of mention" indicates the time spent on a given topic, but doesnot indicate relevance, accuracy, and depth of the coverage. Despitethis limitation, the coding does serve as an index of coverage. Over900 content information cards were collected. A typical samplefollows:

34

Chapter IV Methodology

CONTENT DATA:

Team approach to health careConcept of a:team

COURSE: Nursing as a Social Force EXTENT OF MENTION 4

WEEK: 8

METHOD OF INSTRUCTION: Lecture

Sulnmary

The following prototype outline of the methodology can be followed in

making a study similar to that described in this manual:

1 Faculty decision on the total or partial review of thecui-riculum;

2 Determination of standard, including "extent of mention" orother alternative technique;

Determination of data collection techniques;

4 Collection of data;

5 Analysis of data;

6 Comparison of data ith the standard;

7 Evaluation and recommendations.

In realIty Step 2 (Dete mination of standard) is the crux of any cur-riculum study. In the methodology presented in this manual, astandard has been determined that is a theoretical framework com-posed of two recognized theories (Levels of Prevention and Hierarchy

35

Chapter IV etho ology

of Needs). This standard can be utilized by nurse educators to deline-ate expected behaviors of the nurse in terms of the nursing processand from the behaviors to evolve the content that is considered neces-sary for a nurse to know in order to attain the competency.

The methodology presented in Chapter VI provides a theoretical frame-work for such organization based on: Prevention: the normal, wellindividual (See first ten categories: Health Promotion-Physiologicthrough Specific Protection-Self Actualization); Therap7: the ill orthe ill but active individual (See the next ten categories: Early Detec-tion and Prompt Treatment-Physiologic through Disability Limitation-Self Actualization; Rehabilitation: the recuperating individual in needof rehabilitation to achieve maximum potential (See the next five cate-gories: Rehabilitation-Physiologic through Rehabilitation-Self Actual-ization).

The use of Occupational Health Nursing illustrates how the methodologycan be applied and how the content can serve as an assessment tool fornurse educators in determining what academic content is, or is not, ormight be included for the particular area of concern; e.g. , a course, aunit of study, or the total curriculum.

3 6

44'

REFERENCES

Chapler Liodolo y

1 Keller, Marjorie J. Interim Report of A Study of OccupationalHealth Nursing Content Essential in Baccalaureate Educationfor Professional Nursing. Memphis: The University ofTennessee College of Nursing, 1967, p.3. (Mimeographed)

2 Yura, Helen and Mary B. Walsh. The Nursing Process:Assessing, Planning, IMPlemen

IfnTversi y o A erica _ess,ng. Washington,

967.

Weidenback, Ernestine. Clinical Nu sSpringer Publishing

A Helping Art. N.Y.:

4 Maier, Henry W. Three Theories of Child De elop enHarper and Row,

5 A erican Nurses' Association. Functions, S andards, and uali-fications for Occupational Health Niirses. Prep-area by-tfieccupa lona eá u ses ec on. ew York: AmericanNurses' Association, n. d.

6 American Association of Industrial Nurses. Duties and Responsi-bilities of the Professional Nurse in an Industrial MedicalService, American Association of Industrial Nurses Journal3:13-14, une

7 Brown, Mary Louise in association wi h John Wis er Meigs.Occupational Health Nursing. Springer Publishing Company,Tfic

8 Wagner, Sara P. Role of Occupational Nurse in Efficient o kerUtilization, Archives of Environmental Health 4:451-53,April 1962.

9 Tyer, F.H. Occupational Health Nursing. London: Bailliere, Tindalland Cox,

10 American Medical Association. Medical Directives for OccupationalHealth Nurses, Prepared by the Council on Occupational Health,Archives of Environmental Health 5:631-34, December 1962.

11 Metropolitan Life insurance Company. Correlated Activities in anEmployee Health Program. Prepares y ea an. e are

iision 'ew or Y e opolitan Life Insurance Company, 1962,

37

Cha ter IV Methodology

12 World Health Organization. The Nurse in Industry. Report ofa Seminar sponsored by the internatiolTir EaTEE)T1r Organizationand World Health Organization Regional Office for Europe incollaboration with the government of the United Kingdom andNorthern Ireland. Copenhagen: World Health Organization,1957.

13 Berelson, Bernard. Content Analysis in Communication Resea cGlencoe, Illinois: e ee

14 Rosenthal, Robert. Experimenter Effects in Behavioral Research.New York: App e on ury- oen s, 9 111

15 Barber, T.X. and M. J. Silver. Fact, Fiction, and the ExperimenterBias Effect. Psychological Bulletin Monograph, vol. 70, no. 6,Part 2. Washii-'0On, Amerfean Psycllabgical Association,December 1968, pp. 1-2

Rosenthal, Robert. Experimenter Expectancy and the ReassuringNature of the Null Hypothesis Decision Procedure. PsychologicalBulletin Monograph vol. 70, no. 6, Part 2, Washington, D. C-.-:---Ainerican PSythological Association, December 1968, pp. 30-47.

17 Barber, T . and M.J. Silver. Pitfalls in Data Analysis andInterpretation: A Reply to Rosenthal. Psychological BulletinMonograph, vol. 70, no. 6, Part 2. Was nhi155i1717T.T77American Association, December 1968, pp. 48-

3 8

CHAPTER VDATA ANALYSIS

The content data gathered in The University of Tennessee project from

class presentations were coded to permit two methods of curriculumevaluation: qualitative (an overview) and quantitative. Although allthe observed data are not stated in this manual, the manner of

assessment and some general findings are discussed.

Methods of Analysis

The first method of analysis made possible a comparison of the data

with the standard, i.e., the academic content suggested for thebaccalaureate level of education for nursing practice based on thediscussions of the project's ad hoc committee of nurse educators. Thesenurse educators had agreed that a to-be-determined proportion of the

broad areas of content be assigned to various educational levels of preparation.

The second method of analysis yielded a quantitative comparison of the

assigned with the observed "extent of mention" of the suggested content.

The Principal Investigator arbitrarily assigned "extent of mention" points

(1-4) to each of the components within each of the 25 categories of the

theoretical framework. These "extent of mention" points served ascriteria for all subsequent quantitative assessments of the suggested and

observed content. In utilizing this methodology, any manageable number

of points could be assigned provided that the same criteria are used

throughout.

The content data (content information cards) were placed in only the

one most appropriate V the 25 categories. The data were then furtherclassified into the broad_content areas within each of the 25 categories.Table I consists orEFFF8YEinin eadings only and is presented toillustrate the classification technique.

SCT

AB

LE

EM

A F

OR

CO

DIN

G D

AT

A

1

Cat

egor

yC

ompe

tenc

yI

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d A

cade

mic

Con

tent

E'x

t ent

of1

Men

tion

Aca

dem

ic C

onte

nt O

bser

ved

Ext

ent

ofM

entio

nco

urse

kcad

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lc C

onte

nt C

over

edby

a C

ours

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t atte

oded

by P

rinc

ipal

lInv

estig

ator

,.

1 ,

1

1 ,

I

I

1

Chap e V Data Analysts

The last column in Table I was allocated for the identification a_academic content assumed covered by a course that was notattended by the Principal investigator.

In quantitatively comparing the extent of mention" points in thecriteria with those in the collected data, each broad area of contentwithin each of the 25 categories was scored separately. For eachindividual component the "extent of mention" points assigned in eachbroad content area were totaled. The same procedure was followedfor "extent of mention" points in the observed data. All broad contentarea scores were totaled to yield scores for each of the 25 categories.However, when the observed "extent of mention" exceeded theassigned "extent of mention" only the maximal points assigned inthe criteria were used. For example, under comprehensive healthcare (Health Promotion-Physiological) "characteristics" was discussedin two courses with a total of eight "extent of mention" points for theobserved data (See Chapter VI). In preparing the data for the quantita-tive analysis, a score of only four points was allowable, as this was thenumber assigned in the criterion.*

To accomplish the quantitative assessment, a schema (Table II) wasdeveloped to compare the assigned "extent of mention" total pointsfor the professional nurse level (column 1), the assigned baccalaureatelevel (column 3) and the observed data (column 4) for each broadcontent area in the 25 categories.

The assigned percentage of coverage for the baccalaureate level isindicated in column 2, and the calculated percentages of coverage areindicated in column 5 and 6. A summary by category of the totalsand percents in Table II may be found in Table III.

observed "extent o mention"The data concerning the adequacy of coverage assigne ex en o nin ionfor the studied curriculum are not given. Specifically, all materialsunder columns 5 - 8 in Table I may not be found in Chapter VI.data for columns 4 - 6 in Table II are also deleted. The points andpercentages for lines 3 and 4 are similarly ommitted in Table III. Thisomitted material is not necessary to an understanding of the analysisprocess.

ospec e a a.roa.er range o extenf of mendoi'7"poin s, such as 1-6, would have yielded more accurate inforniation anfiner discriminations.)

41

QU

AN

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IVE

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Chap -er V - Da a Analysis

TABLE III

SUMMARY OF THE QUANTITATIVE CRITERIA FOR ACADEMIC CONTENT

T

Preventive

9 .Cura ive Restorative

<-------->o-..too

--..o,f)--1

.1

P.,

z'+cist

tri

HealthPromotion1)2)3)4)5)

2)3)4)5)

405266

66%

SpecificProtection

Early Diagnosis &Prompt Treatment1) 1012) 743)4)5) 73%

1 432) 103)4)5) 23%

DiabilityLimitation1 982) 7,43)4)5) 75%

1) 492) 283)4)5) 57%

Rehabilitation

1) 712) 483)4)5) 68%

1 322) 163)4)5) 50%

1) 582) 53)4)5)

15076

51%

1)1072) 333)4)5) 31%

o-9 0a) oPCI tr)

6o

4 0-,

1)2)3)4)5)

1)2)3)4)5)

279163

58%

12277

63%

1) 992) 283)4)5) 28%

1) 922) 203)4)5) 2

1)2)3)4)5)

1

2)3)4)5)

5326

49%

8250

61%

1)2)3)4)5)

1

2)3)4)5)

6839

57%

147108

73%

12)3)4)5)

1)2)3)4)5)

9229

32%

_ --4830

62%

g.9#,co

.t:3

,7,3'5),e

1)-2)3)4)

21288

42%

1) 722) 123)4)5) 7

1)2)3)4)5)

2015

75%

1)

4)5)

6746

69%

1)2)3)4)5)

168

50%

Chapte_ V - Data Analysis

Legend for Table III

Assigned "Mention" for Professional Nurse in Occupational Health

2 Assigned "Mention" for Baccalaureate Educat.onal Level

Observed Mention" at Baccalaureate School of Nursing-Observed "Mention" Content

ssi_gne en ion on en5 Approximate Percent of Recommended Undergraduate Coverage

of Total Knowledge Exposure for Category.

44

4 Percent of

Chaster V - Data Analysis

Qualitative Comparison

As the observed data were placed under the appropriate broad area_ ofcontent, the discrepancies between the suggested and observed academiccontent relating to professional nursing in occupational health becameobvious. If a subject area was not included in the data, a gap in thecontent area recording could be observed; if a subject area was extensivelycovered, more than adequate "extent of mention" points could benoted.

This assessment revealed adequate, or more or less than adequate,coverage of the suggested content in each of the 25 categories. It alsorevealed areas of strength or weakness in the general areas of prevention,cure, or restoration. The degree of health-orientation or apathology-orientation in various aspects of the curriculum was readilyapparent. The assessment was also useful in substantiating whetherthe full scope of the needs hierarchy was adequately presented to thestudents in the class setting.

Quantitative Comparison

The quantitative comparison was used to compare the observed contentwith the suggested baccalaureate level content in terms of assigned "extent ofmention." The academic content "extent of mention" as listed inChapter VIand in Table III was used. For example, category"Health Promotion-Physiological" calls for a total of 405 points as the assigned "extent ofmention" for the professional nurse in occupational health and 266 pointsas the assigned "extent of mention" for the baccalaureate level.

