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A curriculum design for disadvantaged students in a baccalaureate nursing program

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A curriculum design for disadvantaged students in a baccalaureate nursing program
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Bessent, Hattie, 1926-
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English
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vii, 80 leaves. : illus. ; 28 cm.

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Nursing -- Study and teaching ( lcsh )
People with social disabilities -- Education ( lcsh )
Foundations of Education thesis Ed. D
Dissertations, Academic -- Foundations of Education -- UF

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Thesis (Ed. D.)--University of Florida, 1970.
Bibliography:
Bibliography: leaves 77-79.
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Manuscript copy.
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Vita.

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Full Text
A CURRICULUM DESIGN FOR DISADVANTAGED
STUDENTS IN A BACCALAUREATE NURSING PROGRAM
By
HATTIE BESSENT
A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF EDUCATION
UNIVERSITY OF FLORIDA 1970




ACKNOWLEDGMENTS

The writer wishes to acknowledge the financial
support from a grant for Nursing Research from the National Institute of Mental Health.
I wish to extend special thanks to Dr. Ira J. Gordon who helped me to develop myself as a person as well as to appreciate learning as an art.
To Dr. Johnnie Ruth Clarke and Miss Annie Laurie Crawford and all the friends who gave their books, their good wishes, and their support during this period I am extremely grateful.
To my grandmother, Mrs. Susie Robinson, and my
sister, Miss Marion Bessent, thanks for your love and patience.
To the faculty, students, and staff of the College of Education, expecially those in the Institute of Human Development, I extend my sincere thanks for your kindnesses.




TABLE OF CONTENTS

Page
ACKNOWLEDGMENTS.......................................13.
ABSTRACT.............................................. v
INTRODUCTION...........................................1I
Significance............................... 8
Procedures................................. 9
Format for Chapter Development.............10
Chapter
I. NURSING EDUCATION AND ITS INFLUENCE
ON A DYNAMIC DEMOCRACY.................... 12
American Educational Ideals................12
Ii. THE CHARACTERISTICS OF THE
EDUCATIONALLY DISADVANTAGED................17
Lower Class Status and Academic
Achievement..................... ....... 23
Lower Class Status and Motivation .... 24
Cognition........................ ........ 30
Values.................... ................ 35
Human Behavior and Change..... ........ ......38
III. REVIEW OF SOME PROPOSED PROGRAMS FOR THE DISADVANTAGED STUDENT IN
NURSING PROGRAMS.......................... 41
Evaluation......................... ....... 51
IV. CURRICULUM DESIGN.........o....... ..............54
Student Selection......................... 57
Curriculum Structure...................... 62
First Year-First Semester
and Second Semester......... .... ........64
Organizational Structure ................. 67

iii




TABLE OF CONTENTS-Continued

REFERENCES .........................................
BIOGRAPHICAL SKETCH ................................

Page
77 80




Abstract of Dissertation Presented to the Graduate Council of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Education
A CURRICULUM DESIGN FOR DISADVANTAGED STUDENTS
IN A BACCALAUREATE NURSING PROGRAM
By
Hattie Bessent
December, 1970
Chairman: Dr. Ira J. Gordon Major Department: Psychological Foundations of Education
A major concern of baccalaureate nursing programs is a curriculum design for disadvantaged youth. The increasing needs for the various types of health services provided by the nursing profession make it imperative that more people be educated for these services. Therefore, the vast source of manpower and/or womanpower represented by the disadvantaged must be tapped in order to secure enough personnel to meet the growing demands of the health services in general and of nursing in particular. Thus, education in nursing must be set up to recapture the talent of the disadvantaged students.
In a period of social change, institutions must deal with social realities, and professions must also examine themselves and their training programs. If we accept that both institutions and professions are concerned with




competence and that society i~s concerned with equal educational opportunity, vo must bring these two goals together. We must develop competent nurses from people who, because of society, have been denied the entry skills required for success in a baccalaureate nursing program.
The purpose of this study was to develop a design for a curriculum to meet the educational needs of disadvantaged students in the baccalaureate nursing program. Because factors such as motivation, cognitive deficit, and operating values' can be adequately treated. by the school,
the study was limited to those factors which can be treated within, the scope of a baccalaureate nursing program.
The study proceeded on the basis of three postulates, which are stated as follows:
1. Disadvantaged students need to perceive themselves
in essentially positive ways.
2. Disadvantaged students need to develop a hierarchy
of values that will enhance mobility within the
general society.
3. Disadvantaged students need to develop cognitive,
conceptual, and social skills necessary for the
accomplishment of their goals.
In addition,- this study gives a description of the disadvantaged student. Emphasis was placed on the disadvantaged student's social, economic and environmental experiences as they relate to his educational achievement. The study also explores the concept of change as it relates to the disadvantaged student in the following aspects:




1. Changing cognitive style
2. Developing an-adequate value system
3. Raising the level of aspirations
review of some proposed programs in nursing was explored for their adequacy in meeting the needs of the disadvantaged student. The characteristics of the disadvantaged student were presented; assumptions were made regarding this student being involved in this curriculum design; a teaching strategy was presented; and expected behavioral outcomes were presented. The focus was on the continuous process of transaction between the pupil characteristics, instructional situation characteristics, and goal characteristics. Suggested research was recommended.

vii




INTRODUCTION

Statement of Problem
There are now approximately 70,000 administrators,
teachers, supervisors, and head nurses employed in hospitals and nursing schools throughout the United States. Yet, this number is insufficient. It is insufficient because schools are not producing enough nursing students. For this reason colleges and universities need a baccalaureate curriculum of sufficient breadth and strength to develop proficiency for expert professional nursing practice.
To provide a source of supply for advanced positions, there must be considerably more students in collegiate undergraduate programs. There must be expert clinicians with
a broad-educational background for research functions in nursing to contribute to health information, to segregate and analyze the components of good nursing care, and to contribute the specific knowledge and skills requisite for various kinds of nursing.
Neither the public nor educators, in general,
uniformly understand the reasons why sound basic collegiate education is a requirfenent for the most skilled duties of the professional nurse and for her advancement. The isolation of nursing education from educational institutions

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has limited communications between teachers and students in nursing schools and in their counterparts in other courses of study. Thus, nurse educators have not had much access to the usual means of continuously examining, with others, the purposes, methods, and needs of a dynamic educational program. Even many nurse educators fail to completely understand the implications of the changes that are taking place in the scope and nature of nursing practice.
Because scientific and technological advances have revolutionized medical practice and health services, every new development in the health sciences has created new responsibilities and new challenges for nursing. The major goal. cited by baccalaureate programs in nursing, therefore, is to provide the educational experiences which will enable the graduate of the program to function as a professional nurse in beginning positions in nursing, including Public Health Nursing.
The health industry will probably become the largest employer of manpower in the middle 1-770s. This industry will require additional professional nurses drawn from a large number of students previously attracted to nursing. Nursing educators must develop a curriculum to provide the basic preparation for nursing practice, to provide for eligibility to pursue advanced study in research methodology, to provide clinical practice in specialties, arid to provide programs of commua-ni-ty healIth maintenance and promotion.




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The nation is currently being challenged by the growing paradox of poverty, especially for the plight of those citizens whose heritage places them at an ed ucational disadvantage making it difficult, if not impossible, for them to fully utilize educational opportunities of which the rest of society avails itself.
The Goldrnark Report (Goldmark, 1923, pp. 486-497) was the first in a series of studies aimed at upgrading nursing education and, hence, nursing. Listing the advantages and the standards of a university school of nursing, the GoZdmark Report recommended that educationally unrewarding routine service be eliminated. It recommended that college work of a liberal nature with a thorough grounding in the fundamental sciences be seen as essential content for professional nursing education.
Margaret Bridgman (1953, p. 14) recommended higher education, at least for teachers and administrators of nursing. Although noting that the hospital schools had improved, she said: "The development of other educational facilities (in institutions of higher education) has been so slow as to leave the total picture substantially unchanged." She set the establishment of broad, strong baccalaureate curriculums as the first requirement in preparing nurses for professional employment. Bridgman stated that these programs should include general content,




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profession-related content, and a major in nursing with both lower- and upper-divisi.on courses. For universities to prepare students for professional practice, certain conditions must be obtained: "Policies applied to nursing are consistent with general standards of colleges and universities, nursing students receive the benefits of genuine college education, and nursing degrees are authentically representative of the completion of an upper-division major in the degree granting institutions" (Bridgman, 1953, p. 97).
Bernice E. Anderson said: "It is curious that
while the environment in which the nurse learns has gone ahead so rapidly and other types of education have progressed, education for nursing has been caught in some backwash and has not gone along with progress in related fields" (1953, p. 213).
More recently, Genevieve and Roy Bixler (1959, p. 1144) remarked that: "Considering the expansion of collegiate education since the end of World War II, the expansion in nursing education is not remarkable." The nonexpansion may be due to inadequate provisions having been made for the great diversity in student population in the collegiate nursing program. The large numbers of failures or dropouts may be attributed to the failure of the collegiate nursing program to implement all of its functions. if the collegiate nursing program is to fulfill




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the educational demands of all its student population, it must first make adequate provisions for that group of students who are not achieving an adequate level of competence for self-fulfillment. These are the disadvantaged students of the collegiate nursing programs.
The growing need for professional nurses can serve as a catalytic force in developing a basic collegiate curriculum which takeF account of the special needs of disadvantaged students. In order to increase the yield of desperately needed professional nurses from these previously deprived groups, it will be necessary to develop a systematic curriculum designed to attain this specific goal. The evidence is now overwhelming that high intellectual potential exists in a larger percentage of individuals from lower status groups than has been previously discovered, stimulated, and trained for socially beneficial purposes.
For this study, the disadvantaged student is defined as one who does not exhibit abilities and skills which the collegiate nursing program usually deems adequate for normal progress through the regular program.
Such a program must provide means for attracting
and recruiting larger numbers of disadvantaged students than have been previously attracted to the nursing profession. Further, it must offer a program of studies which will.




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consider the varying levels of academic and social proficiencies which this group of students possesses. This nursing curriculum designed for disadvantaged students should also consider the aspirational level, the cognitive style, and the operating value system of the disadvantaged student;
Also, this educational program for the disadvantaged must change the attitudes of teachers and of school administrators from one of rejection and fatalistic negation to one of acceptance and of a belief in the educability and human dignity of these students. It must emphasize successful accomplishment and goal attainment.
The educationally disadvantaged youth has a
negative self-concept, a feeling of being trapped, an unending prospect of no hope, and a szlf-denial of ability to control their own futures Amazingly, many of the students involved in projects for the disadvantaged view these programs as a hope, a second chance, an opportunity to break through the ceiling imposed by poverty and failures.
A collegiate nursing curriculum, therefore, should be designed to create situations wherein the students can achieve success, can discover new horizons, and can develop faith and positive expectations within themselves. Since these students are more accustomed to experiencing failure than success, the program should provide situations with




- 7

immediate positive reinforcement. Small successes work well in developing self-confidence and in providing a desire to continue.
Nursing curriculums should proceed on the assumption that many talented and potent ially capable students do not achieve academically because of economic, social, and/or environmental deprivation. But they do succeed because of their strong desire to excel. One of the realities of the contemporary world is that the destiny of one group of students is tied to the destiny of all other groups of students. Our collegiate nursing schools can no longer afford the luxury of serving an educationally elite group.
Approximately one-third of the nation's youth fall into the category of disadvantaged and are imbued with educationally associated problems that arise from the culture of the poor. Riessman (1962) estimates that by' the end of 1970, one-half of the nation's youth will be labeled as educationally disadvantaged unless new and developing program-s are successful.
The increasing need for the various types of health services provided by thec nursing profession makes it imperative that more people be educated for these services. Therefore, the vast source of manpower and/or womanpower represented by the disadvantaged must be tapped in order to secure enough personnel to meet the growing demands of the




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health services in general. and of nursing in particular. So, education in nursing must be set' up to recapture *the talent of the disadvantaged students.
Therefore, the purpose of this study is to develop a design for a curriculum to meet the educational needs of disadvantaged students in the collegiate nursing program. Because factors such as motivation, cognitive deficit, and operating values cart be adequately treated by the school, this study will. be limited to those factors which can be treated within the scope of a collegiate nursing program. Therefore, this study will be concerned with developing a curriculum base which will. help the disadvantaged student to successfully pursue nursing as a career.
The study will proceed on the basis of three postulates, which are stated as follows:
1. Disadvantaged students need to perceive themselves
in essentially positive ways.
2. Disadvantaged students need to develop a hierarchy
of values that will enhance mobility within the
general society.
3. Disadvantaged students necd to develop cognitive,
conceptual, and social skills necessary for the
accomplishment of their goals.
Sign ifi canc e
The major aspects of importance in this study are as follows:




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1. A special curriculum will make nursing as a
career available to large numbers of disadvantaged
students who fail to consider nursing or who fail
in their attempt to pursue nursing as a career.
2. The curriculum should produce changes and new
approaches to the education of teachers of nursing.
3. Such a curriculum should also facilitate upgrading
of the basic curriculum for all nursing students.
4. This type of emphasis upon the disadvantaged will
make a small but significai-t improvement in
increasing the career opportunities for disadvantaged
students.
Procedures
This study is an attempt to provide nursing educators with the results of research on the disadvantaged student. This study will also provide nursing school curriculum planners with a curriculum that is relevant and meaningful to.the disadvantaged student.
It is hoped that this study will provide nursing
educators not only with an opportunity to see a vast source of potential professionals but also with a means for educating them for nursing careers. It is further hoped that this study will serve as a basis for model training programs, as a stimulus for new innovative curriculum change, and as a basis for future hypotheses, assumptions, and theories.




- 10 -

Format for Chapter Development
Chapter I is the introduction. The dominant theme of this chapter is the commitment of the rapidly changing American society to provide equal educational opportunities for all. In view of this commitment, the role of the collegiate nursing school as an institution for providing equal educational opportunities to the disadvantaged student will be developed.
Chapter II will involve the characteristics of the educationally disadvantaged student. Emphasis will be placed on the disadvantaged student's social, economic, and environmental experiences as they relate to his educational achievement. This chapter will also emphasize the concepts of change as it relates to the disadvantaged student in the following aspects:
1. Changing cognitive style
2. Developing an adequate value system
3. Raising the levels of aspirations
Utilizing facts and principles from empirical
research for the disadvantaged youth, an attempt will be made to develop a theory of the dynamics of change as related to the educationally disadvantaged. This change process, once developed, will relate to the nursing program only. Attention will be given to changes in the following areas:




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1. Administration and organization
2. The' teacher and service education
3. The curriculum design
Chapter III will present some nursing programs which
have been proposed to help educationally disadvantaged nursing students. An evaluation will be giver, of these proposals.
Chapter IV will involve the principles of curriculum design and curriculum construction. Generalizations derived from these principles and conclusions derived from the previously presented data will be drawn. together as a guide for a curriculum design for the disadvantaged student in a baccalaureate nursing program.




CHAPTER I
NURSING EDUCATION AND ITS INFLUENCE
ON A DYNAMIC DEMOCRACY
American Educational Ideals
Today, there is increasing concern with the problem of providing education for the disadvantaged youth of America. The solution of this problem is necessary for effective functioning of a dynamic democracy and for the preservation of our democratic ideals. Dewey stated, for example, that "Democracy and education bear a reciprocal relation, for it is not merely that democracy is itself an educational principle, but that democracy cannot endure, much less develop, without education," and that "after all, the cause of democracy is the moral cause of the dignity and worth of the individual" (Dewey, 1950, p. 11).
The advent of experimental science and the
development of industrialism brought new problems for education, one of which is the major problem of adjusting the aims of education to existing social conditions. John Childs feels that the democratic way of life in our own country and throughout the world is undergoing a crucial test. Education, therefore, should do whatever it can to serve the ends of a democratic society by providing an

- 12 -




- 13 -

understanding of the role of such a. society. A democratic society, states Childs, "is grounded in respect for individual human beings and seeks their growth through the development of their ability to think, to choose, and to govern themselves. The values of a free society can be preserved only as its citizens recognize and accept the responsibilities that are corr.elative of their right" (1950, p. 264).
The most outstanding event to occur to cause the members of the American society to look at themselves and plan for positive change was the May 17, 19S4, decision of the United States Supreme Court which ruled that state laws requiring or permitting racially segregated schools violated the equal protection clause of the Fourteenth Amendment of the United States Constitution..
The goals of assuring equality of educational
opportunity and of providing the most effHective education for every child are inherent imperatives of American education in this latter half of thie twentieth century. Any society, therefore, which is to remain viable and dynamic must raise the educational standards for all of its people and must exploit and use constructively high intellectual potential wherever it is to be found.
John Gardner (1961) states our society cannot achieve greatness unless individuals at many levels of ability accept the need for high standards of performance and strive to




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achieve those standards within limits possible for them and that educators cannot meet the challenge facing this free society unless they can achieve and maintain a high level of morale and drive throughout the society.
Equality of educational opportunity for the
disadvantaged student is one of the national priorities of the Office of Education and its implementation ranks high on the list of educational needs of every school district in the United States. The solution to the problem of this country and the implementation of the goals of democracy are dependent upon wise u-se of the potentials of the disadvantaged segment of this society. It is imperative that the quality of the educational experience of this group be such that the disadvantaged will be able to realize their personal goals and to contribute to the growth of the nation. Therefore, this study is concerned with developing a program which will address the needs of the disadvantaged college student. Further, the special concern of this study is the development of a program which will help the disadvantaged student pursue successfully a career Ln a baccalaureate nursing program.
In a period of social change, institutions must deal with social realities, and professions must also examine themselves and their training programs. if we accept




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that both institutions and professions are concerned with competence and that society is concerned with equal educational opportunity, we must bring these two goals together. We must develop competent nurses from people who, because of society, have been denied the entry skills required for success in a baccalaureate nursing program.
Disadvantaged students in a baccalaureate program will present a challenge to persons who work with these programs. Therefore, educators would attempt to create situations where the students can achieve success, can discover new horizons, and. can develop faith and positive expectations within themselves.
Nursing educators in collegiate schools must realize that the complex problem of education for the disadvantaged student cannot be resolved effectively by fragmentary approaches. The problem requires the development of bold, ima ginative, and comprehensive approaches. Education in nursing should have as its challenge the maximum education for all American students without regard to their social, economic, or racial backgrounds because an effective functioning dynamic democracy demands this. Nursing, then, must begin to make the necessary modifications in curriculum and in methods and must provide the educational leadership, guidance, and stimulation that will make it possible for American society to strengthen and improve our system of




- 16
democratic education. When this is done, our nursing schools will be considere-d as a vehicle of mobility and as one of the major agents of social and economic vitality. If it is not done, our nursing schools will contribute to social stagnation and more insidious forms of social class cleavages and distinctions.




