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AUTHOR Keller, Marjorie -; May, W. Theodore TITLE Occupational Health Content inBaccalaureate Nu. sing Education. INSTITUTION Public Health Service (DHE. Cincinnati, Ohio. REPORT NO PHS-Pub-2176 PUB DATE 71 NOTE 126p. AVAILABLE FROMSuperintendent of Docum nts, U.S.Government Printing Office, Washington, D.C.20402 (HE 20.2802N93; S/N 1716-0002; $1.25)

EDRS PRICE MF-$0.65 HC-$6.58 DESCRIPTORS Achievement Tests; BachelorsDegrees; *conceptual Schemes; *contentAnalysis; Course Content; *Curriculum Evaluation;Educational Research; *Health Occupations Education; InserviceEducation; Masters Degrees; *Nursing

ABSTRACT A 4-year project wasconducted at the'University of Tennessee College ofNursing to identify occupatonal health nursing content essential inbaccalaureate education forprofessional nursing. In the process ofdetermining content, a reviewof relevant literature was male, and atheoretical framework wasdeveloped which consisted of an integrationof Leavell and Clark'slevels of prevention approach to health care,and Maslow's hierarchy ofneeds personality theory. Thistheoretical combination resultedin 25 categories, each labeledwith a level of preventionand basic human need. Within each category,competencies needed by a nursein occupational health care wereidentified, and correspondingacademic content was identifiedand delineated intoeducational levels (baccalaureate, graduate, andinservice). The theoreticalframework nursing was then utilizedto assess the contentof one baccalaureate program. Data werecollected by observing classes over a3-year period, and a content analysis wasconducted. Findings revealedth t the theoretical frameworkprovides a method forstructuring the curriculum desired and thatthe methodology can beapplied to all aspects of the nursingcurriculum. In addition tocontent analysis items for an achievementtest were developedand a standardization process wasstarted. (SB) - IP I,, SCOPE OF INTERESTNOTICE The ERIC Facility hasassigned this document for pr. sing to:

In our judgement, thisdocument is also of interest to theclearing- houses noted to the right.Index- ing should reflect theirspecial points of view.

f Occupational Health Content in Baccalaureate NursingEducation

Marjorie J. Keller, R.N., B.S. N. , M.S. Assistant Professor of Nursing and Principal Investigator The University of Tennessee College of Nursing in association with W. Theodore May, Ph. D. Associate Professor, Department of Psychiatry The University of Tennessee College of Medicine

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

U.S. DF:PARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service National Institute for Occupational Safety and Health

Cincinnati. Ohio U$. DEPARTMENT OF HEALTH, EDUCATION & WELFARE OFFICE OF EDUCATION THIS DOCUMENT HAS BEEN REPRO- DUCED EXACTLY AS RECEIVED FROM THE PERSON OR ORGANIZATION ORIG- INATING IT. POINTS OF VIEW OR OPIN- IONS STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDU- CATION POSITION OR POLICY. Public Health Service Publication No. 2176 Reprinted 1971

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

Nursing leaders have long recognizedthe significance and contribution, both real and potential, of occupationalhealth nursing as part of the nursingforce in this country.In 1963 an ad hoc committee phi-pointed the need forclarification of the essentials of occupational health nursing inrelation to the baccalureate nursing curriculum. Steps initiated bythe committee led to the study herein described. The project was conducted with an openand investigative approach.Its course was influenced throughoutby the dynamic nature of nursing itself and thesignificant changes occurring in the health field during the yearsof its activation. These influences are reflected in thedelineation of the role of the occupational health nurse and in theresulting framework for curriculum study and des ign The focus of the project as completedextends beyond the occupational health setting. As interest andconviction have grown regarding the scope and significance ofcomprehensive health planning and care, so nursing, with otherhealth professions, has moved from restricted settingsinto broad community focus. This then is the base,in education and service,from which this study is derived. And thisis the core,with its changing concepts of health and health practice,which has shaped its methodology and findings. The project is itself a beginning step, reflecting asit progressed the changing currents of our time inprofessional education and service.It is our hope and belief that theframework and methodology, and the subsequent fthdingsand recommendations, will form a sound base for continuing studyand implementation destined to strengthen both nursing educationand nursina practice.

Julia Dupuy Smith Project Director Professor of Public Health Nursin College of Nursing The University of Tennessee (*Now retired)

iii PREFACE

This manual presents a methodology foridentifying specific content in a curriculum. It further presentsthe utilization of this methodology in delineating the occupationalhealth nursing content in baccalaureate nursing education and suggestsits application to graduate education. The process and contentshould be of value to individuals concerned withnursing education and nursing practice.

In each chapter the processes involved areclearly described, and the relation between process and contentisdelineated. A theoretical framework is presented utilizing anintegration of a theory from public health and a theory frompsychology.Pertinent literature is reviewed, competencies andcontent for occupational health nursing are identified,and realistic immediate and long term recommendations for leaders in nursingeducation and for practicing occupational health nurses are made.

Ruth Neil Murry, Dean College of Nursing The University of Temlessee ACKNOWLEDGMENTS

The Principal Investigatoracknowledges with appreciation the cooperation, assistance, andpatience of The University ofTennessee College of Nursing facultyand students.Speciax acknowledgment goes to Dean RuthNeil Murry; Julia D. Smith,?roject Director; W. T. May, Ph. D. ResearchConsultant; and the members ofthe Fac- ulty Advisory Committee,Mary Morris, MargaretAnn Newman, and Ruth Bryce. Spec ial Recognition goes to the secretarialpersonnel involved in the typing andclerical dccails necessary tocomplete the project

Appreciation is alsoexpressed to the staffof the Mooney Memorial Library at TheUniversity of TennesseeMedical Units for their unfailingcooperation.Valuable assistance wasalso provided by the librarians atSouthwestern-at-Memphis, MemphisState University, and Memphisand Shelby CountyPublic Libraries.

Particular acknowledgmentis made for thecontributions of Mary Louise Brown,Chief Nurse, OccupationalHealth Program, who served as ProjectOfficer.Without her interest,efforts, and support there would nothave been a project.The contributions of Jane Lee andRuthReilschneider,Nurse Consultants, andLorice Ede, Program Editor,of the OccupationalHealth Program in reviewing and making recommendationsregarding the content aregratefully acknowledged.

In addition, theproject personnel and FacultyAdvisory Committee wish to recognize theinterest and assistanceof the members of the project's ad hoc OccupationalHealth Committee: BettyByers, Anita Harris, Jean S. Felton, M.D.,and Harold Magnuson,M.D.; and the members of the project's adhoc Nurse EducatorsCommittee: Ruth Bryce, Mary Morris,Margaret Shetland,and Catherine Tinkham. v_. ACKNOWLEDGMENTS (Continued)

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

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

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

M. Keller

viii THE THREE BEST THINGS WORK

Let me but do my workfrom day to day, In field or forest, at desk orloom, In roving market-place ortranquil room; Let me but find it in myheart to say, When vagrant wishes beckon meastray, "This is my work; my blessing, not mydoom; "Of all who live, I am the only oneby whom "This work can best be done in theright way."

Then shall I see it not too great, norsmall, To suit my spirit and to prove mypowers; Then shall I cheerful greet thelabouring hours, And cheerful turn, when longshadows fall At eventide, to play andlove and rest, Because I know for me mywork is best. Henry Van Dyke (1852-1933)

The Poems of Henry Van Dyke.New York: Charles lcrn.ner sTons, uoted by permission of the publisher. CONTENTS

CHAPTER PAGE Introduction 1

II Review of the Literature ...... 7 0 00 7 Education...... Nursing 8 Occupational Health Nursing ...... 0900 00 11 III 'Theoretical Framework...... 17 Levels of Prevention...... 0000000000 17 Hierarchy of Needs ...... 0 0000.0 09 18 The Integrated Theoretical Model 19 25 IV Methodology .,, . . Development of Competencies and Content 25 Competencies ...... 29

i __ . 30 Content , , , . --.. Validation of Competencies and Content . . 31 Utilization of the Methodology...... - - - ...400 32

V Data Analysis_ 00000_ 0_ __ 39 ... . .0000000000.0 39 Methods. of Analysis...... 44 Qualitative Comparison . .. Quantitative Comparison ...... 44 VI Delineation of Occupational Health Content for Professional Nursing...... 47. VII The Achievement Test in Occupational Health Nursing.... 75 Development . 75 Assessment 77 Status 81

VIII Findings .. 000099 . 0 . #000009 . 0. 0000 . 0000 . 90 0000000 33 Theoretical Framework ...... 660660. 83 A Methodology for 'Analyzing a Nursing Curriculum_ ...0.0985 Use of Methodology in Changing the Occupational Health Nursing Component of Baccalaureate

_ - , 86 Curricula_ , i _ . - . .. _ 1±77#90 Use. of Methodology in Developing Graduate Programs _in Octupational H ealth Nursing . ...009 0 0 0 0000 87 Achievement. Test in Occupational Health Nursing ...... 87 Suggested Learning Experiences for Professional Nursing Students M.the Work Setting ...... 87 xi CO-i--TENTS

CHAPTER PAGE

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

X Summary 95

APPENDIX A History of Education for Occupational Health Nursing: Mary Louise Brown 99

Rationale for The University of Tennessee Collegeo Nursing CurriculumMary L. Morris 440 113 First Attempt in Fitting Functions and Responsibilities of Professional Nurse in Occupational Health into the Theoretical Framework...... 115 Competencies and Suggested Nursing Actions of the Professional Nurse in Occupational Health 117 The University of Tennessee College of Nursing 404 ...... 4004444 ...4444123

xii

10 CHAPTER I INTRODUCTION

In July 1963, an adhoc committee,composed of representativesof the National League forNursing (NLN) andthe Occupational Health Program* of the PublicHealth Service, met toexplore ways and means for moreadequate integration ofoccupational health nursing content into thebaccalaureate curriculum.It was the consensusof this group of nursesthat the purpose ofthe discussion was not an attempt tomake a specialty ofoccupational health nursing but rather an attemptto identify contentin occupational health inrelation to the basiccurriculum.It is believed that in the basiccontent there is muchthat is applicable to the industrialsetting or to the nursingof the employed adult. There isalso content fromoccupational health nursing possibly notpresently included thatwould contribute to the preparationof professional nursesin baccalaureate programs.(1) The committeerecommended the initiationof a project to test three hypotheses: that provides 1 There is content inoccupational health nursing an essentialcontribution to the preparationof professional nurses in abaccalaureate program.

2 This content can beidentified and taught on abaccalaureate level. This instruction canbe evaluated. It was furtherrecommended that theproject be carried out attwo NLN-accredited collegiateschools of nursing incolleges or universities having adepartment of occupationalhealth or public health in the medicalschool and that the personsselected to conduct the project have facultyappointment with freedomto develop the project. (2)

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

1 C apter I - In roduction

At a meeting on Februa y 27,1964, the following general approach was suggested: Review, identify, and organize current concepts and learning experiences in the literature regarding occupational health.

2 Review and iden ify content .and learning experiences withIn the objectives of current school curriculum. Determine methods of modifying and implementing occupational health components in the program. 4 Help faculty try out and implement the above.

5 Evaluate the project program. (2) The University of Tennessee College of Nursing and the Boston College School of Nursing were selected by the Occupational Health Program of the U.S. Public Health Service as sites at which to conduct this project. Each school was to work independently in developing an appreach and in carrying on the project. The Boston College project, which started in September 1964, was planned for one year. The University of Tennessee project was continued for four and one-half years, commencing in February 1965. This manual is based on the philosophy, approach, methodology, and findings of the project as pursued at The University of Tennessee College of Nursing. A Faculty Advisory Committee for consultation in the planning and evaluating phases consisted of the incumbent faculty, the chairman of the research committee, and the instructor forthe course in scientific methods in nursing. The Dean of the College, the ProjectDirector, and the Principal Investigator met with the Faculty Advisory Committee as needed. Each visit by the Project Officer included a meeting with this group. As the project progressed, consultations were held with a committee of occupational health experts and a committee of nurse educators. The 1963 ad hoc committee was motivated by historical and existing developments in the fields of occupational health nursing and professional nursing education.Their original concerns were influenced by perhaps more significant changes in health concepts, legislation, and planning than have occurred in any similar timespan in recent history. In particular, a more comprehensive concept of health and the necessity for change in the delivery of health care services are clearly manifested in the planning for comprehen % th care for individuals and families in their normal environment.

eeppeti . ac groun e ucaiönor ôcOuaTiähal health nursing.

2 Chapter Ino uction

(7 8 9 10 11) As writers from varioushealth disciplines' " have noted, health care encompasses morethan the traditional preoccupationwith the cultivation of sound health habitsand the detection of diagnosable disease entities. The healthof the individual and thefamily must reflect a well-integrateddynamic balance of physical,psychological, socio-economic, and spiritualfactors. To implement the concept ofcomprehensive health care there isneed for health professionals whounderstand, accqpt, and practicepromotion of health as well as preventionof disease.(12) Every individual, at any given moment issomewhere on the health-illnesscontinuum; and the ideal state is to be at thehealth end, vertical and active.But the worker can apparently be verticaland active and yet be the host of a latent disease process.Promotion of health for the worker aswell as for thegeneral public includes making thewell person a more fully-functioning individual, therebypreventing the completion of the epidemiologic triad (host, agent, andenvironment) leading to a diseased state. Technological and social changesin our society are bringing about new ways for thedelivery of health care. Since thesechanges directly affect nursing practice and nursingeducation, nurses must expandtheir role to meet the challenges. it is imperative that knowledgeand utilization of human ecologybe made an integral partof comprehensive health planningand care. (ii) Ecological factors, be they from the naturalenvironment, the family, work,school, or community,must be assessed in terms ofpromotion of or interfer- ence with health.As for the labor force, theincreasing population of the United States means an increasingnumber of employees.Projected figures indicate that the employeepopulation by the year 2000 will increase by about 42 million(or about 50 percent) over thepresent f gure of 80 million.(14) The work setting has beeninfluenced and will continue to beinfluenced by increasing automation,computerization, unionization, andwork-force mobility, and by decreasinghours at work per week. These allinfluence health. Exposure to new chemicaland biological hazards will preSent other problems. Kahn and Weinerhave,projected 100 significant technological innovations by the year2000 (141) The culturally-differentand minority sectors of ourpopulation will have greater numbers in the workforce.These individuals bring multi-faceted health problems tothe work setting; for example, poor nutrition, high incidence of chronicand infectious illness, anddifferent patterns of social and emotionalliving.(15,16) Chapter I - Introduction

In the light of the multiplicity of these changes,nursing must reassess its role as a member of the community healthcareteams. These teams will include members representingmore than the traditional health p-rofessions (17 3 18 19) Certainto be includedare the consumers of health care services- the indigenous population either at the work setting or in residentialareas. Nurses must be aware of all changes that affect health.Particularly, in a work-oriented societysuch as ours, the influences on health of factors in andout of the work setting cannot be neglected. Probablyevery interaction between nurse and the identified patient is influenced ari. somerespect by a work environment. In several western countries an emerging awakeningof Lnterest in "other than hospital" nursingmay be noted in nursing students. Their job preference is towards practicein the comrnunity,(20,21,22,23) and more and more theyare beginning to seek positions that involve practice in community health. The curriculum evaluation and thecourse content discussed in this manual reflect the trends outlined above in thehealth field and the labor force.

REFERENCES 1 Minutes from meeting in New York City, July 10,1963. Attended by Chairman Rita Kelleher, DorothyBenning, Mary Louise Brown, Irene Courtney, and Margaret Shtland. 2 Notes of meeting taken by Julia D. Smithat Washington, D.C., February 27, 1964. Attended by ChairmanRita Kelleher, Dorothy Benning, Mary Louise Brown, JosephineCipolla, Jean Grey, Lucy Kennedy, Laura Resengael,Julia D. Smith. Community Health Nursing, Newsletter, Divisionon Practice, American Nurses' Association, April, 1968, 3 4 Dunn, Halbert L. High-Level Wellness.Arlin on, Va. R .W. Beatty, inc., 19 6 a 5 Mann, George 3.Future Hospitals Will Go Where the People Ae, Modern Hospital 110:84-89, June 1968. Hilleboe, Herman E. Public Health in theUnited States in the 1970's, American Journal of PublicHealth 57:1588-1610, Septemb Chapter ntroduction

in 7 Hirsch, Sidney, and AbrahamLurie. Social Work Dimensions Shaping Medical CarePhilosophy and Practice, SocialWork 14:75-79, April 1969. The 8 Felton, Jean Spencer. Care,Compassion and Confrontation Correctives in The OccupationalMental Health of the Future, Journal of Occupational Medicine10:331-343July 1968.

9 Lotzkar, Stanley.Dentistry in Health Care Facilities:The Public Health Viewpoint,The Journal of the AmericanDental Association 77111-

10 Branagan, Charles A.Jr.Community Health Care System - Pharmacy's Role, Journal ofthe American Pharmaceutical Association NS9:6-8-=-Z-9 7-2, Peruary York: 11 Caplan, Gerald. Principlesof Preventive Psychiat y. New Basic Books, -IncT,---196-4. Medicine 12 Leaven, Hugh Rodman and E.Gurney Clark. Preventive for the Doctor in his Community.3rd edition.Thr-YaFF c a oo ompany, 65. American 13 Hanlon, John J. AnEcological View of Public Health, Journal of Public Health59: 4-11, January 1969. A Frame ork 14 Kahn, Herman and Anthony J.Weiner. The Year 2000 - for Speculationon the NextThirty- eeears. TNFTVITFMfllan COT, 1967, p.-195-496.

15 Poverty and Health in theUnited StatesA Bibliography of s rac s. e or eca an ea esearcsissociation (37-17ev=rk City, 1968.

16 Winick, Myron and PedroRosso. The Effect of SevereEarly Malnutrition on Cellular Growthof Human Brain, Pediatric Research 3:181-184, March1969. Prac ice 17 Geiger, H. Jack. HealthCenter in Mississippi, Hospital 4:68-81, February 1969.

18 Barry, Mildred C. and CeAl G. Sheps. A New Modelfor Community Health Planning, Arnecan Journal ofPublic Health 59: 226-236, February 1969. Burnis, Joan B. and WilliamC. Ackerly. CollegeStudent Volun- teers in a Child GuidanceClinic, Social Casework50:282-286, May 1969.

5 Chap er IIntroduction

20Mussallem, Helen D. The Changing Role of the Nurse, American Journal of Nursing 69:514-517, March 1969. 21Olson, Edith V. Health ManpowerNeeded: A Shake-up in the Status Quo, American Journal of Nursing 68:1491-1495, July 1968. 22Reinkemeyer, Sister Agnes M.It Won't Be Hospital Nursing, American journal of Nursing 68:1936-1940, September 1968. Davis, Fred, F. L. Olesen, and E. W. Whittaker. Problems and Issues Ln Collegiate Nursing Education. The Nursing Profession: Five Sociological Essays. New York: Jo ni ey an oils,ne.

6 ChAPTER II REVIEW OF THELITERATURE

Education Various conceptualmodels have beendeveloped for viewing and organizing the curriculumcontent of educational programs.Some models are based oneducational objectives; some, oncontent.Tyler's approach for analyzingand interpreting thecurriculum content and instruction, which isbased on the objectivesof the program, dividesthe objectives into twodimensions: behavior andcontent.(A He identifies seven componentsof the behavioral aspect:(1) understanding of important facts andprinciples, (2) familiaritywith dependable sourcesof information, (3) ability tointerpret data, (4) ability toapply principles, (5)ability to study and reportresults of study,(6) broadness and maturity of interests, and(7) nature of social attitudes.Content is identified in operationalterms as a part of theobjective. Accomplish- ment of objectives isevaluated in terms ofbehavioral outcomes. Bloom and Krathwohl use ataxonomy of educationalobjectives as,means for organizingobjectives, behaviors, andevaluation techniques. 3) Objectives are classified ascognitive (related to recalland to solving an intellectualproblem), affective (related to afeeling tone, emotion, or attitude),and psychomotor(related to a motor skill or to neuro- muscular coordination).The cognitive is furtherdivided into knowledge, comprehension, application,analysis, synthesis, andevaluation. The affective is divided intoreceiving, responding,valuing, organizing, and inte nalizing with behaviorchange. The psychomotordomain is not yet sub-divided. Values ofthis system includeclarification of objectives, adaptability to developingevaluation tools, andadaptability to evaluating educational programs. Maccia developed ascheme called SIGGSan organizationof Set, Information,Graph, and GeneralSystems theories.(4)It has been used to develop generalpropositions 'about education.No relevant literature evaluating the use of thismodel was found. Chickering used the dimensionsof student developmentbased on developmental tasks, needs,and student typplogies.(5) Specific aspects of studentdevelopment thus identified werethe development of competence, autonomy,identity, purpose, andintegrity; the mangement of emotions;and the freeing.ofinterpersonal relationships.

7 Chapter II - Review of the Lite atue

Mayhew suggested the use of a two-way chart forconceptualizing curricula. He proposed two dimensions,one consisting of the substantive areas, and the other of the skills,traits, and attitudes necessary in utilizing the substantive materials. He describedthe value of this concept as follows: If the collegiate curriculumcan be visualized as this two- way chart with the divisions of human knowledge extending along the horizontal axis, the skills, traits,approaches and attitudes along the vertical axis, thenit is possible to plot the most important curricula matterswhich should be offered. By describing a curriculum conceptin such form, we can readily expose where imbalances and omissions occur. This construct may be viewedas the first step in thinking about either a college-wide curriculumor the offerings of a division or department, or even the construction ofa single course. Once the framework is established it provides the limits within which the coursescan be built, added or sub- tracted...The chart providesa curricular medium which imposes quite definite, quite stringent, and quitesevere limitations within which the creative energiesof the faculty must operate. The faculty should always havethe right to put anything it wants into the curriculum, butwithin sufficient limitations...(6) Other conceptual models for education generallyhave been developed and described, (7, 8) but the thread thatruns through the literature is that there exists a definite need foran organized approach to the systematic identification of the content and objectivesof an educational program. Nursing Nursing education also has had established its needfor theories or models on which to base curriculumconstruction. Attempts in developing such a theory in a scientificmanner are underway Interested nurses and non-nurses have presented various approaches.(9, 10, 11) Gunter suggests the need fora theoretical framework composed of three parts:(I) a theory of the organism, (2)a theory of medicine, and (3) a theory of interpersonal relations. (12) She also suggeststhat the combination of such theories specifically appliedto nursing will provide the uniqueness necessary to separate areas. nursing from other functionMg

8 hapteIIRevieo the Lite a ure

the King has identifiedthe levels of operationfor nursing as (1) individual, (2) the group,and (3) society.(13) She suggests that these be integratedinto curriculumstructure. In the past few yearsmany approachesfor identifying andorganizing curriculum contend ireashave been developed.In various nursing for Nurs,ag established asub-committee 1961 the National League for on Maternaland Child NursingContent to develop a process identifying essentialcontent in nursing.Their methodologyincluded problem from which theessential content needed identifying a nursing the to resolve the problemwould be determined.The two aspects of information and the frameof reference for content were specific essential content as"the knowledge nursing action.This group defined needs in order to assume that a graduate fromthat type of program (14) the nursing role forwhich that program preparesits graduates." No literature wasfound evaluating the useof this approach. Education The BaccalaureateSeminar of the WesternCouncil on Higher study to develop anapproach for identifying for Nursing conductedbaccalaureate a programs innursing. The selected content essential to perimeters for thecontainment of essential approach identified fourbaccalaureate education innursing, (2) content:(1 ) philosophy of in nursing, characteristics of the graduateof a baccalaureate program and (3) characteristicsof today's college-boundhigh school graduate, (4) implications for thefaculty who will beteaching today's college- bound high school graduate.Essential content withinthese perimeters might be based on (1)nursing needs(physical, environmental,emotional, instructional, coordinationof service) and(2) the backgroundfactors from the biophysicaland psychosocialsciences. Based onthis framework, essential content wasdescribed in six statements: physical and 1 Learning experiencesin identifying environmental needs areessential in all clinical settings. needs, 2 Learning experiencesrelated to emotional needs for instructionand information,and for coordination of patientservices should beempha- sized strongly in allclinical settings. Learning experiencesin communicatingand knowledge of the value andeffect of communication between individualsand/or groups areessential throughout the total program. growth 4 Knowledge and learningexperiences related to and developmentthroughout the life continuumare essential to humaninteraction. Chap-e.- II - Revieof the L :erature

5 Knowledge of social forces influencing individual and/or group behavior is essential for identification and evaluation of nursing needs.