By comparing the assigned with the observed "extent of mention" thedegree of coverage was revealed in the broad content areas. By a care-ful review of the discrepancies between assigned and observed "extentof mention" in the category, a general statement could be made on thetemporality-orientation of content covered, such as whether the contentwas (I) traditional in nature, (2) focused on the present day practice ofnursing, or (3) directed toward the new philosophy and developments innursing and in health services.

Similar analysis of each category can indicate the change in curriculumcontent areas that could be made if the assigned "extent of mention" wereused as a criterion for evaluation.

Through this method it is possible to assess and to recommend changesfor the inclusion of the content needed for professional nursing inoccupational health. A similar procedure could be used in curriculumanalysis by other nursing specialities.

45

CHAPTER VIDELINEATION OF OCCUPATIONAL HEALTH CONTENT

FOR PROFESSIONAL NURSING

The listing of occupational health course content considered essentialfor professional nursing is presented in this chapter. It is this coursecontent that served as the standard used with the xi ..,thodology discussedin Chapters IV and V.

The column headings are explained as follows:

F a nework Category: See Chapter III for explanation of category deriva-tion. (Leaven and Clark's levels of prevention and Maslow'shierarchy of needs)

Competencies: These are the identified competencies of the professionalnurse in the occupational health setting. See Chapter IV for a dis-cussion of competencies.

Course Content In this column is delineated the content needed to performthe competencies of the professional nurse in occupational health. Thecontent is listed in broad content areas (e.g., Health) with detailedelaboration (e.g. Definition, Responsibility, etc. )

"Extent of Mention" Points: See Chapters IV and V for discussion ofderivation and utilization of "extent of mention" points.

Supplementary In-Service Content: This content is believed moredirectly related, both in source and in utilization, to the occupa-tional site and is considered supplemental to the academic contentpresented in institutions of learning.

It is emphasized that the "extent of mention" points were assignedarbitrarily by the Principal Investigator of the project for use in testingthe methodology by assessing the selected curriculum (The University ofTennessee School of Nursing). It is assumed that extent of mention pointswould be assigned at the discretion of the individual utilizing this metho-dology for developing or evaluating a curriculum.

Delineation of Occupational Health Content for Professional NursingCompetency for each of the 25 squares on the grid follows on pages 50through 73 and relate to the grid as shown on Chart I.

54

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32 4 4 4 4 4 4

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927

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Fam

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279

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12 4 4 4 32 4 4 4 4 4 4 4 4 4

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24 4 a 4 4

122

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Med

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14Ph

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124 4 4 4

68

11Ph

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15Im

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6746

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3216

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16

CHAPTER VIITHE ACHIEVEMENT TEST IN

OCCUPATIONAL HEALTH NURSING

In January, 1966, it became evident that another way of utilizing thecontent in the theoretical framework could result in the developmentof an achievement test in occupational health nursing. The purposeof the test was three-fold; (1) to assess what students bring to nursingthat relates to occupational health nursing,(2) to evaluate whether thegraduating seniors have the basic knowledge in occupational healthnursing that all professional nurses need to function in any capacity, and

(3) to measure quantitatively occupational health nursing knowledge ob-tained in any baccalaureate nursing program, regardless of whether ornot the collegiate curriculum provided for systematic presentation ofoccupational health content.

Development

Learning opportunities were made available to the Principal Investigatorfor development of the necessary skills in test development by both theNLN and the Educational Testing Service, Inc. Appropriate readingswere also undertaken. (1, 2, 3, 4,5, 6, 7)

The competencies and academic content from the theoretical frameworkwere used as the point of reference from which the items were developed.In the initial effort, attempts were made to write a representativepercentage of test items for each of the 25 categoric. in the theoreticalframework of content for occupational health nurstilr,. The concomitantdistribution percentages for the levels of preveh11, ere 50 percent forpreventive aspects, 2 5 percent for curative aspe and 25 percent forrestorative aspects. The distribution percentages for the five-needshierarchy were identical, 20 percent for each area of need (Table IV).

However, with overlapping of items in categories and continuing revisionsof the content, the original percentage arrangement could not be main-tained as representatively as desired.

With these assumptions the first test consisted of 102 multiple choiceitems (four alternative answers). Six University of Tennessee Collegeof Nursing faculty members, representing various levels of preparationand areas of speciality, were asked to answer the items and made criticalcomments, particularly regarding clarity. After suggested revisionswere integrated, the test, consisting still of 102 items, wasmailed to 25 occupational health nurses functioning at variouslevels of practice throughout the country. These nurses were selected froma list submitted by the Project Officer. They were instructed to

79

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Chapter VII - The Achievement Test

markthe correct response for criteria purposes and also to assess the

value of each item. Value was defined as how important knowledgeability

of the content area of each item was for the occupational health nursepractitioner. Of the 25 nurses contacted 20 responded.

These data were discussed with the project consultant in test construc-tion. It was recommended that additional items be developed with theidea that two equated 50-item tests might result. Forty additionalitems were constructed and were reviewed by the same selected facultymembers and the same practicing occupational health nurses in asimilar fashion as before. The initial criteria for correct answerswere based as much as possible on two or more printed references.Considerable rewording of items was done as a result of the commentsfrom the nurses.

The 142 test items were evaluated for clarity and were verified foraccuracy of stem and correct alternative by the project's ad hocOccupational Health Committee, both individually and as a group.Unanimity as to keyed accuracy was required for item acceptance. Fouritems were eliminated by this group, leaving 138 items. -1,

Assessment

At the end of the 1967 spring quarter, the test of 138 items was admin-istered at The University of Tennessee to 16 (73 percent) of the graduatingsenior students; 40 students (80 percent) in the junior class; and 36 (72

percent) in the sophomore class. Out-of-class time was scheduled fora majority of the students to take the test. The time needed to completethe 138 items varied from one hour to 21 hours with approximately 11

hours as average time.

In May 1967, representatives of the NLN Testing Service were consultedregarding 1) scoring and analysis of the test items administered to thestudents of The University of Tennessee College of Nuring and 2) thepossibility of and procedure for national standardization. It was agreedthat the scoring and items analysis for the first administration of theitems to The University of Tennessee student body would be done by theNLN. The NLN representatives proposed consideration for undertakingthe national standardization on a contractual basis with The Universityof Tennessee. In preparation for this plan, an additional 32 items weredeveloped and reviewed as before by the project's ad hoc OccupationalllealthCommittee. This was accomplished through mailings. Subsequently theNLN Testing Service withdrew from participation in the test standardization.

*Since the fest and test materials are intended for future testing purposes,no specific informatiOn is presented in this report concerning the test itemsor the instructions for giving or taking the test.

77

-81

Chapter VII The Achievement Test

In the fall of 1967 the 32 new items were administered to the 40 seniorsand the 36 juniors who had taken the original items. The entire test of 171 itemswas also administered to 53 entering sophomore students . (See Table V forInitial Analysis of the Testing Program. ) Inspection of Table V shows a rela-tively increasing percentage of correct responses with each level of progression(by year) of the nursing students. This hoped-for result indicated that,in a general way, the total test was being developed adequately.

After the NLN withdrawal, national standardization was undertaken byproject personnel on the recommendation of the proje:: cons'lltant intest construction. In the first nationwide administrati of tne test,15 out of 40 ran iomly selected NLN-accredited collegiate schools ofnursing partici,pated. Six hundred tests were requested by and sent tothe schools of nursing. Of the 35,7i answer sheets complete,d andreturned by graduating seniors, 293 were usable. Among the reasonsfor discarding 57 of the returned answer sheets were (1) some respondentswere students who were already registered nurses with varying typesand years of experience in nursing and (2)some tests were not completed.The answer sheets were machine-scored and all items c3mputer-analyzed.*The combined results from all schools were:

Number of subjects: 293 (including 41 University of Tennesseenursing students)

Number of items: 171Mean (raw score): 100.00Standard deviation: .12.3Range: 47-132

An overall Analysis of Variance (ANOVA) indicated a significant statisticaldifference between schools on the test (F = 13.90; p< 0.01).

Included in the analysis of each of the 171 items for all respondents(N=293), including The University of Tennessee graduating seniors (N=41),were:

1 Numbers of choices for each alternative on each item,2 Percentage of choices for each alternative on each item,

3 Mean numbers correct on all items for all the subjects usingeach of the four alternatives for each item,

4 Point-biserial correlations of each item on each choice betweencorrectness of choice of alternative and mean score on test.

-Prhe macifineng aria-Triost statistical analysis on the two nationalmailing were performed by The University of Tennessee-BiometricComputer Center under the direction of Mr. Walter Lafferty.78

82

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7).

Chapter VII - The Achievement Test

Following this statistical analysis, all items were evaluated by meansof criteria for useability in an item-analysis fashion. (1,3, 8)

The criteria are listed in order of importance:

1 Point-biserial correlations reaching 1 percent level of signi-ficance with one-tail teSt for correct alternative,

2 Point-biserial correlations reaching 5 percent level of signi-ficance with one-tail test for correct alternative,

3 Point-biserial correlations for incorrect answers should allbe minus and roughly of the same magnitude,

4 Mean total score for subjects responding with correct alterna-tive should be consistently higher than each mean total scorefor subjects wah incorrect alternative answers,

5 The percentage of subjects giving correct answers for eachitem should be between 60 and 70 percent.

Of the 171 items evaluated in this manner, 16 met all of the abovecriteria, 59 met all except criteria 5, 1 failed criteria 1 only, 4 failedcriteria 3 only, 5 failed criteria 3 and 5, 4 failed criteria 1 and 5,while 2 failed criteria 1, 3, and 5. These 91 items were retained forfurther standardization purposes. Twenty-two items did not meet anyof the five criteria; 17 did not, meet four of the criteria; 15 did not meetthree criteria (1 and 3 or 4 or 5); 20 did not meet two criteria; and 6did not meet criteria 5. These 80 items were set aside.

Before the second nationwide testing, 23 additional items were developedto fill in areas of content within the theoretical framework not coveredby the test after the 80 items had been discarded, making a total of 114items. The 23 test items were evaluated for clarity and correctness bythe Principal Investigator and the research consultant and by means ofdocumentation. For this second nationwide administration, 17 out of anew group of 40 randomly-selected and approached NLN accredited baccalaur-eate schools of nursing requested a total of 1011 tests and machine-scoredanswer sheets. Of these 17 colleges, 12 returned 350 usable answer sheets and21 unusable ones. The usable answer sheets from the graduating seniorsat The University of Tennessee College of Nursing, who again cooperated,made a total of 387 usable answer sheets for this standardization attempt.Average time for completion of this form of the test was less than onehour. A similar statistical and item analysis, as in the firststandardization attempt, was performed.

80


The combined results for all schools were:

Number of subjects: 387Number of items: 114Mean (raw score): 74.9Standard deviation: 9.7Range: 26-93

Another Analysis of Variance (ANOVA) again yielded statisticallysignificant differences on the test between schools (F=10.62; p<0.01).

Of the 114 items, 17 met all the five previously mentioned criteria.Criteria 5 was not met by narrow margins by 25 items and by fairmargins by 16 items. Two items did not meet criteria 3; 1, criteria 3and 4; and 1, criteria 1. and 5. This analysis yielded a revised total of62 possible items. Fifty-two items were discarded as inadequate. Afurther analysis of the items discarded after the first national adminis-tration indicated that 13 should be reconsidered for possible future use.

With the utilization of only the presently acceptable 62 items, a break-down by category of the theoretical framework shows reasonably adequatematch of number of items in terms of percentage of assigned "extent ofmention" for the professional nursing student. The following categoriesseemed somewhat over-represented by test items: Health Promotion -Self-Actualization, Early Diagnosis and Prompt Treatment - Safety andProtection, Early Diagnosis and Prompt Treatment - Social, and Rehabilita-tion Psychological. The categories Health Promotion - Physiological andHealth Promotion - Social seemed under-represented by content of test items .