CHAPTER II
THE CHARACTERISTICS OF THE EDUCATIONALLY DISADVANTAGED
The educationally disadvantaged student is a
product of the lower class status. This position in the hierarchy of social stratification in American society represents social and economic deprivation which lead to educational deprivation.
The defining characteristic of the educationally disadvantaged in America is that they are poor and most of them are unemployed, or underemployed. They are labeled according to Neugarten and Havighurst as the lower lower class. in this class can be found according to Havighurst and Neugarten (1962) a large proportion of blacks and other visible minority groups. Edmund Gordon identifies these groups as Negroes, Puerto Ricans, Mexicans, and Southern rural or mountain whites (Gordon and Wilkerson, 1966).
The labelling of the various groups which occupy lower socioeconomic status is not the significant aspect. The problem is their attempt to share in the educational gains of the general society. In order to provide equality of educational opportunity and to make those needed changes in the educational system, it is necessary that curriculum planners or designers have an understanding of the nature of the people to be served.

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The home of the educationally disadvantaged is a crowded, busy, active, noisy place where no one child is the focal point. There are too many children, and the parents have too little time for the m. Consequently, the children spend much more t ime in each other's company and with relatives than they spend with parents.
The home typically includes aunts, uncles, and grandparents, all of whom may, to some degree, play a parental role. This pattern according to Reissman, is technically known as "the extended family." Reissman stated the strength of such a family:
The key to much of the family life is security and
protection. The large extended family provides a small
world in which one is accepted and safe. If help is
needed, the family is the court of fi-rst resort and will
provide it, at least to some extent. Time and energy,
rather than money, are the chief resources provided
(Reissman, 1962, p. 36).
.However, the home of the educationally disadvantaged can become a circumscribed area permeated by attitudes either of despair and apathy or of hostility and -rebellion. This home is often broken by divorce, by desertion, or by forced separation caused by the location or the nature of available work. Here, the family constellation is different from that of the nuclear family which is the supposed norm of the middle class and upper lower class. The father leaves home for extended periods to search for work, to work temporarily elsewhere, or simply to desert his family periodically.




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Older brothers and sisters leave to get married or to take jobs, only to return when -they are unemployed, separated from their spouses, oi divorced. More distant relatives or friends come to stay either to lend support during times of domestic or economic crisis, or permanently. Then it becomes necessary to double up in housing. All of the components of family life lack the long-range uniformity, predictability, and organization Of the traditional, middle class family life from which the school draws inferences.
The organization of the child's home life influences his time orientation. Because of the combination of external pressures on the family, and its own internal structure, for lower class children, the future becomes a vague, diffused region where anything can happen and where possible -rewards are too uncertain and too remote to mean much. The child's discipline, therefore, typically involves physical rewards and punishments which are designed to get him to do or not to do specific, immediate things.
Added to this child's life is a series of critical situations in which irritable and tired adults use erratic physical punishment to maintain discipline. With such a background it is not surprising that few lower class children develop the deferred-gratification pattern of life required for the commitment to the long-range life plan which the middle or upper class child assumes as part of his -world.




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The lower class person is not at all sure that it is rational for him to trade irmpulsiveness for restraint, spontaneity for self-discipline, play for work, or even immediate satisfactions for remote and uncertain rewards. He has no history that these have or will pay off. He lacks interested adults to help him to link present, past, and future together by recalling prior experiences, or by relating such experiences to present occurrences, to predict future ones. They are caught in the present, and they do not plan ahead. They take their pleasure on a moment-tomoment basis.
Because the home atmosphere is much more communal and, to some extent, cooperative, Reissman (1962) belicves sibling rivalry and fear of a new baby brother is somewhat less apt to develop. Perhaps this is because the children never have had much attention in the first place, and have less to lose. Perhaps, also, the fact that the children depend so much on contact with each other, rather than being overly dependent upon the parents, plays a decisive role.
Although education in the United States is compulsory, the lower class child is not necessarily exposed to similar learning opportunities as the middle or upper class child. Class attendance in school is markedly irregular because of the child's frequent illnesses, because of his work, because of his truancy which is totally ignored (through lack of interest) by the authorities and because of a life style




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which makes no demands for attendance to an uninteresting and unrelated school situation. A great many lower class youths fail to complete high school. The reason for this failure is that they do not see the relevance of school to their opportunities in life; many are obliged to work halfor full-time; and the competition of street life with the school is too great, so that the street, with its imitation of the struggle for existence, with its sexual opportunities for adventure, generally wins. From this time on, school for many becomes meaningless and unrewarding., For these students, "Talk, reading and intellectualism in general are viewed as unmasculine-the opposite of action. Moreover, the school is often imaged as a 'prissy place' dominated by women and female values"? (Sexton, 1966, p. 54).
Although the disadvantaged youth views the school negatively, he does not depreciate the value of education. Grier and Cobb stateAny explanation of this drive toward learning must
take into account the dearth of alternative modes of
expression. Black people have always had reason to be skeptical of success in other fields of endeavor, for,
if success were measured in terms of goods acquired,
those goods could easily be taken away. Education was
said to be "something no one can ever take away from you." t was therefore one of the very few areas of
accomplishment where a level of "success" could be
attained within a special Jim Crow Arena Of Competition
(Grier and Cobb, 1968, p. 116).
Besides the Positive feelings toward education, the disadvantaged youth has much to offer. The problem in




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education is that the assets of the disadvantaged youth are not compatible to those the school expects him to have but, as Moss states:
Our society has much to learn from the disadvantaged
on how to survive in a hostile world. It has been said
that people living in a marginal existence are less efficient in dealing with their environment in an abstract, conceptual sense than in devising strategies for coping
with the day to day concrete realities of life and death.
They may not be able to grasp fully how an entire system
works, but they can become proficient in devising ways
to work through a whole network of barriers and obstacles
in order to survive and live. They know better how to
manipulate things not people, roadblocks not structures; with their gifts, they encourage us to view no obstacles
to change, and to value not disdain the unlimited capacity of man to endure and live comfortably with human
frailty and human differences (Moss, 1970, pp. 18, 19).
The depriving effect of lower lower class status does not produce people without values, without goals, without coping techniques. Instead, it produces a group which has devised its own means of coping with its problems within the context.of its own neighborhoods. The motivation, the cognitive skills, and the value system developed by the lower lower class serve its members well in meeting group imposed standards. The problems of deprivation occur when the life style of this class comes into conflict with that of the larger society, particularly when an individual attempts to gain a technical skill which requires formal advanced education.
The problems of deprivation are brought sharply into
focus when achievement is used as a measure of potential for




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admission to programs and to jobs. Furthe-r academic opportunities as well as achievement is dependent upon the level of motivation, cognitive style, and valuc system of the student. Therefore the remaining section of this chapter will explore the motivation, cognitive style, and value system of the poor and their effect upon the disadvantaged youth. This section will also explore the basic issues of how these evolved and their relationship to academic achievement.
Lower Class Status and Academic Achievement
There is an abundant amount of educational research which provides evidence of the low academic achievement of the disadvantaged youth at all educational levels. There is also much research which shows that low academic achievement is related to low socioeconomic status. Sexton considers social-class as a very good predictor of success in school. She stated:
Social class is also a fairly accurate predictor of
success in school. If you know a child's class status, his family income, his parents' educational levels, you
can quite accurately predict what Will happen to him in
school and how successful he will be (Sexton, 1966, p.
278).
It is evident that more lower socioeconomic status students have a lower achievement level than students of high socioeconomic status. Sexton, in her study, stated:
In the lowest income group (group 1, $3500), 10.9
percent of all. students in Bi~g City failed to be promoted




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to a higher grade in January, 1958. This means that more than one out of every ten students in this group were not passed at the end of the school year. In the
highest income group ($11,055) less than one percent
(.8 percent) of all students failed to be promoted
(Sexton, 1966, p. 278).
Coleman appears to be congruent with Sexton.
The schools are remarkably similar in the way they
relate to the achievement of their pupils when the socioeconomic background of the students is taken into account.
It is known that socioeconomic factors bear a strong relation to academic achievement (Coleman, 1966, p. 21).
Further research has shown that socioeconomic
deprivation has a deleterious effect upon academic achievement. Where the home environment and school environment (considered as the "educational environment" by Bloom) is nonreinforcing for the values of the school, academic achievement of children from such environments will be low. "It is evident that when the school and home environments are mutually reinforcing, learning is likely to be greatest" (Bloom, 1964). Children of the poor fail more often in school than the other children and there is a high correlation between this failure and the life style of the home of these students (Gordon, 1966). The low level of academic achievement of disadvantaged youth can be accounted for by the level of their motivation system, their cognitive structure and the hierarchy of their values.
Lower Class Status and Motivation
Motives according to 1,cClelland are learned (McClelland, 1953, p. 324). They are developed when certain




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affective arousal states become associated with certain cues. For an examplewhen a teacher used the word "good" to praise a student for completing a task successfully, the accompanying affective state of satisfaction coupled with the cue "good" serves as a basis for motive development. When cues and arousal states become bonded (redintegration), the process for motivation has begun.
Motivation, then is the sequential approach or,
avoidance behavior chosen to produce or arrive at an affective state. The conditions for the development of a motive are produced by certain perceptual events which cause the arousal of affective states. Affective states may be negative or positive. The difference is determined by the degree of discrepancy between the adaptation level of the organism and the event. The adaptation level is the level of expectancy to which the organism has learned to respond as the result of its experiences.
As a result of family and cultural experiences of
the lower class, the lower class child often has a negative attitude toward school, and his achievement motivation is correspondingly low. Due to lack of knowledge, parents pay little attention to the child's school progress, and almost ignore the child's unsupervised roaming of the streets at night. They provide for the child no school contacts except those insisted upon by the school authorities. Thus, this




- 26 -

representative lower class life style fails to reinforce the child to work hard in school, and to take homework seriously. If the child rakes good grades in school, he must conceal them from his unsuccessful peers and apologize for it rather than boast about it.
Studies of motivation of the lower class student show that many of these students often have unrealistic aspirations. Bloom, Whiteman, and Deutsch's study supports this conclusion. Their study was based on personal interviews with the students and on parents' responses to questionnaires. Their findings revealed that the Negro parents reported more middle class motivation than whites; that is, they had higher educational and occupational aspirations for their children. The Negro children themselves aspired to higher occupations than the white children of comparable class levels (Bloom, Whiteman, and Deutsch, 1963). This aspiration striving presents a problem of attainment. The academic achievement which usually supports such striving and the maintenance of sustained drive toward goal attainmerit is usually lacking in members of the lower class. The economic support and sociopsychological encouragement needed to undergird deferred gratification is not available to the disadvantaged student. Therefore, the high aspiration levels of these students are often unrealistic in terms of achieveMent.




- 27 --

Smith and Anderson's study is congruent with the
above. The purpose of their study was to test the relationship among mobility aspiration, race, and family experience measured by a questionnaire on affectional patterns. The results showed that the Negroes had significantly higher educational and vocational aspirations in contrast to the whites. The authors concluded that the tendency of Negro youth to have higher educational-vocational aspirations seems to be on a fantasy level rather than a reality level (Smith and Anderson, 1962).
On the other hand Gordon and Wilkerson (1966),
explain the motivational pattern of disadvantaged youth as being less highly motivated and having lower aspirations for academic and vocational achievement than do their middle and upper class school peers. Not only is motivation likely to be lower but it is likely to be directed towards goals inconsistent with the demands and the goals of formal education. This depressed level of aspiration is usually consistent with the child's perceptions of the opportunities and rewards available to him. Symbolic rewards and postponements of gratification appear to have little value as motivators of achievement. For disadvantaged children goals tend to be self-centered, immediate, and utilitarian, just as they are for the dominant culture. However, children growing up under more privileged circumstances have many sources




- 28 -

of immediate satisfaction and immediate feedback available as well as evidences of the utilitarian vlue of academic effort. The differences between the-privileged and the disadvantaged in this area are not so much in vaJues as in the circumstances under which the values are called into play. Although the values from which motivation is derived in the disadvantaged child seem to reflect the dominantculture concern with status, material possessions, ingroup morality, Judeo-Christian ethics, and competition, there is usually a lack of concern with the aesthetics of knowledge, symbolism as an art form, introspection, and competition with one's self. In other words, dominant societal goals and values exist among the disadvantaged but the direction. taken and the context in which they operate may not be complementary to academic achievement (Gordon, 1966).
According to McClelland, achievement motivation can be developed so that the disadvantaged youth or adult can successfully manipulate the educative process toward a rewarding goal. The technique of implementation involves the following steps:
1. The more reasons an individual has in advance to
believe that he can, will, or should develop a
motive, the more educational attempts designed to
develop that motive are lihely to succeed.
2. The more an individual perceives that developing
a motive is consistent with the demands of reality
(reason), the more educational attempts designed
to develop that motive are likely to succeed.




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3. The more thoroughly an individual develops and clearly conceptualizes the associative network
defining the motive, the more likely he is to
develop the motive.
4. The more an individual can link the newly developed network to related actions, the more the change in
both thought and action is likely to occur and
endure.
S. The more an individual can link the newly conceptualized association-action complex (or motive) to events in his everyday life, the more likely
the motive complex is to influence his thoughts and
actions in situations outside the training experience.
6. The more an individual can perceive and experience
the newly conceptualized motive as an improvement in the self-image, the more the motive is likely
to influence his future thoughts and actions.
7. The more an individual can perceive and experience the newly conceptualized motive as an improvement
on prevailing cultural values, the more the motive
is likely to influence his future thoughts and
actions.
8. The more an individual commits himself to achieving concrete goals in life related to the newly formed motive, the more the motive is likely to
influence his future thoughts and actions.
9. The more an individual keeps a record of his progress toward achieving goals to which he is committed, the more the newly formed motive is likely
to influence his future thoughts and actions.
10. Changes in motives are more likely to occur in an
interpersonal atmosphere in which the individual
feels warmly but honestly supported and respected
by others as a person capable of guiding and directing his own future behavior.
11. Changes in motives are more likely to occur the
more the setting dramatizes the importance of self-study and lifts it out of the routine of
everyday life.




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12. Changes in motives arc more likely to occur and
persist if the new motive is a sign of membership
in a new reference group (McCleliand, 1965, p.
336).
McClelland (1965) then provides the curriculum designers with a clearer picture upon which to base a program fror developing a motivational system to sustain academic progression. Nursing education must provide a program that will develop a high level of achievement motivation. In a subsequent chapter of this thesis a program for developing a motivation system for sustaining successful pursuit of a baccalaureate nursing program will be presented.
Cognition
As previously stated low academic achievement of the disadvantaged youth has its roots in cognitive development. As to their cognitive style Ausubel concluded that lower class children are trained to respond more to -their concrete, tangible, immediate and particularized properties where middle class children are trained to respond to the abstract, categorical, and relational properties of objects. This difference in perceptual disposition is carried over into verbal expression, memory, concept formation, learning, and problem solving (Ausubel, 1969).
Bernstein stated that the lower class child has
fewer categories for accommodation and/or assimilation of the various stimuli he receives in the school environment




- 31 -

and that the cues which he selects and fits into his categories will be limited. The world he perceives is limited by the labels which he can attach to it, and its meaning to him will be internalized to the extent which his cognitive style will fit it into his established categories (Bernstein, 1961).
According to Deutsch, the coping ability of lower
class children is restricted to that narrow range of stimuli furnished by a ghetto-like environment. The opportunity for many and varied enriching experiences through which the child develops facility in coping is limited (Deutsch, 1963).
The cognitive style of the disadvantaged student has been described as concrete rather than abstract which is comparable to Piaget's concrete-operational state, that is, the attainment of concepts through the manipulation of objects. Because of this style the disadvantaged student is able to organize information at a low level. According to Bernstein, the disadvantaged youth is not predisposed to ordering of symbolic relationships, to imposing of order, and to seeing new relationships. There is evidence of low level cognition in the language of disadvantaged youth, their use of traditional phrases, idioms, and slang which tends to be expressive and less abstract (Bernstein, 1961). flullfish and Smith (1961) feel language and meaning are a necessary ground for advancement to the conceptual level.