6 Learning experiences which provide opportunity to develop independent thought and action in the identification and evaluation of nursing needs are essential.(15) The Western Council on Higher Education for Nursing also conducted anotherpnoject to clarify and delineate nursing content at the graduate level.(16.1r(18,19) However,over the years, this became a project of determining approaches only. Each specialityarea selected a general theoretical framework which was used to approach the development of content in that specific area. Community health nursing selected Parsons' theory of action; medical-surgical nursing, the nursing process and related patient and ilhiess characteristics; psychiatric nursing, nurse-patient interaction; and maternal-child health nursing, the concepts of pattern maintenance, pattern functioning, coping,and vulnerabilities to stress and crisis. Sand used the school objectives as the framework fora curriculum study at the University of Washington.(20) The,objectiveswere separated into Tyler's two components, behavior and content.Categories identified in the behavioral component included (1) uriderstandingof facts and principles, (2) critical thinking, (3) controlled andcoordi- nated motor activities, (4) attitudes, (5) interests andappreciations, (6) communication skills, and (7) habits. Areas of content included (1) the nurse as a person and as a citizen (2) the body of scientific and cultural knowledge, (3) the agency and those it serves, (4) the nursingcare of the patient, and (5) the nurse's heritage and responsibilities. An important result of this study was the recognition of the problems associated with curriculum and student evaluation. A decision-making model utilizing the problem-solvingprocess constituted the theoretical orientation for the curriculumdevelopment at the University of California.This model provided botha "consistent and systematic way of thinking about nursing interventions"and a common way of organizing the knowledge of the curriculum. (21)One course organized within this framework combined three theories in the organization of content:Simon'sdefinition of organizationalbehavior of employees, Getzel's theoryon administration as a hierarchy of sub- ordinate (superordiaate relationships witha social system), and Peplau's experimental learningprocess theory.(22) Thus, at the present stage of theory development innursing education, a variety of approaches are being considerpd and assessed.

10 Chapter IIReview of the LIterature

Occupational Health Nursing Several projects related tointegration of occupational health nursing content into a nursing curriculumhave been conducted by nurses.In 1949-51 Smith conducted a survey atYale University School of Nursing to study the curriculum contentwith respect to occupatio, al health in order to determine areasand scope of integrat within the curriculum; to find newmethods of weaving it throughout the various courses and activitiesinto clinical nursing; to explore possibilities forenrichment of the present content; and to aid inlocating additional hospital and community facilities for teaching purposesin occupational health. (23 She determined through conferenceswith the dean and faculty, reviews of course outlines, and visits toclasses and clinical experience areas utilized for student learning that contentrelated to occupational health was adequately integratedinto that specific curriculum. Brown described ways in which theknowledge and understandings needed by the nurse in industry differ from thoseneeded in other areas of nursingpractice.k24) She advocated provision of learning experiences for students through courseintegration of these identified differences. In 1955 Ditchfield stated that'probably the largest amount of curriculum content essential to the preparationof the nurse for the field of occupational health nursing is contentthat is also essential to all fields of nursing. "(25) She recognizedthat the first problem was not that of integrating occupational health nursingcontent into the curriculum, but rather the identification ofcontent basic to all nursing, including content specific to theunderstanding of occupational health nurs ing. In 1957 an NLN-AAIN ConferenceCommittee prepared a ide for including occupational health nursing inthe curriculum.( ) The sixteen principles developed bythis gr'oup wereused in formulating a means of evaluating theoccupational health nursing content. Theguide included evaluative statements for assessingapplication of principles in the area of occupational health;attitudes, understanding, and abilities basic to general practice inoccupational health nursing; and suggested methods of acquiring the necessaryunderstanding and ability. Henriksen in 1959 thund that the professionalcurricula in six collegiate schools of nursing did prepare nurses forbeginning positions in occupational health nursing, but that the occuational health aspects of a health problem were underdeveloped.(27 ) The methodology used to

11 Chapter IIRevieof the Lte a iu e

reach this conclusion Mcluded questionnaires concerning nursing activities in occupational health that were given to practicingoccupational health nurses, occupational health physicians, and employers and employees. A faculty checklist of abilitieswas then developed from the responses to the questionnaires. The facultywas asked to evaluate their curriculum in the following contentareas: organization and program planning, employee benefits, employee services,records and reports, health services, safety, community relationsand participation in professional activities. A second check list ofunderstandings and abilities based on representative functions of theoccupational health nurses was also used by the faculty in evaluatingcurriculum content. A workshop was held in 1962 by occupational health nurses and nursing educators to develop ways of providing opportunities fornursing students to gain fundamental understandings about the healthof the adult worker. Specific goals of the workshopwere:

1 Increased understanding of the need and potential for providing basic nursing students with fundamentalcon- cepts concerning the health of the workingperson. 2 Identification of areas in the basic curriculum which may provide students with learning experiences related to occupational health, and Identification of occupational health resources, within the school and the community, andways in which they may be utilized to enrich the students' knowledge and understanding of occupational health.(28) A project was conducted at Boston College by Summers 'to identify the occupational health components in baccalaureate nursing education and to determine whether there wasa need to strengthen them. "(29) A checklist of eighteen major subject areas was developed andwas used by the faculty to assess curriculum content.Tabulation of results showed that twenty-nine items (fifty-six percent)on the checklist were not considered to be included in the curriculum. In spite of these efforts, there have apparently beenno studies that utilize a theoretical framework asa criterion for the occupational health content data to be collected bymeans of a study of the nursing education process.

12 Chapter IIRevieof the Lite ature

REFERENCES Basic Principlesof Curriculum andInstruction Tyler, Ralph W. nivers -Syllabus for E ucation icago: Y 0- _icago es Educational Objectives 2 Bloom, BenjaminS.(ed.) Taxonomy of uca lonaoa s -an soc the Classificationof E 1956. ogn WO Doam. iêw 'o av c ay c., Krathwohl, David R.,Benjamin S. Bloom,and Bertram B. Masia. Taxonomy of EducationalObjectivesThe Classificationof

Theory Model 4 Maccia, ElizabethS., et al.An Educational (SIGGS) An Integrationof eo y orma=ion _eory eneray es eory. 0 urn. us, io: ap esearch and orae IfliversiLyu eau o uea'ióna Servi e, 1966. Conceptual Framework. 5 Chickering, Arthur W.The Young Adult - A Project on Studenteve_ optnen a o eges. Vermont: GoddardCollege, 1967. Mayhew, Lewis B. TheCollegiate Curriculum -An Approach to 6 AnalysiS. SREB Yonograp ernegional Education Board, 1967. Verduin, John R. Jr.Conceptual Models inTeachers Education An Approach toTeac mg an Learning. as ing on, ericanA ssoctation o o eges ofTeacher Education, 1967. Research on Teaching -A Project 8 Gage, N. L.(ed. ) Handbook of icago: of the American u a -iona esearcASsoOlaon. an c a y ano., Nursing Research 9 Symposium on TheoryDevelopment in Nursing, 17:196-227, May-June,1968. in Nu sing. NewYork: 10 Rogers, Martha E.Educational Revolution The Macmillan Identifying ResearchAreas 11 Fox, David J. AProposed Model for in Nursing, NursingResearch 13:29-36,Wiriter, 1964.

13 Chapter II - Review of the Literature

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

13 King, Imogene M. A Conceptual Frame of Reference Nursing Nursin_g Research 17:27, January-February 1968. Subcommittee on Maternal and Child Nursing Content. A Process for Identifying Essential Content in Nursing. New York a iOna eague o tits_g,nc., 15 Pair, Nana Tiller, et al. The Report of One Approach to the Identification of Essentiaon en rnacca aurea, e °grams ursin-g. ou :ora o: es ern7 n ei-s a eo kission 1775IFITi Education, February, 1967. 16 Ford, Loretta, et al. Defining Clinical Content Graduate Nursing ProgramsCommum y a ursmg. ou .er,o oraso Wstern interstate Commission lor ITigher Education, February, 1967. 17 Lewis, Lucile, et al. Defining Clinical ContentGraduate Nursing ProgramsMedica urgica er,o ora o: es ern n ëra e ommiion o er Education, February, 1967. 18 Fujiki, Sumiko, et al.Defining Clinical Content-Graduate Nursing. Programs- eS ern n ers -a e5miiisstdni oiiger Education, February, 1967. 19 Highley, Betty L. Defining Clinical ContentGraduate Nursing ProgramMaternal_ an-d 2tiild Health Nursmg. -Moulder, CTDIorado-:Wes-fth-ti Interstate-Commission for Higher Education, February, 1967. 20Sand, Ole. Curriculum Study inasic Nursing Education. New York: nasons 21 McDonald, Frederick J. and Mary T. Harms. A.Theoretical Model for an Experimental Curriculum, Nursing Outlook 14:48-51, August 1966. 22 Dietrich, Betty J. and Doris I. Miller. Nursing. Leadership - A Theoretical Framework, Nursing Outlook14:52-55, August 1966.

14 Chapter IIRevie ite atu e

Health Integration inthe 23Smith, Emily Myrtle.Occupa ional Schoo ursmg urricuu pp aisal Yale University C- eaguexe ange ovem. e e, 1952, p.6. 'o _iona eague orursmg Education, Health Nursing in 24Brown, Mary Louise.Integrating Occupational the Basic Curriculum.Nursing Outlook2:316-18, June 1954. Integrating OccupationalHealth 25Ditchfield, Alda L.Problems that Nursing, into theBasic NursingProgram, Will Presentto Paper presented atthe National League the Nurse Educator. 1955. for NursingConvention, St. Louis,Missouri, May 4, of Industrial 26National League forNursingAmerican Association Nurses ConferenceCommittee. Guide forEvaluating and Health Nursingoncep eeague Teaching Occupational Nursing, 1957. xc_ ange ona eague or Henriksen, Heide L.Curriculum Study ofthe OccupationalHealth 27 Afl ve ure inoopera ion. epor Aspects of Nursing o egia_ec oos ofNursing o anouca_iona rojec m .x Nursing in Minnesota,Sponsored by TheAmerican Journal of Co. and TheMinnesota League forNursing. U S.A. :1959. Nursing for.theStudent 28Report of Workshop onOccupational Health uy urseImverS y as inon,ea e as n on, 271,56,1962. Health Nursing Study, 29Su mers, VirginiaM. An Occupational Nursing Outlook15:64-66, July 1967.

15 CHAPTER III THEORETICAL FRAMEWORK

Occupational health nursing isin the same transition that isaffecting all nursing. With emphasisshifting from emergency care of occupational diseases and injuries topromotion and maintenance of health, a different typeof theoretical framework fromthose discussed in Chapter II seemed essential forassessment of occupational health nursing content in a baccalaureate program. Leave 11 and Clark's levelsof prevention(l) and Maslow'shierarchy of needssystems(2) were selected as being adaptable to a curriculum study and as providing implicationsfor defining the competencies of the professional nurse inoccupational health. Levels of Prevention Leave 11 and Clark identifiedthree levels of prevention: primary (health promotion and specific protection),secondary (early diagnosis and prompt treatment anddisability limitation), and tertiary (rehabilitation). Health promotion relates tofurthering the general health andwell-being of an individualT Specificactivities directed to this goalby the health professionals in industry includeeducating in health habits; promoting adequate nutrition adjusted to thedevelopmental phase of life; fostering healthy personality development;defining and promoting adequatehousing, recreation, and suitable workingconditions; counseling in marriage, sex education, andgenetics; and conducting periodicselective examinations. Specific protection is concernedwith the health professional'sactivities in con ro isease-producing conditionsbefore the individual is affected. Attention is given asindividually needed in such areas as specific immunizations,personal hygiene practices,specific nutrients to bolster diets, andrecommendations of job assignmentspermitting avoidance of allergens andprotection from carcinogensin addition, professional activities are directedtoward the broader environmental areasthat affect the individual as amember of the group, such asenvironmental sanitation, occupationsl diseasehazard prevention, andsafety practices. Early diagnosis and prompt treatment asdefined by Leavell and Clark are in en e

1 to cure and prevent disease processes,

2 to prevent the sp ead ofcommunicable diseases,

17 Chapter In - Theoretical Fraework

_o prevent complications and sequelae, and

4 to shorten the period of disability. (1) The achievement of these goals in early diagnosis requires individual and mass case-finding measures, screening .measures, and selective examinations. Prompt treatment of injuries and disease so disclosed must follow. Disability limitation focuses on preventing or delaying the consequences FraU irT1TEEMTEriced disease process. Two aspects of this level are identified as (1) adequate treatment to arrest the disease process and prevention of further complications and sequelae and (2) provision of facilities to limit disability and avoid preventable death. Rehabilitation has asits mains objective TTto return the affected 11-7-diTirdifaTTUa useful Ave in society and make maximumuse of his remaining abilities. "C 1) To accomplish this objective Leavell and Clark identified such activities as (1) the provision of hospital and community facilities for retraining and educating the individual for maximum use of remaining capacities, (2) the education of the public and industry to utilize the rehabilitated for as full employment as possible, (3) selective placement, (4) work therapy in hospitals, and (5) the use of the sheltered workshop technique. Activities specifically directed toward occupational health for each level were identified and have been used as the basis for assigning the specific competencies of the occupational health nurse.(See Chart I) Hierarchy of Needs In his hierarchical theory of human motivation Maslow(2) identified six basic human needs: physiological, safety or protection, love and belongingness, esteem, self-actualization, and aesthetic. For the purposes of this study the aesthetic needs have not been considered since they have yet to be explored more completely. Maslow's presentation of a general growth-oriented personality theory was evolved through studying self-fulfilled, ergo very healthy, individuals. Since his original formulations, a variety of elaborations and applications have evolved. The most relevant one, for this study, is his highly provocative hypotheses-forwarding hook, Eupsychian Management. (3) Although a number of writers have been concerned with the differences between growth-motivation and deficiency-motivation (Gordon Allport, Eric Fromm, Kurt Goldstein, and Carl Rogers,among others), it is Maslow's theory Of self-actualization which outlines the mostcompre- hensive statement of human motives and need levels.This is presented

2. Chapter IIITheoretical F ame

to in the form of asystem of hierarchicalprepotencies from lowest highest level in humandevelopment. Maslow'stheoretical orientation is one in whichphysiological needs arethe most potent; however, once theseneeds are reasonablysatisfied, more psychologically- oriented needs (security,safety, etc.) become morepronounced. As safety is consistentlygratified, belonging andlove-needs as well as esteem needs emerge morestrongly as motivating forces.Only after these needs are fulfilled, mayself-actualization become manifest. A sharp distinctionis made in thistheoretical system betweengrowth and deficiency motivation.Accordingly, the first fourlevels in the need hierarchy(physiological, safety, love, andesteem) are characterized by some significantdeficiency, similar perhapsto a nutritional deficiency. The necessityof satisfying these basicneeds produces tension, which is experienced asbeing unpleasant. Aprolonged period of deprivation orlack of gratificationleads to physical illness and psychological oremotional disturbances of onekind or another. In the growth-motivatedself-actualizing individual, onthe other hand, this "need" state isdesired rather than rejectedand defended against. Satisfaction at these higherlevels involves morethan a simple tension reduction. Actually, withsatisfaction, desire increasesrather than decreases. The gratificationof growth-motives produceshealth, whereas satisfaction indeficiency areas serves onlyto prevent disease or illness. Actually, in his laterwritings,Maslow(4) has indicated that the motiva- tional nature of theself-actualization tendency isby no means clear,and he described this state asmeta-motivation or unmotivated.In a way, this need for self-actualizationis never fully realized, asis possible with deficiency motivation.Instead, individualgrowth and self-fulfillment is a continuing life-long process.It is developing, ongoing,emerging, and becoming. The five needs selected areoriented first toward healthequilibrium and subsequently towardspersonal growth and positivehealth. They relate to the whole individualin a dynamic mannerthroughout the total life span. For purposesof this project specific commonhuman needs for each broad area havebeen itemized.(See Chart II) The Integrated TheoreticalModel The resultant frameworkthat has been developedfrom the meshLrig of the two describedtheories is composed oftwenty-five categories, each labeled with onelevel of prevention and oneneed. These categories range from"HealthPromotion-Physiological" to"Rehabilitation-Self- Actualization." (See ChartIII)

19 Chart I: HEALTH PROMOTION S rECIFIC PROTECTION LEVELS OF VENT:ION APPLIED TO OCCUPATIONAL HEALTH* I EARLY DIAGNOSIS AND DISABILITY LIMITATION (directed Chiefly at host; (directed at control of PROMPT TREATMENT : REH IMITATION : 1. Fitting job to worker secondarily at agent) 1. environment)Toxic hazards (directed at adult population) Occupational disabihty re- : 1. Pre-placement and periodic 1 . Psychological 2,,, Health Counseling emotionalincludingPre-placement physical evaluation exam and Route:fumes,mists,Agent:respiratory skin, vapors., dustsliquids, systemG.I. aerosols,solids, tract, 2.L minorbasedNon-occupationalandvealed medical on illnessin absenteeismfirst reports aid diability records for 3.2. ReferralscasesexamsProper found handling with disease of 2,, accordinglyandofRe-evaluationtrauma capabilities placement 3. Mental health aspects MoraleSatisfactions I 3.2. RadiationAccident prevention 4. Estimationor disability of productive . ,, 1" Attitude (physical hazards) capacity of worker (follow- des ign hysiologic machineEaseSafety of features using . 5.4. promotionEnvironmentalcontrolCommunicable(immunizations) disease,health neededworkandup and enable tountil such limit continuingretirement) :supervision diability to as I: 5. Worker hygiene andCleanliness.Food-handling service NoiseTemperatureVentilationLighting : *Adapted from Leavell and Clark. Rest service (See reference 136. sanitaryPlant housekeeping facilities and CominonMaslow's Human Hierarchical Needs Motivationbased on Theory Chart II LVE .ANP atibisicaNG: n4; JaX rz7rcteeclz,' IT:, ...... afty , , . , ,. . 10,LOGICW,..h ,,' ec 4 IA' , 'r? 7b, Adapted from Maslow, Motivation and Personality, pp, 843-97. uoiluz

Nursing -flet1131/-11aS Health lsa (Eo1OOqZ - Occupational of 2u0noi sAO'1 HI Content puu aaam Chart pos)Tel -aa Organizing sscs kfor-o Slajus forFrame- - reol2aTois Schema Z ...., -w .,. 4- rd - .,, -. .- cn ... w m Li 111 s--. fa-1 ..-.. A-4 g-i 0 0 a g 0 .0 0 n 0tu u, 0 F. .- Li0 rd N o 0 0 0 0 P-I 4 .i rv Chapter III - TheoreticalFrame o k

REFERENCES Preventive Medicine 1 Leavell, HughRodmanandE. Gurney Clark. for the Doctor in HisCommunity - An Epemiôogicpproac ion lv, YOr a oo opany Elakiston Division,1965. New York: Harper 2 Maslow, Abraham H.Motivation and Personality. and Row, Publishers, Maslow, Abraham H.Eupsychian Manageent: A Journal. Home- wood, Illinois: R c a n 'win,nc an _e orsey Press, 1965. Self- 4 Maslow, A.H. Some BasicPropositions of a Growth and Actualization Psychology.Perceiving, behaving, becoming: a new focusfor education, (ed rt ur Co inon, IJ.C."narbotik of-the A-ssociation forSupervision and Curriculum Development,1962.

23 CHAPTER IV METHODOLOGY

This chapter presentsthe methodology usedin The University of Tennessee Project as aprototype for a methodologythat can be modified to the needs of theparticular curriculumbeing restructured. A number of factorsinfluenced the decision toutilize an open and evolving approach tochoice of design andmethodology.These were: (1) the spanof time allotted,(2) the abilities and interestsof the project personnel,(3) the consultation servicesavailable, (4) the interest of the facultyin supporting a researchstudy, and (5)the apparent need forfurther de-rielopment of asystematic approach to a study of the nursingcurriculum. The primary pu posesof the project were health nursing 1 To identify that knowledgefrom occupational which is essential forprofessional nursing educationand practices, and

2 To develop amethodology for identifyinggiven content areas within a course of study.(1) A secondary purpose wasto develop a methodologyfor determining whether a specific baccalaureateprogram did includethe content necessary to prepare anindividual for a beginningposition in occupational health nursing.The 1963 ad hoc committeeand later the Faculty AdvisoryCommittee had agreed thatinitial planning shou d be focused on studyingthe existing course contentin a systematic manner beforeconsidering possible changes. Development of Competenciesand Content Although the functionsand responsibilities of theoccupational health nurse arewelTegfabiTshed-F cc-71nWiciesand content needed by the professional nurse tofunction m occuPationalbea1111 have never been identified.In this project, firstpriority was given toidentifying the competencies and contentin a systematic manner.

ee Appendix Bfoi-atioiiàeo±T e Un.ve si y oTennessee Co ege of Nursing curriculum. Chapter IV - Methodology

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

1 Pri ciples and skills of communication;

2 Concepts of human growth and development; Principles from physical and behavioral sciences,i.e., anatomy and physiology, microbiology, biochemistry,physics, sociology, anthropology, psychology; 4 Principles on which technicalnursing skills are developed; and the performance of skills of technical nursing,e. g. , taking vital signs, administration of medications, hygienic and comfortskills; 5 General medical and nursing techniquesapplicable to common patho-physiology. In addition, the following criteriawere used in developing the competencies and content necessary for the full functioningof a professionalnurse as a worker in occupational health:

1 Competencies to be stated in general termsand to include those which in all probability will be neededfor an extended tie in the future; 2Statements of specific skills, functions, and bits of knowledge (sOme of which can and hopefully will change) to be avoided.

