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PHXIDSOPH‘I degree in Depart-ant. or Educational Adulnt-tr-tion J hwy ,M/ [Iv f Major pro/essor Date 5, ’7 0 MUN-m. Alf .~ A - r In PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. DATE DUE DATE DUE DATE'DUE ll _ _ _ _M_$U Ie An Affirmative Action/Equal 0mm Institution / A SURVEY OF LIBERAL EDUCATION REQUIREMENTS OF BACCALAUREATE NURSING PROGRAMS: A DESCRIPTIVE STUDY by Maureen Gallagher Leen A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Educational Administration 1990 ABSTRACT A SURVEY OF LIBERAL EDUCATION REQUIREMENTS IN BACCALAUREATE NURSING EDUCATION: A DESCRIPTIVE STUDY by Maureen Gallagher Leen The American Association of Colleges of Nursing charged a national panel to "define essential knowledge, practice and values for the education of the professional nurse". This resulted in the publication of Essentials of College and Qniversity Education for Prgfessignal Nursing (1986). This report endorsed the recommended improvements for liberal education for the undergraduate curriculum of three national panels (Association. of TMmerican. Colleges, 1985; National Institute of Education, 1984; and National Endowment for the Humanities, 1984). This Essentials (1986) document recommended outcomes for the liberal education of the professional nurse. ‘A review of nursing and education literature revealed sparse reaction, commentary or research regarding the status of liberal education in baccalaureate (BSN) nursing education. The purpose of this study was to review liberal education requirements in BSN programs and to gather information about the perceived effectiveness of these programs in meeting the stated Esssngigls outcomes . Data were collected.through mailed and college catalogue surveys from fifty BSN programs stratified by institution type. Data analysis indicated that BSNWgraduates complete less coursework in liberal education studies, in the humanities and social sciences, than other graduates of the same institutions. Respondents rated their liberal education programs as less than effective in meeting a majority of the Esssngisls recommendations. These findings suggest that further research and evaluation of the status of liberal education in professional nursing education is needed to make progress toward the stated gssssgisls_recommendations. Dedicated to Ellen Ida Leen, my husband Charlie and children Ellen, Ann Marie and Charles ACKNOWLEDGEMENTS This study could not have been completed without the support, guidance and assistance of many people. I would like to express special gratitude to Dr. Eldon Nonnamaker, the chairperson of my advisory committee, for his support, encouragement, ideas and patient reading and editing. The other member of my committee, Louis Hekhuis, Marvin Grandstaff and Charles Blackman.provided.direction throughout my graduate studies as well as through the dissertation experience. Lauren Sigman was instrumental in the completion of this project. Her word processing and computer assistance was invaluable throughout the data collection and analysis periods. A special thanks to Julie and Mark DeKoster for their assistance in reading college catalogues as well as their support and encouragement throughout this project. A special thanks to the Hope-Calvin Department of Nursing who also offered support and assistance through my graduate studies. I am especially grateful to my husband, Charlie, who offered endless support, in so many capacities, throughout graduate school. Finally, thank you to my children, Ellen, vi Ann Marie and Chip for their patience, understanding and encouragement. vii 0 Copyright by Maureen Gallagher Leen 1990 TABLE OF CONTENTS Chapter One . . . . . . . . . Introduction . . . . . . Problem Statement . . Significance of the Study Purpose of the Study . . Assumptions . . . . . . Research Questions . . . Limitations of the Study : Definition of Terms . . Summary . . . . . . . . Chapter Two . . . . . . . . . The Liberal Arts Curricula in Institutions of Higher Education . The Evolution of Professional Education in Institutions of Higher Education The Evolution of Professional Nursing Education in Higher Education A Liberal Education Framework . Education Professional Nursing Education . . . . . Summary . . . . . . . . Chapter Three . . . . . . . . Methodology . . . . The Population The Sampling Technique Data Collection Procedures Data Analysis . . . Chapter Four . . . . . . Analysis of Data . . . . Introduction . . . . . The Mailed Survey . Research Question One . Research Question Two . The Catalogue Survey Research Question Three Research Question Four Research Question Five Research Question Six Summary . . . . . . . . . Chapter Five . . . . . . . . viii ana . Liberal OQmQQQDWi-‘H H h’ o c> 13 Major Findings, Conclusions and Recommendations Major Findings and Conclusions . . . Identified.strengths and.weaknesses of liberal education programs for BSN graduates Respondents’ perceived effectiveness in meeting AACN outcomes . Liberal education structure types in schools with BSN programs . . . Coursework pattern for liberal education (all college graduates) . . . . . . . Coursework pattern for liberal education (BSN students) . . . . . . . . The relationship of coursework patterns .in liberal education to perceived effectiveness ratings in meeting .AACN outcomes . . . . . . . . . . . . . . . Recommendations . . . . . . . . . . . . . . . Appendices . . . . . . . . . . . . . . . . . . . . . . List of References . . . . . . . . . . . . . . . . ix 80 81 82 82 84 85 86 87 88 94 109 Table 1: Table Table Table 01wa Table Table 6: Table 7: Table 8: Table 9: Table 10: Table 11: Table 12: Table 13: Figure 1: Figure 2: Figure 3: Figure 4: LIST OF TABLES/FIGURES BSN Programs Stratified Using the Carnegie Classification Categories Stratified Sample Size Mailed Survey Returns by Strata Respondent Length of Time in Present Position vertical Integration of Liberal Education Requirements Writing Requirements Integrated Across the Curriculum Mean Effectiveness Rating of Liberal Education Outcomes in BSN Programs Overall Survey Mean Effectiveness Ratings Greatest Strengths of the Liberal Education Program for BSN Students Greatest Weaknesses of the Liberal Education Program for BSN Students Liberal Education Structure Types for All-College Requirements All-College Liberal Education Requirements Course Hour Ranges All-College Liberal Education Humanities Requirements All-College Liberal Education