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Bruner's category system appears to be compatible with Piaget's schemata. In explaining his system, Bruner uses the terms categorizing and conceptualizing interchangeably. He stated:
To categorize is to render discriminably different
things equivalent, to group the objects and events and people around us into classes, and to respond to them
in terms of their class membership rather than their
uniqueness (Bruner, 1957, p. 2)..
Bruner feels that this acquisition of categories is dependent upon the experiences of the individual (Bruner, 1964). He then observes that, for a person to make any sense out of his environment, he must .be able to select, from an almost infinite number of discriminable objects and events, those which appear to have something in common, and to treat these either as a single category or as a manageable number of categories.
It seems from this theory that cognitive growth is
dependent upon a stimulating environment. If the environment does not provide varied and rich experiences, cognitive growth is hindered. The inadequate cognitive growth of the disadvantaged student in school type categorizing may be attribtued to his lack of experiences which contribute to the development of a cognitive system capable of dealing with schooling. This emphasis on the importance of a variety of experiences in the environment implies the deterimental effects of lack of variety.




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A student from any circumstance who has been
deprived of a substantial portion of the variety of stimuli to which he is maturationally capable of responding is likely to be deficient in the intellectual capacity required for learning. Support for this idea is found in Hunt who, in discussing Piaget's developmental theories, points out that according to Piaget the rate of development is substantially, but certainly not wholly, a function of environmental circumstances. Change in these circumstances is required to force the accommodative modifications of schemata that constitutes development. Thus, the greater the variety of situations to which the child must accommodate his behavioral structures, the more differentiated and mobile these behavioral structures become. Consequently, the more new things a child sees, and the more he hears, the more things he is interested in seeing and hearing. Moreover, the more variation in reality with which he hlas to cope, the greater is his capacity for coping (Hunt, 1961).
Berstein's (1970) position on language goes further. According to Berstein, the child from a woiking class family is oriented towards particularistic meanings and the middle class child is oriented toward universalistic meanings. He feels that there is a distinction between these uses of language which he calls "context bound" and "less context bound." "The language of the middle class child gives




- 34 -

meanings that are free from context and understandable by all, whereas the language of the child from the working class family gives meanings that are closely tied to the context and would be fully understood by others if they have access to the context which originally generated the language" (Bernstein, 1970, p. 346).
The disadvantaged student uses language mainly to
convey concrete needs and immediate consequences, while the middle class child uses language to emphasize the relation of concepts. This difference between the two classes may contribute to the advantage the middle class child has over the lower class child in tasks where precise and abstract language is required for solution. Further, this reasoning may again emphasize the communication gap which exists between the middle class teacher and the lower class child.
Berstein (1970) suggests that this may mean that
the teacher must be able to understand the child's dialect, rather than attempting to change it deliberately. He suggests this because much of the context of our schools is unwittingly drawn from aspects of the symbolic world of the middle class so that when the child begins school he moves into a symbolic system which does not provide for him a linkage with his life outside.
Every teacher who does not already know should learn that the social experience which the child already possesses




- 35 -

is both valid and significant, and that this social experience should be reflected back to him as being valid and significant. It can be reflected back to him if it is part of the texture of the learning experience which we create (Bernstein, 1970).
Therefore if the cognitive style of the disadvantaged youth is concrete rather than logical operational, nursing education must provide a program that will develop a high level of conceptualization beginning where hie is. Inl a subsequent chapter a proposed program for developing these skills will be presented.
Va Uue s
In order to further academic achievement, the
nursing educators must be concerned with the value system of the disadvantaged student. This section will present a theory of value, some research on value systems, as well as proposed plans for nursing education to make positive ad-, justments in the value systems of the disadvantaged.
In every society, men strive for whatever they
judge to be good and right. Thus, motives and values are virtually inseparable because what men strive for must be worth the physical and -psychological endeavor entailed in the struggle. The child first learns values from the important adults in his life, especially his parents. His




- 36 -

association with people of differing values leads the child to examine his own value system, modify or reinforce it in the light of his experiences. This process of value-modification or value-reinforcement is life-long for the individual as his horizons widen and his experiences increase.
Values have bond-connections with environmental stimuli which influence the direction and technique for good attainment of the individual goals. Environmental factors which contribute to the acquisition of strong academic achievement values are necessary for the development of deferred gratification. It is this deferred gratification, the ability to sustain interest and maintain effort over a long period of time in order to achieve some future reward, which is a requisite value for academic achievement and goal attainment.
It is this value which appears to be lacking in the operational value system of the lower class child. He denies delayed gratification. He lacks interest in engaging in activities for which the payoff is in the future and is unpredictable; he is unwilling to make the sacrifice now for the potential gamble ahead; and he tends to shy away from risk-taking. This behavior is understandable; the lower class child has few success models for whom the gamble has paid off. His control over the factors in his environment is so limited that the gains from day-to-day must be used




- 37 -

arid enjoyed. for what pleasure they bring for the moment. The needs of living today are the pressing matters to be forced today; therefore, all that is gained today is open for use today; tomorrow may never come. For the lower class child, value modification or reinforcement which comes through his interac tion1 with his environment can be structured to fester academic achievement only if the environment is altered.
Studies of values reveal that the socioeconomic
status and the child rearing practices of the family appear to play a major role in determining the value judgment development of the child. The lower lower class parents tend to evaluate in terms of consequences while the middle class tend to consider intent. This difference may be due to the behavior of the parents and the moral ethics of the home. Berkowitz states, "The parent who wants his child to be reasonably successful and a responsible and law-abiding citizen apparently has to take an active part in developing appropriate values and motives in the child" (Berkowitz, 1964).
Studies of the child rearing practices of the family, especially disciplinary practices, show that lower class families rely on physical. punishment to develop antiaggression whereas children from middle class families rely on psychological punishment to impede aggression and antisocial atti tudes (iBrkowitz, 1964) The value system of the lowkNer




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class as seen by Harrington is a feeling of pessimism. He believes the pessimism pervades both the personal experiences and expectations of job and family. "This pessimism is involved in a basic attitude of the poor. When pleasure is available they tend to take it immediately" (Harrington, 1962, p. 123). This is the natural pattern of behavior for one
living in a subculture of American life which is without a future.
Therefore it is this value system of the lowe r class which nursing educators must know; further they must utilize this knowledge in providing a program where changes in values
can be achieved, so that lower class students can have equal opportunity to success in baccalaureate nursing programs.
To accomplish this value change, there must be
changes made in the nursing curriculum, in the nursing school environment, and in the individual's perception of himself and the curriculum.
Human Behavior and Chkange
So far-it has been attempted in this thesis to
emphasize that provisions must be made in nursing programs to provide equal access to success experiences in nursing programs for all students. The need for understanding the nature of the student to be served and the environment from whence hRe comes is imperative if nursing programs are to be effective.




- 39 -

The relationship of the individual and his
environment as they are affected by change can be explained in terms of organization as described by Gordon. Organizing one's world is a psychological process. There must be some feeling of balance. Gordon states:
This need for order means that a person in any given
situation will choose that behavior which, from where he
stands, preserves and increases his already ordered world.
It does not mean that growth is completely orderly. It does mean that even though the surrounding world may be
chaotic, each of us takes information in, organizes it within ourselves to make some sense out of it, to make
our lives orderly (Gordon, 1969, p. 8).
Gordon's position is that all living organisms can be defined as open energy systems. An open system means that the person is continually being influenced by and is influencing his environment.
One of the characteristics of the open energy system is that it maintains a "steady state," that is, keeping itself in balance. The organism is constantly active, developing a new organization incorporating new information received from the environment. Curriculum change and behavioral change can thus be made through environmental changes.
The culture where the educationally disadvantaged youth resides is a powerful influence acting upon the individual. In such areas there are many face-to-face encounters which make communication easier and more intense.




- 40 -

Information from the outside is not readily accepted, certain parts are rejected and other parts are accepted. In view of this position Gordon states:
Feedback is the process of receiving and making use
of information from the environment, after you have
acted. The feedback may indicate that behavior formerly
appropriate is no longer received that way and requires
modificatiop. It also may be that some behavior that
was virtually chance was well received and may then lead
down new pathways which might have been unpredictable
to an external observer (Gordon, 1969, p. 9).
Therefore, this study proposes to change the
educational status of the disadvantaged youth by focusing attention upon the transactional aspect of the individual and his environment. The refore,a program must include opportunity for feedback which will enable the student to choose new pathways and construct a new organism, in which new sets of behavior (nursing skills, interpersonal job skills) are seen as functional. It means the total educational innovation must act in uniform fashion to communicate expectations, and ways of behaving that serve as models for the learner. It must be remembered, however, that transactions iwiork both ways. The student will also make his impact or, the college and it will be changed in the process. It cannot just sell without buying.




CHAPTER III
REVIEW OF SOME PROPOSED PROGRAMS
FOR THE DISADVANTAGED STUDENT IN NURSING PROGRAMS
There is evidence to indicate that some
administrators are aware that the educationally disadvantaged youth does possess the potential skills that are required for a nursing degree. It also appears that their awareness has led them to take a realistic step to remedial programs on a preprofessional level to explore these potential skills.
Therefore, this chapter will review some proposed nursing programs. It is hoped that this is a step toward producing a more effective curriculum for disadvantaged youth in nursing. This curriculum can be produced as the results of studies of learning by the behavioral scientists are used as a basis and then translated into experiences which yield measurable, immediate results.
The University of Alabama School of Nursing
The University of Alabama School of Nursing has submitted a proposal to the United States Public Health Service for a program of remediation for the academically disadvantaged students admitted to the School of Nursing.

- 41 -




- 42 -

Remediation programs in mathematics and reading will be made available to those students who meet the preestablished criteria. The programs consist of four phases: selection and diagnosis, remediation, evaluation, and the planning for a decelerated curriculum. University of Miami SchooZ of Nursing
Recruitment has been extended to the Upward Bound Programs, Concentrated Programs, and the Family Health Workers in the Model City area. Disadvantaged students are identified by the School of Nursing for waiver of application fee.
A project proposal, "Upward Bound in Health Related Careers Bridge Program' has been submitted to Division of Student Special Services, Bureau of Higher Education. Twenty students each summer are recruited from the six basic Upward Bound Programs in Florida for a program which includes one college course, tutoring, developmental reading, and special interest groups in drama, art, music, etc. Field trips and observations will. be made in the community to increase awareness of health careers and resources. Self-awareness will be increased by informal contacts with counselors, tutors, and instructors. Part-time work experience will be in community health agencies.
"Expanding Opportunities for Disadvantaged Students in Nursing" is a five year project proposed to the Public Health




- 43 -

Service, Department of Health, Education and Welfare. The objective is to graduate students, although recruited as disadvantaged, who will be knowledgeable and skillful in the area of nursing and have a degree of self-knowledge, self-confidence, knowledge of others, and skills requisite to living in a rapidly changing environment. The project involves: (1) a guided studies program based on a diagnostic test battery (2) paid tutors in the basic sciences; (3) voluntary tutoring systems in nursing courses by the student nurses association; (4) counseling, formal and informal;
(5) individualized programs based on instructor-project student counseling; (6) cultural enrichment; and (7) faculty inservice programs to explore faculty needs and to develop methods for teaching the disadvantaged. The program is designed to supplement the present curriculum so that project students remain an integral part of the student group.
Medical College of Georgia School of Nursing
The School of Nursing has been working for two years with borderline students by inviting them to enter a summer session prior to the freshman year. Of 14 students, 11 still remain in the school. These students, 13 white and one black, enrolled in a full college load. Counseling was given on a regular basis, and tutoring was arranged as indicated.
The School is now refining a project proposal to be submitted to the Division of Nursing, Department of Health,




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Education and Welfare, on July 1, 1970, to work with disadvantaged students. It is planned to offer remedial work, counseling, tutoring, and a decelerated curriculum.
Spalding College School of Nursing
Spalding College of Kentucky recognizes its
responsibility to -the disadvantaged student as one of its major purposes of existence; therefore, all departments, in varying degrees, are involved in working with disadvantaged students. In the summer of 1966 the Nursing Department received Sealantic funds for a two-year project for the development. of a preparation for college program, with emphasis in rezruitment for nursing,
This program provided course content in communication skills (re"-ding, writing, speaking), mathematics, and science. Recreational and cultural activities (picnics, ball games, swimming, camping, plays, operas, field trips to museums and art galleries, and weekend trips providing hotel resort experiences) were planned to provide the student with the opportunity to broaden his/her views of American life.
The content courses are taught in the morning sessions of the college's summer school sessions. Recreational and cultural activities are planned for several, afternoons a Week during the summer session and two afternoons a month during the academic year. Forty-three high school students




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participated in this program. Twenty-eight of these students are currently enrolled in colleges. Eighteen of these students are enrolled. in nursing programs. Spalding intends to apply for additional Sealantic funds for continuation of this project if the Rockefeller Foundation makes these funds available again. University of Maryland School of Nursing
Although there has not been much tangible evidence, progress has been made in increasing opportunities for disadvantaged students in nursing. The major area of progress has been the increased awareness of faculty of the need for integration. In the lower division, the academic and social needs of these students are being met more adequately'through the expanded use of various special services. A counseling plan has been implemented whereby the School of Nursing faculty is responsible for groups of 12 freshmen in nursing, helping freshmen adjust to college life. Emphasis is placed on utilization of special services as needed.
Statewide contact with junior and senior colleges
is invited to identify comparable lower division courses so that transfer to this program will be facilitated. In the upper division, students are allowed to lighten their academic load. To assist them financially in their longer




- 46 -

enrollment at the university, some employment has been created, and students are assisted in obtaining employment. Again, a counseling plan has been initiated whereby experienced faculty have been assigned 20 students for academic counseling. This is in addition to the counseling within courses already in progress in which each faculty member is responsible for counseling six students.
The graduate program is considering seriously a summer program for selected students who are in need for remedial work before beginning their studies in the fall. The graduate faculty is aware of its responsibility to increase opportunities for academically disadvantaged students to succeed in the program once they have been admitted.
University of Mississippi School of Nursing
Some progress has been made in this area since the first Southern Regional Education Board meeting in September, 1969. To date the faculty has implemented the following actions.
1. Obtained approval from the director of the medical
center and the registrar to re-examine recruitment
procedures and admission requirements. Agreement
has been secured to consider applicants who fall slightly below admission standards by admitting them provisionally and allowing them to complete
the freshman year in two instead of one year; and/or providing a summer tutorial program in
academically deficient areas prior to admission.
Student response to the tutorial program has been eWihusiastic. Many have indicated a desire to be
a tutor if needed.




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2. Studied the present lower division curriculum in
order to broaden the base for liberal arts requirements by accepting substitute, alternate, or
comparable courses. This would be helpful to all
students but especially to the disadvantaged.
3. Demonstrated increased concern in recruitment
activities this year. The Recruitment Committee
will continue to search for more effective ways of recruiting students from the disadvantaged sector.
The chairman of the Recruitment Committee has been added to the Admissions Committee to achieve closer
communication between these two committees.
4. The office of Allied Health Professions at the
Medical Center has been successful in recruiting
among the disadvantaged population and has developed
an excellent relationship with black communities.
Closer collaboration with these groups in recruiting
for nursing is anticipated.
University of North Carolina at Chapel Hill School of Nursing
Quota restrictions on the number of women students and out-of-state students have led the School of Nursing of the University of North Carolina at Chapel Hill to look for students within the state from many different groups including men, registered nurses seeking the B.S.N. degree, and academically disadvantaged students. A representative from the School of Nursing sought to tap these groups by visiting Fort Bragg in Fayetteville, North Carolina to talk with medical. corpsmen about nursing, by interviewing registered nurses in the evening college of the University of North Carolina about their future in the baccalaureate nursing program, and by working with organizations which have already established contacts with academically disadvantaged students. The




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Committee for the Advancement of Disadvantaged and Minority Students is an undergraduate group that provides information to the academically disadvantaged high school students in the consolidated university system. A.D.M.S. plans to bring students to visit Chapel lill in the spring. The Educational Talent Search is another project in North Carolina through which academically disadvantaged students are found.
As nursing courses do not begin until the junior year at the University of North Carolina at Chapel Hll, transfer students from community colleges, junior colleges, and senior colleges are encouraged. Community and junior colleges have been visited throughout the state. Course evaluations and information on nursing at the University of North Carolina at Chapel Hill were left with counselors as resource material in talking with students interested in nursing.
University of Tennessee College of Nursing
The medical units at the University of Tennessee received a partial funding ($8,000) of a grant from the American Association of Medical Colleges. This grant will provide vlork-study opportunities for Negro students in health career settings during the summer. The purpose of tho grant is to interest Negro students in the health field
through this summer experience and thereby recruit them into nursing, medicine, pharmacy, dentistry, and the basic medical sciences. In addition to this, the University of Tennessee




- 49 -

College of Nursing has applied for a grant to study the teaching-learning process. If this is funded, a staff member of the Southern Regional Education Board Institute will serve as consultant to the planning of a workshop dealing with "Working with the Disadvantaged Student."
Texas Woman's University College of Nursing
A project proposal has been submitted to Department of Health, Education and Welfare for funds to increase graduation potential of educationally disadvantaged students. With this funding faculty can be assisted in the development of skills which will help to identify and effectively work with educationally disadvantaged students; identify factors which will motivate students to work up to their full potential; carry on a tutorial and guidance program and increase our number of graduates from the College of Nursing.
A new center for the Study of Learning in the
College of Education assists students with reading skills. The College of Nursing is already using these new facilities as well as the services from other departments such as chemistry, biology, and speech departments for those students having these problems.
University of Texas at San Antonio School of Nursing
The Program for Educational Opportunity, under which 25 culturally, financially, and academically disadvantaged




- so -

students were enrolled at Austin, is being discontinued after two years of operation. Project Information, a studentoperated effort to recruit academically qualified students from the lower economic areas, is being accelerated. In the Nursing School one of the major emphases is the promotion of the junior colleges for prenursing education; and the baccalaureate curriculum is designed to accommodate transfer students at the junior year level.
Also, a new financial aid policy has been recently adopted, relating to grade-point averages and course load requirements, which should favorably affect disadvantaged students.
The need for statewide planning has become increasingly obvious, as projects of this nature are being developed by various agencies and organizations. In the San Antonio area, three projects are in operation: (1) Project STAY (Scholarships for Able Youth) is a talent search operation throughout the poverty areas of the city. Financial aid is sought for their places. (2) An Opportunity for Health Careers is a proposal submitted for consideration for foundation support b y the University of Texas Medical School at San Antonio. The intention is that medical, nursing, and dental students, receiving st ipendary support, would recruit disadvantaged students from the local public schools, provide tutorial




- 51 -

assistance as needed, and sponsor activities at the Medical Center to generate and sustain interest in health careers.
(3) The Careers Committee of the Texas Nurses Association may submit a proposal for federal funding for the recruitment of the disadvantaged into nursing programs. The effort will be made to enlist the cooperative sponsorship of several organizations concerned with the promotion of health careers. Activities at both the high school and nursing school levels are to be included. It is further proposed that a pilot area, such as San Antonio, be selected for initial implementation.
Evaluation
One of the best features of these programs appears
to have been the involvement of the administration in schools where the programs have taken place. Such administrative assistance has allowed changes in scheduling, and has helped to mold the curriculum to fit the needs of each program.
Another feature which is a vital element in the
success potential in the nursing programs is the emphasis upon training teachers. This emphasis focuses on the recognition that middle class teachers have difficulty in relating to the lower class student. Special classes for teaching
teachers about the life of the lower class have not been a feature of previous programs.