Content to be prepared for use bynurse educators at the professional nursing level (the baccalaureate graduate); 4 Competencies to be broad in scope to provide forprogressive change; 5 Competenc es to be identified or stated in terms ofwhat could' be done; 6 Occupat onal health nursing co-petencies to be expressed in terms of the nursing process. (2 3, 4)

4 Chapter Methodology

All aspects of the work setting wereconsidered and the following components deduced:

knowledge receiver of understandings Employee - skills

knowledge understandings Environment - receiver of skills

Knowledge (as professional doer/giver of understandings Nu se(as employee) - receiverof skills

Successive schematic diagrams wereused to clarify thinking in the development of the competencies andcontent: These are shown in Section A, 9, and C on page28.

27 LeVels of Prevention: Complete picture of Need occupational health System nurse (Expert level)

Baccalaureate Graduatef In-Service- ,level level

suIP-Levels of Prevention

Need Role of occupational health owledge Systemnurse understandings functions - responsibilities s kills Work - specific knowledge understandings skills

Complete picture of occupational health nurs e

Need Role of occupational Content needed to perform System' , health nurse as occupational health nurse

Complete picture of occupational health nurs e

2 8 Chap _er IV - Methodology

those This approach wassufficiently broad topermit identification of concepts equa ee I amlurriler 1 ano yet nursing.. mcee expereve level been identified and/ororganized, it was necessaryto complete this in order to determinewhat beginning nursesin occupational health, or professional nurses ingeneral, should kmowabout occupationalhealth nursing. projected A detailed accountof the steps involvedin the development of a occupational health nursingrole model(competencies and content)follows. Competencies Based on the func ionsand responsibilitiesof the expert occupational stated by theANA(5) and the AAIN(6) and on health nurse practitioner as Investigator, the observations,reflections, and experienceof the Principal a preliminarylisting of the componentsof nursing in occupational health was made. Thesecomponents are: Nursing of employedadults mergency care Conthming nursing care Health education Health counseling Health maintenance Absentee control Community activities Environmental relationships Nursing and the workenvironment u vey an ana ysiso p an Structure of businessorganization and management Industrial relations Safety/industrial hygiene Disaster planning Types of occupationalhealth nursing programs Records and reports Administration of nursingservice Development of special programs Nursing and the welfarepf the employee ociaegis a ion Effect of industrialrevolutions Employee benefits

and responsibilities wasevaluated inthe The relevance ofthese functions 9, 10, 11, 12) light of availabledocumentations.(7, 8, 29 Chapter IV - Methodology

The first step in the systematic development of the competencies was to fit the identified functions and responsibilities into the theoretical framework.(See Appendix C).After many revisions and subsequent discussion with the project's ad hoc Occupational HealthCommittee, this approach was discarded since a greater depth and breadthwas necessary to define adequately and clearly the role of the professionalnurse in each theoretically-derived category. There evolved a framework of competencies of the professional nurse in occupational health in terms of the nursing process. This process encompasses the steps in comprehensive nursing care; and these steps are applicable to any individual on the health-illness continuum. The competencies, stated in terms of on-the-job behaviors,were cast into thedescribed framework. Specific nursing actions for each competency were then suggested.(See Appendix _D for competencies and suggested nursing actions for the professional nurse in occupational health.) The identified occupational health nursing competencies and suggested nursing actionsare obviously not all-inclusive of professional nursing activities. Content In identifying content, the Principal Investigator used her experiences, observations, and conversations with health professionalsasresources, as well as a broad range of nursing and non-nursing periodicals and publications.Pertinent subjectareas researched included health, nursing, medicine, sociology, psychology, government, community organization, personnel administration, social work, environment, ecology, rehabilitation and toxicology. The academic content needed by the professional nurse (expert practitioner) was identified simultaneously with the nursing competencies needed tn occupational health. As the shift from functions and responsi- bilitiesto competencies occurred M the development of the project, thecontent took on the anticipated breadth. It became evident that the earlier formulation of academic content in terms of knowledge, understandings, and abilities required modification. Discussion with the project's ad hoc Occupational Health Committee led to the identification of principles, concepts, and broad areas of content. Each broad area of academic content was elaborated into appropriate component parts.These identified components of each content area, although comprehensive, are not necessarily to be consideredcomplete. As the competencies interms of the nursing processemerged, the relevant academic content in occupational health was identified for each competency and was stated at the expert level of professional nursing in occupational health.

3 0 Chapter IV - Methodology

In the spring of1968, the project's ad hoc committeeof Nurse Educators and the projectpersonnel delineated the levels ofcontent for three gradations ofeducational preparation-baccalaureate,graduate, and inservice. Subsequently,the Principal investigatorre-organized the identified academic content intothe stated educational levels.The content was then reviewedindependently by each member ofthe committee. The academic content foroccupational health nursing thusderived is presented in Chapter VI. Validation of Competencies andContent In 1965 the Faculty AdvisoryCommittee rejected the use of a panelof experts as a means of validating thecompetencies and academic content because of the time and difficulty involvedin familiarizing such a panel with the project. The opinion of the Principal Investigator asnurse specialist with suitable documentation would be considereddecisive for questionable areas, particularly inview of the open-end character of theproject making it amenable to revision as necessary.

Extent .of Mention The academic content wasassigned a number indicatingthe "extent of mention" that mightbe spent on a given topic in a_class for professional students in nursing.The coding used for"extent of mention" was: 1- less than one sentence erelyentioned) 2- one to two sentences three to five sentences 4- over five sentences In actuality, alte nat ve measuresof coverage and weights m ybe substituted. Subsequently, percentages wereused to indicate the degreeof coverage suggested for each area of academiccontent. The followingpercentages were used:(1) for content that was deemedprimarily baccalaureate level and continuing throughgraduate level - 75 percentbaccalaureate and 25 percent graduate;(2) for content that wasintroduced at-the baccalaureate level, but wasessentially graduate level25 percent baccalaureate and 75 graduate;(3) for content:that was introdudedto a lesser extent at the baccalaureatelevel and was primarilygraduate level-10 percent baccalaureatelevel and 90 percentgraduate level. Chapter IV- ethodology

The suggested percentages (75-25, 25-75) were chosen to fit smoothly with the assigned 1-2-3-4 "extent of mention" points.In order for a lesser extent to be suggested) the 10-90 percentages were used. Considera- tion was given to suggesting more variations of degree of coverage, such as 50-50, 67-33, or 33-67; but this specificity was not undertaken as its value was questionable. The content at the inservice level was not assigned a percentageas there appears to be little content in that area and its nature varies with each work setting.

Utilization of the Methodology Assessment of The University of Tennessee Collegeof Nursing curriculum content itself was deterxnined bythe technique of content analysis as developed by.Berelson. Contentanalysis is "a research technique for the objective, systematic, andquantitative description of the manifest content of communications. "(13)This method can be used in evaluating content ofa communication by cornparing it with (1) an a priori standard, (2) anotherbody of content and (3) a non-content source-. TheTitandard in eachcase is developed by a person other than the one presenting the content. For thepurposes of this project, evaluation of content by comparingone body of content with another was found to be the most appropriate method. The most important elementin content analysis is the standard utilized in making comparisons. The categories thatare developed as the standard, according to Berelson, must be written inan analyzable form appropriate for the content. The occupational healthnursing competencies and content that have been stated within thetheoretical framework of Leaven. and Clark and Maslowcan and do constitute the standard of comparison for this project. A systematic determination of whatwas presented to students was essential to meet Berelson's second criteriafor content analysis. Asking the faculty whether certainprinciples or selected aspects of occupational health nursingwere being presented in their courses did notseem to be the most valid approach. Hence, the Faculty Advisory Committeedecided that the best approachwas for the Principal Investigator to attendclasses and observe selected learning experiences. Due to the limitationsof human energy and time only nursing courses were studied.It was assumed that the nursingcourses would provide the opportunityfor application of the knowledge taughtin the related courses. Admittedly,some occupational health nursing content may have been lost, but the experienceof the Pr inc ipal Investigator indicated that the decisionwas correct.

32 Chapter 11.7 Methodology

the course content It was recognizedthat the datacollected represented point in time andthat the project wasnot.designed to at a particular content adequacy.There was no discussion evaluate faculty or course selected with the facultyregarding what contentmight be added to what, content wasidentified until all datahad been gathered units of study or of thePrincipalInvestigator and analyzed.Nevertheless, the presence(14 15 16 17) was recognizedUnavoid- as creating an"experimenter effect" necessitated an ably, the originaldesign and thelimitation of personnel of these variables.The Principal Investigator unsystematic assessment session of 1965 totest the attended one courseduring the summer indicated suitability of the datacollection techniques,and this experience the adequacy ofthe approach. of each academic yearthe Principal Investigatorwrote At the begimiing explaining how the datawould be the appropriatefaculty chairman year collected and offeredto meet with thefaculty for that particular Principal Investigatorattended meetings to answer anyquestions. The plans and of each year'sfaculty in order tobe kept informed of scheduling for the courses.She declinedparticipation in the testing and evaluation aspectsof the students' progressand the curriculum planning. content analysis wasauditing The basic methodof data collection forconferences of one classof the nursing classesand some clinical within students (Class of1968) for the three-yearperiod of the program the College of Nursing.(See Appendix E fordescription of courses offered.) The coursesaudited over thethree-year period were: Sophomore Year Nursing as a SocialForce I Nursing of Childrenand Adults I and H Junior Year Nursing of Ch ldrenand Adults HI, IV, V Senior Year Nursing of Childrenand Adults VI, VII,VIII Nursing as a SocialForce III Preventive Medicine2 N courses taughtwithin the MedicalUnits but The related required and physiology,biochemistry, not auditedincluded: anatomy growth and develop- TEYsics, microbiology,anthropology, human and ment, scientificmethod in nursing,biostatistics, nutrition, pharmacology. Chap eV - Me hodology

For nursing classes not attended the Principal Investigator obtained tapes of the classes or the notes from one student of high caliber. About ninety percent of the target classes were audited by the Prthcipal Investigator. All handouts, the syllabi, films, and other audio-visual aids were noted and analyzed for content. The Principal Investigator sat with the students in the classroom, but did not participate in the teaching-learning process except when invited by the instructor.Usually the questions directed to the Principal Investigator were related to nursing, public health, or healthcare in general, rather than to occupational health nursing. Observations in the clinical area were started in the sophomoreyear but were discontinued after a few weeks. Thereasons for omitting these observations were 1) an increase in student anxiety caused by the presence of an additional observer, 2) the impossibility of observation of more than a very few student learning experiences, and 3) the difficulty of being present when appropriate content could be observed or audited.It is acknowledged that some content may have been lost. Class and clinical conference content material relevant to the theoretical framework was recorded in written form in terms of broad categories, but details were noted when specific application to occupational health nursing was evident. The data were organized by courses and academic quarter, rather than by speciality area in nursing, according to the organization of the curriculum. At the completion of each course, the recorded content from classes was coded on index cards (content information cards) under the following headings: content data, course number, week, method of instruction, and "extent of mention." Each item of contentwas noted on a separate card. "Extent of mention" indicates the time spent on a given topic, but does not indicate relevance, accuracy, and depth of the coverage. Despite this limitation, the coding does serve as an index of coverage. Over 900 content information cards were collected. A typical sample follows:

34 Chapter IVMethodology

CONTENT DATA: Team approachto health care Concept of a:team

COURSE: Nursing as aSocial Force EXTENTOF MENTION 4

WEEK: 8 METHOD OF INSTRUCTION:Lecture

Sulnmary in The following prototypeoutline of themethodology can be followed making a study similarto that describedin this manual: of the 1 Faculty decision on thetotal or partial review cui-riculum; mention" or 2 Determination of standard,including "extent of other alternativetechnique; Determination of datacollection techniques;

4 Collection of data;

5 Analysis of data;

6 Comparison of dataith the standard;

7 Evaluation andrecommendations. In realIty Step 2(Dete mination ofstandard) is the crux of any curriculum study.In the methodologypresented in this manual, a standard has beendetermined that is atheoretical framework composed of two recognizedtheories (Levels ofPrevention and Hierarchy 35 Chapter IV etho ology

of Needs).This standard can be utilized by nurse educators to delineate expected behaviors of the nurse in terms of the nursingprocess and from the behaviors to evolve the content that is consideredneces- sary for a nurse to know in order to attain the competency. The methodology presented in Chapter VI providesa theoretical framework for such organization based on: Prevention: the normal, well individual (See first ten categories: Health Promotion-Physiologic through Specific Protection-Self Actualization); Therap7: the illor the ill but active individual (See the next ten categories: EarlyDetec- tion and Prompt Treatment-Physiologic through Disability Limitation- Self Actualization; Rehabilitation: the recuperating individual inneed of rehabilitation to achieve maximum potential (See thenext five categories: Rehabilitation-Physiologic through Rehabilitation-Self Actual- ization). The use of Occupational Health Nursing illustrates how the methodology can be applied and how the content can serve as an assessment tool for nurse educators in determining what academic content is, or is not,or might be included for the particular area ofconcern; e.g. , a course, a unit of study, or the total curriculum.

3 6

44' Chapler Liodolo y

REFERENCES

1 Keller, Marjorie J. InterimReport of A Study of Occupational Health Nursing ContentEssential in Baccalaureate Education for Professional Nursing.Memphis: The University of Tennessee College of Nursing,1967, p.3. (Mimeographed)

2 Yura, Helen and Mary B. Walsh.The Nursing Process: Assessing, Planning,IMPlemen ng.Washington, IfnTversi y o A erica_ess,967. Weidenback, Ernestine. Clinical Nu s A Helping Art. N.Y.: Springer Publishing

4 Maier, Henry W. Three Theoriesof Child De elopen Harper and Row,

5 A erican Nurses' Association.Functions, S andards, anduali- fications for Occupational HealthNiirses.Prep-area by-tfie ccupa lona eá u sesec on. ew York: American Nurses' Association, n. d.

6 American Association of Industrial Nurses.Duties and Responsi- bilities of the Professional Nursein an Industrial Medical Service, American Association ofIndustrial Nurses Journal 3:13-14,une

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

8 Wagner, Sara P. Role ofOccupational Nurse in Efficiento ker Utilization, Archives of EnvironmentalHealth 4:451-53, April 1962.

9 Tyer, F.H. Occupational HealthNursing. London: Bailliere, Tindall and Cox,

10 American Medical Association. MedicalDirectives for Occupational Health Nurses, Prepared by theCouncil on Occupational Health, Archives of Environmental Health5:631-34, December 1962.

11 Metropolitan Life insurance Company.Correlated Activities in an Employee Health Program. Prepares y ea an.e are iision'ewor Y eopolitan Life Insurance Company, 1962,

37 Cha ter IVMethodology

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

13 Berelson, Bernard. Content Analysis in Communication Resea c Glencoe, Illinois: e ee 14Rosenthal, Robert. Experimenter Effects in Behavioral Research.

New York: App e on enury- os, 9 111 15 Barber, T.X. and M. J. Silver.Fact, Fiction, and the Experimenter Bias Effect.Psychological Bulletin Monograph, vol. 70, no. 6, Part 2.Washii-'0On, Amerfean Psycllabgical Association, December 1968, pp. 1-2 Rosenthal, Robert. Experimenter Expectancy and the Reassuring Nature of the Null Hypothesis Decision Procedure. Psychological Bulletin Monograph vol. 70, no. 6, Part 2,Washington, D. C-.-:--- Ainerican PSythological Association, December 1968, pp. 30-47.

17Barber, T .and M.J. Silver.Pitfalls in Data Analysis and Interpretation: A Reply to Rosenthal. Psychological Bulletin Monograph, vol. 70, no. 6, Part 2.Was nhi155i1717T.T77 American Association, December 1968, pp. 48-

3 8 CHAPTER V DATA ANALYSIS

gathered in TheUniversity of Tennesseeproject from The content data to permit twomethods of curriculum class presentationswere coded quantitative. Although all evaluation: qualitative(an overview) and of the observed data arenot stated in thismanual, the manner assessment and somegeneral findings arediscussed. Methods of Analysis possible a comparisonof the data The first methodof analysis made for the with the standard,i.e., the academiccontent suggested baccalaureate level ofeducation for nursingpractice based on the project's ad hoccommittee of nurseeducators. These discussions of the to-be-determined proportionof the nurse educatorshad agreed that a educational levels ofpreparation. broad areas ofcontent be assignedto various of the The second methodof analysis yielded aquantitative comparison observed "extent ofmention" of the suggestedcontent. assigned with the assigned "extent ofmention" points The PrincipalInvestigator arbitrarily of the (1-4) to each of thecomponents withineach of the 25 categories theoretical framework.These "extent ofmention" points served as quantitative assessmentsof the suggestedand criteria for all subsequent methodology, any manageablenumber observed content.In utilizing this used of points couldbe assigned providedthat the same criteria are throughout. cards) were placedin only the The content data(content information The data werethen further one mostappropriate V the25 categories. 25 categories. classified into thebroad_content areaswithin each of the Table I consistsorEFFF8YEinin eadings onlyand is presented to illustrate the classificationtechnique. TABLE 1 SC EMA FOR CODING DATA I E'xt ent 1 , . Category Competency Assigned Academic Content Mention of Academic Content Observed MentionExtent of course byby Principalkcadein a Course lclInvestigator Contentnot atteoded Covered

1 1 I

1 Chap e VData Analysts

The last column in Table I wasallocated for the identification a_ academic content assumed coveredby a course that was not attended by the Principal investigator. In quantitatively comparingtheextent of mention" points in the criteria with those in the collecteddata, each broad area of content within each of the 25 categories wasscored separately. For each individual component the"extent of mention" points assigned in each broad content area were totaled.The same procedure was followed for "extent of mention" points in theobserved data.All broad content area scores were totaledto yield scores for each of the 25 categories. However, when the observed"extent of mention" exceeded the assigned "extent of mention" only themaximal points assigned in the criteria were used. For example,under comprehensive health care (HealthPromotion-Physiological) "characteristics" was discussed in two courses with a total of eight"extent of mention" points for the observed data (See Chapter VI).In preparing the data for thequantita- tive analysis, a score of onlyfour points was allowable, as this wasthe number assigned in the criterion.* To accomplish the quantitative assessment, aschema (Table II) was developed to compare the assigned"extent of mention" total points for the professional nurse level (column1), the assigned baccalaureate level (column 3) and the observed data(column 4) for each broad content area in the 25 categories. The assigned percentage of coveragefor the baccalaureate level is indicated in column 2, and the calculatedpercentages of coverage are indicated in column 5 and 6. A summaryby category of the totals and percents in Table II may be found inTable III. observed "extent o mention" The data concerning the adequacyof coverageassigneex en o nin ion for the studied curriculum are notgiven.Specifically, all materials under columns 5 - 8 in Table I may notbe found in Chapter VI. dataforcolumns 4 - 6 in Table II are also deleted.The points and percentages for lines 3 and 4 aresimilarly ommitted in Table III. This omitted material is not necessary to anunderstanding of the analysis process.

ospec e a a.roa.er range oextenf of mendoi'7" poin s, such as 1-6, would haveyielded more accurate inforniation an finer discriminations.)

41 QUANTITATIVE ASSESSMENT OF THE OCCU 1M" ATIONAL HEALTH ACADEMIC CONTENTTABLE H FOR (school) CATEGORY A COMPARISON OF THE ASSIGNED WITH THE OBSERVED EXTENT COMPETENC. SUGGESTEDLEVEL OF NURSING ACADEMIC EDLICATION CONTENT FOR BACCALAUREATE OF MENTION OF ACADEMIC CONTENT' 1 2 L egend: Column l - The assigned "Extent of Mention" for the Professional Nurse in Occupational Health ints ColumnColumncolumn 3 564-2 The- The assigned ObservedsuggestedAcademic "Extent "Extent of of Mention"' Mention'irContent forfor (points). BaccalaureateBaccalaureate Level (per cent). - The Observed "ExtentDifference of Mention" between (perassigned cent). and Observed "Extent of lention" (in Level Column III per cent (points). Chap -er V - Da a Analysis

TABLE III SUMMARY OF THE QUANTITATIVECRITERIA FOR ACADEMIC CONTENT

T 9 . Cura ive Restorative <------>Preventive Health Specific Early Diagnosis &Diability Rehabilitation Promotion Protection Prompt TreatmentLimitation 1 98 1) 71 1) 405 1)58 1) 101 2) 5 2) 74 2) 7,4 2)48 -..o2) 266 to3) 3) 3) 3) 3) o 4) 4) 4) --.. 4) 4) o 5) 73% 5) 75% 5) 68% ,f)--1 5) 66% 5) .1 P., 1 32 1)107 1 43 1) 49 150 2) 76 2) 33 2) 10 2)28 16 2) 3) 3) 3) 3) 3) 4) 4) 4) 4) 4) 5) 57% 5) 50% z5) 51% 5) 31% 5) 23%

'+cist tri 1)99 1) 53 1) 68 1 92 1) 279 39 2)29 2) 163 2) 28 2) 26 2) 3) 3) 3) 3) 3) 4) 4) 4) 4) 4) 5) 57% 5) 32% 5) 58% 5) 28% 5) 49% -9 0 oa) o PCI tr) _ -- 1 147 1)48 1) 122 1)92 1 82 2) 50 2)108 2) 30 2) 77 2) 20 3) 3) 3) 3) 3) 6 4) 4) o4) 4) 4) 5) 73% 5) 62% 5) 63% 5)2 5) 61%

4 0-, 1) 72 1) 20 1)67 1) 16 g1) 212 46 2) 8 .9-2) 88 2) 12 2) 15 #, 3) 3) 3) co 3) 4) 4) .t:3 4) 4) 4) 5)50% 7,3'5) 42% 5) 7 5) 75% 5) 69% , ,e Chapte_ V - Data Analysis

Legend for Table III Assigned "Mention" for Professional Nurse in OccupationalHealth 2 Assigned "Mention" for Baccalaureate Educat.onalLevel Observed Mention" at Baccalaureate School of Nursing 4 Percent of-Observed "Mention" Content ssi_gne en ion on en 5 Approximate Percent of Recommended UndergraduateCoverage of Total Knowledge Exposure for Category.

44 Chaster V - Data Analysis

Qualitative Comparison As the observed data wereplaced under the appropriate broad area_of content, the discrepancies betweenthe suggested andobserved academic content relating to professional nursingin occupational health became obvious.If a subject area was not includedin the data, a gap in the content area recording couldbe observed; if a subject area wasextensively covered, more than adequate"extent of mention" points could be noted. This assessment revealed adequate, or more orless than adequate, coverage of thesuggested content in each of the 25 categories.It also revealed areas of strength or weakness inthe general areas of prevention, cure, or restoration.The degree of health-orientation or a pathology-orientation in various aspects of thecurriculum was readily apparent. The assessment was alsouseful in substantiating whether the full scope of the needs hierarchy wasadequately presented to the students in the class setting. Quantitative Comparison The quantitative comparison was used to comparethe observed content with the suggested baccalaureatelevel content in terms of assigned"extent of mention." The academic content "extent ofmention" as listed inChapter VI and in Table III was used. For example,category"Health Promotion- Physiological" calls for a total of 405 points as the assigned"extent of mention" for the professional nurse in occupational healthand 266 points as the assigned"extent of mention" for the baccalaureate level. By comparing the assigned with theobserved "extent of mention" the degree of coverage was revealed in thebroad content areas. By a care- ful review of the discrepancies betweenassigned and observed "extent of mention" in the category, a generalstatement could be made on the temporality-orientation of content covered, such aswhether the content was (I) traditional in nature,(2) focused on the present day practice of nursing, or (3) directed toward the newphilosophy and developments in nursing and in health services. Similar analysis of each category canindicate the change in curriculum content areas that could be madeif the assigned "extent ofmention" were used as a criterion for evaluation. Through this method it is possible to assessand to recommend changes for the inclusion of the content neededfor professional nursing in occupational health. A similar procedurecould be used in curriculum analysis by other nursing specialities.

