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Xerox University Microfilms 300 North Zeob Road Ann Arbor, Michigan 48106 I I 73-18,915
KINTGEN, Jean Katherine, 1927- DEVELOPING GUIDELINES FOR SEQUENCING CURRICULUM CONTENT FOR CAREER ADVANCEMENT IN NURSING.
The Ohio State University, Ph.D., 1973 Education, adult
University Microfilms, A XEROX Company, Ann Arbor, Michigan ;
THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED. DEVELOPING GUIDELINES FOR SEQUENCING CURRICULUM CONTENT FOR CAREER ADVANCEMENT IN NURSING
DISSERTATION
Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of the Ohio State University
By
Jean Katherine Kintgen, B.S., M.S.
*****
The Ohio State University 1973
Approved by
College of Education ACKNOWLEDGMENTS
My list of acknowledgments is a long one, but the pro cess, too, has been long and many have helped. Sincerest appreciation is expressed to the following:
Professor l . O. Andrews whose scope of knowledge is remarkable but surpassed by the keenness of his interest in what he knows, which, in turn, is surpassed by the depth of his concern about people.
The other committee members, Professor James K. Duncan who was able to penetrate the haze and draw out order and direction at some crucial points, and Professor Julia I.
Dalrymple who has been unusually generous in applying her particular expertise to some of the problems of this study.
’Professor Imogene M. King, formerly Director of the Ohio
State University School of Nursing, who was quick to support the right to pursue an unconventional approach to curriculum development and instructors in the School of Nursing who were conscientious reviewers of the sample nursing care analyses developed in this study.
Many Ohio State University people in Science Education,
Elementary Education, Health Education, and the ERIC Science and Mathematics Education Clearinghouse who generously as sisted in identifying pertinent materials.
Colleagues in several Columbus hospitals who assisted in relation to the "real world" aspects of the problem, particularly those at St. Anthony's where data for the nurs
ing care analyses were collected and, very particularly,
Jeanne Anderson, Director of Nursing, and Ann Pox, nurse
clinician in in-service education.
My good friends, Mary Foley whose iriipressive knowledge
of physiological principles basic to nursing was so helpful
and Virginia Williams who directed me in a marathon of proofreading and almost made .it a joy.
The entire Redding family, good fri^rnds who provided
shelter, nourishment, good conversation, and play therapy
at all the right times.
Members of my family who responded tjo a variety of
needs and, most important, my mother who firmly believed
in the value of this effort and encouraged it at all points
along the way. VITA
May 24, 1927 ...... Born - Chicago, Illinois
1950 ...... B.S, in Nursing, St. Xavier College, Chicago, Illinois
1950-5 1...... Staff Nurse, United States Public Health Service Hospital, • Chicago, Illinois
1951-5 8 ...... Instructor, Chicago area schools of nursing
1957 ...... M.S. in Nursing Education, De Paul University, Chicago, Illinois
1958-62...... Assistant Director of Nursing Service, Mercy Hospital,'Chicago, Illinois
1962-66 Director, Proviso Township School of Practical Nursing
1966-67 Associate Administrator, Illinois Nurses' Association, Chicago, Illinois
1967-70...... Research Associate, The Ohio State University Center for Vo cational and Technical Educa tion, Columbus, Ohio
1970-72...... Chairman, Division of Health Technologies, Columbus Techni cal Institute, Columbus, Ohio
1972 ...... Assistant Professor, Health Occupations Education, Depart ment of Vocational-Technical Education, University of Illinois, Champaign-Urbana, Illinois
iv PUBLICATIONS
Interpretation of Literature on Career Ladders and Lattices in Health Occupations Education.Columbus, Ohio:The Ohio State'University Center for Vocational and Techni- cal Education, 1970.
"The Case for Career Ladde r Approaches.” Chart, LXVII (November, 1970), 259-63.
FIELD S OF STUDY
Fields of study inclu'de Vocational-Technical Education; Teacher Education; and Edub ational Research. Committee mem- bers were Professor Robert M. Reese, Faculty of Vocational- Technical Education; Profe^ sor Emeritus L . O . Andrews, Fac- ulty of Teacher Education; and Professor Desmond L. Cook, Faculty of Educational Res barch.
Adviser for the dissertation is Professor L. O. Andrews. Other members of the reading committee include Professor Julia I. Dalrymple, Faculty of Home Economics Education; Professor James K. Duncan, Faculty of Curriculum and Foundations; and Professor Wesly P. Cushman, Faculty of Health Education. TABLE OF CONTENTS Page
ACKNOWLEDGEMENTS...... ii..
VITA...... iv
LIST OP T A B L E S ...... viii
CHAPTER 9 I INTRODUCTION...... 1
Background and Need Problem Statement Questions to be Answered Assumptions Scope of Study Definitions of Terms Outline of the Report
II:. REVIEW OF THE LITERATURE ...... 13
Overview of the Increasing Interest in the Career Ladder Concept Related Studies
III ’METHODOLOGY ...... 53
Step One: Exploration of Role Definitions and Guides to Curriculum Development in the-Nursing Literature Step Two: Exploration of Elementary and Secondary Level Science and Health Education Literature Step Three: Formulation of Tentative Guidelines Step Four: Assessment of Tentative Guidelines in Terms of Factors in the Actual Nursing Situation Significant Factors Related to Methodology
IV RESULTS...... 82
Step One: Exploration of Role Definitions and Guides to Curriculum Development in the Nursing Literature vi CHAPTER Page
Step Two: Exploration of Elementary and Secondary Science and Health Education As a Source of Direction for Guideline Development Step Three: Formulation of Guidelines Step Four: Assessment of Tentative Guidelines^in Terms of Factors in the Actual'Nursing Situation
V SUMMARY, RECOMMENDATIONS, AND IMPLICATIONS...... 116
Summary Recommendations Implications
APPENDIXES
I ...... 137
II...... 164
III ...... 242
IV ...... 267
BIBLIOGRAPHY...... 272
vii' LIST OP TABLES
TABLE Page
1. COMPARISON OF STATEMENTS RELEVANT TO NATURAL SCIENCE CONTENT IN PLANS FOR STATE BOARD TEST POOL EXAMIN ATIONS FOR LICENSURE OF PRACTICAL - NURSES AND REGISTERED NURSES ...... 85
2. CLASSIFICATION OF NATURAL SCIENCE ITEMS BASIC TO N U R S I N G ...... 94
3. GUIDELINES FOR SEQUENCING NATURAL SCIENCE CONTENT IN NURSING CURRICULA TO FACILITATE THE EMERGENCE OF AN EDUCATIONAL CAREER LADDER ...... 98
4. PATIENTS STUDIED ...... 104
5. LEVELS OF NURSING ACTIVITIES IN NURSING CARE ANALYSES ...... 109
6. ANATOMY AND PHYSIOLOGY CONTENT BASIC TO NURSING IDENTIFIED IN SELECTED ELEMENTARY AND SECONDARY LEVEL SCIENCE AND HEALTH CURRICULUM MATERIALS; RELATED CLASSIFICATION OF CONTENT ITEMS . . 165
7. MICROBIOLOGY CONTENT BASIC TO NURSING IDENTIFIED IN SELECTED ELEMENTARY AND SECONDARY SCIENCE AND HEALTH CURRICULUM MATERIALS; RELATED CLASSIFICATION OF CONTENT ITEMS ...... 226
8. PHYSICS CONTENT BASIC TO NURSING IDEN TIFIED IN SELECTED ELEMENTARY AND SECONDARY LEVEL SCIENCE CURRICULUM MATERIALS; RELATED CLASSIFICATION OF CONTENT ITEMS ...... 234
9. CHEMISTRY CONTENT BASIC TO NURSING IDENTIFIED IN SELECTED ELEMENTARY AND SECONDARY LEVEL SCIENCE CURRICULUM MATERIALS; RELATED CLASSIFICATION OF CONTENT ITEMS ...... 238
viii TABLE Page
10. SAMPLE NURSING CARE ANALYSIS AS ORIGINALLY DEVELOPED BY INVESTIGATOR . . . 248
11. SAMPLE NURSING CARE ANALYSIS AS REVISED ON THE BASIS OF SUGGESTIONS BY REVIEWERS . 257
ix- CHAPTER I
INTRODUCTION
Background and Need
Til e need for personnel at various levels in the health occupations— nursing, physical therapy, occupational therapy, medical technology, medical record work, etc.— seems to he unquestioned, and education has responded with a multipli city of programs to prepare aides and technical workers as well as professional personnel. But there is growing concerq about the lack of provision for career advancement in the emerging educational patterns.
Perhaps the problem is most serious in nursing because the history of nursing and of multiple levels of personnel in nursing is longer than in the other health occupations and patterns are more firmly established. The various kinds of basic programs in nursing {professional, technical, practical nurse, nurse aide) have developed quite indepen dently of each other without consideration of the desir ability of an educational career ladder within the occupation. The rationale was that students should simply be counseled into programs appropriate for them and they would b e content with the outcome. Attempts to implement
1 2
career ladder concepts at this point in time bring to light
the fact that, although several levels of practice have
been recognized and related levels of knowledge and skills
implied, neither the roles of the different levels of
practitioners nor the related levels of knowledge and skill
have been defined in detail adequate for the curriculum de
veloper.
An approach which has been attempted as a basis for
curriculum development in the health occupations, including
nursing, is to determine what tasks the different kinds of
workers actually perform. One might expect this approach
to have merit for career ladder curriculum endeavors but
nursing educators have argued that the situation in which
the task is performed, rather than the task itself, often
determines the knowledge required. Shetland criticizes
the reduction of the skills of various groups to
. . . a series of tasks arranged by systems organizers in terms of degrees of complexity inherent in themselves— without reference to human differences, the context, and the quality of interaction (A44:33).
Another problem relating to the task analysis approach to
curriculum development in nursing and probably some other health occupations is that it does not always lend itself to a natural progression from the simple to the complex.
The need for another approach to the selection of curriculum content for different levels of nursing practi tioners which would facilitate the emergence of a career ladder seems to be indicated. Hopefully, such an approach once developed should have reasonable applicability in other health occupations.
Problem Statement
The alternative to using task analysis as a basis for curriculum development proposed by the investigator was to describe several naturally progressive levels of content knowledge and to relate these to several levels of nursing education and practice (e.g., nurse aide, practical nurse).
It was further proposed that the validity of the levels of content knowledge for the levels of education and practice be tested in terms of needs in the actual nursing situation and the guidelines affirmed or possibly revised. Perhaps, in time, more specifically defined roles would develop or perhaps more specifically defined roles would prove unneces sary.
Although speaking broadly about the health occupations rather than solely about nursing, Luther Christman would seem to support such an approach:
When the delivery of care is viewed as a pro cess through time instead of a series of dis crete acts, it can be seen that scientific knowledge is activated through role expression. 4
It is by means of this device that much of the color and tone is bestowed on each of the pro fessions. If improvement in care is a chief objective, it appears more useful to plan for an expansion of the opportunities for role ex pression and the use of scientific knowledge than to spell out completely and with finality every facet of each discipline (BIO: 10-11).
Within the context of the approach to curriculum development described above, the investigator demonstrated a method of developing guidelines for sequencing natural science content essential in nursing in a manner which should facilitate the emergence of an educational career ladder in that field. The purpose of the study was to determine the feasibility of such a method of developing curriculum guidelines.
The method demonstrated and assessed utilized three sources of direction for the guideline development:
(1) role definitions and curriculum guidelines in the nursing literature, (2) elementary and secondary science and health education literature relating to sequence of content (theories and opinions of educationists, curriculum materials per se), and (3) two aspects of the "real world" situation: actual patient needs and the team of various levels of nursing personnel available to meet these needs.
A major assumption was that there is a body of knowledge in the natural science area that is basic to nursing and that this body of knowledge has been validly identified in the 5 very extensive University of Washington School of Nursing * * curriculum study (A37 ) described in Chapter II.
Briefly outlined, the method consisted of: (1) formu lating, on the basis of the first two sources of direction listed above, tentative guidelines which describe levels, of natural science content and relate these to three recognized levels of nursing personnel (nurse aide, practical nurse, technical/professional nurse), and (2) affirming the tentative guidelines on the basis of a process which considered patient needs and the team of nursing personnel available to meet these needs.
Questions to be Answered
Questions of feasibility which were to be answered through this investigation were as follows:
1. Do role definitions in the nursing literature really
differentiate roles and are the definitions sufficiently
clear and detailed to provide direction for sequencing
content?
2. Do recognized guides to curriculum development in
nursing exist and, if so, do they provide direction
for sequencing content?
3. Do resource persons in the area of science and health
education indicate an interest in the problem under
study and do they suggest specific references and/or areas of investigation in the literature of their
fields which are related to the problem?
4. Are statements of rationale for the sequencing of
content in the natural sciences to be found in the
literature in the areas of science and health education?
5. Do science and health curriculum materials per se
suggest an approach to sequencing content and can a
system be developed for analyzing these materials for
the purpose of discovering some trends which might
provide direction for the development of guidelines for
sequencing natural science content in nursing curricula?
6. Can an appropriate and workable system be developed to
test the validity of tentative guidelines in terms of
"real world" requirements?
Assumptions
The following assumptions are essential to the rationale of this study:
1. A body of knowledge exists in the natural science area
that is basic to the practice of nursing.
2. Knowledge in the natural science area is important in
all levels of nursing practice and a direct relation
ship exists between the level of practice and the
knowledge required.
3. Elementary and secondary level curriculum developers
have given attention to curriculum sequence in terms 7
of the learning process.
4. An overlap occurs between general education in the
science and health areas of the elementary and second
ary curriculum and occupational education for nursing.
5. The validity of occupational curricula is determined
in the "real world" of occupational practice.
Scope of the Study
The scope of the study was limited in the following ways:
1. Although it is believed that the general approach used
to develop guidelines for sequencing curriculum content
would be applicable in other occupational areas of the
health field, this study was limited to nursing as an
occupational area.
2. Although the interrelatedness of the natural sciences,
the behavioral sciences, and medical practice as
sources of knowledge for nursing is recognized, this
study was limited to consideration of natural science
content.
3. Although the importance of the level of knowing as
treated in the Taxonomy of Educational Objectives (F5)
is recognized, this study was limited to a considera
tion of content and does not consider the level at
which the content must be known or understood. 8
4. Although it is recognized that there is an extensive
literature on the subject of nursing roles and curric
ulum, the review of role definitions and guides to cur
riculum development in this study was limited to state
ments of established nursing organizations.
5. Although the movement toward considerably expanded prac
tice for the professional nurse is well documented (B12,
B25) , no distinction has been made in this study between
the level of content knowledge in the natural sciences
required by the technical nurse and that required by
the professional nurse. (Possibly the distinction be
tween the two is in the level of knowing as treated in
the Taxonomy of Educational Objectives (F5) rather than
in the level of content knowledge.)
Definitions of Terms
An effort has been made to use terms as defined gener- ically. For instance, the term, "health occupations educa tion," has been used in its generic sense as educational preparation at all levels for occupations in the health field rather than in the narrower sense of health occupa tions education below the baccalaureate level. The follow ing terms, however, seem to require definition:
1. Career ladder: a mechanism which facilitates vertical 9
career advancement on the basis of learning, which equips
the individual to perform at a higher level.
2. Practical or vocational nurse program: a nursing pro
gram most often within a public education system and
usually about one year in length.
3. Associate degree nursing program: a nursing program
usually in a junior college or similar institution and
approximately two years in length.
4. Diploma nursing program: a hospital controlled nursing
program usually about three years in length.
5. Baccalaureate nursing program: a nursing program in a
senior college or university and generally about four
years in length.
6. Nurse aide: a member of the nursing staff who has gen
erally been prepared for her role through a very brief
training program, often on-the-job.
7. Practical nurse or vocational nurse: a nurse prepared
in a practical or vocational nurse program.
8. Technical nurse: a nurse prepared in an associate de
gree or hospital diploma program.
9. Professional nurse: a nurse prepared in a baccalaureate
or higher degree program.
10. Registered nurse: generally a graduate of an associate
degree, diploma, or baccalaureate nursing program who 10
has passed a state board examination and is licensed
to practice as a registered nurse in some state(s).
11. Nurse clinician: a professional nurse who is highly
compentent in patient care and usually specialized in
a particular clinical area.
12. Nursing activity (term utilized in nursing care
analyses): an element of the patient's total nursing
care which generally encompasses several components
. (e.g., several skills) related in terms of purpose and/
or related in terms of the usual performance of these
components as a unit (e.g., "taking" temperature,
pulse, and respiration) and which generally is per
formed in a single unit of time.
13. Career education concepts:
a. Recognition of preparation for a working career as
the key objective of all education;
b. Recognition of emphasis upon the contribution of
all subject matter to successful careers as an im
portant element of education;
c. Utilization of "hands-on" experience as a method of
teaching and source motivation for abstract aca
demic content;
d. Recognition of career preparation as including de
velopment of work attitudes, human relations skills^ 11
exposure to alternate career choices, and acquisi
tion of job skills;
e. Recognition of home, community, and employment es
tablishment as environments for education;
f. Recognition of "womb to tomb" scope of education
including acceptance of flexibility of the educa
tional system to allow leaving the school early
and provision for return as well as the availabil
ity of education for the productive use of leisure
time and retirement years;
g. Acceptance of the pervasiveness of career education
with regard to all education and the absence of
conflict between career education and other legiti
mate educational objectives; and
h. Acceptance of the emphasis upon the continuing
needs of the individual currently described as the
school "drop out" (F9:5-6).
Outline of the Report
The report of the study has been organized as follows in Chapters III through VI:
Chapter III: Methodology
A. Step One: Exploration of Role Definitions and Guides
to Curriculum Development, in the Nursing Literature. 12
B. Step Two: Exploration of Elementary and Secondary * * Level Science and Health Education Literature.
C. Step Three: Formulation of Tentative Guidelines.
D. . Step Four: Assessment of Tentative Guidelines in Terms
of Factors in the Actual Nursing Situation.
E. Significant Factors Related to Methodology.
Chapter IV: Results
A. Step One: Exploration of Role Definitions and Guides
to Curriculum Development in the Nursing Literature.
1. Statements of Nursing Organizations
2. State Board Test Plans
B. Step Two: Exploration of Elementary and Secondary
Level Science and Health Education Literature.
1. Literature Search for Theoretical Bases
2. Curriculum Materials Review
C. Step Three: Formulation of Tentative Guidelines
D. Step Four: Assessment of Tentative Guidelines in
Terms of Factors in the Actual Nursing Situation.
1. Review of Process
2. Patients Studied
3. Review of a Sample Nursing Care Analysis
4. Validity of Tentative Guidelines
Chapter V: Summary, Recommendations, and Implications CHAPTER II
REVIEW OF THE LITERATURE
Overview of the Increasing Interest in the Career Ladder Concept
. A review of the literature by the investigator in August
1968, to determine the status of the career ladder concept
in the health field provides a benchmark for future develop
ments. At this time it was possible to identify several
strong expressions of need and a few examples of implemen
tation.
Addressing a national seminar on health occupations ed-
ucation centers in 1966, William H. Stewart, Surgeon-General
of the United States Public Health Service, stated that the
health professions and supporting disciplines are mutually
relevant only as they relate to delivering care to the peo.-
ple and that acceptance of this principle will compel the
acceptance of many "corollary blessings" which add up to a
major revolution in the preparation and utilization of health
manpower. . Among these he placed "the need for occupational mobility— both lateral among the various disciplines accord
ing to local demand and individual interest, and vertical
so that each man or woman working in the health field has
the opportunity to render service up to his maximum capac
ity." (A38:4-5)
13 14
Also in 1966, Willard Wirtz, Secretary o£ Labor, ad
dressing a conference on job development under the sponsor
ship of the Department of Labor and the Department of i Health, Education, and Welfare, stated: "It is quite im
portant that auxiliary and health manpower be developed
both with the realization that there are differences in
level and that people have an opportunity to move from one
level to another with due regard for the demands of the
higher level or professional area." (A46:3)
In 1967, Health Manpower Perspective, the report of a
Bureau of Health Manpower study, presented the following
among its conclusions:
The health professions and educational institu tions must develop ways for competent persons to move from one level of health work to another or from one occupation to another. Health workers • should be able to advance in their work opportu nities in accordance with their capabilities and performance. . .
At a time when job content and educational pat terns are both changing rapidly there is an ur gent need for mechanisms to encourage and promote career development opportunities and paths for the health occupations (A47:39).
Leonard D. Fenninger, Director of the Bureau of Health
Manpower stated in an article in a nursing journal in the
following year:
There is no question that people should be able to grow in their jobs if they are to remain sat isfied with them. There is also no question that good experience improves the ability of a person to do a job well and that, if an individual 15
aspires to learn and do more, the opportunity should be available to him and his experience should count as part o£ the preparation. We must find ways of evaluating the significance of experience in relation to formal education so that one does not have to start from scratch if one wishes to change the path he is follow ing. . . It is essential to have paths open without a total retracing of steps. . . (A14:33).
In 1967, also in an article in a nursing journal, econ
omist Eli Ginzberg stated:
A nurse with a newly acquired baccalaureate de gree obviously does not have as much experience as a practical nurse with ten yeras' experience on the unit, but she may receive a higher salary. Then, there are diploma nurses with different amounts of education. Add to these the practi cal nurses who have different amounts of edu cation and experience, and a resulting tension is inevitable. While education is important, experience contributes to the skill of the nurse, as it does to every professional person. Ex perience is tremendously important and it is not acquired by certification, which can only make an initial discrimination.
I do not believe there is any possibility of the professional nursing associations' draw ing the boundaries around each of these groups of nurses and maintaining them in fixed posi tions. Today the boundaries differ in the same city; they differ from one hospital to another; they differ in terms of qualities of nursing services provided. They simply cannot be set once and for all time; there are too many vari ables (Al8:27-8).
While the authorities quoted above took the position
that the need for provisions for career mobility in the
health field was obvious, health professionals as a group were silent. Exceptions were Marjorie Ramphal, Professor,
New York Medical College Graduate School of Nursing, and 16
Wilma West, a national consultant in the field of occupa
tional therapy.
In 1968, calling attention to the fact that a con
siderable amount of time in generic baccalaureate programs
•in nursing is devoted to the development of technical knowl
edge and skills, Ramphal concludes:
Conceivably, curricula could be devised for reg istered nurse students (graduated from technical programs) which would omit this technical content and which, although different from curricula for generic students, might allow registered nurses to arrive at the same goal in a shorter time and with more satisfaction than is possible for them through the generic program (A41:1236).
She adds that the same reasoning might apply with even more
cogency to progression from one level of technical nursing
(practical nurse) to another (registered nurse):
The gap, theoretically, should be smaller. Al though most of us know, and "generously" applaud, at least one former practical nurse who has made or is making the progression, X suggest that it may be even more painful to contemplate systematic encouragement and planned education to facilitate this process than it is to think of encouraging progression from technical to professional nursing (A41:1236).
Also in 1968, in an article describing the very begin nings of organized training for paraprofessionals in occu pational therapy, Wilma West refers to "provision for ver tical mobility— transitional steps to permit upward pro gression between levels on the basis of additional educa tion" as an "unsolved problem." (A52:1711) 17
A few examples of implementation or plans for imple mentation of career ladder concepts in the health field could be identified in the literature in 1968:
1. A fifteen month supplementary pilot program to prepare
licensed practical nurses to become registered nurses
was actually in operation at the Helene Fuld School of
Nursing in New York City. (A15:54)
2. In the academic year 1967-68, nursing areas had been
incorporated into the New York State College Proficiency
Examination Program and, in 1968, A Blueprint for the
Education of Nurses in New York State published by the
New York State Nurses' Association recommended that
"every effort be made to provide opportunities for
graduates of hospital diploma, associate degree, and
practical nursing programs for advanced placement in
degree programs" through this testing program. (A36)
3. The Guide to Structure and Articulation of Occupational
Education Programs published in 1968 by the Oregon State
Department of Education Division of Community Colleges
and Vocational Education included health occupations
as one of twelve occupational clusters. The overall
model called for a common core of instruction in grades
nine, ten, and eleven, through moderately specialized
options in grade twelve to intensive specialization in
the second year of the community college program. 18
Advanced placement or college credit for secondary pro
gram occupational attainment was recommended. (A40:69-
70)
4. The "pre-technical project" under the auspices of the
City of New York Board of Education incorporated the
health occupations area. Pre-technical programs in the
fields of health, business, and engineering were offered
in the eleventh and twelfth grades as a system of remo
tivation for underachieving high school students who
would probably not otherwise qualify for community
college career programs. The plan provided for block
programming students for English, mathematics, and a
laboratory course relating to their respective voca
tional interests (health, business, engineering). The
vocationally oriented laboratory served as the focal
point and learning experiences in English and mathe
matics were closely correlated. (A8:49)
In 1972 a review of the literature for the intervening period presents a different picture. The career ladder con cept has had some significant endorsements and examples of implementation are numerous.
The National Commission for the Study of Nursing and
Nursing Education, an independent study initiated through the efforts of both the American Nurses’ Association and the 19
National League for Nursing, completed its work in 1969 and
# — in its summary report raised the following questions:
Certainly the nursing profession has kept pace with, and even exceeded, the growth of popula tion. Yet, we still find shortages. Can the real cause stem from our failure to recognize the problems in the nursing role that siphon away so many professionals? Is it because there is a whole new universe of needs for nurses? Is it also because we have failed to • organize and articulate the educational pro cess so that meaningful career opportunities are available to each individual? (A34:282)
Further support for the career ladder concept is evi
dent in recent actions of the National League for Nursing.
In February 1970, the NLN Board of Directors endorsed the
"open curriculum." Representing one aspect of the career
. ladder concept, the open cu-riculum is defined as "an idea
for facilitating vertical mobility for nurses within the
field of nursing by granting advanced standing [in a higher
level education program] after an evaluation of their pre
vious education or experience." (A24:779)
In February 1971, the NLN Advisory Committee for Study
of an Open Curriculum in Nursing made a series of recommen
dations including the following:
1. Collection of information pertaining to existing techniques for granting credit and advanced placement;
2. Development of new instruments for granting credit and advanced placement;
3. Study of current experiments and demonstra tions which have open curriculum elements; 20
4. Issuance of guidelines for schools interested in establishing open curriculum practices. (A24:782)
Having completed an initial survey of practices related to'granting credit and advanced placement, NLN is now em barking upon a two-year project funded by the Esso Educa tional Foundation in which four to six selected on-site demonstration projects will be studied in detail to deter mine optimum open curriculum practice. Guidelines and pro cedures for the development of open curriculum systems will be established. (A35:622)
The career ladder concept has also received legislative support. The Nurse Manpower Act of 1971 allows capitation grants to schools of nursing that upgrade the training of practical nurses. In addition, measures aimed at mandatory provisions for vertical mobility in nursing have been under study in various states. (A5:6)
Approaches to the implementation of the career ladder concept have generally taken one of four forms:
1. Proficiency testing;
2. Supplementary programs which build upon previous edu
cation or experience;
3. Integrated programs with built-in provisions for ad
vancement from one level to another; and
4. Work-study programs arranged for individuals employed
in a particular institution. 21
Proficiency testing of individuals entering an edu
cational program who have gained knowledge and skills in a
, program of another kind is now common in nursing education.
In the medical laboratory field tests have been developed by
Educational Testing Service which are intended to assist in
dividuals who have acquired medical laboratory knowledge and
skills in various ways to receive academic recognition and
advanced job placement. (A2:16-7)
Examples of supplementary programs which build upon
previous education or experience are the Med-Vet Project of
El Centro College/ Dallas, Texas (A2:14), and the registered
nurse programs for licensed practical nurses of Providence
Hospital, Southfield, Michigan (A2:ll). The Med-Vet Project
builds on medical corps training of veterans to prepare them
to become registered nurses through an associate degree
nursing program. The Providence Hospital program grants
advanced placement to licensed practical nurses in an es
tablished two-year diploma nursing program. Begun as a
fourteen month supplementary program, the present arrange
ment allows the licensed practical nurse to finish in
twelve months.
Examples of integrated programs with built-in provi
sions for advancement from one level to another represent
adaptations of various kinds of established nursing programs.
Community colleges in Iowa provide a shared curriculum 22
for the first three quarters of the practical nursing and
associate degree nursing programs which are respectively
, four quarters and eight quarters in length (A25:3-ll).
Everett Community College in Everett, Washington, likewise
provides for a shared curriculum for the first three quar
ters of the practical nursing and associate degree nursing
programs, but these programs are respectively four quarters
and six quarters in length and different levels of achieve
ment. are required for credit at the licensed practical nurse
and associate degree nurse levels in the first three quar
ters (A23:2). Identification of health career curriculum'
"cores” has resulted in a one semester curriculum segment
shared by all nursing students (as well as students in other
health programs) at Kellogg Community College in Battle
Creek, Michigan (A28), and a two semester curriculum seg
ment shared by all nursing students at Long Beach City
College, Long Beach California, where the licensed practical
nursing program is two semesters and a summer session in
length and the associate degree nursing program is two semes-
ters in length (A13:1356-8). At Columbus Technical Insti
tute, Columbus, Ohio, the first four quarters of study in
nursing constitutes the total preparation for practical
nursing as well as the first four quarters of the seven
quarter associate degree nursing program. Developmental
and enrichment autotutorial activities are encouraged to 23 meet individual needs during the first four quarters. (A10:
6, 13-5)
The State College of Arkansas, Conway, Arkansas, offers
a baccalaureate program in nursing and admits students who
are interested in pursuing a baccalaureate degree; however,
career options are provided at various points in the total
program. Candidates are prepared to practice as practical
nurses after one year in the program and as registered nurses after two years (A2:15).
Georgia State University, Atlanta, Georgia, offers a
nursing program in which the first two years lead to an
associate of science degree with a major in nursing and
the additional third and fourth year to a bachelor of science degree with a major in nursing. (A29:2-3) The University of Nebraska College of Nursing at' Omaha allows students to pursue articulated programs that can be terminated at any point: associate degree; baccalaureate degree, or master's degree. (A4:670-2)
Recently, work-study programs designed to upgrade health workers have commonly been the results of union- management agreements. These programs combine aspects of the supplementary and integrated programs described above.
The general characteristics of these programs are:
1. They are arranged for employees of a particular agency;
2. The educational program time requirement is moderately 24
decreased, probably in light of the individual’s pre
vious and concurrent experience;
3. Employer and employee contribute time to the education
al program;
4. The employer cooperates with the employee's efforts by
arranging a convenient work schedule;
5. Supplementary remedial work in basic skills is generally
offered.
In the forty-four semester hour program to upgrade nurse assistants to licensed practical nurses at Jackson
Memorial Hospital in Miami, Florida, all courses are'taught at the hospital by faculty of Miami-Dade Junior College.
Fourteen of the forty-four credits earned in the practical nurse program are transferable toward an associate of arts degree. (A2:4-5)
The University of Chicago Hospitals and Clinics pro vide entry level training for nursing aides and offers an eighty week work-study program to train nursing aides for practical nursing. A cooperative arrangement with a Chicago junior college permits licensed practical nurses to com plete a registered nurse program in three trimesters.
Similar programs are offered in the laboratory, clerical, and.supervisory areas. (A21)
The New York City Department of Hospitals includes eighteen institutions. The Department's Central School 25
of Practical Nursing offers a work-study program to upgrade
nurse aides employed throughout the system to become li
censed practical nurses. Another work-study program to
prepare Licensed Practical Nurses to become registered
nurses is available at Hunter College of the City of New
York. (A.30)
The new Ohio State University nursing programs cannot
be classified in any of the above categories but career
ladder aspects are evident. According to Imogene King,
who developed the theoretical framework upon which the
baccalaureate and master's programs are based, these should
provide excellent opportunities for accelerated advance
ment of individuals who have had previous education and
experience in nursing. Progress is dependent upon mastery
learning. Traditional clinical fields are blurred while
the concepts of man, health, perception, interpersonal re
lations, and social systems provide a frame of reference
for the nursing process. (A27)
Related Studies
Studies which relate to career lader curricula might be categorized in accordance with their primary focuses:
1. Career ladder models;
2. Occupational analysis; 26
3. Core curriculum;
4. Differentiation of roles and abilities of different
kinds of practitioners.
A Career Ladder Model
Tashjian (1971) developed a career ladder model for nursing education which provides for sequential education from the associate degree " to the baccalaureate degree nurs ing level, with a core program for health occupations at the beginning. This approach would allow for lateral movement to a related health occupation at the core level, entry into technical nursing practice on completion of the associate degree, or vertical movement from technical nursing educa tion to professional nursing education. After the proposed model was found to be supported by the literature in vari ous relevant areas, it was submitted with a response form to a jury of fifteen persons who were faculty members in as sociate degree nursing, baccalaureate nursing, and health occupations programs. The model submitted included:
1. An introduction including a function-competency spectrum
and a diagram of a career ladder for nursing education;
2. Definitions of terms;
3. Implications;
4. Guidelines for curriculum development;
5. Suggested courses for the model; and 27
6. Required functions and relevant competencies.
In cases of less than 75 percent agreement on the individual items of the instrument, appropriate revisions were made in the model. Few changes were necessary. Next, an accept ability study was done. A copy of the revised model and a response form were sent to respondents who had agreed to participate. Acceptability of the model was based on the responses of forty-eight administrators representing twenty- five associate degree and twenty-three baccalaureate degree programs. The model was endorsed by over 50 percent of the total sample. Most' items received over eighty percent en dorsement. (A45)
Occupational Analysis
Abdellah, et al. describe:, a. .‘project undertaken ; in 1953 under the auspices of the Division of Nursing Re sources of the U.S. Public Health Service in which thirty general hopsitals were surveyed in order to find out what types of patterns were found in general hospitals and to de velop a classification of common nursing problems that would serve as a guide for planning and assigning clinical exper ience for nursing students. While probably not an occupa tional analysis in the truest sense, this study which has influenced many curriculum endeavors has many of the as pects of an occupational analysis. The results were 28 a typology comprising fifty-eight groups of common nursing problems and a typology of nursing treatment. A nursing problem was defined as a "condition or situation faced by the patient or his family which the nurse can assist him to meet through the performance of her professional func tions." It was the hope of the researchers that nursing educators would be encouraged to base the clinical.experi ence of students upon common nursing problems that every nurse would need to learn to solve and that professional competence would be based upon the ability to solve key nursing problems presented by patients and not upon number of beds, operations, or days on a particular service (Al:
12-13).
Some examples of nursing problems identified in the typology are:
. . .to facilitate the maintenance of a supply of oxygen to all body cells. (Al:191)
. . .to identify and accept positive and negative expressions, feelings, and reactions. (Al:195)
A portion of the five-year curriculum project in basic nursing education at the University of Washington School of
Nursing (1952-1957) had many of the earmarks of occupational analysis. The first three years of this study placed em phasis upon teaching students to apply basic science knowl edge in solving nursing problems and evaluating their abil ities to apply such knowledge. In the final two years, the 29 emphasis shifted to the critical problem of identifying the science content applicable to nursing.
The methodology for identifying natural science con tent consisted of:
1. Developing nursing care plans for hypothetical patients
with problems involving the different structures and
functions of the body and analyzing the nursing care
for related science content;
2. Distilling from the science content major concepts as
organizing elements. (Two concepts emerged: homeo
stasis, or the maintenance of a constant internal envii-
ronment, and provision for effective and independent
functioning of the organism.)
3. Identifying factors related, to these major concepts; and
4. Identifying nursing care related to each of the factors
and analyzing it for content in the areas of anatomy and
physiology, pathology, chemistry, and physics.
Examples of the twenty factors finally outlined are: volume and pressure of circulating blood, oxygen supply, electrolyte balance, sleep and rest, and locomotion.
The study also included identification of social science content in which an adaptation of Flanagan's "Critical Inci dent Technique” was used and the nurse?patient situation described was analyzed for social science content. (A37:l-8)
Urey (1968) proposed a task analysis technique which was* 30
intended to provide a systematic method for studying nursing performance as a basis for learning nursing skills. The
technique was based upon two approaches used for industrial
job analysis:
1. A system developed by the War Manpower Commission in
1946 which focuses upon physical activities and per
formance characteristics;
2. A system developed by Verdier predicated on the idea
that a human engages in four functions in performing
any kind of work: perception, judgment, dealing with
stress, and motor activity.
To test the applicability and reliability of the technique two nurse observers simultaneously observed performance of each of six common nursing procedures by different nurses until independent analyses were in agreement, it was con cluded that the technique is practical and reliability can be attained. Descriptions of physical activities and per formance characteristics identified only gross performance requirements. None of the procedures required high level motor abilities and evidences of perception and judgment assessed as significant factors in the procedures were absent; however, stress was assessed to be a critical fac tor. (A50);
Chow's study of nursing action in the care of postoper ative cardiac patients (1968) had the following purposes: 31
1. To identify postoperative nursing action to maintain
the patient's physiologic dynamic equilibrium;
2. To devise a method for analysis of nursing action from
videotape data;
3. To illustrate how the nurse uses selected scientific
data in the solution of nursing problems;
4. To suggest implications for preservice baccalaureate
curriculum.
A closed circuit television system was used to observe and
record the nursing care given to twenty-three patients dur
ing their first four postoperative hours in the surgical in
tensive care unit. Nurse strategies identified totaled 111. \ Eight patient care problems were delineated:
1. Blood imbalance and hematological disorders;
2. Water and electrolyte disequilibrium and disturbance
of acid-base balance;
3. Peripheral circulatory failure;
4. Respiratory insufficiency or failure;
7. Pain;
8. Cerebral damage.
These problems were used as a basis for a literature review
of the natural sciences and medicine to help determine what
knowledge is essential for postoperative cardiac nursing.
The postoperative nurse interview was another method of 32 discovering the nurse's rationale for care and the informa tion she used to make decisions. (A6)
Christal, in a paper presented at the 1970 American Vo cational Association convention, discusses an Air Force com puterized information retrieval system containing many pro grams which analyze occupational data. Some outputs of these programs are normally used in connection with curriculum de sign by persons responsible for training courses in the Air
Force. Major considerations are the percentage of indivi duals assigned to a particular duty who perform specific tasks and the average percentage of time spent in performing the tasks. Task job descriptions which have been developed in clude medical personnel such as the medical laboratory specialist involving 344 tasks. Christal points out that the hardest information to obtain is the identification of tasks for which incumbents are being trained which they are unlikely to encounter. On the other hand, training evalua tion teams and user surveys can readily determine where ad ditional training should be given. In commenting on the complexity of curriculum design, Christal states that the trainer is often faced with the problem of preparing indi viduals for a family of tasks. Since only a small subset can be included in the curriculum, the problem of selecting the best samples of tasks becomes crucial. Some factors to 33 be considered are:
X. Probability that the task will be encountered by the stu
dent at various times after training;
2. Perishability of the skill;
3. Cost of teaching in formal programs versus cost of on-
the-job training;
4. Frequency of inadequate performance;
5. . Consequences of inadequate performance;
6. Probability that the task will be performed in an emer
gency situation;
7. Transferability of skill;
8. Trainability of the skill. (A7)
Anastasia (1971) administered a questionnaire intended to determine the impact of anatomy and physiology content on the work of nurses to 228 graduates of an associate degree pro gram. Though the study did not involve occupational analysis in the strict sense, obviously the nurses had to engage in some form of analysis of their work in order to respond to the questionnaire. On the basis of the replies of the nurses regarding the use of 18 major categories of subject matter and the use and significance of 118 subordinate items in their work, the investigator concluded that the relative use and importance of the content of anatomy and physiology can be measured effectively. All 18 major subject matter areas showed use and significance. However, the findings implied that 34 topics such as histology of bone and bone markings could be dropped from the curriculum; less emphasis could be placed on the nervous system, muscular system, general reproductive system, the cell, and joints; major emphasis should continue to be placed on the circulatory system, respiratory system, fluids and electrolytes, digestive system, skin, and female reproductive system. A correlation was found between the work in which the nurse was engaged and the significance at tached to questionnaire items. (A3)
Nursing has been one of twenty-two occupations under study in the UCLA Allied Health Professions Project initi ated in 1968 which has utilized task analysis as a basis for developing curriculum materials. A total of 306 nurs ing tasks in six functional areas have been analyzed in terms of :
1. Frequency of performance as reported by three categories
of personnel: nurse aides, licensed practical nurses,
and registered nurses;
2. Level of practitioner designated as appropriately per
forming each task by a national technical advisory
committee; and
3. Criticality of tasks as judged by the advisory committee.
Scales were administered to measure human interaction, psychomotor coordination, and cognitive level involved in 35
the tasks but available reports have not included the data derived.