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One disadvantage of the program is that the setting of realistic goals, the assessment of one's ability to reach these goals, and a planned program leading toward these goals are missing from the stated objectives of most of the programs.
It appears that the programs have concentrated upon success of a learning situation which will ,),iel'd results rather than upon specific behaviors that are related to school success. In planning a program for disadvantaged students, a mor e functional curriculum can be produced if the results of studies of learning by the behavioral scientists are used as a basis and then translated into experiences which yield measurable results. Using this approach a program would provide skills and content as well as needed changes in the way an individual may approach a learning task.
All of these reports emphasize the need for basic
theoretical design for curriculums for disadvantaged students. There appears to be an urgent need to connect causal factors to educational efforts in order to determine the effects of educational efforts on the elimination of the effects of causal factors.
All of the reports summarized here show some attempt to aid the disadvantaged student. However, they all lack techniques that will be used to raise the academic level of




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these students, techniques which the writer feels are important factors in planning a curriculum. The core of the problem of educational deprivation seems to be to facilitate the learning process. The problem thus involves a high level of achievement motivation, a facilitating value system, and a high level of conceptualization. It appears that in the review of programs presented they have not concerned themselves with the above factors which are important for facilitating the learning process. In view of this evaluation there appears to be an urgent need to propose a curriculum for. disadvantaged students that will concern itself with these factors.




CHAPTER IV
CURRICULUM DESIGN
In order to formulate some assumptions for
curriculum development, it has been necessary to describe first the factors associated with the disadvantaged student's problems and the effect of these factors on the learner and the learning situation. Some proposed programs for disadvantaged students in nursing schools were presented 0 Chapter III. It is clear that most of these programs do not meet the requirements of specifying how they will overcome pupil deficiencies.
In most of those schools reporting, the goals of the programs were short term. No provisions were made to sustain the student when he encounters higher level of difficulty in subject matter. There was no consideration given to increasing his level of achievement, level of conceptualizing or the development of an adequate value system.
Therefore, in order to develop this curriculum, the design described in Criteria for theories of instruction (Gordon, et al. (1968)) is being used. It requires a statement of pupil characteristic, which in effect has been presented in Chapter I!, a statement of goals, and then a description

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- 55 -

of the means to be used to attain these goals (see Fig. 1). The following pages present the goals and the proposed curriculum design.

Pupil Characteristics

Instructional Situation
Characteristics

Goal Characteristics

Fig. 1: Design for Curriculum
Sozirce: This figure is from Criteria for theories of instruction, prepared by The ASCD Commission on Instructional Theory, Ira J. Gordon, Chairman and Editor, 1968, used with
permission of author, p. 17.




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Broad Goals
Educators can meet the considerations raised on the first page of this chapter if, in proposing curricula for Baccalareate Nursing programs, they consider the following assumptions as their broad goals. The student must:
I. Become aware of man as a sociopsychobiological
being functioning in an everchanging environment.
2. Acquire adequate knowledge, understanding and
skills that are necessary for the nursing role.
3. Develop knowledge of the process of change as it
relates to society's changing health needs.
4. Achieve success as he progresses to attain new
goals.
Specific Outcomes
1. The student is able to identify the role and
functions of the family members and their relationship to family dynamics.
2. The student is able to recognize the relationship
of the family to the community.
3. The student is able to identify characteristics
of a profession and relate these to nursing.
4. The student has knowledge of necessary terminology
and ability to apply these to health care.
5. The student has ability to identify basic human
needs, expressed through the patient's behavior,
and to assist the patient in growth towards
gratification of these needs.
6. The student has ability to relate observed behavior
to the disease process.
7. The student has ability to relate theories and
concepts to observed behavior and to demonstrate
applications of these in nursing procedures.




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8. The student is able to identify major biological,,
emotional, social and intellectual characteristics
of each age/stage of developmennt.
9. The student is able to define the major concepts
and principles related to growth and development,
and their relationship to health care.
10. The student is able to identify concepts of growth
and development which determine selection of goals
and intervention in care of patients.
11. The student must have a knowledge of common elements
contributing to emotional stress and the influence
of cultural, social and psychological factors.
12. The student must have a knowledge of the meaning
that a threat may have to the body image or that a state of health may have on the patient's self,concept.
13. The student is able to differentiate between several
kinds of communication for the purpose of establishing appropriate intervention.
14. The student is able to identify nonverbal communication patterns as a meaningful form of
communication.
15. The student has ability to collaborate with other
health workers in the coordination of the services of the health team as they relate to patient care.
Student Selec~tion
The following techniques may be utilized in the
selection of students:
1. Establishment of economic criteria
2. Evaluation of potential capability
3. Personal interviews
4. Evaluation of written statements of goals by the
students
5. Evaluation, if necessary, by individually
administered -tests.




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Economic Criteria
Unusual or definably different economic circumstances as described by the economic opportunity guidelines may serve as a starting criterion. This income limitation is $3,300 for a family of four with an addition of $700 for each other family member.
Potential Capability
Another kind of student is one whose record shows ingenious misbehavior. She tends to demonstrate her potential and creativity by finding ways to "beat the system." Such students should be identified and encouraged to work toward self-sustaining rather than self-defeating goals. Students who drop out of school are often brighter than many who remain. The ability to recognize that the only way to preserve an intact self is to leave the situation is often indicative of more intelligence and potential capability than our middle class society is usually able to recognize. Further, standardized tests of academic aptitude, as they are typically used, do not realistically reflect a disadvantaged student's true capacities or potentialities.
Some tests, however, can be utilized, if they are interpreted by persons who are aware that performance on such tests is highly correlated with socioeconomic status and that students from grossly unequal backgrounds should not be expected to perform according to middle class standards.




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Therefore, in evaluating and identifying students who are potentially capable, one needs to consider the following factors:
1. High academic averages, but poor test scores
2. An expressed desire to "better myself"
3. The academic status of the high school which the,
student attended
4. Personal background that would have interferred
with normal 'Scholastic development. Other Factors in Selection
Personal interviews by qualified and sensitive
staff members are vital factors in identification of such students who could benefit most from this program. Written statements by these prospective students in regards to their goals and to their concepts of self are valuable if these sentiments are interpreted by a qualified staff person.
In some instances, where potential is questionable, the administration of individual intelligence tests can be a helpful tool.
The administrators must take care, however, not to interpret the test results completely according to middle class norms. It is often more important to consider performnance within and between sub-test areas than to rely upon the total score. Consequently, extremely high risk students receive consideration but are usually thoroughly investigated.




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Instructional Situation Characteristics
If the curriculum design is to provide factors that will enhance academic progression, more effective strategies of teaching are necessary. Ausubel (1969) suggests three considerations for an effective and appropriate teaching strategy for the educationally disadvantaged student. These are:
1. The selection of initial learning material geared
to the learner's existing state of readiness.
2. Mastery and consolidation of all on-going learning
tasks before new tasks are introduced so as to provide the necessary foundation for successful
sequential learning and to prevent unreadiness for
future learning tasks.
3. The use of structured learning materials optimally
organized to facilitate efficient sequential
learning.
Readiness.--This curriculum design will take into consideration the readiness of the disadvantaged student. The starting point will be the student's point of existing knowledge, no matter how far down the scale this happens to be. Ausubel (1969) feels this policy demands eliminating all subject matter that the student cannot assimilate on the basis of his current level of cognitive sophistication. It may mean acquiring basic academic skills before any attempt is made to teach him the subject at hand. For example, it may be necessary to teach basic computational skills before any attempt is made to teach algebra or geometry. This is




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not to perpetuate the status quo; it is an important beginning step in preparing the student to cope with advanced subject matter.
ConsoZlidation.-Before introducing new subject matter, the ongoing subject matter should be mastered. Sassenrath (1959) believes that prior learning is not transferable to new learning tasks unless they are first overlearned. This curriculum design will provide an opportunity for spaced repetitions, reviews, and immediate Stdiah&." StVdnts wilr be in smali g-ohps to integrate their concepts with their practical experience. This small group discussion will provide the opportunity for overlearning.
Materials.-In order to. provide continuity with the integrated approach of this curriculum design, materials from multimedia will be utilized. The material will be appropriate to the experience the student is having at the time. A survey should be made of the community for available media pool. Materials will be selected from such a pool as the student's experiences warrant. These may be films, libraries, newspapers, magazines, video tapes, etc.
Specific Subject Matter
Nursing education is essentially interaction between the nursing student, the teacher, and the patient. The




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content in this curriculum design is geared to develop an awareness in the disadvantaged student to changes in society and in. its needs as they relate to health care; in effective communications with patients as well as other members of the health team; and in being a change agent.
The needs of the patient will be a priority for the nursing student. The use of the nursing procedure will develop the student's skills in observation, information gathering, formulation of hypotheses, implementation, and evaluation. This approach allows for increasing levels of achievement, levels of conceptualizing and the development of a more adaptive value system. This approach also allows for personal growth of the patient.
Curriculum Structure

First Year
First Semester
Physical and Biological
Sciences English
Social Sciences (Sociology
and Psychology) Mathematics Nursing Laboratory

Second Semester
Physical and Biological
Sciences English
Social Sciences (Sociology
and Psychology) Mathematics Nursing Laboratory

Summer Session

Summer Session




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Second Year
First Semester Second Semester
Physical and Biological Physical and Biological
Concepts as They Relate Concepts as They Relate
to Normal Physiological to Levels of Illness
Functions
Nursing Laboratory Nursing Laboratory
Summer Session Summer Session
Supportive Services
In addition to the formal class work, this curriculum requires a learning laboratory to assist the student when help is needed. Student attendance at the learning laboratory may be by teacher assignment or by student choice.
In addition to the English course the curriculum
will provide a communications laboratory. Language skills will receive attention in the laboratory as well as in all other subject areas. It is believed that such language skills as grammar, spelling, and punctuation develop personal meaning and promote competency when they are integrated with other areas. They will be given special emphasis on an individual basis in the learning laboratory.
This curriculum provides the following broad areas of knowledge that must be completed in lower division course work.




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First Year-First Semester and Second Semester
Physical and Biological Sciences
Anatomy and Physiology. -This course is designed
for nurses to help them acquire knowledge and understanding of normal andA abnormal anatomic and physiological functioning of the human body. Laboratory experience is geared to humans. Specimens from cadavers will be used throughout the course. This is not the traditional course of anatomy and physiology.
Chemistry. -This course is designed to include
one-third organic chemistry, one-third inorganic chemistry, and one-third physiological chemistry. It is designed to help the nurse acquire a sufficient amount of such knowledge in a course to enable them to function as intelligent consumers of scientific information. It is not the intent to teach nurses to become chemists, so this course is different from the traditional course in chemistry.
Microbiology. -This course is designed for nurses
to help them gain sufficient understanding of the habitats, methods of transfer, and means of control of microorganisms. This is not t-he traditional course of microbiology.
General Education
English.--This course is designed to help the nurse
to gain knowledge and skills in grammar, writing and reporting.




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There will be emphasis on oral and technical language. This course is different from the traditional course in communications.
Principles of Sociology.-This course is designed to help the nurse gain knowledge and understanding of the basic elements of culture, communities, social institutions and social change as they relate to health care. The format as well as content is geared for nurses and is not the traditional social science course.
General Psychology.-This course is designed to
help the nurse gain an introduction to the study of problems of human behavior. The areas to be explored are heredity, development of the individual, motivation, emotion, learning, sensation and perception. This course provides the content that nurses need in the problems of adjustment that arise in the nurse as well as to the person whom ministry is given. This course is different from the traditional course.
Nursing Laboratory.-This practicum is designed to give the student early exposure in a hospital or community health agency. This exposure is to afford the student a clearer picture of the nursing profession and to be sure of their choice of the profession.
Mathermatics.-This course is concerned with common and decimal fractions, percentages, averages, powers and




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roots in arithmetic, formulas, and simple equations. This knowledge would be of value to the nurse in the understanding of some of the principles of physics met in the use of certain nursing procedures and equipment, such as gastric suction, traction, and even in the use of good body mechanics. This is not the traditional basic math course, but starts where the students are and introduces them to the mathematical operations required on the job before moving to mathematical concepts.
Physical and Biological Concepts
The curriculum structure in the second year consists of Physical and Biological Concepts being given concurrently with the Nursing Laboratory. These courses should be presented in such a way that they complement each other. A continuous interchange and planning is required by teachers of both courses. The emphasis in this course should not be subject matter as such, but application to help the student achieve the basic assumptions noted earlier in this chapter. Junior Year
First and Second Semester
The following broad areas will be explored using an interrelatedness approach to health care.
Family Dynamics
Psychosociobiological Concepts




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Concept of Stress
Growth and Development
Communication
Nursing Procedure
Personality Development
Psychopathology
A Nursing Laboratory will be a major part of this content.
Senior Year
First and Second Semester
The above broad areas will be explored in greater depth, utilizing the Nursing Procedure. The Nursing Laboratory will be a major part of this content.
Organizational Structure
Level I Nursing--Junior Year.--This course would be presented in an integrated approach to the development of concepts relating to communications, human growth and development, levels of health, stress, and psychosociobiological areas as they relate to normal physiological functions.
Level II Nursing.--This is a nursing practicum. The
student is involved in a health agency exploring the concepts from Level I Nursing, utilizing the Nursing Procedure. This course is taken concurrently with Level I Nursing.