45 CHAPTER VI DELINEATION OF OCCUPATIONAL HEALTHCONTENT FOR PROFESSIONAL NURSING

The listing of occupational health course contentconsidered essential for professional nursing is presented inthis chapter.It is this course content that served as the standard usedwith the xi ..,thodology discussed in Chapters IV and V. The column headings are explained asfollows: F a nework Category: See Chapter IIIfor explanation of category derivation.(Leaven and Clark's levels of preventionand Maslow's hierarchy of needs) Competencies: These are the identifiedcompetencies of the professional nurse in theoccupational health setting. See Chapter IV for a discussion of competencies. Course ContentIn this column is delineated the contentneeded to perform the competencies of the professional nursein occupational health. The content is listed in broad content areas(e.g., Health) with detailed elaboration (e.g. Definition, Responsibility, etc.) "Extent of Mention" Points: See Chapters IV and V for discussionof derivation and utilization of "extent ofmention" points. Supplementary In-Service Content: This content isbelieved more directly related, both in source and inutilization, to the occupational site and is considered supplemental tothe academic content presented in institutions of learning. It is emphasized that the "extent ofmention" points were assigned arbitrarily by the Principal Investigator of theproject for use in testing the methodology by assessing the selected curriculum(The University of Tennessee School of Nursing).It is assumed that extent of mention points would be assigned at the discretion of the individualutilizing this methodology for developing or evaluating a curriculum. Delineation of Occupational Health Content forProfessional Nursing Competency for each of the 25 squares on thegrid follows on pages 50 through 73 and relate to the grid as shown on Chart I.

54 CO Delineation of Occupational Health Content listedSuggestedseveraland(4-) broadunder and framework academicstated contentthe appropriate only areas content categories.once. were competency.for found each This educationalto content weave Many throughout concepts level is is starred eventive Curative Resto ative PromotionI'll ea Protectionpeel ic Prompt Treatment,arlly Iliagnosis Limi ation lsasi iity Rehabilitation 1 .,to1-o see pages 50 & 51 see page 60 see page 64 see page 67 see page 71 4P-1-1-, aa1. 1 cal to see page 53 see page 61 see page 65 see page 68 see page 71 CD ..to0 I.(rd, cZJII 00a.),... cn ocal see. pages54 & 55 see page 62 see page 65 see page 68 see page 72 0 --. cd 1

1 0I0.0 .--1 1 0o see page 57 1 see page 63 see page 66 see page 69 see page 73 0 121.3CD I -72 6 '6 ,'''' rr41 6 , 0z 1 0. c's I CD. .,N I Da <11cp 1 .4 cdc) see pages58 & 59 see page 63 see page 66 see page 70 see page 73 COMPETENCY COURHealth ContributingResponsibilityDerinitionindices or healthfactors status Tont I Extent al Oil mien 19m Goad. 6 SUPPLEMENTARY IN-SERVICE CONTENT DimensionsPhilosophy o; health & medical care Ilealth-illness-death continuum 6 Levels of wellness DimensComponentsDef inition ions or wellness 16 24 Comprehensive health care RelationContributingDefinition, of aging factors, process fin life cycle) ;524 26 Holehealth of occupational program in ResponsibilitiesCharacteristics,RoleinfluencesDimensions of each on discipline provision of care medicine 4,4 local area Role of consumer dentistrynursinggovernmentphysicalsocialpharmacy sciences sciences Philosophy oF prevention or niseasc and prom,TargetMethodsTheoryObjectives BasicHon groups ofof philosophyof preventionhealth, use 15 Use of health statistics RafesldeMifieationIncidenceVital data of disease of health stren ha and weaknesses Human ecology RelationshipDimensDefinition ions to healthgeneralillness ecology 14 Assessment of an individual*Basic physiologicComponentFactorsPhysienl Normativeneeds, in oFcharacteristic assessment health standards and medicalfor age groupingservuces ladolescen, s nescencel Groups of employees with special health needs,OlderWoman e.g., employee employee biologicalphysiological considerations, limitations such as pregnancy organizationofspecial employee health in needs the. healthculturalattitudephysiological needs influences,toward . group,factors health in in needsandsociety aging medical employee care Fr ,m culture lit -d fie rent * Communication skills Formal and informal patternsdefinition 32 4 24 8 rumorformscharacteristicsbarriersprinciplesinfluencing of communication factors 44 Development of a program for a health service o 36 4 9 27 SelectionOvercomingEvaluationIdentificationImplementationPlanning a approachespersonnel resistanceof need and methods 4 TrainingDevelopmentFacilities of philosophy and objectives 21 4 16 5 in-plant health team Collaborative role of nursing on health teamsRelationshipsResponsibilityMembersTypesTeam approachof teams of teams of of to team team health membersmembers care 423 specificrelat ionsn health ip wi thservices Health evaluation program T eamPhilosophy nurs ing and objectives 36 44 9 27 screeningTechnical Ftests kills for MethodsComponentsValueLegal aspectsof ofprogram health of for program healthevaluation team health interview 44 Communication of findings screeningphysical examination tests-mass/multiphasic 4 i Interviewing and counseling PurposesFollow-upPrinciples of individuals 24 4q 28 Health instruction InfluencingDevelopingTechniquesBarriers tofactorstrust establishing relationship on nurse effective individual relationship 36 44 27 Teaching-learning process methodsidentificationidentification of health ofof needsteachingof instruction personal opportunities readiness and vulnerability 44 SourcesEvaluatingInfluences and evaluation oneffectiveness ability ofto learnhealth of teaching and education to teach materials individualgroup _44 Positive health habits ReproductiveRestNutritionPersonalPeriodic -rec healthrephygiene t ion-workprocess and dental balance evaluations 20 4 15 Records and reports UsesTypesPrinciples 23 443 i 7 6 forRecords organization and reperts for TOTALS InformationTerminologyLegal aspects recorded used 405 4 266 139 j r COMPETENCY COURSE CONTENTasic safety needs of an individualSafetyProtection SUPPLEMENTARY iNSERVICE CONTENT Injury control AttitudinalNursingIdentificationPhilosophy responsibility influences ofand individual objectives and family needs 10 Injuryin organization control program EpidemiologicFactorsPrograms influencing for approach injury accidents control communitygroupsfamilyindividual Safety statistics AccidentNational and Safety injury Council rates and allied agenciesworkcommunityhome Accidentrates for and organization injury Accident susceptibility TheoriesUse of data in safety programs and educationnon-occupationaloccupational Economic factors in health care IdentificationResearchCost of findings care of personal characteristicslization of services by socio-economic classes Prepaid health care SocializationTrendsPurposeInfluences in health and onof need health costcare due care to economic factors 21 inPrepaid organization health care plans GroupsDh.ordersInfluenceEffectTrendsTypesDevelopment not of in covered planslegislationof prepaidnot unions of covered and plans health coverage care Roleinsurance of nurse program in Social welfare plans ImpactDevelopment, of plans benefits, on development trends of health careSocialUnemploymentMedMedicare agencies Securityica id and programsInsurance TOTA L impact 01 plans on aevelopment ot nealtn care agencies ana programs COMPETENCY COURSE CONTENT Total 20 Ext rit of MentionBac. 15 I Grad. 5 SUPPLEMENTARY INSERVICE CONTENT nfluences on individual and group behaviorReligiousEconomicEthnicCulturalSocial 4 inGroups organization represented Emgloyee as an individual Employee'Btasic social as needsa member of an of individual a family and community 12 4 9 3 Work MeaningInfluences of ofwork employee on work setting, co-worker, work group 21 34 16 5 ofThe work organization to meet its and type CreatingCulturalFunctionsDignityPeer relationshipsand valuespositive of value work and ofattitudes beliefswork towardregarding all work 34 objectives Family RoleFamily in.society structure and relationships 36 4 27 9 onInfi:.ences organization of family AssessmentInfluencesImpactRoles of of members contemporaryonof of familyfamily family relationshipand needs societyfamily members onon familyemployee, structure work setting, community 4 Identification of health needs and health interestsRoleFamily-centered of of groups family in carepatient care 18 24 5 13 Identified health needs HealthTargetSourcesMethodsPhilosophy groupsproblems and use of of data nation, state, community 4 and interests Group process and dynamics RolesTypesGroups of groupof in groups general members 20 4 5 15 organUse of iza groups t in Socio-economic effects of industrial relationshipsHistoricalGroupUse ofbehavior, groups development e.g., influences, and organization attitudes, of union reactions 24 4 6 18 Relationshipsorganization within Union InfluenceUnion-managementInfluencesImpact ofof laborunionization onindividuals, labor disputes relationships disputes on family nation, community, work setting, 4 contract Social aspects of management and supervisionRolePrinciplesPhilosophies of nurse of in ofsupervision industrial supervision relationships 20 4 5 15 Impact of increased leisure time ManagementTheoryPrinciples of management expectationsof administration of employee 16 4 12 4 AttitudesTrendsHazardsPreparation of employees for use and families 4 7 Groups of employees with special health needs,Woman e.g., employee socio-economic factors of working woman for individual, 24 4 18 6 Specialorganizationof employees health needs of OlderEmployeeYounger employee employee from culturally different group developmentsocialin society aspectspressures of of workfamily, aging habits labor force Retirement programs Benefits socio-cultural-economicrelationships factors 12 4 3 9 Retirementfor organization program Population as healthy, productive citizensSocialTrendsPhilosophy factors of retirement for individual, family,. healthy productive community 16 4 12 4 ProfessionalDevelopment socialization ofindividuals professional relationship withmodificationapproaches of therapeutic relationship 20 4 15 Community structure and organization FederalStateRLccal egionalWorld 44 Community health facilities OfficialHistorical and development 'voluntary agencie. P'0",- let ionsh ip -11th 20 44 15 cy:cri TOTALS Comprehens II. .g 163 116 COMPETENCY COURSE CONTENT Total I 8Extent of Mention Bac. Grad. 2 SUPPLEMENTARY IN-SERVICE CONTENT tasic emotional needs of an individual EmotionalEmotions needs of individuals and groups 448 6 HumanSatisfaction growth and developmentmorale ResearchDevelopmental in growth tasks and developmentfrom birth to senesence .. 11 43 3 Individual and group reaction to normalAssessmentBarriers,Definitions promoters, sources stress 44 3 Limit-setting NeedDefinitionBehavior - overt and covert 11 43 Interpersonal concepts,compromise, e.g., avoidance, resistance, etc.Methods conflict, competition, 12 3 Perception SocialInterpersonalPersonality 32 44 27 Special health needs of Groups of employees with special woman employee biologicalpsychological considerations, aspectsmenopausemale-female of work e. g.,relationships for individual, health needs, i.e., dysmenorrhea, pregnancy, family, labor force, 44 employees in organization olderyounger employee employee psychologicaldevelopment of aspects attitudes of ageagingtoward group work 44 Retirement programs employee from culturally-different groupattitudesemotionalfactors toward inrole group within self, acceptance. familyfamily, work setting, in society family, workcommunity setting 44 Retirementorganization program -for - -- litProcess of change RoleStepsEmotionalCoping of in change-agenteffecting with factors resistance change in retirement to change for individual, 12 44 -- MotivatingTheories of changemotivation in habits and behavior 4a 2 TOTALSIt-haracteristics of an emotionally healthy InterpersonalFreedom from relationships excessive stress environment 122 4 77 45 ..

: :

I 24 18 Philosophy, objectivesand health and evaluation standards *Crib:program of a -ia health forUseComponentsDevelopment evaluation promotiona-,d implementation 44 Philosophy of professional nursing and nursEstablishing ing practice group priorities methodsassessing of needs setting priorities 24 4 6 StandardsNursingIndependentProfessionalHistoricalLevels of of process educational developmentpractice andorganizations dependent preparation nursing andfunctions practice 44 Ambulatory services as component of healthRole TrendsMethodsPhilosophycare of nursingprogram for and provision objectives 16 44 Cr) IFiguresTOTALS in parenthesis apply to baccalaureate level COMPETENCY COURSE CONTENT Extent Bas. of Mention SUPPLEMENTARY INSERVICE CONTENT Industrial hygiene and toxicology Principles of environmentalillumination, hygiene,ventilation, e.g., noise, temperature, odors MIN Total 4 I I Grid. 3 programEnvironmental in orzanizaticn hygiene .c) Ina Human physiology in work setting HeatMuscularPhysical stress activity stress 12 44 I 3 9 CL. Processes used irr production or service byEffectsMethods indtstry of of processes developing on understanding health - physical, of processes emotional, social 12 4 1 11 productionProcesses used in LaiC-) Threshold Limit Value UseDefinitionEffects of changing processes on health 14 42 0 I 14 Screeningprogram test in organization for I0-1CC Characteristics of work environment ScreeningValidity tests for protection 12 4 12 Characteristics of LLICI9 Impact of environmental dimensions of healthSystemsGeographicPhysical on development oflayout manufacturing and of climatic plant of aspects 4 0 plant fncilities cc2,, TOTALS health program 58 5 53 COURSE CONTENTharacteristics of a safe living environmentFreedom from hazards Hazardsin organization to health Potential physical, chemical, micro-biologicalPhysiologicalEmergencyPreventiveIdentification and energy aspects care reactions aspects hazards Erevironmental cleanlinesi: and sanitationSanitaryLegislation codes regarding work environment 1 12 4 Policies for organization Organization of industrial safety departmentSecuritySafetyTeamCompany approach program program policies 23 43 organizationSafety program for SafetyWork, education horno and program community safety protectiveattitudesphilosophy toward:use for use equipment 48 EffectsDetection of long-distance and follow-up travel of comnr,nicable on health BehaviorDiurnal cycles - overt and covert disease conditions 12 444 9 Immunizations and other disease control measuresVenerealGastro-intestinalRespiratory disease infections infections 48 6 forImmunization organization progra _ - Disaster planning for community and workCoordinationSpecific settingDiasters need withfor immunizations community hearth program 12 44 orgar..zationDisaster plan for Environmental health problems and programsEffectsDisaster of relief planning programs and actual event on individuals relating to work setting 12 4 1 Environmentalprograms for health organization TOTALS RadiationAir/WaterNatural pollutionand man-made disasters 107 4 33 74 *.,,, COMPETENCY COURSE CONTENT Total Extent Bac.of Mention Grad. SUPPLEMENTAI1Y IN-SERVICE CONTENT v--- Al, co1Iabo'-atesjtnBaeslng 1nft ,5: Ala; :I; _-4 Social effects of change in industry Influence of Industrial Revolution and subsequentWork "ages" environment on 28 4A 21 ''' ..7,;.-P',' 111e410,44e t - 1 :;,.. 9s, - -,. SocialEconomicHealthFamily legislation and life aspects accidents of living 4 f -It, .4i- *.f . J. 4.- . -1..1,74'4, ,./ AutomationMass production 4 i ...... 4. '....3.v.;,,,....,,, - Social characteristics of a work environmenttCompetitiveLines of communication enterprise (1) (1) 71 34 7 64 - s ---- - , 'L 7-- a ..,, .0v- .. % InterdepartmentalClassificationPersonnel policies or workers rebitionships (I) (11 (1) 4 It' C-,...-%-c_tc- 4., ';',..s.,.;-.. .-H,,<* Job descriptions and analyses (1) 4 -,1.. ...- ,---*-0 'I, -.3:- ti' .,,,.... ,, -x--?., v- -s Work scheduling and shift work (1) 4 i31 " "Y-444',% 41 Ile, a ..1l* Vt. 4:- '..,1 t4... It '' s -*, EconomicOrganizationEmployeeVarietiesTypes of ofgroupingsstatus company industries of a of crmpany a ownershipcompany 4 :5 -,' ' rit ,.. 'S ,-. tt, i. EmploymentSources of employees standards 44 ..4"1 av- 1,40. 1 SystemInformalLegal of aspectsorganization placement of business enterprise 4 -L2nin. --a*'- ..1 i.. L ''''k. " e' .t.t .1 INote Numbers in TOTALSparenthesis apply to baccalaureate levelliocial structure of work setting 99 28 71 COURSE CONTENT Total Extent of Mration Bac.. Grad. SUPPLEMENTARY IN -SERVICE CONTENT "Vg Psychological factors in industrial changeWorkimpact environment of social legislation 16 4 12 4 Characteristics of a work environment)" Supervisor-employeeHealthFamily and life accidents relationship and influence on health (I) 52 44 48 Characteristicsorganization of SourcesSecuritySystemsAttitudes ofof of.extra-planttoward workintra-relationships (1)authority and inter-group stress (1) (1) tension 44 SystemsIncentiveEffectAttitudesTypesBlocks ofof to intra-companydeadlines productivetowardsystemsindividual company systemsprogress communications 4 Effects of exposure to hazardoua, stressful, andIndividualEmotional routme aspects jobs of management-labor relationships 12 4 3 9 Personal characteristic patterns of f mployeesCommunityFamily in hazardous, 12 4 1 11 stressful, and routine jobsEconomicApproachGeneral personality toneed living for ac 1111=1=. 92 4 20 72 Exiint of Mention COMPETENCY IdentificationCOURSE CONTENT of a problem in environment MethodsCriteria forof identificationidentification Tata! 48 Can. 5 Grad. 2 SUPPLEMENTARY IN-SERVICE CONTENT WorkUse of setting research as afindings source of(repeat data - Health Promotionspecific -sources, i.e., records, reports, envi- onment, employees including Self-Actualization) 12 31 39 ResearchPhilosophy, methodology objectives, (Se^ and Health standards Promotion for an - DevelopmentCurrentSelf-Actualization)environmental standards control program 2016 4 2 1618 ./ Effect of environmental ch InterrelationshipUseComponents and implementation of et sonmental factors ..r.es on future health:needs 12 4 12 t Figures in parenthesisTOTALS apply to baccalaureate level. MethodsInfluences of on control health 72 4 12 0 COMPETENCY COURSE CONTENT Total Extant of Ma otion Bac. l Grad. SUPPLEMENTARY IN-SERVICE CONTENT Principles and practice of first aid LimitationsCareBasicDefinition of principles specific ;njuries and conditions 18 424 18 Medical directives for emergency care DevelopmentLegalPhilosophy implicationsresponsibilities and objectives 12 4 serviceoccupationalMedical in directives organization health fornursing - -- Occupational and non-occupational disease conditionsImplicationsDefinitions of each category on nursing care 12 3 5 Specific legal aspects Legal aspects of nursing in occupational healthInsuranceMalpracticeGeneral legal process 48 of occupational health EstablishingRecognition ofindividual pathological priorities process SignsCriteriaDiagnostic and symptoms for testing decision for nursing judgment 4 3 Phenenoma of pain NursingNature of management pain 12 44 9 System of referrals ComponentsImpactPhilosophy on family, of of referral continuity co-workers of health and nursing care 16 4 12 orgal.izationReferral system for Comprehensive nursing care RelationshipOperation of ofa referraloccupational system health nurse and health facility 12 44 9 occupationalNursing procedures health servicefor TOTALS MethodsComponentsDefinition of and providing philosophy 101 4 74 27 within the organization COMPETENCY COURSE CONTENT 19Total Extent of Mention Bac.4 15grad. SUPPLEMENTARYPhilosophy IN-SERVICE and policies CONTENT Components of job placement Re-evaluationReoponsibilityIdentificationSafetyPhilosophy considerations of ofand of demands employee supervisor objectives of job of operationappropriate on placement health of employee 43 of organization Workman's Compensation Act InfluencesHistoricalPhilosophy development on andwork objectives setting, health, rehabilitation 24 44 6 18 RoleclaimsWorkman's of nurse inCompenration TOTALS TrendsOperationalBenefits details 43 4 10 33