New items are yet to be written.for these under-represented categories.*

Status

It was hoped two comparable forms of this achievement test could beultimately developed. In light of the authors' experience in developingadequate items, this May be a somewhat unrealistic goal. New itemsfor the inadequately-covered content areas, the present 62 acceptableitems, and the 13 possible items from the first test form should beadministered to a large group of students (perhaps 1,000) for adequatestandardization purposes. Furthermore, aside from senior nursingstudents, the expanded test should be administered (as was done atThe University of Tennessee College of Nursing with the first test form)to nursing students on a cross-sectional basis (Lee, freshmen, sopho-mores, juniors, and seniors) to assess the relative validity of the test.

e s a is ica eva ua ion eata have been referred to the NLNMeasurement and Evaluation Services for the consideration of futurework on this test and possible nation-wide utilization.

81


Reliability studies, if enough items for two tests cannot be developed,need to be done on one form of the test. A more complete analysisof the already existing test data might give additional information fordirection of test development. At any rate, the test is such that consider-able effort is still warranted to develop it as an acceptable achievementtest in occupational health nursing.

-REFERENCES

1 Ebel, Robert L. Educational Measurement. Washington, D.C. :

American CouriEflOirrai-Fifi5FT-T9-51:

2 Ebel, Robert L. Measuring Educational Achievement. EnglewoodCliffs, N.J.: Prentice-Hall, 1965.

3 Shields, Mary R. The Construction and Use of Teacher-Made Tests -Pamphlet No. .57-W. "5FWEITaTiona League or ursmg,

4 ETS Test Development Style Manual. Princeton, N.J. : Educationales mg ervice, e ruary, 6.

5 Selecting an Achievement Test Principles and Procedures.Princeton, N.J-. rkthicational 'resting ervice, 1961.

6 Multiple - Choice Question: A Close Look. Princeton, N.J. :uca lona es ing ervice,

7 Englehart, Max D. Improving Classroom Testing. Department ofClassroom Teachers, American Educationaf ResearchAssociation of the National Education Association, Washington,D.C. : National Educational Association of the United States,December 1964.

8 Making the Classroom Test - A Guide for Teachers. (Evaluationan Advisory ervice eries, 0. ', rmce on, N.J. : EducationalTesting Service, 1959.

82

CHAPTER VIIIFINDINGS

The four parameters of the project that have primary implications fornursing educators and to some extent for nurses in occupational healthare (1) the theoretical framework and its educational applications, (2)a methodology for analyzing a content area of a nursing curriculum,(3) the achievement test in occupational health nursing, and (4) suggestionsfor meaningful learning experiences for professional nursing studentsin the work setting.

The Theoretical Framework

The availability of a theoretical framework is readily perceived bynursing educators as a requirement for curriculum construction. Theframework described herein provides guidelines for meeting Mayhew'ssuggestions for curriculum analysis and evaluation, suCh as exposure ofimbalances and omissions in a curriculum and provision of limitswithin which a course of study might be constructed. It would thusfill the need that apparently exists for an organized approach toidentifying the content and objectives of an educational program. Inaddition, the theoretical framework through its six components, whichare identified and discussed below, provides a method for structuringthe curriculum desired,

1 Integration of two theories with the nursing process as apattern for curriculum development and evaluation: Thetheoretical framework integrates the theories of levels ofprevention and hierarchy of needs with significant activitiesof the nursing process. The framework thus provides afeasible method for identifying,nursing competencies specificto occupational health nursing:: and Other speciality areas in nursingfor example, community health, medical-surgical, maternity,or psychiatric nursing. Its use in identifying more specificcontent areas such as cardiac, neurological, or orthopedicnursing is an untested possibility. By identifying the expectedcompetencies in terms of the nursing process, the relevanceof the content becomes more readily evident. It might evenbe possible to build a total curriculum in baccalaureate nursingby using the methodology suggested in this study.

83

87

Chapter VIII Findings

84

2 Identification of competencies of the professional nurse inoccupationa1 health (Appendix DY: The competencies identifiedwithin the framework should be useful to nursing educators asdeterminants of the elements to be included in course contentrelating to the role of the professional nurse in occupationalhealth. The competencies provide a more detailed descriptionof on-the-job activities of the occupational health nurse thanwere previously provided.

These competencies might also be used by occupational healthnursing leaders (1) in developing job descriptions for the roleof the nurse in industry, (2) in developing short-term trainingprograms, and (3) in constructing nursing manuals for use inoccupational health settings.

3 Identification of appropriate academic occupational healthnursing contenf at the baccalaureate level (Chapter VI): Thesuggested academic content that has been identified could beused in baccalaureate education for nursing students. Em-phasis in this project has been placed on the unity of baccalaure-ate nursing programs by not separating occupational healthnursing content in the curriculum from the whole. The theoret-ical framework itself identifies and demonstrates this onenessin nursing; and, in keeping with the discussions by the originalad hoc committee, the Principal Investigator has identifiedcontent in occupational health nursing in relation to the basiccurriculum. As Ditchfield suggested, the greatest amount ofacademic content essential for the occupational health nursepractitioner is also essential for all nursing practitioners.Undergraduate learning experiences for all nursing studentsmay be greatly enriched by more exposure to the health con-cerns of the adult working population.

4 Identification of appropriate occupational health nursing contentat the graduate-level (Clapter VI ). Occupa lona healt nursingcontent that -is sOlely graduate level is identified, as well as thecontent that begins at the baccalaureate level and continuesthrough graduate study. Use of the methodology in graduatelevel education is more fully discussed in a following section inthis chapter. When baccalaureate nursing programs meetthis project's content criteria ("extent of mention" in allcategories), then the definition of a graduate program deemedsufficient to reach:a clinical specialty level in a broadcommunity health nursing graduate program will be morefeasible.


JrIdentification of appropriate occupational health nursingcontent for in-service education (Chapter VI): Occupationalhealth nursing content specifically applicable tothe work setting, has been identified. Practitioners inoccupational health nursing, particularly those concerned within-service programs, should find the identified content usefulas a guide in planning and implementing in-service programs.The content may also be used in establishing expectations foremployers for a newly-graduated professional nurse.

6 A tool for curriculum evaluation: The over-all theoreticalframework, as well as the method of data collection, is atpresent adequately developed for utilization by nursingeducators in assessing the occupational health nursing contentof their curricula. This provides one set of criteria againstwhich the curriculum content may be measured.

A Methodology for Analyzing a Nursing Curriculum

The methodology created during the course of this project is withinthe purposes of the project as stated in Chapter IV:

1 To identify that content from occupational health nursing whichis essential for professional nursing education and practices, and

2 To develop a methodology for identifying given content areaswithin a course of study.

At no time has the content from occupational health nursing beendelineated as an area independent of nursing content as a whole,but rather it has been seen as permeating the entire academiccontent suggested fer professional students of nursing.

The methodology to identify a given area of content within a courseof study can also be used to assess the following aspects of anynursing curriculum: (1) the overall strengths and weaknesses in acourse of study, (2) the adequacy and depth of coverage of the giventopic, (3) the extent and manner of content overlap, and (4) thespecificity of existing and desired content areas and intensity ofcoverage in particular courses or on particular levels of progression(1st, 2nd, 3rd, 4th year) in the nursing program.

'The methodology has these advantages: (1) it provides a nursingfaculty with a common frame of reference, (2) it is a contemporary,relevant, and dynamic frame of reference, (3) it minimizes prolongeddiscussions as to the need for inclusion or exclusion of a given areaof content, (4) it lends itself to systematic modification, (5) it

85


requires significant cooperation and collaboration between facultiesin nursing and non-nursing courses, (6) it leads to a breakdown inpresently existing compartmentalization. In applying the methodology,it was found that the most time-consuming aspect was the data collection.The theoretical framework provides not only an up-to-date theoret-ical structure, but also a quantitative vehicle for evaluating anynursing curriculum, in fact any total curriculum. The findingsfrom use of the framework in this project have significant long-rangeimplications. If, for instance, each present specialty componentas well as the liberal arts and science components were looked atby means of this theoretical framework, most if not all of theabove noted advantages would be apparent. The results of theevaluation could indicate that the course structure presently existingin schools of nursing needs to be significantly modified. The resultscall for rethinking as to the role of traditional courses, such aschemistry, abnormal psychology, pharmacology, and medical-surgical nursing with the possibility of their merging into a new areaspecifically related to all chemical systems of man's existence onthe health continuum. Reorganizing anthropology, sociology,epidemiology, preventive medicine, and public health nursing contentinto a cohesive, integrated, continuous area (perhaps a sequence)might possibly result in an ecological approach.

Use of Methodology in Changing Occupational Health Nursing Content inT3-accalaureate Curricu a

The quantitative assessment technique can be useful in collectingdata on which to base recommendations for changing the occupationalhealth nursing content in baccalaureate curricula. In Table III ofChapter V the number in line 5 indicates the approximateper cent of recommended coverage of the total knowledgeexposure for each of the 25 categories at the baccalaureatelevel of nursing education; i.e.,

Assigned "Mention" Bac. Ed. Level % of Bac.ssigne en ion , ro . urse in cc. Level Coverage

By quantitatively assessing a total curriculum by the methodologydescribed in this manual, it could be determined whether therecommended approximate percent of coverage is achieved for eachcategory.

For example, for the category labeled "Disability LimitationPhysiological, " it has been recommended that approximately 75percent of the content should be included at the baccalaureate level.If, on quantitative analysis, it should be found that a greater or lesserpercent of coverage is present in the curriculum, a qualitativeassessment of that category could be undertaken to determine whichcontent areas were receiving less than adequate or more than adequatecoverage.

86

Chapter VIII - Findings

Use of Methodology in Developing Graduate Programs in OccupationalHeallh 'nursing

Quantitative assessment techniques could also be used in developinggraduate programs in occupational health nursing and/or in developingthe occupational health nursing component of community health nursingprograms.

The approximate percent of recommended coverage of the totalknowledge exposure for each category at the graduate level maybe determined by subtracting the number in line 5 of Table III inChapter V from 100. The resulting percent would provide a guideto the amount of content coverage recommended for each category.

From the mean calculated for each level of prevention and for each needit was determined that the greatest amount of content needed at thegraduate level is in the areas of Specific Protection (62 percent) andSafety (58 percent). The least amount of content needed at thegraduate level is in the areas of Physiological (28 percent) andDisability Limitation (34 percent). The percentages range from44 55 percent coverage on the graduate level for each remaininglevel of prevention and need. By using Chapter VI the suggestedacademic content could be very specifically identified, providedthe baccalaureate level of content is known.

Achievement Test in Occupational Health Nursing

The achievement test is primarily directed to measuring thenursing students' knowledge in occupational health nursing. Assuch, nursing educators can use the achievement test as a specifictest in evaluating the students' level of knowledge in occupationalhealth nursing. The test also has possibilities as a component ofthe present battery of comprehensive examinations taken prior tograduation and as a part of state board examinations. A secondbroad area for utilization of the test is that all or parts could beused by testing services that develop examinations for employmentscreening and placement of nurses in occupational health positions.The use and validity of the test will be enhanced by the widestpossible dissemination in its further development and standardizationby a recognized national assessment agency, as is at this date(1970) under consideration.

Suggested Learning Experience for Professional. Nursing Students in theWork SetIing

Although no research in the occupational health environment wasspecifically and directly undertaken in The University of Tennesseeproject, nevertheless, note must be taken that in the labor force of

87


the United States, composed of approximately 80 millionindividuals, there is a unique opportunity to study the "normal"active adult.

Ecological factors, promoting or undermining health, from a majorsegment of an individual's life can be assessed. By observation,one can recognize physical, social, cultural, or psychologicalinfluences on an individual. With additional attention, One cangain some insight into pressures from and reactions to theseinfluences. Influences, such as increasing automation andcomputerization, the population explosion, decreasing work weeks,increasing unionization, increasing mobility, and exposure to newchemical and biological hazards are having an effect on employees.Spontaneous discussions elicit many pressures and influences.For instance, during a chance meeting with a long-haul truckdriver, the author was able to learn first-hand about stressfulfactors in long distance trucking. With a few additional questions,the problems of fatigue, loneliness, and the strain and uncertaintyof the hours of work became obvious. These factors most certainlyaffect one's health. They would also affect one's family - their healthand interpersonal relationships. The manifestations of these condi-tions determine the direction of the nursing care needed to lessenthe deleterious effects.