Social Science Requirements All-College Liberal Education Natural Science Requirements BSN Student Liberal Education Humanities Requirements Figure 5: BSN Student Liberal Education Social Science Requirements Figure 6: BSN Student Liberal Education Natural Science Requirements Table 14: Course Requirements Categorized by Outcome Area Table 15: Range of Semester Course Hour Requirements and Mean Effectiveness Ratings xi LIST OF APPENDICES Liberal Education.in Baccalaureate Nursing Programs Research Questionnaire Carnegie Classification Definitions College Catalogue Survey xii Chapter One Igggsdgggisn There is grave concern regarding the status and quality of liberal arts curricula in undergraduate education. Three celebrated reports by the National Institute of Education (NIE) (1984), the National Endowment for the Humanities (1984) and the American Association of Colleges (1985) documented the dilution and the fragmentation of liberal arts education in the last two decades in institutions of higher education. Careerism and vocationalism are decried as the precipitating factors for, this decline in liberal arts education. Colleges and universities have become increasingly interested in professional education programs to meet the demand of the students and the marketplace. These reports charged institutions of higher education to critically review their liberal arts requirements and make a new commitment to the liberal arts curricula that reflects the mission and the philosophy of their institution. Wee (1987) reports that the Carnegie Foundation for the Advancement of Teaching estimated that 60% of colleges and universities are engaging in review of their liberal arts curricula. The general trend is an increase in writing requirements, math, the arts and computer literacy with a decrease in physical 1 2 education and foreign language requirements (Qhangs Trendlines, 1987). The implications of the proposed re-dedication to a strong liberal arts curricula is unclear for professional education. Nursing education has a relatively short history in institutions of higher learning. The change to baccalaureate education is firmly rooted in a commitment to liberal education and the need for knowledge of the humanities. In October of 1986, The American Association of Colleges of Nursing (AACN) issued the report Essentials sf Qsllege ans universigy Egssagisn fsr Profsssisnal Nursing (Essentials). This document reaffirmed the commitment of the nursing profession to liberal education by stating that the professional nurse must be liberally educated to "make informed and responsible ethical choices to help shape the future of society as well as the nursing profession" (p. 6). This document fully endorsed the three national reports and delineated outcomes that reflected the spirit of those documents. These outcomes represent a broad array of disciplines usually represented in a liberal education (see Appendix A) which include reading and writing ability, mathematics, a foreign language competency, the natural sciences, ethics, history, the behavioral sciences, human spirituality and the fine and performing arts. Pre-nursing curricular requirements are heavily weighted in the natural sciences which may vary between institutions 3 but must meet accreditation standards. While liberal education or general education requirements vary between institutions of higher education, it is unclear if students in the nursing major are even afforded the opportunity to select courses in the suggested liberal areas in an institution's recommended four year curriculum. Prgblsm sgsgemeng Nursing education literature reveals that little is written regarding the quality and quantity of liberal arts requirements for baccalaureate nursing programs. Sohn (1986) points out that the profession vigilantly revises the nursing content of the curriculum but appears to pay little attention to the liberal education foundation. The AACN has clearly stated recommended outcomes of a liberal education for baccalaureate nurses. The vehicle and/ or process to arrive at these outcomes is not addressed. The amount and structure of liberal education requirements in baccalaureate nursing programs is not known. It is unclear if pre-nursing curricula, across institutions, are able to provide coursework and learning opportunities to meet these outcomes. The AACN muss report states that “these essentials provide a standard by which faculty can measure the content of the curriculum and the performance of the graduate" (p. 18). The report further states that while there will be differences among institutions, "college and university students in all 4 nursing programs should obtain the essentials identified for the first professional degree in nursing" (p. 18). Nursing faculty was charged to ensure that these essentials were being incorporated in their curriculum. The problem is that there is no evidence of a systematic or organized assessment of liberal education in baccalaureate nursing education. While the nursing literature reveals testimonial support for the need for liberal education for professional nurses, there are, at present, no qualitative or quantitative studies to describe or measure the liberal arts component of baccalaureate nursing education. W The nursing profession has a classic heritage bounded in the true spirit of liberal arts learning. Yet, the nursing profession has not emerged as the professional program with the strongest voice in support of this movement. Business education is the most frequently cited in the literature for its strong propensity for the liberal arts and their newly formed council to strengthen their liberal arts foundation. A review of the nursing literature revealed two pleas to document the need for baccalaureate educated nurses. Woolley (1986) states that the profession must define and differentiate the baccalaureate nurse to the American public. She describes the product of this process as an autonomous, accountable practitioner of nursing who sees and acts beyond the boundaries of following orders and completing tasks; who sees the whole person and the 5 whole process; who has knowledge of the larger world and its many dimensions of knowledge; who is active rather that reactive; and who had the perspective of an educated person on how much more there is to know (p. 199). Stevens (1985) concurs that nursing must convince consumers, employers and university administrators that baccalaureate nurses make