~uuu—w.~-uw"wvw 9..” H.- .. .._ , . -w, '. w «.b -.......q-.— gnu»— “ « ESSI‘ONAL "ROLE" j ROF THE. INFLUENCE OF P ' i l , . '1‘ L EL CAREER MOB BY NURSING STUDENTS INTEREST IN HORIZONTAL Dr E, H T. N 0 Dr U N m Hm .nhw F. T. N E m |\l . 2533: IA". .. L Thesis for the‘Deg‘fee 9f 5%. D“ MCHIGA N STATE. UNIVERSITY RICHARD E. DARNELL 19??! LIBRARY ; Michigan State I University This is to certify that the thesis entitled THE INFLUENCE OF PROFESSIONAL ROLE IDENTIFICATION UPON THE DEVELOPMENT OF INTEREST IN HORIZONTAL CAREER MOBILITY BY NURSING STUDENTS presented by Richard E. Darnell ‘ has been accepted towards fulfillment of the requirements for Ph.D. degree in Education :‘j‘vl / @144 4/ J j/Major pray essor Date February 15, 1971 l 0-169 UT‘ .ut flu. ."dia. ’!‘¢01\.1~1 It' A"'" W10? e“ 1113 of “them ,».'}u--.' x. ,v . V 5:, M . shuts. pky" :_m~ .~ 2 ' ' 7‘ ~ ' -r<.- ‘ ={‘z‘~' QM» preerrnfga 4:. Ger-’75" 's’ w 5 my ‘ i fang-«mac by nursing eta-isn‘t; {gt thugs. two 3330: mm: cue pro: '. ABSTRACT The Influence of Professional Role Identification Upon the Development of Interest in Horizontal Career Mobility by Nursing Students by Richard E. Darnell In response to the present health care crisis and the subsequent development of many new service roles in inter- mediary positions between established health care professions. contributors to the health manpower literature have proposed the establishment of opportunities for career mobility within a given health care profession and between established health care professions. It has been postulated that major factors influencing the development of interest by students in professions offering the possibility of career mobility toward a more highly trained profession are: (1) the professional identity associated with that new health role, and (2) the level of training of these potential practitioners. The develOpment of the nurse physician associate, a new health care role in an intermediary position between the lesser trained pro- fession of nursing and the more highly trained profession of medicine, presented an opportunity to study the dynamics of the development of interest by nursing students in mobility between these two major health care professions. ‘1 fl I‘m." Im‘m "Hit-0' w.“— Thi: first tw: role 169: (1) 4.. y. {2) fi_ This study attempted to evaluate six hypotheses. The first two hypotheses related to the effect of professional role identification upon interest development: (1) Students training for health careers in a less highly trained profession will demonstrate a significantly greater development of interest in a new health care role after identification of that role with the less highly trained profession than will students after identification of that role with an amalgamation of the less and the more highly trained profession. (2) Students training for health careers in a less highly trained profession will demonstrate a significantly greater development of interest in a new health care role after identification of that role with an amalgamation of the less and more highly trained profession than will - -A-a’ - students after identification of that role with the more highly trained profession. The next three hypotheses related to the effect of professional training on interest development: ‘ (3) Students with a high level of training in the less highly trained profession will develop significantly greater interest in a new health care role than will students with an intermediate level of training in the less highly trained profession. ‘ (4) Students with an intermediate level of training in I the less highly trained profession will develop ‘ ———wm—)\Lni \V F' at signif care : traini (5) Studer highl] cant:+ than' in th The ‘ Q f -——-u'— significantly greater interest in a new health care role than will students with a low level of training in the less highly trained profession. (5) Students with a low level of training in the less highly trained profession will develop signifi- cantly greater interest in a new health care role than will students with a minimal level of training in the less highly trained profession. The last hypothesis pertained to the relationship between role identification and level of training: (6) There will be no interaction between role identifi- cation and level of training. Three different occupational information booklets portraying the role of the nurse physician associate as: (1) an expansion of nursing, (2) an extension of medicine. or (3) an amalgamation of nursing and medicine were developed by a nursing advisory committee and a medical advisory committee. each meeting independently with the researcher. Each committee consisted of three trained practitioners in that profession. These booklets were randomly distributed during regular class periods to one hundred and ninety three nursing students enrolled as sephomores. Juniors and seniors at the Michigan State University School of Nursing. Eighty seven freshmen having no class contact with the School of Nursing were randomly exposed to occupational information booklets as part of research activities sponsored by the Nursing School. Subsequent contacts with freshmen were accomplished by having the freshmen serve as paid volunteers. L .41.-.