COMPETENCY COURSE CONTENT Total Extent of Mention Bac. Grad. SUPPLEMEN TARY Ili -SERVICE CONTENT Social changes InfluencesSymptomsNeed for on established behavior and attitudes 15 43 11 4 Individual disorganization, e. g., alcoholism,ExpectedInfluencesEtiology, addiction, outcomes incidence, on family,prognosis signs work treatmentand setting, symptoms, community and rehabilitation clinical course, anti-social behavior Specificin organization programs Group disorganization,rebellion, e.g., crime family conflict,EffectEtiology, of disorganizationincidence,expected signs outcomeson and individual, symptoms, family, deliquency, racialclinical conflict, course, work setting, community 12 4 Specificin organization programs Absenteeism IdentificationPhilosophyPrograms forof of preventioncontrol causes or relief, e.g., community, industry, union 18 43 16 programPhilosophy, in organization policies, TOTALS Socio-economicOver-allSources and absence use ofaspects rates data of absenteeism for individual, family, industry 43 22 31 COMPETENCY PhysiologicalCOURSE CONTENT reaction to stress -7 Anxiety LevelsDefinitionHomeostasisGeneral Adaptation Syndrome 'herapeutic nurse- patient relationshipReductionEffectConstructiveManifestations on of individual,anxiety use of anxiety family, co-workers r,fikz,e4411- TherapeuticDevelopmentalCharacteristics communityvs. stagespsychotherapeutic function '17.41, Pot-v. Cris is TypesCrisis of theorycrises, e.g., emotional disturbances, suicidology, Identification of stress factors in work settingEffectMethods onof ofcrisesindividual, identification disasterson individual, family, community family, community, work setting ------EffectPrograms of repeatedavailableexperience, exposure for reduction death to illness, of stress suffering, onMental employee traumatic health programs for executives TOTALS IdentificationInfluencePsychology on attitudes of of individual, repetitive and behavior family,stress group with exposure 82 50 COURSE CONTENT InvolvementAwart.ness of of need individual to seek in health recognition care of hisCharacteristicsSelf-responsibility problem of climatefor health f eeds ,_nd problems care SUPPLEMENTARY IN-SERVICE CONTENT TOTALS MethodsreachingPhilosophy problem-solving approach Extent of Mention COMPETENCY Case-findingCOURSE process CONTENT Total / 4 4 Bac.1/ Grad. SUPPLEMENTARY INSERVICE CONTENT UseCompilationMethodsDefinition of data of data 12 44 Medical directives and Mii= Medical directives and standing proceduresUseDevelopmentLegal implications 4 occupationalprogramstanding procedures health nurs for ing ta)co Professional nursing skills (as described in ChapterTechnical nursing skills IV) 8 1 Owe Nursing care plans for active but ill individualsUseDevelopment of plan 36 4 27 9 ornursingNursing ganization servicecare plan for in ocE Common pathophysiology BodyIncidenceDisease chemistry; causation e.g., fluid andAcute electrolyte and Chronic balance 48 IMMO PrognosisTreatmentClincialEtiology course 4 Nurse-private health care relationship ResponsibilityOrganizationPreventive measures of of private nursing health to private care health care 12 44 9 3 Work setting and chronic illness AdjustmentResponsibilityEffect of individual'sof medicalof private regime physical health to cal-e changesfit work to nursing onschedule individual, family, co-workers 12 44 forPhilosophy organization and policies 4"a* TOTALS Incidence and trends in chronic illness 98 74 24 COMPETENCY COURSE CONTENT Total Extent Bac.of Mention Grad. SUPPLEMENTARY INSERVICE CONTENT Protection of individual with illness NurseAppropriate as liasion job placementbetween employee and employer 12 4 Anticipatory guidance IdentificationDefinitionFollow-up byof neednurse and opportunities 10 42 Effects of drug therapy on ability to AdverseActionFollow-up of reactions common of teaching drugs rk 4 TOTALSComponents of Treatmentjob placement - Safety (repeat and - EarlyProtection) Detection and Prompt 4919 28 2114 of organizationPhilosophy and policies COMPETENCY COURSE CONTENT Extent of Mention Bac. SUPPLEMENTARY INSERVICE CONTENT Effects of illness on individual, family and workCharacteristicsImpact setting of illness-social of chronically-ill and economic individuals Total 12 44 Grad. Socio-economic effects of displacement fromImpactPerception established of displacement of group illness -nembership on individual, family, work setting 484 Health insurance for catastrophic illnessOtherMajorEconomic insurancemedical aspects insurance coverages 48 forMedical organization insurance plan Social aspects of chronic illness Effect on dailyfamilyeconomicsocial living activities ability 20 4 15 Componenets of nursing program for absenceHomeAssessingUsePhilosophy careof home needs programs and and of objectives familyhospital with visits,for chronic program telephone illness calls 12 4 11 serviceprogramPh ilosophy, for policy,health TOTALSCommunity he 1th agencies related to illnessNurse-agDisease-. llted agencies relationship 68 4 39 29 COMPETENCY COURSE CONTENT Total Extent Bac.of Mention Grad. 2 SUPPLEMENTARY IN-SERVICE CONTENT Behavioral aspeciii of disease process Behavioral Componentdifferences of diseasehealth and ill individuals 28 21 7 Effect of illness CC individual, family, work InfluenceCharacteristicsPerceptionImpactsetting of ofillness of source illness specific - emotional of illness to common on recovery illnesses rate 44 EmotionalCharacteristicsNeed for aspects meaningful of individual of chronic activity with illness chronic illness 12 4 9 3 Effect of displacement from established groupValue-shiftIdentityImpact membership of aspects displacement on individual, family, work setting 12 44 9 3 Emotional support MeansRecognizingDcfinilirm of providing need -,--_,-- 4 7 Process of dying SuddenIndividual'sGriefPhysical death and philosophy emotionaland slow death signsand attitude of --impending toward death 28 44 21 deathforPhilosophy organization of employee and policy following Common pathopsychc _-tgical processes AdjustmentReactionsValue of to mourningpatterns impending of period family,death and co-worit:ars actual death 32 44 24 8 withIncidence mental and illness employees in ClinicalAmericanEtiologyIncidenceInfluence course Psych. of mother-child atric Association relationship classification 4 organization Community mental tit PreventionPrognosTreatment is facilities 844 6 2 Public and professional attitudes toward mentalLegislationPhilosophy and c. ?Alyea health and illness 4 3 1 Mental illness in work setting Attitudes,InfluenceEtiologyIncidence effects, from of illness work and ,nsettingtrends co-workers on practice and facilities 11 43 8 3 TOTALSMedical insurance plans for care of mental illnessTrends 147 4 108 1 37 plansMental for insurance organization COURSE CONTENT Total Extent of Mention Bac. Grad. SUPPLEMENTARY INSERVICE CONTENT Identification of growth potential in individualNeed with illness 11 43 Self-realization of lowered level of wellnessGrowthMethods opportunities of promoting 20 4 15 StigmaChangingSick-roleIllness of as- perceptionscertain meaning one aspect illnesses and toward of preventive total illness-individuals life fieldaspects of individual and public 4 statustreatmentImpact of onrejection employment of Self-recognition of nursing's limitations AcceptanceImpact of of rejection limitations of treatmer: by individual 48 Philosophy, objectives, and starirlar,?= of TrendsCurrentInterpretingprogram- thinking for to ill health and injured professionals and public 48 programPhilosophy, in organizationpolicy and NurseEffect asof ombudsmanchanging medical care and organizationChangingCommunit:,Legislation of delivery role responsibility of of nurse health service TOTALS MeansDefinition 67 4 46 21 COURSEPhilosophy CONTENT of rehabilitation Identification of functional abilities NeedTypesTargetDefinition ofgroup services Activities of Daily Living AdaptingUseMethodsPhilosophy of remaining activities abilities for individual Techniques of physical therapy UseHydrotherapyActiveRationaleHeat of andbrace,applications for passive usecrutches exercising and adaptive devises menttechniquesPhysical in health and therapy programequip- CommunityDevelopment servicesof self-help for techniqueshome care, to i.e., pe?mitMethodsTeaching independence techniques TOTALS TransportationHomeMeals oncare Wheels programs services 71 48 23 COMPETENCY COURSE CONTENT Total Extent of Mention Bee. Grad. SUPPLEMENTAR Y IN-SERVICE CONTENT SafetyProtection record needsfor individuals of individuals with withdisability disabilityCommunityWorkHome setting 12 4 3 organizationpolicyPhilosophy for and 1 C=111 Cognizance of limitations IdentifyingRatesAttitudes limits TOTALSPrinciples of job placement in rehabilitationNeedFitting for job meaningful, and worker satisfying employm.mt 32 44 16 16 6 COMPETENCY Socio-economicCOURSE CONTENT aspects of rehabilitation Social adjustment 28Total 4 Extent of Mention 7Bac. 21Grad. SUPPLEMENTARY IN-SERVICE CONTENT AdjustmentExpectationsBarriersFamilyInfluences influences to of ofemployment co-workers ofdisability co-workers on social on family andadjustment ot life r 'mployees 4 Rehabilitation ofrabe, minority socio-economic groups in woZ1 class, Adjustmentsex,Financial at7e of stress individual and sources to groups of c'ting, i.e., religion, 28 4 21 HealthSourceAdjustmentStigmaHabilitationDevelopment needsand of background ofbackground ofco-workers of individual work of habits employee to workand attitude 4 Modification of immediate environment EvaluationEffectingIdentifying changes needsof results 12 4 Community rehabilitation services RehabilitationFacilitiesVocationalSheltered workshopsfor Rehabilitation in specific hospitals disability A gency 16 4 servicesCommunity in localrehabilitation area TOTALSIndustrial, union, and insurance carrier rehabilitationServicesHire the by Handicapped insuranceservice carriers, Program unions 92 48 29 63 programPhilosophy, in organizationpolicy, COMPETENCY 'COURSE CONTENT Total Extent cf Mention Bac. grad. 4 SUPPLEMNTARY IN-SERVICE CONTENT Emotional aspects of rehabilitation ChangesValue-shiftCoping and in bodygrieving image 16 44 12 Effects of disability on family and co-workersStagesPerceptions in peroonal adjusthient and acceptance of disability 48 Special rehabilitation problems of employeeSelf-acceptanceReactionsImpact on co-workers with emotional illness 12 4 9 employeesIdentified needs in organization of Trends in rehabilitative care ShelteredAcceptance workshops by co-workers 12 4 areaFacilities in local *. TOTALS Half-wayDay and houses night care centers 48 4 30 18 can COMPETENCY COURSE CONTENT Total Extent Bac.of Mention Grad SUPPLEMENTARY IN-SERVICE CONTENT Striving for highest potential and growth IdentificationPhilosophy and of attitude growth opportunities 84 6 2 Philosophy, policy, TOTALSPhilosophy, objectives, and current standardsTrendsDevelopment for a rehabilitation program 16 4 program for organization

...... CHAPTER VII THE ACHIEVEMENTTEST IN OCCUPATIONAL HEALTHNURSING

In January, 1966,it became evident thatanother way of utilizing the content in the theoreticalframework could result in thedevelopment of an achievement testin occupational healthnursing. The purpose of the test wasthree-fold; (1) to assess whatstudents bring to nursing that relates to occupationalhealth nursing,(2) to evaluatewhether the graduating seniors havethe basic knowledge inoccupational health nursing that all professionalnurses need tofunction in any capacity,and (3) to measure quantitativelyoccupational health nursingknowledge obtained in any baccalaureatenursing program, regardlessof whether or not the collegiatecurriculum provided forsystematic presentationof occupational health content.

Development Learning opportunities weremade available to thePrincipal Investigator for development of the necessaryskills in test developmentby both the NLN and the EducationalTesting Service, Inc.Appropriate readings were alsoundertaken. (1,2, 3, 4,5, 6, 7) The competencies andacademic content fromthe theoretical framework were used asthe point of referencefrom which the items weredeveloped. In the initial effort,attempts were made towrite a representative percentage of test itemsfor each of the 25 categoric.in the theoretical framework of content foroccupational health nurstilr,.The concomitant distribution percentages forthe levels of preveh11,ere 50 percentfor preventive aspects, 2 5 percentfor curative aspe and 25 percent for restorative aspects. Thedistribution percentages forthe five-needs hierarchy were identical,20 percent for each areaof need (Table IV). However, with overlappingof items in categories andcontinuing revisions of the content, the originalpercentage arrangementcould not be main- tained as representatively asdesired. With these assumptionsthe first test consistedof 102 multiple choice items (four alternativeanswers). Six University ofTennessee College of Nursing facultymembers, representingvarious levels of preparation and areas of speciality, wereasked to answer the itemsand made critical comments, particularlyregarding clarity. Aftersuggested revisions were integrated,the test,consisting still of102 items, was mailed to 25 occupationalhealth nurses functioningat various levels of practice throughoutthe country. These nurses wereselected from a list submittedby the Project Officer.They were instructed to q y75

79 PLACEMENT GRID OF FIRST SET OF ITEMS TABLE IV Health erevention, Specific50% LevelEarly of PreventionDiagnosis and Curative, 25% DisabilityLimitation* ,,,, e.___ Restorative, 25% Rehabilitation > . .,-,,--i tto,ocd Promotion Promotion Prompt Treatment 20% P-I..4.79, r/1 ' -1-' a) ' 20% bA tn ca 2 0 % 0a)Z a)-I0 0 12D 0,gz V4 1 20% a) 2=PA oinc) tie ,--I as 11-, cao I ri CdN and restorative aspects.uisarniity Limitation areas or Levels o vI44 i-,o 0 ... r ±-'revefltiofl, it may e no e , is split mo otn cura ive Chapter VII - TheAchievement Test markthe correct responsefor criteria purposesand also to assessthe Value was defined ashow importantknowledgeability value of each item. health nurse of the content areaof each item wasfor the occupational practitioner. Of the25 nurses contacted20 responded. These data werediscussed with the projectconsultant in test construc- that additional itemsbe developed with the tion.It was recommended result. Forty additional idea that two equated50-item tests might faculty items were constructedand were reviewedby the same selected members and the samepracticing occupationalhealth nurses in a similar fashion asbefore. The initialcriteria for correct answers were based asmuch as possible ontwo or more printedreferences. Considerable rewordingof items was done as aresult of the comments from the nurses. evaluated for clarity and wereverified for The 142 test items were by the project'sad hoc accuracyof stem and correct alternativeindividually and as a group. Occupational HealthCommittee, both Four Unanimity as to keyed accuracywas requiredfor item acceptance. items were eliminatedby this group, leaving138 items. -1,

Assessment admin- At the end of the1967 spring quarter,the test of 138 items was of Tennessee to 16(73 percent) of thegraduating istered at The University 36 (72 senior students; 40students (80 percent) inthe junior class; and percent) in the sophomoreclass. Out-of-classtime was scheduled for a majorityof the students totake the test. Thetime needed to complete the 138 items variedfrom one hour to21 hours with approximately11 hours as average time. consulted In May 1967,representatives of the NLNTesting Service were regarding 1) scoring andanalysis of the test itemsadministered to the students of The Universityof Tennessee Collegeof Nuring and 2) the possibility of andprocedure fornational standardization.It was agreed that the scoring and itemsanalysis for the firstadministration of the items to The University ofTennessee student bodywould be done by the NLN. The NLN representativesproposed considerationfor undertaking a contractualbasis with The University the national standardization on 32 items were of Tennessee.In preparation forthis plan, an additional developed and reviewed asbefore by the project'sad hoc Occupationalllealth Committee. This wasaccomplished through mailings.Subsequently the NLN Testing Servicewithdrew from participationin the test standardization. future testing purposes, *Since the fest and testmaterials are intended for the test items no specificinformatiOn is presented inthis report concerning or theinstructions for giving ortaking the test.

77 -81 Chapter VIIThe Achievement Test

In the fall of 1967 the 32 new items were administered to the 40 seniors and the 36 juniors who had taken the original items. The entire test of 171items was also administered to 53 entering sophomore students.(See Table V for Initial Analysis of the Testing Program. ) Inspection of TableV shows a relatively increasing percentage of correctresponses with each level of progression (by year) of the nursing students.This hoped-for result indicated that, in a general way, the total test was being developed adequately. After the NLN withdrawal, national standardizationwas undertaken by project personnel on the recommendation of the proje:: cons'lltantin test construction.In the first nationwide administratiof tne test, 15 out of 40 ran iomly selected NLN-accredited collegiate schoolsof nursing partici,pated.Six hundred tests were requested by and sentto the schools of nursing. Of the 35,7ianswer sheets complete,d and returned by graduating seniors, 293were usable. Among the reasons for discarding 57 of the returnedanswer sheets were (1) some respondents were students who were already registered nurses with varying types and years of experience in nursing and (2)some testswere not completed. The answer sheets were machine-scored and all itemsc3mputer-analyzed.* The combined results from all schoolswere: Number of subjects: 293 (including 41 University ofTennessee nursing students) Number of items: 171 Mean (raw score):100.00 Standard deviation:.12.3 Range: 47-132 An overall Analysis of Variance (ANOVA) indicateda significant statistical difference between schoolson the test (F = 13.90; p< 0.01). Included in the analysis of each of the 171 items forall respondents (N=293), including The Universityof Tennessee graduating seniors (N=41), were:

1 Numbers of choices for each alternativeon each item, 2 Percentage of choices for each alternativeon each item, 3 Mean numbers correct on all items for all the subjectsusing each of the four alternatives for each item, 4 Point-biserial correlations of each itemon each choice between correctness of choice of alternative andmean score on test. -Prhe macifineng aria-Trioststatistical analysis on the two national mailing were performed by The University ofTennessee-Biometric Computer Center under the direction of Mr.Walter Lafferty. 78

82 StudentsNo. of INITIAL ANALYSIS OF TESTING PROGRAM* (maximum possible QuestionsNo. of score) TABLE V PercentMean No. correct and StandardCorrectofDeviation Number age Ranges Numericalofand scores Percent- ClassClass of of 1967 1968 (Late(Graduating juniors,seniors) seniors) early 4016 138171 100.35(60%)88.37(64%) 10.87 8.32 80-12578-109 (46%-73%) (56%-79%) Class of 19701969 (Entering(Late earlysophomores, sophomores) juniors) 53 36 171 85.38(50%)95.22(56%) 10.01 8.99 53-10372-112 (30%-60%)(42%-66%) (May-October*Results trom 1967).nFa-- grim rifgfration of testTotal to University 145 of Tennessee College of Nursing Students Chapter VII - The Achievement Test

Following this statistical analysis, all items were evaluated by means of criteria for useability in an item-analysis fashion. (1,3, 8) The criteria are listed in order of importance:

1 Point-biserial correlations reaching 1 percent level of significance with one-tail teSt for correct alternative, 2 Point-biserial correlations reaching 5 percent level of significance with one-tail test for correct alternative, 3 Point-biserial correlations for incorrect answers should all be minus and roughly of the same magnitude, 4 Mean total score for subjects responding with correct alternative should be consistently higher than each mean total score for subjects wah incorrect alternative answers,

5 The percentage of subjects giving correct answers for each item should be between 60 and 70 percent. Of the 171 items evaluated in this manner, 16 met all of the above criteria, 59 met all except criteria 5,1 failed criteria 1 only, 4 failed criteria 3 only, 5 failed criteria 3 and 5, 4 failed criteria 1 and 5, while 2 failed criteria 1, 3, and 5.These 91 items were retained for further standardization purposes. Twenty-two items did not meet any of the five criteria; 17 did not, meet four of the criteria; 15 did not meet three criteria (1 and 3 or 4 or 5); 20 did not meet two criteria; and 6 did not meet criteria 5.These 80 items were set aside. Before the second nationwide testing, 23 additional itemswere developed to fill in areas of content within the theoretical framework not covered by the test after the 80 items had been discarded, makinga total of 114 items. The 23 test items were evaluated for clarity and correctness by the Principal Investigator and the research consultant and bymeans of documentation. For this second nationwide administration, 17out of a new group of 40 randomly-selected and approached NLN accredited baccalaureate schools of nursing requested a total of 1011 tests and machine-scored answer sheets. Of these 17 colleges, 12 returned 350 usable answer sheets and 21 unusable ones. The usableanswer sheets from the graduating seniors at The University of Tennessee College of Nursing, who again cooperated, made a total of 387 usable answer sheets for this standardization attempt. Average time for completion of this form of the testwas less than one hour. A similar statistical and item analysis,as in the first standardization attempt, was performed.

80 Chapter VIIThe AchievementTest

The combined results forall schools were: Number of subjects:387 Number of items: 114 Mean (raw score): 74.9 Standard deviation: 9.7 Range: 26-93 Another Analysis of Variance(ANOVA) again yielded statistically significant differences on thetest between schools (F=10.62;p<0.01). Of the 114 items, 17 metall the five previously mentionedcriteria. Criteria 5 was not met by narrowmargins by 25 items and byfair margins by 16 items. Twoitems did not meet criteria 3; 1,criteria 3 and 4; and 1, criteria 1. and5.This analysis yielded a revisedtotal of 62 possible items.Fifty-two items were discarded asinadequate. A further analysis of the itemsdiscarded after the first nationaladminis- tration indicated that 13should be reconsidered for possiblefuture use. With the utilization of only thepresently acceptable 62 items, abreak- down by category of thetheoretical framework showsreasonably adequate match of number of items in termsof percentage of assigned"extent of mention" for the professional nursingstudent. The following categories seemed somewhat over-representedby test items: HealthPromotion - Self-Actualization, Early Diagnosis and PromptTreatment - Safety and Protection, Early Diagnosis and PromptTreatment - Social, andRehabilita- tion Psychological. The categoriesHealth Promotion - Physiologicaland Health Promotion - Social seemedunder-represented by content of testitems. New items are yet to bewritten.for these under-representedcategories.*

Status It was hoped two comparableforms of this achievement test couldbe ultimately developed.In light of the authors' experience indeveloping adequate items, this May be a somewhatunrealistic goal. New items for the inadequately-covered content areas,the present 62 acceptable items, and the 13 possible items fromthe first test form should be administered to a large group of students(perhaps 1,000) for adequate standardization purposes. Furthermore,aside from senior nursing students, the expanded test should beadministered (as was done at The University of Tennessee Collegeof Nursing with the first testform) to nursing students on a cross-sectionalbasis (Lee, freshmen, sophomores, juniors, andseniors) to assess the relative validity ofthe test.

e s a is ica eva ua ioneata have been referred to the NLN Measurement and EvaluationServices for the consideration offuture work on this test and possiblenation-wide utilization. 81 Chapter VIIThe Achievement Test

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

-REFERENCES

1 Ebel, Robert L. Educational Measurement. Washington, D.C.: American CouriEflOirrai-Fifi5FT-T9-51:

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

3 Shields, Mary R. The Construction and Use of Teacher-Made Tests- Pamphlet No. .57-W. "5FWEITaTiona League orursmg, 4 ETS Test Development Style Manual. Princeton, N.J. :Educational es mg ervice,e ruary, 6.

5 Selecting an Achievement TestPrinciples and Procedures. Princeton, N.J-. rkthicational 'restingervice, 1961.

6 Multiple - Choice Question: A Close Look. Princeton, N.J. : uca lonaes ingervice,

7 Englehart, Max D. Improving Classroom Testing. Department of Classroom Teachers, American Educationaf Research Association of the National Education Association, Washington, D.C. :National Educational Association of the United States, December 1964. 8 Making the Classroom Test - A Guide for Teachers.(Evaluation an Advisory erviceeries,0. ',rmce on, N.J. :Educational Testing Service, 1959.

82 CHAPTER VIII FINDINGS

The four parameters of the project that have primary implicationsfor nursing educators and to some extent for nurses in occupationalhealth are (1) the theoreticalframework and its educational applications, (2) a methodology for analyzing acontent area of a nursing curriculum, (3) the achievement test in occupational health nursing, and (4) suggestions for meaningful learning experiences for professional nursing students in the work setting. The Theoretical Framework The availability of a theoretical framework is readily perceivedby nursing educators as a requirement for curriculum construction. The framework described herein provides guidelines for meeting Mayhew's suggestions for curriculum analysis and evaluation, suCh as exposure of imbalances and omissions in a curriculum and provision of limits within which a course of study might be constructed.It would thus fill the need that apparently exists for an organized approach to identifying the content and objectives of an educational program.In addition, the theoretical framework through its six components, which are identified and discussedbelow, provides a method for structuring the curriculum desired,

1 Integration of two theories with the nursing process as a pattern for curriculum development and evaluation: The theoretical framework integrates the theories of levels of prevention and hierarchy of needs with significant activities of the nursing process. The framework thus provides a feasible method for identifying,nursing competencies specific to occupational health nursing:: and Other speciality areas in nursing for example, community health, medical-surgical, maternity, or psychiatric nursing.Its use in identifying more specific content areas such as cardiac, neurological, or orthopedic nursing is an untested possibility. By identifying the expected competencies in terms of the nursing process, the relevance of the content becomes more readily evident.It might even be possible to build a total curriculum in baccalaureate nursing by using the methodology suggested in this study.

83 87 Chapter VIIIFindings

2 Identification of competencies of the professionalnurse in occupationa1 health (Appendix DY: The competenciesidentified within the framework should be useful to nursing educatorsas determinants of the elements to be included incourse content relating to the role of the professionalnurse in occupational health. The competencies providea more detailed description of on-the-job activities of the occupational healthnurse than were previously provided. These competencies might also be used by occupationalhealth nursing leaders (1) in developing job descriptions for therole of the nurse in industry, (2) in developing short-termtraining programs, and (3) in constructing nursing manuals for use in occupational health settings.