health care and economic sense. There should be a distinctive difference in the professional practice and education of the collegiate nurse. Strong proponents of the movement to "reclaim a legacy" are carefully scrutinizing the "new" and prolific health professions that have entered the college arena. Hook and Kahn (1986) summarize this sentiment by saying that "‘career capping’ courses are thwarting the character and mission of higher education" (p. 45). They conclude that if career skills can be learned without a liberal arts foundation, they can and should be learned elsewhere, outside of the university setting. Nurse educators must be proactive, articulate, creative and innovative in their support of the liberal arts issue. The pre-nursing' college curricula. must reflect the profession's historic and. philosophic commitment to the liberal arts tradition. The domain of nursing embraces a holistic approach to man. The practice of nursing involves cultural knowledge, literacy, critical thinking and highly developed problem solving skills. Nursing is, perhaps, the best suited to 6 articulate the value and. need for liberal learning for professionals. A Clearly, there is a need for a serious review of the liberal arts component of professional nursing education. This information would provide a sound base for the profession, and the AACN, to make prescriptive recommendations for baccalaureate nursing education to supplement the global outcomes of the AACN Esssngisls report (1986). It is time to seriously address, as the NIE report has charged, whether the current four year baccalaureate curricula can accomplish both professional nursing and liberal education. ngpsss sf ghe Study The nursing literature reveals minimal study of the liberal education content in baccalaureate nursing education. The process must begin with describing and defining the current practices. It is also important to determine if nursing educational leaders perceive these current practices to be effective in achieving the AACN outcomes. The purpose of this study is twofold. The first is to gather data to describe the amount, length and structure of liberal education requirements for baccalaureate nursing students from a representative sample of undergraduate nursing programs. The second purpose is to gather data regarding the perception of nursing' educators of ‘their' program's effectiveness in meeting the AACN outcomes. Assumptions This study is based on the following assumptions: 1. College and university catalogues will accurately describe the liberal arts requirements for graduation. 2. College and university catalogues will accurately describe the pre-nursing curricula. 3. The respondents to the questionnaire will be sufficiently cognizant of the liberal arts requirements for baccalaureate nursing students at their institution to be able to rate its effectiveness in meeting the AACN outcomes. Resesrsh Quesgions In a randomly selected sample of NLN accredited baccalaureate nursing (BSN) programs stratified by institution type: 1. How do the nurse educational leaders rate their program’s effectiveness in achieving the AACN recommended outcomes? 2. What do the nurse educational leaders identify as the greatest strength and greatest weakness of their liberal arts program for their student nurses? 3. What is the frequency of liberal education structure types (core, prescribed distribution, minimally prescribed distribution, free electives or determined by college degree)? 4. What is the coursework pattern (range of course hours in the humanities, social sciences and natural science 8 divisions) for all graduates of the institution in the liberal education program? 5. ‘What is the coursework pattern (range of course hours in the humanities, social sciences and natural science divisions) for the BSN graduates of the institution? 6. Do specific course requirements in areas related to an AACN outcome correlate with a more effective rating on the mailed survey? Limigsgisns sf ghs S§udy This study is limited to: 1. A randomly selected sample of NLN accredited BSN programs stratified according to the Classification of Insgitugions sf Highsr Egussgisn (The Carnegie Foundation for the Advancement of Teaching, 1987). 2. Available and accessible institution catalogues. 3. The information available in the catalogue of the institution that describes their liberal arts required program for graduation and the pre-nursing curricula. Definition of Terms Liberal arts requirements 1. a program to introduce students to a broad range of human knowledge and to develop in them an ethical sensitivity and a socially responsible philosophy of life. The goals focus on the development of responsible world citizens capable 9 of life long learning and social contribution regardless of undergraduate major (Wee, 1987, p.435). 2. all non-nursing (professional) coursework. §EEE§£1 This is a descriptive study to assess the status of liberal arts requirements for baccalaureate nursing students in a representative sample of NLN accredited BSN programs. The data gathered will describe the length, structure and coursework patterns that currently exist and their perceived effectiveness in achieving the recommended outcomes of the AACN. This assessment will provide necessary information regarding the present state of professional nursing education with respect to the liberal arts education so that planning to meet professional and higher education standards can progress. Chapter Two Th Li r l r ul in Ins i utions f Hi h r Ed a ion In the 1980’s, there was renewed concern regarding the status of liberal arts education in the undergraduate curricula in institutions of higher education. The efficacy of the present education system was questioned by three celebrated reports. Educational experts attempted to come to consensus on the definition and the meaning of a liberal arts education. The first report, in 1984, was. a federal. panel on excellence in higher education sponsored by the National Institute of Education. This group defined the purpose of liberal arts curricula. "to foster' the shared. values and knowledge that binds us together as a society" (CHE, 10/24/84 p. 1). This report concluded that colleges and universities were not realizing their full potential in liberal arts education because undergraduate curricula were "excessively vocational”. The group recommended that "all bachelor degree recipients should have at least two full years of liberal