-“— r1al hypothesis which were investigated. The hypotheses kuaxree been stated in both the null and research form: The first two hypotheses relate to the effect of .iCiearitification upon interest development: Ho:1 Hazl Hox2 There will be no significant difference in the development of interest in a new health care role by students training for health careers in a less highly trained profession after identification Of that role with the less highly trained profession. or with an amalgamation of the less and more highly trained profession. Students training for health careers in a less highly trained profession will demon- strate a significantly greater development of interest in a new health care role after identification of that role with the less highly trained profession than will students after identification of that role with an amalgamation of the less and the more highly trained profession. There will be no significant difference in the development of interest in a new health care role by students training for health careers in a less highly trained profession after identification of that role with an amalgamation of the less and more highly trained profession or with the more highly trained profession. Students training for health careers in a less highly trained profession will demonstrate a significantly greater develOpment of interest in a new health care role after identification of that role with an amalgamation Of the less 46 era. ~.J -v (.[IW 111.55? u.) .. Ilia!) film... .- ,‘N‘: . V I.'i' I 47 and more highly trained profession than will students after identification Of that role with the more highly trained profession. The next three hypotheses relate to the effect of yorwb:fessional training on interest development: HO:3 Ha:3 HO:4 Haz4 Hoz5 :Ha35 There will be no significant difference in the development of interest in a new health care role by students with a high level of training in the less highly trained profession and students with an intermediate level of training in the less highly trained profession. Students with a high level of training in the less highly trained profession will develOp significantly greater interest in a new health care role than will students with an inter- mediate level of training in the less highly trained profession. There will be no significant difference in the develOpment of interest in a new health care role by students with an intermediate level of training and students with a low level of training in the less highly trained profession. Students with an intermediate level of training in the less highly trained profession will develop significantly greater interest in a new health care role than will students with a low level of training in the less highly trained profession. There will be no significant difference in the develOpment of interest in a new health care role by students with a low level of training in the less highly trained profession and those with minimal level of training in the less highly trained profession. Students with a low level of training in the less highly trained profession will develop significantly greater interest in a new health care role than will students with a minimal level of training in the less highly trained profession. 'The last hypothesis pertains to the relationship t) (as 13Ween role identification and level of training: ft 0" P‘- h: 1)) 48 HO:6 There will be no interaction between role identification and level of training. Ha:6 There will be interaction between role identification and level of training. POpulation Utilized Nursing students were selected because of the develOp- ment Of the nurse physician associate as a major significant example of horizontal mobility in health care professions. Nursing students were also selected because of their accessi- bility and because nurses in practice would more likely be exposed to situational variables which might be confounded with treatment main effects. The population for this study consisted of students assocciated with the School of Nursing, Michigan.State University. The student body of the Michigan State University School of Nursing is comprised of the following: 90 sophomores. 9O juniors and 90 seniors. the seniors representing both senior nursing students with no professional work experience and seniors who are registered nurses who have returned to Obtain the B.A. degree. Approximately 160 students who have expressed an interest in a nursing major upon entry at Michigan State University comprise the freshman class. These students take no formal nursing course work during the first year. and their programs are not controlled by the School of Nursing. 49 Independent Variables There are two factors under test. Factor T having three levels representing treatment and Factor L having four levels and representing level of training. Factor T. Level l~-occupationa1 information in booklet form representing the nurse physician associate as an expansion of the physician role. (See Appendix A.) Level 2--occupational information in booklet form representing the nurse physician associate as an expansion of the nurses role. (See Appendix B.) Level 3--occupational information in booklet form representing the nurse physician associate as an amalgamation of the role of nursing and medicine. (See Appendix C.) Factor L. Level l--freshman who have expressed an interest in a nursing career. Level 2--nursing students in the sophomore year. Level 3--nursing students in the junior year. Level 4--nursing students in the senior year. r n — up» v. . :3" In 1 l is: . :rEh.l. FA“ iC‘A h. vs— a \ ‘4 C 3 ‘ 50 Experimental desigg matrix. The