Three levels of curriculum were designated on the basis of the frequency of performance as reported by the three categories of personnel. Since the results of the study indicate no significant differences in the frequency with which approximately 60 percent of the 306 tasks are per
formed by the three categories of personnel, this group of tasks was designated as Level I (performed by nurse aides, licensed practical nurses, and registered nurses). On the basis of the frequency with which the other tasks were per formed by licensed practical nurses and registered nurses, they were designated as Level II (performed by licensed practical nurses and registered nurses) and Level III (per formed by registered nurses only). Instructional units were developed accordingly. Available reports do not indicate the utilization made of data on the judgments of the ad visory committee regarding appropriate levels of personnel for the respective tasks; the criticality of the tasks; or the human interaction, psychomotor coordination, and cogni tive level elements. (A19, 49, 53, 54)
The overall goal of the Health Services Mobility Study initiated in 1968 and still in progress is to develop an effective method of job analysis and strategies based on 36
this method of analysis which will make possible upward job mobility for hospital workers and relieve hospitals of ser ious health manpower shortages. "The desired goal is to develop ladders, which run from low-vacancy high-employment entry jobs, to high-shortage skilled and professional jobs, with intermediary jobs between. A secondary goal is to pro vide choices among job ladders to employees at lower levels where investment in training and experience is at a mini mum." (A20:1/1)
The HSMS system of job analysis has four components:
1. Task identification;
2. Task rating on each of sixteen skill scales;
3. Task rating within an organized system of knowledge
classification;
4. Statistical manipulation of the task data for identi
fication of interrelated skills and knowledge categories
and, finally, identification of task sequences based
on families of these interrelated skills and knowl
edges. (A17:l/7)
The pilot test was carried out at the Dr. Martin Luther
King, Jr. Health Center, an entity of Montefiore Hospital in the Bronx. The center is an ambulatory care community health center that has pioneered in the provision of family- oriented medical care. A stimulus for cooperation on the 37 part of the center was interest in accumulating information about the functioning of the Family Health Team which would‘ contribute to the development of a primary care practition er. (A18:2/1-2)
Job titles chosen for the pilot test were:
! 1. Radiologist;
2. Obstetrician-gynecologist;
3. Internist;
4. Pediatrician;
5. Nurse practitioner;
6. X-ray technician;
7. Family health worker;
8. Licensed practical nurse--emergency room;
9. Licensed practical nurse— unit;
10. Electrocardiogram technician; ■
11. Medical assistant;
12. Dark room aide. (A18:2/5)
Task identification, the first component of the job analysis, was accomplished through interviewing and observ ing the twelve performers listed above. Probably the most unique aspect of this component is the detailing of the elements of the task ("the smallest possible meaningful units of work resulting from physical and/or mental acti vity") . The attention given to teaching and decision making 38
is evident in some of the elements in the task of removing
sutures:
4. Explains to patient. . .what is to be done. . . .
7. . . .May decide to irrigate with antiseptic. . . .
8. May decide to prescribe antibiotics. . . .
Also included in the task identification are indications of:
1. The output of the task;
2. Materials which the performer is expected to choose
and use in the task; and
3. The recipient, respondent, or co-worker involved in
the task. (A18:2/7-8)
Task rating on the basis of skill scales, the second
component of the job analysis, was also accomplished through
interviews with the performers. The HSMS method identifies
sixteen learnable skills: three manual skills; two inter
personal skills; three skills involving precision in the
use of language; two skills dealing with decision making;
four general intellectual skills; and two "responsibility
skills" relating to the recognition of the consequences of
error in task performance. A rating scale has been de
veloped for each of these sixteen skills. Examples of des
criptive statements in the Human Interaction Scale are as
follows: 39
Scale value 0: "The task does not require the performer to
be in contact with or to interact with other
people."
Scale value 9: "The task requires the performer to inter
act with others in the performance of the
task. The performer is required to be keenly
sensitive to and perceptive of the other per
son (s) 1 relevant characteristics or state of
being, and to be acutely aware of very sub
tle or very complex feedback so as to adjust
his behavior accordingly." (A18:2/13-16)
Task rating on the basis of an organized system of knowl edge classification, the third component of the job analysis, is also accomplished through interview with the performers.
Subject categories which compose the HSMS Knowledge Classi fication System meet the following criteria:
"1. . . .represent organized bodies of knowledge which can
be conceived of as ranging in content from simple to ad
vanced levels and which can be required at varying levels
in a variety of tasks.
"2. . . .are not merely the names of the individual steps
of tasks.
"3. . . .even at lowest levels of use, require a learning
effort beyond every day experience and beyond the usual
process of maturation. The learning effort involved may 40
be formal or informal, but it must involve a conscious
effort to be acquired so that it can be applied in dif
ferent situations."
"4. . . .can be identified as being required in competent
task performance."
The following is a sample section of the HSMS Knowledge
Classification made up of subject categories:
"11700000 Zoology
"11710000 Invertebrate zoology
"11720000 Vertegrate zoology (through mammalia, but
excluding humans)
"11730000 Human zoology
"11731000 Normal structure and function. . . .
"11731100 Regional anatomy. . . .
"11731200 Topographic anatomy. . . .
"11731300 Hematopoietic system. ..."
A total of 201 subject categories were identified in the pilot study tasks. Each subject category identified in each task was rated on the basis of the Levels of Knowl edge Scale. Examples of descriptive statements in this scale follow:
Scale value 0: "The task does not require the performer
to consciously apply knowledge in this 41
subject category which has been gained in
a learning experience requiring more than
the memorization of the overt steps of the
specific task being scaled.”
Scale value 1.5: "The task requires that the performer con
sciously apply a limited amount of de
tailed knowledge in this subject cate
gory including such things as technical
or special terms or facts."
Scale value 9.0: "The task requires that the performer have
a very deep understanding of this subject
category in terms of its content, the
structure of its ideas, and its uses. The
performer must consciously apply a very
great amount of detailed knowledge in this
subject area, including such things as
technical or special terms or facts."
(A17:2/22-25)
Statistical manipulation of the task data for identifi cation of interrelated skills and knowledge categories and the identification of task sequences based on families of these interrelated skills and knowledges, the fourth component of the HSMS system of job analysis involves several steps:
First, the computer program "reads in," task by task: 42
1. The skills involved in each task and the respective
scale values for these skills;
2. The knowledge categories for each task and the respec
tive scale values for these categories.
The print-out indicates the skills and knowledge categories
involved in all the tasks and the task locations and scale
values for each skill and knowledge category identified.
The program also files these data for inputs into the factor
analysis which follows. (A17:2/29-30)
Next, factor analysis examines the statistical relation
ship of every variable with every other variable and groups
these in such a way as to best account for all the variabil
ity represented by the ratings of all the tasks on all the
variables. The result in the case of the pilot application
of the method was a six factor solution accounting for 73
percent of the variance. A task's loading on a factor re
flected its scale values on the skills and knowledge cate
gories and also the number of those skills and knowledge
categories determining the factor. Thus, the more cate gories and skills involved in the factor and the higher
the task's scale value for these, the higher the task's
loading on the factor.
Although there are many ramifications to the process followed, essentially, a task was assigned to the factor on which it loaded highest and also assigned to other 43 factors on which it loaded high if the manifest content of the task and the factor warranted this (A18:3/7-24)
Since the objective was to identify rungs on a ladder, an additional type of analysis was necessary. The tasks in a factor were laid out in rank order of their loadings on the factor and the skills and knowledges were laid out in order of their appearance in the tasks, from low to high on the factor. In this way, major cut-off points when marked increases in scale level occurred or when blocks of new knowledge categories were needed could be identified. This information indicated which tasks within a factor were at relatively the same level. Finally, task level groupings across factors were related with the use of tasks appearing in more than one factor as a guide. In this way, seven levels were identified. (The following possible character izations were suggested in relation to academic and occu pational terms:
Level 1 Aide; entry; unskilled; on-the-job training.
Level 2 Assistant; semi-skilled; on-the-job training
with credit.
Level 3 Technician; some special training; about one year.
Level 4 Semi-professional; two or more years of training.
Level 5 Professional I; professional training.
Level 6 Professional II; highly rigorous and/or special
ized professional training. 44
Level 7 Surgery or its equivalent in post professional
training.)
The following verbal descriptions were given to the six
factors:
1.. Surgery, diagnosis, and prescription;
2. Pediatric diagnosis and prescription;
3. Machine related care and radiology;
4. Social service and counseling;
5. Physical care and treatment;
6. Female care.
A major product of the pilot application of the methodology,
therefore, was a plan of task sequences by factor and level
as a basis for the development of curriculum and job lad
ders {A17:3/26-30).
The following comments of the project director point up a primary difference between this study and some others based upon job analysis:
There appears to be a tendency in the field of "paraprofessional" or "allied health occupations" training to confuse task performance and curricu-. lum design. A number of projects have attempted to design curricula for new occupations or to de velop programs for existing occupations with a view towards making some upward mobility possible for health services employees. These projects col lect task data to determine what activities the curricula would have to prepare the employees to do, but they then set about to design curricula which would teach students to perform the steps of the tasks, as the tasks are currently being done. That is, the curricula are designed to teach the actual procedures or steps of the tasks, and little more. 45
The design of curricula based solely on teach ing how to do the steps of tasks is a corruption of the possible uses of task analysis in curricu lum design. The focus on teaching task procedures makes the curriculum content (and the student) ob solete as soon as technology changes and/or the procedures are changed. This leaves the performer with non-transferable knowledge.
The focus on teaching task procedures does not lay the foundation of skills and knowledge needed to build upon if upward mobility is to be achieved through efficient design of job and cur riculum ladders. The objective of job and educa tional ladders should be to carry the individual potentially through all the steps in a ladder from entry level to professional levels, even though they provide exit points along the way.
The difference in learning which separates the on-the-job trained performer ("first you do this, and then you do that") from the performer trained in terms of organized knowledge ("you have to do certain kinds of things under certain kinds of circumstances") is that the first type of learning is not transferable, and the second is transferable. Transferability of learning means that an investment of time.and effort in learning something is usable in more than one context; and this is the basis of mobility. (A17:4/2-4)
Core Curriculum
While reports of the Program for Educational Mobility
for Health Manpower (1970) do stress the core content rather
than the career ladder concept, the project does indeed
have important implications for this concept from two stand points: First, the identification of core content is a major consideration in any career ladder endeavor. Second
ly, this particular project includes practical nurse and 46 registered nurse preparation and these titles are commonly placed on the same career ladder.
The Program for Educational Mobility was initiated through an elven-week workshop in which a science faculty committee representing four community colleges in San Diego and Imperial counties met with allied health educators to examine science curricula required in the allied health professions in order to design core curricula required in health occupations. The original plan called for the de velopment of job analyses on the basis of visitations to clinical areas. Actually, the report of the workshop in dicates that it must have been recognized early that if practical results were to be produced, an eclectic approach would have to be used. Visitations were made to clinical facilities and similar projects were investigated. Probably the results accrued primarily from the integration of the experiences of the science faculty members and the allied health educators (Al:l-14). The allied health educators explained the tasks required of the technicians and science faculty members responded in terms of their knowledge of the structures of their fields. The project director ob serves: "When the allied health educator could clearly state in performance terms, 'the student will be able. . .,' then concrete discussion followed." (A2:8) Another state ment of the project director in a recent article about 47 the undertaking explains the nature of the approach taken:
The main idea was to get rid of the "stuff" not needed and, at the same time, not de stroy the inner logic of the material. A unit of learning or concept was distilled . out and the term "module" came to be ap plied. The problem became one of pulling out first in order to examine the smorgas bord of needs before developing sequencing. (A12:35)
The results of the initial eleven-week workshop, of efforts and experiences in the four-month period immediately following, and of a second three-day workshop at the end of that time were modules in such areas as anatomy and physiology, physics, and chemistry. Master charts list the titles of modules vertically and job titles horizontal ly, indicating the approriateness of the module for the job. The combination of job titles listed depends upon the subject matter area, but job titles given attention are dental assistant, dental laboratory assistant, dental labor atory technician, inhalation therapist, medical assistant, medical records technician, licensed practical nurse, occu pational therapy assistant, physical therapy assistant, radiologic technologist, medical secretary, medical labora tory assistant, biomedical repair technician, biomedical cardio-respiratory technician, biomedical physiology tech nician, monitoring technician, dental hygienist, nurse
(associate degree). (All, 12, 33) 48
Soon to be available is the report of a .study by the
Association of Schools of Allied Health Professions and
the National Institutes of Health in which visitations have been made to institutions which have utilized the core ap
proach at various educational levels in order to derive
recommendations regarding implementation of the concept.
(A43)
Differentiation of Roles and Abilities of Different Kinds of Practitioners
Mandrillo (1969) attempted to determine whether gradu ating baccalaureate degree nursing students and graduating associate degree nursing students differ in their cognitive
skills in relating scientific knowledge to nursing problems.
The investigator-made test was intended to measure recall of knowledge and the intellectual abilities and skills of under standing, applying, and analyzing knowledge. Data obtained
from 155 graduating baccalaureate degree students and 106 graduating associate degree nursing students demonstrated
that baccalaureate degree students possessed significantly more knowledge and performed significantly better than the associate degree students in the extent to which the knowl edges were associated with four patient problems. (A32) 49
McKenna (1970) conducted a study concerning the identi
fication of elements of professional nursing practice and
technical nursing practice. An assumption was that profes
sional and technical nursing are two kinds of practice rather
than two levels of practice. Job descriptions were written which provided for differentiation of practice as follows:
1. The four "nurse clinicians" (graduates of baccalau
reate degree programs) were to perform those tasks in
volved in, and emerging from, the collection of data
and the development of nursing goals and orders; and
2. The six "nurse practitioners" (graduates of associate
degree or diploma nursing programs) were to perform
those tasks involved in, and emerging from, the imple
mentation of the medical and nursing orders.
After functioning in accordance with these job descriptions
for six weeks, the nurses, using a dictionary of terms de
veloped for this study, recorded the tasks they performed
during seven consecutive work periods. The study data in
cluded 3,801 tasks consisting of 33.4 different tasks. Of
the total 73 percent were performed exclusively by either the nurse clinicians or the nurse practitioners; however, the nurse practitioners performed appropriate tasks with greater consistency than the nurse clinicians. (It is specu
lated that perhaps there were not a sufficient number of tasks of the first order.) There were differences in the knowledge sources and basic skills associated with the two groups of tasks, but no difference in the sources- of deci sions associated with the two groups of tasks. It was con cluded that it is possible to develop a system of nursing service in which there is a demonstrable difference between professional nursing practice and technical nursing practice.
(A31)
Waters, et al. (1970) attempted to explore and des cribe evidence of differences in nursing practice between graduates of associate degree and baccalaureate degree nurs ing programs. A comprehensive review of the literature brought to light a consensual body of writings on the sub ject. Descriptions of professional nursing included such factors as selecting nursing actions which may be innovative or probabilistic and utilizing practice as a means of gather ing data for refining and extending practice. Technical nursing is- described as focusing toward the care of patients with identified nursing problems and involving the analysis and interpretation of information obtained from physicians, professional nurses, and others. (A51:2-3) The methodology of the study consisted of deriving criteria for describing differences between technical and professional nursing from the literature; interviewing head nurses and directors of nursing; observing in the work setting and interviewing the 51 two kinds of graduates. Interview data from head nurses and directors supported differences in practice between the two groups of graduates. Associate degree graduates were viewed as practicing technical nursing; baccalaureate graduates were seen as practicing technical nursing more often than professional nursing. Those baccalaureate graduates who were seen as practicing professional nursing dealt with pro blems that could be described as "wider in scope, less com mon, having more alternatives to solutions, and often psy chological in nature." A limitation of the study was "the nebulous definition of professional nursing itself, and the difficulty in operationalizing a concept described as wide in scope, theoretical in nature, etc." (A51)
Summary.
Examples of several different kinds of studies which impinge upon the career ladder concept have been presented in the latter section of this chapter. Some, such as
Tashjian*s career ladder model study, the UCLA Allied Health
Professions Projects, and the Health Services Mobility Study, have the promotion of the career ladder concept as an expli cit goal. The majority, however, were included for other reasons: the occupational analysis studies because some form of occupational analysis seems to be imperative in all 52
career ladder endeavors and therefore various kinds of methodology are of interest; the core curriculum studies because core curriculum efforts contribute to career ladder
curriculum efforts and vice versa (the kind of endeavor that
comes first probably depends upon the demands of the parti
cular situation); role and ability differentiation studies because clear and realistic role definitions— if it is pos
sible to develop such— should facilitate career ladder devel opment.
While more effective coordination of major research efforts might be desirable, the benefit of multiple approaches seems to be evident. It is interesting to note that, while
the reports of the Program for Educational Mobility indicate that the workshop participants believed that their efforts might be unnecessary if the results of some major projects underway at the time had been available, the products of the workshop project were very different from those of the
UCLA Allied Health Professions Projects to which the workshop participants looked forward. CHAPTER III
METHODOLOGY
This chapter presents in detail four major steps used
to develop and test guidelines intended to aid in sequencing
natural science content essential to nursing in a manner
which would facilitate the emergence of an educational ca
reer ladder in that field:
1. Exploration of role definitions and. guides to curriculum
development in the nursing literature as a source of
direction for guideline development;
2. Exploration of elementary and secondary level science
and health education literature as a second source of
direction for guideline development;
3. Formulation of tentative guidelines;
4. Assessment of tentative guidelines in terms of factors
in the actual nursing situation as a third source of
direction for guideline development.
A discussion of rationale for the use of each of the three sources of direction prefaces the details of the particular step which utilizes that source. Concluding the chapter is a discussion of factors identified in the course of the study which the investigator believes are significant to any consideration of the methodology or the guidelines which resulted* n 54
Step One: Exploration of Role Definitions and Guides to Curriculum'Development in the Nursing Literature ~
Rationale
The rationale for this source of direction is quite obvious. Statements issued by nursing organizations most directly involved with education and practice in the field concerning educational programs and curricula and the roles of practitioners might be expected to provide some assis tance in identifying levels of practice and related levels of required content to be studied in educational programs.
The Process of Exploration
The nursing literature from 1964 to the present was searched for statements of recognized nursing organizations regarding nursing roles. A total of sixteen publications of the American Nurses' Association, the National League for Nursing, the National Federation of Licensed Practical
Nurses, and the National Association for Practical Nurse
Education and Services were found and utilized. The investigator selected from these sixteen publications statements relevant to the purpose of this study and then attempted to abstract implications for the sequencing of natural science content. The 1964 joint American Nurses'
Association and National Federation of Licensed Practical 55
Nurses Statement of Functions of the Licensed Practical
Nurse (B5) and the 1965 American Nurses' Association
Educational Preparation for Nurse Practitioners and
Assistants to Nurses; A Position Paper (Bl)f which des
cribes the roles of the professional nurse, the technical
nurse, and the nurse aide, provided a basis for the analysis
of the other statements. The implications abstracted from
the sixteen publications were then summarized.
In addition, the investigator analyzed the separate
plans for state board test pool examinations for registered
nurse and practical nurse licensure developed by the
Committee on Blueprint for Licensing Examinations of the
American Nurses' Association Council of State Boards of
Nursing (B7, B8). Apparent differences in the natural
science knowledge required for the practical nurse and the
registered nurse were abstracted and summarized as implica
tions for sequencing natural science content.
Step Two: Exploration of Elementary and Secondary Level Science and Health Education Literature
Rationale
For purposes of this study, the natural science content
identified as relevant to nursing in the University of
Washington School of Nursing study (A37) was accepted as the body of content to be sequenced. The decision to 56 explore the status of science and health education at the elementary and secondary levels as a source of direction for developing guidelines for the sequencing of this content was based upon the assumption that, because science educa tion and health education, for some time, have been offered at successive levels in the elementary and secondary school curricula, educators in these fields have given attention to the matter of sequencing content. It was speculated that statements of rationale for various curriculum approaches might describe some theoretical bases for sequencing natural science content related to such matters as inherent difficulty of content or the process of intel lectual development. Furthermore, it was assumed that science and health curriculum materials themselves would reflect such theoretical bases as well as the experience of educators in connection with sequencing content for ! effective learning.
The investigator recognizes a possible question related to the use of elementary and secondary curriculum approaches based upon theories of intellectual development as a source of direction for the development of guidelines for the sequencing of natural science content in nursing curricula. This is the question of whether a sequence which focuses upon giving the child adequate experiences with concrete operations and assisting him to move from 57 concrete operations to formal operations is. appropriate to the needs of the older adolescent or adult in the nursing program. One might ask whether individuals continue to use concrete operations in some areas even though they have progressed to the level of formal operations in other areas?
For example, would the 30 year-old practical nurse student who utilizes a highly abstract mode of thought in many areas need to operate quite concretely in the science area because of lack of previous exposure? A review of the literature on cognitive development in adolescence answers this question:
It is apparent . . . that the transition from concrete to abstract cognitive function ing takes place specifically in each separate subject matter area and invariably presupposes a certain necessary amount of sophistication in each of the areas involved. This state of affairs follows directly from intraindividual differences in experience and component intel lectual abilities. Inhelder and Piaget . . . explicitly recognized that complete inter- situational generality cannot be expected at any stage of development, referring to this phenomena as "horizontalage." This prediction has been confirmed by many other investigators.
Thus, even though an individual character istically functions at the abstract level of cognitive development, when he is first intro duced to a wholly unfamiliar subject matter field he tends initially to function at a concrete-intuitive level. But since he is able to draw on various transferable elements of his more general ability to function abstractly, he passes through the concrete stage of function ing in this particular subject matter area much 58
more rapidly than would be the case were he still generally in the concrete stage of cogni tive development (F>4:40 7-08).
While sequences emphasizing progression from the concrete to the abstract are probably more important in curricula designed for younger children, such sequences are obviously very appropriate in curricula for adolescents and adults. The less sophisticated the learner in the given subject matter, the more important an approach that will lead him from the concrete to the abstract. It should also be noted in this connection that if career education concepts which would integrate general and vocational education very closely throughout the school experience should prevail, sequences built upon theories of intellec tual development will indeed be appropriate.
The Process of Exploration
In the first step in exploring the status of elemen tary and secondary education as a source of direction for guideline development, the investigator attempted to identify statements of rationale for curriculum approaches which might describe some theoretical bases for sequencing natural science content. A limited search of the literature was « carried out in the science education and health education fields. In the next step, the investigator studied elementary and secondary level science and health curriculum materials in an attempt to identify patterns of sequence which might serve as a basis for sequencing natural science content in nursing curricula. A group of materials recommended by educators in the two fields, as products of recognized curriculum development efforts at the national and state levels or as popular textbooks or textbook series were selected for an in-depth analysis, The group of elementary and secondary level curriculum materials "packages" include the following:
1. Products of the School Health Education Study: The bases for curriculum development in this study are concepts about health. Curriculum materials are being developed at four levels bn the kindergarten through grade twelve continuum. For each of ten concepts about health, the following are or will be available for each of the four levels: a "teaching-learning guide," a bibliography of resources, and a set of transparencies accompanied by
"instructional units" for use by the teacher in showing the transparencies and presenting the lesson. To date, materials for eight of the ten concepts are available.
Materials for five of the eight concepts include natural science content and were utilized by the investigator for in-depth analysis. The group of materials relating to the 60 five concepts and analyzed by the investigator includes thirty-two components: twenty “teaching learning guides," and twelve sets of transparencies and "instructional units" {J>56^63)v
2. The Pennsylvania Department of Education Conceptual
Guidelines for School Health Programs in Pennsylvania: A
Program Continuum for Total School Health: This resource is a one-volume curriculum guide for kindergarten through grade thirteen £D43).
3. Products of the Science Curriculum Improvement Study:
These elementary level curriculum materials as currently distributed by Rand-McNally and Company include teacher's guides, student manuals, and kits of materials* Physical and life science units are suggested for six grade levels.
The project trial editions were utilized by the investiga tor and either a teacher's manual or a student guide was analyzed in depth for each of thirteen units (tD65r-7.7) *■ .
4. Products of th£ Science— A Process Approach: These elementary level curriculum materials distributed by Xerox
Education Division are being developed in relation to the sequential development of progressively higher level intel lectual processes that are essential for the learning of science. Teaching guides and kits of materials are avail able at seven levels generally corresponding to kindergarten 61 through grade six. Sample materials were examined but in- depth analysis was limited to study of a comprehensive wall chart illustrating the sequence of exercises in terms of the developing intellectual processes as well as in terms of the relationships between and among exercises (D2).
5. Products of the Elementary Science Study; These curricu lum materials currently distributed by the Webster Division of McGraw-Hill Book Company include 112 units for which various kinds of printed materials, audiovisual aids, and kits of materials are supplied. Sample materials were examined by the investigator but analysis was limited to study of The Elementary Science Study Reader and A Working
Guide to the Elementary Science Study, which together describe the units; classify them as physical science, biological science, earth science, or general; and relate grade levels to them (D16, 17).
6. Introductory Physical Science, a product of the
Introductory Physical Science Study: This textbook published by Prentice-Hall as the principal product of the project is intended for use at the secondary level in a course which serves both as a terminal program for those who will not study physics or chemistry at the senior high school level and a foundation for future study.for those who will.
The textbook was analyzed in-depth by the investigator (D21). 62
7. Biological Science; An Inquiry into Life, a product
of the Biological Science Curriculum Study; This textbook
published by Harcourt, Brace, and World and two others
taking alternate approaches to the study of biological
science at the high school level are products of the study.
The two alternate textbooks and other project materials
were examined by the investigator but in-depth analysis
was limited to the textbook indicated (D4-11).
8. The Health and Growth textbook series: This series published by Scott, Foresman and Company includes text books for grades one through eight. Each was analyzed
in-depth by the investigator (D44-47).
9. Modern Health and Modern Sex Education: This textbook and sex education supplement published by Holt, Rinehart, and Winston are intended for use at the secondary level.
Each was analyzed in-depth by the investigator (D29, 42).
10. The Science Is . . . textbook series: This series published by Scott* Foresman and Company includes textbooks for grades one through eight. Each was analyzed in-depth by the investigator (D32-39).
11. The Science . . . textbook series: This series pub lished by D. C. Heath and Company includes textbooks for grades one through eight. Each was analyzed in-depth by the investigator (D48-54). 63
The source for the body of content which was a basis
for the analysis of the above curriculum materials was
Nordmark and Rohweder's Scientific Foundations of Nursing
(A37} which outlines the science content identified as
basic to nursing in the University of Washington School of
Nursing study described in Chapter II. Five hundred and
thirty-three items which comprise the "Anatomy and Physi
ology, " "Physics," and "Chemistry" sections of "Part II:
Natural Sciences and Nursing Applications" were utilized.
As has been indicated, the purpose of the analysis
was to identify already existing patterns of sequence of
natural science content basic to nursing which might serve
as a basis for sequencing natural science content within
nursing curricula designed to provide a career ladder.
The process consisted of careful examination of each of the
78 separate textbooks, manuals, or other curriculum materal
forms listed above for the extent of coverage of each of
the 533 items representing the body of natural science
content identified as basic to nursing. The extent of
coverage of. each item in each set of curriculum materials
was recorded as "similar coverage" (XXX); "majority of
item content covered" (XX); "some coverage" (X); or "no coverage" (blank space). The complete analysis is presented in Appendix II.
(It should be noted with regard to this analysis that when recordings were compiled, it was apparent that coverage 64
of items from Nordmark and Rohweder's anatomy and physio
logy sections was mainly in the health and biological
science materials while coverage of those items in the
general science and physical science materials was insignif
icant. On the other hand, coverage of the chemistry and
physics items was mainly in the general science, physical
science, and biological science materials, while coverage
of these items in the health materials was insignificant.
For purposes of simplication, therefore, the general science and physical science materials have been eliminated from
the anatomy and physiology sections of the analysis and the health materials from the chemistry and physics sections.)
When all of the elementary and secondary level materii-
als had been analyzed as explained above, the 533 natural science items basic to nursing were classified as "Level I" if the content was considered to be commonly covered at the elementary level; "Level II" if the content was con sidered to be commonly covered at the secondary level; and "Level III" if the content was considered to be com monly covered in post secondary or advanced high school science courses. The specific process utilized was as follows:
1. The anatomy and physiology and microbiology sections:
a; Recordings of at least "majority of item content
covered" (XX) for at least two of the three sets of elementary level health curriculum materials
analyzed served as a basis for classifying the item
from Nordmark and Rohweder's Scientific Foundations
of Nursing as Level I. b. Recordings of at least "majority of item content
covered" (XX) for at least three of the four secon
dary level health curriculum materials analyzed or
for the Biological Science Curriculum Study textbook
confirmed by similar coverage by Smallwood and
Green's Biology (D78) served as a basis for classi
fying the Scientific Foundations of Nursing as Level
II. c. The remaining items were classified as Level III.
The physics and chemistry sections: a. Recordings of at least "majority of item content
covered" (XX) for at least three of the five elemen
tary level general science curriculum materials ana
lyzed served as a basis for classifying the item as
Level I. b. Recordings of at least "majority of item content
covered" (XX) for at least two of the three secon
dary level general science and physical science mate
rials analyzed or for the Biological Science Curri
culum Study textbook confirmed by similar coverage 66
in Smallwood and Green's Biology1 served as a basis
for classifying the item as Level II.
c. The remaining items were classified as Level III.
A review of items as classified at this point indicated
i that there were many classified as Level III which seemed to represent no more complexity than Level II items. The dif ference between the Level II items and this group of Level
III items seemed to be simply that the latter involved details of information particularly pertinent to nursing skills and judgments. This group was, therefore, reclassified as Level II-A.
Step Three; Formulation of Tentative Guidelines
In step two, the three levels of natural science con tent were described primarily in terms of the broad educa tional level at which the content is commonly studied. At this point, the analysis was examined for details which would more adequately describe the content of each level. Other curriculum materials included in the bibliography were utilized to provide additional insights. Three levels of natural science content were then described in broad
1 Since biological science is studied by a majority of students at the high school level, content which is not found in a majority of health education materials might be commonly studied in the biological science course. Only the Biologi cal Science Curriculum Study textbook was analyzed in-depth, but, where indicated, coverage of the item was confirmed in the textbook used by average tenth graders in the Columbus, Ohio, public school system. 67
terms and in relation to the areas of anatomy and physio
logy, physics, chemistry, and microbiology*.
i Next the descriptions of the three levels of content
' thus derived were very tentatively related with the nursing
education and practice levels of nurse aide, practical
nurse, and technical and professional nurse and considered
as very tentative guidelines for sequencing natural science
content in nursing curricula. These very tentative guide- *k lines were examined for compatibility with the findings of
the exploration of statements regarding nursing roles and
the state board test plans in step one of the process.
The emerging tentative guidelines were tested in step four
below.
Step Four; Assessment of Tentative Guidelines in Terms of Factors in the Actual Nursing Situation
Rationale
One of the assumptions upon which this study is based
is that the validity of curricula designed to prepare
individuals, to function in an occupational area is determined
in the "real world" of occupational practice. The process
which was used to test the validity of the tentative guide
lines developed in this study was based upon the rationale
that the percentage of nursing activities essential in
the clinical situation which require a particular level of 68 scientific understanding should correspond in at least a gross manner to the percentage of personnel prepared at this level and available to perform the activities. Since the shifting of proportions of nursing personnel prepared at the several levels has been and is projected to continue to be rather gradualf 2 these proportions should provide fairly reliable (although gross) norms for testing the validity of approaches to content selection in curriculum development.
The Process of Assessing the Tentative Guidelines
Overview of the Process
Twenty-four hour nursing care analyses were developed for each of 27 randomly selected patients in a 238-bed medical-surgical hospital. These analyses included:
(1) nursing activities indicated in the care of the patient; (2) the frequency indicated for each activity; and
(3) the natural science understandings indicated for the performance of each activity. The natural science under standings were classified as Level I, Level II, or Level
III in accordance with the tentative guidelines which described three levels of natural science content. Each nursing activity in each analysis was then classified as
2See ’'Information Regarding the Composition of Nursing Manpower" in Appendix IV. V
69
Level I, Level II, or Level III on the basis of the
highest level natural science understanding required for
the performance of that activity. The sums of Level I,
Level II, and Level III activities were computed for each
nursing care analysis and these sums were used to compute
the sums of of Level I, Level II, and Level III activities
included in the 27 analyses. These sums were converted
into percentages of the total number of activities in the
27 analyses. The percentages of Level I, Level II, and
Level III activities in the 27 analyses were compared to
the percentages of nursing personnel prepared at the three
nursing education and practice levels which had been equated
with the three levels of content in the guidelines. Finally,
a decision was made regarding the affirmation of the tenta
tive guidelines.
Choice of the Setting for Selection of Patients
The decision to utilize medical-surgical hospital units
for the selection of patients for this study was made on
the basis of the fact that such units, at least at the present time, represent the most common setting in which nursing personnel are employed. According to the 1966
American Nurses' Association Inventory of Registered
Nurses . approximately 65.3 percent of all employed registered nurses were employed in hospitals (FI:19) and, according 70
to the 1967 American Nurses' Association Inventory of Li
censed Practical Nurses# approximately 65.9 percent of all
licensed practical nurses were employed in hospitals (FIs 166).
Likewise, in 1969, probably about 64 percent of all aides, * orderlies, and attendants were employed in hospitals (F13:58).
Obviously, the medical-surgical areas in hospitals employ a
larger number of nursing personnel than any other kind of
hospital clinical area. The Inventory of Registered Nurses
offers evidence of this preponderance of employment in medical-
surgical areas. Of the registered nurses who indicated they were employed in hospitals in 1966, only 91 percent reported
the type of clinical area in which they were employed. This
91 percent included 43.5 percent who reported they were em
ployed in medical-surgical areas and another 17.9 percent who
reported they were employed in "general practice" in hospi
tals (Fl:19). In other words, 61.4 percent of all those who
indicated they were employed in hospitals or 67.5 percent of
those who indicated their clinical areas reported employment
either in medical-surgical nursing per se or in "general practice" which was probably primarily medical-surgical nursing.
The decision to use the particular hospital selected was based upon the convenience of location and the willing ness of administrators and staff members to cooperate. 71
The Process in Detail
Selection of Patients— For purposes of this study,
patients were designated by their room and bed numbers. The
numerical designation for each such location was written on
a slip of paper and placed in a receptacle. At the beginning
of each of two separate weeks, the investigator drew four
teen of these slips in order to select fourteen patients for
study. Two of the fourteen patients were designated for
study for each of the seven days of each of the two weeks.
(It should be noted that twenty-seven, instead of twenty-
eight nursing care analyses,■resulted because one patient was
discharged early in the 24-hour period designated for study.
It might also be noted that the sampling procedure in one
case resulted in the selection of the same patient for study
on two different days because of her transfer from one loca
tion in the hospital to another. Thus the total number of
patients represented by the twenty-seven nursing care anal yses was twenty-six.)
Development of Nursing Care Analysis:— The nursing care analysis form which is presented in Appendix III provides
for the listing of nursing activities; an indication of the
frequency of each activity in the 24-hour period; and a list ing of natural science understandings for each nursing activ ity. 72
Nursing activities were listed on the basis of their
being required in order to provide acceptable nursing care
for the particular patient during the particular 24-hour
period. Frequencies were designated on the same basis. (The
activities and the related frequencies, therefore, are in
tended to depict what should have been in the patient's
nursing care and, not necessarily, what actually transpired.)
Natural science understandings were included if they were considered basic to:
1. Knowing how to do the related nursing activity (includ
ing dealing with special precautions, adaptations, etc.,
and the use and care of equipment) in the particular
patient situation involved; or
2. Understanding the general purpose(s) and significance
of the related nursing activity; or
3. Understanding the particular purpose(s) and significance
of the nursing activity in the patient situation involved.
The following methods were utilized in the development of the analyses described:
1. Study of the patient's chart;
2. Conferences with nurses on the patient units and nursing
in-service education staff;
3. Conferences with other nurse clinicians; and
4. Use of nursing and medical reference materials .
In addition, in order to obtain an assessment of the 73 investigator's competency in developing the analyses on the above basis, as well as to obtain guidance in the proceed; the investigator submitted copies of one fairly complex anal ysis to twelve faculty members in a fully approved university school of nursing for review. All of these.faculty members were currently or very recently involved in medical-surgical nursing and could properly be considered clinicians. Nine of them returned the analysis with their comments and suggestions which were utilized in the revision of the analysis reviewed and in the development of the other analyses. All notations regarding the addition of nursing activities and natural sci ence understandings were given careful consideration. The in corporation of these activities and understandings had to be on a subjective basis but, in most instances, if they could not be identified in another form, they were incorporated.
Where clinicians suggested the inclusion of understandings regarding pathology, the investigator attempted to identify the underlying anatomical or physiological understanding(s) already present. When these had been omitted, they were in corporated. Frequencies were adjusted on the basis of an average of those suggested by clinicians except in cases in which there was complete disparity of opinion in which in stances a judgment had to be made by the investigator. Sam ples of the materials sent to the twelve faculty members, to gether with the revised analysis, are presented in Appendix
III. 74
Classification of the Nursing Activities— When the
twenty-seven nursing care analyses had been completed, the
investigator classified each nursing activity in each anal ysis in accordance with the tentative guidelines which had been previously developed. In other words,.the nursing ac
tivities considered to be required for acceptable care of each patient in the situation described were classified in accordance with the lowest level of.practitioner who would be prepared to perform the activity if the guidelines were applied in the educational preparation of nursing personnel.
This was accomplished by first classifying each natural sci ence understanding in accordance with the guidelines and then classifying each nursing activity on the basis of the highest level understanding required for the performance of that activity.
Comparison of Percentages of Three Levels of Nursing
Activities with Employment Figures for Three Levels of Per sonnel— The sums of Level I, Level II, and Level III nursing activities were computed for each nursing care analysis and these sums were used to compute the sums of Level I, II, and
III activities included in the twenty-seven analyses. These percentages were compared with percentages of the three levels of nursing personnel estimated to have been employed in the past and projected to be employed in the future. On the 75 basis of this comparison, a gross assessment was made of the validity of the guidelines in terms of "real world" demands.
Significant Factors Related to Methodology
In the course of implementing the methodology of the study, the investigator identified certain factors which should be understood in connection with the guidelines which are reported in Chapter IV and also in connection with the recommendations for possible future application of the meth odology presented in Chapter V. These factors are discussed below in terms of the steps to which they are related.