education". They published twenty-seven recommendations to remedy the identified shortcomings. The recommendations do not emphasize merely increasing required courses in the humanities. The report clearly states 10 11 that additional courses lead to fragmentation and departmental politics. The recommendations foster a unified philosophical stance to raise expectations nationally and increase the value of liberal education as an integral part of a bachelor’s degree of any kind. The implementation of these recommendations would “radically restructure" undergraduate curricula and probably extend professional degree programs beyond the usual four year time frame. In November of 1984, The National Endowment for the Humanities published a report on the status of undergraduate education. This group focused specifically on the humanities as an integral part of the liberal arts curricula. The author, William Bennett, defines the humanities as "history, literature, philosophy and the ideals and practices of the past that have shaped society" (CHE, 11/28/84, p. 46). Bennett reported that one can earn a bachelor’s degree at over 72% of the colleges and universities without studying American literature or history, European history, classical Greece or Rome or a foreign language. This panel recommended a reshaping of the undergraduate curricula to clearly define an educated person, regardless of major, as one with a common base of study in history, philosophy, language and literature. The report charged college presidents to become involved in academic affairs to ensure that curricula reflected these principles. 12 The third landmark report came in February of 1985. The American Association of Colleges (AAC) report, Integrisy in h 11 rr 1 , responded to serious decay in the undergraduate curriculum. This committee focused on a minimum required curriculum defined as "intellectual, aesthetic and philosophic experiences that should enter into the lives of men and women, engaged in baccalaureate education" (Cg, 2/13/85, p. 13). The proposed curriculum is not merely a set of required courses. It is defined as nine "experiences" that reflect "methods and processes. modes of access to understanding and judgement that should inform all study“ (£91985, p.15). This report called for a renewed dedication to a common coherent curricula in institutions of higher education. Analysis of these three reports reveals a commonality of the definition of the problem, general agreement on the “spirit" of the meaning of an educated person, and some consensus on the nature of the changes that need to take place. College and university administrators and faculty are challenged to scrutinize and re-organize the present system of undergraduate education which is so closely inter-related with professional education. 13 Ths Evglggign gf Prgfsssignal Egucagion in Insgiggsigns of Higher Egucasion American colleges and universities originated as bastions of liberal education. They were strongly rooted in religious purposes and the study of classics for general education. Levine (1978) reports that colonial colleges strongly resisted the introduction of professional courses and considered them incompatible with the missions of the institutions. However, in 1765, the College of Philadelphia established a medical curricula; while the College of William and Mary established the study of law in 1779. Colleges still resisted the pressure to educate professionals. The Yale report of 1828 extolled Yale’s classical curriculum as the best foundation for all professions. When enrollments continued to decline during the Civil War, many colleges, however, began to offer courses in law, medicine, and divinity (Levine, 1978). Rudolph (1962) reports that the 1862 Morrill Land Grant Act and the development of new technology resulted in significant growth of professional education in colleges. By the end of the nineteenth century, American colleges produced more teachers that any other graduates. Cornell was the first institution to blend the classical curricula with career and work related study. Soon, Harvard introduced a free elective system, allowing students to choose their own courses to complete their studies. Therearly 1900’s 14 found about 25% of the college population enrolled in professional programs ranging from applied sciences to business (Levine, 1978). The growth of professional programs in the twentieth century has been phenomenal. Influenced by social and political factors, industrial and technological developments, colleges and universities have continued to meet the demands for professional education. A.catalog study by Levine (1978) reveals that.a.majority of universities and four year colleges offer business, education and health science degrees. Several systems to regulate the blending of liberal arts and. professional curricula. have evolved" Levine (1978) succinctly classifies them into three major categories: core curricula, distribution requirements and free electives. Core curricula define a series of courses in the humanities, social and natural sciences that are required of all students. Distribution requirements direct students to take a minimum number of courses in certain academic areas. Some distributions offer little latitude in courses 'that must be selected from short, predetermined lists with a limited number of electives in designated. areas (prescribed distribution). Other institutions have "cafeteria style" or "smorgasbord" approaches where a few courses are specified (minimally prescribed distribution) or recommended (recommended.distribution guidelines). Baily (1977) observes 15 that this system has sent students on a "mindless search for convenient courses and easy grades" (Chickering, 1981, p.1). The free elective system places no constraints on course selection and liberal arts may be neglected if the student chooses. Some institutions do not determine liberal education requirements for all students but leave it at the discretion of the school or the department of the major within a recommended general education framework. The prescribed distribution program is the most common. Up to 85% of colleges and universities subscribe to this type of liberal arts program. How has liberal education fared in the system? The Carnegie Foundation for the Advancement of Teaching (1977) reports, "it is a disaster area that has been losing ground for more than 100 years" (Levine, 1978). Th v n f Pr f sion 1 N rsin Edu a ion n