Exposure to the labor force in action can provide observations ofwellness" as described by Dunn. (1) The variety of levels of

health is unlimited from the employee reaching for peak-wellnessto the one in poor health in a relatively unhealthy environment.Not only can individual wellness be studied, but elements of family,community, environmen41, and social wellness are also subjectto student observation. (2)

The transactions between the employee and the work setting oileropportunities for studying individuals learning the developmentaltasks of adult life, as described by Havighurst. (3) Too frequentlythe growth and development content in nursing education stops withthe adolescent, or theory only is presented for the actiVe adult.The tasks after age eighteen are as important in fulfillment for anindividual as the earlier tasks. Every one of us has been andcontinues to be in the process of learning these tasks.

The basic human needs and their influence on an individual's healthplay a major role in the relationship of an employee to his co-workers,the work setting, and to the family as well. Examples of theinfluence of basic needs on the health of an individual are unlimite.:.For instance, work is a major source of satisfaction and of thefeeling of belonging for many people. Safety and protection needs asmet in the work setting are basic to injury control programs, and

88


to economic security programs. The effect of such programson the health status of the adult are an important considerationfor the nurse who is responsible for planning and giving care.

Observation of the work environment can help the student see thecorrelation of job and income and an individual's and his family'shealth. Numerous studies bear testimony to the effects of blue-collar work on health. (4)

Group cohesion or disorganization can be studied with the subse-quent effects on health. The evidence of a feeling of esprit de corps,or its lack, in the work unit can be observed and felt by a perceplivestudent. Th' nursing team of which the student is a member shouldprovide such an experience.

The student can be guided in the development of a philosophyof seeing an individual as a productive citizen - one with abilitiesand potential. So frequently, health personnel fall into the habitof looking at a person and seeing a diabetic, a cardiac, or a handi-capped patient in a wheelchair. Awareness of limiting factors maybe necessary, but focusing on strengths is essential. Movementin the reorganization of health care services is toward a greatincrease and broadening of ambulatory services for citizens at alllevels of wellness. This trend in developing health services forpromoting and maintaining health will require that nurses developthis wellness-oriented philosophy in addition to a pathophysiologicviewpoint.

A work setting with a health care facility can provide the studentwith the opportunity to function within an organized frameworkfocusing on primary prevention. Most occupational health programspractice some forms of health promotion and maintenance. In awell-developed occupational health program, all levels of preventionon the "health-sickness continuum" can be studied. The opportunitiesar.e available for the nurse to participate in a program that permitsher to interact with active, but ill adults who are developing theirpotential abilities and making a contribution to society.

The work environment provides for the student a rounding out oflearning experiences regarding the concept of continuity of care.Much is written and said about continuity of care, but what might bethe most difficult segment is seldom mentioned - that of returningthe individual to being an active, productive citizen. Assisting anindividual in adjustment to a job or assisting the co-workers inaccepting him may be vital to the rehabilitation of an employee.In such a situation, a nurse could act as the liasion between placeof employment and family setting by interpreting the health needsof an individual and thereby facilitating job placement.

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93;


REFERENCES

1 Dunn, Halbert L. High-level Wellness for Man and Society,American Journal of Public Health, 49:786-792, June 1959.

2 Dunn, Halbert L. High-level Wellness Arlington, Virginia: R. W.Beatty, Inc., 1961.

3 Havighurst, Robert J. Developmental Tasks and Education (2nd ed.New York: David Mc Ray Co., Inc., 195.

4 Shostak, Arthur B.and William Gomberg (ed.). Blue-Collar World- Studies of the American Worker. Englewood Cliffs, N.J. :Prentice Hall, Inc., 1964.

90

CHAPTER aRECOMMENDATIONS

The findings of The University of Tennessee project might well provideimpetus to the integration of occupational health nursing content intonursing curricula and to the development of learning experiences for theprofessional nurse in the work setting. These experiences could bedirectly related to the role of the occupational health nurse or couldprovide observational or participational experiences for promoting thesymthesizing of concepts needed by the professional nurse to functionin any setting.

The unified approach in developing the competencies for the professionalnurse in oc-nipational health and the related academic content may wellserve to hasten the practice of the expanded role of this nurse; also,it may start the move towards the fulfillment of the goals for communityhealth -iursing practice as set forth by the Community Health N=sing

of Practice of the American Nurses' Association. (1)

With the expanded role for the professional nurse in occupational healthoutlined, nursing educators will be even more aware of the Lecessityfor the inclusion of the essential content relating to occupational healthnursing in the curricula of schools of nursing.

These implications lead to the presentation of the following immediateand long-range recommendations:

Immediate Recommendations

For Nursing Educators:

1 That the findings of this project be applied in assessingbaccalaureate nursing programs of varying philosophies andin varying geographical locations.

2 That consultation from knowledgeable individuals be requested,as needed, by nursing educators to implement the findingsof this project.

For Practicing Occupational Health Nurses:

1 That the academic content areas identified by this projectbe integrated into the philosophy and practice of occupationalhealth nursing by means of formal courses in nursing and thesupportive sciences, continuing education programs, and in-service education programs.

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95

Chapter IX Recommendations

2 That the acquired academic content be integrated into theidentified competencies of the professional nurse, in occupationalhealth by applicable modifications of nursing philosophy andpractice in occupational health.

For Nursing Educators and Practicing Occupational Health Nurses

1 'That, where geographically feasible, there be coordinatedefforts in advancing the professional level of education andpromotion of the establishment of clinical laboratory settingsfor the students of professional nursing.

2 That these individuals and State and Federal nursing consultantscooperatively support an organizational mechanism for theimplementation of all of the above recommendations.

3 That appropriate organizations explore with available resourcesthe possibility of the standardization of the achievement testin occupational health nursing.

Long-Range Recommendations

For Nursing Educators:

1 That consideration be given to establishing a graduate programin community health nursing in which occupational health nursingis an identifiable component.

2 That the described methodology be utilized to assess othercontent areas of the nursing curricula with close contactassured between the personnel in relevant and high caliber clinicallaboratory settings and nursing educators.

3 That consideration be given to utilization of the describedmethodology in developing nursing theory.

For Practicing Occupational Health Nurses:

92

1 That mechanisms be instituted for the development of an aware-ness of the increasing need for working relationships betweenoccupational health nurses and other community health nursingpractitioners (public health, school health, and office nursing).

2 That the professional nurse in occupational health participatein the planning and implementation of the emerging reorganiza-tion in the health delivery system and that the role of the nurseexpand accordingly.

Chapter IX Recommendations

For Nursing Educators and Practicing Occupational Health Nurses:

1 That the cornpetencie6 and content for the professional nurse

in occupational health be continually refined and redefinedas the social, technological, industrial, and health aspectsof the environment change.

REFERENCES

1 Community Health Nursing, Newsletter, Division on Practice,American Nurses Association, April, 1968, p.3.

93

CHAPTER XSUMMARY

From 1965 to 1969 a project was conducted at The University ofTennessee College of Nursing to identify occupational health nursingcontent essential =_.baccalaureate education for professional nursing.

Relevant literature was reviewed in the areas of education, nursing,and occupational health nursing. After this review, a theoreticalframework was developed and applied consisting of an integration ofLeave 11 and Clark's levels of prevention approach to health care andMaslow's hierarchy of needs personality theory.

The meshing of these two theories produced 25 categories, eachlabeled with a level of prevention and a basic human need. Withineach category, the competencies and thereby the role of the profession-al nurse in occupational health were spelled out as behavioralobjectives in terms of the nursing process. Corresponding academiccontent was identified and delineated into levels of the educationalprogram (baccalaureate, graduate, and in-service.) The contentneeded by the professional nurse in occupational health at the baccalaure-ate level, but equally essential to all nursing, was identified.

The theoretical framework was used to assess the occupational healthnursing content of one baccalaureate program. The methodology in-cluded content data collection and analysis. The data were analyzedboth qualitatively and quantitatively. Raw data and the actual findingsfrom the assessment of The University of Tennessee College of Nursingcurriculum were omitted from this publication, however, they weremade available to the faculty of the program and to the Project Officer.

Items for an achievement test in occupational health nursing weredeveloped from the competencies and content identified and a standardi-zation process was started. Additional work is required for thestandardization.

Recommendations of an immediate and of a long-range nature have beenproposed for nurse educators and practicing occupational health nurses,individually and combined.

The implications of the results of the project fall into four areas: (1) Useof the theoretical framework and its application to nursing education;

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98

Chapter X - Summary

(2) use of the methodo]..clgy in evaluating any content area of a nursingcurriculum (with the =latent area af occupational health nursing alreadyworked out); (3) continued refinement of the occupational health nursingachievement test; and (4) exploration of suggested ideas to provide additionalmeaningful learning experiences for professional nursing students in thework setting.

This discussion of The University of Tenrcessee project on occupationalhealth nursing competencies and academic content has been presentedin this publication as a ready source fcw use by nursing educators and toa lesser extent occupational health nurses.

96

- 9.9. jr,

.... You have been tolt:LaAls.,:: that life is darkness, and inyour weariness you echa- ,,,,,,drat was said for the weary.And I say that life is iT darkness save when thereis urge,And all urge is blind selw-Trthen there is knowledge,And all knowledge is vain- .F.E-ave when there is work,And all work is empty -3-when there is love;And when you work with love you bind yourself toyourself, and to one a/in-tier, and to God.

And what is it to work wtth love?It is to weave cloth with threads drawn from yourheart, even as if your beloved were to wear that cloth.It is to build a house with affection, even as if yourbeloved were to dwell in that house.It is to sow seeds with tennerness and reap the harvestwith joy, even as if your beloved were to eat the fruit.It is to charge all things yuu fashion with a breadth ofyour own spirit,And to know that all the blessed dead are standingabout you and watching . .

Kahlil G.ibran(1833-1931)

Gibran, Kahlil. The P=phet. New York: Alfred A. Knopf,1923, pp. 26-27. Quotuf by permission of the publisher.

100

APPENDIX A

EDUCATION FOR OCCUPATIONAL HEALTH NURSING

Mary Louise Brown, R.N.

This appendix summarizes the course of occupational health nursingeducation up to the University of Tennessee project on which thismanual ig based. Only those events meaningful to understandingthe emergence of the project itself are described.

1910-1920

The decade from 1910 to 1920 saw the initial appearance of the variousskeins that were to be woven into the fabric of occupational healthnursing; the industrial nurse herself as an aware and dedicated person;the field of practice as one of rich opportunities demanding expertworkers with sound technical training; the organizations to meet theneed for professional stimulation and leadership; the training programsranging from short term courses to graduate level programs; andfederal participation as a motivating force towards uniformity inexcellence.

The effect of World War I on occupational health nursing practice andeducation was well expressed by one professor of public health nursingin 1919:

Many returning nurses have already accepted positions inpublic health nursing, and it is significant that a largeproportion, among them women of proved executive andteaching ability in other lines of work, are showing specialinterest in industrial nursing The field of industryoffers enormous opportunities for health work for the bene-fit of groups otherwise difficult to reach. The industrialnurse(3ince she spends her working day in the factory, isin many instances the agent on whom we must mainly relyto instruct industrial workers in the ways to prevent sick-ness and to maintain health. (1)

In 1915 the nursea working in industry in Boston formed the BostonIndustrial Nurse Club. This club became the New England Associationof Industrial Nurses in 1918. It continues to function and representsthe beginning of organizations for professional industrial nurses. In1942 it participated in the formation of the American Association ofIndustrial Nurses (AAIN).