Step One
A major factor to be considered in regard to the ex ploration of role definitions and guides to curriculum de velopment is the extent of materials analyzed. The only ma terials included were statements of recognized nursing or ganizations and the state board test plans. A more compre hensive analysis might have included information about local efforts which will probably influence more official role definitions and guides to curriculum development in the fu ture. Likewise, a more comprehensive analysis might have considered recent and ongoing studies which will also un doubtedly influence role definitions and guides to curricu lum development in the future. An example of a study report 76 which would have particular implications for the role of the professional nurse is the "HEW White Paper," Extending the Scope of Nursing Practice (B25), the report of the Sec retary's Committee to Study Extended Roles for Nurses.
t Another which would have implications for the roles of all nurses is An Abstract for Action (B12), the report of an independent study on nursing and nursing education initi ated through efforts of the American Nurses' Association and the National League for Nursing and financed through
Kellogg Foundation funds. Other references relating to role definitions and guides to curriculum development are listed in the bibliography.
Step Two
The following are factors related to exploration of elementary and secondary level science and health education literature which warrant consideration:
1. The search of science and health education literature
for statements of rationale for curriculum approaches
which might describe some theoretical basis for sequenc
ing science content could not be claimed to be compre
hensive. The investigator utilized the Educational Re
sources Information Services and was guided by educators
in the science and school helath education fields, but
was limited by relative unfamiliarity with the two fields. Curriculum materials were recommended for examination
by a limited number of educators in the science and
school health education fields.
In examining the materials, the investigator worked
within the limitations of the body of materials that
could feasibly be collected from libraries, curriculum
laboratories, and publishers.
Some curriculum materials were in the process of develop
ment and, therefore, the coverage of content attributed
to some of these may have fallen short of coverage in
the completed set. For instance, the materials for an
entire concept in the School Health Education Study,
which will probably have considerable natural science
content had not yet been published at the time of the analysis.
The original items from Nordmark and Rohweder which were used as a basis for analyzing the elementary and secondary materials were not similar in terms of importance or detail. These original items vary in length from one line to two pages.
The type of curriculum materials studied determines the manner in which content is indicated. For instance, therefore, a greater degree of extrapolation on the part of the investigator occurs in connection with the examination of a curriculum guide than a textbook or lesson plan. 78
7. In general, the focus in products of the elementary
science curriculum stidies is upon processes in which
' students are encouraged to engage rather than upon
content.
8. Judgments about the coverage of items in the various
curriculum materials were made solely by the investi
gator.
9. The designation of items as Level I, Level II, and Level
III was made simply on the basis of their coverage, or
lack of coverage by a majority of the curriculum ma
terials examined for the particular level.
Step Three
Beyond the factors listed in step two but closely associated with them, another factor which sould be con sidered has to do with the formulation of the tentative guidelines: The abstraction of the characteristics of natural science items basic to nursing in each of the levels as a basis for guideline formulation was solely an activity of the investigator. Obviously inputs from science educa tors familiar with the structure of the various science areas would have been valuable.
Step Four
Factors related to the final step of the process of 79 guideline development which warrant consideration are as follows:
1. While an effort was made to utilize a fairly typical
setting for the selection of patients and while pa- 4 tients were randomly selected within that, setting, a
random sampling of patients cannot be claimed.
2. While an effort was made to utilize clinicians in the
development of the nursing care analyses, these clini
cians were utilized as resource persons on an informal
basis (except in the case of the review of the sample
nursing analysis). For the most part, they made sug
gestions in those areas in which the investigator re
cognized a need for expertise and sought their assist
ance and they made their suggestions on the basis of
information about the particular nursing situation
which was made available through the investigator.
This problem had particular significance for decisions
about frequencies for nursing activities which might
better have been made on the basis of the clinician's
first hand information about the total nursing situ
ation.
3. Leadership activities, such as teaching personnel and
assessing the adequacy of a nursing care plan, were
accounted for in the analyses in an artificial manner
which might not depict the occurrences which would 80
be appropriate in the various situations. Zn other
words, activities described as follows appear in every
analysis and frequencies are recorded for them:
a. Assess knowledge and skills of nursing staff avail
able in terms of patient's needs. As,sign various
aspects of nursing care accordingly.
b. Teach nursing staff member(s) on the basis of the
above assessment.
c. Make thorough assessment of patient's status and the
adequacy of the nursing care plan. (Synthesize per
sonal observations and reports and suggestions of
other nursing personnel. Consult with other mem
bers of the health team.) Revise plan.
If the specific assessment and teaching activities indi
cated in connection with the care of each patient had
been recorded hour by hour, the listing of activities
and frequencies might have been different.
4. The criteria for decisions regarding the inclusions of
natural science understandings were inadequate for that
purpose. • Determining that a particular natural science understanding was required for performance of the nurs
ing activity was fairly straightforward. Determining
that a natural science concept was essential to under
standing the significance of a nursing activity, on the
other hand, was sometimes a nebulous operation. 81
5. Validation of the tentative guidelines on the basis of
comparisons between the percentages of activities re
quiring the respective levels of natural science con
tent and the percentages of personnel who would be pre-
pared at these levels if the proposed guidelines were » applied in selecting natural science content in nurs
ing curricula assumes that:
a. The average time required to perform nursing activ
ities is the same for each of the three levels; and
b. Constraints in assigning nursing personnel in ac
cordance with the level of knowledge required are
minimal.
Neither assumption is likely to be more than generally
true, and certainly reality would account for signifi
cant variations in individual situations. CHAPTER IV
RESULTS
This chapter deals with the cumulative results of the process of guideline development. Reporting follows the sequence of the four steps of the process.
Step One: Exploration of Role Definitions and Guides to Curriculum Development in the Nursing Literature
Statements of Nursing Organizations
The analyses of sixteen statements of recognized nurs ing organizations relating to role definitions for the vari ous levels of nursing personnel are presented in total in
Appendix I. On the basis of these analyses, it is con cluded that role definitions are not sufficiently differ entiated to provide specific assistance in developing guide lines for sequencing natural science content. Statements not in agreement are fairly common and there are even seem ing discrepancies between statements of the same organiza tion. The outcome of the analyses is limited to the fol lowing observations which may, at the most, contribute to a general framework for guideline development:
1. The need for natural science content in all kinds of
nursing curricula is acknowledged. 82 83
2. The need for natural science content is related to the
level of practice. There appears to be significance
for the matter of sequencing natural science content
in the fact that the statements indicate, that certain
aspects of nursing practice increase in importance
with the level of practice: (a) independence of
practice; (b) responsibility for informal and formal
teaching; (c) responsibility for supervision of others,
and (d) responsibility for coordination and synchroniza
tion of the patient's total health care.
3. There has been recognition of the expansion of the
practical nurse role since the 1964 joint American
Nurses' Association and National Federation of Licensed
Piactical Nurses statement, and, consequently, probably
a need for an expansion of the "fixed and limited
body of scientific facts" prescribed at that time.
4. There is some indication of recognition of expansion
of the technical nurse role outlined in the 1965
American Nurses Association position paper, and
consequently, possibly a need for an increased body of
content in the natural science area.
5. There is some question as to whether the need of the
professional nurse level over the technical nurse level
is one of increased content or a need of a higher
"level of knowing" in terms of the Taxonomy of 84
Educational Objectives (P 5>. It might be noted that
only one of the statements analyzed specifies natural
science courses (apparently at an advanced level)
concurrent in the curriculum with upper division
nursing courses.
State Board Test Plans
The Committee on Blueprint for Licensing Examinations
of the American Nurses" Association Council of State Boards/ of Nursing develops test plans for State Board Test Pool
Examinations for practical nurse and registered nurse licensure. The practical nurse test plan is the basis for development of test items for graduates of practical nurse programs. The registered nurse test plan, on the other hand, is the basis for development of test items for grad uates of associate degree, diploma, and baccalaureate programs. A comparative analysis of sections of the two test plans relevant to natural science content is presented in Table 1.
The six sections identified as relevant to natural science content are presented in both test plans. Differ ences between the two test plans which may have significance for sequencing natural science content are as follows:
1. The section directly related to natural science know
ledge is most specific: The practical nurse candidate 85
TAMX | COKTAKIPOJf or CTAttWJVT* MHJtVAVT 10 KAn’KAt. t Cl KATE CONTKHT 1H HASS IVk STATE M A W TEST TOOL KKAHIA'ATIOKS tv)k LICFkdtTCE Cl IXACT1CAL KVKKKS AND EKED KI'pftEA Comparison of the Knowledge acquired by the* Practical tiutae and the Knowledge Ktalrrcnt* In rr •knows the general causes, rode* of "Knows causes, mode* of transfer* and — The tern "most eesaon" la used in transfer and relative Incidence, of incidence of diseases and abnoraal connection with the practical nurse the m at common diseases and abnormal conditions* and understands aethods level of knowledge about diseases end conditions, and understand* aethods for for their prevention and control* abnoraal conditions, and the tora their prevention and control* ■most well known" in cenneetion with •A. Causes of and factors predisposing facts and principles about cause* •A, The m a t iaportant causes of the to physical and Rental diseases and transBission* and prevention and fsetora predisposing to diseases abnoraal conditions* control* and abnormal conditions, ■». Transmission of disease* •0* Transoissioti of disease, •C* Incidence and relative importance — The theory of immunity is excluded* •C* Importance of conditions, as to of diseases and health probleas. whether they constitute major "D« Prevention and control of health problems, coaawiicable diseases. •D* Prevention and control of "I* trevention and control of non- communicable diseases* coattunicabl* disease* and condi ■1, Prevention and control of non* tions* communicable diseases and "0* Boles and eh.-iraeteristies of conditions* organisations et.d agencies cotw earned with prevention and •lieitstiom control of disease and mainten Mill not be testrd relative to the ance and improvement of physical less common diseases In any of and mental health. these aspects; will not be tested "0* Interpretation of related on the theory of immunity, or oh numerical data*” details of preventive progress, or on any but the rout ucll-knovn facia and principles relative to cause, transmission, prevention and control," "Knows gross nanlfrntsUon of cannon "Know aaniresist ions of disease* and — The term "gross” is used In connec dlscstte* and abnormal condition** abnoinal conditions, with major empha tion with the practical nurse level sis upon those winch are concon, of knowledge about diseases and •A. Ayeploiw Shd fouinr, abnormal conditions and specifically *h. Cross efirctn on thr l Issues. "A. Syrptoiifl and course of physical about effect* upon the tissues. "C. Prognosis end complication* and menial disease* and nbnornAl (including corplirMJon* of sur- ronditionn, inclu‘lir«g trtminnlcgy. grty, r-uch an st«nW and hemutrhage), "D, a M it** lolnuonihip to synj.torw: sr.J flo^riSf, "I.JnilaUons ■C, IriovimwJti, inclvliMi tn«v|*v1gr of Kill not U tcvtivl on unrowvjn con* rcrf;»on>(Mi* g'uis fr»i |»il u iitc. timorm, or on a»y hgi th* tronl •D. Cqnf;|ir«ilMl.x flM mr'iuilac." itp jrta iit n.wnfe«ihiinhfi,01 on h'twHforttd |lu« phyn|r*iAtilo u/.in in fo tr.ilia n 86 t M U 1 front.) Cenp.trisiwi of tho Knowledge Acquired by the Practical Nurse and the Knowledge Statcwcntn In frjctlr.il Nurse Test Plan Bt.it,•‘srnts in kiwiteterwl hunt- Tret Plan Mcguircd by the Maalstered Nuree •Know* purposes, effects and danger# of •Understands theory ef Medical and — In-depth understanding of physio Measures usrdi preventive, diagnostic, nursing care, logic efrects of ttratncnts and supportive, therapeutic •Understand* whet nursing Measures ate •Understands what nursing Measures are — Knowledge basic to selecting conplex likely to be neat helpful to patienta likely to be Moat helpful to patients nursing ntesuree for specific acutely with specific needs, and knows how to with specific needs, and knows how to ill patients or establishing priorities carry out or aaalat with coaatonly used carry out or eealst with cosaonly-uaed of nursing cere for patients with procedures. procedures, couples need is not Included in the practical nurae level. •11, (election of specific Measures of •A. Selection ef specific Measures of care in accordance with pat lent care in accordance with patients' — (valuation ef cqulpnent and proce neede. needs, including safety aeasurea, dures in terns ef scientific princi ■>. Differentiation between safe and ■I, (valuation of nuralng procedures, ples is net included in the practical unsafe codifications of nursing "C, How to prepiie for, carry out, or nurae level. Matsures, assist with, preventive, diagnostic •C. How to prepare for, carry out, or supportive, and therapeutic aaaiet with Measures used in care aeasurea. of patients, •D, How to report and record, •D, How to report and record, ■B, (valuation of priority of needs of •I, (valuation of priority of needs of a patient or a group of patients an asslgnrd patient or group of in terns of possible choices of patients In terns of possible nuralng care,* choices of nursing cere, •LtMltstlonsr Will not bo tested on selection of couples nursing Measures for speci fic patients who are acutely 111, Will not be tested on evaluation of procedures in terns of scientific principles. Will not be tested on divided dotsge probleas and conversion froa the Metric aysten to the apothecary syaten and vice verse. Will not be tested on evaluation ef equipeent in terns of scienti fic principles. Will not be tested on ability to establish priorities in terse of possible choices of nursing care of patients with corpios nerds escept in csergrncles when neither e registered nurse nor • doctor is pitrent." / 8*7 should be able to pass the licensure examination with a knowledge of "gross" anatomy and physiology, elemen tary microbiology, and possibly very basic physics. He should need no knowledge of chemistry. 2. The section on causes, transfer, and control and preven tion of diseases in the practical nurse test plan indi cates that no knowledge of the theory of immunization is required. 3. Other sections of the test plan indicate in a general way that the level of knowledge in the natural science area relating to practical nurse practice is somewhat lower than that relating to registered nurse practice. Step Twoi Exploration of Elementary and Secondary Science and Health Education As a Source of Direction for ” Guideline Development Literature Search for Theoretical Bases The literature search in the fields of health and science education was unproductive of explicit theoretical bases for sequencing natural science content. However, some relevant ideas were identified. These might be classi fied under four somewhat overlapping concepts relating to the sequencing of content: 1. Little is known about what kind of sequence is best. 2. Probably nothing is intrinsically difficult. 88 3. Effective sequencing has something to do with content, but (at least at the elementary level) has more to do with approaches or methods to involve individuals in activities and processes which assist their intellectual development. 4. There is a natural structure of curriculum in the structure of nature itself. Little Known About Best Sequence The following statement by Philip Morrison explains the mixed strategy advocated by the Elementary Science Study developers: Learning theorists do not yet fully under stand which approach, which experiences, in which sequences, produce the situation that makes an individual child or group of children respond (Cl9:3). Likewise, according to Grobeman, psychologists consulted in the Biological Sciences Curriculum Study, encouraged experimentation with different kinds of approaches. He says they were unable to answer the questions involved, such as: Is it better to begin with familiar materials and move to the unfamiliar? Or is it better to begin with the less complex and move to the more complex? Or is it better to cover each topic fully or to cover a topic partially and elaborate at a later time? (C8:66-67) . Strasser says that efforts, at least, are based upon 89 arbitrary decisions, one variety of which has to do with "primacy." Regarding primacy, he says: . . . as far as we know, because one indi vidual has learned something in a given sequence does not necessarily mean that all individuals will or should learn the same subject material in the same sequence (C103:13). Nothing Intrinsically Difficult David Page states: It is appropriate that we warn ourselves to be careful of assigning an absolute level of difficulty to any particular topic. When I tell mathematicians that fourth-grade students can go a long way into "set theory" a few of them reply: "Of course." Most of them are startled. The latter ones are completely wrong in assuming that "set theory" is intrinsically difficult. Of couise, it may be that nothing is intrin sically difficult. We just have to wait until the proper point of view and corres ponding language for presenting it are revealed (F6:40). Evidence that subject matter generally considered difficult is being successfully taught to relatively young students may also give support to the possibility that nothing is intrinsically difficult. Midgley defends "Chemistry for Kids," a junior high school chemistry program (C17:454). Pella and Voelker report that classificational concepts of physical and chemical change were successfully taught in grade six (C21:311). 90 Activities and Processes Most Important In connection with the Elementary Science Study. Hawkins states that scientific inquiry may be educationally more fundamental than the facts and principles established with its use, but, at the same time, agrees' with, the empha sis on a return to subject matter. He says: But the subject matter of science is . . , not to be found in books. The subject matter of the liquid state of matter is the liquid state of matter, and we had better sometimes have some in the classroom (C19:2). The Elementary Science Study units are intended to lead a child to ask natural questions of his environment and to find answers to these questions. In the process, the units are guided by basic threads of scientific investigation including inquiry, evidence, instrumentation, measurement, classification, and deduction. The units are not ordered by any other classification system; nor does any unit emphasize the acquisition of individual skills (Cl9:7). The Science— A Process Approach project, as the title indicates, stresses scientific processes rather than con tent. The aim is that children in the elementary grades acquire successively more complex process skills: recog nizing and using space and time relations, observing, classifying, measuring, communicating, inferring, predict ing, formulating hypotheses, making operational definitions, controlling and manipulating variables, experimenting, 91 formulating models, and interpreting data (D1:18). Scientific facts, laws, and theories are introduced into the overall framework and the developers believe that the details of scientific content which appear in the program are as comprehensive as many would wish to prescribe, for an 4 elementary science program. However, Gagne says: At the end, the student will not necessarily know anything that can be identified as physics, or chemistry, or biology, or geology. But a scientist should be.able to tell such a student what he is studying and the techniques he is using, and what he has found in a rela tively brief fashion and the student should be able to display a rather profound understanding of it immediately (C7:3)^ Piaget's work is cited as part of the theoretical basis for the materials Karplus and his associates developed in connection with the Science Curriculum Improvement Study. The SCIS Sourcebook states: While the ordinary everyday experiences of children apparently provide a sufficient experiential base for them to move from a level of intuitive operations to concrete operations, specially designed experiences are necessary for children to move into the level of formal thought (D64:2). The Science Curriculum Improvement Study is much more con cerned with content than either Science— A Process Approach or the Elementary Science Study. The Sourcebook states further: In the long range, the SCIS program attempts to present scientific concepts consistent with the children's intellectual growth, developing a hierarchy of abstractions.(D64:2), 92 Natural Structures of Curriculum in Structure of Nature Statements regarding the Science Curriculum Improve ment Study. Elementary Science Study, and Introductory Physical Science indicate that their developers believe that there are natural structures of curriculum inherent in the structure of nature. The Science Curriculum Improvement Study project is described as "based upon the structure of science as seen by modern scientists" (D64:2).. The SCIS Sourcebook points out that the hierarchy of concepts ranging from very basic ones to more sophisticated ones reflects concern for con sistency with the nature and structure of science (D64:2). . In Elementary Science Study units the structure of science ijs the structure: However ''messy," "unstructured," free or play ful the teaching/learning strategy may be, there is always the implicit structure of nature in what is presented in a class (C19:7). Of the Introductory Physical Science project, Haber- Schaim says: We have chosen as a central theme of this course the introductory study of matter. If we look around us we see a bewildering variety of matter; we can try to bring order into this seeming chaos by breaking up the many kinds of matter into simpler components, and then combining these components into a pattern. If we cannot build a pattern, then we can only catalogue things as a collector catalogues stamps (CIO:4). 93 Curriculum Materials Review The process used to analyze elementary and secondary level curriculum materials in terms of content identified as basic to nursing was explained in detail in Chapter III. The entire analysis is presented in Appendix IX. Although no statistical analysis is intended, some quantitative factors seem notable. Of the 533 items repre senting content basic to nursing, 99 or 16.51 percent were designated, on the basis of the process described in Chapter III, as Level I or commonly studied at the elemen tary level, and 193 or 36.21 percent as Level II or commonly studied at the secondary level. Two hundred and fifty-rtwo. items or 47.28 percent remained. However, when the 252 items were re-examined, it ap peared to the investigator that 158 of them were of no great er complexity than those designated as Level II. The dif ference seemed to be that the 158 represented content of greater detail that is particularly pertinent to nursing judgments and skills. When these items were grouped as Level II-A, only 94 items or 17.64 percent remained and were designated as Level III. A summary of this classifi cation of items follows in Table 2. Further examination of the classified items indicated 94 TABLE 2 CLASSIFICATION OF NATURAL SCIENCE ITEMS BASIC TO NURSING Natural Science Areas® Number of Items Level Level Level Level Anatomy and Physiology I II II-|A III Total 1. Volume and Pressure of Circulating Blood 11 12 15 . ■11 49 2. Adequate Supply of Oxygen 3 15 5 8 31 3. Nutrition 15 11 7 1 34 4. Fluid Balance 2 14 6 10 32 5. Electrolyte Balance 0 1 1 7 9 6. Acid-Base Balance 0 1 0 5 6 7. Elimination 2 6 10 11 29 8. Enzymes and Hormones 3 5 0 0 8 9. Temperature Regulation 0 0 3 1 4 10. Sleep and Rest 3 3 1 2 9 11. Locomotion 2 17 25 0 44 12. Bones, Muscles and Fluids that Protect and Support 0 5 4 0 9 13. Skin and Mucous Membrane 3 10 2 5 20 14. The Inflammatory Res ponse and Immunity 1 3 5 2 11 15. Physical Discomfort 0 1 2 12 15 16. The Sensory Process (Excluding Pain) 12 8 8 7 35 17. Cognition, Memory, and Association of Ideas 3 5 0 1 9 18. Speech 0 2 0 2 4 19. Reproduction 4 17 3 0 24 Microbial Injury 12 18 53 0 83 Physics 10 20 5 3 38 Chemistry 2 19 3 6 30 Total 88 193 158 94 533 Percent 16.51 36.21 29.64 17.64 100 aAs outlined in Madelyn T. Nordmark, and Ann W. Rohweder, Scientific Foundations of Nursing. Philadelphia: J. B. Lippincott Company, 1967. the following factors which appear to have significance for guideline development: 1. The majority of the items (65.85 percent) are.classi fied as Level II or Level 1I-A. 2. Level I items, comprising 16.51 percent of the total, are included in 13 of the 19 "Anatomy and Physiology" sections as well as in the "Chemistry" and "Physics" sections. Sections with high percentages of Level I items are: "Nutrition," 44.12 percent of all the items in this section; "Enzymes and Hormones," 37.5 percent; "Sleep and Rest," 33.33 percent; "Sensory Processes (Ex cluding Pain)," 34.21 percent; "Cognition, Memory, and Association of Ideas," 33.33 percent; "Physics," 26.32 percent. 3. Three hundred eighty-eight or 72.80 percent of the 533 items were found to be covered to some extent by at least one of the sets of elementary level curriculum materials. Subsections and sections with high percentages on this basis are: "Enzymes and Hormones," 100 percent; "Bones, Muscles, and Fluids that Protect and Support," 100 per cent; "Cognition, Memory and Association of Ideas," 100 percent; "Reproduction," 91.67 percent; "Chemistry," 86.67 percent; "Physics," 94.74 percent. 4. Level III items, comprising only 17.64 percent of the total, are notable for their inclusion of content 96 relating to the more complex operations of the nervous system, the physics of fluid balance, and chemistry including electrolyte and acid-base balance. The following gross observations about the elementary and secondary level curriculum materials also seem to have significance for guideline development. 1. The anatomy and physiology of all body systems is probably commonly studied in some depth in the elemen tary grades. 2. Physics and chemistry content is probably commonly introduced early in the elementary school curriculum. 3. Anatomy and physiology is probably commonly studied in much greater depth at the secondary school level than at the elementary level. 4. The biochemistry of cell physiology is probably commonly studied in some depth in high school biological science. . Step Three: Formulation of Guidelines At this point, three levels of science content pertin ent to nursing had been described primarily in terms of the segment of the school experience in which the content appeared to be commonly studied. As explained in Chapter III, the analysis which had been developed in step two above.and, particularly, the trends and highlights which had been identified were examined for details which would 97 more adequately describe the content of each level, other curriculum materials were utilized to provide additional insights. Descriptions of three levels in terms of content in the areas of anatomy and physiology, microbiology, physics, and chemistry resulted. The three levels described were then very tentatively related to recognized nursing education and nursing practice levels. The following very tentative guidelines emerged {Table 3). As outlined in Chapter III, the above guidelines were then examined for compatibility with the findings of the exploration of statements regarding nuzsing roles and the state board test plans in step one. Since the implications derived from the analysis in step one were so limited, little direct conflict with the guidelines could be ex pected and very little was identified. The role of the nurse aide was so sketchily described in the statements analyzed that it is impossible to draw any conclusions about compatibility of the guidelines with this role and implied educational preparation. It is the judgment of the investigator that the content suggested would appear surprisingly extensive to. nurses, This judg ment is confirmed by the fact that the practical nurse test plan even excludes knowledge of chemistry very specifically and makes no mention of physics. However, the consideration that the content indicated for the nurse 98 TABLE 3 GUIDELINES FOR SEQUENCING NATURAL SCIENCE CONTENT IN NURSING CURRICULA TO FACILITATE THE EMERGENCE OF AN EDUCATIONAL CAREER LADDER Level I (Nurse Aide) Level II (Practical Nurse) Level III (Technical and Professional Nurse) General Science and health Science and health content Moro complex science Guido content commonly commonly studied at tho content commonly studied at the ele secondary school level occurring in post- mentary school level augmented by details of secondary courses or augmented by details apparently similar diffi advancod high school of apparently similar culty which are particu courses. (In general, difficulty which are larly pertinent to nurs science content particularly pertin ing. (Excludes content Identified as basic ent to nursing. generally studied only to.nursing and not in advanced high school Included in Level I courses such as physics or II.) and chemistry.) Anatony The body as a unit and functioning through Physiology systems and inter acting with the environment. The cell as the Details of cellular basic unit of the structure; cellular func body; basic ele- . tions of synthesising ments of the cell; materials and producing introduction to energy; details of mito cell division. sis and meiosis, includ ing the roles of deoxy ribonucleic acid and ribonucleic acid. Gross anatomy and Clinically significant Mora intricate de physiology of. all details of structure and tails of structure body systems. In functioning of systems and functioning of clues location, and organa, Includes the nervous and approximate sire, interrelationships between circulatory systems. general shape, and and among body systems. primary functions Excludes more intricate of principal organs. details of structure and (Further clarifica functioning of the ner tion relevant to vous and circulatory sys specific systems tems, (Further clarifica follows,) tion relevant to specific systems follows.) — Musculoskeletal — Musculoskeletal system: system: composition identification of impor of bone, kinds of tant specific components bones, general func of the-syste^m (bones, tions of bones* basic muscles, tendons, etc.), elements of joints, details of their struc functioning of some ture and functioning. readily observable joints; general* nature of muscle tissue, primary function of muscles, functioning of some readily observable muscles, — Nervous system: — Nervous system: Major — Nervous system: very gross anatomy aspects of structures, Details of struc and vory general functions, and interrela tures, functions and operation of tho tionships of the central, interrelationships of narvous system: in peripheral, and autonomic the divisions of the troduction to tho divisions of the system nervous system, nature'of nervous (including basic elements especially of tho tissue. of stress phcnomana); pri sympathetic and para mary functions of major sympathetic compon parts of tho brain and ents of tho autono areas of tho cerebrum; mic division includ major aspects of impulse ing innorvation of conduction; identifica visceral organs and tion of clinically signi details of stress ficant norvcs. phenomena; details of the functions of all parts of tho brain and areas of the cerebrum; details of impulso conduc tion routes. 99 TAUIC J {€0011(101x11 Level 1 (Nurse Aide) Level It (Practical Nurse) Level 111 (Technical and Professional Nurno) Anatomy — Circulatory sys- — Circulatory system! and t c m blood an details of circulatory Fhysiol- fluid which trans cycle including identifi •gy ports nutrlrnta, cation of blood vessels oxygen, and wante of major clinical signi products; gross ficance; lymphatic cir structures and culation; origins and general functions functions of vnrioua of venous, arterial, types of blood cells; and capillary ves blood types; Ah factor; sels; introduction antigen-entlbody pheno- to circulatory cycle including identification of nnjor vessels entering and leav ing tlie heart. — Nutrition! basic — Hutritlom classifi — Hutritlom tee food groups and cation of nutrientsr chemistry section their major func functions and sources of below. tions; nutritional specific important requirements in nutrients and groups general terms; of nutrients. major factors which affect nutritional requirements; gon- eral functions of water in the diet. Micro Microorganisms as Clinically Important facta biology causes of disease; about common microorgan rapidity'of micro isms; body sites whore organism reproduc microorganism" are normal tion; general fac ly present; factors which tors favoring the determine effectiveness growth of micro of disinfection and steril organisms; gcnoral ization; Immunity laetivo, methods of steril passive, natural, acquir isation and disin ed); important facta about fection; modes of available immunity and transmission. sensitivity tests and anti genic biologicala. thyslcs Introduction to Development of major con Details of mechanisms major concepts cepts including applica of fluid and electro involving! tion of'simple mathema lyte balance. -molecules, atoms, tics; very.general intro ions; duction to fluid and -elements, compounds; electrolyte balance, -states of matter; -diffusion; •solutions; •gravity; •energy; -force; -work; -pressure; -friction; •principles of simple machines; -sound; -heat, tempora- ture; •light. Chemistry Introduction to the Introduction to the na Moderately detailed language of chemical ture and importance of symbolic presentation formulas; rationale structural formulas for of clinically signifi for very simple organic molecules and the cant chemical reac chemical fornulsn; significance of molocular tions in tho body such Introduction to the structure in chemical an extracellular di phenomenon of sub reactions; examples of gestion, glycolysis, stances interacting structural fornulsn for major phases of tho with each other to some common molecules; citric acid cycle, form new substnnces; details of enzyme acti amino acid synthesis,, principles under- ■ vity; verbal and simple adenosine triphosphate lying very ainplo diagrammatic cxplnnation production in muscle chemical reactions; of highlights cf clini cells, hemoglobin introduction to the cally significant chem breakdown, blood clot concept of enzyme ical reactions in tho ting processus, buffer activity. body such an extracell mechanisms. ular ennrgy production anil alarnqe through glucnso oxidation and the energy tr.in.ifcr cycle, ini rnr:el lulnr synthrafn of cellular mniurialri involving drnxyt ihnriui.'ir'ir and ribniiueleie acids, |i]». aide level would commonly be studied in science and health courses before grade seven would seem to support the guide lines. i The guidelines certainly were in accord with the very t broad implications that science content is needed in nurs ing curricula at all levels and that the extent of the need is related to the level of education and practice. Probably the most serious question which arose related to the practical nurse level. The guidelines defined the inclusion of content more extensive than some of the defini tions of the practical nurse role would imply and also more extensive than the state board test plan for practical nurses. The following factors, however, seemed to argue in favor of the guidelines: 1. There is evidence in the analysis of the statements that an expanded role for the practical nurse is gaining recognition. 2. The general guide to the selection of natural science content for the practical nurse level in the guidelines calls for.science and health content commonly studied at the secondary school level. In actuality, this would mean content commonly studied by students by the • end of the tenth grade since content commonly studied in advanced science courses (e.g., physics, chemistry) is excluded. Prom this standpoint the level of science / 101 content described in the guidelines for the practical nurse level would seem very conservative. Another question which arose relates to the decision of whether or not to separate the technical nurse and the pro fessional nurse levels in the guidelines. The following factors seemed to argue in favor of relating both technical nurse education and practice and professional nurse educa tion and practice to one level of natural science content: 1. In terms of the outline of the body of natural science content basic to nursing utilized in this study, the content not included.in Levels I or II was limited. 2. Although it is speculated that professional nurse prac tice requires higher "levels of knowing" in terms of the Taxonomy of Educational Objectives/ and the impor tance of these dimensions is recognized, the purpose of this study is limited to developing guidelines to assist in the sequencing of content. The foregoing tentative guidelines were therefore allowed to stand to be tested in step four. Step Four; Assessment of Tentative Guidelines in Terms of Factors in the Actual Nursing Situation Review of Process The process of assessing the tentative guidelines in relation to factors in the "real world" situation is explain ed in detail in Chapter III. Briefly reviewed, that process is as follows: Actual 24-hour patient care situations were analyzed in terms of nursing activities indicated, the frequency of each activity, and the natural science understand ings basic to each activity. (See sample nursing care analyses in Appendix III.) Each natural science understanding related to each nurs ing activity in each of the nursing care analyses was classified as Level I, Level II, or Level III in ac cordance with the tentative guidelines presented in Table 3. In other words, each natural science under standing was classified in terms of the level of prac titioner who would have that understanding if the guidelines were applied in the educational preparation of nursing personnel. (See the revised sample analysis in Appendix III in which levels are affixed to all natural science understandings.) Each nursing activity was classified as Level I, Level II, or Level III on the basis of the highest level natural science understanding(s) of all those listed as basic to the performance of the nursing activity. The resulting classification of the nursing activity, therefore, would be indicative of the lowest level of practitioner who would be prepared to. perform that ac tivity if the guidelines were applied in the educational 103 preparation of nursing personnel. (See revised sample analysis in Appendix III in which levels are affixed to all nursing activities.) 4. The numbers of Level I, Level II, and Level III nurs ing activities were computed for each nursing care analysis and for the total twenty-seven analyses. 5. Percentages of the totals of Level I, Level II, and Level III nursing activities in the twenty-seven nurs ing care analyses were computed. 6. The above percentages of the totals of Level I, Level II, and Level III nursing activities were compared with employment percentages of the corresponding levels of nursing personnel in order to arrive at an indica tion of the validity of the guidelines for sequencing natural science content in terms of the "real world" situation. Patients Studied The random selection of patients as explained in Chapter III resulted in the study of the twenty-six patients briefly identified in Table 4. 104 TABLE 4 PATIENTS STUDIED Patient Age Code Reason for Hospitalization "Shic^StSaied" Mrs. A. 69 Chills and fever (possible ,10th pyelonephritis) Miss B. 42 Back and leg pain (possible 4th lupus erythematosis) Mrs. C. 35 Back and leg pain (laminec- 7th (3rd post- tomy and discectomy) operative day) Mrs. D. 46 Back and leg pain (probable 3rd spinal pathology) Mrs. E. 53 Back and leg pain (probable 5th spinal pathology Mr. P. 38 Back and arm pain 8th (muscle spasm) Mr. G. 36 Motorcycle accident (subse 15th quent quadriplegia) Mr. H. 70 Possible cerebrovascular 3rd accident Mr. I. 60 .Possible cerebrovascular 11th accident Mrs. J. 58 Myocardial infarction 3rd Mrs. J. 58 Myocardial infarction (subse 8 th quent cerebrovascular accident) Mr. K. 65 Myocardial ischemia 8 th Mr. L. 48 Myocardial infarction 8th Mr. M. 65 Possible myocardial infarction 3rd Mr. N. 45 Possible myocardial infarction 3rd Mr. 0. 