Hi h r Edu ion The genesis of collegiate nursing education in the United States is steeped in a commitment to the liberal arts. In 1923, the Goldmark report, funded by the Rockefeller Foundation, espoused the necessity of university education for nurses. .A direct outcome of this study was the establishment of the Yale University School of Nursing. The study, Ngrsing for she Future (Brown, 1948), funded by the Carnegie Corporation, focused on determining the needs of society for nurses. Its major recommendation was to advocate the establishment of schools of nursing in 16 universities and colleges to educate nurses in the liberal arts and humanities tradition. The next four decades saw continuous and consistent growth of baccalaureate nursing programs. There are presently over 400 generic undergraduate nursing programs in existence in all fifty states represented in all types of four year institutions (NLN, 1987). In 1985, the.American Nursing Association reaffirmed its 1965 position that preparation for professional nursing practice is the baccalaureate degree in nursing. The ANA adopted titles and educational requirements for two levels of nursing practice the technical nurse (Associate Degree in Nursing, ADN) and professional nurse (Bachelor of Science in Nursing, BSN). The professional nursing curriculum is most strongly influenced by the accrediting body, the National League for Nursing (NLN). The criteria state that a majority of the nursing coursework must be at the upper division level (the last two years). The NLN criteria quite broadly states that the discipline of nursing must be "supported by appropriate prerequisites and accompanied by cognates in arts, sciences and humanities“ (NLN, 1988). Appropriate pre-requisites may constitute a majority of the coursework for the first two years leaving little time or room for liberal arts requirements. Sohn (1986) reports that a majority of baccalaureate schools sampled required courses 17 in biology, chemistry, anatomy, physiology, biochemistry, and microbiology. Others frequently require physics, genetics, pharmacology, pathophysiology, nutrition and epidemiology. The growth of nursing knowledge in the discipline of nursing has been phenomenal in the last twenty years. The revision of nursing course content is a continuous process. Rogers (1985) and Tiessen (1987) discuss the trend to increase professional course hours to include advances in technology for monitoring and manipulative skills. While nursing education leaders continue to vigorously support the need for a "liberalizing" education in an institution.of higher learning, it is unclear if this has been operationalized as professional baccalaureate nursing education has evolved at the baccalaureate level. A Lipsrsl Egugatign Frsmewgrk The education literature in the 1980’s is replete with books, journal articles and position papers on the state of liberal. education. in 1college 'undergraduate curricula and proposals for its strengthening. It is noted that the term general education is used infrequently in the more recent discussions. The Carnegie Foundation for the Advancement of Teaching (1985) refers to general education and defines it as "a core of educational experiences to help students recognize common bonds" (p.27). The North Central Association (NCA) also uses 18 the term to refer to General Institutional Requirements for graduation (Wee, 1987). Gaff (1983) uses the term general education exclusively arguing "the term, while large enough to encompass various interpretations, does possess a recognizable configuration of qualities“ (p.7). The author then enumerates eight criteria common to the concept. The AAC (1985) has yet adopted a new phrase, "the minimum required curriculum" which enumerates nine essential experiences to a quality undergraduate program. The report assiduously avoids the use of either the term liberal or general education. In 1987, the Carnegie Foundation published its most recent study on the undergraduate experience in America. The findings support the need for renewal. The author, Boyer, discusses general education and concludes, "general education urgently needs a new breath of life. More coherence is required to relate the core program to the lives of students and to the world they are inheriting" (p. 90). He suggests the approach of "an integrated core" defined as a program of general education that introduces students not only to essential knowledge but also to connections across the disciplines, and, in the end to the application of knowledge to life beyond the campus. The integrated core concerns itself with the universal experiences that are common to all people, with those shared activities without which human relationships are diminished and the quality of life reduced (p.91). 19 He then suggests seven areas of inquiry as an academic framework for the "integrated core". Hirsch (1987) makes a plea for a “common core of cultural information" to insure cultural literacy. He suggests an extensive curriculum in the K-12 years throughout the country that would impart "traditional literate knowledge, the information, attitudes and assumptions that literate Americans share" (p. 127). Hirsch defines the contents of cultural literacy in an extensive list of terms developed into a dictionary (1988). Bloom (1987) concurs that adding core requirements that were abandoned in the sixties will not achieve serious liberal education. While he strongly advocates the Great Books approach to curriculum, the goals of a liberal education have great breadth. Bloom concludes, "a good program of liberal education feeds the student’s love of truth and passion to live a good life... (p. 345) ...it prepares the way for the discussion of a unified view of nature and man’s place in it" (p. 347). A review of these recent theorists regarding liberal education reveals several common themes. There does not seem to be a distinction between the terms general and liberal education. They are used interchangeably by many and the goals, outcomes and criteria reflect similar, if not identical, ideals. 