3 Identification of appropriate academic occupational health nursing contenf at the baccalaureate level(Chapter VI): The suggested academic content that has been identifiedcould be used in baccalaureate education for nursing students.Em- phasis in this project has been placedon the unity of baccalaureate nursing programs by not separating occupational health nursing content in the curriculum from the whole.The theoretical framework itself identifies and demonstrates thisoneness in nursing; and, in keeping with the discussions by the original ad hoc committee, the Principal Investigator has identified content in occupational health nursing in relation to the basic curriculum. As Ditchfield suggested, the greatest amountof academic content essential for the occupational healthnurse practitioner is also essential for all nursing practitioners. Undergraduate learning experiences for all nursing students may be greatly enriched by more exposure to the healthcon- cerns of the adult working population. 4 Identification of appropriate occupational health nursingcontent at the graduate-level (Clapter VI ).Occupa lona healt nursing content that -is sOlely graduate levelis identified, as wellas the content that begins at the baccalaureate leveland continues through graduate study. Use of the methodologyin graduate level education is more fully discussed ina following section in this chapter. When baccalaureatenursing programs meet this project's content criteria ("extent of mention"in all categories), then the definition ofa graduate program deemed sufficient to reach:a clinical specialty level ina broad community health nursing graduateprogram will be more feasible.

84 Chapter VIIIFindings

appropriate occupationalhealth nursing Jr Identification of content forin-service education(Chapter VI): Occupational health nursingcontent specificallyapplicable to the work setting, hasbeen identified.Practitioners in occupational health nursing,particularly those concernedwith in-service programs,should find the identifiedcontent useful as a guide inplanning and implementingin-service programs. The content may alsobe used in establishingexpectations for employers for a newly-graduatedprofessional nurse.

6 A tool for curriculumevaluation: The over-alltheoretical framework, as well as themethod of data collection,is at present adequatelydeveloped forutilization by nursing educators in assessingthe occupational healthnursing content of their curricula.This provides one setof criteria against which the curriculumcontent may be measured.

A Methodology forAnalyzing a NursingCurriculum The methodology createdduring the course ofthis project is within the purposes of theproject as stated inChapter IV: health nursing which 1 To identify that contentfrom occupational is essential forprofessional nursingeducation and practices,and

2 To develop a methodologyfor identifying givencontent areas within a course ofstudy. At no time has thecontent from occupationalhealth nursing been delineated as an areaindependent of nursing content as awhole, but rather it has been seen aspermeating the entireacademic content suggested ferprofessional students of nursing. The methodology toidentify a given area of contentwithin a course of study can also beused to assess the followingaspects of any nursing curriculum:(1) the overall strengths andweaknesses in a course of study,(2) the adequacy and depthof coverage of the given topic, (3) the extent and mannerof content overlap, and(4) the specificity of existing anddesired content areas andintensity of coverage in particular coursesor on particularlevels of progression (1st, 2nd, 3rd, 4th year) inthe nursing program. 'The methodology has these advantages:(1) it provides a nursing faculty with a common frame ofreference, (2) it is acontemporary, relevant, and dynamic frame ofreference, (3) it minimizesprolonged discussions as to the need for inclusion orexclusion of a given area of content,(4) it lends itself to systematicmodification, (5) it

85 Chapter VIIIFindings

requires significant cooperation and collaboration betweenfaculties in nursing and non-nursing courses,(6) it leads to a breakdown in presently existing compartmentalization. In applying the methodology, it was found that the most time-consuming aspectwas the data collection. The theoretical framework provides not onlyan up-to-date theoretical structure, but also a quantitative vehicle for evaluatingany nursing curriculum, in fact any total curriculum. Thefindings from use of the framework in this project havesignificant long-range implications.If, for instance, each present specialtycomponent as well as the liberal arts and science componentswere looked at by means of this theoretical framework, most ifnot all of the above noted advantages would be apparent. The resultsof the evaluation could indicate that the course structurepresently existing in schools of nursing needs to be significantly modified.The results call for rethinking as to the role of traditionalcourses, such as chemistry, abnormal psychology, pharmacology,and medical- surgical nursing with the possibility of their merginginto a new area specifically related to all chemical systems of man'sexistence on the health continuum.Reorganizing anthropology, sociology, epidemiology, preventive medicine, and public healthnursing content into a cohesive, integrated, continuousarea (perhaps a sequence) might possibly result in an ecological approach. Use of Methodology in Changing Occupational Health NursingContent in T3-accalaureate Curricua The quantitative assessment techniquecan be useful in collecting data on which to base recommendations for changing theoccupational health nursing content in baccalaureate curricula.In Table III of Chapter V the number in line5indicates the approximate per cent of recommended coverage of the total knowledge exposure for each of the 25 categories at the baccalaureate level of nursing education; i.e., Assigned "Mention" Bac. Ed. Level % of Bac. ssigne en ion, ro .urse in cc. Level Coverage By quantitatively assessinga total curriculum by the methodology described in this manual, it could bedetermined whether the recommended approximate percent ofcoverage is achieved for each category. For example, for the category labeled "DisabilityLimitation Physiological, " it has been recommendedthat approximately 75 percent of the content should be included at thebaccalaureate level. If, on quantitative analysis, it shouldbe found that a greateror lesser percent of coverage is present in the curriculum,a qualitative assessment of that category could beundertaken to determine which content areas were receiving less thanadequate or more than adequate coverage.

86 Chapter VIII - Findings

Use of Methodologyin Developing GraduatePrograms in Occupational Heallh 'nursing Quantitative assessmenttechniques could also be used indeveloping graduate programs in occupationalhealth nursing and/or in developing the occupational healthnursing component of communityhealth nursing programs. The approximate percentof recommended coverage of thetotal knowledge exposure for eachcategory at the graduate level may be determined bysubtracting the number in line 5of Table III in Chapter V from 100. Theresulting percent would provide aguide to the amount of content coveragerecommended for each category. From the mean calculatedfor each level of prevention andfor each need it wasdetermined that the greatestamount of content needed atthe graduate level is in the areas ofSpecific Protection (62percent) and Safety (58 percent). Theleast amount of content needed atthe graduate level is in the areas ofPhysiological (28 percent) and Disability Limitation (34percent). The percentages rangefrom 44 55 percent coverage on thegraduate level for eachremaining level of prevention andneed. By using Chapter VI thesuggested academic content could be veryspecifically identified, provided the baccalaureate level ofcontent is known. Achievement Test in OccupationalHealth Nursing The achievement test isprimarily directed to measuringthe nursing students' knowledgein occupational health nursing.As such, nursing educators can usethe achievement test as aspecific test in evaluating thestudents' level of knowledge inoccupational health nursing. The test alsohas possibilities as a componentof the present battery ofcomprehensive examinations takenprior to graduation and as a part of stateboard examinations. A second broad area for utilization of the testis that all or parts couldbe used by testing services thatdevelop examinations foremployment screening and placement of nursesin occupational healthpositions. The use and validity of the test willbe enhanced by the widest possible dissemination in its furtherdevelopment and standardization by a recognized national assessment agency,as is at this date (1970) under consideration. Suggested Learning Experiencefor Professional. NursingStudents in the Work SetIing Although no research in theoccupational health environment was specifically and directly undertakenin The University of Tennessee project, nevertheless, note mustbe taken that in the laborforce of

87 Chapter VIII - Findings

the United States, composed of approximately 80 million individuals, there is a unique opportunity to study the "normal" active adult. Ecological factors, promoting or undermining health, from a major segment of an individual's life can be assessed. By observation, one can recognize physical, social, cultural, or psychological influences on an individual.With additional attention, One can gain some insight into pressures from and reactions to these influences.Influences, such as increasing automation and computerization, the population explosion, decreasing work weeks, increasing unionization, increasing mobility, and exposure to new chemical and biological hazards are having an effect on employees. Spontaneous discussions elicit many pressures and influences. For instance, during a chance meeting with a long-haul truck driver, the author was able to learn first-hand about stressful factors in long distance trucking. With a few additional questions, the problems of fatigue, loneliness, and the strain and uncertainty of the hours of work became obvious. These factors most certainly affect one's health. They would also affect one's family- their health and interpersonal relationships. The manifestations of these conditions determine the direction of the nursing care needed to lessen the deleterious effects. Exposure to the labor force in action can provide observations of wellness" as described by Dunn. (1) The variety of levels of health is unlimitedfrom the employee reaching for peak-wellness to the one in poor health in a relatively unhealthy environment. Not only can individual wellness be studied, but elements of family, community, environmen41, and social wellness are also subject to student observation. (2) The transactions between the employee and the work setting oiler opportunities for studying individuals learning the developmental tasks of adult life, as described by Havighurst. (3) Too frequently the growth and development content in nursing education stops with the adolescent, or theory only is presented for the actiVe adult. The tasks after age eighteen are as important in fulfillment for an individual as the earlier tasks. Every one of us has been and continues to be in the process of learning these tasks. The basic human needs and their influence on an individual's health play a major role in the relationship of an employee to his co-workers, the work setting, and to the family as well. Examples of the influence of basic needs on the health of an individual are unlimite.:. For instance, work is a major source of satisfaction and of the feeling of belonging for many people. Safety and protection needs as met in the work setting are basic to injury control programs, and

88 Chapter VIII - Findings to economic securityprograms. Theeffect of such programs on the healthstatus of the adult are animportant consideration for the nurse who isresponsible for planningand giving care. Observation of the workenvironment can helpthe student see the correlation of job andincome and an individual'sand his family's health. Numerous studiesbear testimony to theeffects of blue- collar work on health.(4) Group cohesion ordisorganization can bestudied with the subsequent effects on health.The evidence of afeeling of esprit de corps, or its lack,in the work unit canbe observed and felt by aperceplive student.Th' nursing team ofwhich the student is amember should provide such an experience. The student can beguided in the developmentof a philosophy of seeing an individual as aproductive citizen - onewith abilities and potential. Sofrequently, health personnelfall into the habit of looking at a personand seeing a diabetic, acardiac, or a handicapped patient in awheelchair. Awarenessof limiting factors may be necessary, butfocusing on strengths isessential. Movement in the reorganizationof health care servicesis toward a great increase and broadeningof ambulatory servicesfor citizens at all levels of wellness. Thistrend in developinghealth services for promoting and maintaininghealth will require that nursesdevelop this wellness-orientedphilosophy in addition to apathophysiologic viewpoint. A work setting with ahealth care facility canprovide the student with the opportunity tofunction within anorganized framework focusing on primaryprevention. Most occupationalhealth programs practice some forms ofhealth promotion andmaintenance.In a well-developed occupationalhealth program, alllevels of prevention on the"health-sickness continuum" can bestudied. The opportunities ar.e availablefor the nurse to participatein a program thatpermits her to interact withactive, but ill adultswho are developingtheir potential abilities andmaking a contribution tosociety. The work environmentprovides for the student arounding out of learning experiencesregarding the concept ofcontinuity of care. Much is written and saidabout continuity of care,but what might be the most difficult segmentis seldom mentioned -that of returning the individual to being anactive, productivecitizen.Assisting an individual in adjustment to ajob or assisting theco-workers in accepting him may bevital to the rehabilitationof an employee. In such a situation, a nursecould act as the liasionbetween place of employment andfamily setting byinterpreting the healthneeds of an individual andthereby facilitating jobplacement.

89 93; Chapter VIIIFindings

REFERENCES

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

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

3 Havighurst, Robert J.Developmental Tasks and Education (2nd ed. New York: David Mc Ray Co., Inc., 195. 4 Shostak, Arthur B.and William Gomberg (ed.). Blue-Collar World - Studiesof the American Worker. Englewood Cliffs, N.J. : Prentice Hall, Inc., 1964.

90 CHAPTER a RECOMMENDATIONS

The findings of TheUniversity of Tennesseeproject might well provide impetus to the integrationof occupational healthnursing content into nursing curricula and to thedevelopment of learningexperiences for the professional nurse in the worksetting.These experiences could be directly related to the roleof the occupational health nurse orcould provide observational orparticipational experiences forpromoting the symthesizing of concepts neededby the professional nurseto function in any setting. The unified approach indeveloping the competenciesfor the professional nurse in oc-nipational health and therelated academic content maywell serve to hastenthe practice of theexpanded role of this nurse;also, it may start the movetowards the fulfillment ofthe goals for community health -iursing practice as setforth by the CommunityHealth N=sing of Practice of theAmerican Nurses' Association.(1) With the expanded rolefor the professional nursein occupational health outlined, nursing educatorswill be even more awareof the Lecessity for the inclusion of theessential content relating tooccupational health nursing in the curricula ofschools of nursing. These implications lead tothe presentation of thefollowing immediate and long-range recommendations:

Immediate Recommendations For Nursing Educators:

1 That the findings of thisproject be applied in assessing baccalaureate nursing programsof varying philosophiesand in varying geographicallocations. requested, 2 That consultation fromknowledgeable individuals be as needed, bynursing educators toimplement the findings of this project. For PracticingOccupational Health Nurses:

1 That the academic content areasidentified by this project be integrated into thephilosophy and practice ofoccupational health nursing by meansof formal courses innursing and the supportive sciences, continuingeducation programs, and inservice education programs. 91

95 Chapter IXRecommendations

2 That the acquired academic content be integrated into the identified competencies of the professional nurse, in occupational health by applicable modifications of nursing philosophy and practice in occupational health. For Nursing Educators and Practicing Occupational Health Nurses

1 'That, where geographically feasible, there be coordinated efforts in advancing the professional level of education and promotion of the establishment of clinical laboratory settings for the students of professional nursing.

2 That these individuals and State and Federal nursing consultants cooperatively support an organizational mechanism for the implementation of all of the above recommendations.

3 That appropriate organizations explore with available resources the possibility of the standardization of the achievement test in occupational health nursing.

Long-Range Recommendations For Nursing Educators:

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

2 That the described methodology be utilized to assess other content areas of the nursing curricula with close contact assured between the personnel in relevant and high caliber clinical laboratory settings and nursing educators.

3 That consideration be given to utilization of the described methodology in developing nursing theory. For Practicing Occupational Health Nurses:

1 That mechanisms be instituted for the development of an awareness of the increasing need for working relationships between occupational health nurses and other community health nursing practitioners (public health, school health, and office nursing). 2 That the professional nurse in occupational health participate in the planning and implementation of the emerging reorganization in the health delivery system and that the role of the nurse expand accordingly. 92 Chapter IXRecommendations

Health Nurses: For NursingEducators andPracticing Occupational cornpetencie6 and contentfor the professionalnurse 1 That the refined and redefined in occupationalhealth be continually aspects as thesocial, technological,industrial, and health of the environmentchange.

REFERENCES Division on Practice, 1 Community HealthNursing, Newsletter, American NursesAssociation, April,1968, p.3.

93 CHAPTER X SUMMARY

From 1965 to 1969 aproject was conducted atThe University of Tennessee College of Nursingto identify occupationalhealth nursing content essential =_.baccalaureateeducation for professionalnursing. Relevant literature wasreviewed in the areas ofeducation, nursing, and occupational healthnursing. After this review, atheoretical framework was developed andapplied consisting of anintegration of Leave 11 and Clark'slevels of prevention approach tohealth care and Maslow's hierarchy of needspersonality theory. The meshing of these twotheories produced 25 categories,each labeled with a level of preventionand a basic human need.Within each category, the competenciesand thereby the role of theprofession- al nurse in occupationalhealth were spelled out asbehavioral objectives in terms of the nursing process.Corresponding academic content was identified anddelineated into levels of theeducational program (baccalaureate,graduate, and in-service.) Thecontent needed by the professional nursein occupational health atthe baccalaureate level, but equallyessential to all nursing, wasidentified. The theoretical framework wasused to assess the occupationalhealth nursing content of onebaccalaureate program. Themethodology included content data collectionand analysis. The data wereanalyzed both qualitatively and quantitatively.Raw data and the actualfindings from the assessment of TheUniversity of Tennessee Collegeof Nursing curriculum were omitted fromthis publication, however,they were made available to the faculty ofthe program and to theProject Officer. Items for an achievementtest in occupational health nursing were developed from the competencies andcontent identified and astandardi- zation process was started.Additional work is required forthe standardization. Recommendations of an immediateand of a long-range naturehave been proposed for nurse educatorsand practicing occupationalhealth nurses, individually and combined. The implications of theresults of the project fall into fourareas: (1) Use of the theoretical frameworkand its application to nursingeducation;

95 98 Chapter X - Summary

(2) use of the methodo]..clgy in evaluating anycontent area of a nursing curriculum (with the =latent area afoccupational health nursing already worked out); (3) continued refinementof the occupational health nursing achievement test; and (4) explorationof suggested ideas to provide additional meaningful learning experiences forprofessional nursing students in the work setting. This discussion of The Universityof Tenrcessee project on occupational health nursing competencies andacademic content has been presented in this publication as a ready sourcefcw use by nursing educators and to a lesser extentoccupational health nurses.

- 9.9. jr, ....You have been tolt:LaAls.,::that life is darkness, and in your weariness youecha- ,,,,,,drat was said for the weary. And I say that life isiT darkness save when there is urge, And all urge is blindselw-Trthen there is knowledge, And all knowledge is vain- .F.E-avewhen there is work, And all work is empty -3-when there is love; And when you work with love youbind yourself to yourself, and to one a/in-tier,and to God. And what is it to work wtthlove? It is to weave cloth withthreads drawn from your heart, even as if your beloved wereto wear that cloth. It is to build a house withaffection, even as if your beloved were to dwell in thathouse. It is to sow seeds withtennerness and reap the harvest with joy, even as if yourbeloved were to eat the fruit. It is to charge allthings yuu fashion with a breadthof your own spirit, And to know that all theblessed dead are standing about you and watching . .

Kahlil G.ibran (1833-1931) Gibran, Kahlil. The P=phet.New York: Alfred A. Knopf, 1923, pp. 26-27. Quotuf by permissionof the publisher.

100 APPENDIX A EDUCATION FOR OCCUPATIONALHEALTH NURSING Mary Louise Brown, R.N.

This appendix summarizesthe course of occupational health nursing education up to the Universityof Tennessee project on which this manual ig based. Only thoseevents meaningful to understanding the emergence of the projectitself are described.

1910-1920 The decade from 1910 to1920 saw the initial appearance ofthe various skeins that were to be woveninto the fabric of occupationalhealth nursing; the industrial nurseherself as an aware and dedicated person; the field of practice as oneof rich opportunities demandingexpert workers with sound technicaltraining; the organizations to meetthe need for professional stimulationand leadership; the training programs ranging from short term coursesto graduate level programs; and federal participation as amotivating force towards uniformity in excellence. The effect of World War I onoccupational health nursing practiceand education was well expressedby one professor of public healthnursing in 1919: Many returning nurseshave already accepted positions in public health nursing, and it issignificant that a large proportion, among them women ofproved executive and teaching ability in other lines of work, areshowing special interest in industrial nursing The field of industry offers enormous opportunitiesfor health work for the bene- fit of groups otherwisedifficult to reach. The industrial nurse(3ince she spends her workingday in the factory, is in many instances the agent onwhom we must mainly rely to instruct industrial workersin the ways to prevent sickness and to maintainhealth. (1) In 1915 the nursea workingin industry in Boston formedthe Boston Industrial Nurse Club. Thisclub became the New EnglandAssociation of Industrial Nurses in1918.It continues to function andrepresents the beginning of organizationsfor professional industrial nurses.In 1942 it participated in theformation of the AmericanAssociation of Industrial Nurses (AAIN).

9 g/99 101 Appendix A

Again in Boston, the first course of study designed for industrial nurses was begun in 1917 by the College of Business Administration of Boston University, a two 2-hour lecture a week course given over a 16-week period with 2 weeks of supervised field service in an industrial medical department. (2) From October 1, 1918, to June 30, 1919, a comprehensive course for occupational health nurses was offered in cooperation with Yale University. The students had "exceptional advanthges in their theoretical training, including lectures, laboratory facilities and excursions to factories and various industrial plants which illustrate the practical needs of public health and public health nursing. "(3) In 1914 the U.S. Public Health Service (USPHS) created a unit, The Division of Industrial Hygiene, dedicated solely to the protection of the health of American workers. (4) This division evolved into the present Bureau of Occupational Safety and Health, Consumer Protection and Environmental Health Service, U.S. Department of Health, Education, and Welfare.

1920-1930 The most significant development during the second 10-year period was the growing awareness of the need for specialized preparation that came out of studies of public health nursing practice. As a result of the conference convened by the Rockefeller Foundation in 1918, a committee with Professor C. E.A. Winslow as Chairman was appointed to prepare a definite proposal for a course of training for public health nursing. Miss Josephine Goldmark, appointed Secretary in June 1919, conducted -the study and prepared the report which was published in 1923. The Goldmark Report influenced nursing and nursing education in the United States probably more so than any other survey conducted before 1919 or thereafter.It seems appropriate to call attention to the report's conclusion and recommendations concerning industrial nursing: The industrial nurse shares with the industrial physician rich possibilities for preventive work. According to the census of 1920* a substantial proportion of our entire nation, 13 million men and women, spend their working day congregated in manufacture and mechanical pursuits, and another million and a quarter as sales persons in stores.....While nurses in industrial work as in other specialities have achieved success through their own initiative and persistence, yet the lack of special training for this special field has been a grave handicap for the most capable and has often nullified the efforts of the less capable. No less indispensable is es ima esat som- :1 mi lion men and women are so engaged. The 1968 ANA Facts on Nursing list 19, 500 occupational health nurses. 100 Appendix A

for the industrial nurse than for other publichealth nursesfor the detection of disease, incipient and acute, foreducation as well as curative work - is the preparationwhich we have already outlined for all public health nursing. Thisshould consist of a basic hospital course of 2 years and 4 months,followed by sound training in public health nursing, with specialemphasis and time devoted to training in industrial conditions.(5) In 1920, the National Organization forPublic Health Nursing (NOPHN) inaugurated an Industrial Nurse Section.

1930-1940 Many occupational health nurses lost theirjobs during the depression of the 1930's. Those who were retained foundthat workers were seeking help with their family-related health andwelfare problems. It must be remembered that workers did nothave unemployment compensation insurance nor medical and hospital careinsurance as so many do today. From this period canbe traced the acceptance of health counselor and health educator as roles for the occupational health nurse. The nurse's original involvement in carefor industrial injuries can be traced back to the influence of the workmen's compensation legislation enacted by the States beginningin 1913. The decade of the 30's saw the expansion of the FederalGovernment's commitment with passage of the Social Security Act in1935. Federal funds were provided to the USPHS for grants-in-aid tothe States for public health work, including industrial hygiene. These grants stimulated the development of state industrial hygieneunits. Nurse consultants were first added to these units in 1939 whenthe Indiana State Board of Health and early in 1940 when Michiganemployed industrial nurse consultants to help industry and industrial nurses develop and upgrade health services for workers.(6) The Industrial Hygiene Division of the USPHS initiatedseminars to train health personnel to work in the state industrialhygiene units. These seminars were conducted for public health nursesemployed by the Federal Government and those employed by Statehealth units as industrial nurse consultants. Frequently, public healtheducators from the developing schools of nursing in universitiesand colleges also attended.