60 Coronary insufficiency and 1st possible impending congestive heart failure Mr. P. 70 Evaluation of cardiac status 2nd (possible congestive heart failure) Mrs. Q. 57 Infected lesion on sole of 5th foot (diabetes) 105 TABLE 4 (continued) Hospital Day on Patient Age Reason for Hospitalization Code which Studied Mrs. R. 82 Subcapital fracture of neck 5th (first of femur (insertion of 1 postoperative prosthesis) day.) Mrs. S. 85 Intertrochanteric fracture 13th of femur Mr. T. 56 Left inguinal hernia (her 5th (2nd post niorrhaphy) operative day) Mrs. U. 72 Bilateral inguinal hernia 12th (9th post (subsequent nutritional operative day) problems) Mrs. V. 26 Cholelithiasis 3rd (1st post (cholecystectomy) operative day) Mrs. W. 47 Abdominal pain 4 th Mrs. X. 78 Possible bowel obstruction 2nd Mr. Y. 50 Rectal bleeding, obstructive 5th ventillatory impairment (hemorrhoidectomy) Mr. z. 71 Prostatic hypertrophy (supra 5th (3rd post pubic prostatectomy) operative day) It is again noted that the sampling procedure utilized re sulted in the selection of the same patient ("Mrs. J") for study on two different days. Review of a Sample Analysis As explained in Chapter III, one fairly complex nursing care analysis developed by the investigator as described was submitted for review to twelve nurse clinicians • The purposes were to obtain an assessment of the investiga tor's competency in developing the analysis in the manner 106 outlined and to obtain guidance in the process. Samples of the materials sent to the clinicians and the analysis re vised in accordance with the suggestions of the nine faculty members who responded are presented in Appendix III. Adequacy of the Original Analysis The original analysis by the investigator accounted for approximately 87 percent of the different nursing activ ities included in the analysis revised on the basis of the review by clinicians and 72 percent of the total number of activities (sum of the frequencies of the different activi ties) . The shifts in the respective proportions of Level I, II, and III nursing activities were in an upward direction (i.e., Level I to Level II and Level II to Level III). Some of the details of these shifts show in the following figures: Original Revised Analysis Analysis Number Percent Number Percent Total of different nurs ing activities 20 100.00 23 100.00 Different nursing activi ties: Level I 3 15.00 2 8.26 Level II 15 75.00 16 69.57 Level III 2 10.00 5 21.74 Total of all nursing ac tivities (sum of frequen cies of different nurs ing activities) 53 100.00 74 100.00 Total nursing activities: Level I 9 16.98 5 6.75 Level II 41 77.36 56 75.68 Level III 3 5.67 13 17.57 / 107 The shifts in the respective proportions of Level I, II, and III nursing activities are further explained ae follows: 1. Of the 3 different activities that were added, 2 were classified as Level II and 1 was classified as Level III. 2. On the basis of the natural science understandings that were added, 1 of the original 20 different nursing activities was reclassified from Level I to Level II and 2 others were reclassified from Level II to Level III. 3. Changes in the numbers and percentages for "total nursing activities" result from the above changes as well as from the adjustment of the frequencies of 4 Level II activities. Guidance for the Development of Other Analyses The revisions in the sample nursing care analysis which resulted from the review by the nurse clinicians suggested, in general, the need for more adequate identification of ap propriate nursing activities and underlying natural science understandings.. In particular, there was a need for greater attention to the identification of less obvious science un derstandings related to such nursing activities as teaching and assessment. Thus, the investigator was guided toward more adequate utilization of resource persons and reference material. 108 Validity of the Tentative Guidelines Table 5 presents the numbers and percentages of Level I, Level II, and Level III nursing activities in the twenty- seven nursing care analyses as derived from the first five steps of the process reviewed on pages 105-107. The level of the activity is indicative of the lowest level of prac titioner who would be prepared to perform the activity if the guidelines were applied in the educational preparation of nursing personnel. The text which follows discusses the comparisons of Level I, Level II, and Level III nursing activities in the twenty-seven analyses against the employ ment percentages of the corresponding levels of nursing personnel in order to arrive at an indication of the valid ity of the guidelines for sequencing content in terms of the "real world" situation. As indicated in Chapter III, projections for 1975 and 1980 in Appendix IV convey a very gradual change in the proportions of the three categories of personnel which constitute nursing manpower. (A tendency for a slight decrease in percentages of total nursing manpower for re gistered nurses and nurse aides and a slight increase for licensed practical nurses is projected (F14:24). Of the nursing manpower figures presented in Appendix IV those relating to nursing personnel employed in community 109 TABLE 5 LEVELS OP NURSING ACTIVITIES IN NURSING CARE ANALYSES Patient Code Nursing Activities Level Level Level Tota I II III Mrs. A. 29 23 0 52 Miss B. 20 13 0 33 Mrs. C. 17 37 8 62 Mrs. D. 18 26 8 52 Mrs. E . 16 17 0 33 Mr. P. 20 20 0 40 Mr. G. 8 73 8 89 Mr. H. 15 30 0 45 Mr. I. 5 44 8 57 Mrs. J. 16 95 9 120 Mrs. J . 0 43 8 51 Mr. K. 28 11 8 47 Mr. L. 19 35 8 62 Mr. M. 27 35 11 73 Mr. N. 22 43 19 84 Mr. 0. 13 36 10 59 Mr. P. 14 9 8 31 Mrs. Q. 15 29 8 52 Mrs. R. 33 46 11 90 Mrs. S. 5 56 13 74 Mrs. T. 23 9 0 32 Mrs. U. 18 31 10 59 Mrs. V. 33 42 0 75 Mrs. W. 19 10 0 29 Mrs. X. 21 17 0 38 Mr. Y. 15 27 0 42 Mr. Z. 26 43 8 77 Total 495 900 163 1558 (Percent) (32) (58) (10) (100) 110 hospitals seemed most appropriate since the nursing situa tions in this study were selected from within a medical- surgical community hospital. The following percentages were based upon estimates of the numbers of nursing person- t nel employed in community hospitals in 1969 {FI3:40) 1. Aides, orderlies, and attendants: 40 percent 2. Licensed practical nurses: 18 percent 3. Registered nurses (technical and professional): 42 per cent. Grossly adjusted to exclude the estimated 4.9 percent of registered nurses employed as administrators, consultants, and instructors in hospitals (F2:15) and probably not involved in the day-to-day planning and ministration of nursing care included in the nursing activities in this study, the percentages change only slightly to become 41 percent for registered nurses and 19 percent for licensed practical nurses. Therefore, nursing personnel available for day-to- day planning and ministration of nursing care are employed and probably will continue to be employed in the following proportions with the gradual changes noted above: 1. Aides, orderlies, and attendants: 40 percent 2. Licensed practical nurses: 19 percent 3. Registered nurses (technical and professional): 41 per cent. Ill These percentages were utilized as norms in attempting to test the validity of the tentative guidelines. As indicated in Table 5, the twenty-seven nursing care analyses in this study included the following percentages of t nursing activities: Level I (relating to nurse aide practice): 32 percent Level II (relating to practical nurse practice): 58 per- j cent Level III (relating to professional and technical nurse practice): 10 percent Thus, within the limitations of the method of testing the validity of the guidelines in this exploratory study, as cited in Chapter III, one might reason as follows: 1. The guidelines provide for adequate preparation of per sonnel to carry out Level I activities since (if the guidelines were applied in the educational preparation of nursing personnel) all personnel would be prepared at least at this level. 2. The guidelines provide for more than adequate prepara tion of personnel to carry out Level III activities since (if the guidelines were applied in the educational preparation of nursing personnel) 41 percent would be prepared at this level and only 10 percent of the ac- . tivities require this level preparation. / 112 3. The guidelines seem to provide inadequate preparation for personnel to carry out Level II activities. Al though (if the guidelines were applied in the educa tional preparation of nursing personnel) 60 percent would be prepared at least at this level— 41 percent t at Level III and 19 percent at Level II— ,some of the time of the Level III personnel obviously would be utilized in carrying out Level III activities. The above analysis suggests possible approaches to re vising the guidelines: 1. Should guidelines for the selection of Level I content be broadened in order to allow for the inclusion of content basic to a larger proportion of nursing ac tivities? 2. Should guidelines for Level II content be related to both practical nurse and technical nurse practice and education and guidelines for Level III content be re lated only to professional nurse practice? The investigator arrived at the decision not to revise the guidelines as suggested above on the basis of the follow ing considerations: 1. Intensive manipulation of guidelines based upon data for which there is no claim of preciseness in this ex ploratory study seems open to question. (The kind of /" 113 study which should lead to more precise data is suggest ed in Chapter V.) 2. Broadening guidelines for the selection of Level I con tent to allow for the inclusion of content basic to a larger proportion of nursing activities seems to have the effect of diminishing the naturalness of the dis tinction between Level I and Level II content. 3. Adaptations necessary to assist personnel prepared at Level I to carry out some Level II activities seem rea sonable. For instance, nurse aide preparation might be supplemented to include Level II content basic to nurs ing activities particularly important on a specific nursing unit? or professional and technical nursing personnel might continue, to a more limited degree, the present practice of devoting some of the time in which they are not engaged in Level III activities to support ing aides in activities for which they have not acquired the underlying understandings. (In this connection, it should be noted that many activities were classified as Level II pn the basis of requiring Level II content to understand the significance of the activity rather than actually to perform it.) 4. Relating the content described by Level III guidelines only to professional nurse education and practice would not be reasonable. Only about 9.9 percent of nurses employed in hospitals in 1969 had baccalaureate degrees (F2:12) and this percentage is increasing very slowly (F2:10). Since, on this basis, nurses with baccalau reate degrees would represent only about 4 percent of all the nursing personnel in day-to-day planning and ad ministration of nursing care, the percentage of person nel prepared at Level III would be entirely too low to meet the needs of patients included in this study. Summary Nursing activities in this study were classified in terms of the lowest level of nursing practitioner who would be pre pared to perform them if the proposed guidelines were applied in sequencing natural science content in nursing curricula. (The lowest level practitioner prepared to perform a Level I activity would be a nurse aide; the lowest level practitioner prepared to perform a Level II activity would be a practical nurse; the lowest level nursing practitioner prepared to per form a Level III activity would be a registered nurse.) Com parisons of percentages of Level I, Level II, and Level III nursing activities (as defined above) in the twenty-seven 24-hour nursing care analyses against employment percentages of nurse aides, practical nurses, and registered nurses pro vide some support for the validity of the proposed guidelines. 115 Although the support is not strong, the foregoing analysis indicates that the guidelines are in reasonable accord*with the demands of the "real world" situation. CHAPTER V SUMMARY, RECOMMENDATIONS, AND IMPLICATIONS This chapter presents a summary of the study and speci fic answers to questions of feasibility. Recommendations for a comprehensive study in the nursing area arise directly from the analysis of the methodology employed in this explor atory study. Additional recommendations relate to the appli cation of the methodology in curriculum studies in other areas of education for the human services and to the need to study a curriculum dimension which was not treated in this study. The final sections of the chapter discuss implica tions for curriculum development in the broad context of occupational education and for the current career education movement. Summary The various kinds of basic programs in nursing (profes sional, technical, practical nurse, nurse aide) have deve loped quite independently of each other without considera tion of the desirability of an educational career ladder with in the occupation. The rationale has been that, the student should be assisted to select the program appropriate for him and then be content with the outcome. Attempts to implement career ladder concepts at this point in time bring to light 116 / 117 the fact that, although several levels of practice and re lated levels of knowledge and skills seem to be implied, neither the roles of the different levels of practitioners nor the related levels of knowledge and skill have been de fined in detail adequate for the curriculum developer. The process for developing guidelines for sequencing content for career advancement by the investigator was to describe several naturally progressive levels of content; to relate these to several levels of nursing education and practice thus formu lating guidelines for the sequencing of content; and finally to affirm or revise these guidelines on the basis of needs in the actual nursing situation. The purpose of the study was to determine the feasibility of such a process. The study was limited to the consideration of natural science content. Three sources of direction were utilized in the implementation of the process: (1) role definitions and cur riculum guidelines in the nursing literature, (2) elementary and secondary science and health education literature relat ing to sequence of content (theories and opinions of educa- t tionists, curriculum materials per se) , and (3) two aspects of the "real world" situation: actual patient needs and the team of various levels of nursing personnel available to meet these needs. / 118 Questions of Feasibility Answers to questions of feasibility posed in Chapter I are inherent in the discussion of the process of developing the guidelines in Chapter III and in the results of the var ious steps of the process reported in Chapter IV, since the underlying issues of feasibility are: (1) Can the process be implemented? and (2) Is the process productive of results in terms of the purpose of the study? Specific feasibility questions and answers are summarized below: 1. Do role definitions in the nursing literature really differentiate roles and are the definitions sufficiently clear and detailed to provide direction for sequencing content?— The analyses of statements of recognized nursing organiza tions in Appendix I indicates that role definitions f'o not really differentiate roles and that certainly the defini tions are not sufficiently clear and detailed to provide direction for sequencing content. Statements not in agree ment are fairly common and there are even seeming discrepan cies between statements of the same organization. The out come of the analyses reported in Chapter IV is limited to a few observations which, at the most, contribute to a general framework for guideline development. 2. Do recognized guides to curriculum development in nursing exist and, if so, do they provide direction for 119 sequencing content?--Some of the statements referred to above provide very general guidance in curriculum development. In addition, although not intended for this purpose, the separ ate state board test plans for the registered nurse and practical nurse licensure examinations may be .considered in this category. The comparative analysis of those two plans in Chapter IV points up a few straightforward statements which differentiate the levels of knowledge related to re gistered nurse and practical nurse education but also demon strates the vagueness of many statements when they are placed side by side. 3. Do resource persons in the areas of science and health education indicate an interest in the problem under study by the investigator and do they suggest specific re ferences and/or areas of investigation in the literature of their fields which are related to the problem?— Educators contacted in both the fields responded with interest. The investigator encountered no refusals of assistance and sug gestions for exploration included specific references, pro posed areas of study, and general encouragement regarding the resources of the Educational Resources Information Centers services. Personal copies of various materials were also made available to the investigator. 4. Are statements of rationale for the sequencing of 120 content to be found in the literature in the areas of science and health education?— The literature search in the fields of health and science education was unproductive of expli cit theoretical bases for sequencing natural•science con tent. However, various references indicated ongoing, study which impinges upon the problem. 5. Do science and health curriculum materials per se suggest an approach to sequencing content and can a system be developed for analyzing these materials for the purpose of discovering some trends which might provide direction for the development of guidelines for sequencing natural science content in nursing curricula?— A cursory examina tion of elementary and secondary level curriculum materials in the science and health education fields suggested a rather natural progression from the simple to the complex. This observation led to the development of a system of examining such curriculum materials which culminated in the proposal of three levels of science content as organizing elements for guidelines to sequence natural science content in nursing curricula. The investigator examined a large array of selected elementary and secondary level science and health curriculum / 121 materials for their coverage of 533 natural science items identified as basic to nursing in a previous curriculum study. In this way, each of the 533 items was classified 1 as Level I if commonly studied at the elementary level, * Level II if studied at the secondary level,.and Level III if not commonly studied at either of these levels. The culmination of several intervening steps was the proposal of the following "general guides" to the sequencing of natural science content in nursing curricula: Level I {Nurse Aide).— "Science and health content commonly studied at the elementary school level augmented by details of apparently similar difficulty which are particularly per tinent to nursing." Level II (Practical Nurse).— "Science and health content com monly studied at the secondary school level augmented by de tails of apparently similar difficulty which are particu larly pertinent to nursing. (Excludes content generally studied only in advanced high school courses such as physics and chemistry.)" Level III (Technical and Professional Nurse).— "More complex science content commonly occurring in postsecondary courses or advanced high school courses. (In general, science con tent identified as basic to nursing and not included in Level I or II.)" 122 (The total process of arriving at the above framework and other elements of the guidelines is detailed in Chapter III, pages 55-67. Technical problems related to the process are discussed in Chapter III, pages 76-78. Numerical data emanating from the process are reported in Chapter IV, pages 93-97 and the detailed analysis of the curriculum materials is presented in Appendix II, pages 165-241.) 6. Can an appropriate and workable system be developed to test the validity of tentative guidelines in terms of "real world" requirements?— A system was developed which took into consideration the needs of patients and the team of personnel prepared at several levels who must meet these needs. The process which was used to test the validity of the tentative guidelines for sequencing natural science content in nursing curricula was based upon the rationale that the percentage of nursing activities essential in the clinical situation which require a particular level of scientific understanding should correspond in at least a gross manner to the percentage of personnel prepared at this level and employed to give nursing care. Twenty-four hour nursing care analyses were developed for each of twenty-six randomly selected patients in.a 238- bed medical-surgical hospital. (Since one patient was / 123 selected for study during two 24-hour periods, twenty-seven analyses were actually developed.) These analyses included: (1.) nursing activities indicated in the care of the patient; i (2) the frequency indicated for each activity; and (3) the natural science understandings indicated for the performance of each activity. The natural science understandings were classified as Level I, Level II, or Level III in accordance with the tentative guidelines which described three levels of natural science content. Each nursing activity in each analysis was then classified as Level I, Level II, or Level III on the basis of the highest level natural science under standing required for the performance of that activity. The sums of Level I, Level II, and Level III activities were computed for each nursing care analysis and these sums were used to compute the sums of Level I, Level II, and Level III activities included in all the twenty-seven analyses. These sums were converted into percentages of the total number of activities in the twenty-seven analyses. The percentages of Level I, Level II, and Level III activities in the twenty- seven analyses were compared to the percentages of nursing personnel prepared at the three nursing education and prac tice levels which had been equated with the three levels of content in the guidelines. Finally, a decision was made regarding the affirmation of the tentative guidelines. (The total process of testing the guidelines is detailed 124 in Chapter III, pages 67-75. Problems related to the process are discussed in Chapter III, pages 78-81. Results of the application of the process, including numerical data, are presented in Chapter IV, pages 108-115.) 0 Recommendations A Comprehensive Study in Nursing On the assumption that adequate resources would be avail able, the process demonstrated in this exploratory study might be applied in a comprehensive study in nursing with the following ramifications: 1. Tentative guidelines for sequencing behavioral science content might be developed in a manner similar to that of the exploratory study. Analysis of role definitions * and guides to curriculum development might be eliminated as a beginning step and the tentative guidelines merely examined against such definitions and guides for serious conflict. If the body of behavioral science content identified in Scientific Foundations of Nursing were to be used as a basis for analyzing school curriculum mate rials, a team of behavioral science educators might be utilized to translate this body of content into items more adaptable to analysis. An organized approach such as a survey of health educators could be used to identi fy school curriculum materials having behavioral science content. A team might be utilized for the analysis itself to provide a means of measuring the reliability 4 of the process, to reduce tedium, and to facilitate de cisions in dubious areas. The wording of the tentative guidelines might be a cooperative effort of instruc tors of both the behavioral sciences and nursing. The guidelines for sequencing natural science content which were a product of the exploratory study might be reworded with the assistance of natural science edu cators for greater clarity and consistency. The validity of the tentative natural and behavioral science guidelines might be assessed in a manner simi lar to that of the exploratory study but more adequate in the following respects: a. Greater attention might be given to the selection of a representative sample of patients: Nurse clinicians employed in hospitals might be selected for participation in the study on a stratified basis relating to their clinical specialties. They might, in turn, randomly select patients to be studied. b. Nurse clinicians might participate directly. Pro visions might be made for their thorough orienta tion to the project. They might give total nursing / 126 care to the patients selected for specified periods of time during which they would have no other re sponsibilities and record in diary form every activ ity of nursing care and the amount of time devoted to each. c. Efforts might be exerted toward providing for a better process of decision-making in regard to the inclusion of science understandings as basic to nursing activities: The criteria utilized in the exploratory study might be improved and decisions might be made by teams of nursing clinicians instead of an individual. The use of teams would also provide a means of measuring the reliability of the process. d. Proportions of Level I, II, and III educational pre paration required for the care of the sample of patients might be more accurately computed: These calculations might be made on the basis of the pro portions of time needed for activities classified at-the respective levels rather than the numbers of activities at the respective levels. e. The assessment process might be repeated utilizing nursing care situations in the community rather than the hospital. 127 4. Data collected in step four (assessment of tentative guidelines in terms of factors in the actual nursing situation) might be analyzed more intensively. For in stance, the extent to which various high level under standings (e.g., the chemistry of acid-base balance, electrophysiology of cardiac contraction) are utilized in nursing activities might be studied and implications for curriculum abstracted. Study in Other Areas Involving Human Services The investigator has observed that the process demon strated in the exploratory study may have value in the deve lopment of guidelines for sequencing content to facilitate an educational career ladder in other areas of education for human services. In other words, the process should be parti cularly appropriate in any area in which the human element is prevalent and, therefore, the situation and not the iso lated task determines the understandings needed. The areas of occupational therapy and physical therapy are probably good examples. Studies involving a process such as the one demonstrated herein should provide a basis for curriculum decision-making in connection with broad health occupations programs encompassing various areas (e.g., nursing, medical laboratory, physical therapy), as well as various levels (e.g., aide, technician, professional). Thorough study of 128 the individual areas in accordance with the methodology proposed would assist in the identification of core content on a sound basis, whereas efforts of this kind have often been superficial. Career lattices allowing for horizontal mobility between occupational areas in the health field as well as vertical mobility within one occupational area would then hopefully be based on a much firmer rationale than is generally the case at this time. Study of the Level of Knowing The exploratory study described deals with content scope (anatomy and physiology, microbiology, physics, chemistry) and content depth (difficulty, complexity). As has been implied at several points in preceding chapters, particularly in discussions related to the role of the professional nurse, there is need to examine the level of knowing appropriate to each level of nursing education and practice. The hypothetical models in Plate I illustrate the three dimensions suggested. Volumes enclosed by the dark lines indicate possible requirements of content scope, content depth, and level of knowing. The models are not intended to depict exact mathematical proportions between different edu cational levels but rather to convey the directions in which knowledge might be expanded at each level. J/ 129 PLATE I HYPOTHETICAL MODELS SHOWING A THREE-DIMENSIONAL EXPANSION OF NATURAL SCIENCE KNOWLEDGE PROGRESSING FROM THE NURSE AIDE TO THE PROFESSIONAL NURSE LEVEL £ 4 J CU 0) o +J d 0) +> d o V ?p-* Content Scope Content Scope Fig. 1 Natural Science Fig. 2 Natural Science Knowledge: Nurse Knowledge: Practical Aide Nurse a cu Q 4J d v Content Depth • Content Depth Content Scope Content Scope Fig. 3 Natural Science Fig. 4 Natural Science Knowledge: Technical Knowledge: Professional Nurse Nurse 130 Figure 1 depicts natural science knowledge at the nurse aide level. Full scope is indicated on the basis that the exploratory study argued for some content in each of the areas of anatomy and physiology, microbiology, chemistry, and physics. The depth of content,on the other hand, is shown as limited, on the basis of the results of the explor atory study. The level of knowing is also illustrated as limited on the basis that it might be hypothesized that the nurse aide needs to utilize knowledge primarily in applica tion. Figure 2 depicts natural science knowledge at the prac tical nurse level. The volume is shown to expand in terms of content depth on the basis of the results of the explora tory study. It is shown to expand also in terms of level of knowing on the basis that it might be hypothesized that the practical nurse needs to utilize knowledge not only in application but in some analysis, synthesis, and evaluation. Figure 3 depicts natural science knowledge at the techni cal nurse level. The volume is shown to expand to full con tent depth on the basis of the results of the exploratory study. It is shown to expand also in terms of level of knowing on the basis that it might be hypothesized that the technical nurse needs to utilize knowledge increasingly in analysis, synthesis, and evaluation. 131 Figure 4 depicts natural science knowledge at the pro fessional nurse level. The volume is shown to expand in terms of level of knowing on the basis that it might be hypothesized that most of the professional nurse's activi ties require utilization of knowledge in analysis, synthesis, and evaluation. (As has been indicated, the models are not intended to depict exact mathematical proportions. It would seem entirely possible that the expansion of knowledge for the professional nurse in terms of the level of knowing would be greater than the dimensions of the model would imply.) Implications A Conceptual Model Careful consideration of the findings of the study may imply that an important outcome is an incipient conceptual model for the selection and ordering of curriculum content which may be applicable in many areas of occupational edu cation. This model consists of five elements of rationale: 1. There is a logical conception of an occupational role which serves as a beginning for the selection of appro priate curriculum content. This conception derives from what the worker is seen to do— the tasks he performs. 2. An occupational role can, to a large extent, be an expression of knowledge acquired. This is in contrast, as i/ 132 Gilpatrick points out,* to endeavoring to fashion the role on the basis of tasks which have been learned. The state ment of Luther Christman which was discussed in Chapter I might be paraphrased as follows: When the delivery of [a service] is viewed as a process through time instead of a series of dis crete acts, it can be seen that. . . knowledge is activated through role expression. . . . If improve ment in [the service] is a chief objective, it ap pears more useful to plan for an expansion of the opportunities for role expression and the use of. . . knowledge than to spell out completely and with finality every facet of [the role of every kind of worker.] (B10:10-ll) 3. The cumulative wisdom of educators provides a general basis for bringing order to the knowledge elements associated with the logical conception of the role. (In de veloping guidelines for sequencing natural science content in the study just completed, the investigator looked for patterns of sequencing in elementary and secondary health and science education materials.) Thus, the answer to a curriculum problem may emerge from the synthesis of ideas that have not previously been seen as related and the point of departure for the curriculum developer may be to look beyond his immediate field of study. 4. An approximation of the content of the desired cur riculum can be generated on the basis of elements one through 3 Gilpatrick's criticism of curriculum designs which "cor rupt" the use of task analysis is presented on pages 44-5 of this study. 133 three. This is to say the curriculum developer, recogniz ing that an occupational role can, to a large extent, be an expression of knowledge acquired, might derive a body of knowledge from a logical conception of an occupational role and then look to the cumulative wisdom of. educators as a general basis for bringing order to the knowledge ele ments . 5. The functional validity of the curriculum content can be tested against the demands of the real world situation. If the role expressed meets the needs of the clients of the service, there is reason to believe that the content is ap propriate. Discrepancies between the demands of the situa tion and the role expressed indicate the need for modifica tion. The above model has been presented in very basic form. The investigator recognizes the need to subject it to further study and analysis at a later time. Career Education Concepts While the purpose of the study was to arrive at some method of sequencing content to facilitate a career ladder in nursing education, as the investigator explored the areas of elementary and secondary science and health education for 134 a key to the solution of this problem, it was impossible not to relate the surge of interest in "career education" to ex periences encountered in the elementary and secondary edu cation exploration. Present career education concepts cer tainly espouse the integration of general and voqational edu cation; the large volume of science content commonly studied in nursing curricula which the investigator identified in elementary and secondary level materials argues strongly for the implementation of such integration. Surely situa tions would be similar in other occupational areas. Then what would prevent such a development from coming to pass? In the process of moving horizontally and verti cally within the school curriculum, the investigator had the rewarding experience of receiving assistance from willing and interested educators in areas related to the health oc- \ cupations field and of "discovering" major developments in these areas. The result was an increasing sensitivity to the problem of the probably necessary and realistic dedi cation of educators to subject matter areas, or levels of teaching, or both. Evidence of this is abundant in high school health occupations programs which introduce "related technical information" as if it had been invented by voca tional education and, furthermore, introduce it at a level considerably below that at which the student had studied the 135 same content some years earlier in his health or science class. Health occupations educators, for the most part, seem to be unaware of major curriculum developments in science and health education. Likewise, it is the impres sion of the investigator that science educators are often unaware of developments in curricula in the health educa tion area and vice versa. An obvious recommendation to health occupations educa tors is an admonition to become aware of developments in re lated curriculum areas at all levels; but, when one con siders the difficulty of attaining such awareness, a nat ural question is: How can "the system" change to assist the serious student of curriculum development? University faculties frequently include specialists in the theory of curriculum development and specialists in curriculum in the separate subject matter areas; school systems employ curriculum specialists. The experience of carrying out this exploratory study leads directly to the conviction of the need of a generalist who would deal with the articulation and integration of K through 14 curriculum. He would have to spend considerable time in the school situation and would have to work very closely with special ists in the theory of curriculum development and specialists in curriculum in the subject matter areas. The implementa tion of this kind of role should assist general and vocational 136 educators to become aware of each other. The vocational educator would recognize the importance of the base of general education (such as health or science knowledge) upon which he should be able to build and, in turn, might offer his particular expertise in demonstrating the practical im portance of some subject matter generally taught in general education areas. Instead of taking pride in teaching in an eleventh grade vocational" course science content to which the student was unsuccessfully exposed at an earlier stage, he might assume his share of responsibility for successful learning at the earlier stage. The result could be a cur riculum in which general education content would be inter spersed with many more opportunities to work with knowledge in the processes of applying, analyzing, synthesizing, and evaluating which are so much a part of effective voca tional education. t I I APPENDIX I ANALYSES OF STATEMENTS REGARDING NURSING ROLES 137 ANALYSES OF STATEMENTS REGARDING NURSING ROLES ANA Position Paper on Nursing Education (1965) The American Nurses' Association publication. Educational Preparation for Nurse Practitioners and Assistants to Nurses (Bl) is the most comprehensive of all statements on .-nursing education and nursing practice to date. It describes the roles of the nurse aide, the technical nurse, and the professional nurse. The role of the practical nurse is not described because, in the words of the paper, The association . . . proposes that the nursing profession . . . systematically work to facili tate the replacement of programs for practical nursing with programs for beginning technical nursing practice. . . (Bl:15). Technical nursing practice is related to associate degree program preparation and the role of the diploma graduate is not specified because the demise of the diploma program is projected: It is reasonable to expect that many diploma schools of nursing will participate . . .i n planning for the development of baccalaureate programs; others in the development of associate degree programs (Bl:14). Statements relating to the three roles follow. The Nurse Aide Although given specific recognition in this paper the nurse aide role is described very briefly: 138 139 [Nurse aides] perform delegated tasks in the care of the sick in the hospital . . . in homes as well as in a variety of organized health facilities (Bl:9). / The Technical Nurse An attempt is made in this paper to describe the role of the technical nurse in detail. Statements which have relevancy to the purpose of this study follow: Technical nursing practice is carrying out nursing measures as well as medically delegated techniques with a high degree of skill, using principles from an ever-expanding body of science. It is understanding the physics of machines as well as the physiologic reactions of patients. It is using all treat ment modalities with knowledge and precision. Technical nursing practice is evaluating patients' immediate physical and emotional reactions to therapy and taking measures to alleviate distress. It is knowing when to act and when to seek more expert guidance. Technical nursing practice involves work ing with professional,nurse practitioners and others in planning the day-to-day care of patients. It is supervising other workers in the technical aspects of care. Technical nursing practice is unlimited in depth but limited in scope. Its complexity and extent are tremendous. It must be rendered, under the direction of professional nurse prac titioners .... Education for this practice requires attention to scientific laws and principles with emphasis on skill. It is education which is technically oriented and scientificially founded, but not primarily concerned with evolving theory (Bl:7-8). The Professional Nurse An attempt is also made in this paper to describe the role of the professional nurse in detail. Statements which have relevancy to the purpose of this study follow: 140 The essential components of professional nursing are care, cure, and coordination. The care aspect is more than "to take care of"; it is "caring for" and "caring about". . . . It is dealing with human beings under stress, frequently over long periods of time. It is providing comfort and support in times of anxiety, loneliness, and helplessness. It is listening, evaluating, and interviewing appropriately. The promotion of health and healing is the cure aspect of professional nursing. It is assisting patients to understand their health problems and helping them to cope. It is the administration of medications and treatments. And it is the use of clinical nursing judgment in determining, on the basis of patients' reactions, whether the plan for care needs to be maintained or changed. It is knowing when and how to use existing and potential resources to help patients toward recovery and adjustment by mobilizing their own resources. Professional nursing practice . . . is coordinating and synchronizing medical and other professional and technical services as these affect patients. It is supervising, teaching, and directing all those who give nursing care. Professional nursing practice is constant evaluation of the practice itself. It is asking questions and seeking answers— the research that adds to the body of theoretical knowledge. It is using this knowledge, as well as other re search findings, to improve services to patients and service programs to people. It is collabor ating with those in other disciplines in research, in planning, and in implementing care. Further, it is transmitting the ever-expanding body of knowledge in nursing to those within the profession and outside of it (Bl:5-6). Discussion The very limited description of the nurse aide role in the ANA position paper allows only the insight that some level of natural science knowledge is indicated. 141 Comparison of the roles of the technical nurse and the professional nurse results in the following observations: 1. While professional practice is characterized as theory- oriented and technical nursing practice as technique- oriented, the importance of understanding, the scientific bases for nursing and medical techniques is stressed in connection with technical nursing practice. 2. The statement that "technical nursing practice is unlimited in depth" seems to argue for a firm scientific base. 3. Evaluation of nursing needs, planning of nursing care, and the supervision of other workers (implying informal teaching and explanation) are referred to in the des criptions of both professional and technical nursing practice but are given greater importance in the description of professional nursing practice. 4. Professional practice is described as encompassing "constant evaluation of the practice itself" and "research that adds to the body of theoretical knowledge." Technical practice, on the other hand, is "not primarily concerned with evolving theory." 5. The description of professional practice encompasses collaborating in interdisciplinary programs to promote the maintenance of health and to provide care as well as to synchronize and coordinate medical and other 142 professional and technical services as they affect patients. The description of technical practice refers only to "working with professional nurse practitioners and others in planning the day-to-day care of patients. 6. Professional nursing practice is described as including the transmittance of the "ever-expanding body of know ledge in nursing." This "transmittance" can probably be interpreted as meaning primarily the formal teaching function. Implications relating to selecting natural science content for the various kinds of nursing programs are abstracted from the above observations only with great difficulty and then are subject to considerable conjecture. The first and second observations outlined above serve to establish the need for a firm foundation in the natural sciences for both the technical and professional levels of nursing practice. Implications in the other observations are quite nebulous. One of three conclusions might'be drawn: 1. Professional nursing practice requires greater breadth and depth.of understanding in the natural science area. 2. Professional and technical nursing practice require similar breadth and depth of understandings in the natural science area; however, professional nursing practice requires greater intellectual ability in utilizing the needed understandings (i.e., analysis, synthesis, evaluation). 