design of this experiment utilized a two way factorial approach: FIGURE I EXPERIMENTAL DESIGN Factor T1 T2 T3 Covariable Extent of previous exposure to the role of the nurse physician associate was ascertained prior to exposure to the experimental treatment and used as a covariable in the analysis of data. (See Face Page, Appendix A. B. and C.) Dependent Variables Six dependent variables were employed in the following order: (1) Early stated interest by student--the students response to a six level question regarding his interest in seeking further information on the role of the nurse physician associate (see Appendices, A, B, and C). (2) Early stated interest assumed held by others--the students response to a six level question regarding the level of his peers’interest in seeking further information on the role of the nurse physician associate (see Appendices, A, B, and C). 1))va-IIIEE’ . wry . hr Fic- h hurt 51 (3) Manifest interest-~the student's response to the Opportunity to obtain extra information by making a request with a postcard (see Appendices A. B. and C). by the utilization of library material made available for that purpose (see Appendix D). and by speaking with a resource person on the role of the nurse physician associate (see Appendix E). (LP) 'Tested interest-~the student's response to a twenty item, four-choice multiple choice test (see Appendix G) on factual knowledge given to him in the form of an information sheet (see Appendix F) during the preceding class meeting. (.55) Late stated interest by student--the student's response to a six level question regarding her interest in seeking a career Opportunity as a nurse physician associate (see first page. Appendix G). ( 6 ) Late stated interest assumed held by others--the student's response to a six level question regarding the level Of his peers' interest in seeking a career Opportunity as a nurse physician associate (see first page. Appendix G). ”R23”: grimental Methodology §OpnomoreI junio; ggd agnior nursing stuggnta. One class ‘lv’EaLEB selected at random from the two available to sophomore nursing students on day one and day two Of the experimental mgthodology (see Figure II). Each of the three experimental fit:::=‘fiéatments‘was distributed at random tO students enrolled in Wt:.]l ‘3 class. one-third of the students receiving one form of ‘ E '~ ‘3': v-mwown.‘— “nu—‘4'- 52 the occupational information booklet (see Appendix A). one- third of the students receiving a second form Of the occupa- tional information booklet (see Appendix B). and one-third Of the students receiving the third form of the occupational infor- mation booklet (see Appendix C). Each occupational information booklet consisted of. in order of presentation. the covariable. the independent variable. measures of early stated interest by student. measures of early stated interest assumed held by Others. and an information sheet containing details Of how further information could be obtained by meeting with a resource Person. utilizing library resource material or mailing a post- card which was provided in the booklet for each subject. When Possible. the booklets were distributed to classes meeting at 1'Jl'le same time in order to avoid confounding of the experimental treatment by a student receiving more than one type of informa- tional booklet due to her presence in both class sessions. c‘3'1'1:t‘ounding of the experimental treatment was also controlled by having the student return the occupational information book- 131: after exposure to it and allowing the student only to retain the informational sheet describing the availability of informa- t ion seeking activities. A similar procedure was followed with Junior and senior subjects with the exception that three junior aha three senior classes were randomly selected because of as: Iliziller class size. During days one through five. all sophomore. junior and thor subjects had available to them the resource person. This it‘son was stationed in a central location in the Nursing School. ' "l: I is location being identified by a large 18" x 24" sign stating k AHIIlvu’aE‘il‘. Luff twt wn“ 9‘. . 3‘. 53 "Nurse Physician Associate Resource Person." From days one through nine. reading materials were placed in the Nursing School library. these materials being also identified by an 8' x 12” sign stating "Nurse Physician Associate Resource materials here." Day ten was the last day that postcards received postmarked on that day or earlier were counted as an information seeking response. 0n the first class meeting approximating day ten. an information sheet on the role of the nurse physician associate (see Appendix F) was given to each subject. The student was asked to read the sheet for content and offer his Opinion as to the effectiveness Of the content and organization of the material. He was asked to return the information sheet at the next class meeting. This information sheet was utilized to equalize the level of knowledge Obtained through individualized information seeking. Equalization of knowledge had two essential purposes: (1) To alleviate misunderstandings and biases regarding the role of the nurse physician associate which may have been fostered by exposure to one of the independent variables. (2) To build upon previous information seeking behavior as an advanced organizer thus allowing the measurement of selective retention of the contents of the information .sheet to serve as