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Level III Nursing-senior Year.-Concepts of
psychopathology and personality development will be presented on an integrated approach as they relate to levels of illness.
Level IV Nursing. -The student is involved in a health agency exploring Level III concepts by utilizing the health procedure. This course is taken concurrently with Level III Nursing.
Subject content courses or Nursing Practicums
should be completed by students at the student's own rate. Therefore, emphasis should not be placed on grades, but on successful completion of a course, even if it means taking a course in the span of two semesters. Such emphasis requires a change in the traditional grading system to accommodate this type of academic training for this profession.
Whether or not a student is outstanding would be
based upon individual success in any area of study and determined by a pattern which would indicate a high level of conceptualization, a high level of motivation, and an acceptable value system. This design would involve training teachers in preservice as well as in in-service programs. Teachers involved in this curriculum would need to be cognizant of the teaching strategies described above which are needed to influence the learning styles, the level of




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aspiration, and the value system of the disadvantaged student. Most important of all, these teachers would need to know more about the characteristics of the disadvantaged and of his subculture.
Administrative Assistance
This curriculum design, also, requires the assistance of administrative officers who are interested in equality of education. Morphet and Johns (1967) believe the administrative officer's democratic action will promote the group or individual creativity, productivity, and satisfaction without harm to other groups or individuals. This type of administra,tive attitude respects the dignity of individuals or groups that is consistent with democratic behavior.
The administration must show a definite expression or concern for the welfare of disadvantaged students. Too often, the affairs of the university are so organizationally oriented that the student is the last to be considered. The administration should periodically ask for a report of progress being made in the welfare of the disadvantaged student. In order for counseling services to provide effective assistance to disadvantaged students,.there must be philosophical and financial commitment. Administrative officers, counselors, and instructional staff should work together in




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making necessary provisions foi, courses in assisting the disadvantaged student in learning how to study as well as budgeting of time.
Counseling Services
This curriculum design will require the assistance of counselors to whom the students can relate. Counselors should realize that each student brings to the counseling scene a different set of attitudes, interests, and abilities regardless of his group membership. When the counselor has some knowledge of these differences and takes them into account during the counseling sessions, all students can benefit from the counseling services. The counselor Must have knowledge of the life style of the disadvantaged student. They must be able to structure a warm and accepting helping situation to enhance the success of the counseling session. Counselors need to know how to plan a goal attainment strategy; and they need to know what alternatives the students have. Such knowledge will help the disadvantaged student make realistic attainable goal choices.
Because of the low incomes of most disadvantaged students, many of them will need financial assistance. Analysis of financial need will reveal many aspects of family life which are different. Counselors assisting students with applications for financial assistance should




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be aware that the life style of a disadvantaged student's family will differ from his own and that the evaluation of financial necessity should be within the context of the applicant's family pattern. Further, these students may need assistance in completing the application forms. When giving such assistance special care should be taken so that questions which may prove to be embarassing to disadvantaged students will not harm the counseling relationships.
Clarke feels guidance means to help the student
through the hurdles of admission and registration procedures. She states "Many students are lost before entering the college because of the formality of procedures. Their lack of sophistication in these procedures tends to 'turn them off "' (Clarke, 1970, p. 17).
Disadvantaged students are less familiar with the
formal atmosphere of the college. They need special orientation to the college. They are less apt to explore the unfamiliar environment, they are uncomfortable in the presence of so many unknowns, they are reluctant to ask directions for fear of betraying their lack of information.
College orientation should be, if at all possible, counselor initiated activity designed to acquaint the student with those aspects Of college life which most students discover themselves. Procedures which are usually given in large orientation sessions should be reinforced in informal




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casual settings. Informal introductions to those staff persons in charge of various operations of the college such as the bookstore, Registrar's staff, staff of the finance office, and the libr ary staff should be arranged. When the disadvantaged student is enabled to bring the routine operational aspects of the college within his perceptual field and develops the ability to cope with his relationships to these operations, he becomes more open and more accepting to his other experiences at the college.
Both counselors and students can learn from eacn other in informal exchange in the lounges and other areas where students gather. It is in this type of exchange that the disadvantaged student becomes more communicative and begins to develop feelings of belonging.
Organization for Instruction
The teachers selected for the program must be able to create a warm and accepting classroom atmosphere and should also be capable of structuring a learning environment conducive to student success. These teachers should be selected on the basis of their genuine interest in and knowledge of the characteristic of the disadvantaged student. They should have knowledge of learning theories as well as knowledge of teaching strategies that will. enhance behavioral change in the disadvantaged student. Equally




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important, the teachers should be self-confident and flexible. They should indicate a willingness to have their sessions audited and a willingness to consider more effective techniques for presenting different learning tasks.
The organizational structure of such a curriculum
as this should include persons with knowledge of many areas and with the knowledge that planning and implementing learning experiences should be a team effort. The aim of the program, therefore, is to view the student as a whole;for to isolate any area of the student's academic deficiencies and to focus on this area would insure lit-tle success. Because the student needs constant reinforcement when the knowledge, skill, and understanding of many disciplines are used to help her to develop academically and when all instructors unite in their efforts to reinforce each discipli ne the least competent student will experience success. It is evident then, that team teaching is the appropriate approach for this curriculum design.
EvaZuation
The evaluation of the effectiveness of this
curriculum will Inot be measured by the progress which the student makes on tests. However, standardized tests (in spite of their biases) of cognitive achievement (SCAT, etc.) and assessment of tile affective domain (self-concept scale,




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self-reports, etc.) will be utilized at the beginning of the program to develop local norms and to determine predictive measures.
The evaluation of the effectiveness of this
curriculum should be measured by behavioral changes and changes in academic status of the students. Evaluation should, also, include reviewing the overall objectives of the curriculum to see if these objectives have been met. Thus behavioral change in students appears to be an important facet in evaluating a design of this nature.
Suggested Research
This program should be designed to provide data on such issues as:
1. Different effects on the disadvantaged student's
ability to learn by the teaching strategies presented in this design opposed to the traditional
approaches. This would require that the disadvantaged students be randomly assigned to different approaches.
2. Different effects on the disadvantaged student and
the nondisadvantaged student's ability to learn by
the teaching strategies presented in this design
opposed to the traditional approaches. This would require that nondisadvantaged students be randomly
assigned.
3. Such a research effort not only requires random
assignment of both groups to both treatments, but




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also the development of a set of pre- and postmeasurements. These can include the traditional achievement tests, but should also be developed and based on the specific outcomes described in
this chapter. That is, for example which student, when employed as a nurse, is better able to relate
observed behavior to the disease process? The
ultimate test, then, of this curriculum, is job performance and the quality of life, not grades
and test scores.
Summary
To a considerable degree the history of the American
school curriculum revolves around one important question:
How can the curriculum best provide for the educational.
needs of each learner? Throughout our history a general
curriculum has been considered adequate for all. In the
nineteenth and twentieth centuries, educators have become
concerned about individual differences. The abundant
knowledge about individual differences has created tremendous. conflict among curriculum planners. This question
and its resolution were sharply and clearly stated in the
Rockefeller Brothers' Fund (1953) report on education:
From time to time one still hears arguments over
quantity versus quality education. Behind such arguments is the assumption that a society can choose to
educate a few people exceedingly well or to educate a
great number of people somewhat less well, but that it
cannot do both. But a modern society such as ours
cannot choose to do one or the other. It has no choice
but to do both. Our kind of society calls for the
maximum development of individual potentialities at
all levels (p. 22).
Fortunately the demand to educate everyone up to
the level of his ability andl the demand for excellence in




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education are not incompatible. We must honor both goals. We must seek excellence in the context of concern for all.
It is hoped that this design will solve some of
the problems encountered by curriculum planners in nursing education. The theoretical framework which has been attempted here provides a basis for curriculum -planning .solutions. It is hoped that what is described and assumed in this design, if implemented, will produce behavioral changes t1hat are needed at this time for the disadvantaged student in a Baccalaureate Nursing program.




REFERENCES

Amos, W. E., & Grambs, J. Counseling the disadvantaged
youth. New Jersey: Prentice-Hall, 1968.
Anderson, B. E. Some paradoxes in nursing. Teachers
College Record, January, 1953, 54, 213.
Ausubel, D. P. A teaching strategy for culturally deprived
pupils: Cognitive and motivational considerations.
Readings in school learning. New York: Holt,
Rinehart, & Winston, 1969, 407-417.
Ausubel, D. P., & Ausubel, P. Ego development among
segregated Negro children. Readings in school
Learning. New York: Holt, Rinehart, & Winston,
1969, 418-460.
Bernstein, B. Social class and linguistic development:
a theory of social learning. In A. H. Halsey, J.
Floud, & C. A. Anderson (Eds.) Education, economy, and society. Glencoe: Free Press, 1961. P. 228.
Bernstein, B. Education cannot compensate for society.
New Society, 1970, 26, 344-347.
Berkowitz, L. The development of motives and values in the
child. New York: Macmillan, 1964.'
Bixler, G. K., & Bixler, R. W. The professional status of
nursing. American Journal of Nursing, August, 1959,
59, 1144.
Bloom, B. S. Stability and change in human characteristics.
New York: John Wiley & Sons, 1964.
Bloom, R., Whiteman, R., & Deutsch, M. Race and social class
as separate factors related to social environment.
Paper presented at the meeting of the American
Psychological Association, Philadelphia, September,
1963.
Bridgman, M. ColZegiate education for nursing. New York:
Russell Sage Foundation, 1953.

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Bruner, J. S. A study of thinking. London: John Wiley &
Sons, 1957.
Bruner, J. S. On going beyond the information given. The
cognitive processes. New Jersey: Prentice-Hall,
1964.
Childs, J. L. Education and morals. New York: AppletonCentury-Crofts, 1950.
Clarke, J. R. A curriculum design for disadvantaged
community junior college students. Doctoral
dissertation, University of Florida, April, 1966.
Clarke, J. R. What's the hang-up? Poor people-poor
education. Occupations and Education in the 70's
Promises and Challenges. Washington, D. C.:
American Association of Junior Colleges, 1970, 15.
Coleman, J. S. Equality of education opportunity.
Washington: Government Printing Office, 1966.
Deutsch, M. P. The disadvantaged child and the learning
process. Education in depressed areas. New York: Bureau of Publications, Teachers College, Columbia
University, 1963.
Dewey, J. Philosophy of education. New Jersey: Littlefield,
Adams, & Co., 1950.
Dole, A. Reported determinants of educational choice.
Personnel and Guidance Journal, 1964,42,564-570.
Gardner, J. W. Excellance. New York: Harper & Row, 1961.
Goldmark, J. Nursing and nursing education in the United
States. New York: Macmillan, 1923.
Gordon, E. W., & Wilkerson, D. A. Compensatory education
for the disadvantaged. New York: College Entrance
Examination Board, 1966.
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Grier, William H, O Cobb, Price M. Black rage. New York:
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Harrington, M. The other America. New York: Macmillan,
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Havighurst, R. J., & Neugarten, B. Society and education.
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Hullfish, H. G., & Smith, D. G. Reflective thinking.
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Riessman, F. The overlooked positives of disadvantaged
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Doubleday & Company, 1958, 22.
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BIOGRAPHICAL SKETCH

Hattie Bessent was born, December 26, 1926, in Jacksonville, Florida.
She graduated from the Florida Agricultural and
Mechanical University in 1959 with a B.S. Degree in Nursing. She received the Master of Science Degree with a major in Psychiatric Nursing at Indiana University in 1962.
From 1962-1967, Miss Bessent served in the capacity of Assistant Professor of Psychiatric Nursing at Florida Agricultural and Mechanical University. In 1968, she received a career teacher's grant from the National Institute of Mental Health utilized at the University of Florida.
Miss Bessent has published articles in the Journal of Psychiatric Nursing and is a member of Pi Lambda Theta, Sigma Theta Tau, and Delta Sigma Theta Sororities. Miss Bessent is the sister of Miss Marion Bessent, an elementary school teacher of Jacksonville, Florida, and the granddaughter of Mrs. Susie Robinson of Jacksonville, Florida.

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I certify that I have read this study and that in
my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Education.
Ira J. Gor on
Professor f Education
I certify that I have read this study and that in
my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Education.,
Donald L. Avila
Professor of Education
I certify that I have read this study and that in
my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Do tor o -ducatio'.
obert Emile ter
Associate ro- ssor of Education
I certify that I have read this study and that in
my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Education.
Polly Barton
Associate Professor of Nursing




This dissertation was submitted to the Dean of the College of Education and to the Graduate Council, and was accepted as partial fulfillment of the requirements for the degree of Doctor of Education. December, 1970
Dean, Coll"4ge.of Education
Dean, Graduate School




Full Text

PAGE 1

A CURRICULUM DESIGN FOR DISADVANTAGED STUDENTS IN A BACCALAUREATE NURSING PROGRAM By HATTIE BESSENT A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION UNIVERSITY OF FLORIDA 1970

PAGE 2

ACKNOWLEDGMENTS The writer wishes to acknowledge the financial support from a grant for Nursing Research from the National Institute of Mental Health. I wish to extend special thanks to Dr. Ira J. Gordon who helped me to develop myself as a person as well as to appreciate learning as an art. To Dr. Johnnie Ruth Clarke and Miss Annie Laurie Crawford and all the friends who gave their books, their good wishes, and their support : during this period I am extremely grateful. To my grandmother, Mrs. Susie Robinson, and my sister, Miss Marion Bessent, thanks for your love and pa tience. To the faculty, students, and staff of the College of Education, expecially those in the Institute of Human Development, I extend my sincere thanks for your kindnesses.

PAGE 3

TABLE OF CON1'ENTS ACKNOWLEDGMENTS Page ii AB s TRAC rr C V INTRODUCTION ....................... . . . l Chapter I. II. I I I. IV. Significance . . . . . . 8 Proaedul'es ...... Cl 9 Forinat for Chapter Developm e nt . . 10 NURSING EDUCATION AND ITS INFLUENCE ON A DYNAMIC DEMOCRACY ................ American Educational Ideals THE CHARACTERISTICS OF THE EDUCATIONALLY DISADVANTAGED Lower Class Status and Academ i c 12 12 17 Aahie-vement ~........................ 23 Lower Class Status and Motiva t ion ...... 24 Cognition . . . . . . . 3 0 Values . . . . . . . . .. 35 Human Behavior and Change .............. 38 REVIEW OF SOME PROPOSED PROGRAMS FOR THE DISADVANTAGED STUDENT IN NURSING PROGRAMS ...................... 41 Evaluation . . . . . . . 51 CURRICULUM DESIGN ........................ Student Selection ........... ......... Curriculum Structure .................. First Year-Firs t Sem e ster and Se c ond S em es t er ................ Organiza t i o na'l Structure .............. iii 54 ,. ..., :, I 62 64 67

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TABLE OF C0N'f E NTS -Contim 1e d Page REFERENCES .................... ..... .. . . . 7 7 BIOGRAPHICAL SKETCH 80 jy

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Abstract of Dissertation Presented to the Graduate Council of the Universi t y of Flor ida in Par t i a l Fu l fil l ment of the Requirements for the Degree of Doctor of Education A CURRICULUM DESIGN FOR DISADVANTAGED STUDENTS IN A BACCALAUREATE NURSING PROGRAM By Hattie Bessent December, 1970 Chairman: Dr. Ira J. Gordon Major Department: Psychological Foundations of Education A major concern of baccalaureate n ursing programs is a curriculum design for disadvantaged youth. The increasing needs for the various types of health services provided by the nursing profession make it imperative that more people be educated for these services. Therefore, the vast source of manpower and/or womanpower represented by the disadvantaged must be tapped in order to secure enough personnel to meet the growing demands of the health services in general and of nursing in particular. Thus, education in nursing must be set up to recapture the talent of the disadv a ntaged students. In a period of social change, institutions must deal with social realities, and professions must also examine themselves and their training pTograms. If we ai:cept that both institutions and professions are concerned with V

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competence and that society is concerned with equal educational opportunity, we must bring these two goals together. We must develop competent nurses from people who, because of society, have been denied the entry skills required for success in a baccalaureate nursing program. The purpose of this study was to develop a design for a curriculwn to meet the educational needs of disad vantaged students in the baccalaureate nursing program. Because factors such as motivation, cognitive deficit, and operating valuei can be adequately treated by the school, the study was limited to those factbrs which can be treated within the scope of a baccalaureate nursing program. The study proceeded on the basis of three postulates, which are stated as follows: 1. Disadvantaged students need to perceive themselves in essentially positive ways. 2. Disadvantaged students need to develop a hierarchy of values that will enhance mobility within the general society. 3. Disadvantaged students need to develop cognitive, conceptual, and social skills necessary for the accomplishment of their goals. In addition, this study gives a description of the disadvantaged student. Emphasis was placed on the disad vantaged student's social, economic and environmental experiences as they relate to his educational achievement. The study also explores the concept of change as it relates to the disadvantaged student in the following aspects: vi

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1. Changing cognitive style 2. Developing an adequ a t e value sys t em 3. Raising the level o f aspirations A review of some proposed programs in nursing was explored for their adequacy in meeting the needs of the disadvantaged student. The characteristics of the disad vantaged student were presented; assumptions were made regarding this student being in v olved in this curriculum design; a teaching strategy was presented; and expected behavioral outcomes were presented. The focus was on the continuous process of transaction between the pupil characterist i cs, instructional situation characteristics, and goal characteristics. Suggested research was recommen d ed. vii

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INTRODUCTION Statement of Problem There are now approximately 70,000 administrators, teachers, supervisors, and head nurses employed in hospitals and nursing schools throughout the United States. Yet, this number is insufficient. It is insufficient because schools are not producing enough nursing students. For this reason colleges and universities need a baccalaureate curriculum of sufficient breadth and strength to develop proficiency for expert professional nursing practice. To provide a source of supply for advanced positions, there must be considerably more students in collegiate undergraduate programs. There must be expert clinicians with a broad educational background for research functions in nursing to contribute to health jnformation, to segregate and analyze the components of good nursing care, and to contribute the specific knowledge and skills requisite for various kinds of nursing. Neither the public nor educators, in general, uniformly understand the reasons why sound basic coll egiate education is a requirement for the most skilled duties of the professional nurse and for her advancement. The iso lation of nursjng education from educational institutions 1

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2 has limited communications between teachers and students in nursing schools and in their counterparts in other courses of study. Thus, nurse educators have not had much access to the usual means of continuously examining, with others, the purposes, methods, and needs of a dynamic educational program. Even many nurse educators fail to completely understand the implications of the changes that are taking place in the scope and nature of nursing practice. Because scientific and technological advances have revolutionized medical practice and health services, every new development in the health scie11ces has creat e d ne w responsibilities and new challenges for nursing. The major goal cited by baccalaureate programs in nursing, therefore, is to provide the educational experiences which will enable the graduate of the program to function as a professional nurse in beginning positions in nursing, including Public Health Nursing. The health industry will probably become the largest employer of manpower in the middle 1S70s. This industry will require additional professional nurses d1 awn from a large number of students previou s ly attracted to nursing. Nursing educators must develop a curriculum to provide the basic preparation for nursing practice, to provide for eligibility to pursue advanced study in research methodology, to provide cl i n i ~al practice in specialties, and to provide program s of communjty health mainten a nce and promotion.