143 3. Professional and technical nursing practice require similar breadth and depth of understandings in the natural science area and a similar degree of intellec tual ability in utilizing the needed understandings; however, professional nursing practice requires greater concentration in the area of the behavioral sciences because of the emphasis upon the teaching and synchron izing and. coordinating functions. (It should be noted that professional nursing practice as described in the position paper encompasses levels of professional education from the baccalaureate through the doctoral degree in nursing. Baccalaureate education would, therefore, not be preparation for all the aspects of profes sional practice described.) ^ Joint NFLPN-ANA Statement of Functions of the Practical Nurse (1964) Whereas the ANA position paper describes the roles of the nurse aide, the technical nurse, and the professional nurse while it purposefully omits the role of the practical nurse, a joint statement of the National Federation of Licensed Practical Nurses and the American Nurses1 Associa tion issued in the previous year attempts to describe the role of the practical nurse in detail. Statements which have relevancy to the purpose of this study follow: 144 The licensed practical nurse gives nursing care under the supervision of the registered professional nurse or physician to patients in simple nursing situations. In more complex situations the licensed practical nurse functions as an assistant to the registered professional nurse. A simple nursing situation is one that is relatively free of scientific complexity; In a simple nursing situation the clinical state of the patient is relatively stable and the mea sures of care ordered by the physician require abilities based on a comparatively fixed and limited body of scientific facts and can be performed by following a defined procedure step by step. Measures of medical and personal care are not subject to continuously changing and complex modifications because of the clinical or behavioral state of the patient. The nursing that the patient requires is primarily of a physical character and not instructional. , . . the licensed practical nurse must know and utilize fundamental principles of human behavior and have an appreciation of the effects of stress upon individuals and groups. A practical understanding of human growth and behavior makes it possible to note signs of change and disturbance in the patient*s activity patterns (B5). Discussion Some key concepts in the NFLPN-ANA paper seem to be: (1) a stable nursing situation as the principal orientation of the practical nurse role;.(2) "limited" and "practical" scientific knowledge as the basis for practical nursing activities; (3) supervision by a physician or a profes sional nurse at all times and very close supervision in complex nursing situations; (4) ability to recognize 145 deviations from the normal but not to respond to such be yond reporting. The statements establish the need for some natural science knowledge and indicate that a high level of such knowledge is not essential. The statements do not, however, provide adequate guidelines for selecting content appropriate to the practical nurse level of practice. ANA Statement on "Health Occupations Supportive to Nursing" (1964) The American Nurses' Association publication, Health Occupations Supportive to Nursing (B2), includes the follow ing statement describing the role of the nurse aide which is relevant to the purpose of this study: The role of this auxiliary worker Cnurse aide] is that of assisting the registered nurse or licensed practical nurse in the nursing service, which operates according to the type of health, facility it serves. This work should be delegated by a registered nurse and performed under the direction of a regis tered nurse or a licensed practical nurse. It should consist of the simple tasks involved in assisting in the personal care of individuals who are ill or otherwise disabled and assisting in the maintenance of a safe and healthful environment (B2:6). Discussion The above statement in Health Occupations Supportive to Nursing is more descriptive than the statement concerning the nurse aide role in the ANA position paper. It limits ¥ I i 146 the activities of the nurse aide to tasks relating to personal care and maintenance of a favorable environment. The implications for selecting natural science content for nurse aide curricula are still not clear, although some t such content is obviously indicated. t NLN Statement of Characteristics of Associate Degree Nursing Programs (not dated) The National League for Nursing Department of Associate Degree Programs publication, Characteristics of Educational Programs in Nursing Leading to an Associate Degree, includes the following statement relevant to the purpose of this study: Graduates of this program are prepared to give patient centered nursing care in beginning general duty nurse positions. They are prepared to draw upon a background of scientific and humanistic understanding in administering care to patients (B2D). Discussion The above statement provides no additional dimension to the ANA position paper and is not in conflict with it. NLN Statements on Practical Nursing and Practical Nursing Education (1968) Statements Regarding Practical Nursing and Practical Nursing Education published by the National League for 147 Nursing in 1968 contains the following statements which are relevant to the purpose of this study: Appropriate basic concepts in the biolo gical and behavioral sciences and in nursing care are related to the care of selected patients of all age groups with common devia tions from health. Graduates are prepared to serve as members of the health team under the supervision of the registered nurse or the physician in giving nursing care consistent with individual educa tion and abilities (B18:3-4). Discussion Certain aspects of the 1968 NLN statements on practical nursing represent deviations from the ANA position paper: 1. The emphasis upon "simple nursing situations" is missing. 2. The secondary role of the practical nurse as "assistant to the registered nurse" in complex nursing situations is not specified. 3. The idea of "individual education and abilities" as a factor to be considered in relation to the functions of the practical nurse is introduced. These aspects may indicate a movement to a mote complex and more independent role of the practical nurse which might require greater content in the natural science area. 148 Statements of Three Organizations on Charge Nurse Responsibilities of Practical Nurses (1968-69) Each of three organizations, the National Federation i of Licensed Practical Nurses, the American Nurses' Associa tion, and the National Organization for Practical Nurse Education and Service, have issued statements entitled Charge Nurses Responsibilities in Extended Care Facilities which are relevant to the purpose of this study. The statement of the National Federation of Licensed Practical Nurses issued in 1968 is as follows: Be it resolved that the NFLPN in con vention assembled go on record in support of requirements for charge nurse in an extended care facility to be a licensed practical nurse who is a graduate of an approved school of practical nursing with additional preparation in unit management (Bll:29). The statement of the American Nurses' Association issued in 1968 is as follows: The registered nurse alone, is prepared, by education and experience to assume charge nurse responsibilities. . . . The position of the American Nurses' Association is that licensed practical nurses who are graduates of state approved programs in practical nursing should be relieved of such responsibilities as quickly as possible; that under no circumstances should a practical nurse licensed by waiver be permitted to assume these responsibilities (Bll:29). The statement of the National Association for Practical Nurse Education and Service issued in 1969 is as follows: I i 149 We deplore this proposal [the above ANA statement] which would bar all licensed prac tical vocational nurses from serving as charge nurses in extended care facilities during afternoon and night tours of duty— a role in which, over the years, they have demonstrated outstanding competence. . . . We believe it is possible that some practical nurses who have been licensed by waiver are, because of their experience, equally well or even better prepared to function as charge nurses . . . than are graduates of practical/vocational . . . or professional nursing programs who have had little or no appropriate employment experience. .... We propose the development of criteria and tools for evaluating the ability of such nurses (Bll:29). Discussion The disagreement in the statements relating to charge nurse responsibilities in extended care facilities is obvious. The NPLPN and NAPNES statements would certainly extend the role of the licensed practical nurse outlined in the NFLPN-ANA joint publication in 1964: 1. Some licensed practical nurses would assume responsi bility for the total nursing care of some patients whose conditions are not stable. They would, there fore, have to take action rather than simply recognize and report deviations from the normal. 2. Some licensed practical nurses would doubtlessly assume responsibility for patients whose primary needs (in the words of the previous joint statement) are of an instructional nature. 150 3. Licensed practical nurses functioning as charge nurses in extended care facilities would be responsible for supervision and informal teaching of other nursing personnel. The implication of the above would seem to be. the require ment of increased content in the area of the natural sciences. Although the ANA statement focuses upon precluding th.e assignment of charge nurse responsibilities to practical nurses, it does raise another question. Does the failure of the statement to distinguish between professional and technical nursing practice in this statement accord techni cal nurses in extended care facilities all the aspects of the professional role? If so, the discussion of technical and professional roles in the section on the ANA position paper is pertinent here. NLN Career Information Brochure on Practical Nurse and Registered Nurse Education and Roles (1969) Do You Want tp Be a Nurse? published by the National League for .Nursing in 1969 to provide basic information about roles and educational programs to prospective students uses the title, registered professional nurse to apply to both technical and professional nurses. The nurse aide role is omitted. 151 Statements relevant to the purpose of this study which concern practical nurse educational programs and roles are as follows: [In the hospital] the licensed practical or vocational nurse . . . works under the direction of the registered nurse, assisting with the care of all types of patients (B15:5). Practical nursing education equips the graduate for direct patient care under super vision (B15:19). The following statement concerns practical and tech nical nursing roles: Some registered nurses without special preparation and an increasing number of licensed practical nurses are employed in community health work, assisting public health nurses (B15:7). The following statement concerns the technical nurse role: If you want to be an R.N. concentrating on caring for patients in hospitals, nursing homes, and similar institutions, the associate degree or diploma program may best answer your needs (B15:19). The roles of the professional nurse and the technical nurse are not differentiated in the following statement: . . . the registered professional nurse . . . is .the planner of a patient's nursing care. Her daily work includes expert attention to the critically ill, teaching patients to take part in their own therapy, and supervision of practical nurse and nurses' aides. . . (B15:5). The following statements concern professional nurse educational programs and roles: 152 The baccalaureate program . . . leads directly into graduate study which prepares for advanced clinical practice, teaching, and other leadership responsibilities (B15:19). To be a qualified public health nurse, you need to have a college degree from a nationally accredited program which includes preparation for public health nursing (B15:7). Discussion Statements in Do You Want to be a Nurse? are in general agreement with the ANA position paper and the NFLPN-ANA joint publication. Two differences are outstanding: 1. In terms of institutional practice, the roles of the professional nurse and the technical nurse are not differentiated, whereas the position paper stresses the roles of the professional nurse-as planner, evaluator, collaborator, and researcher. Failure to differentiate in this brochure may be simply that the information is less detailed or it may be a matter of attributing a higher level role to the technical nurse. 2. Unlike the NFLPN-ANA joint publication, this brochure refers to.the practical nurse in public health. Even though the practical nurse in public health is referred to as an assistant, practice in the community seems to connote greater independence. This more independent role, particularly in terms of patient and family instruction, may indicate the need for higher level content in the natural science area. 153 NAPNES Statement of Functions of the Practical Nurse (1969) The Declaration of Functions of the Licensed Practical/ Vocational Nurse issued by the National Association for Practical Nurse Education and Service in 1969 contains the following statements relevant to the purpose of this study: The LPN/LVN recognizes and is able to meet the basic needs of the patient. The LPN/ LVN is taught the underlying principles of nursing care and is prepared to execute thera peutic and technical skills. The LPN/LVN may assist in teaching and demonstrating nursing procedures to other personnel. An LPN/LVN through education and clinical experience has acquired the necessary knowledge, skill, and judgment to provide nursing care under the direction of a registered nurse, licensed physician, or a licensed dentist. Through, continuing education, the LPN/LVN prepares to assume progressively more complex nursing responsibilities. [The LPN/LVN] participates in the planning, implementation, and evaluation of nursing care, and teaches the maintenance of health and prevention of disease. [The LPN/LVN] observes and reports to the appropriate person significant symptoms, reactions, and changes in the condition of the patient, and records pertinent information. [The LPN/LVN] assists with the rehabili tation of the patient and family according to the patient care plan: a. provides support for emotional needs. b. teaches appropriate self-care. c. advocates use of community resources. [The LPN/LVN] prepares to assume responsi bilities as a charge nurse under direction (B13). 154 Discussion Apparent deviations of this declaration from the 1964 NFLPN-ANA joint statement are along the following lines: 1. There is no reference in NAPNES paper to the "simple nursing situation" in which the NFLPN-ANA'statement indicated the practical nurse would perform her more independent role. 2. The LPN role is extended to include personnel teaching and charge nurse responsibilities. 3. The patient teaching role of the practical nurse is clearly specified. All of the above would seem to point to the requirement of greater knowledge in the natural science area. NFLPN Statement of Functions and Qualifications of the Licensed Practical Nurse (1970) The Statement of Functions and Qualifications of the Licensed Practical Nurse originally issued in 1970 and revised in format and vocabulary in 1972 includes the following statements relevant to the purposes of this study The work of the licensed practical nurse (LPN/LVN) is an integral part of nursing. Under the direction of a qualified health pro fessional , the licensed practical nurse is a recognized member of the health care team and performs nursing functions commensurate with his education and demonstrated compentencies. On a selective basis, this will include the performance of a wide range of nursing 155 activities. For purposes of this statement, nursing activities encompass situations ranging from: — providing direct patient care at the bed side in relatively stable nursing situations such as hospitals, extended care units, nursing homes, private homes, and other health care facilities and agencies; — to performing functions in semi-complex situations, such as hospital nursing service units, recovery rooms and labor rooms; — to more complex situations, such as hospital nursing service units, intensive or coronary care units and emergency rooms; — to the promotion of personal and community health— an important function of all well prepared members of the health care team; — to promoting and carrying out preventive measures in community health facilities such as well-baby clinics, out-patient clinics and services* In semi-complex and complex nursing situa tions a greater depth of knowledge and a higher level of judgment are required of the LPN; and a closer working relationship with, and the greater the degree of direction by, the health professional. The licensed practical nurse contributes to community health through nursing activities usually performed outside patient-care insti tutions, e.g., visiting nurse associations, well-child and other public health clinics, and industrial nursing units. Continuing education is essential to prepare the LPN for her expanding role and to keep her informed of changes in nursing and medicine. It includes those organized educa tional experiences which are planned to help licensed practical nurses achieve more produc tive and satisfying fulfillment of their role as health workers. . . . With additional preparation, the LPN is qualified to assume greater responsibility in: a. Patient care management, such as: (1) Serving as a team leader, charge nurse or unit manager, and (2) Supervising other nursing and health related personnel. 156 b. Specialized areas such as Intensive care, coronary care, emergency, rehabilitation, operating room, obstetrics, pediatrics, health clinics and geriatrics (B14:25-9). Discussion i Several aspects of the above statements seem to repre sent deviation from the joint NFLPN-ANA publication of 1964: 1. The connotation of the term "health professional" which replaces the "registered professional nurse or physician" of the NFLPN-ANA publication is unclear. ■ If this health professional might be an individual with limited understanding of nursing, greater independence on the part of the licensed practical nurse might be assumed. 2. While the closer working relationship with the "health professional" in more complex situations is recognized as it is in the NFLPN-ANA statement, the requirement of greater knowledge and a higher level of judgment on the part of the licensed practical nurse in these situations is also expressed. 3. The role of the practical nurse in community health is emphasized. As stated earlier, practice in the community seems to connote greater independence. 4. The need for continuing education is emphasized as leading to leadership responsibilities and expanded clinical piactice. (Discussion under the section on ii 157 organizational statements on charge nurse responsi- bilities is pertinent here.) All of the above aspects seem to imply,the need for increased natural science content in practical nurse curricula. While the 1970 NFLPN staterrent was a unilateral announcement, it did receive endorsement from the National League for Nursing. It is inducted in the appendices of the 1972 NLN publication, Licensed Practical Nurses in Nursing Services (B16) and referred to in the text of the publication as follows: The Statement of Fuhctions and Qualifi- cations of the Licensed Practical Nurse . . . issued by the National Federation of Licensed Practical Nurses in June 1970, describes the work of the licensed practical or vocational nurse as being an integral part of nursing. The Federation says of the statement that it "reflects the expanding role of the LPN in today's health care-systarn" and that it "will serve as a guide for nursing service directors, for the development of curriculum in schools of practical nursing and for the design of continuing education programs for the LPN," The statement is aljso a useful guide to the scope of activities that may be assigned to the practical nurse. Both employer and employee should study th? information it con tains carefully, and copies of the full state ment should be available to all personnel in employment areas. It is important for all to realize that some of the functions described are to be carried out only by selected LPN's after they have been given appropriate instruc tion (B16:10). 158 NLN Career Information Brochures on Four Kinds of Nursing Programs (1971) Four brochures issued by the National League for Nursing (B33,B19,B22,B21).in 1971 respectively describe practical,associate degree, diploma, and professional (baccalaureate and higher degree) nursing roles and educa tional programs. Unlike the position paper, these bro chures describe the diploma, as well as the associate degree, program and the roles of graduates of these two programs separately. Statements in the four brochures which are relevant to the purpose of this study follow: Let's Be Practical About a Nursing Career, the bro chure relating to practical nursing, states: Practical nursing programs prepare men and women to give nursing care, under the supervision of a registered nurse or physi cian, to patients in simple nursing situations. In more complex situations, the licensed practical nurse functions as an assistant to the registered professional nurse (B23:l). Associate Degree Education for Nursing, the brochure relating to associate degree nursing programs and the roles of graduates of such programs states: . . . the majority of registered nurses work in hospitals or other institutions and are engaged in giving direct nursing care to the sick. These nurses are usually called general duty or staff nurses and sometimes "bedside” nurses. Since staff nurses give direct care to patients, they must possess a high degree of technical nursing knowledge and skill and have an understanding of the 159 scientific principles of the nursing care they give. An associate degree program will meet your needs if . . . you would like to give direct nursing care to the sick. . . (B19:2). Education for Nursing the Diploma Way, the brochure relating to diploma nursing programs and the roles of » graduates of such programs#states: Graduates of accredited diploma programs in nursing (1) know basic scientific principles and utilize them in planning and giving quality nursing care to people; (2) recognize the indication of disease and disabilities and the psychological, social, and physical needs of patients; (3) have the understanding and the skills necessary to organize and implement a plan of nursing care that will meet the needs of groups of patients and promote the restora tion of health; (4) are qualified to plan for the care of patients with other members of the health team and to direct other members of the nursing team. . .(B22:3). College Education; Key to a Professional Career in Nursing, the brochure relating to baccalaureate and higher degree programs in nursing and related nursing roles, states: Upper-division courses in nursing theory and nursing practice build on preceding and concurrent courses in the sciences and the humanities; thus, students achieve the broad understanding and the skills needed today in professional nursing. Graduates of accredited collegiate pro grams in professional nursing are prepared to give high-quality nursing care to patients and their families and to direct the nursing care given by other nursing team members work ing with them. Graduates are qualified for employment in general nursing practice in any setting where professional nursing care is given: hospitals and public health agencies of all kinds, the military and other Federal nursing services, nursing homes, and others (B21:2). 160 Discussion In general the NLN career information brochures parallel the statements in the ANA position paper and the ANA-NFLPN joint publication. Some notable differences are 1. There are no references in the description of the role of the associate degree to the planning, evaluating, and supervising functions which are included in the role described in the position paper. The absence of such references may be merely a matter of a difference in the amount of detail in the two papers or it may imply a lower level of practice for the associate degree graduate. 2. The specific reference in the description of the baccalaureate program to science courses concurrent with upper-division nursing courses clearly assumes inclusion of higher level science courses in the baccalaureate program, NLN Statement on Role. Knowledge and Abilities of the Diploma Graduate (1971) The National League for Nursing Council of Diploma Programs publication, Statement on Role. Knowledge, and Abilities of the Diploma Giaduate. includes the following statements relevant to the purpose of this study: 161 The diploma program in nursing prepares an individual, eligible for licensure as a registered nurse, who functions as a generalist in hospitals and similar community institutions. The nurse in these settings provides nursing care to and engages in therapeutic, rehabilita tive, and preventive activities in behalf of individual patients and groups of pdtients. In order to fulfill the role, the graduate of the diploma program has knowledge of nursing as an art and a science which encompasses . . . physical, biological, and behavioral prin ciples .... In order to fulfill the role, the graduate of the diploma program as a nurse: 1. Ascertains the physical and psychological needs, habits, and resources of patients. 2. Establishes priorities of nursing care for individuals or groups of patients based on needs. 3. Implements plans of care that are modified as necessary. 4. Applies scientific principles and concepts involved in the promotion and restoration of health. 5. Recognizes situations or patient responses that have significance for other members of the health team. 6. Detects symptomatic changes in patients (either spontaneous or in response to diag nostic and therapeutic measures) that require independent action and/or the need to seek more expert assistance. 7. Performs procedures (including manual skills) and activities involved in nursing care with disciplined attention. 8. Responds appropriately to environmental and safety hazards whether related to physical setting, equipment, and/or actions of others. 9. • Participates in the total care of the patient by coordinating the skills and abilities of other nursing personnel in administering nursing care. 13. Helps the patient and family understand the plan of nursing care and the role each plays to effect the fullest possible success of therapy during hospitalization and thereafter. 14. Assesses the effectiveness of nursing care (624:463). 162 Discussion The kind of practice described in this paper seems to be similar to the technical nurse role described in the ANA position paper. Differences between the two role descriptions may be variations in vocabulary or may. repre sent real differences in the proposed roles. Possible deviations in the NLN paper follow: 1. The "generalist" role is stressed. 2. The role in assisting the patient and the family to understand the plan of care is specified. 3. The role in long-range planning for patient care is specified. 4. The role in recognizing situations that have signifi cance for other members of the health team is specified. 5. There is no mention of any form of guidance from the professional nurse. If the above should be understood to connote a more exten sive role than the one described for the technical nurse in the position paper in terms of considerable responsibil ity for coordination and synchronization of the patient's total health care, for teaching and interpretation, and for long-range planning for patient care, as well as greater independence of practice, there is the possible implica tion of the need for greater knowledge in the natural science area. The discussion under the section on the 163 ANA position paper on possible differences in requirement of natural science content in the professional and technical curricula is pertinent here. APPENDIX II ANALYSES OF SCIENCE AND HEALTH EDUCATION CURRICULUM MATERIALS 164 T A B L E 6 . ANATOMY AND PHYSIOLOGY CONTENT BASIC TO NURSING IDENTIFIED IN SELECTED ELEMENTARY AND SECONDARY LEVEL SCIENCE AND HEALTH CURRICULUM MATERIALS; RELATED CLASSIFICATION OF CONTENT ITEMS ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education Mational cation Guide Natl. Study Gr. 7 - 8 Giiide Natl. Study Supplement Study (D32-37) (D43) 056-63) 038-39) 043) 056-63) 0 4 2 , 29) 0 4 ) Volume and Pressure ct~ circulating 31ood Cardiovascular System Circulatory cycles exchange through capillaries.0 XXXC XXX XXX XXX XXX XXX XXX XXX Circulatory rout.-.: right side of heart to lungs to left side of heart XXX XXX XXX XXX XXX XXX XXX XXX to systemic cir culation. 3. Origin and bifur cation of aorta. XXX XXX XXX XXX XXX XXX XXX 4.. Smooth muscle tissue in walls of arterial ves XX XX XX XXXXXX XXX sel; effect of aging. ' aAs idencifiad in the University of Washington School of Nursing "Curriculum Study in Basic Nursing Education* and outlined in: Madelyn T. NorJn.irk and Anne W. Rohweder, Scientific Foundations of Nursing. 2nd ed. Philadelphia: J.B. Lippincott uo., 19o7 ^Phrases in this column indicate the content of items from Nordmcrk end Rohweder under "Anatomy.and Physiology" sections. Since the original items vary in length from two lines to two pages, some items are considerably abbreviated in the phrases m this table and reference to the original .source is suggested. Sequence is the same as in the original. 165 cTha following key is used to indicate extant of content identified by the investigator: XXX, similar coverage; XX, majority of item content covered; X, some coverage of item content. dyhc numerals in this column indicate the level associated with the item by the investigator_on the basis of the curriculum materials analyzed. Level I: commonly studied at the elementary level; Level II: commonly studied at the secondary level; Level II-A: degree of complexity similar to that of Level II items but inclusive of detail particularly pertinent to nursing; Level III: commonly studied in advanced high school or post-secondary science courses. TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING1 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (032-37) (043) (056-63} (D33-39) (043) (D56-63) (042, 29) (04) 5. Palpability of arteries.lying over firm tissue. XXXX II-A 6. Muscular mechanism which occludes uterine blood vessels. II-R 7. Sinuses which drain blood from brain, face, scalp, mas toid region. II-A 3. Largo blood supply of'certain organs. XX II-A Nature c: venous wails; valves in veins. XX XXX XX XX XXXXXX I 10. Cardiac muscle blood supply through coro nary arteries. XX XX XX XXX II H Ol TABLE 6. (CONT.) ANATOMY AMD PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Matcrials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) 1038-39) (D43) {056-63} (D42, 29) (04) Blood Volume 1. Cardiovascular system primar ily a closed system; blood loss through re productive functions;re lated factors. XX XX XX XX XX 2. Slcod volume related to body weight and sur face area; rap id blood loss. XX XX XX II-A 3. Blood volume affected by fluid balance variations. XXI 4. Agglutination and hemolysis from mixing of incompatible blood types. X XXX XXX XXX XXX II Circulatory effect on color of skin ar.c .mucous membrane. XX XX X XXX XX XXX II . ' 6. Characteristics . of capillary, venous, and 167 arterial bleed ing. X XX XX II-A 7 . Body's defences against ex- sanguination. XX XX XX XX II TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Katerials- Sex Education National cation Guide Katl. Study Gr. 7 - 8 Guide Katl. Study Supplement Study (032-37) (043) (DS6-63) (D38-39) (D43) (056-63) (042, 29} (04) Blood Clotting 1. Blood clotting mechanism. XXX III 2. Normal clotting time. X X X X X II-A 3. Normal bleeding . time. X X X X II-A 4. Normal pro thrombin time. II-A Blood Pressure 1. Arterial blood pressure de fined. XXX XX XXX X X XXX XXX XXX X 2. Factors vhich determine arterial blood pressure. jgj XX XX XX XX I 3. Rationale or blood pressure measuring pro cedure. XX XX XX II 4. • The pulse; pal pability; fac tors vhich do- - etermine strength. XX XXX X X XX X X X XXX I 168 5. Pulse pressure. XX XX XX XX I 6. Effect of pos ture upon ar terial blood pressure. XI-A TABLE 6. {CONT.} ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education Kational cation Guide Natl. Study Gr. 7 - 6 Guide Natl. Study Supplement Study (D32-37) (043) (D56-63J (D38-39) (□43) (056—63) (042, 29) (04) Strenuous phys ical exercise and blood pres sure. XX XXX XX XXII Factors deter- ming amount of blood pumped into arteries. ' X XXXXX III 9. Blood flow from atria to ventri cles: patency of valves; venous return. XX XX XX III 10. Cardiac workload: amount fcf circu latory blood, bicod pressure, gravity, oxygen need, particular tissue neud. XX XX XX XX II 11. Relationship of heart rate: to sice of the in dividual and XX blood pressure. XX II-A 12. Relationship between heart rate and meta bolic rate. XX XXXX XXX XX XXX • I 13. Acceleration and depression of 169 heart rate by neural and hor monal mechanisms. XX XX XXX XX II TABLE 6. [CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook . Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Secies Curriculum Materials- Series Curriculum Materiais- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37J (D43) (D56-63) (038-39) (D43) (D56-63) (D42, 29) 0 4 ) 14. Cardiac conduc tion system. XXX XXX XXX II 15. Apical heart beat; location of auscultation. XX XXX XXX XXX XXX 16. Audibility o£ fetal heart beat. II-A 17. Autonomic con trol of arteriole walls; vasomotor centers. X XX III 18. Blood pressure affected by emo tions through relationship of eaotiar.s to auton omic nervous sys tem. X XXXXXXXX II 19. Causes o: local vasodilatation. X XX III 20. Causes of gen eralised vaso dilatation. X III 21. Causes of local vasoconstriction. X XX III 22. Causes of gener 170 alized vaso constriction. III TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health Stats Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook: Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 3 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-39) (D43) (D5S-63) (D42, 29) (D4) 23. Relationship be tween fluids in other closed sys tems and the car diovascular sys tem. III 24. Effects of very slow circulatory rate upon veins. XXX X XX. II-A' 25. Reduced arterial blood pressure as a cause of de creased glomerular filtration. x X III General Circulation 1. Effectiveness of systematic circu lation in horizon II-A al body position. XXX X XX X * 2. Decreased func tioning the re sult of de er eased volume and pressure or circulating blood in any tissue. XXX * , XXX • XXX XXX XXX I ' 3. Blood increase to specific tissues: in creased tissue functioning. injury, heat. -X XX XX XX XX II TABLE'6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health ' Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (038-39) (D43) (D56-63) (042, 29) (04) 4. Sensations caused by in adequate cir culation to peripheral . nerves. XX II-A . 5. Inadequate cir culation to muscle as cause of pain. XX Ill 6. Circulatory re sponse to local injury. III Adequate Sunplv of Oxygen Respiratory System 1. Provision for exchange of gases between atmosphere and blood. XXX XX XXXXXXXXXXXX XXX XXX I 2. Air passages of respira tory tract. XXX XX XXX XXX XX XXX XXX XXX I 3. Anatomy and functions of the nose; para nasal sinuses. XXX XXX XX XXX XXX II T A B L E €. ( C O S T . ) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING^ CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health Stato- Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Xateriais- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guido Natl. Study Supplement Study (D32-37) (D43) (D56-63) (038-39) (D43) (D56-63) (D42, 29) (D4> 4. Coumon passage way or alimen tary ar.d respi- atory tracts in the pharynx. XXX XXX XXX XXX II 5. Improper func tioning of the muscles of the tongue. II-A 6. Location and function of tonsils; en largement. XX XX XXX IX 7. Location and anatcmy of the larynx. XX XX XX XXX XXX II 8. Absence of car tilage support between termi nal bronchioles. XX XX XX XX II 9. Elasticity of bronchioles and alveoli; in crease Of fi brous tissue during aging process. X XX XXX II- 10. Sr.coth muscle composition of 173 bronchioles; par asympathetic and sympathetic con trol. X XXX XX III TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health . Education Education Health • Education■ Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement . Study (D32-37) (D43) (D56-63) (D38-39) (D43) (D56-63) (D42, 29) (04) 11. Anatomy and function of alveoli. XX XX XXX XXX XX II 12. Mucous lining of respiratory tract; func tions of mucus. .XX XX XX XX XX II 13. Sneeze and ccugh reflexes; center in medulla. XX XX XX II Process of Breathing 1. Breathing m e c h anism: muscular action in inspi ration and expi ration; pleura; subatmospheric pressure; vital ■ capacity. XX XX XXX XXX XX XXII 2. Innervation of intercostal muscles. X X X X III 3. Innervation of III diaphragm. X X X . X 4. Innervation of auxiliary respi ratory muscles. III 5. Inspiratory, ex piratory, and pneunotaxic nerve centers. X III TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Katerials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-3S) (D43) (D56-63) (D42. 29} (D4) 6. Chemical stimu lation of the respiratory centers. X XX XX III 7. Voluntary con trol of respi ratory rate and depth. X X XXX XX X XX XXX XXX I 8. Effects of emo tions on respi ratory rate and depth. X X XX XX II 9. Respiratory rate variation vith age, X XXX II-A 10. Respiratory rate and oxygen need. X II-A 11. Shallow respi ration and "dead space" in upper respiratory tract. II-A Transportation of Oxygen t o Tissues 1.' Diffusion of oxygen from alveoli into capillary. X X X X XX XX II 2. Functional cir culation in lungs. XXX XXX XXX XXX X II TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health U.S. Health Biological Education Health Education Education Health Education Education Science General Textbook. Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-39) (□43) (D56-63) (D42, 29) CD4) 3. Most of oxygen carried in com bination with hemoglobin; mature and im mature cells; normal blood counts- at Use oC Oxygen by Cells 1. Oxygen r e quirements of cells depen dent upon meta bolic rates; determinants of metabolic rate. XX X X XX X X XXX XXX II 2. Cellular meta bolism related to available oxygen: oxygen debt; petechiae. X X XX XX II 3. Lice without oxygen possible * •for only a short time; lack of oxygen in brain . . . stem and cere bral cortex. X X X XX XX III 4. Anxiety as a re sult of inade quate oxygen supply. III TABLE 6. (COOT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (032-37) (D43) (D56-63) (D38-3S) (043) (056-63) (042, 29) (04) Nutrition Normal Nutrition 1. Functions of nutrients. XXX XXX XXX XXX XXX XXX XXX XXX I 2. Major food groups. XXX XXX XXX XXX XXX XXX XXX XXX I 3. Carbohdrates: functicns; caloric yield; caloric require ment; starch most abundant; absorption as monosaccharides; conversion ci giuccsc to gly cogen; excess glucose; nerve cells* need of glucose. XX XX XXX XX XXX XX XXX I 4. Fatty acids as constituents of 4 protoplasm. XX XXX XX IX 5. Fa t the rain source of re serve food; ca loric yield; fatty acids; glycerol. X XX XX XXX XX XXX XX 177 6. Oily substances which cannot be hydrolyacd and absorbed. XXX II-A TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Haterials- Series Curriculum Materials- Sex' Education National . cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32— 37) (D43) (D56-63) (D3B-39) (D43) (D56-63) ID42, 29) (D4) 7. Protein: usej increased need at some times; absorption; es sential amino acids. XX X X XXX XX XXX II 8. Important minerals. XXX X XXX XX XXX II 9. Important v ita mins; sources, functions. X XXX XXX X II-A 10. Causes of the hunger sensa tion. XX X XX XXX XX II 11. Factors affect ing appetite. XXX XX XXX XXX XX I Digestive Tract and Accessory Structures 1. Processing of food in the mouth; swallow ing; muscula ture and control of esophagus; control of car diac valve. XX XXX XX XXX XXXXX XXX XX Processing of food in the stomach. XXX XX XXX XX XXX XXX XXX 178 3. Digestion in the snail intestine; absorption into lymph and blood. XX XX X X X X X XX XX TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Studv Gr. 7 - 8 Guide Natl. Study Supplement Study (032-37) (M3) (D56-63) (D38-39) (043) (DS6-63) (042, 29) (04) 4. Changes in the digestive tract during the aging process. II-A Chewing and Swallowing 1. Purposes of mastication. XXX XXX XXX XXX XXX XXX XXX I 2. Chawing of food; action of tongue. XXX XXX XX XXX XXX XXX XXX I 3. Saliva: stim ulation of glands; con- . trol of se cretion; pur pose. XXXXXX X XXX XXX XXX XXX I 4. Swallowing process. XX XX XX XXX XXX XXX I S. Regurgitation of food as a result of pres sure on cardiac sphincter. II-A Digestion and Absorp • tion of Food • 1. Gastric move ments; effect of distention. XX XX X XX XXX XX XXX I 179 TABLE 6. (CONT.) ANATOMY AMO PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Hatl. Study Gr. 7-8' Guide Natl. Study Supplement Study (D32-37) (043) (056-63) (038-39) (043) (056-63) (042, 29) (D4) 2.. Factors deter mining the rate of food passage through the pyloric sphinc ter. XXX x XX XXX n 3. Stomach empty ing time. XXZ XXX XXX XXX XXX I 4. Passage of chyme to ileum; factors deter mining rate. XX XX XX XX XX 5. Digestion time in small intes tine. XXX XXX XXX XXX XXX 6. Amounts of di gestive juices; rcabsorpticn of these secretions. X XI—A 7. Salivary, pan creatic, and intestinal en zymes in the hydrolysis of carbohydrates. XXX XXX X X XXX XXX XXX II 8. Emulsification 'and hydrolysis of fats: hor monal stimu lation of gall bladder. XX XX X X XXX XX XX II 180 TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (032-37) (D43) (056-63) (038-39) (043) (056-63) (042, 29) (04) 9. Gastric, pan creatic, and in testinal enzymes in the hydroly sis of proteins; hydrochloric acid essential to activation of pepsin. . XX XX XX XXX XXXXXX II IQ. Blood supply to digestive tract during diges tion; muscular activity; emo tional experi ences. X XX. XXXXXX XXX II 11. Gagging: occur ence with nau sea or mechani cal stimulation of pharynx or uvula. II-A 12. Vomiting: ac complished pri marily through contraction of abdominal muscles; projectile vomit ing; vomiting of ■ fecal material. IX-A 13. Vomiting center: factors whi c h stimulate the II-A . H* center. X 00 TABLE 6. (CONT.) ANATOMS AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guidc Natl. Study Supplement Study (D32-37) (D43) (056-63) (D38-39) (D43) (056-63) (D42, 29) (34) Utilization of Nu trients by the Body 1. Metabolism of carbohydrates, proteins, fats. XX XX XX XX XX II 2. Factors influ encing meta bolic rate. XX XXX XXX II Fluid Balance Fluid 3alaneo in General 1. Content and dis tribution of water ir. the body; plasma; diffusion across capillary wall. X XX III 2. Maintenance of water necessary in the various compartments. , X XXX XXX XXX XXX II 3. Diffusion, dialysis, osnios is • XXX H I , 4. Intracellular water require ment. XXX III 182 J> TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D.43) (D56-63) (D38-39) (D43) (D56-63) (D42, 29) CM) 5. Maintenance oC isotonicity of body fluids through reten tion and elim ination of water and elec trolytes. X III C. Cell hydration determined by sodium ions in extracellular fluid. III 7. Factors affect ing amount of water in inter stitial fluid. X III 3. Maintenance of osmotic pressure of blood through plasma proteins. X III 9. Eater taken into body and produced as a by-product of biochemical reactions; in take reguire- * ments; thirst. XX XX XX XX II 10. Water in gas trointestinal secretions nor 183 mally absorbed „ in small intes tine. XXX xxx X XXX II TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook e r . d Textbook- Classifi Series Curriculum Materials- Series Curriculum Matcrials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) 0 4 3 ) (DS6-63) (D3S-39) (D43) (D56-63) (D42, 29) (D4) 11. Absorption of water from in testinal con tents by colon. XXX XXX XXX XXX II 12. Routes of bodily water loss. XXX XXX XXX XXX XXX XXX I 13. Total daily water loss; amounts lost through various routes. XX XX XX II Production of Urine 1. Role of kid neys: fluid ‘ balance; elec trolyte bal ance; acid-base balance; excre tion of wastes. XXXX XX II 2. Position of kid neys; surround-, ing tissue. XXX XX XX II 3. Nephrons: anat omy, number. XX XXX II 4. Mechanism by which fluid is forced into Bow man's capsule. XX nx 1B4 TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (043) (D56-63) (038-39) (D43) (056-83) (D42, 29) 0 4 ) 5. Composition and amount of fil trate from C ow man's capsule. XXX XX II 6. Reabsorption and excretion b y the renal bubules. XXX II 7. Factors in glo merular filtra tion and tubu lar reabsorp tion. XX X 111 8. Water necessary for excretion of nitrogenous wastes and main taining threshold substances in solution. XX XXX II 9. Rate of urine production; be ginning of urine production by the r.owbom. XX XX II-A 10. Other factors influencing urine pro duction. X X X II-A 11. Flow of urine ' through the urinary system: 185 gravity; peri staltic action of smooth muscle. XX XXII TABLE 6. (COST.) ANATOMY AKD PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (043) (D56-63) (038-39) (D43) (DSu-63) (042, 29) (04) 12. Physical charac teristics of urine. XXX II-A 13. Specific grav ity of urine; relationship to volume. XX XX II-A 14. Degenerative kidney changes in old age. II-A Lymphatics 1.. Lymphatic c ir culation. XX XXX XXXXXX XI 2. Entrance of lymph into lym phatics; mainte nance lymph flew. X XXX II-A Sweat 1. Distribution of sweat glands; composition of sweat. X XXX XXX III 2. Sweat secretion primarily heat- regulating mech anism; occurrence 186 in. emotional stress. XXX XXX XXXII TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC T O ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (DS6-63) (D38-39) (□43) (D56-63) (D42, 29) (D4) 3. Autonomous con trol of sweat glands. XXX XXX XXX XXX XXX Electrolyte Balance 1. Role of elec trolytes in metabolic pro cesses; osmotic pressure; acid- base balance; tissue irrita bility; enzyme activation. XII 2. Normal osmotic body fluid pres sure of 0.9 per cent sodium chlo ride; everhydra- tion ar.d under- hydration of body cells as results of change. III 3. Distribution of electrolytes in body fluids. III 4. Proper conccntra- . tions of potassium and sodium impor tant to fluid bal ance and acid-base III balance. 