a dependent variable in the study. On the second class meeting after day ten. the amount of information retained by each subject was tested using a twenty-item. multiple choice cognitive recall test (see Appendix G) which served as the measure of tested interest 54 in this study. At this time. a measure was obtained of late stated interest by student and late stated interest assumed held by others (see Appendix G). On days fifteen through nineteen. informal personal interviews were held with a sample of three subjects selected at random from each of the cells of the experimental design. Each of the thirty-six subjects was interviewed according to an open-ended interview format (see Appendix H). The major purposes of the interviews were to ascertain the extent of positiveness which subjects felt toward the infor- mational program on the role of the nurse physician associate and to ascertain if they engaged in information seeking behaviors other than those which were explicitly measured as dependent variables. The assessment Of the likelihood Of certain contaminating variables was also made possible by the interview procedure. Those persons whom it was impossible to contact personally were contacted by phone. Since research has indicated that interviewers Often record the answer they expect to hear rather than the answer actually given (Smith. 1950). two independent interviewers other than the researcher were utilized to collect interview data. Freshman nursing students. A freshman sample was an extremely difficult one to obtain because freshman nursing Students have no official contact with the School of Nursing and do not take any nursing courses during their first year. In addition. time demands on freshmen. who were more affected by mid-term schedules. were different from those made upon sophomores. juniors and seniors whose availability was 55 influenced by professional workshops and conferences. In order to allow maximum participation, it was necessary to conduct the study at a separate time for freshmen while the study for sophomores. juniors and seniors was conducted simultaneously. The study for freshmen was initiated seven days earlier than the study for sophomores. juniors and seniors. and involved a different methodology for securing subjects. The past experience of faculty members of the School of Nursing in obtaining freshman nursing students for research purposes mediated against attempting tO obtain a freshman sample in formal freshman classroom settings. Inability to locate the subjects. reluctance Of instructors offering general courses to relinquish class time for research efforts directed toward a particular discipline. large lecture sections and small recitation sections whose student constituencies are constantly in flux were offered by members of the faculty of the School of Nursing as strong reasons why a freshman nursing sample should not be Obtained during regular class hours. An alternative approach was. however. possible. Despite the possibility of exerting differential experimental influence on freshmen as compared to sophomores. juniors and seniors. this alternative approach was utilized by the researcher as part of the research methodology because it appeared it was the only reasonable Option which was available to him. Through the auspices Of Dr. Isabelle Payne of the School of Nursing. the first contact session. consisting Of exposure to the experimental treatments.-was held in an evening the ex; in 'n h so I} I'll... 45a:itnisu3i$ .tc. “U 56 meeting which was called by the School of Nursing in order to gain demographic and psychological data from the freshmen. The second contact session in which the nursing students received the information sheet was structured by informing the student at the first contact session (see Appendix J) that he could pick up an envelope on the ninth or tenth experimental day containing information which might be of interest to him and which would also contain one dollar. Included in that envelOpe was a notice (see Appendix K) that an additional two dollars could be obtained by making contact number three. held on the twelfth or thirteenth experimental day. when responses to the cognitive recall test and late interest measures were Obtained. The experimental treatments were applied to these persons in exactly the same manner as sophomore. junior and senior students. This was insured by the same introduction of the experimental treatment to all experimental subjects through the utilization Of a standardized statement to all subjects (see Appendix I). The dependent variables were also collected in similar fashion as those obtained from sophomore. junior and senior students. v 0 m nt of nd ndent d e n nt Vari bl Indepgndent variablgs. The first draft of the experimental treatments was constructed by the researcher. This draft in- <£1uded written content. photographs. diagrams and format layout. When this was accomplished. a medical advisory COImnittee consisting of three physicians associated with the 57 FIGURE II EXPERIMENTAL METHODOLOGY Day Dgy Number Exposure to occupational information Monday 1 booklets (Group contact #1) Resource person available Tuesday 2 Library resources available ”ganged Resource person available ay 3 Library material available Thursd a Resource person available ay Library material available Friday 5 Resource person available (last day) Library material available Saturday 6 Sunday 7 Monday 