20 There is agreement that the ideal liberal education curriculum is a combination of prescribed cgngeng and a unique mg. Common content references that emerge are as follows: 1. Language - the crucial connection (Boyer, 1987); literacy : writing, reading, speaking and listening (AAC, 1985; Hirsch, 1987) English composition (Carnegie, 1985); (Gaff, 1983) 2. Art - (AAC, 1985); the esthetic experience (Boyer, 1987; Gaff, 1983; Carnegie, 195) 3. History - historical consciousness (AAC, 1985); heritage (Boyer, 1987, Gaff, 1983) 4. Math - (Carnegie, 1985) understanding numerical data (AAC, 1985, computational skills (Gaff, 1983) 5. Science - (AAC, 1985); the ecology of the planet (Boyer, 1987; natural sciences (Carnegie, 1985) 6. International/global'education - (Carnegie, 1985), international and multicultural experiences, foreign language study (AAC, 1985, Gaff, 1983) 7. Values - (AAC, 1985; Gaff, 1983) the search for meaning (Boyer, 1987); Philosophy/Theology (Carnegie, 1985) None of the frameworks suggest that a "set" of prescribed courses in these area will accomplish the common goals delineated for a liberal education. Yet all suggest that the common knowledge of all of these areas is a necessity. There is little attention in the literature to the amount of course hours in the undergraduate curricula that are needed 21 to achieve this common core of knowledge. The Carnegie Commission for the.Advancement of Teaching (1985) reports that approximately one third of all coursework in baccalaureate education is comprised of general education in the institutions surveyed. The NIE report (1984) recommends two full years of liberal education while the Bennettreport (1984) recommends that 50% of undergraduate hours be devoted to general or liberal education. The other researchers place emphasis on the process of implementation leaving latitude in the amount and more attention to the outcome. There are also common themes that emerge inlexamining'the recommended process to achieve a liberal education. Many authors in the literature agree that the term ”interdisciplinary" connotes a dilution of content and that its previous attempts have fared poorly in higher education. Yet the ideal process discussed refers repeatedly to learning across disciplines. Boyer (1987) states, "general education is not complete until the subject matter of one discipline is made to touch another" (p. 91). The term "connect" and ”connectedness” emerge as descriptors of this process. Wee (1987) captures the essence of this concept as "the interrelatedness of disciplines, of cultures, of North and South, of men and women, of rich and poor, of past, present and future“. The second common theme addresses the present isolation of liberal education from the major or professional program of 22 study. The AAC (1985) calls this essential "study in depth" defined as "sequential learning, building blocks of knowledge" (p. 24). This concept would exclude the general education format of only low level introductory courses in the beginning of the college experience and the idea of "getting the general education out of the way" (Wee, 1987). Reading, writing, speaking and listening would not be limited to composition and speech classes but emphasized throughout the four year curricula regardless of department. .A consistent attention to these skills and methods of communication would prevail (AAC, 1985; Gaff, 1983). "Writing across the curriculum" has surfaced as one of the signposts of this particular concept. Boyer (1987) reviews this emergent concept in many college curricula. He states, "the entire college, not just the English department, must help develop the student’s capacity to weigh evidence, integrate knowledge, and. express ideas with clarity and precision" (p. 79). This theme often includes the blending of the liberal education with the professional education or major in some formal manner. The AAC (1985) refers to institution of the historical concept of a capstone course in moral philosophy that challenges "students into humanistic relationships with their subjects" (p. 21). Boyer (1987) deems the concept "the enriched major" which "encourages students not only to explore a field in depth, but 23 also to put their field of'special study in perspective" (p.110). This process can take place in many forms and methods. It is a philosophical commitment of the institution that would be articulated in some curricular format. The vehicle is most commonly referred to in the literature as the "capstone" course or seminar. The third common theme of the unique process of liberal education relates to pedagogy and philosophies of education and learning. The terms "spirit of inquiry", "critical thinking" and "discovery" are typical of this common thread in the process. The recommendations call for increased dialogue among faculty and students as opposed to heavy reliance on the lecture as the primary method of teaching. Smaller classes, seminar formats and leaning activities that foster the analysis and. synthesis rather than the regurgitation of information are among the recomendations to achieve this process in liberal education. In summary, the literature available regarding the discussion of liberal education in the undergraduate curricula is abundant. Yet, it reflects concurrence in regard to many parameters; namely, a common core of knowledge and a process to integrate this knowledge into chosen disciplines, professions and humanism in the global community. 24 Prgfsssignsl Ngrsing Egucatign and Liberal Educagion The nursing literature reveals several leading authors voicing strong support for the value of liberal education in professional nursing education. Schrum (1985) reminds readers of the historical roots of this commitment. She quotes Mary Adelaide Nutting in 1916 and 1929 who supported the "liberalizing' of nurses by exposing them to the "spirit of loving knowledge" (p. 183) that is available only in the humanities. Rogers (1985) affirms that "Professional education demands a firm belief in oneself that can only be achieved through a full university program with a strong emphasis on humane learning and the nature of service to society" (p. 382). Donaldson (1983) makes an eloquent plea, "Let us not abandon the humanities" in which she proposes that science alone cannot address nursing concerns. She speculates that the profession of nursing, by its very nature, focuses on the wholeness of man. This uniqueness aligns the nursing profession, philosophically, with humanistic concerns that can only be explored and discovered in serious study of the humanities. This commitment was culminated in 1986 by the American Association of Colleges of Nursing in their report, Essensials gf gollsgs gng,gnivsrsity Edggagign for Prgfsssional Nursing. 