187 TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculun Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32T 37) (D43) (DS6-63) (038-39) (043) (056-63) (042, 29) (04) 5. Kidney function in electrolyte bal ance: retention and elimination of water; cubular reabsorption of electrolytes; tubular excre tion of potassium; substitution of ammonium ion for sodium ion as necessary. XX III 6. Tubular reabsorp- tion of electro lytes influenced by adrenocortical hormones. X XII 7. Electrolytes lost through urine and sweat. XXX XXII 8. Sodium require ment influenced by sweat produc tion. XXX X X II-A 9. Functions of calcium. XX III Acid-3use 3alance 1 . pH require ment for nor mal cellular functioning. X X III TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS______CURRICULUM MATERIALS______Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (056-63) (D38-39) (043) (D56-63) (042, 29) (04) 2. Factors involv ed in mainte nance of proper pH. Ill 3. pH of plasma d e pendent upon ratio between carbonic acid and sodium bi carbonate; ad justment of ratio. III 4. Alkali reserve: bicarbonate buff er system. III 5. Hydrochloric acid produced by gas tric glands. XXXXXX II 6. High alkalinity of intestinal digestive juices. X X X III Elimination Elimination front the Castro-Intestinal Tract 1. Anatomy o f large intestine. XX XX XXXX XX II 2. Factors involved in water absorp tion in the large 189 intestine. XXXXX XX II TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY conte: rr basic to ELEMENTARY LEVEL SECONDARY LEVEL NURSING® CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Hoalth State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education Nacional cation Guide Natl. Study Gr. 7 - 3 Guide Natl. Study Supplement Study (032-37) (D43) (D56-63) (D38-39) (D43) (056-63) (042, 29} (D4) 3. Causes of peri staltic move ment in the large intes tine. X XXX III 4. At o n y of smooth muscle of large intestine. XXX II-A 5. Feces: composi tion; character; time in large intestine. XX XX XXX X X II 6. Meconium. II-A 7. Defecatory Mech anism. XX III 8. Stimulation of peristalsis . through entrance of food into the stomach. II-A 9. Voluntary con striction of anal sphincter. III 10. Frequency of bowel move ments. XXX XXXXXX II-A, 11. Prolonged inter nal pressure against rectal 190 walls a cause of headache and lethargy. XXX III TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY COSTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Scries Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (038-39) (D43) (056-63) (042, 29) (04) 12. Stimulation of sensory nerve endings for pain and pressure in the bowel wall. . XXX III 13. Causes of gas in the intes tinal tract. X II-A 14. Elimination of gap from the intestinal tract. II-A . Elimination of Nitro genous Wastes from the Kidneys 1. Elimination of nitrogenous wmsCcs from protein neta- . bolisa; blood urea nitrogen level. X X X X X X XX XXX Ill 2. Urea normally present in sweat. X X XXX • XXX III Elimination of Urine 1. Anatomy o f blad- ' ' dcr, ureters, urethra. XXX XX XX XXX XX XX XXX XXX I 2. Location of bladder. XX XXX XX XX XXX XX XXX XTtX I TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CGRRICOLUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbooic Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-39) (D43) (056-63) (D42, 29) (04) 3. Voluntary and reflex action in release of urine from the bladder. III 4. Nervous and muscular mech anisms in the act of mic turition. III 5. Awareness of the need to void. II-A 6. Distention of the bladder. XX xx II-A 7. Less and re covery of blad- . II-A ■ der tone.' 3. Urine overflow. II-A 9. Prostatic gland: structure, func tion, enlarge ment. XXXX XX II-A Elimination of Bile Pig ments and Detoxification by the Liver. 1. Continuous excre tion of bile by 192 liver; amount produced; storage and con centration in gall bladder. XX XX XX XX II TABLE G. (CONT.) AXATOXY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - B Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-39) (D43) (DS6-63) (042, 29} (04) 2. Components or bile; fat emal- sification. XXXXX III 3. Detoxification by the liver. XXX III Elimination of Car bon Dioxide in the Lungs 1. Carbon dioxide carried to lungs in vari ous forms. X X X x XX X X XX XXX II 2. Partial pres sure of car bon dioxide in alveoli .less than that in venous blood; carbon dioxide release and diffusion in alveoli; ex halation. XX X XX X XX XXX II Enzymes and Hormones Enzymes 1. Enzymes de fined as or 193 ganic cata- . 4 lysts; pro duction de pendent upon nutrition and metabolic pro- . cesses. XX XX XXX XXX X XXX XXX TABLE 6. (CONT.) AXATOXY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3, CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- ■ Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (032-37) (043) (D56-63) (038-39) (043) (DS6-63) (042. 29) (D4) 2. Body processes which involve enzymes. X X X XX X XXX XX XX Hormones 1. Hormones de fined as chemi cal regulators produced by the endocrine glands? hormones affect ing digestive processes; trans portation by the blood. XX XX X XX XX XXX XX XXX I 2. Location of pituitary se cretions of anterior and posterior pitu itary lobes. X X X XX X XX XXX XX XX 3. Location and secretion of thyroid gland. XX X X XXX XXX X XXX .XX IX 4. Location of parathyroids; calcium and ■ phosphorus metabolism affected. X X XXX XXX X XXX X II 5. Location of 194 adrenals; secretions o f cortex and medulla. X X x XX XX X XX X II TABLE 6. (COOT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUH MATERIALS______CURRICULUM MATERIALS______Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Suoolement Study (D32-37) (D43) (D56-63) (033-39) (043) (OSS-63) (D42, 29) (D4) 6. Pancreas an exocrine and endocrine gland; in sulin. XXX XXX XXX XXX XXX XXX XXX I Temperature Re gulation 1. Optimal temp erature; variations. X X X XX XX II-A 2. Functioning of body cells in extreme body temparatures; ability of cells of cen tral nervous system to function. X XX II-A 3. Temperature; heat produc tion, distri bution, loss. X . XX XX X II-A 195 § TABLE 6. (CONT.) a :;ATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-39) (D43) (D56-63) (D42, 29) (D4) 4. Regulatory center in hy pothalamus; vasoconstric tion, sweat gland activity, construction of arrector pili muscles; temp erature varia tions in the infant; ac tions of toxins and other chemi cal sub stances. XX III Sleep and Rest 1. Amount of sleep re quired; sleep patterns learned. XX XX XX XXX XXX XXX I 2. Metabolic rate during sleep; deep sleep more restful than light. XX XX XX XXX XX XXX I 3. Metabolic rate and the func tioning of various sys 196 tems; effect of muscular activity. XX XX XX XX XXX XXX XXX TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 3 Guide Natl. Study Supalement Study (D32-37) (D43) (D56-G3) ID38-3S) (D43) (D56-63) (D42, 29) (D4) 4. Reducing body demands to in crease response to stress. XX XX II-A S. Energy required either to re spond to a stim-- ulus or repress a response. XX III Factors that interfere with II sleep and rest. XX XX XXX 7: Sleeplessness accompanied by restlessness, hyperac tivity, and muscular III tension. XXX Normal fatigue after strenuous work; restora tion or abil ity to work ar.d feeling of II well-being. XXX XXX X XX XXX XXX 9 . Muscle fa tigue from continuous contraction II of muscles. XXX XXX XXX XXX TABLE 6. (CONT.) a n a t o m y a n d PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General 'Textbook Education Curriculum Textbook Education Curriculum Textbook and Textboak- Classifi Series Curriculum Materials- Series Curriculua Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (032-37) (043) (056-63) (D38-39) (D43) (056-63) (042, 29) (04) Locomotion General Consider ations 1. Basic tissues and functions of the skele ton; factors determining movement at articulations; characteris tics of free ly movable joints; bursae. E X XX X X X XXX XX 2. Nature of bone; developmental changes in bone; factors in bone pro duction, growth, repair; effects of pressure, stress, weight bearing, dis use. X X XXX XX XXX IZ 3. Movement through mus cles; struc ture of mus cles, attach ment to bones. XXX XXX XXX XXX X X X XX X XXXXX 198 TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC T O ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Hcalth State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook* Classifi Series Curriculum Katerials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - f Guide Natl. Study Supplement Study (D32-37) (043) (D56-63) (D38-39) (D43) (056-63) (042, 29) (04) 4. Muscular con tractions: oxi- dat ion-reduc- tior. reactions in muscle fi bers; fre quently re peated “all out" contrac tions; violent contractions; nervous con trol, clonus; tetany; co ordinated ac tion of agonist and antagonist muscles in posi tion change. XX XX XX XXX XX II 5. Cerebral control of motor func tion; limited voluntary con trol by infant. XXX XXX XXX XXX XXX XX II 6. Passages of motor fibers to medulla and scinal cord. XX XX XX XX II Passage of motor fibers from medulla down spinal cord to an terior horn call. X X’ XXX XXX III 661 TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7-8, Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (038-39) (043) (056-63) (042, 29) (04) 8. Relationship between posi tion of mus cle innervat ed and level of origin of lower motor II -neuron. XXX XXX XXX 9. Brachial and lumbosacral plexuses. XXX III 10. Superficial nerves in the lower extremi II-A ties. 11. Functions of cerebellum. XX XX XXX I 12. Role of pro prioceptors in musculo - skeletal sys tem: trans mission to the brain. XXX XXX -XXX XXII 1 3 . Reflex mech anisms govern ing relative positions of head, trunk, limbs; re ception and transmission 200 ofimpulses. XX XX XXX II TABLE 6. (CONT.) ANATOM? AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CCRRICUI MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Katerials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D36-39) (D43) (D56-63) (D42, 29) (D4) Facts about Speci fic Bones, M u s cles,* Joints 1. Bones of upper ex XXX II tremity. XX XX II—A 2. Shoulder joint. XXX XXX 3. Muscles that originate on the trunk and insert on the shoulder XX II-A girdle. 4. Muscles that originate on the trunk and shoulder girdle and insert o n the XX II-A humerus. 5. Elbow joint XX XXX II and muscles. X XX 6. Wrist joint XX II-A and muscles. X 7. Joints be tween the metacarpal and carpal XX II-A bones. 201 8. Joint between the metacarpal and phalangeal XX II-A bones. TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Hcalth State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Secies . Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (DS6-63) (D38-39) (D<3) (D56-G3) (D42. 29) (D4) 9. Joints between the phalanges. XX II-A 10. Anatomy of vertebral column. XXX XXX XXX II 11. Spinal curves. X XX II-A 12. Fixation mus cles of the spine. II-A 13. Muscles ori ginating in pelvic girdle and inserting on the ribs. II-A 14. Muscles ori ginating on vertebrae and shoulder girdle and inserting on posterior skull. II-A 15. Muscles ori ginating on temporal bone and cervical spine and in serting on clavical and r ib cage. II-A 202 TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO . ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 3 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-39) (043) (D56-63) (D42, 29) (D4) IS. Bones of the lover extrem ity; relaxa tion of liga ments of pelvic girdle in preg nancy. XX XX X XX II 17. Hip joint. XXX XXX XXX XXX II 18. Muscles ori ginating on vertebrae a nd pelvic girdle and inserting on femur. X X II-A 19. Knee joint. X XX XX X II-A 20. Muscles ori- nating on pel vic girdle or femur and in serting on tibia. X X X X II-A 21. Ankle joint. X X X X II-A 22. Tarsal and meta tarsal artic ulations. XX II-A 23. Metatarsal and phalangeal articulations. XX II-A 24. Intcrphalangeal 203 joints of the foot. XX XX XX II 25. Arches of the foot. X X XXX II-A TABLE 6. (COOT.) ASATOKY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-S3) (D38-39) CD43) (D56-63) (D42, 29) 26. Major muscle groups II-A Posture 1. Characteristics of good posture. XX XXX XXX XX II 2. Dorsal recum bent posture. XX X XX X XXX II 3. Supine posture. X X X X X XXX II-A 4. Side lying posture. X XXX II-A 5. Functional hand position. II-A 6. Functional position of the foot. X XXX II-A 7. Contraction of spinal mus cles fcr erect posture a re flex mech anism; loss of the reflex II-A mechanism. 8. Relationship of posture to emotional XXX II status. XXX XXX TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 ■ Guide Natl. Study Supplement Studv (D32-37) (D43) (D56-63) (D38-39) (D43) (D56-63) (042, 29) (D4) Bones, Muscles, and Fluid That Protect and Suanorc 1. Functions of skull. XX XX XX XX XXXXX II 2. Suture lines; closure of suture lines. XX XX XXX II 3. Cerebrospinal fluid; pro duction; cir culation; ab sorption; amount; func tion. XX II-A. 4. Structure and functions of vertebral column; re lationship to spinal cord. XX XXXX II 5. Thoracic cage: structure; contents; rib movement in breathing; ori gin of diaphragm. XXX XXX XX XXX II. 6. Pelvic girdle; 205 contests of true pelvis. XX XX XXX .. II TABLE 6. (COST.) ANATOMY AMD PHYSIOLOGY CONTEXT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Secies Curriculuia Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (032-37) (043) (056-63) (D38-39) (D43) (056-63) (042, 29) (D4) 7. Anatomy and functions of abdominal muscles. II-A 8. Muscles of the pelvic floor. II-A 9. Action of the abdominal mus cles in vari ous body ac tivities. II-A Skin and Mucous Membrane The Integument 1. Skin as the largest organ of the body; entire body surface en veloped; con tinuous with epithelium of external orifices. XX XXX XXX XX XXX XXX XX X I 2. Functions of healthy skin. XXX XXX XXX XXX XXX XXX XXX X I 3 . Skin compos 206 ed of two lay ers: struc tures of der mis and epi dermis XXX XX XX XXX XX XX XX TABLE 6. (CONT.) AXA70XY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS______CURRICULUM MATERIALS Health State Health Health - State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education - Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7.- 8 Guide Natl. Study Supplement Study 032-37) 043 ) 056-63} 038-39) 043) (056-63) 0 4 2 , 29) (D4) 4. Nature of the skin deter mined by keratinized epidermis and secretions; production and functions of various secre tions; effects of rubbing and pressure; nat ure of epi dermis of XXX XX II children. XXX XXX 5. Melanin pro XXX XXX II duction. XXX XXX 6. Factors af fecting re sistance to II-A injury. 7. Cutaneous vascular re sponses to XXX III injury. 8. Skin tem perature related to II.' blocd flow. XXX XXX XXX XXX 9 . Physiologic skin re 207 action de pendent upon sensory per ception and vasomotor XXX II activity. XXX XXX TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY COSTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING4 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education. National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (038-39) (043) (056-63) (D42, 29) (04) 10. Decrease in sensation due to pro longed cold ness. XXX III 11. Adaptation of sensory re ceptors to prolonged heat. III 12. Itching: sites; causes; the scratch reflex. III 13. Production of nails. XXX XXX XXX XXX xxx II 14. Development of hairs; structure of hair folli cles. XXX XX xxx XX II Mucous Membrane 1. Respiratory, gastro-in- tcstir.nl, and genitourinary tracts lined with mucous membranes.- XXX XXX XXX xxx II 2. Functions of healthy mu 208 cous membranes. XX XX XX II TABLE 6. (CONT.} ANATOM* AND PHYSIOLOGY CONTENT BASIC 70 ELEMENTARY LEVEL SECONDARY LEVEL NURSING1 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Katerials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-39) (D43) (056-63) (042, 29) (04) 3. Functions of mucus. xxx XXX XXX X XI 4. Effects of mucous m em brane irri tation. X X III 5. Nature of mu cous membrane lining of mouth; under lying struc ture; glands and glandular secretions. XX XX XX X XI 6. Lubrication of vaginal lining through mucus frcm cer- . vix; acidity due to fermen tative action. XI—A Inflammatory Response and laaunrty 1. Body's pri mary defense mechanisms. XXX XX xxx XX II 2. Acquired 209 immunity. xxx xxx xxx xxx II TABLE 6. {CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* C u r r i c u l u m m a t e r i a l s CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education Mational cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Suoplement Study (D32-37) (D43) (D56-63) (D38-39) (D43) (D56-63) (D42, 29) (D4) 3. Species, racial, and individual differences in ability of bedy to re sist injury. XXX II-A 4. Less resis tance for in dividuals at extremes of age. XX II-A 5. Basic purposes of inflammation. xxx X XX II 6. Inflammatory reaction to local injury. XX XX X X III 7. Mobile in flammatory cells and white blood cell phenom ena in inflam mation. II-A 8. Leukocytes: number; pro duction. XX XX II-A 9.. Lymphoid 210 tissue: loca tions; func tions. XX XX XX II-A 10. Reticulo endothelial system. III ( TABLE 6. (CONI.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education ' Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl..Study Supplement Study (D32-37) (D43) (056-63) (038-39) (043) (D56-63) (D42, 29) (04) 11. Antigen- antlbody phenomenon. XX XX XX xxx XX XX Physical Discomforts 1. Pains stim uli; regions supplied pri marily by pain fibers; sensi- ■ tivity of n u s - . clcs and ten dons; adapta tion; toler ance. XX X II-A 2. Kinds of pain. X II-A 3.' Relative in- ' sensitivity of viscera; causes of visceral pain. III 4. Manifestations of visceral irritation. III 5. Reception and transmission of a painful vis ceral' stimulus to the thala 211 mus. XXIII TABLE 6. (COOT.) ANATOMY a n d PHYSIOLOGY CONTEXT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sox Education National cation Guide Natl. Study Gr. 7 - B Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D30-39) (D43) (D56-63) (D42, 29) (D4) 6. Reception and transmission of a painful cut aneous or deep stimulus to the thalamus. XX III 7. Pain perception at the level of the thalamus. III 8. Transmission of a painful stim ulus from the thalamus to the cerebrum. XX XX III 9. Perception of the irritation of the axon or dorsal root of a nerve fiber. III 10. Absence of pain receptors in brain tissue. xxx xxx II 11. Hypersensi tivity of sense per ception ' cen ters for pain as a result of' repeated stim ulation. Ill 12. Attitudes to 212 ward pain and sensitivity. III TABLE 6. (CONT.) ANATOMY ASD PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook” Classifi 'Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement • Study (032-37) (D43) (D56-63) (D38-39) (043) (056-63) (042, 29) (D4> 13. Pain dependent upon percep tion and per sonal reac tion. XX III 14. factors that affect per sonal reac III tion to pain. 15. Effects of unpleasant organic sen XX III sations. Sensory Processas (Excluding Pain)~ Vision Shape and posi tion of the X eye. xxx xxx xxx xxx xxx xxx xxx 2. Kali of eye ball com posed of ... three lay ers: com ponents of . . tiver“y«;. XXX XXX X XXX xxx XX xxx xx I 3. Contents of 213 ofetheVeye. XXX XXX * X XXX XXX XX xxx I TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSIXGa CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- , Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (043) (056-63) (D38-39) (D43) (D56-63) (D42, 25) (D4) 4. Conjunctiva, eyelids? eye lashes; meibo II mian glands. X XX XX XX 5. Nature and function of tears? tear ducts; re flex move ments of eyelids; tear drain age through the nose; corneal stim ulation and tear produc tion; salt concentra tions irri tating to XX X XX I the eye. XX XX XX 6. Cornea; pain fibers; II-A blood vessels. 7. Eyeball; II-A blocd supply. 8. Intraocular fluids; pro duction; drainage, XII pressure. X 214 9. structure of optic nerve; op xxx xxx XX IX tic disc. XX xxx TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSINGa CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Katl. Study Gr. 7 - B Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (D38-39) (D43) (056-63) (D42, 29) (D4) 10. Course of optic nerve to brain; cor relation of eye movements in the mid- brain; per ception of light in the visual cortex; interference with parts of the optic nerve; "con scious vision.’ XX XX XX II 11. Opening and closing of the eye. XX XX XX XX XX I 12. Refraction: adjustment of pupil size; accommodation. XX XX XX XX XXX XXX X 13. Retinal stim ulation b y - light and mechanical means. XXX II-A 14. Glare: ef fect on vis ual acuity; eyestrain; squinting to reduce glare. XXX XXX II—A 215 15. Factors af fecting need for illumina tion. II-A TABLE 6. (COST.) ANATOMY ASB PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education S c ie n c e General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (DS6-63) (D38-39) (D43) (DS6-63) (D42, 29) (D4) 16. Extrinsic eye muscles: con trol; develop ment of asso ciated move ment; assoc iation with vestibular apparatus. X X X X X X X III 17. Binocular vision im portant for depth per ception and visual field. XX XX XX II Hearing 1. General func tions of the ear; anatomy of outer, middle, and inner ear. XX XX X XXX XX X XX X I 2. Transmission of sound waves; lessened move ment or the ossicles in - old age. XX XXX " X XX XXX X XXX XX 3. Fatigue and nervous irri tability from 216 continued audi- ‘ tory stimule- tion. ■ X** III TABLE 6. (CONT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING4 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Series Curriculum Materials- Series Curriculum Materials- Sex Education National catica Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32r37> (D43) (D56-63) (D33-39) (D43) (D56-G3) (042, 29) (04) 4. Route of the ccchlcar divi sion or the acoustic nerve: conscious per XX II ception. XX XX 5. Hearing gen erally last sense to be lost; loss of con sciousness. III 6. Labyrinthine stimulation the primary factor in motion sick ness; vomit ing center. XX XXXXIII 7. Effect of quick cool ing or heat ing of fluid in semicir cular canals. III Superf icial Touch and Pressure 1. Sensation of touch and pressure through stim 217 ulation of end organs. XXX ' X XXX XXX X XXX XXX II TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health state Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classic! Series Curriculum. Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guida Natl. Study Supplement Study (032-37) (D43) (D56-63) (D38-39) (D43) (D56-63) (D42, 29) (D4) 2. Transmission of touch and pressure im pulses to the brain. III 3. Cerebral lo cation of pressure and touch per ception. XXX XXX XXX XXX II Heat and Cold 1. Heat and cold receptors in skin and mu cous membrane; fewer recep tors in mu cous membrane. XX h -a 2. Route of sen sory impulses for heat and cold; con scious per ception in the cerebral cor tex. XX XX XX XX II 'Taste and Smell 1. Location of olfactory end organs; sensitivity to chemical stin-.ilatio.-i. XXX XXX XXX XXX XX TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY CONTEXT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL SUBSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi- Sesie3 Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (056-635 (038-39) (D43) (D56-63) (D42, 29) (04) 2. Route of ol factory im pulses; con scious per ception in the cere bral cortex. XXX XX XXX XX XXX XXX 3. Location of taste buds; sensitivity to chemical stimulation. XXXXX XXX XXX X X XXX XX 4. Route of taste impulses; con scious per ception in the cerebral cortex. XXXXX XXX XXXX XX 5. Decrease in number of taste buds with age. . II-A 6. Smell more acute than taste. II-A Cocnlt ion.. Memory. Association of Ideas 1. Cortical gray matter as chief organ of psychic life in man. XXX XXX XXX XXXXXX XXXXXX TABLE 6. (CQNT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CUaRICULUi-1 MATERIALS Health ' State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education S c ie n c e General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook* Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 3 Guide Natl. Study Supplement Study (D32-37) (D43) (056-63) (D3S-39) (D43) (D56-63) ( M 2 , 29) (04) 2. Mental capac ity as a func tion of cortex as a whole; quantity prob ably more im portant than specific loca tion. xix 3. Intelligence dependent u p on knowledge through sen sory proc esses; stim uli perceived a nd stored as memories in the cere XXX XXX XXX II bral cortex. XXX XXX 4. P e r c e p t io n XXX XXX XXX I defined. XXX XXX XXX S. Organiza tions of in ternal and extarnal stimuli into a meaningful whole a de terminant of X XX XXX XXX II behavior. XX XX 6. Changes in be havior based on 220 changes in cen tral nervous XXX XX system. X X XX XXX TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING1 CURRICULUM MATERIALS' CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study 'Supplement Study (D32-37) (D43) (D56-63) (038-39) (043) (D56-63) (042, 29) (D4) 7. Location and function of association areas of the cerebral cor II tex. XX XX XXX XXX XX 8. Prefrontal lobes and highly as sociative abstract thought and XX XX X emotions. XX XXXXX XXX XXX 9. Gradual de velopment of mental fac XXX II ulties. XXX XXX XXX Speech 1. Larynx, mouth, throat, lips, tongue in vocal sound II production. XX XX XXX 2. Sensory and motor aspects XXX XX II of stecch. XXX 3 . Involvement of cerebral cortex as a whole in speech; loca tions of cen XX III ters. XXX TABLE 6. (COOT.) ANATOMY AND PHYSIOLOGY CONTEST BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS______CURRICULUM MATERIALS ______Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook" Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (038-39) (D43) (D5G-63) (042, 29), (04) 4. Development of speech in childhood. X XXX III Reproduction . Female 1. Locations and functions of internal and external organs of reproduction. X XX XX X XX XXX XX XX X 2. Secondary sex charac teristics. X XXX XXX X XXX XXX XXX XX I 3. Effects of gonadotropins produced by the anterior pituitary. X XX XXX X XXX ir - 4. Ovulation, for mation of cor pus iuteua. X X XX X XXX XXX X • XXX ii 5. Functions of estrogen. • X XXX XXX X . XXX ii 6. Production and func tions of pro 222 gesterone. ' .X X XXX XX xi TABLE 6. (COOT.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health . Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Haterials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (056-63) (038-39) (043) (056-63) (042, 29) (D4) 7. In case of unfertilized ovum, de crease of hormones and menstruation. X XX X XX XXX XX XXX ZZ 8. Menstrual cycles usual age ranges for o n set and cessa tion; length, of cycle; time of ovulation; amount -of dis charge; common symptoms; fac tors causing interruption. X XX XX X XXX XXX XX XX I 9. Normal vagi nal dis charges. X XXX XXX II-A • 10. Menopause: usual age ' range; symp toms; atrophy of reproductive organs; psychic changes. X XX XXX XX X XZ •- Kale 1. General func tions of re 223 productive o r g a n s . X XX- XX X XXX xxx XXX xxx TABLE 6. (CONT-) ANATOMY AMD PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING3 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health K.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Katerials- Sex Education National cation Guide Natl. Stud/ Gr. 7 - 3 Guide Natl. Stud/ Supolement Stud/ (D32-37) (D43) (D56-63) (038-39) (D43) (056-63) (IW2, 29) (04) 2. Anatom/ and functions of testes and surrounding XX II tissue. XX XX 3. Anatomy and location of seminiferous tubules and II epididymus. X XX xxx xxx 4. Anatomy and location of XI vas.deferens. X X xxx xxx 5. Anatomy, loca tion, and func tion of seminal II vesicles. XX xxx xxx 6. Anatomy, loca tion, and func tion of ejacu- II latory ducts. XX xxx xxx 7. Anatomy, loca tion, and func tion of pros II trate gland. XX xxx XX 8 . Anatomy, loca tion, and func tion of bul bourethral II glands. XX xxx XX TABLE 6. (COST.) ANATOMY AND PHYSIOLOGY CONTENT BASIC TO ELEMENTARY LEVEL SECONDARY LEVEL NURSING4 CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classifi Series Curriculum Materials- Series Curriculum Materials- Sex Education National cation Guide Natl. Study Gr. 7 - 8 Guide Natl. Study Supplement Study (D32-37) (D43) (D56-63) (038-39} (D43) (D56-63) (042, 29} (D4) 9. Anatomy o£ penis; en gorgement of cavernous tissues under cerebral and spinal stim uli. X XX XXX XX II 10. Introduction of semen Into femal repro ductive tract. X XX XXX xxx II 11. Components of semen. X XX xxx xxx X II 12. Secondary sex characteristics. XXX xxx XXX xxx xxx xxx ■ II 13. Anterior pitu itary hor mones. XX xxx II-A 14. Adrenal cor tex andro gens. XX xxx II-A 225 TABLE 7. MICROBIOLOGY CONTENT BASIC TO NURSING IDENTIFIED IN SELECTED ELEMENTARY AND SECONDARY SCIENCE AND HEALTH CURRICULUM MATERIALS; RELATED CLASSIFICATION OF CONTENT ITEMS M C PO B ToroG Y row TERT B A sre ELEMENTARY "LEVEL SECONDARY LEVEL TO NCASI.^ BASIC CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health ' Health State Health H.5. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbook- Classi- Series Curriculum Materials- Series Curriculum Materials- sex Education National fica- Guide Natl. Study Gr. 7 -8 Guide Natl. Study Supplement Study tion (D32-37) (D43) (D56-63) ■ (D38-39) (D43) (DS6-63) (M2, 29) (D4) Microorganisms 1. Microorganisms, harm- * A 1 css and pathogenic.1* XXX? XXX XXX XXX IT 2. Microorganisms as c a u se s o f a l l commun icable diseases. XXX XXX X XXX XXX XXX Z 3. Infections caused by dis case-oroducing microorganisms. XXX X XXX XXX XX ' II 4. Protozoa as micro scopic animals; some protozoa disease- producing. XXX XXX XXX XX ■ 5. Typos of disease- producing microscopic plants; forms of bacteria; rata of -bacteria reproduction. XX XXX X XXX XI aAs identified in the University of Washington school of Nursing “Curriculum Study in Basic Nursing Education" and outlinc-d in; Kadclyn T. Xordmark and Anne W. Rohweder, S cientific Foundations of Nursing. 2nd ed. Philadelphia: J. E. Lippir.cott Co., 1967. * bPhrases in this column indicate the content of items from Kordmark and Rohweder in Chapter 20: “Microbial Injury". Since the original items vary in length from one line to more than one-half page, some items are considerably abbreviated in the table and reference to the original source is suggested. Sequence is the same as in the original. cThe following key is used to indicate extent of content identified by the investigator: XXX, sim ilar coverage; XX, m ajority of item content covered; X, some coverage of item content. d 7he numerals in this column indicate the level associated with the item by the investigator on the basis of the 226 curriculum m aterials analyzed. Level I: commonly studied at the elementary level; Level IX: commonly studied at the secondary level; Level IX-A: degree of complexity sim ilar to that of Level XX items but inclusive of detail particularly pertinent to nursing; Level XXI: commonly studied in advanced high school or post-secondary science courses. TABLE 7. {COST.) ::rcHOiicLCGV c o s t s :? b a s i c ELSKEXTARY LEVEL 5EC0H3'.RY LEVEL t o ::uR3i::sa cuRzir.;Luy. materials . a.’R?.rCJ MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Ecuctzicn tctcr.ce Textb oo k. Education Curriculum Textbook Education Curriculum Textbook and 7e.<;cc;c- Classi- Series Curriculum Materials- Series Curriculum Materials- Sex Education Xsticr.sl :i ra Guide ' Sstl. Study Gr. 7 - 8 Guide Xatl. Stucv supolecor.r Scudv cier. (D 3 2 -3 7 ) (313) ( 3 5 6 - 5 3 ) (D3S-35) ( M 3 ) (355-63) ‘ (oil. 23) (Si) 6. Ultracicroscopic forms: rickettsia and viruses. XX xxx xxx XI 7. Resistant spore production by aone bacteria. xxx xxx 8. Mobility of bacteria ana protozoa xxx xxx IX £g 1. Most pathogenic organ isms acscphilic; effects of temperature. XX XX xx xxx xxx 2. Microorganisms' need of moisture; effect of aiyir.g. XX XX xxx xxx xxx 3. Microorganisms* need of organic food; effect of fr"cdom from organic materials. XXX xxx xxx xxx 4. Effect of ultraviolet lignt upon sicro- drg-r.iscs, XX xxx xxx XI 5. Effect of some chemicals upon micro organisms, XX xxx xx xxx S. Sterilization defined; 227 general methods of sterilization. XX XX XX XX xxx 7. Disinfection defined; common methods of disinfection. XX XXX XX XXX xxx xxx TABLE 7. (COKT.) MXCROLIGLCGY CCHTEHT BASIC' SL3X3XTASY LEVEL SSCCEOAHY LEVEL t o x o R s i::c a CCRRICuZX'X MATERIALS ein»9r~JLEM m a t e r ia l s H e a lth State Health Health State Health H.S. Health b i o l o g i c a l E d u c a tio n Health Education Education Health Education E d u c a tio n Science Cmcral T e x tb o o k Education Curriculum Textbook Education Curriculum Textbook and leX rC C C k— CI e SSI— S e r ie s Curriculum M aterials- Series Curriculum Katerials- Sex Education national fict- Guide Xatl. Study Cr. 7 -8 Guide Xatl. Study Suuolamt.tt S tu d y t i t n ( 0 3 2 - 3 7 ) (043) (D5G-S3) (235-13) (043) (056-53) (0 4 2 . 2 5 ) iE4 8. Bactcriostasis defined; gwr.f ta l methods of - bactcriostasis. XX XX xxx II 9. Factors involved in methods of steriliza t i o n . X XXXX xxx i i - a Source* of Sinease- Proonci.ro Mi.croornar.isns 1. Discharge of living organisms by a person or animal as the major source of communicable disease; carriers defined. XX xxx XX xxx xxx xxx 2. Bacteria normally pre sent or. body surfaces as - a cause of infection. X IX—A Transf.-r of Microorganisms 1. Modes of direct transfer of microorganisms. XXX xxx xxx xxx xxx xxx xxx 2. Kvics of indirect trans fer of microorganisms. XXX xxx XXX' xxx xxk xxx 3. Factors which determine • th e !-.r,de o f t r a n s f e r o f comaunicable diseases. XXX xxx xxx xxx xxx xxx Some Pathogenic Bacteria (basic Facts) 228 1. Salmonella typhosa. X XX X IX-A 2. Other species of Salmonella. X II-A KICr.OEIClOCY COSTEXT BASIC e l z m e h t a r y l e v e l SSCOHEARY LEVEL TO KC&SISC* ccaaicciiiH m a t e r i a l s CL'RRrcL'LVT’ MATERIALS Health state Health Health State Health H.S. Health Eioicgicr Education Health Education Education Health Education Education Science Textbook Education Curriculum Textbook -Education Curriculum Textbook and Textbook II* H Series Curriculum Materials- Series Curriculum Materials- Sex Education Maticr.nl Guide Eatl. Study Gr. 7 - 8 Guide Xatl. Study Suocleoent Etude 032-375 043) 056-53) 038-39) 043) 035-53) (S42, 2-5) 04) 3. Species of Shigella causing dysentery. X X I I —A 4. Vibrio coma. X X I t - A 5. Species of the genus 3 r u c e l l a . XX XX II-A 6. Pasteurella tularensis. II-A 7. Pasteurella pestis. II-A 8. Kemophillus pertussis. X X XX X II-A 9. Corr.obacteriuia diphthcriae. X XX X X I t - A 10. Xeisseria neningitides. XX II-A 11. Xeisseria gonorrhea. XX XX XX XI—A 12. Diplococcus pneumoniae. XX XX. II-A 13. Species of Streptococci causing scarlet fever, septic sore throat, upper respiratory in fections, erysipelas, and puerperal fever. X • X II-A 14. Staphlococcus aureus. X X II-A 15. Clostridium botulinum. XX xxx XI-A 15. Clostridium tetani. XX X n - A 17. Species of Clostridium causing gas gangrene. XX XI-A 18. Mycobacterium tubercu l o s i s . xxx XX XX XI-A TABLE 7. (COKT.) m ic r e -u o l c s e c g x t e e t b a s ic e l z m e h t a r y l e v e l s e c o h e a f .y l e v e l TO ECRSIHG® c u r r ic u l u m m a t e r ia l s uiTSP.iit-S H e a lth S t a t e Health Health S t a t e Health H.S. Health 3iolcric.il E d u c a tio n Health Education E d u c a tio n H e a lt h Education Education Science Gi: «il 4 I Textbook Education C u r ric u lu m * exti.oo4v Education Curricu.ua Textbook add T e x tb o o k - C l. S e r ie s Curriculum Haterials- Series C u r ric u lu m Haterials- Sex Education Eatitr.il ='i Guide Katl. Study C r . 7 - 8 Guide Uati. Study Supplement Study t i : C £>32-37) (D 4 3 ) (D 5 S -5 3 ) 0 3 6 - 3 9 ) (D43) 055-63) tbil, 23) 0 4 ) 19. Mycobacterium leprae. II-A 20. Treponema pallidum . XX X" I I - A 21. Species of Borrelia ar.d i'uschacteriud causing Vincent's stom atitis, gingi v itis . and angina. II-A Sore Pathogenic Rickettsia 1. Rickettsia, obligate parasites of some arthropods. XXX II-A 2. Transmission of Rickettsia, xxx II-A 3. Reservoirs of epidemic typhus, Rocky Mountain spotted fever and Q f e v e r . XX II-A Sent Pathooenic Viruses tfcuwic facts) 1. Viruses, obligate intracellular para sites that cause specific communicable diseases and infec tions in many tissues of the body following these diseases. XXXXX II 2. Virus of psittacosis. II-A 3. Virus of smallpox to and chicken pox. XXX II-A TABLE 7. (COST.) KICACilGLQClf COHTELT BASIC e l e k s :;t a ?.y l e v e l SECGhSARV LEVEL , TO suasisc"* cuamc-JU-K m a t e r i a l s CVRRTCULIi:-! MATERIALS Health State Health Health State Health H.S. Health Biolcricsl Education Health Education Education Health Education Education Science Ctr.eral Textbook Education Curriculum Textbook Education Curriculum Textbook ar.d Textrcok- Citsii- Scries Curriculum Materials- Series Curriculum Materials- sex Education Xatior.tl Guide Xatl. Study Gr. 7 - 8 Guide Satl. Studv Supoleoent Stuoy titr. (232-37) (D43) (255-53) (233-39) (343) (355-63) (342. 25) <34 > 4. Virus of herpes simplex. XX X II-A 5. Virus of rubeola. XX X XXX II-A 6. Virus of rubella. * X X X XXX II-A 7, Virus of infectious hepatitis. XX xxx xxx II-A 8. Virus of scrum hepatitis. xxx II-A 9. Virus of influenza. X XX xxx xxx xxx II 10, Virus of coscon cold. X X xxx xxx II-A 11. Virus of cusps. XX X xxx II-A 12. Virus of infectious mononucleosis. • X II-A 13. Virus of rabies. XX XX xxx II 14. Virus of poliomyelitis XX xxx xxx II-A 15. Virus of encephalitis. X II-A (E-j'lC i'.ictfl ■ • - .1. Unclcanliness and moisture factors in - fungus diseases. XX X 11-A 2. Saprophytic food- spoilage fungi. XX II-A 3. Dermatophyte fungi. X X II-A 231 4. Candida' albicans'. '• XI-A TA3LS 7. (COST.) KICAGcIOIjGCY CaSTEST SASIC ELEKCXTARY LEVEL SSCOHg Kr Y LEVEL 10 uv?ji::ca CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Scic-r.ce Gcr.eca Textbook Education Curriculum Textbook Education Curriculum Textbook and Textecck- Classi- Scries Curriculum Materials- Series Curriculum Materials- Sex Education Xaticr.il ri ee Guide Satl. Study Gr. 7 - 8 Guide Mail. Study Supplement Study rier. (032-37) (043) (356-63) (036-35) (343) (056-63) (342, 29) (34 / S. Histoplasaa capsulatum. II-A 6. Cocciaiodes ijnnitis. II-A Sore Fathetrenic Protozoa < ii-.slc i'.irts) 1. Endamcba histolytica. X X X II-A 2. Species of the genus Plasnodia. X XX XXXXXX II 3. Trichomonas vaginalis. II-A Sore Specific Helminths i\.rt> 1. Pi n wo rS3 II-A 2. Intestinal hookworms. xxx X II 3. Intestinal roundworms. II-A 4. Trichina worm. xxx XX II 5. Tapeworm. xxx X II-A Tr— * 1. Natural immunity. xxx . ■ xxx II 2. Specific antibodies. . xxx xxx II 3. Active immunity. xxx xxx II "4. Prolonged immunity ' attached to certain diseases. x II-A 232 S. little if any immunity developed with certain diseases. X II-A { TABLE 7. '(OORT.) MICROBIOLOGY COSTENT BASIC ELEMENTARY LEVEL SECONDARY LEVEL TO NURSING* CURRICULUM MATERIALS CURRICULUM MATERIALS Health State Health Health State Health H.S. Health Biological Education Health Education Education Health Education Education Science General Textbook Education Curriculum Textbook Education Curriculum Textbook and Textbooks Cl as si - Series Curriculum Materials- Series Curriculum Materials- Sex Education National fica- Gulde Natl. Study Gr, 7 - 8 Olide Natl. Study Supplement Study tion (D32-37) (043) (056-63) (038-39) (043) (056-63) (D42, 29) (04) • 6. Common antigenic biologicala. XXX X II-A 7. Common immunity tests. XX XX-A 8. Passive Immunity. XXX XX XI .233 TABLE 8. PHYSICS CONTEST BASIC TO HORSING IDENTIFIED IN SELECTED ELEMENTARY AND SECONDARY LEVEL SCIENCE CURRICULUM MATERIALS; RELATED CLASSIFICATION OF CONTENT ITEMS PHYSICS CONTENT BASIC ELEMENTARY LEVEL CURRICULUM MATERIALS SECONDARY LEVEL CURRICULUM MATERIALS TO NURSING3 Science Textbook Science Curriculum Science Textbook Physical Biological Series Materials Series Science Science General National Studies Textbook- Textbook- Classifi Naticnal National cation Study Study * (D32-37) (D48-52) (D6S-77) (D16-17) (D2) (D38-39) (D53-54) (D21J {D4> 1. Gravity, the force of attraction between two objects.b XXC- XX X X X XXX xxx n d 2. L aw o f gravitation. X X XX XX II 3. Weight, the attrac tion of the body by the earth. XX XX X X X XXX XXX II 4. Energy, the capac ity to do work; energy required dependent upon resistance. XX XX XXX X xxx xxx II 5. Pressure, force exerted on a unit area. X X X xxx XX XXX II 6. Pressure exerted by - liquids at rest. XXX X X II-A aAs identified in the University of Washington School of Nursing “Curriculum Study in Basic Nursing Education: and outlined-in: M-adelyn T. Wordmark and Anne K. Rohweder, Scientific Foundations of Nursing, 2nd ea., Philadelphia: J. 3. Lippincott Co., 19G7. ^Phrases in this column indicate the content of items from Nordmark and Rohweder under the “Physics-" sections. Since the original itens vary in length from one to eleven lines, some items in the table are considerably abbreviated -n the phrases in the table and reference to the original source is suggested. Sequence is the same as m tne original but repetition is eliminated. cThe following Key is‘used to indicate extent of contGnt identified by the investigator: JOCX, similar coverage; XX, majority of item content covered; X, some coverage of item content. In this table "X“ has beer, recorded .or some ^ iturns about which the respective curriculum materials do not present specific information but a general concept which is 234 basic to understanding the specific information. dThe numerals in this column indicate the level associated with the item by the investigator on the basis of the curriculum materials analyzed: Level I, commonly studied at the elementary level; Level II, commonly studied at the secondary level; Level II-A, degree of complexity similar to that of Level II items but inclusive of detail particularly pertinent to nursing; Level III, commonly studied in advanced high school or postsecondary science courses. TABLE 8. (CONT PHYSICS CONTENT BASIC ELEMENTARY LEVEL CURRICULUM MATERIALS SECONDARY LEVEL CURRICULUM MATERIALS TO NURSING* Science Textbook Science Curriculum Science Textbook Physical Biological Series Materials Series " Science - Science General National Studies Textbook- Textbook- Classifi- National National. cation Study Study (032-37) (D48-S2) (065-77J (016-17) . (D2) (038-39) (053-54) (021) (04) 7. Viscosity defined. XXX X II-A 8. Solubility of gases in liquid; effect of heat and pressure. X- XXX X X II 9. Atmospheric pressure, pressure of air . above earth; sea level pressure. X X X XXX XX X XI 10. Flow of liquids and gases from areas of higher to areas of lower pressure. X X X X X X X X XX 11. Effect of reducing space in which a gas is confined. X X X xxx xxx xx 12. Membrane permea bility. X XX X II 13. - Energy, capacity to do wo'rk; heat, a form of energy. XX XXX XXX X • xxx XXX XXX XXX XI 14'. Formula for nutri tional calorie. X XX X X XXX XX ■ XX II ,15. .Specific gravity: definition, formula. X X X XXX XXX II 16. Evaporation defined. . XX X XXX X XX XXX XXX XXX XXX I 235 17. Heat as "kinetic energy of molecules." XX * 'XX XX X XXX XXX XXX XXX XI TA5LE S. (CONT.) p h i s : c o n t e n t b a s i c ELEMENTARY LEVEL CORRIC'JLEM MATERIALS SECONDARY LEVEL CCRRICULUM KACZKI .'IS _:cs~ _* i u NuRSl..