8 Library material available Tuesday 9 Library material available (last day) Last day post cards will be counted as response (criteria-postmark) Wednesday 10 Information sheet given to subjects at end of class period. Group contact #2 Amount of information retained tested Thursday 11 in next class period (tested , interest). Group contact #3 Friday 12 Saturday 13 Sunday 1“ Monday 15 Interviews with students Tuesday 16 Interviews with students Wednesday 17 Thursday 18 Interviews with students Friday 19 Interviews with students 58 Office of Medical Education Research and DevelOpment served to make modifications and suggestions regarding additions and deletions to each of the occupational booklets. Their major focus. however. was on the booklet representing the role of the nurse physician associate as an extension Of medicine. The utilization Of their professional medical judgments regarding the nuances being reflected in the booklets served to validate the independent variables by members of the profession of medicine and. thus. served to add legitimacy to the study for the profession of medicine. Soon after. a nursing advisory committee was formulated composed of three members of the faculty of the School of Nursing. Michigan State University. These nurses served a function similar to the medical advisory committee. However. they concentrated their efforts on the occupational information booklet repre- senting the role Of the nurse physician associate as an extension of nursing. and legitimated the study for the profession of nursing. Each committee operated independently of the other. and the integration of their suggestions and comments into the final form of the booklets was made by the researcher. This product was then referred to a media specialist who produced the final version of the booklet in an attractive and professional appearance. The booklets were finally prepared by a commercial printer. Qgpegdgnt vgrigblgg. The initial versions of the dependent variables were constructed by the researcher. Suggestions regarding modifications were made by members of the research committee. A field test of the measure of tested interest was ‘l'«\, V... vs ti ‘- Q.‘ Li) I ‘ 59 undertaken. The multiple choice test was first given to ten laymen in order to determine items which would be unreliable because they were interrelated with other items on the test. As a result Of this procedure, one item which yielded the correct answer to another item was rewritten. The results of this procedure indicated that uninformed subjects scored no better than chance on the dependent variable. However. in order to increase the reliability Of this measure. the number of items was increased from fourteen to twenty. This larger number of items would permit a more efficient calculation of a split-half reliability coefficient after the experimental methodology was completed. Face validity for the measure of tested interest was assumed because each item was carefully constructed to measure exactly one and only one independent informational segment of the inflirmation sheet as a simple recall of information task. Control of Confounding Variables In any experimental study. a biased estimate of treatment main effects can be Obtained by the introduction of a con- founding variable which exerts a differential influence on subjects exposed to one specific experimental treatment. Control of this possibility becomes a major consideration in the develOpment of the internal validity of an experimental study. Control of contamination in this study was attempted by the following approaches: The selection of the experimental design. The experi- mental design employed in this study was a sophisticated 60 version of the post-test-only control group design (Campbell and Stanley. 1963, p. 25). This design controls the major sources Of internal invalidity such as history. maturation. testing. instrumentation, regression. selection. mortality and the interactive effects of selection with other sources. Its major weakness. as with the best Of experimental designs. is that it does not control for the effects of unique inter- session history without a replication of the experimental procedure. This design has greater deficiencies in external validity. or the range of generalization one may infer from experimental treatments. Although it controls for the interaction of testing and treatment. the possibility of interaction between selection and treatment and reactive arrangements exists. In addition. the utilization of multiple dependent variables with this design. without randomization Of the order of exposure of experimental subjects to them, constitutes a subtle form of multiple treatment interference. The specific experimental methodology employed. The experimental methodology employed attempted to control for the possibility of experimental treatments being confounded by subjects being exposed to more than one experimental treat- ment. It reduced this threat to internal validity by attempting to apply the experimental treatment to all subjects at the same time period. by asking subjects to refrain from accepting more than one booklet if the opportunity arose. by ascertaining whether or not subjects had indeed received more than one booklet. and by removing the independent 61 variable after subjects were exposed to it. However. to the extent that subjects communicated the nature of the focus of the booklet they