25 The report fully endorses the three National reports (AAC, 1985; NIE, 1984; NEH, 1984). We recommend that the education of the professional nurse reflect the spirit of these reports so that the graduate will exhibit qualities of mind and character that are necessary to live a free and fulfilling life, act in the public interest locally and globally, and contribute to I‘lgaltjh. care improvements and the nursing profession The report endorses a liberal education that will ensure the professional nurse that ability to demonstrate selected qualities (see Appendix A). Examination of this list of outcomes implies the need for a core of knowledge (content) combined with an educational process that closely parallels common parameters identified in the liberal education literature for all undergraduate curricula. Content that is referred to in these outcomes are as follows: 1. Language - reading, writing and speaking English clearly and effectively. 2. Foreign language - understand a second language at an elementary level. 3. Art - appreciating the role of fine and performing arts in human expression. 4. History - comprehending life and time from historical and contemporary perspectives. 5. Math - using mathematical concepts. 6. Science - using concepts from behavioral and biological sciences. 26 7. International and.Global education - understand other cultural traditions. 8. Values - understand the nature of human values; comprehend the nature of human spirituality. This report acknowledges that the outcomes will not be achieved by set of specific courses. It states that the entire academic community, from all disciplines, must share the responsibility for this learning. The Esssntials report does not delineate specific recommendations for the process or methods inherent to these goals. The report concludes that these outcomes may be achieved in a four year undergraduate curriculum and charges professional nurse educators to assure that these essentials are met. A review of the nursing literature reveals a paucity of comments or reactions to the status of liberal education in professional nursing' education or the .AACN report. Enthusiastic endorsements of 'the recommitment to liberal education can be found (The Michigan Association of Colleges of Nursing, 1987). There is little evidence of the efforts or progress that baccalaureate nursing' education. has made in really operationalizing changes in undergraduate curriculum to achieve the liberal education goals. There are only two studies in the nursing literature that address the relationship of liberal education to professional 27 nursing curriculum. The first was a quantitative study regarding the amount and type of course requirements. Sohn (1986) reviewed the general education component of 18 baccalaureate nursing programs in Canada. She found that the requirements ranged between 35-50% of the total credits for graduation and about 70% of these are courses in the natural or social sciences that are rsggirsd for entrance into the professional school and have some direct relevance to nursing. The second was a descriptive study regarding the value that nursing educators placed on liberal education. Rosenkotter (1983) surveyed nursing educators regarding the importance of general education using the components of the Phenix framework. She found that nursing educators ranked synnetics (personal knowledge and awareness) and empirics (science) as the most important subject matter. These rankings were followed in descending order by symbolics (language and math), synoptics (history, philosophy, religion) and lastly, esthetics (the arts). A review of Dissertation Abstracts revealed only one study regarding liberal and baccalaureate nursing education in the 1980’s. Balcerski (1981) examined factors that influenced the liberal arts content of baccalaureate nursing curricula. These findings indicated that "nurse educators continue to state their belief in the importance of the liberal arts, but that in most current baccalaureate nursing programs the liberal arts base is not broad" (p. 13). Some of the limiting 28 factors identified.were the lack of value that employers place on a liberal education, the accreditation standards for electives, and the assumption that faculty do advise students to select an appropriate cross-section of courses. Summary The literature review substantiates that there is not any current study in the United States that has reviewed liberal education requirements in baccalaureate nursing education. There is not a published study that even begins to assess how or if the AACN essentials are influencing professional nursing education. Important decisions regarding professional nursing education for nursing of the future will continue to be made. Sakalys and Watson (1986) review the trends in higher education andutheir influence on nursing and foresee decreased specialization at the undergraduate level. These authors predict that serious commitment to educational quality will lead to the decision that will restructure the "first professional nursing degree into a postbaccalaureate-degree model" (p. 299). Schrum (1985) also laments the diminution of the liberal arts in nursing education and reports "just beginning to question whether the current four year academic programs can accomplish their purpose" (p. 183). These ponderings may be premature or they may be accurate predictors. Careful study of liberal education in 29 baccalaureate nursing education is needed in order to even begin to make prescriptive changes to meet the goals of the profession. Chapter Three Msshgdology W The population consists of all of the nursing education programs that provide generic baccalaureate education (BSN programs) that are accredited by the National League for Nursing (NLN, 1986). Th Sam n hni A. Carnegie Foundation Study (1985) that previously surveyed liberal education requirements in institutions of higher education reported the data according to the Carnegie Classification of higher education. "This classification groups American colleges and universities on the basis of their missions and educational functions“ (Boyer, 1987, p.1). The classification system was developed in 1973. "Over the years, the system has gained credibility and served as a helpful guide to.scholars and.researchers. (Boyer, 1987, p. 1) Use of this classification system allows the description of liberal education requirements between. and. among’ the various categories of institutions of higher learning. Since baccalaureate nursing education