«* Science Textbook Science Curriculum Science Textbook Physical Biological Series Materials Series Science Science Central National Studies Textbook- Textbock- Clatsifi- National Katisr.nl Studv Study (D32-37) (D46-52) (065-77) (D16-17) (02) (D33-39) (053-54) (D21) (Di) 18. Heat: conduction; - radiation; convec ■ tion. XXX xxx X X X xxx xxx XX I 19. Friction as a means of changing mechan ical energy to thermal energy. xxx XXX X II 20. Force defined. X X X XX X XX XX X XXX I 21. Work, force acting through a distance. XX X X X X X X XXX XXX II 22. Torque defined X X X X XXX X III 23. Center of gravity defined; .location of center of gra vity in the human body. X III 24. Relationship of gravitational pull to force required for lifting as opposed to pushing . o r pulling. X X X xxx xxx II 25. Body in equili brium: position o f - center of gravity. X II-A 26. Sums o f forces and torques for a body ■ in equilibrium. X X II-A 27. Hooke's Law. xxx X X xxx XX II TABLE 8.-(COST.) PHYSICS CONTEXT BASIC ELEMENTARY LEVEL CURRICULUM MATERIALS- SECONDARY LEVEL CURRICULUM MATERIALS TO NURSING* Science Textbook Science Curriculum Science Textbook Physical ^XOlS^aCbl Series Materials Series Science Science ■ Ganeraj. National Studies Textbook- Textbook- Classic National National cation. Studv Study (D32-37) (048-52) (D55-77) (016-17). (D2) (D38-39) (053-54) (D21) (04) 26. Lever defined; ■ effect of shorten ing arm. XX xxx xxx II 29. Friction, force opposing motion between contacting surfaces; effect of surface irregularities. XX XX xxx xxx xxx 30. Light: a form of electromagnetic radiation. X xxx XX II 31. Factors affecting illumination. X xxx X II-A 32. Refraction of light defined. xxx xxx XX xxx xxx I 33. Effect of converg ing lens xxx xxx XX xxx XXX I 34. Origin and conduc tion of sound. xxx xxx xxx xxx xxx I 35. Pitch of sound defined. xxx XX xxx X xxx XX I 36. Intensity of sound heard as loudness. xxx XX xxx X xxx XX I 37. Transmission of pressure exerted o n a confined liquid. XX II-A to 38. Beat, a form of u energy; temperature, -o measure of intensity o f heat. XX xxx xxx xxx xxx xxx XX TABLE 9 CHEMISTRY CONTENT BASIC TO NURSING IDENTIFIED IN SELECTED ELEMENTARY AND SECONDARY LEVEL SCIENCE CURRICULUM MATERIALS; RELATED CLASSIFICATION OF CONTENT ITEMS CHEMISTRY CONTENT BASIC ELEMENTARY LEVEL CURRICULUM MATERIALS SECONDARY LEVEL CURRICULUM MATERIALS TO NURSING* Science Textbook Science Curriculum Science Textbook Physical Biological Series Matorials- Series Science Science General National Studies Textbook- Textbook- Classifi National National cation Study Study (D32-37) (D48-52) (D6S-77) (D16-17) (D2) (D3S-39) (D53-54) (D21) (04) 1. Immiscible liquids defined.® XC XXX X X XXX XXX IId 2. Crystallization of . plaster of Paris powder. _ XXX II-A 3. Shrinkage of sons plastic cast materials as they dry. XXX XX II-A 4. Composition of hemoglobin; oxy-hemo globin; chemical breakdown of hemoglo bin: chemical diges tion of hemoglobin. X X X X X X XX. II aAs identified in the University of Washington School of Nursing "Curriculum Study in Basic Nursing Education" and outlined in: Madclvn T. Mardnark and Anne W. Rohweder, Scientific Foundations of Nursing. 2nd ed., Philadelphia: J. B. Lippincott C o., 1967. b?hrases in this column indicate the content of item3 from Kordmark and Rohweder under the "Chemistry” sections. Since tko original itens vary from one lino to one-half page, some itesi3 are considerably abbreviated in the phrases in the table and reference to the original source is suggested.' Sequence is the same as in the original but repetition is eliminated. . . cThe following key is used to indicate extent of content identified by the Investigator: XXX, similar coverage; XX, majority of item content covered; X, some coverage of item content. In this tabic "X" has been recorded for some items abour'which the respective curriculum materials do not present specific information but a general concept which is basic tc understanding the specific information. For instance. Science Curriculum Improvement Studies materials present the concepts of interaction and systems which are basic to understanding chemical reactions of all kinds. ^Tne numerals in this column indicate the level associated with the item by the investigator on the basis of the curriculum materials analyzed: Level I, commonly studied at the elementary level; Level XI, commonly studied at the 238 secondary level; Level II-A, dogrec of complexity similar to that of Level II items but inclusive of detail particularly pertinent to nursing; Level III, commonly studied in advanced high school of postsecondary science courses. TABLE 9. (COOT.) CHEMISTRY CONTEXT SASIC ELEMENTARY LEVEL CURRICULUM MATERIALS SECONDARY LEVEL CURRICULUM MATERIALS Science Textbook Science Curriculum Science Textbook Physical Biological Series Materials • Series . Science Science General 'National Studies . Textbook- Textbook- Classifi National National cation Study Study (D32-37) (D4S-52) (065-77) (016-17) (02) (028-39) (053-56) (021) (04) 5. Percents of oxygen and carbon dioxide in the atmosphere. X X X. X XXX XXX XXX 11 6. Oxidation of carbon i and hydrogen in nutrients. X X XX X xxx XXXXX 11 7. Carboxyhemoglobin, product of combina tion of carbon monoxide and hemo globin. X X X . X XX XXXX 8. Enzymes, organic catalysts. xxx xxx - XX 9. Hydrolysis of food. XX X X xxx X X xxx XX • 10. Starch, a poly saccharide; hydroly sis of starch XX .X X XX X X xxx ■ XX r 11. Maltose, sucrose, lactose: disacchar- ides; hydrolysis of disaccaridcs. X X X X XX X X xxx XX 12. Esters of fatty acids and alcohols: lipids; hydrolysis of lipids; emulsification of , lipids; some simple . . lipids; some compound lipids; insolubility of lipids in Water; mineral oil, an 239 insoluble hydrocarbon. X r X X X XX X 'X XX" XX SEXISTS? COXTEOT BASIC ELSIffiNTARX LEVEL CUKHICOLGK MATERIALS CUKHICOLGK ELSIffiNTARXLEVEL BASIC COXTEOT SEXISTS? 13. Proteins, complex mole complex Proteins, 13. 15. Solution defined; water defined; Solution 15. 18. Dialysis defined. Dialysis 18. osmosis; of Definitions 17. 20. Electrolytes defined; Electrolytes 20. formation defined; Ion 19. in defined Diffusion 16. 14. Energy derived through derived Energy 14. MO ihn iis XX limits. within oyetds peptones, polypeptides, to hydrolysis nitro gen; containing cules mn cd. X acids. amino oin xx notion. consti in variation reactions biochemical soi rsue iso pressure; osmotic attraction of anions and anions of attraction negative and positive of X phospnocreatine. and diphosphate, physiological saline physiological solution; hypertonic cations to the Respec the to cations ieadngtv in. X ions. negative and tive solution. solution a of tuents solvent; commonest the adenosine triphosphate, adenosine gly cogen, glucose, involving scmipcrmeable nembranc; scmipcrmeable tive poles. tive ions; examples of posi of examples ions; em fmlcls in molecules of terms oi, hypotonic, tonic, 323} D65) DS7) D61) {32} (D16-17) (D6S-77) (D46-52) {332-37} Science Textbook Science Curriculum Science Textbook Science eis Materials. Series X • X X X X X XXX XX X X X X X X X X XXX X XX X X X XX X National Studies National ) □83} 035) D1 (D4) (D21) (053-54) {□38-39} cec etok hscl biological Physical Textbook Science X X XX II XXX X X XX X X XX X I I XXX II XXX XXX XXX XXX XX X X X XXX XXX X XX X XX II II X XXX XXX XXX XXX XXX S2COS3AR? LEVEL CCHKtCVLCX MATERIALS CCHKtCVLCX LEVEL S2COS3AR? eis cec Sine General Science . Science Series etok Txbo- Ciassifi- Textbook- . Textbook- ainl ainl cation National Kational td Stcdv Study III X X X III X ■ 240 TABU 9. (CONS.) CHEMISTRY CONTENT BASIC ELEMENTARY LEVEL CURRICULUM MATERIALS SECONDARY LEVEL CURRICULUM MATERIALS *0 NURSING Science Textbook science curriculum • Science Textbook Physical Biological! Series Materials Series . Science Scicnco General Rational Studies . Textbook- Textbook- Classifi- National National cation Study Study (032-37) (D4B-S2) (D65-77) (D16-17) (D2) (038-39) (053-54) (D21) (04) 21. Absence of appropriate enzymes for digestion of cellulose. X XXX XXX II 22. Fermentation defined; formation of carbon dioxide and hydrogen. XX XX XX X X XXX II 23. Putrefaction defined. X X X X X X XX II 24. Chemical breakdown of hemoglobin to form bile salts. - X XX X X X III 25. Exothermic chemical reactions defined. XX XXX X XXX XXX II 26. Rates of alcohol and water evaporation. TYV XXX XXX XX 27. Surface tension reduc tion by soaps and detergents; nature of soap. X XX II-A 28. Surface tension reduction an aid in fat emulsification. . XX XXX XI 29. Skin irritation by chemical compounds such as proteolytic • enzymes'. ■ X . 9 X X III 30. Body fluids such as . urine and sweat decomposed by micro .241 organisms to produce > irritating substances. X 7C X X X X X - III APPENDIX III SAMPLE NURSING CARE ANALYSES 242 INSTRUCTIONS FOR REVIEWING NURSING CARE ANALYSIS Attached is the description of an actual nursing care situation during a specific 24-hour period. Accompanying this description is an analysis which proposes: (1) Nursing activities indicated over the 24-hour period and a frequency for each activity; (2) Natural science understandings indicated as basic to the respective nursing activities. You are asked to review both aspects of the analysis and to identify components with which you seriously disagree. Guidelines Please review the analysis in terms of the following guidelines: (1) A nursing activity should be included if it is required in your conception of acceptable nursing care for the particular 24-hour period; the frequency designated should also reflect your conception of acceptable nursing care. (2) A natural science understanding should be included if it is basic to: (a) Knowing how to do the nursing activity (including special precautions, adaptations, etc.f and the use and care of equipment) in the particular situation described; (b) Understanding the general purpose(s) and significance of the nursing activity; or (c) Understanding the particular purpose(s) and significance of the nursing activity in. the situation described. (It is obvious that the various nursing activities would generally be performed by various kinds of nursing personnel orderlies, aides, practical nurses, technical nurses, professional nurses. However, please base your 243 244 considerations regarding the inclusion of natural science understandings upon the nature of the nursing activity in the^ particular situation described. Try not to be' Tnflu- enced by your expectations of the kind of nursing practi tioner you think would probably be performing the activity. That ist please base your considerations upon guideline #2 above.) Specific Instructions (1) It is suggested that you begin by reviewing the nursing activities proposed: (a) On the form provided, list additional nursing activities which you feel strongly should be included in the care of the patient during the 24-hour period specified; record the approximate frequencies you propose for the activities you add. (b) In the analysis itself, cross out nursing acti vities which you feel strongly are not indicated. (c) In the analysis itself, revise any frequencies with which you seriously disagree by crossing out the numbers which appear and inserting the approximate frequencies you propose. (2) After you have made the necessary decisions about the inclusion and frequency of nursing activities, review the natural science understandings proposed for each nursing activity (which you have not crossed out): (a) In the blank spaces to the right of the proposed natural science understanding in the analysis, list additional natural science understandings which yoii feel strongly are important in connec tion with the respective nursing activities. (b) Cross out those natural science understandings proposed in the analysis which you feel strongly are not indicated. (3) If there are comments you care to offer, please use the reverse side of the form provided for additional nursing activities. 245 Special Note It should be emphasized that the analysis is intended to be comprehensive only in terms of including activities which have bases in the area of the natural sciences. Thus some activities relating to the patient's psycho-social well-being are not included even though all such activities are recognized as integral components of the patient's nursing care. THANK YOU FOR YOUR ASSISTANCE 1 PLEASE RETURN BY February 14, 1972. 246 SAMPLE NURSING CARE SITUATION * Patient: Mrs. S. Reason for Hospitalization: Inter trochanteric fracture of left femur. Age: 85 Period Studied: 7:00 a.m. on the thirteenth hospital day to 7:00 a.m. on the fourteenth hospital day. Mrs. S. suffered her injury in a fall at home. Surgery was not undertaken because of the patient's general condition. Mrs. S. was a small, emaciated woman. Her daughter stated that she had "always" had a cough. The patient had been dyspneic and coughing productively since her admission. The impression on a recent X-ray was a chronic inflammatory process such as bronchiectasis or idiopathic fibrosis. An electrocardiogram on admission was within normal limits and a second one a week later showed sinus tachycardia and premature ventricular contractions. The urine contained Eschericia coli. Mrs. S. appeared dehydrated and was slightly anemic. She had no teeth or dentures. There was a tendency for her to assume fetal position of the legs and contractures appeared to be present although the family stated that the patient had been walking prior to her fall. Buck's extension was attempted shortly after admission but was not tolerated at that time. It was reapplied later and was in effect during the period studied. The traction was to be released periodically for position change. 247 For about two days prior to the period studied, the patient had been more dyspneic and alert and responsive only on occasion. Oxygen at four liters per minute was ordered and was being given by nasal catheter, A progress note on the day before the 24-hour period under study suggested the possibility of "small emoblization." 2000 cc of 5 per cent dextrose in normal saline was ordered for the day of the study. Mrs. S. refused her oral medications on the day under study (Furadantin, Fergon, and potassium chloride). The patient's family visited during the evening and stayed through the night. TABLE 10 SAMPLE NURSING CARE ANALYSIS AS ORIGINALLY DEVELOPED BY INVESTIGATOR FREQUENCY IN NURSING ACTIVITIES 24 HOURS NATURAL SCIENCE UNDERSTANDING INDICATED 1. Assess knowledge and skills of 3 All the understandings listed in this entire analysis except nursing staff available in terms of additional understandings listed fornursing activities .patient’s needs. Assign various #18 and #19. £2] aspects of nursing care accordingly. Also: (Anticipating consequences of possible "small embolization"} a. Basic anatomy and physiology of circulation. £2]c b. Basic anatomy and physiology of the central nervous system. £2] 2. Teach nursing staff member(s) on 3 Same as for nursing activity #1. £2] the basis of the above assessment. 3. Take temperature, pulse, and 4 (Choice of rectal temperature) £1] respirations. a. Oxygen introduced directly into the oropharynx lowers the temperature of the oral cavity. £1] aIn .this nursing situation, it is proposed that "quick observations" should be made frequently. These would include observing general appearance; apparent comfort; pulse; respirations; functioning of oxygen and intravenous set-ups, urinary catheter, and traction. These observations are not listed as separate activities since nursing personnel are in contact with the patient frequently for other pur poses and it is assumed that "quick observations" will be made in connection with the various other nursing activities. To account for the natural science understandings involved in making these obser vations, it is proposed that the understandings listed on pages 13 and 14 at the end of this analysis arc indicated in connection with every nursing activity in which there is patient contact. jj* Phrases in parentheses are inserted in this column to indicate the basis for including the natural science understanding(s) which follow. c Numbers in brackets to the left of nursing activities indicate classifications of Items in terms of ' the guidelines for sequencing natural science content which were developed as part of this study. These numbers did not appear on the analyses submitted for review. d Numbers in brackets to the left of nursing activities indicate classifications of nursing activities on the basis of natural science understandings indicated. These numbers did not appear on the analyses submitted for review. 248 TABLE 10. (Continued) (Purpose) b. Inflammatory processes are commonly accompanied by a rise in body temperature. [1] (Inserting thermometer) c. Gross anatomy of the rectum. Cl] d. Normal temperature range. [1] e. The temperature of a body cavity varies according to the blood supply and the extent to which it may be influ enced by external conditions. £1] (Care and cleaning of thermometer) f. Most substances expand when heated. Mercury has a rela tively large expansion per unit rise in temperature. £1] g. Microorganisms may be spread through contact with contaminated articles. [1] h. Removal of some microorganisms may be accomplished mechanically. [1] i. Destruction of susceptible microorganisms may be accomplished through the use of chemicals. [1] (Taking the pulse) 3. Relationship between ventricular contraction and the movement of the artery that is palpated. [1] k. Normal range of pulse rates. [1] 1. Factors which commonly affect the pulse rate. £1] (Taking the respirations) m. Gross anatomy and physiology of respiration. £1] n. Normal chest and abdominal movement on inspiration and expiration. £1] o. Normal range of respiratory rates. £l] p. Factors which normally affect the respiratory rate. £13 4. Give water, liquid feedings. 6 (Checking the ability to swallow) (In addition to water and a. Anatomy and physiology involved in swallowing. liquid feedings given by — Local anatomy and physiology. family in the evening and — Basic elements of central nervous system involvement £2] during the night.) in the swallowing process. [2J (Providing for nutrition) b. Role of water in the body. £1] c. Primary roles of the five basic groups of nutrients. £l] d. Nutrients present in common liquids. £l] e. Normal range of daily fluid requirements. £1] (Providing for comfort and proper position) 249 f. Very gross anatomy and physiology of the digestive system. £lj g. Basic elements of central nervous system involvement in the digestive process. £2] TABLE 10. (Continued) Bathe 1 (Prevent chilling) a. The amount of body heat is related to blood flow and insulation by subcutaneous fat. There is a tendency toward loss of subcutaneous fat and deterioration of vasoconstricting mechanisms in old age. [2j (Facilitating respirations during the bath procedure) b. Gross anatomy and physiology of the respiratory system. [1] c. Gross structures and locations of sweat and sebaceous glands. £1] d. Body secretions may be odorous. Cl] e. ‘Microorganisms are normally present on the skin and may break down body secretions and excretions to produce irritating chemicals. £2] (Judgment regarding frequency of bathing body parts) f. Sebum production generally decreases beyond middle age. Cl] (Massaging action) g. Massage stimulates circulation. [1] h. The circulatory process is commonly slowed in old age and inactivity. £1} (Moving the patient) j. Anatomy of the femur and hip joint. £2] k. Reduction of organic and mineral content in thebones in old age. Cl] (Body mechanics for the nurse) 1. Proper relationships of body parts to each other. Cl] m. Functions of muscles and tendons. Cl] n. Process of muscular contraction. C2] o. Meaning of gravity. [1] p. Meaning of center of gravity. C2] q. Principle of widening the base and lowering the center of gravity. C2] r. Protective preparation for lifting, moving, carrying (for protection of back, abdominal organs, pelvis). — Contraction of gluteal muscles — Contraction of abdominal muscles. C2] s. Use of leg muscles in combination with arm muscles in lifting. C2] t. Pushing, pulling, sliding, or rolling to avoid over 250 coming entire force of gravity involved in lifting. C2] u. Use of weight of body as a force for pulling or push ing. C2] v. Anatomy of spine and its anatomical relationship to the spinal cord and spinal nerves.' [2]- 10. (Continued) 6. Give mouth care 4 (Purpose) r2] a. The mouth receives may types of bacteria. [1] b. Food which remains in the mouth is broken down by these bacteria to cause unpleasant odors and tastes. Cl] c. Salivation provides for natural cleaning and germ- killing. In dehydration, salivation is decreased. [1] d. Adequate vitamin intake is essential to the health of mucous membrane. [1] (Avoiding aspiration) e. Anatomy and physiology of pharynx and trachea. [2] 7. Change linens (Preventing skin breakdown and irritation) C2] a. .Contact with rough surfaces results in friction which may breakdown cutaneous tissue. [1] b. Detergent ingredients may act as antigens. [2] (Preventing spread of microorganisms) c. Microorganisms may be transmitted through air currents. [1] (Turning the patient) d. Anatomy of the femur and hip joint. [2] e. Reduction of organic and mineral content in the bones in old age. CH (Body mechanics for the nurse) Same as in nursing activity #5, k through u. 8. Position; massage pressure 8 (Promoting good body alignment) areas. a. Basic facts about anatomical interrelationships among [2] nerves, muscles, bor.es, tendons. [2] b. Proper relationships of body parts to each other. Cl] (Promoting evaporation of dampness in skin surfaces) c. Fluids evaporate when exposed to air. Cl] d. Dampness causes maceration of skin' which predisposes to skin breakdown. Cl] (Preventing compression of blood vess'els, stimulating circulation) e. Blood vessels transport blood to and from body parts. Nutrients and oxygen are carried to the cells, waste products away from the cells. Cl] f. Movement and massage stimulate circulation. Cl] g. Pressure on a body part may deprive it of the material 251 it needs and, at the same time, produce congestion in f the part. Cl] (Promoting respirations, preventing hypostatic pneumonia) h. Gross anatomy of the respiratory system. Cl] i. Use of diaphragm and intercostals. [2] TAB 10. (Continued) (Preventing pressure on superficial nerves) j. Effect of pressure on nerves. [1] k. Superficial location of peroneal nerve as it passes around the neck of the fibula. Cl] (Turning, handling urinary reservoir) 1. Anatomy of the femur and hip joint. £2] m. Reduction of organic and mineral content in the bones in old age. Cl] n. A fluid flows from an area of greater pressure to one of lesser pressure. C2] 0. The pressure exerted by liquid in a reservoir varies directly with the height of the reservoir. C2] p. Microorganisms are spread through contaminated materials. Cl] (Maintaining proper traction) q. Principle of traction and countertraction. Cl] r.. Use of a fixed pulley to adjust direction of force. Cl] (Body mechanics for the nurse) Same as in nursing activity #5: k through v. 9. .Exercise joints through range (Maintaining immobilization of fractured femur) of motion. a. Anatomy of femur and hip joint. C2] [2] (Importance of exercise) b. Effects of muscular activity and inactivity. C2] (Carrying out exercises) c. Types of joints. C H d. Normal movement of each joint. C2] e. Reduction of organic and mineral content in the bones in old age. Cl] 10. Start intravenous infusion of (Purpose) 5% dextrose in normal saline. a. Role of water. [1] C2] b. General functions of sodium. C2] c. Function of glucose. Cl] d. Basic cellular anatomy. Cl] e. Basic facts about osmosis and diffusion. [2] f. Basic anatomy and physiology of the kidneys. C2] (Checking the solution) g. Substances introduced into the tilood stream pass directly into the extracellular space. C2] 252 (Cleansing and disinfecting the skin; mainttining or re establishing the sterility of administration equipment) h. Microorganisms may be transmitted through the air or through direct contact with contaminated articles. Cl] 1. The mechanical process of cleansing removes many microorganisms. Cl] j. Microorganisms are destroyed by physical and chemical means. Cl] 4 rAa 10. (Continued) k. Considerations important in the use of chemical and physical means: time allowed, kind of material treated, type of organisms present. [2] (Seriousness of introducing microorganisms) 1. All circulating blood has access to all parts of the body. [2] (Preventing the introduction of air) m. It is important for the blood to flow freely and continuously through the heart and blood vessels. C2] .(Applying the tourniquet, inserting the needle) • n. Restriction of the outflow of a vein distends it. C D (Establishing the flow) o. A fluid flows from an area of greater pressure to one of lesser pressure. £2] p. The pressure exerted by a column of liquid in a container varies directly with the height of the column. C2] q. Negative venous pressure in a vein in an extremity may be created by raising the extremity above the level of the heart. [2] r. Meaning of a vacuum. C2] s. When the cardiovascular system is intact, strong ventricular contraction prevents circulatory overload and venous congestion. C2] (Immobilisation of the extremity) t. Effects of activity and inactivity upon muscles. C2] 11. Add 10C0 cc of S% dextrose in 1 Same as for nursing activity #10: a,b,c,d,e,g,h,i,j,1, C23 normal saline to I.V. m,n,o,p. 12. Discontinue I.V. 1 (Preventing introduction of air) C2] a. It is important for the blood to flow freely and continuously through the heart and blood vessels. C2j b. A fluid flows from an area of higher pressure to one of lower pressure. C2j _ c. Negative pressure in the veins of an extremity may be created by raising the extremity‘above the level of the heart. [ 2] (Care of puncture area) d. Microorganisms may enter through breaks in the skin'. Cl] 13. Encourage deep breathing and 6 a. Oxygen is required by all cells of the body to coughing. accomplish their functions. [1] 253 C2] b. The lungs supply oxygen to all body parts through the circulation. Cl] c. Gross anatomy of bronchi and lungs. Cl] d. Use of diaphragm and intercostal muscles. C2] e. Relationship of inspiration and expiration to negative and positive pressure within the lungs. [2] f. Normal function of the cough. C2] TAB 10. (Continued) 14. Fill water pitcher and (Flavor of water) exchange cup. a. Hater becomes 11 flat"-on standing because of loss of air Cl] bubbles and settling out of minerals. [1] (Preventing transmission of microorganisms) b. Microorganisms may be spread through contact with / I( - contaminated articles.. Cl] 15 Change oxygen catheter.- 2 (Maintenance of continuous flow through the nasal catheter) [2] a. Mucus is produced in the respiratory tract. Cl] (Introducing the catheter) b. Anatomy of nasal passages and oropharynx. [2] 16. Summarize intake and 3 (Importance of measures which assess the adequacy of the output. process of urinary excretion) Cl] a. General purpose of urin.ary exretion. £1] (Knowing what to include in summary) b. Routes of fluid intake. [1] c. Routes of fluid output. [1] (Recognizing possible discrepancies in -record keeping) d; "Normal" relationship between amount of intake and amount of output. Cl] 17. Hake thorough assessment of 1 ' Same as for nursing activity #1 patient's status and the Also: adequacy of the nursing care ("Evaluating adequacy of nutritional intake, knowing when plan. (Synthesize personal to confer with nutritionist). observations and reports and a. Average daily caloric, protein, vitamin, and mineral suggestions o f other nursing requirements. [2] personnel. Consult with b. Factors which normally affect the above requirements. [1] other members of the health (Evaluating the seriousness of omission of medications) team} Revise plan. c. (Furadantin) The consequence of chemical substances C33 in the body is related to the rate of their excretion. C2] d. (Fergon) Iron is essential to the manufacture of hemoglobin. £2] - e. (Fergon) The average diet barely provides the daily iron requirement because such a small percentage is" absorbed. C2] f. (Potassium chloride) Potassium is not conserved in the body but continues to be lost in the urine when the potassium intake is inadequate.. C2] g. (Potassium chloride) Importance of electrolyte balance; role of potassium in nervous and muscular activity. [3] jo in 4b TABLE 10. (Continued) 18. Visit patient and family. 2 Same as for nursing activity #17. (Answer questions;converse about the family's concerns; elicit cooperation in: — observing the patient (comfort, I.V. fluids, etc.) [3] — encouraging liquid intake. 19. Prepare for sleep 1 (Physiological need of sleep) £23 a. Decreasing body demands during stress allows greater total body response to stress. £2] b. The lower the metabolic rate the less the circulatory, respiratory, nutritional, and excretory demands. £2] c. During sleep the metabolic rate is normally consider ably reduced. £2] d. Requirement of "REM" sleep. £2} (Promoting sleep) e. Limiting stimuli such as discomfort promotes sleep. £2j 20. Give Seconal 50 mg. intra- 1 (Action of drug) £ 2] muscularly. a. Basic facts about absorption and excretion of chemical substances. £2] b. General functions of cerebral cortex. £2] (Possibility of allergy) c. Antigen-antibody basis of allergy. £2] (Injection technique) d. Major blood vessels, nerves, bones in the injection site. £2] e. Pathogenic microorganisms may be transmitted by contact with contaminated articles. £1] f. Microorganisms may be transmitted through the air. £lj "Quick observations" described on See (General appearance) first page of analysis. first a. Relationship of skin color to adequacy of respiratory £13 page and circulatory functions. £1] of (Reactions to discomfort) analy- b. Gross anatomy and physiology of the neuro-muscular sis system. £1] (Pulse) c. Relationship between ventricular -contraction and the movement of the artery that is palpated. £13 ' d. Normal range of pulse rates. £l] e. Factors which normally affect pulse rate. £l] (Respirations) 255 f. Gross anatomy and physiology of respiration. £1] g. Normal chest and abdominal movement on inspiration and expiration. .£13 h. Normal range of respiratory rates. £1] i- Factors which normally affect the respiratory rate. £l] TABLE 10. (Continued) (Condition o£ nasal catheter) j. Production o£ mucus in the respiratory tract. [1] (Intravenous fluids: importance of function) k. Role of water. [1] 1. Function of glucose. [1] (Intravenous fluids: maintaining needle in vein) m. Gross anatomy of veins and surrounding tissue. Cl] (Intravenous fluids: observing flow to prevent circulatory overload) n. Normally the strength of the ventricular contraction prevents venous congestion. Cl] (Catheter function: • importance; significance of observations) o. Normal rate of urine production (roughly). Cl] p. Relationship of fluid intake to urinary output. Cl] q. General purpose of urinary excretion. Cl] r. Gross anatomy of urinary system. Cl] (Response to possible observation of displaced-catheter) s. Microorganisms are transported by contaminated articles. Cl] (Maintenance of traction) t. Principle of traction and countertraction. Tl] u. Use of a fixed pulley to adjust direction of force. Cl] 256 I TABLE 11 SAMPLE HORSING CARE ANALYSIS AS REVISED ON THE BASIS OF SUGGESTIONS BY REVIEWERS FREQUENCY IN NURSING ACTIVITIES 24 HOURS NATURAL SCIENCE UNDERSTANDINGS INDICATED3 1. Assess knowledge and 3 All the understandings listed in this entire analysis skills of nursing staff Also: b available in terms of (Anticipating consequences of possible "small embolization") . patient's needs. Assign a. Anatomv and physiology of circulation including blood clottinq.cr2] various aspects' of b. Anatomv and nhvsioloqv of the central nervous system. L2] ” nursing care accordingly. (Coping with problems of nutrition) C3] c. Average daily- caloric, protein, vitamin, and mineral require ments, [2] d. Factors which normally affect the above requirements. [1] e. Roles of electrolytes. £3] (Coping with problem of administering oral medications) f. (Furadantin) -The consequence of chemical substances in the body is related to the rate of their excretion. l 2j g. (Fergon) Iron is essential to the manufacture of hemoglobin. [2] h. (Fergon) The average diet barelv provides the daily iron requirement because such a small percentage is absorbed, 12] aIn this nursing situation, it is proposed that "quick observations" should be made frequently. These would include observing general appearance; apparent comfort; pulse; respirations; functioning of oxygen and intravenous set-ups, urinary catheter, and traction. These observations are not listed as separate activities since nursing personnel are in contact with the patient frequently for other purposes and it is assumed that "quick observations" will be made in connection with the various other nursing activities. To account for the naturalscience understandings involved in making these observations, it is proposed that the understandings listed on pages 13 and 14 at the end of this analysis are indicated in connection with every nursing activity in which there is patient contact. b * Phrases in parentheses are inserted in this column to indicate the basis for including the natural science understanding^) which follow.. cUnderlined elements are those which have been added or revised. **Numbers in brackets to the right of natural science understandings indicate classification of items in terms of the guidelines for sequencing natural science content which were developed as part of this study. - 3 eNumbers in brackets to the left of nursing activities indicate-classification of nursing activities on the basis of the natural science understandings indicated. TABLE 11. (Continued) i. feotassium chloride) Potassium is not conserved in the body but continues to be lost in the urine when the potassium intake is inadequate. [2J j. (Potassium chloride) Importance of electrolyte balance: role of otassium in nervous and muscular activity. [3] fRespiratory therapy) ■ k. Role of respiration in electrolyte and acid-base balance. [3] Teach nursing staff Same as for nursing activity #1. member(s) on the basis of the above assessment Take temperature, pulse (Choice of rectal temperature) and respirations. a. Oxygen introduced directly into the oropharynx lowers the temperature of the oral cavity. [1] (Purpose) b. Inflammatory processes are commonly accompanied by a rise in body temperature. [1] (Inserting thermometer) c. Gross anatomy of the rectum. [1] d. Normal temperature range. [1] e. x'he temperature of a body cavity varies according to the blood supply and the extent to which it may be influenced by external conditions. [1] (Care and cleaning of thermometer) f. Most substances expand when heated. Mercury has a relatively large expansion per unit rise in temperature. Cl] g. Microorganisms may be spread through contact with contaminated articles. [1] h. Removal cf some microorganisms may be accomplished mechanically. Cl] i. Destruction of susceptible microorganisms may be accomplished through the use of chemicals. Cl] . (Taking the pulse) j. Relationship between ventricular contraction and the movement of the artery that is palpated. Cl] k. Normal range of pulse rates. Cl] 1. Factors which commonly affect the pulse rate. Cl] m. Details of cardiac activity. C2] (Taking the respirations) n. Gross anatomy and physiology of respiration. [1] 258 o. Normal chest and abdominal movement on inspiration and expira tion. Cl] p. Normal range of respiratory.rates. Cl] q. Factors which normally affect the respiratory rate. [1] TABLE 11. (Continued) 4. Take blood pressure (General purpose) [2] a. Physiology of blood pressure — Relationship between ventricular contraction and arterial blood pressure — Factors affecting blood pressure £2] (Specific purpose— possibility-of embolus and resulting shock) b. Relationship between patency of vessels and blood pressure. £2] c. Inoortance of vascular patency. [2] d. Importance of circulation in vital centers of brain. [2] (Taking the blood pressure) e. Location of the brachial artery. Cl] f. Physics of blood pressure measurement with the sphygmomanometer— relationship of pressure of blood to pressure of air to pressure of mercury. f2j ' ~ — . Give water, liquid (Checking the ability to swallow) feedings. (In addi a. Anatomy and physiology involved in swallowing. tion to water and — Local anatomy and physiology. liquid feedings given — Basic elements of central nervous system involvement in the by family in the swallowing process. C2] evening and during (Providing for nutrition) the night. b. Role of water in the body. [1] C2] c. Primary roles of the five basic groups of nutrients. [1] d. Nutrients present in common liquids. Cl] e. Normal range of daily fluid requirements. Cl] (Providing for comfort and proper position) f. Very gross anatomy and physiology of the digestive system. Cl] g. Basic elements of central nervous system involvement in the digestive process. C2] 6. Assess level of (Purpose and significance) consciousness. a. Involvement of cereoral cortex and thalamus in maintenance of [3] consciousness. L3J b. Relationship of vascular patency to maintenance of brain function] Clj • (Assessing) _ c. Manifestations of various levels of consciousness. C3] 7. Bathe (Prevent chilling) [2] a. The amount of body heat is related to blood flow and insulation by subcutaneous fat. There is a tendency toward loss of subcutaneous fat and deterioration of vasoconstricting mechanisms in old age. C2] (Facilitating respirations during the bath procedure) 259 b. Gioss anatomy and physiology of the respiratory system. Cl] (Cleansing) c. Gross structures and locations of sweat and sebaceous glands. Cl] TABLE 11. (Continued) d. Action of soap. C2] e. Mechanical action in cleansing. [1] f. Body secretions may be odorous. Cl] g. Microorganisms are normally present on the skin and may break down body secretions and excretions to produce irritating chemicals. [2] (Judgment regarding frequency of bathing body parts and use of moisturizers) h. Sebum production generally decreases beyond middle age. Cl] i. Adequate fluid intake and circulation prevents drying. Cl] (Massaging action) j. Massage stimulates circulation. Cl] k. T h e circulatory process is commonly slowed in old age and inactivity. Cl] (Moving the patient) 1. Anatomy of the femur and hip joint. C2] m. Reduction of organic and mineral content in thebones in old age. Cl] (Body mechanics for the nurse) n. Proper relationships of body parts to each other. Cl] o. Functions of muscles and tendons. Cl] p. Process of muscular contraction. C2] q. Meaning of gravity. Cl] r. Meaning of center of gravity. C2] s. Principle of widening the base and lowering the center of gravity. C2] t. Protective preparation for lifting, moving, carrying (for protection of back, abdominal organs, pelvis). — Contraction of gluteal muscles. — Contraction of abdominal muscles. C2] u. Use of leg muscles in combination with arm muscles in lifting. C2] v. Pushing, pulling, sliding, or rolling to avoid overcoming entire force of gravity involved in lifting. C2] w. Use of weight of body as a force for pulling or pushing. C2] x. Anatomy of spine and its anatomical relationship to the spinal cord and spinal nerves. [2] 8. Give mouth care _9_ (Purpose) C2] a. The mouth receives many types of bacteria. Cl] b. Food which remains in the mouth is broken down by these bacteria to cause unpleasant odors and tastes. Cl] c. Salivation provides for natural cleaning and germ-killing. In dehydration, salivation is decreased. Cl] 260 d. Adequate vitamin intake is essential to the health of mucous membrane. Cl] e. Adequate fluid intake and circulation prevent drying of the lips. Cl] (Cleansing) . • £Z Gross anatomy of mouth. Cl] (Avoiding aspiration) g. Anatomy and physiology of pharynx and trachea. [2] TABLE 11. (Continued) Change linens 1 (Preventing skin breakdown and irritation) a. Contact with rough surfaces results in friction which may break down cutaneous tissue. [ 1 ] b. Detergent ingredients may act as antigens. [2] (Preventing spread of microorganisms) c. Microorganisms may be transmitted through air currents. £l] (Turning the patient) d. Anatomy of the femur and hip joint. [2] e. Reduction of organic and mineral content in the bones in old age. Cl] (Promoting dry surface) f. Dampness causes maceration which predisposes to breakdown. Cl] (Body mechanics for the nurse) Same as in nursing activity #7: k through u. Position; massage 10 (Promoting good body alignment) pressure areas. a. Basic facts about anatomical interrelationships among nerves, muscles, bones, tendons. [2] b. Proper relationships of body parts to each other.Cl] (Promoting evaporation of dampness on skin surfaces) c. Fluids evaporate when exposed to air. Cl] d. Dampness causes maceration of skin which predisposes to skin breakdown. Cl] (Preventing compression of blood vessels, stimulating circulation) e. Blood vessels transport blood to and from body parts. Nutrients and oxygen are carried to the cells, waste products away from the cells. [ 1 ] f. Movement and massage stimulate circulation. Cl] g. Pressure on a body part may deprive it of the material it.needs and, at the same time, produce congestion in the part. Cl] (Choosing massage agent) h. Adequate fluid intake and circulation prevent drying and cracking of skin. Llj i. Sebum production generally decreases bevond middle ace. Cl] (Considering problem of embolization) " ! T" j. Basics cf blood clotting mechanism. C2] k. Basic anatomy and physiology of circulation. T2] (Promoting respirations, preventing hypostatic pneumonia) 1 . G l o s s anatomy of the respiratory system. Cl] ' m. Use of diaphragm and intercostals. £2] (Preventing pressure on superficial nerves) n. Gross anatomy and physiology of the nervous system. [1] o. Effect of pressure on nerves. CTj p. Superficial location of peroneal nerve as it passes around the neck of the fibula. £l] (Turning, handling urinary reservoir) q. Anatomy of the femur and hip joint. C2] r. Reduction of organic and mineral content inthe bones in old age. Cl] I 4 TABLE 11. (Continued) s. A fluid flows from an area of greater pressure to one of lesser pressure. [2] t. The pressure exerted by liquid in a reservoir varies directly with the height of the reservoir. C2] u. Microorganisms are spread through contaminated materials. [1] (Maintaining proper traction) v. Principle of traction and countertraction. Cl] w. Use of a fixed pulley to adjust direction of force. Cl] (Body mechanics for the nurse) Same as in nursing activity #7: k through v. 1 1 . Remove and reapply (Observing for signs of thrombosis) elastic bandages; a. Location of pedal and femoral oulses. C2] check skin color. • b. Relationship of vascular patency to condition of tissue. Cl] temperature and gen (Purposes of elastic bandages in addition to relationship to traction) eral condition; cl importance of blood supply to vital organs". Cl] : cncck and d. Importance of movement of blood through veins in the extremities: C2j and femoral pulses: (Purpose of periodic removal of bandages) give skin care. el Tight skin coverings prevent evaporation of moisture. Cl] [2] f . Dampness causes maceration of skin which predisposes to break down. [lj (Applying moisturizer) gT Adequate fluid intake and circulation prevent drying of skin. Cl] h. Sebum production generally decreases beyond middle a g ~ £17 12. Exercise joints (Maintaining immobilization of fractured femur) through range of a. Anatomy of femur and hip joint. C.2] motion. (Importance of exercise) [2] b. Effects of muscular activity and inactivity C2] (Carrying out exercises) c. Types, of joints. Cl] d. Normal movement of each joint. C3] e. Reduction of organic and mineral content in the bones in old age. Cl] (Observing patient) £~. Relationship Eetween exercise and cardiac activity. C2] 13. Start intravenous (Purpose) infusion of 5% a. Role of water Cl] dextrose in normal b. General function of sodium. C2] saline. c. Function of glucose. Cl] [2] d. Basic cellular anatomy. Cl] e. Basic facts about osmosis and diffusion. C2] f. Basic anatomy and physiology of the kidneys. C2] 262 (Checking the solution) g. Substances introduced into the blood stream pass directly into the extracellular space. C2] - TABLE 1 1 . (Continued) (Cleansing and disinfecting the skin; maintaining or re-establishing the sterility of administration equipment) h. Microorganisms may be transmitted through the air or through direct contact with contaminated articles. [1] i. The mechanical process of cleansing removes many microorganisms. Cl] j. Microorganisms are destroyed by physical and chemical means. Cl] k. Considerations important in the use of chemical and physical means: time allowed, kind of material treated, type of organisms present. [2] (Seriousness of introducing microrganisms) 1. All circulating blood has access to all parts of the body. [2] (Preventing the introduction of air) m. It is important for the blood to flow freely and continuously through the heart and blood vessels. [2] (Applying the tourniquet, inserting the needle) n. Restriction of the outflow of a vein distends it. Cl] (Establishing the flow) o. A fluid flows from an area of greater pressure to one of lesser pressure. [2] p. The pressure exerted by a column of liquid in a container varies directly with the height of the column. [2] q. Negative venous pressure in a vein in an extremity may be created by raising the extremity above the level of the heart. [2] r. Meaning of a vacuum. [2] s. When the cardiovascular system is intact, strong ventricular contraction prevents circulatory overload and venous congestion. C2] . (Immobilization of the extremity) t. Effects of activity and inactivity upon muscles. [2] 14. Add 1000 cc S% 1 Same as for nursing activity #11: a,b,c,d,e,g,h,i,j,l,m,n,o,p. dextrose in normal C2] saline to I.V. 15. Discontinue I.V. 1 (Preventing introduction of air) [2] a. It is important for the blood to flow freely and -continuously through the heart and blood vessels. C2] b. A fluid flows from an area of higher pressure to one of lower pressure. [2] c. Negative pressure in the veins of an extremity may be created by raising the extremity above the level of the heart. C2] (Care of puncture area) d. Microorganisms may enter through breaks in the skin. [1] 263 TABLE 11. (Continued) 16. Encourage deep a. Oxygen is required by all cells of the body to accomplish their breathing and functions. [1] coughing. b. The lungs supply oxygen to all body parts through the circula C2] tion. [1] c. Anatomv of bronchi and luners. f27 d. Use of diaphragm, intercostal muscles, and abdominal muscles. [2] e. Relationship of inspiration and expiration to negative and positive pressure within the lungs. [2] f. Normal function of the cough. £2] g. Mechanism of the cough. £ 2] (Preventing spread of' microorganisms) h. Microorganisms are commonly present in respiratory secretions. [1] 17. Fill water (Flavor of water) pitcher and a. Water becomes "flat" on standing because of loss of air bubbles exchange cup. and settling out of minerals. £1] Cl] (Preventing transmission of microorganisms) b. Microorganisms may be spread through contact with contaminated articles. £1] 18. Change oxygen (Maintenance of continuous flow through the nasal catheter) catheter and add a. Mucus is produced in the respiratory tract. £l] distilled water. (Introducing the catheter) C2] b. Anatomv and physiology of the unoer respiratory tract. £2] c. Oxygen is required by all cells of the body to accomplish their functions. £1] d. The lun^s supply oxygen to all body parts through the circula tion. |_1J (Maintenance of humidification) e. Moisture is required for health of mucous membrane. £1] 19. Summarize intake (Importance of measures which assess the adequacy of the process of and output. urinary excretion) Cl] a. Basic anatomy and physiology of excretory systems. £1] b. General purpose of urinary excretion. £1] (Knowing what to include in summary) c. Routes of fluid intake. £1] . d. Routes of fluid output. £1] (Recognizing possible discrepancies in record keeping) e. "Normal" relationship between amount of intake and amount of output. £1] 264 t 4 1 TABLE 11. (Continued) 2 0 . Hake thorough assess 1 Same as for nursing activity #1 ment of patient's sta. tus and the adequacy of the nursing care plan. (Synthesize personal observations and reports and sug gestions of other nursing personnel. Consult with other members of the health team). Revise plan. £3] 21. Visit patient and 2 Same as for nursing activity #1. family. (Answer questions; converse about the family's concerns; elicit cooperation in: — observing the patient (comfort, X.V. fluids, etc.) — encouraging liquid intake. £3] 22. Prepare for sleep 1 (Physiological need of sleep) £2] a. Decreasing body demands during stress allows greater total body response to stress. [2] b. The lower the metabolic rate the less the circulatory, respira tory, nutritional, and excretory demands. [2] c. During sleep the metabolic rate is normally considerably seduced. £2] d. Requirement of "REM” sleep. £2] (Promoting sleep) e. Limiting stimuli such as discomfort promotes sleep. £2] 23. Give Seconal 50 1 (Action of drug) mg. intramuscu a. Basic facts about absorption and excretion of chemical 2 larly. substances. £2j £ ] 265 b. General functions of cerebral cortex. £2] c. Importance of "REM" sleep. [2] (Possibility of allergy) d. Antigen-antibody basis of allergy. £2] (Injection technique) e. Major blood vessels, nerves, bones in the injection site. £2] TABLE 11. (Continued) f. Pathogenic Microorganisms may be transmitted by contact with contaminated articles. [1] g. Microorganisms may be transmitted through the air. Cl] "Quick Observations” See (General appearance) described on first first . a. Relationship of shin color to adequacy of respiratory and circula- page of analysis. page tory functions. [1] [1] of b. Relationship between skin turgor and hydration. Cl] analy- c. Significance of perspiration, fll sis. (Reactions to discomfort) d. Gross anatomy and physiology of the neuro-muscular system. Cl] (Pulse) e. Relationship- between ventricular contraction and the movement of the artery that is palpated. Cl] f. Normal range of pulse rates. Cl] g. Factors which normally affect pulse rate. Cl] ' (Respirations) h. Gross anatomy and physiology of respiration. Cl] i. Normal chest and abdominal movement on inspiration and expira tion. Cl] j. Normal range of respiratory rates. Cl] k. ' ctors which normally affect the respiratory rate. Cl] (Cor.aition of nasal catheter: humidification of oxygen) 1. Oxygen is required by all cells of the body to accomplish their functions. Cl] m. The lungs s u p p I v oxygen to all body parts through the circulation, 'cij 1 n. Mucus is produced in the respiratory tract and is a sticky sub stance £ij ” “ ~ ' o. Moisture is required for the health of the mucous membrane. Cl] (Intravenous fluids: importance of function) p. Role of water. Cl] q. Function of glucose. Cl] ' . (Intravenous fluids: maintaining needle in vein) r. Gross anatomy of veins and surrounding tissue*. Cl] (Intravenous fluids: observing flow to prevent circulatory overload) • s. Normally the strength of the ventricular contraction prevents venous congestion. Cl] (Catheter function: importance; significance of observations) t. Normal rate of urine production (roughly). Cl] u. Relationship of fluid intake to urinary output. Cl] 266 v. General purpose of urinary excretion. Cl] w. Gross anatomy of urinary system. Cl] (Response to possible observation of displaced catheter) x. Microorganisms are transported by contaminated articles. Cl] (Maintenance of traction) y. Principle of traction and cauntertraction. Cl] z. Use of a fixed pulley to adjust direction of force. Cl] ■ APPENDIX IV INFORMATION REGARDING THE COMPOSITION OF NURSING MANPOWER 267 INFORMATION REGARDING THE COMPOSITION OF NURSING MANPOWER The Health Manpower Source Book (1970) estimates the 1967 nursing manpower in practice as follows: 1. Registered nurses: 659,000 2. Licensed practical nurses: 320,000 3. Aides, orderlies, attendants, and home health aides: 775,000 (F14:24) On the basis of the above figures for 196 7, the total nursing manpower supply was 1,754,000 and the percentages of the constituent groups as follows: 1. Registered nurses: 38% 2. Licensed practical nurses: 18% 3. Aides, orderlies, attendants, and home health aides: 44% The Health Manpower Source Book (1970) presents the following employment projections: 1975 1980 1. . Registered nurses: 816,000 895,000 2. Licensed practical nurses: 546,000 675,000 3. Aides, orderlies, attendants, and home health aides: 1,000,000 1,150,000 (F14:24) On the basis of the above figures, the total nursing manpower supply for 1975 would be 2,362,000 and for 1980 it would be 2,720,000. The percentages for the constituent groups would be as follows: 268 269 1975 1980 1. Registered nurses: 35% 33% 2. Licensed practical nurses: 23% 25% 3. Aides, orderlies, attendants, and home health aides: 42% 42% Health Manpower in Hospitals (1970) presents the follow ing estimates for equivalent full time employment of nursing personnel in hospitals in 1969: 1. Registered nurses: 390,200 2. Licensed practical nurses: 188,200 3. Aides, orderlies, and attendants: 528,800 (F13:32) On the basis of these figures, the 1969 equivalent full time employment total for nursing personnel in the three categories was 1,107,200; the percentages for the constituent groups were as follows: 1. Registered nurses: 35% 2. Licensed practical nurses: 17% 3. Aides, orderlies, and attendants: 48% Health Manpower in Hospitals (1970) presents the following estimates for the number of nursing personnel employed in community hospitals (non-federal short-stay general or special hospitals excluding psychiatric and tuberculosis institutions) in 1969: 1. Registered nurses: 397,700 2. Licensed practical nurses: 173,900 3. Aides, orderlies, and attendants: 379,600 (F13:40) 270 On the basis of the above figures, the 1969 total for nursing personnel in the three categories was 951,200; the percentages for the constituent groups were as follows; 1. Registered nurses: 42% 2. Licensed practical nurses: - 18% 3. Aides, orderlies, and attendants: 40% Health Manpower in Hospitals (1970) presents the follow ing 1969 estimates for employment of nursing personnel in community hospitals which reflect variations among geo graphical regions: North- North east Central South West 1. Registered nurses: 123,300 118,800 86,500 69,100 2. Licensed practical nurses: 43,800 49,300 57,200 23,600 3. Aides, orderlies, and attendants: 82,700 128,700 114,300 53,900 (Fl3:58) On the basis of the above figures, the percentages for the three groups employed in community hospitals in the four regions are as follows: North North east Central South West 1. Registered nurses: 49% 40% 34% 47% 2. Licensed practical nurses: 18% 17% 22% 16% 3. Aides, orderlies, and attendants: 33% 43% 44% 37% Interviews with nursing administrators in five Columbus, Ohio short-term general hospitals provided the 271 following percentages for the three categories of nursing personnel employed in medical-surgical units in these hospitals in November 1971. (The percentages below relate to personnel directly involved in the planning and ministra tion of day-to-day patient care and exclude administrative and other nursing personnel not so involved.) 1. Registered nurses: 37% 2. Licensed practical nurses: 17% 3. Aides, orderlies: 46% (p3,8,10,11,12) Facts About Nursing (1970-71) provides the following information about admissions to registered nurse and practical nurse schools: 1964-5 1965-6 1966-7 1967-8 1968-9 1969-70 1. Registered nurse schools: 57,180 60,191 58,021 60,673 63,408 69,677 2. Practical nurse schools: 36,489 38,755 41,269 45,076 49,107 55,635 (F2:81,193) On the basis of the above figures, the percentages for admissioiis to registered nurse and practical nurse school were as follows: 1964-5 1965-6 1966-7 1967-8 1968-9 1969-70 1. Registered nurse schools: 61% 61% 59% 58% 56% 56% 2. Practical nurse schools: 39% 39% 41% 42% 44% 44% BIBLIOGRAPHY 272 SOURCES CONSULTED A. Literature Review: Career Ladder Concept and Related " Abdellah, Faye G.; Beland, Irene L.; Martin, Almeda; and Matheney, Ruth V. Patient-Centered Approaches to Nursing. New York: Macmillan,, I960.- American Hospital Association. Career Mobility Profiles. Chicago, Illinois: The American Hospital Associa tion, 1971. Anastasia, Antoinette Marie. "The Impact of Anatomy and Physiology on the Work of the Nurse." Unpub lished Ed.D. dissertation, Columbia University, 1971. Boyle, Rena E. "Articulation from Associate Degree through Masters." Nursing Outlook. XX (October, 1972), 670-2. Bullough, Bonnie. 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"Core Courses and a Career Ladder." American Journal of Nursing. LXXI (July, 1971), 1356-8. 14. Fenninger, Leonard D. "Education in the Health Pro fessions." Nursing Outlook. XVI (April, 1968). 30-33. 15. Feuer, Helen Denny. "Operation Salvage." Nursing Outlook. XV (November, 1967), 54. 16. Gilpatrick, Eleanor. Health Services Mobility Study: Second Progress Report for Phase Three. Technical report ten. New York: The Research Foundation, City University of New York, 1971. 17. Gilpatrick, Eleanor. Suggestions for Job and Curricu lum Ladders in Health Center Ambulatory Care: A Pilot Test of the Health Services Mobility Study Methodology. HSMS research reports four and five. New York: The Research Foundation, City University of New York, 1972. 18. Ginzberg, Eli. "Nursing and Manpower Realities." Nursing Outlook. XV (November, 1967), 26-9, 275 19. Goldsmith, Katherine L.; Jensen, Mary E. • Wood, Lucile A.; and Zimmerman, Don. 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XIX (December, 1971), 779-82. 25. Kerr, Elizabeth E. An Overview of Health Occupations in Iowa. Iowa City, Iowa: The University of Iowa Division of Health Affairs, 1970. 26. King, Imogene M. Interview at the Ohio State Univer sity, Columbus, Ohio, January 6, 1972. 27. King, Imogene* M. Toward a Theory for Nursing. New York: John Wiley and Sons, Inc., 1971. 28. Klopfenstein, Thomas D. Form letter describing the Kellogg Community College "core and cluster" health careers project. Battle Creek, Michigan: Kellogg Community College, October 13, 1970. 29. Lane, Evangeline B. "The Associate Degree Program— A Step to the Baccalaureate Degree in Nursing?" Paper presented at the meeting of the National League for Nursing Council of Baccalaureate and Higher Degree Programs, New Orleans, Louisiana, March 22-4, 1972. 276 30. McCrae, Jean. "Nurses' Aide to Licensed Practical Nurses Program." Paper presented at the meeting of the National League for Nursing Council of Practical Nurse Programs, Miami, Florida, May 1, 1970. 31. Me Kenna, Marion Elizabeth. "Differentiating Between Professional Nursing Practice and Technical Nursing Practice." Unpublished Ed.D. dissertation, The University of Florida, 1970. 32. Mandrillo, Margaret Paula. "A Comparative Study of the .Cognitive Skills of ,t.he Graduating Baccalaureate Degree and Associate Degree Nursing Students." Unpublished Ed.D. dissertation, Columbia University, 1969. 33. Meek, Doris A. "Core Curriculum in the Health Sciences." Junior College Journal. XXXXII (March, 1972), 32^5. 34. "National Commission for the Study of Nursing and Nursing Education: Summary Report and Recommenda tions." American Journal of Nursing. LXX (February. 1970), 279-94. 35. "NLN Develops Study of Open Curriculum Programs." Nursing Outlook. XX (October, 1972), 622. 36. New York State Nurses' Association. A Blueprint for the Education of Nurses in New York State. New York City: New York State Nurses' Association, 1968. 37. Nordmark, Madelyn T., and Rohweder, Ann W. Scientific Foundations of Nursing. Philadelphia: J. B. Lippincott Company, 1967. 38. The Ohio State University Center for Vocational and Technical Education. Health Occupations Education Centers. Report of a Seminar. Columbus, Ohio: The Ohio State University Center for Vocational and Technical Education, 1966. 39. "Ohio MA Program and Slated Doctoral Program to Articulate with Revised Basic Programs." American Journal of Nursing. LXXIX (September, 1972), 1560. 40. Oregon State Department of Education. Division of Community Colleges and Vocational Education. Guide to Structure and Articulation of Occupational Education Programs. Salem, Oregon: Oiegon State Department of Education, 1968. 277 41. Ramphal, Marjorie. - "Needed: A Career Ladder in Nursing." American Journal of Nursing. LXVIII (June, I960), 1234-7. 42. Sand, Ole. Curriculum Study in Basic Nursing Education. New York: Putnam, 1955. 43. Schoen, Kathryn. "Innovations in Curricula in the Health Professions.and Their Evaluation." Paper presented at the meeting of the American Educa tional Research Association, Chicago, April 5, 1972. 44. Shetland, Margaret L. "This I Believe about Career Ladders, New Careers, and Nursing Education." Nursing Outlook. XVIII (September, 1970), 32-5. 45. Tashjian, Helen Elizabeth. "Evaluation of a Career Ladder Model for Nursing Education." Unpublished Ed.D. dissertation, Boston University, 1971. 46. Training Health Service Workers— The Critical Challenge: Proceedings of the Conference on Job Development and Training for Workers in Health Services. Washington, D.C.: Government Printing Office, 1966. 47. U.S. Public Health Service. Bureau of Health Manpower. Health Manpower Perspective. 1967. Washington, D.C.: Government Printing Office, 1967. 48. U.S. Public Health Service. Bureau of Health Manpower Education. Division of Allied Health Manpower. Eguivalencv and Proficiency Testing: A Survey of Existing Testing Programs in Allied Health and other Health Fields. Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1971. 49. The UCLA Allied Health Professions Projects. The Background, the Programs, the People. Los Angeles: University of California Division of Vocational Education, 1970. 50. Urey, Blanche Irene. "A Method for Analysis of Nursing Tasks." Unpublished Ed.D. dissertation, Columbia University, 1968. 51. Waters, Verle; Chater, Shirley; Urrea, Judithe; and Vivier, Mary Louise. "Differences' in Nursing Prac tice between Graduates of Associate Degree and Baccalaureate Degree Programs." Paper presented at the meeting of the National League for Nursing Council of Associate Degree Programs, Honolulu, Hawaii, March 4-6, 1970. 278 52. West, Wilma. "Occupational Therapy Philosophy and Perspective." American Journal of Nursing. LXVIII (August, 1968), 1708-11. 53. Wood, Lucile A. The Nursing Program in the UCLA Allied Health Professions Projects. Summary Report. Los Angeles: University of California Division of Vocational Education, 1970. 54. Wood, Lucile A., and Preeland, Thomas E .' The Nursing Program in the UCLA Allied Health Professions Proiects. Progress Report. Los Angeles: Univer sity of California Division of Vocational Education, 1971. B. Nursing Roles and Curriculum 1 . American Nurses' Association. Educational Prepara tion for Nurse Practitioners and Assistants to Nurses: A Position Paper. New York: American Nurses' Association, 1965. 2 . American Nurses' Association. Health Occupations Supportive to Nursing. New York: American Nurses' Association, 1965. 3. American Nurses' Association. Information about Assistants to Nurses. New York: American Nurses' Association, 1967. 4. American Nurses' Association. Standards of Nursing Practice Working Paper. New York: American Nurses' Association, 1972.(Mimeographed). 5. American Nurses' Association and the National Federa tion of Licensed Practical Nurses. Functions of the Licensed Practical Nurse-. New York: American Nurses' Association, 1964, 6 . American Nurses' Association Congress for Nursing Practice. Scope of Nursing Practice Working Paper. New York: American Nurses Association, 1972 . (Mimeographed). 7. American Nurses' Association Council of State Boards of Nursing Committee on Blueprint for Licensing Examin ations, Test Plan for Licensing Examination for Practical Nurses, April, 1971. (Mimeographed). 279 8. American Nurses' Association Council of State Boards of Nursing Committee on Blueprint for Licensing Examinations. Test Plan for Licensing Examination for Registered Nurses, April, 1971. (Mimeographed). 9* Ayers, Rachel; Bishop, Rowena; and Moss, Fay. "An Experiment in Nursing Service Reorganization.” American Journal of Nursing. LXIX (April, 1969). 10. Christman, Luther. "Education of the Health Team". Journal of the American Medical Association. CCXIII. (July 13, 1970), 10-11. 11. "The Licensed Practical/Vocational Nurse as Charge Nurse in Extended Care Facilities; Three Positions." Bedside Nurse. II (March, 1969), 29. 12. Lysaught, Jerome P. An Abstract for Action. New York; McGraw-Hill Book Company, 1970, 13. National Association for Practical Nurse Education and Service. Declaration of Functions of the Licensed Practical/Vocational Nurse. New York: National Association for Practical Nurse Education and Service, 1969. 14. National Federation of Licensed Practical Nurses. The Statement of Functions and Qualifications of the Licensed Practical Nurse. New York: National Federation of Licensed Practical Nurses, 1972. 15. National League for Nursing. Do You Want to be A Nurse? New York; National League for Nursing, 1969. 16. National League for Nursing. Licensed Practical Nurses in Nursing Services. New York: National League for Nursing, 1972. 17. National,League for Nursing. Nursing Education in the Seventies. New York; National League for Nursing, 1972. 18. National League for Nursing. Statements Regarding Practical Nursing and Practical Nursing Education. New York: National League for Nursing, 1968. 19. National League for Nursing Department of Associate Degree Programs. Associate Degree Education for Nursing. New York: National League for Nursing, 1972. 280 20. National League for Nursing Department of Associate Degree Programs. Characteristics of Educational Programs in Nursing Leading to an Associate Degree. New York: National League for Nursing, n.d. 21. National League for Nursing Department of Baccalaureate and Higher Degree Programs. College Education: Key to a Professional Career in Nursing. New York: National League for Nursing, 1972. ' 22. National League for Nursing Department of Diploma Programs. Education for Nursing the Diploma Way. New York: National Leagge for Nursing, 1972. 23. National League for Nursing Department of Practical Nursing Programs. Let's Be Practical About a Nursing Career. New York: National League for Nursing, 1972. 24. "Role, Knowledge, and Abilities of the Graduate of the Diploma Program in Nursing." Nursing Outlook. XIX (July, 1971), 463. 25. U. S. Department of Health, Education, and Welfare. Secretary's Committee to Study Extended Roles for Nurses. Extending the Scope of Nursing Practice. Washington, D.C.: United States Printing Office, 1972. 26. Western Interstate Commission for Higher Education. The Graduate of Associate Degree Nursing Programs: Who Is This Nurse? Boulder, Colorado: Western Interstate Commission for Higher Education, 1968. 27. Western Insterstate Commission for Higher Education. The Graduate of Baccalaureate Degree Nursing Pro- • grams: A Description of Expected Competencies. Roles and Behaviors. Boulder, Colorado: Western Interstate Commission for Higher Education, 1968. C. Elementary and Secondary Science and Health ; Education: References Concerning Curriculum and Curriculum Materials : 1, American Association for the Advancement of Science Commission on Science Education. Science— A Process Approach: Commentary for Teachers. Washington, D.C.: American Association for the Advancement of Science, 1964. 281 2. Atherton, Ralph. "The Place of Introductory Physical Science in the Curriculum." School Science and Mathematics. LXVII (October, 1967), 629-30. 3. Baird, Robert W., "The Introductory Physical Science Course in Junior High." School Science and Mathematics. LXVII (October, 1967),,624-5. 4. Beyrer, Mary K., Nolte, Ann E. and Solleder,- Marian K. A Directory of Selected References and Resources for Health Instruction. Minneapolis: Burgess Publishing Company, 1969. 5. Chin, Long Fay. "A Survey of Science Teaching in the Public Secondary Schools of the Great Lakes and Far West Regions of the United States in the 1970- 71 School Year." Unpublished Ph.D. dissertation, The Ohio State University, 1971. 6. Eisen, Norman B., and Sheak, June Daw. Perspectives for administrators. Beverly Hills, California: Macmillan Educational Services, Inc., 1970. 7. Gagne, Robert M. "The Psychological Basis of Science— A Process Approach." American Association for Science Miscellaneous Publication 65-8. Washington, D.C.: American Association for the Advancement of Science, 1965. 8. Grobeman, Arnold B. The Changing Classroom: The Role of the Biological Sciences Curriculum Study. Garden City, New York: Doubleday and Company, Inc., 1969. 9. Grout, Ruth E. Health Teaching in Schools. 4th ed. Philadelphia: W. B. Saunders, 196 3. 10. Haber-Schaim, Uri. "Introductory Physical Science: Objectives and Content of the Course." Adapted from a lecture given at Florida State University, Tallahasse, 1966. 1 1 . Kilander, H. Frederick. School Health Education. 2nd ed. New York: The Macmillan Co., 1968. 12. Lawson, Chester A. So Little Done— So Much to Do. Berkeley: University of California Science Curriculum Improvement Study, 1969. 282 13. Lepper, Robert E. "A Cross-Cultural Investigation of the Development of Selected Piagetlan Science Concepts, Social Status, and Reading Readiness," Journal of Research In Science Teaching. V (1967-68), 324-37. 14. Maben, Jerrold William. "A Survey of Science Teaching in the Public Elementary Schools of Two Selected Regions of the United States During the 1970-71 School Year!" Unpublished Ph.D. dissertation, The Ohio State University, 1971. 15. Maybaum, William H, "Introductory Physical Science for Academic Sevenths in Abington Township." The Science Teacher. XXXVII.(May, 1970), 69-70. 16. Mayshark, Cyrus, and Irwin, Leslie. Health Education in Secondary Schools. 2nd ed. Saint Louis: C. V. Mosby Co., 1968. 17. Midgley, Calvin P. "Reading, Writing, Arithmetic, and Chemistry." American Biology Teacher, XXXI (October, 1969), 454-55. 18. Oberteuffer, Delbert and Beyrer, Mary K. School Health Education: A Textbook for Teachers. Nurses, and Other Professional Personnel. 4th ed. New York: Harper and Row, 1966. 19. The Ohio State University. Members of the Elementary Education Faculty. "Elementary Science Study." Mimeographed paper prepared for elementary educa tion students, n.d. 2 0 . The Ohio State University. Members of the Faculty of Elementary Education. "Teaching Science— A Process Approach: Some Questions and Answers." Mimeographed paper prepared for elementary education students, n.d. 21. Pella, Milton O . , and Voelker, Alan N. "Teaching the Concepts of Physical and Chemical Change to Elementary School Children." Journal of Research on Science Teaching. V (1967-68), 311-23. 22. School Health Education Study. A Summary Report. Washington, D.C.: School Health Education Study, 1964. 283 23. School Health Education Study. Synthesis of Research in Selected Areas of Health Instruction. Washington. D.C.: School Health Education Study, 1963. 24. Strasser, Ben B. "Scope and Sequence?" Science and Children. VI (January-February, 1969), 13-14. 25. Thomson, Barbara S., and Voelker, Alan M. "Programs for Improving Science Instruction in the Elementary School." Science and Children. VII (May, 1970), 29-37. 26. Turner, C. E. Planning for Health Education in Schools. London; Longirtans, Green and Co. Limited and the United Nations Educational, Scientific and Cultural Organizations, 1966. 27. Vannier, Maryhelen. Teaching Health in Elementary Schools. New York; Harper and Row, 1963. D. Elementary and Secondary Science and Health Education; Curriculum Materials Per Se TTncluding textbooks and curriculum guides) 1* American Association for the Advancement of Science. Science— rA Process Approach; Description of the Program. C * York; Xerox Educational Division, .. 2. . Science— A Process Approach. Wall Chart. New York: Xerox Education Division, 1967. 3. Beauchamp, Wilbur L.; Mayfield, John C.- and Hurd, Paul DeHart. Everyday Problems in Science. Glenview, Illinois; Scott Foresman and Co., 1968. 4. Biological Sciences Curriculum Study. Biological Science; An Inquiry into Life. 2nd edition. New York; Harcourt, Brace and World, Inc., 1968. 5. ' Biological Science; An Ingulry into Life. Student Laboratory Guide. 2nd edition. New York: Harcourt, Brace and World, Inc., 1968. 6. ______. Biological Science; An Inguiry into Life. Teacher's Manual. New York: Harcourt, Brace and World, Inc., 1964. 284 7. ______. Biological Science: Molecules to Man. Revised edition. Boston: Houghton Mifflin Co., 1968. 8. . Biological Science: Patterns and Processes. New York: Holt, Rinehart and Winston, Inc., 1966. 9. . High School Biology. Chicago: Rand McNally and Company, 1963. 10. ______. High School Biology. Student's Manual. chic ago: Rand McNally and Company, 1964. 1 1 . ______. High School Biology. Teacher's Guide. Chicago: Rand McNally and Company, 1964. 12. Colorado State Department of Education. Office of Instructional Services. K-12 Health Instruction Guide for Colorado Schools. Denver: Colorado State Department of Education, 1965. 13. The Commonwealth of Massachusetts Department of Education. Division of Curriculum and Instruction Bureau of Elementary and Secondary Education. Health Education Curriculum Guide Grades One to Twelve. Boston: Commonwealth of Massachusetts, Department of Education, 1971. 14. Connecticut State Department of Education. The Status of Health and Family Life Education in Connecticut Public Schools. Hartford: Connecticut University, 1967, 15. Day, Myrtle V. A Teacher's Handbook of Resources for the Teachers of Health in the Secondary Schools. Lincoln, Nebraska: State Department of Education, 1966. 16. The Elementary Science Study of the Education Develop ment Center, Inc. The Elementary Science Study Reader. Newton, Massachusetts: The Elementary Science Study of Education Development Center, Inc., 1970. 17. . A Working Guide to the Elementary Science Study. Newton, Massachusetts: The Elemen tary Science Study of the Education Development Center, Inc., 1970. 285 18. Fodor, John T .; Gmur, Ben C.; and Sulton, Wilfred C. Framework for Health Instruction in California Public Schools Kindergarten through Grade Twelve. Sacramento: California State Department of Education, 1970. 19. Gallagher, J. Roswell; Goldberger, I. H.• Hallock, Grace T. Health for Life. Boston, Massachusetts: Ginn and Company, 1964. 20. Hechtlinger, Adelaide. Handbook of Modern Experiments for High School Biology. West Nyack, New York: Parker Publishing Co., Inc., 1971. 2 1 . Introductory Physical Science Group, Educational Services Incorporated. Introductory Physical Science. Englewood Cliffs, New Jersey: Prentice-Hall, Inc., 1967. 22. . Introductory Physical Science. Teacher's Guide. Englewood Cliffs, New Jersey: Prentice-Hall, Inc., 1967. 23. Irwin, Leslie W.; Farnsworth, Dana L .• Coonan, Caroline De Kelner; and Gavel, Sylvia. All About You. Book One of the Dimensions in Health Series. Chicago: Lyons and Carnahan, 1967. 24. . You and Others. Book II of the Dimensions in Health Series. Chicago: Lyons and Carnahan, 1967. 25. . Growing Every Day. Book III of the Dimensions in Health Series. Chicago: Lyons and Carnahan, 1967. 26. Irwin, Leslie. W.; Farnsworth, Dana L.? and Fraumeni, Florence Genua. Finding Your Way. Book IV of the Dimensions in Health Series. Chicago: Lyons and Carnahan, 1967. 27. Irwin, Leslie W.; Farnsworth, Dana L.* and Shafer, Barbara Hunt. Foundations for Fitness. Book VII of the Dimensions for Health Series. Chicago: Lyons and Carnahan, 1967. 28. ______. Patterns for Living. Book VIII of the Dimensions in Health Series. Chicago: Lyons and Carnahan, 1965. 286 29. Julian, Cloyd J., and Jackson, Elizabeth Noland. Modern Sex Education. New York: Holt, Rinehart, and Winston, Inc., 1967. 30. Lankenau Hospital Department of Health Education. Health Education Curriculum Guide. Ardmore, Pennsylvania: Main Line Project Learning, 1969. 31. McComb, Patricia (ed.). A Guide for Instruction in Health and Safety. Grades Seven to Twelve. Curriculum Bulletin No. 24 Supplement. Minneapolis: State Department of Education, 1965. 32. Marshall, J., Stanley and Beauchamp, Wilbur L. Book I: Science Is Fun. Glenview, Illinois: Scott- Foresman and Co., 1968. 33. ______. Book II: Science is Learning. Glenview, Illinois: Scott-Foresman and Co., 1968. 34. . Book III: Science is Exploring. Glenview, Illinois: Scott-Foresman and Co., 1968. 35. . Book IV: Science is Experimenting. Glenview, Illinois: Scott-Foresman and Co., 1968. 36. . Book V; Science is Discovering. Glenview, Illinois: Scott-Foresman and Co., 1968. 37. . Book VI; Science is Adventuring. Glenview, Illinois: Scott-Foresman and Co., 1968. 38. . Book VII: Science is Explaining. Glenview, Illinois: Scott-Foresman and Co., 1968. 39.______. Book VIII: Science is Understanding., Glenview, Illinois: Scott-Foresman and Co., A968. 40. New York.State Education Department. Bureaus of Elementary and Secondary Education. Health Educa tion Prototypes for Evaluation and Discussion. Albany: New York State Education Department, 1970. 41. New York State Education Department. Bureau of Secondary Curriculum Development. Suggested Guidelines for the Development of Courses of Study in Health Education for Junior and Senior High Schools. Albany: New York State Education Department, 1970. 287 42. Otto, James H. ; Julian, Cloyd I.; and Tether, J. Edward. Modern Health. New York: Holt, Rinehart and Winston, Inc., 1967. 43. Pennsylvania Department of Education. Bureau of General and Academic Education Division of Health, Physical and Conservation Education. Conceptual Guidelines for School Health Programs in Pennsyl vania: A Program Continuum for Total School Health. Harrisburg, Pennsylvania: Pennsylvania Department of Education, 1970. 44. Richmond, Julius; Pounds, Elenore T.; and Fricke, Irma. Health and Growth. Books I, XI, and III. Glenview, Illinois: Scott, Foresman and Company, 1971. 45. : Pounds, Elenore T.; Fricke, Irma; and Sussdorf, Dieter H. Health and Growth. Books IV and V. Glenview, Illinois: Scott, Foresman and Company, 1971. 46. ______; Pounds, Elenore T.; Jenkins, Gladys; Gardner, Wesley; Wallace, Ann; and Sussdorf, Dieter H. Health and Growth. Book VI. Glenview, Illinois: Scott, Foresman and Company, 1971. 47. t Pounds, Elenore T.; Jenkins, Gladys,* Gardner, Wesley; and Sussdorf, Dieter H. Health and Growth. Books VII and VIII. Glenview, Illinois: Scott, Foresman and Company, 1972. 48. Schneider, Herman and Nina. Book I: Science for Work and Play. Teacher's Edition. 3rd edition. Boston: D. C. Heath and Co., 1968. 49. . Book II: Science for Here and Now. Teacher~s Edition. 3rd edition. Boston: D. C. Heath and Co., 1965. 50. ' Book III: Science Far and Near. Teacher's Edition. 3rd edition. Boston: D. C. Heath and Co., 1965. 51. . Book V: Science in Our World. Teacher's Edition. 3rd edition. Boston: D. C. Heath and do., I$65. 52. . Book VI: Science for Today and Tomorrow, Teacher's Edition. Boston: D. C. Heath and Co., 1961. 288 53. Book VII: Science in the Space Age Teacher7? Edition. Boston: D c. Heath and Co., 1961. 54. . Book VIII: Science in Your Future. Teacher*? Edition. Boston: D. C. Heath and Co., 1964. 55. School Health Education Study. Health Education, a Conceptual Approach to Curriculum Design. St. Paul, Minnesota: 3M Education Press, 1967. 56. ■ Health Education. A Conceptual Approach: Growth and Development Influences and Is Influenced by the Structure and Functioning of the Individual (Concept l). Teaching-Learning Guides for Levels I-IV. St. Paul, Minnesota: 3M Education Press, 1969. 57. ■ Health Education. A Conceptual Approach; Giowth and Development Influences and Is Influenced by the Structure and Functioning of the Individual (Concept 1). Transparency Proofs for Levels I-IV. St. Paul, Minnesota: 3M Education Press, 1969. 58. . Health Education. A Conceptual Approach: There Are Reciprocal Relationships Involving Man. Disease, and Environment. (Concept 5). ' Teaching- Learning Guides for Levels I-IV. St. Paul, Minnesota: 3M Education Press, 1969. 59. Health Education. A Conceptual Approach: There Are Reciprocal Relationships Involving Man. Diseases and Environment. (Concept 5). Transparency Proofs for Levels I-IV. St. Paul, Minnesota: 3M Education Press, 1969. 60. Health Education. A Conceptual Approach: The Family Serves to Perpetuate Man and to Fulfill Certain Health Needs. (Concept 6). Teaching- Learning Guides for Levels I-IV. St. Paul, Minnesota: 3M Education Press, 1967. 61. Health Education. A Conceptual Approach; The Family Serves to Perpetuate Man and to Fulfill Certain Health Needs (Concept 6). Transparency Proofs for Levels I-IV. St. Paul, Minnesota: 3M Education Press, 1967. 289 62. . Health Education. A Conceptual Approach; Use of Substances That Modify Mood and Behavior Arises from a Variety of Motivations (Concept 9). Teaching-Learning Guides for Levels I-IV. St. Paul, Minnesota: 3M Press, 1967. 63. .______. Health Education. A Conceptual Approach: Food Selection and Eating Patterns are Determined by Physical. Social. Mental. Economic and Cultural Factors (Concept 10). Teaching-Learning Guides for Levels I-IV. St. Paul, Minnesota: 3M Press, 1972. 64. Science Curriculum Improvement Study. SCIS Sourcebook. Berkeley: The Regents of the University of California, 1968. 65. . Communities. Teacher * s Guide. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1969. 66. . Ecosystems. Teacher's Guide. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1970. 67. ' Energy Sources. Student Manual. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1969. 68. . Environments. Teacher's Guide. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1968. 69. . Interaction and Systems. Teacher's Guide. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1963. 70. .* Life Cycles. Teacher's Guide. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1967. 71. . Models for Electric and Magnetic Inter action. Student Manual. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1968. 72. . Organisms. Teacher»s Guide. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1964. 290 73. . Phases of Matter. Teacher’s Guide. Trial Edition. Berkeley: University of California Science Curriculum Improvement Study, 1968. 74. . Populations. Teacher's Guide. Preliminary Edition. Berkeley: University of California Science Curriculum Improvement Study, 1969. 75. ______, Relativity. Teacher's Guide. Preliminary Edition. Berkeley: University of California Science Curriculum Improvement Study, 1968. 76. ______. Relativity of Position and Motion. Teacher's Manual. Trial Edition. Berkeley: University of California Science Curriculum Improve ment Study, 1964. 77. ■ Subsystems. Teacher's Manual. Berkeley: Regents of the University of California, 1966. 78. Smallwood, William h., and Green, Edna R. Biology. Morristown, New Jersey: Silver Burdett Co., a Division of General Learning Corporation, 1968. 79. South Carolina State Department of Education. Guide for the Teaching of Health Grades Kindergarten through Twelve. Columbia: South Carolina State Department of Education, 1968. 80. Valeda. The Talking Glass Lady. Hinsdale, Illinois: The Hinsdale Health Museum, n.d. 81. "Valeda, the Talking Glass Lady." Script for older children and adults. Hinsdale, Illinois: The Hinsdale Health Museum, n.d. (Mimeographed). 82. Washington State Office of Public Instruction. State of Washington Health Education Guide to Better Health. 1966. Olympia: Washington State Office of Public Instruction, 1966. 83. Wilson, Charles C., and Wilson, Elizabeth Avery. Health and Living. Book V of Health for Young America Series. New York: The Bobbs-Merrill Company, Inc., 1968. 84. . Health and Happiness. Book VI of Health for Young America Series. New York: The Bobbs- Merrill Company, Inc., 1968. 291 85. . Men. Science and Health. Book VII of Health for Young America Series. New York: The Bobbs-Merrill Company, Inc., 1968. 86. . Health. Fitness and Safety. Book VIII of Health for Young America Series. New York: The Bobbs-Merrill Company, Inc., 1968. E. Clinical Information 1. Anthony, Catherine Parker. Textbook of Anatomy and Physiology. 7th ed. Saint Louis: The C. V. Mosby Company, 1967. 2. Asperheim, Mary Kaye. The Pharmacologic Basis of Patient Care. Philadelphia: W. B. Saunders Company, 1968. 3. Beeson,Paul B., and McDermott, Walsh, ed. Cecil-Loeb Textbook of Medicine. Philadelphia: W. B. Saunders Company, 1967. 4. Beland, Irene L. Clinical Nursing: Pathosphysiological and Psychosocial Approaches. 2nd ed. New York: Macmillan, 1970. 5. Bruner, Lillian Sholtis; Emerson, Charles Phillips, Jr.; Ferguson, L. Kraeer* and Suddarth, Doris Smith. Textbook of Medical-Surgical Nursing. 2nd ed. Philadelphia: J, B. Lippincott Company, 1970. 6. Falconer, Mary W.? Norman, Mabelclaire Ralston; Patterson, H, Robert; and Gustafson, Edward A. The Drug. The Nurse. The Patient. 4th ed. Philadelphia: W. B. Saunders Company, 1970. 7. Guyton,Arthur C. Basic Human Physiology. Philadelphia: W. B. Saunders Company, 1971. 8. Kozier, Barbara Blackwood, and DuGas, Beverly Witter. Fundamentals of Patient Care, a Comprehensive Approach to Nursinc?. Philadelphia: W. B. Saunders Company, 1967. 9. Mordel, Harriet Coston; Sorensen, Gladys E. ; Giblin, Elizabeth C.; and Kaufmann, Margaret A.,ed. Nursing Care of the Patient with Medical-Surgical Disorders. New York: McGraw-Hill Book Company, 1971. 292 10. Sutton, Audrey Latshaw. Bedside Nursing Techniques in Medicine and Surgery. 2nd ed. Philadelphia: W. B. Saunders Company, 1969. 11. Watson, Jeannette E. Medical-Surgical Nursing and Related Physiology. Philadelphia: W. B. Saunders Company, 1972. 12. Young, Clara Gene, and Barger, James D, ■Introduction to Medical Science. Saint Louis: The C. V. Mosby Company, 1969. P. Other 1. American Nurses' Association. Facts About Nursing; A Statistical Summary. 1969 Edition. New York: American Nurses' Association^ 19^0. 2. . Facts About Nursing: A Statistical Summary. 1970-71 Edition. New York: American Nurses Association, 1971. 3. Anderson, Jeanne. Interview held at St. Anthony's Hospital, Columbus, Ohio, November, 1971. 4. Ausubel, David P., and Ausubel, Pearl. "Cognitive Development in Adolescence." Review of Educational Research. XXXVI (October, 1966), 403-13. 5. Bloom, Benjamin S., ed. Taxonomy of Educational Objectives. Handbook 1: Cognitive Domain. New York: David McKay Company, Inc., 1956. 6. Bruner, Jerome S. The Process of Education. Cambridge,.Massachusetts: Harvard University Press, 1960. 7. . Toward a Theory of Instruction. Cambridge, Massachusetts: Harvard University Press, 1966. 8. Goode, Margaret. Interview held at Grant Hospital, Columbus, Ohio, December, 1971, 9. Hoyt, Kenneth B. ; Evans, Rupert N.; Mackin, Edward F.; and Mangum, Garth L. Career Education: What It Is and How to Do It. SaltLake City: Olympus Publishing Company, 1972. 293 10. Hubbard, Bonnie. Interview held at Mount Carmel Hospital, Columbus, Ohio, December, 1971. 11. Merz, Rose Marie. Interview held at Mercy Hospital, Columbus, Ohio, November, 1971. 12. Mott, Virginia. Interview held at Riverside Methodist Hospital, Columbus, Ohio, December, 1971. 13. U.S. Public Health Service, Bureau of Health Manpower Education. Health Manpower in Hospitals. Washing ton, D.C.i Government Printing Office, 1970. 14. U.S. Public Health Service, Bureau of Health Profes sions Education and Manpower Training. Health Manpower Source Book 21; Allied Health Manpower Supply and Requirements: 1950-80. Washington. D.C.: Government Printing Office, 1970.