received to their peers. confounding effects did occur. These effects were probably greater the higher the degree of reactivity caused by the carrying out of the experiment and could be expected to influence levels of T and levels of L equally. Minor differences in experimental methodology caused by differential application of the experimental treatments to members of different classes and differential availability of dependent variables to members of different classes also constituted sources Of potential internal invalidity. However. to the extent that these did occur. they would exert a con- founding influence On levels Of L and not effect levels of T. Some control was provided to reduce this possibility for experimental treatments by utilizing standardized instructions for introducing them to subjects. One of the most serious potential contaminating variables was inherent in the resource person. This variable had two potential deleterious components: (1) role. and (2) identity. The role component of this contaminating variable was based upon the fact that it was impossible to envision a person with enough information on the role Of the nurse physician associate who was not a nurse. a physician or someone who had not received training in a health care role. This professional identity could not help but provide subtle nuances in information giving which could constitute experimental bias. 62 The identity component of this contaminating variable was based upon the fact that although many individual physicians and nurses on campus were professionally equipped to act as the resource person. all had been exposed to the researcher's proposal in either an advisory or informational fashion and then.would introduce a subtle form of experimentor bias. In addition. the nature and extent of their normal respon- sibilities made their availability questionable. Although there was some temptation for the researcher to act as the resource person. this constituted such a crass introduction of experimentor bias that this possibility was abandoned. It was therefore decided to concurrently employ and train two professional actors to function on alternate days as resource persons. One male and one female were chosen in order to equalize a sexual identification bias associated with the predominately female profession of nursing and the predominately male profession Of medicine. Each was briefed extensively on the role of the nurse physician associate and had several dress rehearsals where simulated nursing students met with them to seek information. The actors were not informed of the nature of the research project they were engaged in and were told to portray experts on the role of the nurse physician associate rather than to assume any particular professional identity. The construction of independent and dependent variables. Hints as to the underlying purpose of the study were not made available to the experimental subjects by the instrumentation used. The subjects were not aware of the experimental methodology in advance of procedures being carried out. and LA yd !1.:.Ifl.v..riun.7 ‘1.j,.€Ef... . 63 all independent and dependent variables were constructed to approximate the field testing of occupational information booklets. Some subjective estimate of any contaminating variables which were operating in this study was made through the use of the interview procedures. Experimental data analysis. Where contaminating effects did occur because Of differential availability of the dependent variables because of unavoidable differences in class schedules. experimental data was examined to ascertain if the nature and extent of such contamination Offered a plausible rival hypothesis for the effects observed. Statistical Methodology Employed ' For many years. experimental research in the social sciences has utilized the statistical procedures developed by Fischer in which the differential effects of two or more independent variables on one dependent variable has been assessed by an analysis of variance (ANOVA). In those cases in which more than one dependent variable was present. a separate analysis of variance was carried out for each dependent variable. There was one major difficulty with this approach. One of the assumptions to which analysis of variance is not robust is the assumption of independence. Multiple variables. such as those employed in this study. are rarely independent of each other. Until recently. this problem was usually "swept under the rug" because a more viable approach was not readily available. 'fl.‘..av;.u.u.l.n.0£>ligu _ L t. .n‘ on With the advent of modern computer science and recent breakthroughs in theoretical statistics. a new approach to alleviating the problem of multiple interrelated dependent variables has been developed. The statistical approach is known as multivariate analysis of variance (MANOVA). ANOVA yielded an F ratio for each factor in the experimental design and an F ratio for each order interaction with the dependent variable under test. Furthermore. this statistical approach indicated whether or not the given F ratio was statistically significant at a given level of alpha. However, the MANOVA computer program developed by Finn yields two types of F ratios. One type is known as a multi- variate F ratio and the other is called a univariate F ratio. The multivariate F ratio indicates whether or not all dependent variables are simultaneously statistically