9 g/99

101

Appendix A

Again in Boston, the first course of study designed for industrial nurseswas begun in 1917 by the College of Business Administration of BostonUniversity, a two 2-hour lecture a week course given over a 16-weekperiod with 2 weeks of supervised field service in an industrial medicaldepartment. (2)

From October 1, 1918, to June 30, 1919, a comprehensive course foroccupational health nurses was offered in cooperation with YaleUniversity. The students had "exceptional advanthges in their theoreticaltraining, including lectures, laboratory facilities and excursions tofactories and various industrial plants which illustrate the practicalneeds of public health and public health nursing. "(3)

In 1914 the U.S. Public Health Service (USPHS) created a unit, TheDivision of Industrial Hygiene, dedicated solely to the protection ofthe health of American workers. (4) This division evolved into thepresent Bureau of Occupational Safety and Health, Consumer Protectionand Environmental Health Service, U.S. Department of Health, Education,and Welfare.

1920-1930

The most significant development during the second 10-year period wasthe growing awareness of the need for specialized preparation that cameout of studies of public health nursing practice. As a result of theconference convened by the Rockefeller Foundation in 1918, a committeewith Professor C. E.A. Winslow as Chairman was appointed to preparea definite proposal for a course of training for public health nursing.Miss Josephine Goldmark, appointed Secretary in June 1919, conducted-the study and prepared the report which was published in 1923.

The Goldmark Report influenced nursing and nursing education in theUnited States probably more so than any other survey conducted before1919 or thereafter. It seems appropriate to call attention to thereport's conclusion and recommendations concerning industrial nursing:

The industrial nurse shares with the industrial physician richpossibilities for preventive work. According to the census of 1920*a substantial proportion of our entire nation, 13 million men andwomen, spend their working day congregated in manufacture andmechanical pursuits, and another million and a quarter as salespersons in stores. ....While nurses in industrial work as in otherspecialities have achieved success through their own initiative andpersistence, yet the lack of special training for this special fieldhas been a grave handicap for the most capable and has oftennullified the efforts of the less capable. No less indispensableis es ima es at som- :1 mi lion men and women are so engaged.

The 1968 ANA Facts on Nursing list 19, 500 occupational health nurses.

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Appendix A

for the industrial nurse than for other public health nurses forthe detection of disease, incipient and acute, for education aswell as curative work - is the preparation which we have alreadyoutlined for all public health nursing. This should consist of abasic hospital course of 2 years and 4 months, followed by soundtraining in public health nursing, with special emphasis and timedevoted to training in industrial conditions. (5)

In 1920, the National Organization for Public Health Nursing (NOPHN)inaugurated an Industrial Nurse Section.

1930-1940

Many occupational health nurses lost their jobs during the depressionof the 1930's. Those who were retained found that workers wereseeking help with their family-related health and welfare problems.It must be remembered that workers did not have unemploymentcompensation insurance nor medical and hospital care insurance as somany do today. From this period can be traced the acceptance ofhealth counselor and health educator as roles for the occupationalhealth nurse. The nurse's original involvement in care for industrialinjuries can be traced back to the influence of the workmen'scompensation legislation enacted by the States beginning in 1913.

The decade of the 30's saw the expansion of the Federal Government'scommitment with passage of the Social Security Act in 1935. Federalfunds were provided to the USPHS for grants-in-aid to the States forpublic health work, including industrial hygiene. These grantsstimulated the development of state industrial hygiene units. Nurseconsultants were first added to these units in 1939 when the IndianaState Board of Health and early in 1940 when Michigan employedindustrial nurse consultants to help industry and industrial nursesdevelop and upgrade health services for workers. (6)

The Industrial Hygiene Division of the USPHS initiated seminars totrain health personnel to work in the state industrial hygiene units.These seminars were conducted for public health nurses employed bythe Federal Government and those employed by State health units asindustrial nurse consultants. Frequently, public health educatorsfrom the developing schools of nursing in universities and collegesalso attended.

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193

Appendix A

1940-1950

The 1940's are the World War Il years in which Federal participationand expanded industrial nursing needs went hand and hand. In 1941the USPHS Industrial Hygiene Division was asked to guide the develop-ment of industrial health programs in defense industries. The servicesof a full-time narse consultant were requested and one of the publichealth nurse consultants was assigned to work with the physicians,engineers, and chemists in plamiing for nursing. This was the firstspecialized nursing consultant position created in the USPHS.

Early in 1940 the Public Health Nursing Section of the American PublicHealth Association (APHA) appointed a committee to study duties ofindustrial flirses. Industry in the meantime haci expanded from peace-time to wartime production, and the number of nurses in industryhad increased from over 5, 500 in 1941 to about 10, 000 by 1942 and to11, 200 by 1943. The PHS Industrial Hygiene Division collaborated withthe APHA committee, The resulting report(7) served as a basis fordetermining the range and standards of industrial nursing practices,and for prescribing programs of study for industrial. nurs es Thereport was written by occupational health specialists and emphasizedthe nurses' informational needs in industrial hygiene, occupationalinjuries and diseases, workmen's compensation, and safety. Itsupported the 1939 NOPHN's recommendation that courses in principlesof teaching, social case work, community organization and resources,industrial relations, personnel administration, industrial hazards,nutrition, communicable disease control, mental hygiene, and personalhygiene should be included. (8)

AAIN was founded hi 1942 to establish sound principles, standards, andpolicies in the field of education and in the practice of industrial nursing.In 1944 the AAIN Committee on Education outlined the first basic coursefor use by colleges and universities in preparing qualified professionalnurses in industrial nursing. (9) In 1949 the AAIN Committee proposed"Criteria for Evaluation of Programs of Study in Industrial Nursing."This was used to limited degree by the National Nursing AccreditingService in approving programs of study. (10)

in 1944 the American Nurses' Association (ANA) through its Board ofDirectors approved the formation of the Industrial Nurse Section. (11)In 1958 the name was changed to Occupational Health Section in line withthe movement to use "occupational" instead of "industrial" because thelatter had the connotation of heavy industry and manufacturing. (12) Overthe years committees from both the National and the State sections ofthe ANA presented reports that have influenced this field of practice,the most notable being the "Functions, Standards, and Qualificationsfor Practice of Occupational Health Nursing" first published in 1958 andrevised in 1960 and 1968. (13)

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164

Appendix A

Review of the prdfessional literature from the middle 1940's to themiddle 1950's shows that 20 or more schools of nursing had announcedcredit courses and/or degree programs for nurses in industry. (14)Five programs (Columbia University, Harvard University, Johns Hopkins,Yale University, and the University of Michigan) admitted industrialnurses to master degree programs. The USPHS loaned Emily M.Smith, an experienced occupational health nurse consultant, to Columbiain 1947-48 and to Yale in 1949-50 to develop and conduct programs ofstudy in occupational health nursing. In 1951 Yale employed a full-timeoccupational health nurse faculty member. This position was filled untilJune 1961, and training for graduate students was provided during that10-year period.

The University of Pittsburgh, Wayne State University, Seton HallCollege in New Jersey, the University of Buffalo, St. John's University,New York University, Peabody College, The University of California inLos Angeles, the University of Washington, Simmons College, BostonCollege, Boston University, the University of Minnesota, the Universityof Chicago, Loyola University in Chicago - all offered credit courses foroccupational health nurses or degree programs either in the field ofindustrial nursing or as a sub-specialty of public health nursing.

Only the University of Washington, Wayne State University, Boston College,and the University of Pittsburgh are known to have had full-timeoccupational health nurse educators to coordinate their baccalaureatedegree programs in industrial nursing. All other schools utilized thepart-time services of occupational health nurse consultants from Stateor Federal official agency occupational health units and/or nurses fromindustry.

In 1942 Public Health Curriculum Guide developed by a joint committeeof the NOPEN and the USPHS was first published. This contained a uniton industrial hygiene.

The many inquiries from nurses working in industry, industrial physi-cians, management, and nurse educators about the industrial nursingcontent in B.S. degree programs led to the development of an AdvisoryCommittee on Industrial Nursing with members from NOPHN's IndustrialNursing Section and from AAIN. Their report was approved by the JointCommittee of the NLN and NOPHN on "Integration of Social and HealthAspects of Nursing in the Basic Curriculum." This said in part:

103-105

Appendix A

A A course in industrial nursing should not be included in thebasic curriculum for the following reasons: The undergrad-uate curriculum is intended as a foundation only, containingtheory and practice essential .in any type of nursing. Itsultimate aim is the preparation of the student to function asa beginner in any of the major fields of nursing. If she wishesto advance to positions of greater responsibility or to aspecialized branch of service in any field, she must obtainadditional postgraduate study.

B Because of the above factors, as well as the great pressure toshorten the curriculum, it does not seem advisable for schoolsto add any courses. However, because of the obvious need inthe industrial field we recommend that schools of nursing examinecarefully their own curricula and endeavor to give moreemphasis to the industrial implications throughout the entirecourse of study. (15)

This statement set the pattern that has been followe-3 by schools ofnursing.

In 1946-47 Ella Louise Fortune, a graduate ..2tv.dent at Catholic University,did a comparative study of the content of the t:ourses and programs inindustrial nursing with the duties of nursec. ,imployed in industry. Atthe time she began her study, there were 32 schools in the United Statesand the Territory of Hawaii offering public health nursing programsthat had been approved by the Education Committee of the NationalOrganization for Public Health Nursing.

Her study was limited to the determination of (1) the availability ofcourses and programs in industrial nursing, (2) the availability ofadvanced courses required for supervisory and consultant positionsin industrial nursing, (3) the content of the courses, (4) the relativeimportance of items found in course outlines, and (5) a comparison ofthe items with the duties being performed by industrial nurses.

The following are selected quotes from Miss Fortune's summary andconclus ions :

104

The 8 schools offering only courses in industrial nursing have atotal of 9 courses; the 5 schools offering programs in industrialnursing offer a total of 19 courses.

Two schools accept courses in industrial nursing for credit towarda "Certificate in Public Health Nursing", 13 schools accept thecourses for credit towards a bachelor's degree; 10 schools do notgive graduate credit for courses in industrial nursing.

106

Appendix A

Thetse is 1itt1 correlation between the frequency of the dutiebeing perfornled by nurses in industry and the importance of

the various topics being given in courses in industrial nursing,as rated by the nurses participating in this study.

Nurses Who have had theoretical preparation for industrialnursing are Providing a broader n'arsing service to the employeesin the duties they are performing than those nurses working inindlastrY who have not been 50 prepared; also, the nurses whohave had public health nursing experience are rendering morenursing service than those without this experience. (16)

1950-1960

League t%change was a format instituted by the National League ofNursing Education (NLNE) and continued by the NLN as a means wherebyits mertibers could share exPeriences and ideas. The first Exchangepublished in 1952 was "Occupational Health Integration in the YaleUniversity School of Nursing. "(17) This was a report'of the work thatEmily M. Sznith had done during her special assignment from the PublicHealth Service to 'Yale University November 1949 to June 1951.

During the 1950's,as was true in the latter part of the 1940's, many 1-or 2-day TiorkShop$ were conducted for industrial nurses. The ExtensionDivision of the University of Minnesota had conducted annual courses ontopics of current interest to occupational health nurses, and as a resultof their Fifteenth Annual Course held in the Spring of 1955, LeagueExchange Number 16, "Guide for the Orientation of Newly EmployedOccupational Health Nurses," was published. (18)

League Exchange nimber 19, Iirrhe Educational Responsibilities of theNurse Consultant in occupational Health,' was a report of a workshopconducted at Yale university in September 1956 for 26 nurse consultantsfrom Canada, Puerto Rico, and the United States. (19) The members ofthe wol,kshop identified 10 understandings and abilities that theyconsi4red to be basic for effective practice for a nurse working in

industry,

During the 1950s 3 re5earch projects were conducted. Erma Barschak,Mianii university, Ohio, conducted in 1954-195 a study of occupationalhealth nursing Practices in the Ohio Valley. (20/ In 1957 Wendell Smith,Bucknen. thliversity, coriducted a study of industrial nursing functionin PentisylVania, (31) The third Project conducted by Heide Henriksenidentified What was being taught and what could be taught in collegiatebasic nursing education programs. Six schools in Minnesota took part. (22)

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Appendix A

The AAIN's Michigan Discussional held in 1954 brought together a groupof 37 persons representing industrial nurses and physicians, management,and nursing educators to discuss the educational needs of the industrialnurse, particularly the nurse working alone. Problem areas involvedin preparing the nurse to accept the varied responsibilities of industrIgl,nursing were identified, and numerous recommendations were made.