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3 The nation is currently being challenged by the growing paradox of poverty, especially for the plight of those citizens whose heritage places them at an educational disadvantage making it difficult, if not impossible, for them to fully utilize educational opportunities of which the rest of society avails itself. The GoZdmark Report (Goldmark, 1923, pp. 486-497) was the first in a series of studies aimed at upgrading nursing education and~ hence, nursing. Listing the advantages and the standards of a university school of nursing, the GoZdmark Report recommended that educationally unrewarding routine service be eliminated. It recommended that college work of a liberal nature with a thorough grounding in the fundamental sciences be seen as essential content for professional nursing education. Margaret Bridgman (1953, p. 14) recommended higher education, at least for teachers and administrators of nursing. Although noting that the hospital schools had improved, she said: "The development of other educational facilities (in institutions of higher education) has been so slow as to leave the total picture substantially unchanged." She set the establishment of broad, strong baccalaureate curriculums as the first requirement in preparing nu rses for professional employment. Bridgman stated that these programs should include general content,

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4 profession-related content, and a major in nursing with both lowerand upper-divisi on courses. For universities to prepare students for professional practice, certain conditions must be obtained : "Policies applied to nursing are consistent with general standards of colleges and uni versities, nursing students receive the benefits of genuine college education, and nursing degrees are authentically representative of the completion of an upper-division major in the degree granting institutions" (Bridgman, 1953, p. 97). Bernice E. Anderson said: "It is curious that while the environment in which the nurse learns has gone ahead so rapidly and other types of education have progressed, education for nursing has been caught in some backwash and has not gone along with progress in related fields" (1953, p. 213). More recently, Genevieve and Roy Bixler (1959, p. 1144) remarked that: "Considering the expansion of col legiate education since the end cf World War II, the expansion in nursing education is not remarkable." The noncxpansion may be due to inadequate provisions having been made for the great diversity in student population in the collegiate nursing program. The large numbers of failures or dropouts may be attributed to the failure of the collegiate nursing program to implement all of its functions. If the collegiate nursing program is to fulfill

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s the educational demands of all its student population, it must first make adequate provisions for that group oi students who are not ~chieving an adequate level of compe tence for self-fulfillment. These are the disadvantaged students of th~ collegiate nursing programs. The growing need for professional nurses can serve as a catalytic force in developing a 1asic collegiate curriculum which ~ake~ ac~ount of the special needs of disadvantaged students. In order to increase the yield of desperately needed professional nuries from these previously deprived groups, it will be necessary to develop a system atic curriculum designed to attain this specific goal. The evidence is now overwhelming that high intellectual potential exists in a larger percentage of individuals from lower status groups than has been previously discovered, stimulated= and trained for socially beneficial purposes. For this study, the disadvantaged student is defined as one who does not exhibit abiJ.ities and skills which the collegiate nursing program usually deems adequate for n~rmal progress through the regular program. Such a program must provide means for attracting and recruiting larger numbers of disadvantaged students than have been previously attracted to the nursing profession. Further, it must offer a program of studies which will

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6 consider the varying levels of acad~~ic and social proficiencies which this group of stud e nts possesses. This nursing curriculum designed for disadvantaged students should also consider the aspirational level, the cognitive style, and the operating value system of the disadvantaged student; Also, this educational program for the disadvantaged must change the attitudes of teachers and of school adminis trators from one of rejection and fatalistic negation to one of acceptance and of a belief in the educability and human dignity of these students. It must emphasize suc cessful accomplishment and goal attainment. The educaticnally disadvantaged youth has a negative self-concept, a feeling of being trapped, an unending prospect of no hope, and a self-denial of ability to control their own futures Amazingly, many of the students involved in projects for the disadvantaged view these programs as a hope, a second chance, an opportunity to break through the ceiling imposed by poverty and failures. A collegiate nursing curriculum, therefore, should be designed to create situations wherein the students can achieve success, can discover new horizons, and can develop faith and positive expectations within themselves. Since these students ar e more accustomed to experiencing failure than success, the program should provide situations with

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7 imm e diat e positive reinforcement. Snnll successes work well in developing self-confidence and in providing a desire to continue. Nursing curriculums should proceed on the assumption that many talented and potentially capable students do not achiev e acad em ically bec a use of economic, social, and/or environmental deprivation. But they do succeed because of their strong desire to excel. One of the re a lities of the contemporary world is that the destiny of one group of students is tied to the destiny of all other groups of students. Our collegiate nursing schools can no longer afford the luxury of serving an educationally elite group. Approximately one-third of the nation's youth fall into the category of disadvant a ged and are imbued with educationally associated problems that arise from the culture of the poor. Riessman (1962) estimates that by the end of 1970, one-half of the nation's youth will be labeled as educationally disadvantaged unless new and developing progr a ms are successful. The increasing need for the various types of health services provide d by the mnsing profession makes it impera tive that more p e ople be educ a ted for these services. Therefore, the v a st source of manpower and/or wom a npower repres e nted by the disadv a ntaged must be tapped in order to secur e enough pe r sonnel to me e t the growing d ema nds of th e

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8 health services in general and of nursing in particular. So, education in nursing must be set up to re~apture the talent of the disadvantaged students. Therefore, the purpose of this study is to develop a design for a curriculum to meet the educational needs of disadvantaged students in the collegiate nursing program. Because factors such as motivation, cognitive deficit, and operating values can be adequately treated by the school, this study will be limited to those factors which can be treated within the scope of a collegiate nursing program. Therefore, this study will be concerned with developing a curriculum base which will help the disadvantaged student to successfully pursue nursing as a career. The study will proceed on the basis of three postulates, which are stated as follows: 1~ Disadvantaged students need to perceive themselves in essentially positive ways. 2. Disadvantaged students need to develop a hierarchy of values that will enhance mobility within the general society. 3. Disadvantaged students need to develop cognitive, conceptual, and social skills necessary for the accomplishment of their goals. Significance The major aspects of importance in this study are as follows:

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9 1. A special curriculum will make nursing as a care e r available to large numbers of disadvantaged studerits who fail to consider nursing or who fijl in their attempt to pursue nursing as a caree r 2. The curriculum should produce changes and new approaches to the education of teachers of nursing. 3. Such a curriculum should also facilitate upgrading of tho basic curriculum for all nursing students. 4. This type of emphssis upon the disadvantaged will make a small but significant improvement in increasing the career opportunities for disadvantaged students. Procedures This study is an attenpt to provide nursing educators with the results of research on the disadvantaged student. This study will also provide nursing school curriculum planners with a curriculum that is relevant and meaningful to.the disadvantaged student. It is hoped that this study will provide nursing educators not only with an opportunity to see a vast source of potential professionals but also with a means for educating th em for nursing careers. It is further hoped that this study will serve as a basis for model training programs, as a stinmJ us for new innovative curriculum change, and as a basis for future hypotheses, assumptions and theories.

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10 Format for Chapter D e velopment Chapter I is the introduction. The dominant theme of this chapter is the commitment of the rapidly changing American society to provide equal educational opportunities for all. In view of this commitment, the role of the collegiate nursing school as an institution for providing equal educational opportunities to the disadvantaged student will be developed. Chapter II will involve the characteristics of the educationally disadv a ntaged student. E m phasis will be placed on the disadvantaged student's social, economic, and environmental experiences as they relate to his educational achievement. This chapter will also emphasize the concepts of ch a nge as it relates to the disadvantaged student in the foilowing aspects: 1. Changing cognitive style 2. Developing an adequate value system 3. Raising the levels of a~pirations Utilizing facts and principles from empirical research for the disadvant ag ed youth, an attempt will be made to develop a theory of the dyn a mics of change as related to the educationally disadvantaged. This change process, onc e developed, will r e lat e to the nursing program only. Attention will be given to ch a nges in the following 2re a s:

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11 1. Administration and organization 2. The tea chcr and inservice education 3. The curriculum design Chapter III will present some nursing programs which have been proposed to help educationally disadvantaged nursing students. An evaluation will be given of these proposals. Chapter IV will involve the principles of curriculum design and curriculum construction. Generalizations derived from these principles and conclusions derived from the previously presented data will be drawn together as a guide for a curriculum design for the disadvantaged student in a baccalaureate nursing program.

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CHAPTER I NURSING EDUCATION AND ITS INFLUENCE ON A DYNAMIC DEMOCRACY American Educational Ideals Today, there is increasing concern with the problem of providing education for the disadvantaged youth of America. The solution of this problem is necessary for effective functioning of a dynamic democracy and for the preservation of our democratic ideals. Dewey stated, for example, that "Democracy and education bear a reciprocal relation, for it is not merely that democracy is itself an educational principle, but that democracy cannot endure, much less develop, without education," and that "after all, the cause of democracy is the moral cause of the dignity and worth of the individual" (Dewey, 1950, p. 11). The advent of experimental science and the development of industrialism brought new problems for education, one of which is the major problem of adjusting the aims of education to existing social conditions. John Childs feels that the democratic way of life in our own country and throughout the world is undergoing a crucial test. Education, therefore, should do whatever it can to serve the ends of a democratic society by providing an 12

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) 3 understanding of the role of such a society. A democratic society, states Childs, "is grounded in Tespect for individual human beings and seeks their growth through the development of their ability to think, to choose, and to govern them selves. The values of a free society can be preserved only as its citizens recognize and accept the responsibilities that arc correlative of their right" (1950, p. 264). The most outstanding event to occur to cause the members of the American society to look at themselves and plan for positive change was the May 17, 1954, decision of the United States Supreme Court which ruled that state laws requiring or permitting racially segregated schools violated the equal protection clause of the Fourteenth Amendment of the United States Constitution. The goals of assuring equ~lity of educational opportunity and of providing the most effective education for every child are inherent imperatives of American edu cation in this latter half of the twentieth century. Any society, therefore, which is to remain viable and dynamic must raise the educational standards for all of its people and must exploit and use constructively high intellectual potential wherever it is to be found. John Gardner (1961) states our society cannot achieve greatness unless individuals at many levels of ability accept the need for high standards of performance and strive to

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14 achieve those standards within limits possible for them and that educators cannot meet the challenge facing this free society unless they can achieve and maintain a high level of morale and drive throughout the society. Equality of educational opportunity for the disadvantaged student is one of the national priorities of the Office of Education and its implementation ranks high on the list of educational needs of every school district in the United States. The solution to the problem of this country and the implementation of the goals of democracy are dependent upon wise use of the potentials of the disadvantaged segment of this society. It is imperative that the quality of the educational experience of this group be such that the disadvantaged will be able to realize their personal goals and to contribute to the growth of the nation. Therefore, this study is concerned with developing a program which will address the needs of the disadvantaged college student. Further, the special concern of this study is the development of a program which will help the disadvantaged student pursue successfully a career in a baccalaureate nursing program. In a period of social change, institutions must deal with social realities, &nd professions must also examine themselves and their tr~ining programs. If we accept

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. 15 that both institutions and professions are concerned with competence and that society is concerned with equal edu cational opportunity, we must bring these two goals together. We must develop competent nurses from people who, because of society, have been denied the entry skills required for success.in a baccalaureate nursing program. Disadvantaged students in a baccalaureate program will present a challenge to persons who work with these programs. Therefore, educators would attemp~ to create situations wl1er~ the students can achieve success, can discover new horizons, and can develop faith and positive expectations within themselves. Nursing educators in collegiate schools nrust realize that the complex problem of education for the disadvantaged student cannot be resolved effectively by fragmentary approaches. The problem requir e s the development of bold, imaginative, and comprehensive approaches. Education iri nursing should have as its challenge the maximum education for all American students without regard to their social, economic, or racial backgrounds because an effective functioning dynamic democracy demands this. Nursing, then, must begin to make the necessary modifications in curriculum and in methods and must provide the educational leadership, guidance, and stimulation that will make it possible for America n society to strengthen and improve our system of

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1 6 democratic education. Whe11 this is done, our nursing schools will be consider e d as a vehicle of mobility and as one of the major agents of social and economic vitality. If it is not done, our nursing schools will contribute to social stagnation and more insidious forms of social class cleavages and distinctions.

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CHAPTER II THE CHARACTERISTICS OF THE EDUCATIONALLY DISADVANTAGED The educationally disadvantaged student is a product of the lower class status. This position in the hierarchy of social stratification in American society represents social and economic deprivation which lead to educational deprivation. The defining characteristic of the educationally disadvantaged in America is that they are poor and most of them are unemployed, or underemployed. They are labeled according to Neugarten and Havighurst as the lower lower class. In this class can be found according to Havighurst and Neugarten (1962) a large proportion of blacks and other visible minority groups. Edmund Gordon identifies these groups as Negroes, Puerto Ricans, Mexicans, and Southern rural or mountain whites (Gordon and Wilkerson, 1966). The labelling of the various groups which occupy lower socioeconomic status is not the significant aspect. The problem is their attempt to share in the educational gains of the general society. In order to provide equality of educational opportunity and to make those needed changes in the educational system, it is necessary that curriculum planners oi designers have an understanding of the nature of the people to be served. 17

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18 The home of the educationally dis a dvantaged is a crowded, busy, active, noisy place where no one child is the focal point. There are too many children, and the parents have too littl e time for them. Consequently, the children spend much more time in each other's company and with relatives than they spend with parents. The home typically includes aunts, uncles, and grandparents, all of whom may, to some degree, play a parental role. This pattern according to Reissman, is technically known as "the extended family." Reissman stated the strength of s~ch a family: The key to much of the family life is security and protection. The large extended family provides a small world in which on e is ~ccepted and safe. If help is needed, the family is the court of first resort and will pro~ide it, at l e ast to some extent. Time and energy, rather than money, are the chief resources provided (Reissm an, 1962s p. 36). However, the home of the educationally disadvantaged can become a circumscribed area permeated by attitudes either of despair and apathy or of hostility and rebellion. This home is often broken by divorce, by desertion, or by forced separation caused by the location or the nature of available work. Herc, the family constellation is different from that of the nuclear family which is the supposed norm of the middle class and upper lower class. The father leaves home for extended periods to search for work, to work temporarily elsewhere, or simply to desert his family periodically.

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19 Older brothers and sisters leave to get married or to take jobs, only to return when they are unemployed, separated from their spouses, or divorced. More distant re lativ es or friends come to stay either to lend support during times of domestic or economic crisis, or permanently. Then it becomes necessary to double up in housing. All of the components of family life lack the lon g-range uniformity, predictability, and organi zation of the traditional, middle class family life from which the school draws inferences. The organization of the child's home life influences his time orientation. Because of the combination of external pressures on the family, and its own internal structure, for lower class children, the future becomes a vague, diffused region where anything can happen and where possible rewards are too uncertain and too remote to mean much. The child's discipline, therefore, typically involves physical rewards and punishments which are designed to get him to do or riot to do specific, immediate things. Added to this child's life is a series of critical situ ations in which irritable and tired adults use erratic physical punishment to maintain discipline. With such a background it is not surprising that few lower class children develop the d e ferred-gratification pattern of life required for the commitment to the long-range life plan which the middle or upper class child assumes as part of his world.

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.. 20 The lower class person is not at all sure that it is rational for him to trade impulsiveness rC;straint, spontaneity for self-discipline, play for work, or even immediate satisfactions for remote and un~ertain rewards. He has no history that these have or will pay off. He lacks interested adults to help him to link present, past, and future together by recalling prior experiences, or by relating such experiences to present occurrences, to predict future ones. They are caught in the present, and they do not plan ahead. They take their pleasure on a moment-to rnoment basis. Because the home atmosphere is much more communal and, to some extent, cooperative, Reissman (1962) believes sibling rivalry and fear of a new baby brother is somewhat less apt to develop. Perhaps this is because the children never have had much attention in the first place, and have less to lose. Perhaps, also, the fact that the children depend so much on contact with each other, rather than being overly dependent upon the parents, plays a decisive role. Although education in the United States is compulsory, the lower class child is not necessarily exposed to similar learning opportunities as the middle or upper class child. Class attendance in school is markedly irregular because of the child's f r equent illnesses, b e cause of his work, because of his truancy which is total1y ignored (through lack of interest) by th e authorit i e s and becau s e of a li f e style

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21 which makes no demands for attendance to an uninteresting and unrelated school situation. A great many lower class youths fail to complete high school. The reason for this failure is that they
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22 education is that the assets of the disadvantaged youth are not compatible to those the school expects him to have but, as Moss states: Our society has much to learn from the disadvantaged on how to survive in a hostile world. It has been said that people living in a marginal existence are less effi cient in dealing with their environment in an abstract, conceptual sense than in devising strategies for coping with the day to day concrete r~alities of life and death. They may not be able to grasp fully how an entire system works, but they can become proficient in devising ways to work through a whole network of barriers and obstacles in order to survive and live. They know better how to manipulate things not people, roadblocks not structures; with their gifts, they encourage us to view no obstacles to change, and to value not disdain the unlimited ca pacity of man to endure and live comfortably with human frailty and human diff~rences (Mbss, 1970, pp. 18, 19). The depriving effect of lower lower class status does not produce people without values, without goals, without coping techniques. Instead, it produces a group which has devised its own means of coping with its problems within the context of its own neighborhoods. The motivation, the cog nitive skills, and the value system developed by the lower lower class serve its members well in meeting group imposed standards. The problems of deprivation occur when the life style of this class comes into conflict with that of the larger society, particularly when an individual attempts to gain a technical skill which requires formal advanced education. The problems of deprivatio11 are brought sharply into focus w hen achiev e ment is used as a measure of potential for