programs exist in all of the Carnegie categories of four year institutions, the population 30 31 was stratified using this system (see Table 1) (see Appendix B for category definitions). Table 1 B h l r ' n N r in Pr r in th Uni ed t a i rn l ific i n ngegory Number gf Progrsms Research Universities I 34 Research Universities II 16 Doctorate-Granting Universities I 24 Doctorate-Granting Universities II 22 Comprehensive Universities and Colleges I 159 Comprehensive Universities and Colleges II 37 Liberal Arts Colleges I 15 Liberal Arts Colleges II 56 Professional Schools 18 TOTAL 381 The size of the sample from this stratified population was determined by using an estimation formula specifying that the sample mean should lie within beta units of the population mean, with probability equal to .95. (Scheaffer, R., Mendenhall, W. and Ott, L. 1986, p. 86) These calculations determined the sample size per strata to estimate the population mean (see Table 2). A sample was then drawn from each strata using a table of random numbers. 32 Table 2 Ssmple §izs gsr Sgrsgs Qggsgggy Sample sizs Research Universities I 6 Research Universities II 3 Doctorate-Granting Universities I 4 Doctorate-Granting Universities II 4 Comprehensive Universities and Colleges I 28 Comprehensive Universities and Colleges II 6 Liberal Arts Colleges I 3 Liberal Arts Colleges II 10 Professional Schools __; TOTAL 67 D n P r Data were gathered through a questionnaire mailed to chairpersons of the sample schools and by a survey of the sample school catalogues. Th 1 rv A questionnaire was developed after pertinent literature was reviewed" A.pilot study was conducted in the fall of 1988. The questionnaire was mailed to ten schools in the state of Michigan that were not selected in the random sample. The cover letter explained the study and the pilot procedure. Comments and. clarification of items or ‘terminology ‘were requested. 33 Seven surveys were returned. A few respondents suggested changes in format. The revised questionnaire consisted of four parts (see Appendix A) Part I concerned the demographic data of the respondent. In Part II, general program information concerning student population size and degrees offered was requested. In Part III, the respondents were asked several general questions about the nature of their liberal education program that reflect 'current recommendations in the literature. In addition, they were asked to identify the greatest strength and the greatest weakness in their liberal education for baccalaureate nursing students. Finally, in Part IV, the respondents were asked to rate the overall effectiveness of their program in meeting the recommendations of the American Association of Colleges of Nursing (October, 1986) for liberal education in baccalaureate nursing programs. The surveys were sent to the sample schools in March of 1989 with a stamped return envelope. A stamped return postcard.to request survey results, under separate cover, was included. The questionnaires were identified with a Strata number. The cover letter explained that confidentiality was guaranteed by the researcher. Reminder post cards were sent to schools that did not return the survey in two weeks. Follow-up letters, another 34 survey instrument and stamped return envelope were sent to non-respondents two weeks after the post card reminder. Fifty one responses were received from the 67 sample schools (see Table 3). Tgls 3 Mailed §grvsy Reggrns by Strata S§ra§a Number Sent Number Returned Research Universities I 6 4 Research Universities II 3 2 Doctorate-Granting 4 3 Universities I Doctorate-Granting 4 4 Universities II Comprehensive Universities 28 20 and Colleges I Comprehensive Universities 6 5 and Colleges II Liberal Arts Colleges I 3 2 Liberal Arts Colleges II 10 9 Professional Schools _; _g TOTAL 67 51 35 W In addition to the mailed survey, the catalogues of the sample schools were surveyed. The purpose of the catalogue survey was to determine the amount, structure and coursework that comprised the liberal education components of the curriculum. First, the catalogues were surveyed to determine the liberal education courses that are required for all students to graduate from the institutions. Then, the catalogues were surveyed to determine the liberal education coursework (defined as all non-nursing [professional] courses) required for BSN graduates of that institution. The survey tool was designed to record divisional requirements in the humanities, social and natural sciences patterned after the Carnegie study (1985). The survey tool also included items to determine specific course requirements that reflect current recommendations in the literature for a liberally educated person and specific coursework appropriate to the AACN recommended outcomes (see Appendix C). In September of 1988, catalogues were requested from the sample schools for the 1988-89 academic year. The researcher read ten catalogues using the survey tool as a pilot study. The survey tool was re-organized and simplified to categorize data more efficiently for analysis. Two assistants were trained to read catalogues and use the survey tool. The catalogue survey tool was identified 36 with a Strata number to correspond to the mailed survey. The catalogue surveys were completed in June of 1989. Da§a Analysis Simple, descriptive statistics were used to analyze the descriptive data that were gathered in this study to answer the research questions. The data that were gathered in the mailed survey, where the respondents rated their program in meeting the AACN outcomes, were organized to determine means and frequencies of ratings, by strata, and for the entire sample population. In the catalogue survey, ranges, and frequencies of coursework patterns of liberal education requirements and specific course were determined for all graduates of the sample institutions and for BSN graduates of the sample institutions. Specific course requirements (in the catalogue survey) that would support achievement of the AACN outcomes were identified and compared to perceived effectiveness ratings (on the mailed survey). The responses to the open-ended questions, regarding the strengths and weaknesses of liberal education program of the sample schools, were listed and categorized by frequency of the type of response. Chapter Four Analysis gf Daga Ingrgduggign This chapter presents an analysis of the data that were gathered in this study. The purpose of the data collection was to