At the 1940 American Nurse Association (ANA) Biennial Conventiona committee to study the possibility of unification of the severalnursing organiza-Ions was established. By 1950 the members of the6 national nursing co-rganizations (AAIN, ACSN, ANA, NACGN, NLNE,and NOPHN) had accepted a general plan for two organizations. By1952 all but the AAIN had agreed to merge into either the modified ANAor the new NLN. (24, 25)

In June 1952 when the ANA, 24.CSN3 NLNE, and the NOPHN voted intoexistence the revised ANA and the new NLN, the members of the ANAOccupational Health Nurse Section asked that a committee be formedto study industrial nursing's place in the NLN. (26) At the first conventionof the NLN in June 1953 the Committee's recommendation that anOccupational Health Nursing Interdivisional Council be formed wasaccepted. In response to the frequent requests from a small group ofconcerned and deeply committed occupational health nurse members ofthe NLN for a more active program in occupational health nursing, MaryLouise Brown, then assistant professor of occupational health nursingat Yal- University, was employed by the NLN in 1956 to be the part-timeoccupational health nursing staff member.

In 1956 the AAIN and the NLN's Occupational Health Nursing Inter-divisional Council established an NLN-AAIN conference committee.In 1957 two representatives from ANA and one from the PHS wereadded. This Committee developed the Guide for Evaluating andTeaching Occuational Health Nursing Concepts, League ExchangeNumber 24. (21) The Committee had been formed to consider theeducational needs of occupational health nurses. They first identifiedthe things peculiar to occupational health nursing and on this basisaccepted the 10 understandings and abilities that nurses need to functionas occupational health nurses as stated by the occupational health nurseconsultant in League Exchange Number 19. These 2 concepts were thenincorporated into thelormat of the "Self- Evaluation Guide for CollegiateSchools of Nursing': Part II, as prepared by the NLN, League ExchangeNumber 24, was widely distributed, but not widely used.

Two milestones in any review of nursing education in the United Stateswere published by the Russell Sage Foundation: the publication ofEsther Lucile Brown (Nursing for the Future) and Margaret Bridgman(Collegiate Education for Nursmg"). These publications, reflecting the

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Appendix A

changes in the philosophy of the leaders in nursing education, resultedin a more clearly defined statement on nursing education and muchgreater accepta.nce of college education as the base for professionalnursing. In the year 1959 another milestone in nursing education wasreached when the NLN Board of Directors decided that (1) the NLN willaccredit no new programs in nursing that provide for specialized pre-paration at the baccalaureate level and (2) after a period of 5 years(or as of 1963) the NLN will accredit only those baccalaureate programsin nursing (without specialization) that include public health nursing as apart of the curriculum. (28) This action reemphasized that specializationin occupational health nursing, or in any area, was to be at the master'sdegree level. It also had the effect of including public health as an integralpart of the basic baccalaureate program, thus enriching the program forall students of nursing.

1960-1969

The last of the 10-year periods, the present decade, saw attempts toresolve and crystallize 2 basic thrusts of the nursing profession: (1)defining technical and professional practice and the related levels ofeducation for nursing and (2) reorganization of the organizations.

Following the discontinuance of the part-time occupational health nurseNLN staff position in 1961, the steering Committee of the Council onOccupational Health Nursing developed a project that they proposed becarried on at the NLN by an occupational health nurse who would beemployed full time to give leadership to occupational health nursingeducation. The project director would (1) survey schools of nursingfor their activities in the area of occupational health nursing; (2) developpilot projects in selected universities for the development and evalua-tion of tools for the integration of occupational health nursing into thebasic program; (3) provide consultation to schools as requested.

After the Steering Committee developed the project, they discussed itwith the NLN General Director and others on the staff. In October1962 Miss Dorothy Benning, Chairman of the Interdivisional Council onOccupational Health, and Mrs. Jane Lee met with the Steering Committeeof the Department of Baccalaureate and Higher Degree Program to talkwith them about the Occupational Health Council's proposed project. Anad hoc committee was then appointed to examine the educational needsin the field of occupational health nursing and to prepare a statement thatcould be used by both groups. This committee met in July 1963 anddetermined that a committee could not examine the educational needs inthe field of occupational health nursing and prepare a statement thatcould be used by both groups. They suggested that a project be developedto identify those concepts essential to occupational health nursing and

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Appendix A

basic to the practice of all nursing and hence to be included in basiceducational programs. This suggestion led to the development of a pro-ject and the negotiating of contracts by the Federal Government with theBoston College School of Nursing and The University of Tennessee Collegeof Nursing, which were selected because they were in two different partsof the county and they presented two diffelent plans. The Boston projectwas for one year. (29) The manual, of which this history is a part,reflects the experience of The University of Tennessee during the periodFebruary 1965 to August 1969.

Other publications in this area and at this time were "Selecting Occupa-tional Health Services fo:72 Nursing Student Learnin_g Experiences"(30) andthe"Bibliography on Occupational Health Nurs ing"(31) by the NLN; "SelectedAreas of Knowledge or Skills Basic to Effective Practice of OccupationalHealth Nursing" by the ANA. (32)

The ANA Committee on Education, which has as its function to study andto make recommendations for meeting the Association's responsibilitiesin nursing education, published as a position paper a report which setsforth 8 assumptions and the position that "education for those who workin nursing should take Rlace in institutions of learning within the generalsystem of education. "(62) This report delineates the essential componentsof professional nursing and technical nursing practice.The 1960's will also be remembered for the amount of Federal health-related legislation that was passed, including the extension to 1964 ofthe Professional Nurse Traineeship Program and the passage in 1964of the Nurse Training Act. Of interest too are data from the InteragencyConference on Nursing Statistics in 1967 that an estimated 7.2% of the19, 500 occupational health nurses in the United Stated had a baccalaureatedegree, 1.5%, an associate degree; and 1.0%, a master's degree.

Conclusion

The summary of events has indicated how the project described in thismanual came about and has shown the long standing intense interest inthe project goal of identifying educational content in nursing educationfor occupational health nursing. It is hoped that the data and theorypresented will contribute to progress in occupational health nursing andnursing education by providing qualitative and quantitative methods foruse by faculties in the evaluation of the nursing curriculum.

It is believed that the hypotheses set for this prOject by the ad hoccommittee of the NLN in 1963 have been tested and found valid.Occupational health nursing content can be identified and the methoddeveloped for evaluation of the content can be used effectively.

108

:110

Appendix A

REFERENCES

1 Strong, Anne H. "Problems in The Training of Industrial Nurses, "Journal of Industrial Hygiene, Vol. 1, No. 6, October 1919,p.--Z 97.

2 Mcgrath, B. "Fifty Years of Industrial Nursing in the UnitedStates, " Public Health Nursing, Vol. 37, No. 3, March 1945,p. 119-124.

3 Fourteenth Annual Report, "The Visiting Nurse Association, "

New Haven, Conn. 1918.

4 Heiman, H. "Occupational Health 1914 - 1964, " Public HealthReport, Vol. 79, No. 11, November 1964, p. 941.

5 Goldmark, Josephine, Nursing and Nursing Education in theUnited States, The Macmillan Co., New York, ran,171-58 - 159.

6 Brown, M. L. "Nursing in Occupational Health, " Public HealthReport., Vol. 79, No. 11, November 1964, p. 967.

7 Whitlock, O.M., Tasko, M.V., Kohl, F.R. Nursing Practicesin Industry. (P.II. Bulletin 283), U.S. Government PFuifingOffice, Washington, D.C. 1944.

8 "Committee on Professional Education of A. P.H.A. ", DesirableQualifications of Nurses Appointed to Public Health NursingPositions in Industry,lt American29:789, Vol. 29, No.7 Ju y , pp.

ourna

9 Minutes of Committee on Education for year 1944, AmericanAssociation of Industrial Nurses, New York, (unpublished).

10 Statement of Committee on Education, riteria for Evaluation ofPrograms of Study in Industrial Nul_sing, " Published byAmerican Association of Industrial Nurses, New York, 1949.

11 "The Biennial, " American Journal of Nursing, Vol. 44, No. 7,July 1944, p. 927.

12 The 1958 Convention, American Journal of Nursing, Vol. 58,No. 7, p. 980.

13 Occupational Health Nurse Section, "Functions, Standards andQualifications for Occupational Health Nurses, " AmericanNurses Association, New York, 1958, Revised 1960 and 1968.

109

111

Appendix A

14 Educational Opportunities in Industrial Hygiene, " Industrial HygieneNews Lefter-, Vol. , NO. 4,Apri1T1048, p. 8-117b71.3"761-7-31-",--No. 6, June 1951, p. 84-87.

15 Industrial Nursing in the Basic Curriculum, Report of the Advisory--Committee on inclUsfrial -Nursin'g, American Journal of Nursing,

45:478, June 1945.

16 Fortune, Ella L. A Comparative Study of the Content of theCourses and Programs in Industrial Nursing with the Duties-61 the Nurtlffiflp oy-e717n-Tridiria presenfgato Facu.,. y o e c oo o ursing Education in the CatholicUniversity of America, Washington, D.C., 1947.

17 League Exchange No. 1, Occupational Health Integration in theYale University Schoo ursing, a lona eague or ursing,New York, 1952.

18 League Exchange No. 16, Guide for the Orientation of Newly EmployedOccupational Health Nurses, National League for l\TUrsing, NewYork, 1956.

19 League Exchange No. 19, Educational Responsibilities of OccupationalHealth Nurses, National League for Nursing, New York, 1956.

20 Barschak, Erna. Today's Industrial Nurse and Her Job, New York,A. P. Putnam's Sons, 1-9b6.

21 Smith, W. The Industrial Nurse - An Analysis of Her Function,Bucknell Uriiversity, Lewisburg, 1957.

22 Henriksen, H. Curriculum Study of the Occupational Health Aspectsof Nursing, St. Paul, Bruce Publishing Co., 1959.

23 Report of the Ann Arbor Discuss ional, "The Nurse in Industry, "Sponsored by American Association of Industrial Nurses Inc.with the Institute of Industrial Health, University of Michigan,1954.

24 Brown, M. L. "Industrial Nursing's Place in the New Structure, "Nursing World, Vol. 126, No. 4, April 1952, p. 176-177.

25 Editorial, "AAIN's Decision of 1952, " American Association ofIndustrial Nurses' Journal, Vol. 7, o. arc

26 Brown, M. L., Millington, R.H. "Should Industrial Nurses Belongto NLN?" Nursing World, Vol. 127, No. 6, June 1953, p. 28-29.

110

112

Appendix A

27 The League Exchange No. 24, Guide for_ Evaluating and TeachingOccupational Health Nursing Concepts, 5affona1 League for

ursing, ew or ,

28 NLN, "Responsibilities in Public Health Nursing Education, " Reportissued by the NLN Department of Baccalaureate and HigherDegree Programs, August 1961.

29 Summers, V.N. "An Occupational Health Nursing Study, "Nursing Outlook, Vol. 15, No. 7, July 1967, p. 64-66.

30 Council on Occupational Health Nursing, "Selecting OccupationalHealth Services for Nursing Student Learning Experiences, "National League for Nursing, New York, 1964, p. 3-7.

31 "Selected Areas of Knowledge on Skill Basic to Effective Practiceof Occupational Health Nurses' Section, New York, AmericanNurses' Association, March 1966.

32 American Nurses' Association, A Position Paper, EducationalPreparation for Nurse Practitioners and Assistants to Nurses,

ew or , e Assocla

111

113

APPENDIX BRATIONALE FOR THE UNIVERSITY OF

TENNESSEE COLLEGE OF NURSING CURRICULUMMary L. Morris, Ed.D*

Curriculum study usually begins when there are major dissatisfactionswith the current program. This was our impetus. While we felt thatour program has many strengths, we also recognized that majorweaknesses existed; namely,

1 The need for strengthening the liberal arts portion of theprogram.

2 The need for an organizing focus in the nursing major, allwithin the usual time span by the baccalaureate program.Therefore, many choices have to be made.