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23 admission to programs and to jobs. Further academic opportunities as well as achievement is dependent upon the level of motivation, cognitive style,and value system of the student. Therefore the remaining section of this chapter will explore the motivation, tognitive style, and value system of the poor and their effect upon the disadvantaged youth. This section will also explore the basic issues of how these evolved and their relationship to academic achievement. Lower Class Status and Academic Achievement There is an abundant amount of educational research which provides evidence of the low academic achievement of the disadvantaged youth at all educational levels. There is also much research which shows that low academic achievement is related to low socioeconomic status. Sexton considers social class as a very good predictor of success in school. She stated: Social class is also a fairly accurate predictor of success in school. If you know a child's class status, his family income, his pHrents' educational levels, you can quite accurately predict what will happen to him in school and how successful he will be (Sexton, 1966, p. 27 8) It is evident that more lower socioeconomic status students have a lower achievement level than students of high socioeconomic status. Sexton, in her study, stated: In the lowest income group (group 1, $3500), 10.9 percent of all students in B:i.~ City failed to be promoted

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24 to a higher grade in January, 1958. This means that more than one out of every ten students in this group were not passed at the end of the school year. In the highest income group ($11,055) less than one percent (.8 percent) of all students failed to be promoted {Sexton, 1966, p. 278). Coleman appears to be congruent with Sexton. The schools are remarkably ~imilar in the ~ay they relate to the achievement of their pupils when the socio economic background of the students is taken into account. It is knoi,;n that socioeconomic factors bear a strong re lation to academic achievement (Coleman, 1966, p. 21). Further research has shown that socioeconomic deprivation has a deleterious effect upon academic achievement. Where the home environment and school environment (considered as the "educational environment" by Bloom) is nonreinforcing for the values of the school, academic achievement of chil dren from such environments will be low. "It is evident that when the school and home environments are mutually rein forcing, learning is likely to be greatest'' (Bloom, 1964). Children of the poor fail more often in school than the other children and there is a high correlation between this failure and the life style of the home of these students (Gordon, 1966). The low level of academic achievement of disadvantaged youth can be accounted for by the level of their motivation system, their cognitive structure and the hierarchy of their values. Lo~er CZass Status and Motivation Motives according to McClelland are learned (Mc Clelland, 1953, p. 324). They are developed when certain

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25 affective arousal states become associated with certain cues. For an example,when a teacher used the word "good" to praise a student for completing a task successfully, the accompanying affective state of satisfaction coupled with the cue "good" serves as a basis for motive development. When cues and arousal states become bonded (redintegration), the process for motivation has begun. Motivation, then is the sequential approach or, avoidance behavior chosen to produce or arrive at an affec tive state. The conditions for the development of a motive are produced by certain perceptual events which cause the arousal of affective states. Affective states may be nega tive or positive. The difference is determined by the de g ree of discrepancy between the adaptation level of the organism and the event. The a
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26 representative lower cliss life style fails to reinforce the child to work hard in school, and to take homework seriously. If the child reakes good grades in school, he must conceal them from his unsuccessful peers and apologiz~ for it rather than boast about it. Studies of motivation of the lower class student show that many of these students often have unrealistic aspirations. Bloom, Whiteman, and Deutsch's study supports this conclusion. Their study was based on personal inter views with the students and on parents' responses toques tionnaires. Their findings revealed that the Negro parents reported more middle class motivation than whites; that is, they had higher educational and occupational aspirations for their children. The Negro children themselves aspired to higher occupations than the white children of comparable class levels (Bloom, Whiteman, and Deutsch, 1963). This aspiration striving presents a problem of attainment. The academic achievement which usu~lly supports such striving and the maintenance of sustained drive toward goal attain ment is usually lacking in members of the lower class. The economic support and sociopsychological encouragement needed to undergird deferred gratification is not available to the disadvantaged student. Therefore, the high aspiration levels of these students are often unrealistic in terms of achieve ment.

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27 .. Smith and Anderson's study is congruent with the above. The purpose of their study was to test the relatibn ship among mobility aspiration, race, and family experience measured by a questionnaire on affectional patterns. The results showed that the Negroes had significantly higher educational and vocational aspirations in contrast to the whites. The authors concluded that the tendency of Negro youth to have higher educational-vocational aspirations seems to be on a fantasy level rather than a reality level (Smith and Anderson, 1962). On the other hand Gordon and Wilkerson (1966), explain the motivational pattern of disadvantaged youth as being less highly motivated and having lower aspirations for academic and vocational achievement than do their middle and upper class school peers. Not only is motivation likely to be lower but it is likely to be directed towards goals incon sistent with the demands and the goals of formal education. This depressed level of aspiration is usually consistent with the child's perceptions of the opportunities and re wards available to him. Symbolic rewards and postponements of gratj fication appear to have little value as motivators of achievement. For disadvantaged children goals tend to be self-centered, immediate, and utilitarian, just as they are for the dominant culture. However, children growing up under more privileged circumstances have many sources

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28 of immediate satisfaction and i m m e diate feedback available as well as evidences of -~h e utilitarian V,Jluc of academic effort. The differences betw ee n the privil eged and the disadvantaged in this area a re rtot so much iu valu es as in the circumstances under which the values are called into play. Although the values from which motivation is derived in the disadvantaged child seem to reflect the dominant culture concern with status, material possessions, ingroup morality, Judea-Christian ethics, and competition, there is usually a la~k of concern with the aesthetics of knowl edge, symbolism as an ar~ form, introspection, and competition with one's self. In other words, dominant societ a l goals and values exist among the dis ad vantaged but the direction taken and the context in which they operate may not be com plementary to academic achievem ent (Gordon, 1966). According to McClelland, achievement motivation can be developed so that the disadvantaged youth or adult can successfully manipulate the educative proces s toward a rewarding goal. The technique of implementation in v olves the following steps: 1. The more reasons an individu a l h as in advance to beJ ieve that he can, will, or should dev elop a motive, the more education al a ttempts desi gned to develop that motive are lik ely t o succeed. 2. The more an individual perceives that developing a motive is consistent with th e demands o f reality (reason), the more educational c1ttempts designed to develop th at motive are lik ely to succeed.

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29 3. Tl1e more thorou g hly an individual develops and clearly conceptualizes the associative network defining the motive, the more ljkcly he is to develop the motive. 4. The more an individual can link the newly developed network to related actions, the more the change in both thought and action is likely to occur and endure. 5. The more an individual can link the newly concep tualized association-action compl e x (6r motive) to events in his everyday life, the more likely the @otive complex is to influence his thoughts and actions in situ a tions outside the training experi ence. 6. The more an ind i vidual can perceive and experience the newly conceptualized motive as an improvement in the self-ima g e, the more the motive is likely to influence his future thoughts and actions. 7. The more an individual can perceive and experience the newly conceptualized motive as an improvement on prevailing cultural values, the more the motive is likely to influence his future thoughts and actions. 8. The more an individual commits himself to achiev ing concrete goals in life related to the newly formed motive, the more the motive is likely to influence his future thoughts and actions. 9. The more an individual keeps a reco r d cf his pro gress toward achieving goals to which he is com mitte d the more the newly formed motive is likely to influence his future thoughts and actions. 10. Changes in motives are more likely to occur in an \ interpersonal atmosphere in whicl1 the individual feels warmly but ho n estly supported and respected by others as a person capable of guiding and djrecting his own future behavior. 11. Changes in motives are more likely to occur the more th e setting dramatizes the importance of self-study and lifts it out of the routine of everyday life.

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30 12. Changes in motives are more likely to occur and persist if the new motive is a sign of membership in a new reference group (McClelland, 1965, p. 336). McClelland (1965) then provides the curriculum designers with a clearer picture upon which to base a program for developing a motivational system to sustain academic pro gression. Nursing educatio!l must provide a program that will develop a high level of achievement motivation. In a subsequent chapter of this thesis a program for developing a motivation system for sustaining successful pursuit of a baccalaureate nursing program will be presented. Cognition As previously stated low academic achievement of the disadvantaged youth has its roots in cognitive devel opment. As to their cognitive style Ausubel concluded that lower class children are trained to respond more to their concrete, tangible, immediate and particularized prop e rties where middle class children are trained to respond to the abstract, categorical, and relational properties of objects. This diff e rence in perceptual disposition is carried over into verbal expression, memory, concept formation, learning, and problem solving (Ausubel, 1969). Bernstein stated that the lower class child has fewer categories for accommodation and/or assimilation of the various stimuli he receives in the school environment

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31 and that the cues which he selects and fits into his categories will be limit e d. The world he perceives is limited by the labels which he can attach to it, and its meaning to him will be internalized to the extent which his cognitive style will fit it into his established categories (Bernstein, 1961). According to Deutsch, the coping ability of lower class children is restricted to that narrow range of stimuli furnished by a ghetto like environment. The opportunity for many and varied enriching experiences through which the child develops facility in coping is limited (Deutsch, 1963). The cognitive style of the disadvantaged student has been described as concrete rather than abstract which is comparable to Piaget's concrete-operational state, that i s the attainment of conc~pts through th e manipulation of ob jects. Because of this style the disadvantaged student is able to organize information at a low level. Accordjng to Bernstein, the disadvantaged youth is not predisposed to ordering of sy m bolic relationships, to imposing of order 1 and to seein g new relationships. There is evidence of low level cognition in the language of disadvantaged youth, their u s e of traditional phrases, idioms, and slang which tends to be expressive and less abstract (Bernstein, 1961). Hullfish and Smith (1961) feel language and meaning are a necessary ground for advanc e ment to the conceptual level.

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32 Bruner's category system appears to be compatible with Piaget's schemata. In explaining his system, Bruner uses the terms categorizing and conceptualizing interchange ably. He stated: To categorize is to render discriminably different things equivalent, to group the objects and events and people around us into classes, and to respond to them in terms of their class membership rather than their uniqueness (Bruner, 19 S 7, p. 2) .. Bruner feels that this acquisition of categories is dependent upon the experiences of the individual (Bruner, 1964) He then observes that, for a person to make any sense out of his environment, he must .be able to select, from an almost infinite number of discriminable objects and events, those which appear to have something in common, and to treat these either as a single category or as a manageable number of categories. It seems from this theory that cognitive growth is dependent upon a stimulating environment. If the environment d6es n~t provide varied and rich experiences, cognitive growth is hindered. The inadequate cognitive growth of the disad vantaged student in school type categorizing may be attribtued to his lack of experiences which contribute to the development of a cognitive system capable of dealing with sch0oling. This emphasis on the importance of a va r i ety of experier..ccs in the ~nvironr il ent implies the deterimental ef fetts of lack of variety.

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33 A student from any circumstance who has been deprived of a substantial portion of the variety of stimuli to which he is maturationally capable of responding is likely to be deficient in the intellectual capacity required for learning. Support for this idea is found in Hunt who, in discussing Piaget's developmental theories, points out that according to Piaget the rate of development is substantially, but certainly not wholly, a function of environmental cir cumstances. Change in these circumstances is required to force the accommodative modifications of schemata that con stitutes development. Thus, the greater the variety of situations to which the child must accommodate his behavioral structures, the more differentiated and mobile these behav ioral structures become. Consequently, the more new things a child sees, and the more he hears, the more things he is interested in seeing and hearing. Moreover, the more varia tion in reality with which he has to cope, the greater is his capacity for coping (Hunt, 1961). Berstein's (1970) position on language goes further. According to Bcirstein, the child from a working class family is oriented towards particularistic meanings and the middle class child is oriented toward universalistic meanings. He feels that there is a distinction between these uses of language which he calls "context bound'' and "less context bound." "The language of the middle class child gives

PAGE 41

34 meanings that are free from context and understand a ble by all, whereas the language of the child from the working class family gives meanings that are closely tied to the context and would be fully understood by others if they have access to the context which originally generated the language" (Bernstein, 1970, p. 346). The disadvantaged student uses language mainly to convey concrete needs and immediate consequences, while the middle class child uses language to emphasize the relation of concepts. This difference between the two classes may contribute to the advantage the middle class chjld has over the lower class child in tasks where precise and abstract language is required for solution. Further, this reasoning may again emphasize the communicati6n gap which exists be tween the middle class teacher and the lower class child. Berstein (1970) suggests that this may mean that the teacher must be able to understand the child's dialect, rather than attempting to change it deliberately. He sug gests this becaus e much of the context of our schools is unwittingly drawn from aspects of the symbolic w :Hld of the middle class so that when the child begins school he moves into a symbolic system which does no t p ro vide for him a linkag e with his life outside. Every teacher who does not alre ad y know should learn th at the socia l experience w hicl 1 the child already possesses

PAGE 42

35 is both valid and significant, and that this social experience should be reflected back to him as being valid and significant. It can be reflected back to him if it is part of the texture of the learning experience which we create (Bernstein, 1970). Therefore if the cognitive style of the disadvantaged youth is concrete rather than logical operational, nursing education must provide a program that will develop a high level of conceptualization beginning where he is. In a subsequent chapter a proposed program for developing these skills will be presented. Vatues In order to further academic achievement, the nursing educators must be concerned with the value system of the disadvantaged student. This section will present a theory of value, some research on value systems,as well as proposed plans for nursing education to make positive ad justments in the value systems of the disadvaritaged. In ~very society, men strive for whatever they judge to be good and right. Thus, motives and values are virtually inseparable because what men strive for must be worth the physical and psychological endeivor entailed in the struggle. The child first learns values from the im portant adults in his life, especially his parents. His

PAGE 43

36 association with people of differing valu e s leads the child to examine his own value system, modify or reinforce it in the light of his experiences. This process of value-modi fication or value-reinforcement is life-long for the indi vidual as his horizons widen and his experiences increase. Values have bond-connections with environmental stimuli which influence the direction and technique for good attainment of the individual goals. Environmental factors which contribute to the acquisition of strong academic achievement values are necessary for the development of deferred gratificatio~. It is this deferred g T atification, the ability to sustain interest and maintain effort over a long period of time in order to achieve some future reward, which is a requisite value for academic achievement and goal attainment. It is this value which appears to be lacking in the operational value system of the lower class child. He d~nies delayed gratification. He lacks interest in engaging in activities for which the ~ayoff is in the future and is unpred i ctable; he is unwilling to make the sacrifice now for the potential gamble ahead; and he tends to shy away from risk tak{ng. This behavior is understandable; the lower class child has few success models for whom the gamble has paid off. His control over the factors in his environment is so limited that the gains from day-to-day must be used

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37 and enjoyed for what pleasure they bring for the moment. The needs of living today are t]1e pressing matters to be forced today; therefore, all that is gained today is open for use today; tomorrow may never come. For the lower class child, value modification or reinforcement which comes through his interactjon with his environment can be structured to foster academi c achievement only if the environment is altered. Studies of values reveal that the socioeconomic status and the child rearing practices of the family appear to play a maj or role in determining the value judgment developm ent of the child. The lower lower class parents tend to evaluate in terms of consequences while the middle class tend to consider intent. Thii difference may be due to the behavior of the parents and the moral ethics of the home. Berkowitz states, ''The parent who wants his child to be reasonably successful and a responsible and law-abiding citizen apparently has to take an active part in developing appropriate values and motives in the child'' (Berkow itz, 1964). Studies of the child rearing practices of the family, especially disciplinary practices, show that lower class families rely on physical punishment to develop antiaggression whereas children from middle class familj es rely on psycho logical punislunent to impede aggression and antisocial attitudes (Berkowitz, 1964). The value system of the lower

PAGE 45

38 class as seen by Harrington is a feeling of pessimism. He believes the pessimism pervades both the personal experiences and expectations of job and family. ''This pessimism is involved in a basic attitude of the poor. When pleasure is available they tend to take it immediately" (Harrington, 1962, p. 123). This is the natural pattern of behavior for one living in a subculture ofAmericanlife which is without a future. Therefore it is this value system of the lower class which nursing educators must know; further they must utilize this knowledge in providing a program where changes in values can be ach i eved, so that lower classstud~nts can have equal opportunity to success iti baccalaureate nursing programs. To accomplish this value change, there must be changes made in the nursing curriculum, in the nursing school environment, and in the individual's perception of himself and the curriculum. Human Behavlor and Change So far it has been attempted in this thesis to emphasize that provisions must be made in nursing programs to provide equal access to success experiences in nursing programs for all students. The need for understanding the nature of the student to be served and the environment from whence he comes is imperative if nursing programs are to be effective.

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39 The r~lationship of the individual and his environment as they are aected by change can be explained in terms of organization as described by Gordon. Organizing one's world is a psychological process. There must be some feeling of balance. Gordon states: This need for order means that a person in any given situation will choose that behavior which, from where he stands, preserves and increases his already ordered world. It does not mean that growth is completely orderly. It does mean that even though the surrounding world may be chaotic, each of us takes information in, organizes it within our~elves to make some sense out of it, to make our lives orderly (Gordon, 1969, p. 8). Gordon's position is that all living organisms can be defined as open energj systems. An open system means that the person is continually being influenced by and is influencing hjs environment. One of the characteristics of the open energy system is that it maintains a "steady st.ate," that is, keeping itself in balance. The 01ganism is constantly active, developing a new organization incorporating new information received from the environment. Curriculum change and behavioral change can thus be made through environmental changes. '!'he culture where the educationally disadvantaged youth resides is a powerful influence acting upon the individual. In such areas there are many face-to-face encounters ~hich make communication easier and more intense.

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40 Information from the outside is not readily accepted, certain parts are rejected and other parts are accepted. In view of this position Gordon states: Feedback is the process of rece1v1ng and making use of information from the environment, after you have acted. The feedback may intlicate that behavior formerly appropriate is no longer received that way and requires modification. It also may be that some behavior that was virtuaJly chanc0 was well received and may then lead down new pathways which might have been unpredictable to an external observer (Gordon, 1969, p. 9). Therefore, this study proposes to change the educational status of the disadvantaged youth by focusing atteniion upon the transactional ai~e~t of th~ individual and his environment. Thirefore,a program must include opportunity for feedback which will enable the student to choose new pathways and construct a new organism, in which new sets of behavior (nursing skills, interpersonal job skills) are seen as functional. It means the total edu cational innovation must act in uniform fashion to communi cate expectations, and ways of behaving that serve as models for the learner. It must be remembered, however, that transactions work both ways. The student will also make his impact on the college and it will be changed in the process. It cannot just sell without buying.