significant at a given alpha level for a given hypothesis examined by the experimental design. This study will yield a multivariate F for each of the hypotheses under test. It will also yield univariate F ratios for each of the dependent variables associated with each of the five hypotheses under test. The univariate F ratio indicates whether or not a given dependent variable is statistically significant at a given alpha level for a given hypothesis examined by the experimental design assuming that dependent variable is independent Of every other dependent variable in the study. Because this assumption is a tenuous one. one must be extremely cautious in inter- preting reports of statistical significance for univariate F ratios. Such care is necessary because violation of the 65 assumption of independence elevates the alpha level to an unknown degree. The most productive approach in dealing with the univariate F is probably to ignore it. and deal with alternate statistical approaches in which alpha can be stabilized. Four different alternative statistical sets of criteria have been developed to overcome the deficiencies of the univariate F ratio. They are Hotelling's trace criterion procedure. Roy's largest root. Wilk's lambda procedure and the use of the step-down F ratio. In this study. the step-down F ratio will be utilized. Three factors mediate the interpretation of the step-down F ratio. (1) The individual step-down F ratios for each Of the dependent variables examined by a hypothesis under test can have their exact alpha level determined prior to the statistical analysis of the data. This calculated alpha level determines the probability of a type 1 error as it exists adjusted for the effect of other dependent variables. In this study. six dependent variables are utilized. and the calculated appropriate alpha level for each is equal to the alpha level Of the multivariate F ratio divided by the number of dependent variables or .oL/6 or .00166. This indicates that the null hypothesis should not be rejected as it relates to any dependent variable unless the value of the obtained step-down F ratio exceeds the tabled value of F at alpha equal to .00166. (2) 66 The step-down F ratio is also highly dependent on the order dependent variables are presented to the computer. The computer proceeds to examine each dependent variable so that three or less possibilities are present for a given dependent variable depending on its order of consideration: (a) The dependent variable is not significant at a given alpha level. (b) The dependent variable is significant at a given alpha level. (c) The dependent variable is not testable. Let us use. as an example. this study which utilized six dependent variables. The computer examines the first variable presented and finds it either significant or not. Should it find the first variable significant. then any variable which is examined afterward is not testable. Should it find the first variable not significant and proceed to the second and find it significant. then any variable examined after is not testable. In other words. once significance is ascertained for one variable. all other following variables are not testable because they violate the assumption of independence. It thus becomes imperative that the researcher assign the order of his dependent variables with care. utilizing his intuition regarding the importance Of their respective contributions. The present research utilized the dependent variables 67 in the following selected order of presentation in terms of their potential significance: Early stated interest by student. Late stated interest by student. Early stated interest assumed held by others. Late stated interest assumed held by others. Tested interest. Manifest interest. It has been suggested by some that perhaps all possible ordering arrangements of dependent variables be attempted to determine maximum significance. However. this approach makes the true alpha level of the resultant combination elevated to an unknown degree. TO partially overcome the problem of inability to determine significance through the ordering process. tables of intercorrelations between dependent variables and post hoc comparisons provide meaningful clues as to their respective contri- butions to treatment main effects. The step-down F ratio can be made more powerful by the utilization Of covariables. Multivariate analysis Of covariance (MANCOVA) utilizes one or more covariables to ascertain whether or not the covariable influences dependent variables. The effect of the covariable is ascertained by a series of regression analyses. A question Often arises as to the relationship between a multivariate F ratio for a given hypothesis and the step-down F ratios associated with each of the dependent 68 variables for that hypothesis. If one of the step-down F ratios is significant. it follows that the multivariate F ratio will generally be significant. If none of the step-down F ratios for a given hypothesis are significant. it follows that the multivariate F ratio will generally not be significant. It is. however. theoretically possible for-a multivariate F ratio to be significant with none of the associated step-down F ratios significant. as well as a multivariate F ratio not to be significant when the step-down F ratios associated with it are statistically significant. This confusing situation exists because the statistical procedures for determining