101 193 Appendix A

1940-1950 The 1940's are the World War Il years in which Federal participation and expanded industrial nursing needs went hand and hand.In 1941 the USPHS Industrial Hygiene Division was asked to guide the development of industrial health programs in defense industries. The services of a full-time narse consultant were requested andone of the public health nurse consultants was assigned to work with the physicians, engineers, and chemists in plamiing for nursing. Thiswas the first specialized nursing consultant position created in the USPHS. Early in 1940 the Public Health Nursing Section of the American Public Health Association (APHA) appointed a committee to study duties of industrial flirses.Industry in the meantime haci expanded frompeace- time to wartime production, and the number of nurses in industry had increased from over 5, 500 in 1941 to about 10, 000 by 1942 andto 11, 200 by 1943. The PHS Industrial Hygiene Division collaborated with the APHA committee, The resulting report(7) servedas a basis for determining the range and standards of industrial nursing practices, and for prescribing programs of study for industrial.nurs esThe report was written by occupational health specialists and emphasized the nurses' informational needs in industrial hygiene, occupational injuries and diseases, workmen's compensation, and safety.It supported the 1939 NOPHN's recommendation thatcourses in principles of teaching, social case work, community organization andresources, industrial relations, personnel administration, industrial hazards, nutrition, communicable disease control, mental hygiene, and personal hygiene should be included. (8) AAIN was founded hi 1942 to establish sound principles, standards, and policies in the field of education and in the practice of industrial nursing. In 1944 the AAIN Committee on Education outlined the first basiccourse for use by colleges and universities in preparing qualified professional nurses in industrial nursing. (9) In 1949 the AAIN Committee proposed "Criteria for Evaluation of Programs of Study in Industrial Nursing." This was used tolimited degree by the National Nursing Accrediting Service in approving programs of study. (10) in 1944 the American Nurses' Association (ANA) through its Board of Directors approved the formation of the Industrial Nurse Section. (11) In 1958 the name was changed to Occupational Health Section in line with the movement to use "occupational" instead of "industrial" because the latter had the connotation of heavy industry and manufacturing. (12)Over the years committees from both the National and the State sections of the ANA presented reports that have influenced this field of practice, the most notable being the "Functions, Standards, and Qualifications for Practice of Occupational Health Nursing" first published in 1958 and revised in 1960 and 1968. (13)

102 164 Appendix A

Review of the prdfessional literature from the middle 1940's to the middle 1950's shows that 20 or more schools of nursing had announced credit courses and/or degree programs for nurses in industry.(14) Five programs (Columbia University, Harvard University, Johns Hopkins, Yale University, and the University of Michigan) admitted industrial nurses to master degree programs. The USPHS loaned Emily M. Smith, an experienced occupational health nurse consultant, to Columbia in 1947-48 and to Yale in 1949-50 to develop and conduct programs of study in occupational health nursing.In 1951 Yale employed a full-time occupational health nurse faculty member. This position was filled until June 1961, and training for graduate students was provided during that 10-year period. The University of Pittsburgh, Wayne State University, Seton Hall College in New Jersey, the University of Buffalo, St. John's University, New York University, Peabody College, The University of California in Los Angeles, the University of Washington, Simmons College, Boston College, Boston University, the University of Minnesota, the University of Chicago, Loyola University in Chicago - all offered credit courses for occupational health nurses or degree programs either in the field of industrial nursing or as a sub-specialty of public health nursing.

Only the University of Washington, Wayne State University, Boston College, and the University of Pittsburgh are known to have had full-time occupational health nurse educators to coordinate their baccalaureate degree programs in industrial nursing. All other schools utilized the part-time services of occupational health nurse consultants from State or Federal official agency occupational health units and/or nurses from industry. In 1942 Public Health Curriculum Guide developed by a joint committee of the NOPEN and the USPHS was first published.This contained a unit on industrial hygiene. The many inquiries from nurses working in industry, industrial physicians, management, and nurse educators about the industrial nursing content in B.S. degree programs led to the development of an Advisory Committee on Industrial Nursing with members from NOPHN's Industrial Nursing Section and from AAIN. Their report was approved by the Joint Committee of the NLN and NOPHN on "Integration of Social and Health Aspects of Nursing in the Basic Curriculum." This said in part:

103 -105 Appendix A

A A course in industrial nursing should not be included in the basic curriculum for the following reasons: The undergraduate curriculum is intended as a foundation only, containing theory and practice essential .in any type of nursing.Its ultimate aim is the preparation of the student to function as a beginner in any of the major fields of nursing.If she wishes to advance to positions of greater responsibility or to a specialized branch of service in any field, she must obtain additional postgraduate study. B Because of the above factors, as well as the great pressure to shorten the curriculum, it does not seem advisable for schools to add any courses. However, because of the obvious need in the industrial field we recommend that schools of nursing examine carefully their own curricula and endeavor to give more emphasis to the industrial implications throughout the entire course of study.(15) This statement set the pattern that has been followe-3 by schools of nursing. In 1946-47 Ella Louise Fortune, a graduate ..2tv.dent at Catholic University, did a comparative study of the content of the t:ourses and programs in industrial nursing with the duties of nursec. ,imployed in industry. At the time she began her study, there were 32 schools in the United States and the Territory of Hawaii offering public health nursing programs that had been approved by the Education Committee of the National Organization for Public Health Nursing. Her study was limited to the determination of (1) the availability of courses and programs in industrial nursing,(2) the availability of advanced courses required for supervisory and consultant positions in industrial nursing, (3) the content of the courses, (4) the relative importance of items found in course outlines, and (5) a comparison of the items with the duties being performed by industrial nurses. The following are selected quotes from Miss Fortune's summary and conclus ions : The 8 schools offering only courses in industrial nursing have a total of 9 courses; the 5 schools offering programs in industrial nursing offer a total of 19 courses. Two schools accept courses in industrial nursing for credit toward a "Certificate in Public HealthNursing",13 schools accept the courses for credit towards a bachelor's degree;10 schools do not give graduate credit for courses in industrial nursing.

104 106 Appendix A

Thetse is 1itt1correlation between the frequencyof the dutie being perfornled by nurses inindustry and the importanceof the various topicsbeing given in courses inindustrial nursing, asrated by the nursesparticipating in this study. Nurses Who have hadtheoretical preparation forindustrial nursing are Providing abroader n'arsing service to theemployees in the duties they areperforming than those nurses workingin indlastrY who have not been 50prepared; also, the nurses who have had publichealth nursing experience arerendering more nursing service than thosewithout this experience.(16)

1950-1960 League t%change was aformat instituted by the NationalLeague of Nursing Education (NLNE) andcontinued by the NLN as a meanswhereby its mertibers could share exPeriencesand ideas. The first Exchange published in 1952 was"Occupational Health Integration in theYale University School of Nursing."(17) This was a report'of the work that Emily M. Sznith had done duringher special assignment from thePublic Health Service to 'Yale University November 1949 toJune 1951. During the 1950's,as was true inthe latter part of the1940's, many 1- or 2-dayTiorkShop$ were conducted forindustrial nurses. The Extension Division of the Universityof Minnesota had conducted annual courseson topics of current interest tooccupational health nurses, and as aresult of their Fifteenth AnnualCourse held in the Spring of1955, League Exchange Number 16, "Guide forthe Orientation of NewlyEmployed Occupational HealthNurses," was published.(18) League Exchange nimber19, Iirrhe Educational Responsibilitiesof the Nurse Consultant inoccupational Health,' was a report of aworkshop conducted at Yale university inSeptember 1956 for 26 nurseconsultants from Canada, Puerto Rico, andthe United States.(19) The members of the wol,kshop identified 10understandings and abilities thatthey consi4red to be basic for effectivepractice for a nurse workingin industry, During the 1950s3 re5earch projects wereconducted. Erma Barschak, Mianii university, Ohio,conducted in 1954-195 astudy of occupational health nursing Practices in theOhio Valley.(20/ In 1957 Wendell Smith, Bucknen. thliversity,coriducted a study of industrialnursing function in PentisylVania,(31) The third Project conducted byHeide Henriksen identified What was being taught andwhat could be taught incollegiate(22) basic nursing education programs.Six schools in Minnesotatook part.

105 Appendix A

The AAIN's Michigan Discussional held in 1954 brought togethera group of 37 persons representing industrial nurses and physicians, management, and nursing educators to discuss the educational needs of the industrial nurse, particularly the nurse working alone. Problem areas involved in preparing the nurse to accept the varied responsibilities of industrIgl, nursing were identified, and numerous recommendations were made. At the 1940 American Nurse Association (ANA) Biennial Convention a committee to study the possibility of unification of the several nursing organiza-Ions was established. By 1950 the members of the 6 national nursing co-rganizations (AAIN, ACSN, ANA, NACGN,NLNE, and NOPHN) had accepted a general plan for two organizations.By 1952 all but the AAIN had agreed to merge into either the modifiedANA or the new NLN. (24,25) In June 1952 when the ANA, 24.CSN3 NLNE, and the NOPHN voted into existence the revised ANA and the new NLN, the members of theANA Occupational Health Nurse Section asked that a committee be formed to study industrial nursing's place in the NLN. (26) At the firstconvention of the NLN in June 1953 the Committee's recommendation thatan Occupational Health Nursing Interdivisional Council be formedwas accepted.In response to the frequent requests from a small group of concerned and deeply committed occupational healthnurse members of the NLN for a more active program in occupational health nursing, Mary Louise Brown, then assistant professor of occupational health nursing at Yal- University, was employed by the NLN in 1956 to be the part-time occupational health nursing staff member. In 1956 the AAIN and the NLN's Occupational Health Nursing Inter- divisional Council established an NLN-AAIN conference committee. In 1957 two representatives from ANA and one from the PHSwere added. This Committee developed the Guide for Evaluating and Teaching Occuational Health Nursing Concepts, League Exchange Number 24. (21) The Committee had been formed to consider the educational needs of occupational health nurses. They first identified the things peculiar to occupational health nursing andon this basis accepted the 10 understandings and abilities that nurses need to function as occupational health nurses as stated by the occupational healthnurse consultant in League Exchange Number 19. These 2 conceptswere then incorporated into thelormat of the "Self- Evaluation Guide forCollegiate Schools of Nursing': Part II,as prepared by the NLN, League Exchange Number 24, was widely distributed, but not widely used. Two milestones in any review of nursing education in the United States were published by the Russell Sage Foundation: the publication of Esther Lucile Brown (Nursing for the Future) and Margaret Bridgman (Collegiate Education for Nursmg"). These publications, reflecting the

106 Appendix A changes in the philosophy of the leaders innursing education, resulted in a more clearly defined statement onnursing education and much greater accepta.nce of college education asthe base for professional nursing.In the year 1959 another milestone innursing education was reached when the NLN Board of Directors decidedthat (1) the NLN will accredit no new programs in nursing thatprovide for specialized preparation at the baccalaureate level and(2) after a period of 5 years (or as of 1963) the NLN will accredit only thosebaccalaureate programs in nursing (without specialization) that includepublic health nursing as a part of the curriculum.(28) This action reemphasized that specialization in occupational health nursing, or in any area, wasto be at the master's degree level.It also had the effect of including public health as anintegral part of the basic baccalaureate program, thusenriching the program for all students of nursing.

1960-1969 The last of the 10-year periods, the presentdecade, saw attempts to resolve and crystallize 2 basic thrusts of the nursingprofession:(1) defining technical and professional practiceand the related levels of education for nursing and (2) reorganization ofthe organizations. Following the discontinuance of the part-timeoccupational health nurse NLN staff position in 1961, the steeringCommittee of the Council on Occupational Health Nursing developed a projectthat they proposed be carried on at the NLN by an occupational health nursewho would be employed full time to give leadership to occupationalhealth nursing education. The project director would (1) survey schools ofnursing for their activities in the area of occupationalhealth nursing; (2) develop pilot projects in selected universities for the developmentand evaluation of tools for the integration of occupationalhealth nursing into the basic program; (3) provide consultation to schools asrequested. After the Steering Committee developed theproject, they discussed it with the NLN General Director and others on thestaff.In October 1962 Miss Dorothy Benning, Chairman of the Interdivisional Council on Occupational Health, and Mrs. Jane Lee met with the SteeringCommittee of the Department of Baccalaureate and Higher Degree Programto talk with them about the Occupational Health Council's proposed project.An ad hoc committee was then appointed to examine theeducational needs in the field of occupational health nursing and to prepare astatement that could be used by both groups. This committee met inJuly 1963 and determined that a committee could not examine theeducational needs in the field of occupational health nursing and prepare a statementthat could be used by both groups. They suggested that a projectbe developed to identify those concepts essential to occupationalhealth nursing and

107 Appendix A basic to the practice of all nursing and hence to be includedin basic educational programs. This suggestion led to the developmentof a project and the negotiating of contracts by the FederalGovernment with the Boston College School of Nursing and The University ofTennessee College of Nursing, which were selected because theywere in two different parts of the county and they presented two diffelent plans.The Boston project was for one year. (29) The manual, of which this historyis a part, reflects the experience of The University of Tennesseeduring the period February 1965 to August 1969. Other publications in this area and at this timewere "Selecting Occupa- tional Health Services fo:72 Nursing StudentLearnin_g Experiences"(30) and the"Bibliographyon Occupational Health Nurs ing"(31) by the NLN; "Selected Areas of Knowledge or Skills Basic to EffectivePractice of Occupational Health Nursing" by the ANA. (32) The ANA Committee on Education, which hasas its function to study and to make recommendations for meeting theAssociation's responsibilities in nursing education, publishedas a position paper a report which sets forth 8 assumptions and the position that "educationfor those who work in nursing should take Rlace in institutionsof learning within the general system of education. "(62) This report delineatesthe essential components of professional nursing and technical nursingpractice. The 1960's will also be remembered for theamount of Federal health- related legislation thatwas passed, including the extension to 1964 of the Professional Nurse TraineeshipProgram and the passage in 1964 of the Nurse Training Act. Of interesttoo are data from the Interagency Conference on Nursing Statistics in 1967 thatan estimated 7.2% of the 19, 500 occupational healthnurses in the United Stated had a baccalaureate degree, 1.5%, an associate degree;and 1.0%, a master's degree.

Conclusion The summary of events has indicated howthe project described in this manual came about and has shown thelong standing intense interest in the project goal of identifying educationalcontent in nursing education for occupational health nursing.It is hoped that the data and theory presented will contribute toprogress in occupational health nursing and nursing education by providing qualitativeand quantitative methods for use by faculties in the evaluation of the nursingcurriculum. It is believed that the hypothesesset for this prOject by the ad hoc committee of the NLN in 1963 have been testedand found valid. Occupational health nursing contentcan be identified and the method developed for evaluation of thecontent can be used effectively.

108

:110 Appendix A

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

2 Mcgrath, B. "Fifty Years of Industrial Nursing in theUnited States, " Public Health Nursing,Vol. 37, No. 3, March 1945, p. 119-124. " 3 Fourteenth Annual Report,"The Visiting Nurse Association, New Haven, Conn. 1918.

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

5 Goldmark, Josephine, Nursing andNursing Education in the United States, The MacmillanCo., New York, ran, 171-58 - 159.

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

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

8 "Committee on Professional Education of A.P.H.A. ",Desirable Qualifications of Nurses Appointed toPublic Health Nursing Positions in Industry,lt Americanourna 29:789, Vol. 29, No.7 Ju y ,pp.

9 Minutes of Committee on Educationfor year 1944, American Association of Industrial Nurses, NewYork, (unpublished).

10 Statement of Committee on Education, riteria for Evaluation of Programs of Study in Industrial Nul_sing," Published by American Association of IndustrialNurses, New York, 1949.

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

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

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

109 111 Appendix A

14Educational Opportunities in Industrial Hygiene, " Industrial Hygiene News Lefter-, Vol. ,NO. 4,Apri1T1048, p. 8-117b71.3"761-7-31-",-- No. 6, June 1951, p. 84-87. 15 Industrial Nursing in the Basic Curriculum, Report of the Advisory --Committee on inclUsfrial -Nursin'g, American Journal of Nursing, 45:478, June 1945. 16Fortune, Ella L. A Comparative Study of the Content of the Courses and Programs in Industrial Nursing with the Duties -61 the Nurtlffiflp oy-e717n-Tridiria presenfga to Facu.,. y o ec oo oursing Education in the Catholic University of America, Washington, D.C., 1947. 17League Exchange No. 1,Occupational Health Integration in the Yale University Schoo ursing,a lona eague orursing, New York, 1952. 18 League Exchange No. 16, Guide for the Orientation of Newly Employed Occupational Health Nurses, National League for l\TUrsing, New York, 1956. 19 League Exchange No. 19, Educational Responsibilities of Occupational Health Nurses, National League for Nursing, New York, 1956. 20Barschak, Erna.Today's Industrial Nurse and Her Job, New York, A. P. Putnam's Sons, 1-9b6. 21Smith, W. The Industrial Nurse- An Analysis of Her Function, Bucknell Uriiversity, Lewisburg, 1957. 22Henriksen, H. Curriculum Study of the Occupational Health Aspects of Nursing, St. Paul, Bruce Publishing Co., 1959. 23Report of the Ann Arbor Discuss ional, "The Nurse in Industry, " Sponsored by American Association of Industrial Nurses Inc. with the Institute of Industrial Health, University of Michigan, 1954. 24Brown, M. L."Industrial Nursing's Place in the New Structure, " Nursing World, Vol. 126, No. 4, April 1952, p. 176-177. 25Editorial, "AAIN's Decision of 1952, " American Association of Industrial Nurses' Journal, Vol. 7,o. arc 26 Brown, M. L., Millington, R.H. "Should Industrial Nurses Belong to NLN?" Nursing World, Vol. 127, No. 6, June 1953, p. 28-29.

110

112 Appendix A

27The League Exchange No.24, Guide for_ Evaluating and Teaching Occupational Health NursingConcepts, 5affona1 League for ursing, ewor , 28NLN, "Responsibilities in PublicHealth Nursing Education, " Report issued by the NLN Department ofBaccalaureate and Higher Degree Programs, August1961. 29 Summers, V.N. "An OccupationalHealth Nursing Study, " Nursing Outlook, Vol. 15, No.7, July 1967, p. 64-66.

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

31 "Selected Areas of Knowledge on Skill Basic toEffective Practice of Occupational Health Nurses'Section, New York, American Nurses' Association, March 1966.

32American Nurses' Association, A PositionPaper, Educational Preparation for Nurse Practitionersand Assistants to Nurses, ewor , e Assocla

111 113 APPENDIX B RATIONALE FOR THEUNIVERSITY OF TENNESSEE COLLEGE OFNURSING CURRICULUM Mary L. Morris, Ed.D*

Curriculum study usuallybegins when there are majordissatisfactions with the current program.This was our impetus.While we felt that our programhas many strengths, wealso recognized that major weaknesses existed;namely, the 1 The need for strengtheningthe liberal arts portion of program.

2 The need for an organizingfocus in the nursing major,all within the usual time spanby the baccalaureate program. Therefore, many choiceshave to be made. In respect to(1):It was felt that inaddition to a sound foundationin the behavioral andphysical sciences which aresupportive to the nursing major, an educated personneeded to know more than"his own time, language, and culture". Wealso felt that thebaccalaureate degree in nursing shouldinclude approximately the samerequirements, exclusive of majorsubjects, as other baccalaureatedegrees conferred by the parent university,the University of Tennesseethus, the inclusion of foreign language,philosophy, anthropology, etc.It is our hope that the student willacquire a sound foundationrather than a. superficial knowledge of the coursesincluded as well as the desireto go on learningindependently in these and otherfields. In respect to the Nursingmajor: The baccalaureatecurriculum has evolved from the hospitalschool and has patterneditself after the geography of the hospital intoMedical-Surgical, OB, Peds, etc.It has lacked an organizingfocus. Montag has pointedout that: Med-Surgical Nursing is atherapy Maternity Nursing aphysiological process Nursing of Children an age group Psychiatric Nursing a condition Public Health Nursing aplace. Even if the teachingapproach has not focused onthese, there has been an influence on,and a deterrent to, creativitybrought to bear by the service-centeredness of thecurriculum divisions. It is believed that oneorganizing concept thatcould be used is that of basic human needsEramon toall persons and theintervention both nursing and medically which canaid the indivi.dual inmeeting these needs. This is based on aconcept of man's attemptto maintain a dynamic equilibrium betweenhis external and internalenvironment v'Profébor 6f mfrthhg,coudge---6rNursing, The University of Tennessee 112/ 113 114 Appendix B

and his adjustment.It was felt that this concept could be used throughout the program in teaching the care of adults and children in all stages of wellness and illness and in all settings. The early nursing courses would focus on the areas of human needs where stressors which are threatening to the integrity of theperson can be removed or made less threatening by nursing.intervention.Progression would be to the areas in which a specific need is altered through disease processes or other circumstances so as to require medical therapy for alleviation. The nurse would retain an independent function with respect to all but the specifically altered human need and wouldassume a colleague or dependent function with other disciplines in aiding the patient. Thus all nursing courses would focus on needs andways of meeting these according to the situation and all would focus primarilyon the professional nursing role. No courses have been identified by title.The real challenge now is for faculty to, within this framework, identify content, learning experiences and teaching approaches that will enableus to implement a new program.