In respect to (1): It was felt that in addition to a sound foundation inthe behavioral and physical sciences which are supportive to the nursingmajor, an educated person needed to know more than "his own time,language, and culture". We also felt that the baccalaureate degreein nursing should include approximately the same requirements,exclusive of major subjects, as other baccalaureate degrees conferredby the parent university, the University of Tennessee thus, theinclusion of foreign language, philosophy, anthropology, etc. It is ourhope that the student will acquire a sound foundation rather than a.superficial knowledge of the courses included as well as the desire togo on learning independently in these and other fields.

In respect to the Nursing major: The baccalaureate curriculum hasevolved from the hospital school and has patterned itself after thegeography of the hospital into Medical-Surgical, OB, Peds, etc. Ithas lacked an organizing focus. Montag has pointed out that:

Med-Surgical Nursing is a therapyMaternity Nursing a physiological processNursing of Children an age groupPsychiatric Nursing a conditionPublic Health Nursing a place.

Even if the teaching approach has not focused on these, there has beenan influence on, and a deterrent to, creativity brought to bear by theservice-centeredness of the curriculum divisions.

It is believed that one organizing concept that could be used is that ofbasic human needsEramon to all persons and the intervention bothnursing and medically which can aid the indivi.dual in meeting theseneeds. This is based on a concept of man's attempt to maintain adynamic equilibrium between his external and internal environmentv'Profébor 6f mfrthhg, coudge---6rNursing,The University of Tennessee 112/

113

114

Appendix B

and his adjustment. It was felt that this concept could be used throughoutthe program in teaching the care of adults and children in all stages ofwellness and illness and in all settings.

The early nursing courses would focus on the areas of human needs wherestressors which are threatening to the integrity of the person can beremoved or made less threatening by nursing.intervention. Progressionwould be to the areas in which a specific need is altered through diseaseprocesses or other circumstances so as to require medical therapyfor alleviation. The nurse would retain an independent function withrespect to all but the specifically altered human need and would assumea colleague or dependent function with other disciplines in aiding the patient.Thus all nursing courses would focus on needs and ways of meeting theseaccording to the situation and all would focus primarily on the professionalnursing role. No courses have been identified by title. The real challengenow is for faculty to, within this framework, identify content, learningexperiences and teaching approaches that will enable us to implementa new program.

114

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cris

is

prom

o-I-

Ton

of f

ull u

se o

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251

mai

ning

abi

litie

s: pe

velo

pmen

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reat

est p

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of r

ehab

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ted

empl

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.A

bove

line

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unct

ions

and

res

pons

ibili

ties

of n

urse

. Bel

owlin

e -

Kno

wle

dge

and

abili

ties

to fu

lfill

func

tions

and

resp

onsi

bilit

ies

Appendix D

Competencies and Suggested Actionsof the Professional Nursein Occupational Health

117

117

COMPETENCY SUGGESTED NURSING ACTIONr"ra=.ISOea

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..=o-

Assesses physical healthneeds of employees

Identifies physical health needs by observation, interview, analysis of records, reports, examinationsCorrelates identified needs and age groupingIdentifies groups of employees with special physk:al health needs

Collaborates in planningfor health promotion andmaintenance in worksett ing

Participates on health team in formulating philosophy and objectives for meeting needs of employeesbased on current standards and establishei; policiesCommunicates health needs of employees to health teamInterprets occupational health nursing as a member of the intra-plant and extra-plant health team

Intervenes to promotehealth maintenance

Organizes nursing aspects of health screening and evaluation programConducts health interviewConducts screening tests, e.g., vital signs, electracardiogram, laboratory tests, vision and hearing testsAssists physician in hysical examination procedures, e.g., draping, chaperoningMaintains records and reports for well employees iInterprets examination findings to employeeGuides employee to improved health habits through counseling, teaching, and demonstration, e.g.,personal hygiene, diet, dental and general health care, rest, recreationPromotes positive attitudestoward health and health care among employees, familyInterprets health-related information

aft...a..-a

Collaborates in assessingsafety needs of employeeand family

...

Identifies safety needs through observation, interview, and analysis of records and reportsIdentifies patterns of accident susceptibilityEvaluates employee's environment for effectiveness of safety measures

intervenes to promotesecurity of employee andfamily from economicstress due to non-occupational illness andinjury

Interprets health and medical insurance plansIdentifies patterns of health needs from analysis of records and reports and utilization of health care servicesAssists in compiling medical insurance claimsEstimates impact of illness on family from claim data

r.3

(5?)

Assesses social healthneeds of employee andfamily

Identifles health need relating to social adaptation of employee and family through observation,interview, analysis of records and reportsCorrelates identified needs and developmental Level and age grouping of employeeAnalyzes employee-employee relationship:Analyzes employer-employee relationshi.,..i,Analyzes employee-family relationshipsIdentifies groups of employees with specil ri.-ii.-Is

Collaborates in planning andintervening to promotesocial adaptation of em-ployee and family

Collaborates in providing setting conducive to adaptationInterprets effect of total environment on health of employee and familyGuides employee and family in social adaptation through counseling, interviewing, teaching, demonstration

Collaborates in planninghealth maintenance activi-ties for total communityhealth program

Interprets occupational health nursing to communityCommunicates health needs of employee and familyCoordinates occupational health program with organized community health program

=OAciio.=Caanre)

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Assesses emotionalhealth needs of employees

Identifies needs of employees through observation, interview, analysis of recordsCorrelates idcntified needs and developmental level and age groupingIdentifies groups of employees with special health needs

Collaborates in planningand intervening to pro-mote emotional health

Communicates identified needs to health teamInterprets effects of total environment on emotional health of well, productive citizenGuides employee and family through counseling, interviewing, teaching, demonstrationCollaborates in providing setting conducive to good emotional health

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Assesses growth needs andhealth potential of employees

Identifies growth needs and health potential of employee through observation, interview, analysis of recordsCorrelates identified needs and developmental level

Collaborates in planningand intervenes to promotegrowth

Communicates identfied needs to health teamGuides employt-' to attainment of growth through interviewing, counseling, .teaching, and demonstrationProvides nursirw leadership in planning recreational and self-development programs in plant and communityPromotes self-responsibility for hr ..1.th and health careRecognizes health team as members of the labor force and as individuals

Participates in and conductssystematic studies relatingto health of employees

Identifies health problems of employee and family in need of studyInitiates studies and projects using systematic research methodology

Collaborates in evaluatingthe total health promotionand health evaluationprogram

Appraises program and services based on philosophy, objectives, current stai dards, and puliciesPredicts future health needs and problems of employee, family, community, work environmentRevises program and services based on changing needs and utilization of servicesAnalyzes relationship of nursing to other health team members -- in-plant and communityEvaluates nursing program based on philospphy, objectives, policies, legally recognized practicestandards, and independent and dependent nursing functionsEvaluates own performance, and personal and professional developmentEstimates budget needs for nursing programKeeps abreast of current thinking and direction of changes in nursing and delivery of health care

...

118 118

COMPETENCY SUGGESTED NURSING ACTION

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Collaborates in assessingthe work setting forhazards to physical health

Identifies physical hazards to employee and familyObserves and examines employee to prevent toxicity from environmental exposureObserves work environment I'm needed control measuresCorrelates relationship of employee health and physical environmentIdentifies aspects in work setting promoting health of employee

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Collaborates in providinga safe environment

Serves as a member of the safety teamCommunicates safety needs and effect of environmental hazards on employee and family to safety and health teamRecommends and promotes use of protective measures and equipmentObserves adherence to sanitarian and food-handling regulationsGuides employee and family in developing positive attitudes towUrd safety and protectionGuides employee and family in safety, education through counseling, teaching, and demonstrationAnalyzes patterns of symptomology from records and reports.Communicates health needs for transcontinental and intercontinental travel to health team and individuals involved

Collaborates in providingprogram to control corn-rnunicable disease inwork setting

Identifies need for immunizations based on travel regulations, agency recommendations, and in-plant dataAdministers immunizing agents as prescribedEvaluates and refers employees with communicable disease conditions for medical care

Collaborates in planningcontrol programs forcommunity healthproblems

Recognizes influence of work environment on community healthAnalyzes community-plant relationshipCommunicates need for control programs to in-plant and extra-plant health teamsAssists di planning in-plant and community prngra ms for disasters

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Collaborates in assessinginfluence of soc'^l aspectsf work environ ent on

health

Identifies influences on health of employees frorr work settingAnalyzes social influences from work setting and employee-family relationships on health of employee

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Collaborates in assessinginfluences on employeeemotional health from workenvironment

Observes work environment for influences on emotional health of employee and familyIdentifies personal characteristics of employees in hazardous, stressful, and routine job operationsCommunicates special health needs of employees in hazardous, stressful, and routine jobsAnalyzes emotional influences from work setting and employee-family relationshipsPredicts psychological effects of change in work environment on employees and families

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Participates in and con-ducts systematic studiesrelating to environment

.......Identifies health problems present in environmentInitiates studies and projects using systematic research methodologyApplies findings in environmental controlCommunicates findings to health team and interested individuals and groupsParticipates in interdisciplinary studies and projects

Collaborates in evalu-ating total program forenvironmental control

Appraises program based on philosophy, objectives, legal requirements, and policiesPredicts future environmental problemsRevises program based on health needs and utilization rand results of programEvaluates nursing contribution to environmental control program based on philosophy, objectives,and independent and depend, it functions

I

119

COMPETENCY

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SUGGESTED NURSING ACTION

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Provides emerge carefor physical injui.., andillness

Recognizes legal limitations for nursingRecognizes signs and symptoms of pathological conditionsCarries out nursing diagnostic procedures to establish need for careAdministers emergency care, e.g., aseptic techniques for lacerations, removing foreign bodies,splinting, administering oxygen, administering medicationCommunicates by interpreting pathological processes and implications to health team or appropriate individuals .Provides for continuing care, e.g., medical treatment, return visits, transportationBegins rehabilitation processMaintains appropriate records and reportsOrganizes non-professional first aid services

Intervenes to assist em-ployee seeking medicalcare for identifieddisease process

Communicates with health facilityRefers employee for continuing health and nursing careGuides employee in obtaining and carrying out medical careFollows-up on employee with illness

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Collaborates in trrovidingsafe environment foremployee with limitedhealth problem

Iden the demands on empinvee's health of job operation, e.g., stress, heavy lifting, walking,.toxic materialsCommunicates health status of e.aployee to health team or appropriate individualsRecommends placement of employee for employee's and co-werkers ' safetyObserves employee for satisfactory rlacement

Collaborates iv promotingsecurity of employee andfamily from economicstress due to occupationalillness or injury

Complies with Workman's Compensation Act.Maintains appropriate records and reports

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Co'laborates in assessingand providing service tocontrol influences fromemployee and group dis-organization or socialchange on health employee

Identifies health problems of employees related to disorganization or social changeRecogni, es effects of disorganization or social change on employee, work setting and communityAnalyzes influence of social change or disorganization on health and behavior patterns of employee and familyCommunicates to health team effects of social change causing disorganizationGuides employee and family in coping with effects of social change or disorganization

Collaborates in assessingand providing servicesfor control of short-termabsence

Identifies employee with high-rate of absences from records and reportsIdentifies causes of behavior patterns from study of total environmentGuides employee in seeking remedial careDetermines causes of absence of employee and interprets to appropriate individuals,

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Provides eraergency carefor emotional crisis of ...0*employee

...,Identifies immediate stressors.and symptoms of and reactions to crisisEstablishes and maintains therapeutic nurse-patient relationshipReduces anxiety level of employee, family, co-workersProvides emotional supportRefers employee for continuing health and nursing careCommunicates needs of employee to health team or appropriate individuals

Assesses effect ofstress on employee

Identifies signs and symptoms of stress and tensionCommunicates needs of employee to health team or appropriate individuals

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Creates climate con-ducive for employee toseek health care

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Demonstrates attitude of acceptance of employeeProvides assistance needed for employee to recognize and meet own health needs

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Provides c,...,-e to relievesigns and symptoms ofillness and injury

Identifies employees with long-term illnessDevelops nursing care plan based on identified needs

Carries out medical directives, e.g., dressing changes, administration of medication, rest periods

Performs technical nursing skills, e.g., checking vital signs, heat or cold applications

Observes employee for progressing signs of disease processCommunicates employee's condition to health team or appropriate individuals

Collaborates in providing continuing health and nursing careEvaluates employee's and family's understanding of physical aspects of disease conditions,their understandings of medical orders and ability to carry outTeaches skills and provides information relating to care of employee, e.g., temperatures,administration of medications, dressing changes

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Collaborates in providingsafe environment foremployee with diseaseprocess

identifies the demands on employee's health of job operations

Comr ,: icates health status of employee to health team or appropriate individuals

Recommends placement of employee for employee's and co-worker's safety .