the multivariate F ratio and the step-down F ratio are independent of each other and have slightly different powers under different circumstances to reject the null hypothesis. It should be recalled. however. that under certain circumstances. more than one of the step-down F ratios for a given hypo- thesis could be in theory significant. but this possibility is not testable with a constant and known alpha level utilizing our present theoretical understanding of infer- ential statistics. RANCOVA represents a significant breakthrough in statistical methodology for research in the social sciences. Its advan- tages far outweigh its limitations in this present study. Note should be taken that because MANCOVA is employed. only one experimental hypothesis has been written for all depen- dent variables measuring that hypothesis. Chapter IV Analysis of Results Sample Two hundred and eighty-three subjects participated in the study and were distributed as indicated in Table I. Mortality of Freshmen Sample A total of eighty-seven freshmen were exposed to experimental treatments and measures of previous exposure to the role of the nurse physician associate. early stated respondent interest. early stated interest assumed held by others and manifest interest were obtained. However. only thirty-six of these freshmen participated in both contact number two and contact number three under the experimental conditions outlined previously. This loss of subjects represented an experimental mortality of 58.7% and a loss of power for the testing of experimental main effects with late stated respondent interest. late stated interest assumed held by others and tested interest. A chi-square test for independence did not reveal statistically signi- ficant differences in mortality as a function of exposure to experimental treatments (see Table II). Cell Means Cell means for each treatment combined with each level were obtained for all dependent variables and for preknowledge 69 70 which served as a covariable (see Table III). The means for pooled manifest interest represent a scale from 0-3, in which each subject was assigned a score of one for each evidence of manifest interest he demonstrated. Table IV portrays differen- tiated cell totals for manifest interest. Effect of Utilization of Preknowledge as a Covariate Visual inSpection of the correlations between the dependent variables and the covariate yielded no meaningful relationships (see Table V). A chi-square test for association between dependent variables and covariable was not significant (chi- square = 6.16. d.f. = 6, p = 0.40). Furthermore. an examination of multiple regression data utilizing the covariate yielded no significant effect of the covariable upon the dependent variables with the exception of some minor potential effect on early stated respondent interest (see Table VI). It was therefore decided to reanalyze the data after eliminating the covariable in order to increase power. Test of Hypotheses hypotheses pelating to tpeatment gffects associgpgg with professionalpele identification. Multivariate analysis of variance indicated no main effect caused by exposure to occupational information booklets. Both the multivariate F ratio and all six step-down F ratios did not yield significant differences (see Table VII). Ho: I and Ho: II failed to be rejected. Ho: I There will be no significant difference in the develOpment of interest in a new health care 71 TABLE I DISTRIBUTION OF EXPERIMENTAL SUBJECTS BY TREATMENT AND LEVEL T (health (Medicine) (Nursing) Care) L1 (Freshmen) 28 30 29 87 L? (SOphomores) 28 26 29 83 Is (Juniors) 22 17 18 57 LA (Seniors) 17* 20** 19*** 56 95 93 95 283 * Includes A registered nurses with clinical experienCe ** Includes 7 registered nurses with clinical experience see Includes 1 registered nurse with clinical experience TABLE II CH1 SQUARE FOR DIFFERENTIAL LORTAIITY OF Fesszmsw SALPLE T3 T1 T2 (Health .___ (Medicine) (Nursing) Careli thinber of Fresh- Fkin completing 15 18 18 51 EIZDtaCt # 1 only I“lumber of Fresh- m€3n completing all 13 12 ll 36 LEirree contacts g 28 30 20 87 d.f. = 2 Chi square = 0.395 (not significant at p - .0“) msoMCmm eem.m mem.m me a ase.m (cm a Nem.m mme.e --meeo assess \ x . . \.\ 2.. msoflQSh mmm.a mew.s mrm : Haw.c an: o :30 o No : :ImAMU Swamom \ x \ . mososo no: mmm.a msa.m gem m ems.m use.o sau.m arm a :umsmu hemmem \ x . .. . . I .. 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Ho: V was rejected and Has V was accepted. Ha: V Students with a low level of training in the less highly trained profession will develop significantly greater interest in a new health care role than will students with a minimal level of training in the less highly trained profession. Hypothesis relating to interaction effects. No main effects for interaction were obtained (see Table XII). Ho: VI fafiiled to be rejected. Ho: VI There will be no interaction between role identification and level of training. \Compari§on of Interest DevejLODUN-2nt WW and enior Nur in tudent ho re e i tered Nur e In order to explore the possibility that the twelve senior Students who are registered nurses constituted a different level of interest development than those ’48 senior nursing students “”10 had not had previous professional responsibility. the data was re calculated with those two groups 0f senior nursing SWdente differentiated (see Table XIII). 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