114 ns FIRST ATTEMPT AT FITTINI. I-UNCTIONS AND RESPONSIBILITIES IN OCCUPATIO.YAL HEALTH INTO THEORETICAL FRAMEWORK APPENDIX C OF A PROFESSIONAL NURSE Rev.Rey.Rey. 2/679/66 3/67 4/ 66 Health Promotion Speciffc -Protection ,Curative Disability Limitation MIN :Restorative- Rehabilitation AssistanceNursingGuidance inrole relating health in counseling evaluationto physical and programhealth inter- 1 HealthParticipationParticipation guidance inmenthygiene environmental inrelating programs program to environ- on specific 6 AssistanceReferralEmergency and withcare additional health forprogramand physical injuries evaluation care illnesses 11 ContinuingAssistance withnursingprogram jobhealthre-assignment careplacement evaluation and follow- and 16 RehabilitationAdministrationIdentification of processmaining of employee's physical abilities therapy re- 21 .r.oo MotivationConceptCommon of human ofwellness individualsonviewing needs individual and and theirand group groupinfluence be- behavior EnvironmentalToxicology and physiologicsanitation industrial hygiene problems -'çParticipationHealthCase-findingEmergency in screening immunization care methods programs Nursing(See Blockfollow-up 12)up Nursing role in physical therapy CharacteristicsHealthPrinciples evaluation and methodshavior of fora work anin of healthindividual environmenthealth care teaching Processes used production or service 7 Assistance.Development With ofjob immunization re-assignment program :2 AsSisf5Tice with job placement 17 AsSiStance witn appropriate job 22 CharacteristicsInterpretationGuidanceAssist in identification relating ofstresses ofhealth toa healthsafe insuranceofand living livinghazards habits plans envIronm= ConceptAssistance.GuidanceParticipation measures' of relating accidentwith in safetydisaster to prevention use program planningof safety RoleControlInterpretationMaintenance of nurseof infectious of ofinmanagement employee employeejob re-assignmentdiseases health health records to Requirement of a job operation Appl,cation of ActivityLivingplacement of principles Daily to work setting u)tiit M SafetyConcept promotion of prepaidenvironment health care SafetyConceptFoodDisaster statistics serviceof accidentprograms susceptibility CommunicationControlLegal aspects and treatment skillsofinfectiousnursing occupational measures diseases health of Guidance relating to social adaptaTtion 11 . Interpretation of social welt- ptans.CReferrals Participation in program on absence 13 ParticipationNursing follow-up in program for onabsence1/3 continuing work Iiii-eTpretation toemploying management handicapped re- 111111116 Cooperation withprogram total community health ' Partiinterpretation cipationprograms in oflaws selected governme are emp 1 ntal labor oyee Identification ofdisorganization individua, 'ior group Needs of individualabsence and family during Cooperation; of communityfacilities health 1.4 tnl-in2lit Eito DevelopmentInfluencesinfluences ononhavior and individualofplant professional by an employeeand group relation- and be- WomeStateSocial------and welfare Federal plans laws and andene n as workers (includin b regulation fits h s Social disorganizationSystemWorkmen'sAbsence of referrals programs Compensation (role o. Act...id-sing) Soc...1Social aspectsaspects of jeblonF.-tm re-assi3nment illness 5teturn-to-workRehabilitiation processcommunity facilities in lit:21 ic=7,1 7,g di OrganizationUseIdentification of groups ofship healthbusinessinterests with needs "well" establishments of andgroups individuals Aging employeesmakers) g ome- MeaningSocial effects of work of ilidustrialto an individual change and . GuidanceCommunitySocialClassification effects relating health offamilyof workers industrialrelationsto program erricitidtial health 4 Participation in selected programs 9 Emergency care for emotional crisis 14 Guidance in adjustmentadjustment and re- to 24work setting ao o -' es o AssistanceCharacteristics with healthprogram of an evaluation emotionally healthy UnderstandingAgingWomen workers as workersrelating of use of to self rrontal in work health AddictionEmotionalParticipation and distress the in work program setting for addiction RehabilitationEmotional aspects of emotionallyemployees of rehabilitation ill 51..... ?-.. oTic 2.. GroupSupervisoryEmotional interaction process factorswork setting and inin industrialindustrial health change relations setting c DeveloptnentGuidanceTesting program relating ofand nursing meetto growth selr-deveTopment employee program needsto 5 PromotionDevelopment of oTself-recognitionlevelwork nursing ofsetting wellness care plan of lowered in 13 Nursi-ngContinuityNursing folleie-up-for care of careon completiona forcontinuing an employeework-life" of basis 9 a pevelopmeni:promo-I-Ton1 of of full greatestofmaining use rehabilitated of potentialre- abilities employee 25 c't00 IdentificationSelf-responsibilityIndividual ofdevelopmentand employee forcare health needs to behaviorfullest Use of recordshealthy in identification conditions of un- Employee and family needs in crisis u1

Competencies and SuggestedActions of the Professional Nurse in Occupational Health

117 117 COMPETENCY SUGGESTED NURSING ACTION Assesses physical health Identifies physical health needs by observation, interview, analysis of records, reports, examinations rneeds of employees Correlates identified needs and age grouping Identifies groups of employees with special physk:al health needs Collaborates in planning Participates on health team in formulating philosophy and objectives for meeting needs of employees for health promotion and based on current standards and establishei; policies maintenance in work sett ing Communicates health needs of employees to health team "ra Interprets occupational health nursing as a member of the intra-plant and extra-plant health team .= ISO Organizes nursing aspects of health screening and evaluation program ea -c-a Intervenes to promote Conducts health interview .cn a-. ..= health maintenance Conducts screening tests, e.g., vital signs, electracardiogram, laboratory tests, vision and hearing tests o- Assists physician inhysical examination procedures, e.g., draping, chaperoning Maintains records and reports for well employees i Interprets examination findings to employee Guides employee to improved health habits through counseling, teaching, and demonstration, e.g., personal hygiene, diet, dental and general health care, rest, recreation Promotes positive attitudestoward health and health care among employees, family Interprets health-related information ... Collaborates in assessing Identifies safety needs through observation, interview, and analysis of records and reports safety needs of employee and family Identifies patterns of accident susceptibility Evaluates employee's environment for effectiveness of safety measures ...aaft ..-intervenes to promote Interprets health and medical insurance plans asecurity of employee and family from economic Identifies patterns of health needs from analysis of records and reports and utilization of health care services stress due to non- Assists in compiling medical insurance claims occupational illness and injury Estimates impact of illness on family from claim data Identifles health need relating to social adaptation of employee and family through observation, interview, analysis of records and reports Assesses social health Correlates identified needs and developmental Level and age grouping of employee needs of employee and family Analyzes employee-employee relationship: Analyzes employer-employee relationshi.,..i, Analyzes employee-family relationships Identifies groups of employees with specil ri.-ii.-Is r.3 (5?) Collaborates in planning and Collaborates in providing setting conducive to adaptation intervening to promote social adaptation of em- Interprets effect of total environment on health of employee and family ployee and family Guides employee and family in social adaptation through counseling, interviewing, teaching, demonstration Collaborates in planning Interprets occupational health nursing to community health maintenance activities for total community Communicates health needs of employee and family health program Coordinates occupational health program with organized community health program Assesses emotional Identifies needs of employees through observation, interview, analysis of records health needs of employees Correlates idcntified needs and developmental level and age grouping = Identifies groups of employees with special health needs ciOA .=io Communicates identified needs to health team Ca Collaborates in planning an Interprets effects of total environment on emotional health of well, productive citizen re) and intervening to pro- m- mote emotional health Guides employee and family through counseling, interviewing, teaching, demonstration Collaborates in providing setting conducive to good emotional health Assesses growth needs and Identifies growth needs and health potential of employee through observation, interview, analysis of records health potential of employeesCorrelates identified needs and developmental level Communicates identfied needs to health team Collaborates in planning Guides employt-' to attainment of growth through interviewing, counseling, .teaching, and demonstration and intervenes to promote Provides nursirw leadership in planning recreational and self-development programs in plant and community growth Promotes self-responsibility for hr ..1.th and health care Recognizes health team as members of the labor force and as individuals

03 Participates in and conducts Identifies health problems of employee and family in need of study l.-r., systematic studies relating gto health of employees Initiates studies and projects using systematic research methodology .....= mx Appraises program and services based on philosophy, objectives, current stai dards, and pulicies ...- co Predicts future health needs and problems of employee, family, community, work environment CI) Collaborates in evaluating Revises program and services based on changing needs and utilization of services the total health promotion Analyzes relationship of nursing to other health team members -- in-plant and community and health evaluation Evaluates nursing program based on philospphy, objectives, policies, legally recognized practice program standards, and independent and dependent nursing functions Evaluates own performance, and personal and professional development Estimates budget needs for nursing program Keeps abreast of current thinking and direction of changes in nursing and delivery of health care

... 118 118 COMPETENCY SUGGESTED NURSING ACTION Collaborates in assessing Identifies physical hazards to employee and family the work setting for Observes and examines employee to prevent toxicity from environmental exposure Ftohazards to physical health el Observes work environment I'm needed control measures rii .co Correlates relationship of employee health and physical environment a... ..= ga- Identifies aspects in work setting promoting health of employee Serves as a member of the safety team Communicates safety needs and effect of environmental hazards on employee and family to safety and health team Recommends and promotes use of protective measures and equipment Collaborates in providing Observes adherence to sanitarian and food-handling regulations a safe environment Guides employee and family in developing positive attitudes towUrd safety and protection Guides employee and family in safety, education through counseling, teaching, and demonstration Analyzes patterns of symptomology from records and reports. a...... Communicates health needs for transcontinental and intercontinental travel to health team and individuals involved ....aa go coaCollaborates in providing Identifies need for immunizations based on travel regulations, agency recommendations, and in-plant data program to control corn- rnunicable disease in Administers immunizing agents as prescribed work setting Evaluates and refers employees with communicable disease conditions for medical care Recognizes influence of work environment on community health Collaborates in planning control programs for Analyzes community-plant relationship community health Communicates need for control programs to in-plant and extra-plant health teams problems Assists di planning in-plant and community prngra ms for disasters Collaborates in assessing Identifies influences on health of employees frorr work setting c., influence of soc'^l aspects Analyzes social influences from work setting and employee-family relationships on health of employee C2 f work environ ent on health Observes work environment for influences on emotional health of employee and family ca s.3 toCollaborates in assessing Identifies personal characteristics of employees in hazardous, stressful, and routine job operations go influences on employee Communicates special health needs of employees in hazardous, stressful, and routine jobs .==emotional health from work ea environment Analyzes emotional influences from work setting and employee-family relationships a.. co Predicts psychological effects of change in work environment on employees and families Ct. Identifies health problems...... present in environment Participates in and con- Initiates studies and projects using systematic research methodology ducts systematic studies Applies findings in environmental control =relating to environment tr.:. Communicates findings to health team and interested individuals and groups IV Participates in interdisciplinary studies and projects co 4..= Appraises program based on philosophy, objectives, legal requirements, and policies seca ...t. Predicts future environmental problems TVCollaborates in evalu- Revises program based on health needs and utilization rand results of program VIating total program for environmental control Evaluates nursing contribution to environmental control program based on philosophy, objectives, and independent and depend, it functions I

119 . . - COMPETENCY SUGGESTED NURSING ACTION Provides emerge care Recognizes legal limitations for nursing for physical injui.., and illness Recognizes signs and symptoms of pathological conditions Carries out nursing diagnostic procedures to establish need for care Administers emergency care, e.g., aseptic techniques for lacerations, removing foreign bodies, splinting, administering oxygen, administering medication

Communicates by interpreting pathological processes and implications to health team or appropriate individuals . !al) ca Provides for continuing care, e.g., medical treatment, return visits, transportation .....II Begins rehabilitation process C/7 ..ca.. Maintains appropriate records and reports a- Organizes non-professional first aid services Communicates with health facility Intervenes to assist em- Refers employee for continuing health and nursing care ployee seeking medical care for identified Guides employee in obtaining and carrying out medical care disease process Follows-up on employee with illness ...... -.. Iden the demands on empinvee's health of job operation, e.g., stress, heavy lifting, walking,.toxic materials Collaborates in trroviding safe environment for Communicates health status of e.aployee to health team or appropriate individuals - employee with limited Recommends placement of employee for employee's and co-werkers ' safety a, health problem t .44 Observes employee for satisfactory rlacement .4a) a Collaborates iv promoting Complies with Workman's Compensation Act. security of employee and family from economic Maintains appropriate records and reports stress due to occupational illness or injury 4" Co'laborates in assessing Identifies health problems of employees related to disorganization or social change and providing service to Recogni, es effects of disorganization or social change on employee, work setting and community control influences from employee and group dis- Analyzes influence of social change or disorganization on health and behavior patterns of employee and family organization or social Communicates to health team effects of social change causing disorganization change on health employee Guides employee and family in coping with effects of social change or disorganization ,= to, Collaborates in assessing Identifies employee with high-rate of absences from records and reports and providing services Identifies causes of behavior patterns from study of total environment for control of short-term absence Guides employee in seeking remedial care Determines causes of absence of employee and..., interprets to appropriate individuals, Identifies immediate stressors.and symptoms of and reactions to crisis Establishes and maintains therapeutic nurse-patient relationship Provides eraergency care Reduces anxiety level of employee, family, co-workers ..I'D for emotional crisis of ...0* --' employee Provides emotional support .=c Refers employee for continuing health and nursing care CZ, LI, Communicates needs of employee to health team or appropriate individuals 0-vs Assesses effect of Identifies signs and symptoms of stress and tension stress on employee Communicates needs of employee to health team or appropriate individuals CM414111MR, Creates climate con- Demonstrates attitude of acceptance of employee ducive for employee to = seek health care Provides assistance needed for employee to recognize and meet own health needs ..... cc NJ = .4.4 . ssT., ....- tz, Cm

.... .

120 120 SUGGESTED NURSING ACTION COMPETENCY Provides c,...,-e to relieve Identifies employees with long-term illness signs and symptoms of Develops nursing care plan based on identifiedneeds illness and injury Carries out medical directives, e.g., dressingchanges, administration of medication, restperiods Performs technical nursing skills, e.g., checkingvital signs, heat or cold applications disease process OA Observes employee for progressing signs of = appropriate individuals 7= Communicates employee's condition to health team or te, Collaborates in providing continuing health and nursing care .=a., ea. Evaluates employee's and family'sunderstanding of physical aspects of disease conditions, their understandings of medical orders andability to carry out Teaches skills and provides information relating to careof employee, e.g., temperatures, administration of medications, dressing changes identifies the demands on employee's health ofjob operations Comr ,: icates health status of employee tohealth team or appropriate individuals Collaborates in providing .6...3. Recommends placement of employee for employee'sand co-worker's safety ...... insafe environment for I"teemployee with disease Observes employee for satisfactory jobplacement process Recognizes effect of prescribed drugs on employee Observes employee and family for effects ofillness Observes effect of employee's illness on worksetting Assesses socio-economic social limitations needs of employee and Identifies problems of employee and familycoping with disease process, economic stress, family with disease process Assists in compiling insurance claims Observes employee and family in their totalenvironment = Guides employee and family in copingwith effects of illness co" Collaborates on planning Communicates needs of employee and family tohealth team or appropriate individuals and intervenes to enable establishing new socialization patterns adaptation of employee Guides employee and family in and family to illness Collaborates in continuing health and nursing carethrough guidance, follow-up, support Assesses employee's and family'ssocio-economic needs during absence from work Observes psychological effect of illness on employee ar1 family Assesses emotional Observes psychological effect of employee'sillness on co-workers needs of employee and problems in coping with disease process, emotional stress family where employee Identifies with employee and family has disease Evaluates employee's and family's understandingof emotional aspects of.illness Plans and intervenes to I .ides emotional support caenable employee and Guies employee and family and co-workersin adjusting to illness 7,family to cope with illness =emotional aspects of Guides employee and family during terminal .=.=illness eaa.. Recognizes psycho-pathological procer ce) team or appropriate individuals C. Communicates needs of employee and family to health 1 Guides employee and family in obtainingmedical care i Provides care for provision of meaningful activity, transportation, ) employee with mental Collaborates in providing continuing care, e. a. , i illness follow-up, emotional support Guides employee and family in meetingphysiological and safety needs i Guides co-workers associated with employee ...... Collaborates in providing Identifies opportunities for continued growth ofemployee opportunity for meeting Communicates identified needs cf employee =growth potential needs of ..-ca employee co Appraises program based on philosop..y,objectives, and policies ...t ii. Pre.' cts future needs and changes tn health caredelivery =Collaborates in evaluat- and utilization of service i... ing total program for ill Revises program based on changing needs mit and injured employees Evaluates nursing contribution based on nursingphilosophy and objectives, policies, legally ...- recognized practice standards, independentand dependent nursing functions V)

ilM11111111111

ti 12 1 COMPETENCY SUGGESTED NURSING ACTION Collaborates in assessing Identifies remaining abilities through observation, interview, records and reports and testing physical needs Communicates abilities to appropriate individuals Interprets philosophy of rehabilitation =co Applies principles of Activities of Daily Living to work setting 7) i Administers selected physical therapy, e.g., exercises, hydro-therapy, .cea 1 heat applications, supportive equipment .= 'Plans and intervenes to cupromote fullest Teaches self-help skills, e.g., transportation, housekeeping, personal care, transfer functioning Communicates identified needs to health team or appropriate individuals Collaborates in providing continuing health and nursing care ,...... ,.:!ollaborates in pro- Observes employee's total environment for safety and adaptation for indPpendent functioning .Z...' - :Jing safety of Analyzes attitules of employee toward safety .....,..- environment co Collab,-rates as described under Disability Limitations Safety and Protection in placement of employee :-) Observes employee for suitable placement in work setting

Assesses socio- Identifies problems of employee in work setting and of employee and family in home and community economic needs of Observes employee and family in coping i-'"ri tho social setting employee and family Identifies needs of en-workers in assisting with rehabilitation process Communicates needs of employee, family az d co-workers Plans and intervenes to Counsels with employee, family, and co.-workers c.., promote social adaptation c'of empinyee Recommends environmental adjustments to meet employee needs Observes employee for adjustment to disability and social setting Collaborates with Interprets occupational health nursing contribution to restorative program community health Interprets community rehabilitation services to health team or appropriate individuals facilities Communicates employee and family needs to health team or appropriate sources z. Assesses emotional Identifies needs of employee in work setting and of employee and fmnily in home and community 76- needs of employee and Observes employee and family in coping with affects of disability 7 .....C-/ family to Identifies needs of co-workers in accepting employee co II Counsels employee and fsmily in adjustment to disability .==Plans and intervenes to rppromote emotional Counsels co-workers in expectations and acceptance of E.mployee cz-: adjustment of employee, Communicates identified needs family, co-workers Provides emotional Support for employee and family .mm=1 ...... Plans and in'ervenes Communicates and interprets growth needs to promote fUlest Guides employee and family to positive actions and attitudes by counseling, teaching, demonstration Prestoration potential Recognizes productive work as a means of self-actualizing co wr Appraises program based on rihilosophy, objectives, and policy ra 4= Predicts future needs and chfinges in rehabilitation process Ca Collaborates in Revises program based on(changing needs and utilization of service "cc evaluating rehabili- -a...L. tation program Evaluates nursing contribution to program based on nursing philosophy, objectives, and V, independent and dependent nursing functions

...... , .

122 122 APPENDIX E The University of Tennessee College of Nursing Curriculum*

NOTE: Figures under Course Title represent credit hours and lecture- laboratory class time. Course Description Anatomy 1N A study of the structure of the human body and its 4(3-2) parts. Biochemistry 1N General Chemistry. An introduction to elementary 2(2-0) principles of chemistry.Lectures, demonstrations and conferences. Biochemistry 2N Organic Chemistry and Biochemistry.Properties 4(3-3) and behavior of physiochemical systems and elementary organic chemistry; biochemistry of foodstuffs, digestion, and absorption.Prerequisite: General Biochemistry 1N. Biochemistry 3N Biochemistry. A continuation of 2N. Topics include 4(3-4) blood and other tissues, intermediary metabolism and the excretions. Laboratory work is devoted to quantitative analysis of blood and urine. Microbiology 1N Microbiology. An introductory course emphasizing 3(2-4) the morphology, growth, modes of transmission, and relationship to diseases of pathogenic microorganisms. Means of protecting the patient and the nurse fromin- fection are emphasized. Physiology 1N A study of the functions of the human body. 3(2-2) Physiology 2N A continuation of physiology 1N. 4(3-2) Preventive Biostatistics.Lectures and exercises dealing with Medicine 1N the collection, tabulati a, and graphic representation 2(2-0) of quantitative data. The student studies frequency distributions, centering constants, dispersion constants, and simple correlation.

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

123 l 3 Appendix E

Psychology 1N Human Growth and Development. Basic considera- 3(3-0) tion is given to the behavioral changes from infancy through adulthood. Using these data as a background, the student becomes familiar with modern theoretical positions on the dynamic forces associated with this behavior. Attention is given to both nomothetic principles and individual differences Psychol.:,gy 2N Human Growth and Development. Continuation of 3(2-2) Psychology 1N Psychology 3N Psychology of Adjustment. 3(2-0) Psychology 4N Pernal Adjustment. This course covers psycho- 3(3-0) logical development of adolescence through senescence, personality characteristics and changes through time, and the dynamics of adjustments to each phase. Psychology 5N The Scientific Method in Nursing. A course including 3(3-0) individual and group discussions based on the origin, selection, presentation and evaluation of problems in the care oi patients Nursing as a A course of lectures, conferences and observations Social Force I designed to introduce the student to professional nursing 3(3-0) as a social force and a service to mankind. The historical development of nursing is considered, Introduction is made to a concept of the professional nursing role and its components with emphasis on the family as a unit of society. Nursing of Classroom and laboratory study designed to provide Children and the student with concepts, principles and skills basic Adults I to nursing. Focus is on the human needs common to 6(4-6) all persons and on the nursing care and intervention which may assist the patient in maintaining a dynamic equilibrium Nursing of A continuation of Nursing of Children and Adults I Children and Adults 11 5(3-6)

124 Appendix E

Introduction to basicnutrition; a course toincrease Pharmacology and understanding and skillsprerequisite Nutrition Survey basic knowledge, nutrition through- 3 (3-0) to the correlatedstudy of applied out the basiccurriculum. Thepharmacology survey is a coursedesigned to introducethe student to understanding andresponsibilities prerequisiteto the safe and accurateadministration of drugs.This includes reliable sourcesof drug information, standards, classificationand recognition ofsocial problems associatedwith indiscriminate useof drugs. This course concernsitself with developmentof Anthropology man in hisphysical and culturalaspects through 3(3-0) time and space.Genetics and embryology are among abackground disciplinescovered. Emphasis is given tosub-cultures in themid-south. and laboratoryexercises which Physics A course of lectures knowledge 3(2-2) provides the studentwith a fundamental )f the basic principlesof physics and theirapplica- tion to nursing inthe care of patientsand the operation of equipment.This course includesthe equivalents used in thehospital; basic principles which apply to bodymechanics and normalfunctioning of the body; forces;pressure; power;energy; friction; motion; gases; natureand measure of heat,light and sound; andelectricity. study designed todevelop Nursing of Classroom and laboratory the ability to plan,give and evaluatenursing care Children and and to gain knowledgeof the Adults III to hospitalized persons home 11(6-15) facets of comprehensivenursing care in the and in the community.C ntent givesevidence that the organizing conceptof basic humanneeds pro- gresses to areasin which the needs arealtered through disease processesin the child andthe adult. and Adults III. Nursing of A continuation ofNursing of Children Children and Adults IV 11(6-15) and Adults III Nursing of A continuation ofNursing of Children Children and and IV Adults V 12(7-15)

125

125 Appendix E

Nursing of A continuation of the basic nursing concepts with Children and major emphasis on the principles and skills, which Adults VI are utilized providing comprehensive nursing care 11(6-15) for the patients in maternity, psychiatry, and public health.Clinical learning experiences are selected in a variety of locations including the home, the clinic, the hospital, the health department, the physicians' office, and other community health and welfare agencies.All learning experiences emphasize continuity and co-ordination of health care. Emphasis is placed on ccrinseling and teaching individual patients and groups of patients including families. Nursing of A continuation of Nursing and Children and Adults VI Children and Adults VII 11(6-15) Nursing as a A discussion of the history and trends of professional Social Force II nursing. Emphasis is placed on the personal and 3(3-0) professional responsibilities of the professional nurse. Patient-Centered Classroom and laboratory study of the nursing care of Nursing selected patients during illness and convalescence. 9(6-9) Guided practice in analyzing the patients' physical, emotional and social needs and in planning and executing a program of nursing care to help meet these needs.Includes field trips to selected community agencies Preventive Epidemiologic Approach to Health end Disease. Focus Medicine 2N on basic human needs is directed toward the community 3(3-0) as a whole.Evolving philosophy and scope of the public health movement are considered. Multiple influences affecting health and disease in contemport living are emphasized. Concepts from biostatistics and epidemiology are utilized in assessing community health status and planning programs of protection and health promotion. Changing patterns in community organization and in the funding and delivery of health services are examined. Open to all students in Medical Units.

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