Observes employee for satisfactory job placementRecognizes effect of prescribed drugs on employee

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Assesses socio-economicneeds of employee andfamily with diseaseprocess

Observes employee and family for effects of illnessObserves effect of employee's illness on work settingIdentifies problems of employee and family coping with disease process, economic stress, social limitations

Assists in compiling insurance claims

Collaborates on planningand intervenes to enableadaptation of employeeand family to illness

Observes employee and family in their total environment

Guides employee and family in coping with effects of illnessCommunicates needs of employee and family to health team or appropriate individuals

Guides employee and family in establishing new socialization patternsCollaborates in continuing health and nursing care through guidance, follow-up, support

Assesses employee's and family's socio-economic needs during absence from work

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Assesses emotionalneeds of employee andfamily where employeehas disease

Observes psychological effect of illness on employee ar 1 family

Observes psychological effect of employee's illness on co-workersIdentifies with employee and family problems in coping with disease process, emotional stress

Evaluates employee's and family's understanding of emotional aspects of.illness

Plans and intervenes toenable employee andfamily to cope withemotional aspects ofillness

I .ides emotional supportGuies employee and family and co-workers in adjusting to illnessGuides employee and family during terminal illness

Provides care foremployee with mentalillness

...........

Recognizes psycho-pathological procerCommunicates needs of employee and family to health team or appropriate individuals

Guides employee and family in obtaining medical careCollaborates in providing continuing care, e. a. , provision of meaningful activity, transportation,follow-up, emotional supportGuides employee and family in meeting physiological and safety needs

Guides co-workers associated with employee

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Collaborates in providingopportunity for meetinggrowth potential needs ofemployee

Identifies opportunities for continued growth of employee

Communicates identified needs cf employee

Collaborates in evaluat-ing total program for illand injured employees

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Appraises program based on philosop..y, objectives, and policies

Pre.' cts future needs and changes tn health care deliveryRevises program based on changing needs and utilization of serviceEvaluates nursing contribution based on nursing philosophy and objectives, policies, legallyrecognized practice standards, independent and dependent nursing functions

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Collaborates in assessingphysical needs

Identifies remaining abilities through observation, interview, records and reports and testingCommunicates abilities to appropriate individualsInterprets philosophy of rehabilitation

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Plans and intervenes topromote fullestfunctioning

,.......

Applies principles of Activities of Daily Living to work settingAdministers selected physical therapy, e.g., exercises, hydro-therapy,heat applications, supportive equipmentTeaches self-help skills, e.g., transportation, housekeeping, personal care, transferCommunicates identified needs to health team or appropriate individualsCollaborates in providing continuing health and nursing care

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,.:!ollaborates in pro-- :Jing safety ofenvironment

Observes employee's total environment for safety and adaptation for indPpendent functioningAnalyzes attitules of employee toward safetyCollab,-rates as described under Disability Limitations Safety and Protection in placement of employeeObserves employee for suitable placement in work setting

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Assesses socio-economic needs ofemployee and family

Identifies problems of employee in work setting and of employee and family in home and communityObserves employee and family in coping i-'"ri tho social settingIdentifies needs of en-workers in assisting with rehabilitation process

Plans and intervenes topromote social adaptationof empinyee

Communicates needs of employee, family az d co-workersCounsels with employee, family, and co.-workersRecommends environmental adjustments to meet employee needsObserves employee for adjustment to disability and social setting

Collaborates withcommunity healthfacilities

Interprets occupational health nursing contribution to restorative programInterprets community rehabilitation services to health team or appropriate individualsCommunicates employee and family needs to health team or appropriate sources

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Assesses emotionalneeds of employee andfamily 7

z.Identifies needs of employee in work setting and of employee and fmnily in home and communityObserves employee and family in coping with affects of disabilityIdentifies needs of co-workers in accepting employee

Plans and intervenes topromote emotionaladjustment of employee,family, co-workers

Counsels employee and fsmily in adjustment to disabilityCounsels co-workers in expectations and acceptance of E.mployeeCommunicates identified needsProvides emotional Support for employee and family

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Plans and in'ervenesto promote fUlestrestoration potential

...............Communicates and interprets growth needsGuides employee and family to positive actions and attitudes by counseling, teaching, demonstrationRecognizes productive work as a means of self-actualizing

Collaborates inevaluating rehabili-tation program

. ...... .. .. .,

Appraises program based on rihilosophy, objectives, and policyPredicts future needs and chfinges in rehabilitation processRevises program based on(changing needs and utilization of serviceEvaluates nursing contribution to program based on nursing philosophy, objectives, andindependent and dependent nursing functions

.

122122

APPENDIX EThe University of Tennessee College of Nursing Curriculum*

NOTE: Figures under Course Title represent credit hours and lecture-laboratory class time.

Course DescriptionAnatomy 1N4(3-2)

Biochemistry 1N2(2-0)



Microbiology 1N3(2-4)

Physiology 1N3(2-2)

Physiology 2N4(3-2)

PreventiveMedicine 1N2(2-0)

A study of the structure of the human body and itsparts.General Chemistry. An introduction to elementaryprinciples of chemistry. Lectures, demonstrationsand conferences.

Organic Chemistry and Biochemistry. Propertiesand behavior of physiochemical systems and elemen-tary organic chemistry; biochemistry of foodstuffs,digestion, and absorption. Prerequisite: GeneralBiochemistry 1N.

Biochemistry. A continuation of 2N. Topics includeblood and other tissues, intermediary metabolism andthe excretions. Laboratory work is devoted to quanti-tative analysis of blood and urine.

Microbiology. An introductory course emphasizingthe morphology, growth, modes of transmission, andrelationship to diseases of pathogenic microorganisms.Means of protecting the patient and the nurse from in-fection are emphasized.

A study of the functions of the human body.

A continuation of physiology 1N.

Biostatistics. Lectures and exercises dealing withthe collection, tabulati a, and graphic representationof quantitative data. The student studies frequencydistributions, centering constants, dispersion constants,and simple correlation.

*As-listed m The Nursing Biilletins for 1966-68, 1961F-69, and 191'9-71%The University of Tennessee, Knoxville, Tennessee.

123

l 3

Appendix E

Psychology 1N3(3-0)

Psychol.:,gy 2N3(2-2)

Psychology 3N3(2-0)

Psychology 4N3(3-0)

Psychology 5N3(3-0)

Nursing as aSocial Force I3(3-0)

Nursing ofChildren andAdults I6(4-6)

Nursing ofChildren andAdults 115(3-6)

124

Human Growth and Development. Basic considera-tion is given to the behavioral changes from infancythrough adulthood. Using these data as a background,the student becomes familiar with modern theoreticalpositions on the dynamic forces associated with thisbehavior. Attention is given to both nomotheticprinciples and individual differences

Human Growth and Development. Continuation ofPsychology 1N

Psychology of Adjustment.

Pernal Adjustment. This course covers psycho-logical development of adolescence through senescence,personality characteristics and changes through time,and the dynamics of adjustments to each phase.

The Scientific Method in Nursing. A course includingindividual and group discussions based on the origin,selection, presentation and evaluation of problems inthe care oi patients

A course of lectures, conferences and observationsdesigned to introduce the student to professional nursingas a social force and a service to mankind. Thehistorical development of nursing is considered,Introduction is made to a concept of the professionalnursing role and its components with emphasis on thefamily as a unit of society.

Classroom and laboratory study designed to providethe student with concepts, principles and skills basicto nursing. Focus is on the human needs common toall persons and on the nursing care and interventionwhich may assist the patient in maintaining a dynamicequilibrium

A continuation of Nursing of Children and Adults I

Appendix E

Pharmacology and Introduction to basic nutrition; a course to increaseNutrition Survey basic knowledge, understanding and skills prerequisite3 (3-0) to the correlated study of applied nutrition through-

out the basic curriculum. The pharmacology surveyis a course designed to introduce the student tounderstanding and responsibilities prerequisite to thesafe and accurate administration of drugs. Thisincludes reliable sources of drug information,standards, classification and recognition of socialproblems associated with indiscriminate use of drugs.

Anthropology3(3-0)

Physics3(2-2)

Nursing ofChildren andAdults III11(6-15)

Nursing ofChildren andAdults IV11(6-15)

Nursing ofChildren andAdults V12(7-15)

This course concerns itself with development ofman in his physical and cultural aspects throughtime and space. Genetics and embryology areamong a background disciplines covered. Emphasisis given to sub-cultures in the mid-south.

A course of lectures and laboratory exercises whichprovides the student with a fundamental knowledge)f the basic principles of physics and their applica-tion to nursing in the care of patients and the opera-tion of equipment. This course includes theequivalents used in the hospital; basic principleswhich apply to body mechanics and normal functioningof the body; forces; pressure; power; energy; friction;motion; gases; nature and measure of heat, lightand sound; and electricity.

Classroom and laboratory study designed to developthe ability to plan, give and evaluate nursing careto hospitalized persons and to gain knowledge of thefacets of comprehensive nursing care in the homeand in the community. C ntent gives evidence thatthe organizing concept of basic human needs pro-gresses to areas in which the needs are alteredthrough disease processes in the child and the adult.

A continuation of Nursing of Children and Adults III.

A continuation of Nursing of Children and Adults IIIand IV

125

125

Appendix E

Nursing ofChildren andAdults VI11(6-15)

Nursing ofChildren andAdults VII11(6-15)

Nursing as aSocial Force II3(3-0)

Patient-CenteredNursing9(6-9)

PreventiveMedicine 2N3(3-0)

126

A continuation of the basic nursing concepts withmajor emphasis on the principles and skills, whichare utilized providing comprehensive nursing carefor the patients in maternity, psychiatry, and publichealth. Clinical learning experiences are selectedin a variety of locations including the home, theclinic, the hospital, the health department, thephysicians' office, and other community health andwelfare agencies. All learning experiences emphasizecontinuity and co-ordination of health care. Emphasisis placed on ccrinseling and teaching individual patientsand groups of patients including families.

A continuation of Nursing and Children and Adults VI

A discussion of the history and trends of professionalnursing. Emphasis is placed on the personal andprofessional responsibilities of the professional nurse.

Classroom and laboratory study of the nursing care ofselected patients during illness and convalescence.Guided practice in analyzing the patients' physical,emotional and social needs and in planning andexecuting a program of nursing care to help meetthese needs. Includes field trips to selected communityagencies

Epidemiologic Approach to Health end Disease. Focuson basic human needs is directed toward the communityas a whole. Evolving philosophy and scope of the pub-lic health movement are considered. Multiple influ-ences affecting health and disease in contemportliving are emphasized. Concepts from biostatisticsand epidemiology are utilized in assessing communityhealth status and planning programs of protection andhealth promotion. Changing patterns in communityorganization and in the funding and delivery of healthservices are examined. Open to all students inMedical Units.

* U.S. GOVERNMENT PRINTING OFFICE . 1971 0-429-495