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CHAPTER III REVIEW OF SOME PROPOSED PROGRA.~S FOR THE DISADVANTAGED STUDENT IN NURSING PROGRAMS There is evidence to indicate that some administrators are aware that the educationally disad vantaged youth does possess the potential skills that are required for a nursing degree. It also appears that their awareness has led them to take a realistic step to remedial programs on a preprofessional level to explore these potential skills. Therefore, this chapter will review some proposed nursing programs. It is hoped that this is a step toward producing a more effective curriculum for disadvantaged youth in nursing. This curriculum can be produced as the results of studies of learning by the behavioral scientists arc used as a basis and then translated into experiences which yield measurable, immediate results. The University of Alabama School of Nursing The University of Alabama School of Nursing has submitted a proposal to the United States Public Health Service for a program of remediation for the academically disadvantaged students admitted to the School of Nursing. 41

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42 Remediation programs in mathematics and reading will be made available to those s tude nts who meet the preestablished criteria. The programs consist of four phases: selection and diagnosis, remediation, evaluation, and the planning for a decelerated cur1iculum. University of Miami School of Nursing Recruitment has been extended to the Upward Bound Programs, Concentrated Programs, and the Family Health Workers in the Model City area. Disadvantaged students are identified by the School of Nursing for waiver of application fee. A project proposal, "Upward Bound in Health Related Careers Bridge Progra~' has been submitted to Division of Student Special Services, Bureau of Higher Education. Twenty students each summer are recruited from the six basic Upward Bound Programs in Florida for a program which includes one CQllege course, tutoring, developmental reading, and special interest groups in drama, art, music, etc. Field trips and observations will be made in the community to increase awareness of health careers and resources. Self-awareness will be j~criased ty informal c0ntacts with counselors, tutors, and inst--ructors. Part-time work experience will be in communi ty health agencies. "Expanding Opportunities for Disadvantaged Students in Nursingn is a five year project proposed to the Public Health

PAGE 50

43 Service, Department of Health, Education and Welfare. The objective is to graduate students, although recruited as disadvantaged, who will be knowledgeable and skillful in the area of nursing and have a degree of self-knowledge, self-confidence, knowledge of others, and skills requisite to living in a rapidly changing environment. The project involves: (1) a guided studies program based on a diagnostic test batter~ (2) paid tutors in the basic science~ (3) volun tary tutoring systems in nursing courses by the student nurses association; (4) counseling, formal and informal; (5) individualized progra ms based on instructor-project student counseling; (6) cultural enrichment; and (7) faculty inservice programs to explore faculty needs and to develop methods for teaching the disadvantaged. The program is designed to supplement the present curriculum so that project students remain an integral part of the student group. Medical College of Georgia School of Nursing The School of Nursing has been working for two years with borderline students by inviting them to enter a summer session prior to the freshman year. Of 14 students, 11 still remain in the school. These students, 13 white and one black, enrolled in a full college load. Counseling was given on a regular ba s is, and tutoring was arranged as indicated. The School is now refining a projecT proposal to be sub1 n itted t o the Division of Nursing, Department of Health,

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44 Education and Welfare, on July 1, 1970, to work with disadvantaged students. It is planned to offer remedial work, counseling, tutoring, and a decelerated curriculum. SpaZding CoZZege Sohooi of Nursing Spalding College of Kentucky recognizes its responsibility to the disadvantaged student as one of its major purposes of existence; therefore, all departments, in varying degrees, are involved in working with disadvantaged students. In the summer of 1966 the Nursing Department received Sealantic funds for a two-year project for the development of a preparation for college program, with emphasis in recruitment for nursing. This program provided course co11tent in communication skills (reading, writing, speaking), mathematics, and science. Recreational and cultural activities (picnics, ball games, swimming, camping, plays, operas, fj eld trips to museums and art galleries, and weekend trips providing hotel resort experiences) were planned to provide the student with the opportunity to broaden his/her views of American life. The content courses are taught in the morning sessions of the college's summer school sessions. Recreational and cultural activities are planned for several afternoons a week during the summer session and two afternoons a month during the acado111ic year. Forty-three high school students

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45 participated in this program. Twenty-eight of these students are currently enrolled in colleges. Eighteen of these students are enrolled jn nursing programs. Spalding intends to apply for additional Sealantic funds for continuation of this project if the Rockefeller Foundation makes these funds available again. University of Maryland School of Nursing Although there has not been much tangible evidence, progress has been made in increasing opportunities for disadvantaged students in nursing. The major area of progress has been the increased awareness of faculty of the need for integration. In the lower division, the academic and social needs of these students are being met more adequately through the expanded use of various special services. A counseling plan has been implemented whereby the School of Nursing faculty is responsible for groups of 12 freshmen in nursing, helpjng freshmen adjust to college life. Emphasis is placed on utilization of special services as needed. Statewide contact with junior and senior colleges is invited to identify comparable lower division courses so that transfer to this program will be facilitated. In the upper division, students are allowed to lighten their academic load. To assist them financially in their longer

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46 enrollment at the uniiersity) some employment has been created, and students are a ssisted in obtaining employment. Again, a counseling plan h a s been initiated whereby experienced faculty have be e n assigned 20 students for academic counseling. This is in add i tion to the counseling within courses already in progress in which each f aculty member is responsible for counseling six students. The graduate program is conside~ing seriously a summ e r program for selected students who are in need for remedial w ork before beginning their studies in th e fall. The graduate f a cul ty is aware of its responsibility to increase opportunities for academically disadv a nt age d students to succeed in the program once t hey have been admitted. University of Mississippi School of N u rsing Some progress has been made in this area since the first Southern Regional Education Board m e eting in September, 1969. To date the faculty has impl e mented the followi n g actions. 1. Obtained approval from the director of the medical center and the registrar to re-examine r e cruitment procedures and admission requir e men t s. Agreement has b e en secured to consider applicants who fall sligh t ly below admissio n st a ndards by admitting them provision a lly &nd a llo wi ng them to complete th e freshm a n year in two ins t ead of on e year; a n d/o r providing a summer tuto r ial pro g r a m in acad e mically deficient areas prior to a dmi s sion. St u d en t response to th e tutorial p r o g r a m has been e Dt hu sias t:ic. Ma ny hav e indi c a ted a de s ir e to b e a tut o r i f n ee d ed

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47 2. Studied the present lower division curriculum in order to broaden the base for liberal arts require ments by accepting substitute, alternate, or comparable courses. This would be helpful to all students but especially to the disadvantaged. 3. Demonstrated increased concern in recruitment activities this year. Tho Recruitment Committee will continue to search for more effective ways of recruiting students from the disadvantaged sector. The chairman of the Recruitment Committee has been added to the Admissions Committee to achieve closer communication between these two committees. 4. The office of Allied Health Professions at the Medical Center has been successful in recruiting among the disadvantaged population and has developed an excellent relationship with black communities. Closer collaboration with these groups in recruiting for nursing is anticipated. University of North Carolina at Chapel Hill Scho o l of Nursing Quota restrictions on the number of women students and out-of-state students have led the School of Nursing of the University of North Carolina at Chapel Hill to look for students within the state from many different groups includi ng men, registered nurses seeking the B.S.N. degree, and aca demically disadvantaged students. A representative from the School of Nursing sought to tap these groups by visiting Fort Bragg in Fayetteville, North Carolina to talk with medi cal corpsmen about nursing, by interviewing registered nurses iri the evening college of the University of North Carolina about their future in the baccalaureate nursing program, and by working with organizations which have alre a dy established contacts with academically disadvantaged students. The

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48 Committee for the AdvancePlent of Disadvantag e d an transfer students from conununity colleges, junior colleges, and senior colleges are encouraged. Community and junior colleges have been visited throughout the state. Course evaluations and information on nursing at the University of North Carolina at Chapel Hill were left with couns e lors as resource material in talking with students interested in nursing. University of Tennessee College of Nursing The medical units at the University of Tennessee received a partial funding ($8,000) of a grant from the American Association of Medical Colleges. This grant will provide work-study opportunities for Negro students in health career settings during the summer. The purpose of the grant is to interest Negro students in the health field throug}1 this summer experience and thereby recruit them into nursing, medicine, pharmacy, dentistry, and the basic medical sciences. In addition to this, the University of Tennessee

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49 College of Nursing has applied for a grant to study the teaching-learning proces s. If this is funded, a staff member of the Southern Regional Education Board Inst i tute will serve as consultant to the planning of a workshop dealing with "Working with the Disadvantaged Student." Texas Woman's University College of Nu rs ing A project proposal has been submitted to Department of Health, Education and Welfare for funds to increase graduation potential of educationally disadvantaged students. With this funding faculty can be assisted in the development of skills which will help to identify and effectively work wjth educationally dis a dvantaged students; identify factors which will motiv ate students to work up to their full potential; carry on a tutorial and guidance program and increase our number of graduates from the College of Nursing. A new center for the Study of Learning in the College of Education assists students with reading skills. The College of Nursing is already using these new facilities as well as the services from other departments such as chemistry, biology, and speech departments for those studen t s having these probl em s. Univ ePsity of Texas at San Antonio School of Nursing The Program for Educational Opportunity, under which 25 cu]tura l ly, financially, and academically disadvantaged

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50 students were enrolled at Austin, is being discontinued after two years of operation. Project Information, a student operated effort to recruit academically qualified students from the lower economic areas, is being accelerated. In the Nursing School one of the major emphases is the promotio11 of the junior colleges for prenursing education; and the baccalaureate curriculum is designed to accommodate transfey students at the junior year level. Also, a new financial aid policy has been recently adopted, relating to grade-point averages and course load requirements, which should favorably affect disadvantaged students The need for statewide planning has become increasingly obvious, as projects of this nature are being developed by various agencies and organizations. In the San Antonio area, three projects are in operaticn: (1) Project STAY (Scholar ships for Able Youth) is a talent search operation throughout the poverty areas of the city. Financial aid is sought for their places. (2) An Opportunity for Health Careers is a proposal submitted for consideration for foundation support by the University of Texas Medical School at San Antonio. The intention is that medical, nursing, and dental students, receiving stipendary support, would recruit disadvantaged students from the local public schools, provide tutorial

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51 assistance as needed, and sponsor activities at the Medical Center to generate and sustain interest in health careers. (3) The Careers Committee of the Texas Nurses Association may submit a proposal for federal funding for the recruitment of the disadvantaged into nursing programs. The effort will be made to enlist the cooperative sponsorshj_p of several organizations concerned with the promotion of health careers. Activities at both the high school and nursing school levels are to be included. It is further proposed that a pilot area, such as San Antonio, be selected for initial implemen tation. Evaluation One of the best features of these programs appeaTs to have been the involvement of the administration in schools where the programs have taken place. Such administrative assistance has allowed changes in scheduling, and has helped t6 mold the curriculum to fit the needs of each program. Another feature which is a vital element in the success potential in the nursing programs is the emphasis upon training teachers. This emphasis focuses on the recog nition that middle class teachers have difficulty in relating to the lower class student. Special classes for teaching teachers about the life of the lower class have not been a feature of previous programs.

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52 One disadvantage of the program is that the setting of realistic goals, the assessment of one's ability to reach these goals, and 4 planned program leading toward these goals are missing from the stated objectives of most of the programs. It appears that the programs have concentrated upon success of a learning situation which will yield results rather than upon specific behaviors that are related to school success. In planning a program for disadvantaged students, a more functional curriculum can be produced if ..I the results of studies of learning by the behavioral scientists are used as a basis and then translated into experiences which yield measurable results. Using this approach a program would provide skills and content as well as needed changes in the way an individual may approach a learning task. All of these reports emphasize the need for basic theoretical design for curriculums for disadvantaged students. There appears to be an urgent need to connect causal factors to educational efforts in order to determine the effects of educational efforts on the elimination of the effects of causal factors. All of the reports summarized here show some attempt to aid the disadvantaged student. However, they all lack techniques that will be used to raise the academic level of

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53 these students, techniques which the writer feels are important factors in planning a curriculum. The core of the problem of educational deprivation seems to be to facilitate the learning process, The problem thus involves a high level of achievement motivation, a facilitating value system, and a high level of conceptualization. It appears that in the review of programs presented they have not concerned themselves with the above factors which are important for facilitating the learning process. In view of this evaluation there appears to be an urgent need to propose a curriculum for disadvantaged students that will concern itself with these factors.

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CHAPTER IV CURRICULUM DESIGN In order to formulate some assumptions for curriculum development, it has been necessary to describe first the factors associated with the disadvantaged student 1 s problems and the effect of these factors on the learner and the learning situation. Some proposed programs for dis advantaged stud~nts in nursing schools were presented in Chapter III. It is clear +;hat most of these programs do not meet the requirements of specifying how they will over come pupil d e fi c iencies. In most of those schools reporting, the goals of the programs were short term. No provisions were made to sustain the student when he encounters higher level of difficulty in subject matter. There was no consideration given to increasing his level of achievement, level of Coi1ceptualizing er the development of an ad.equate value system. Therefore, in ord e r to develop this curriculum, the de sign described in CP1:teria for theo"f'-ies of instruct ion (Gordon, et al. (1968)) is being used. It requires a statement of pupil charact er ist l cs, which in effect has been presented in Chapter II, a statement of goals, and then a description 54

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55 of the means to be used to attaj n these goals (see Fig. 1). The following pages present the goals and the proposed curriculum design. Pupil Characteristics Instructional Situation Characteristics Goal Characteristics Fig. 1: Design for Curriculum Sourc e : This f igure is from Cr ite ria far th e ories of ins t ~~a t i o n, pr~pared by The A SCD Com11ission on Instructional Theory, Ira J. Gordon, Chairman ~nd Editor, 1968~ used with permission of author, p 17.

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56 Broad Go-:ils Educators can meet the considerations raised on the first page of this chapte~ if, in proposing curricula for Daccalareate Nursing progrRms, they consider the following assump t ions as their broad goals. The student must: 1. Become aware of man as a sociopsychobiological being functioning in an ever~changing environment. 2. Acquire adequate knowledge, understanding and skills that are necessary for the nursing role. 3. Develop knowledge of the process of change as it relates to society's changing health needs. 4. Achieve success as he progresses to attain new goals. Specific Outcomes 1. 2. 3. 4. s. 6. 7. The student is able to identifv the r6le and functions of the family members and th.sir rela tionship to family dynamics. The student is able to recognize the relationship of the family to the community. The student is 2ble to identify characteristics of a profession and relate these to nursing. The st~dent has knowledge of necessary terminology and ability to apply these to health care. ThB student has ability to identify basic human ne eds, expres :;er:1. through the patient's behavior, and to assist the patient in growth towards gratification 0 these needs. The student has ability to relate observed behavior to the disease process. The student has ability to relate theories and concepts to observed behavior and to demonstrate applications of these in nursing procedures.

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57 8. The student is able to identify major biological, emotional, social and intellectual characteristics of each age/stage of development. 9. The student is able to define the major concepts and principles related to growth and development,. and their relationship to health care. 10. The student is able to identify concepts of growth and development which determine selection of goals and intervention in care of patients. 11. The student must have a knowledge of corunon elements contributing to emotional stress and the influence of cultural, social and psychological factors. 12. The student must have a knowledge of the meaning that a threat may have to the body image or that a state of health may have on the patient's self v concept. 13. The student is able to differentiate between several kinds of communication for the purpose of estab lishing appropriate intervention. 14. The student is able to identify nonverbal com munication patterns as a meaningful form of communication. 15. The student has ability to collaborate with other health workers in the coordination cf the services of the health team as they relate to patient care. Student Selection The following techniques may be utilized in the selection of students: 1. Establishment of economic criteria 2. Evaluation of potential capability 3. Personal interviews 4. Evaluation of written statements of goals by the students 5. Evaluation, if necessary, by individually administered tests.

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58 Economic Criteria Unusual or defin d bly d ifferent economic circumstances as described by the economic opportunity guidelines may serve as a starting criterion. This income limitation is $3,300 for a family of four with an addition of $700 for each other family member. Potential CapabiZity Another kind of student is one whose record shows ingenious misbehavior She tends to demonstrate her potential and creativity by finding ways to ''beat the system.'' Such students should be identified and encouraged to work towa~d self-sustaining rather than self-defeating goals. Students who drop o~t of school 2re often brighter than many who remain. The ability to recognize that the only way to preserve an intact self is to leave the sit uation is often indicative of more intelligence and p otential capability than our middle class society is usually able to recognize. Further, standardized tests of academic aptitude, as they are typically used, do not realistically reflect a disadvantaged stu
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59 Therefore, in evaluating and identifying students who are potentially capable, one needs to consider the following factors: 1. High academic averages, but poor test scores 2. An expressed desire to "better myself" 3. The academic status of the high school which the stude!'lt attended 4. Persona l background that would have interferred with normal scholastic development. Other FaatoPs in Selection Personal interviews by qua l i f ied and sens i ti ve siaff membe r s are vital factors in identification of such students who could benefit most from this program. W ritten statements by these prospective students in regards t o their goals and to their concepts of self are valuable if t hese sentiments are interpreted by a qualified staff person. In some instances, where potential is questionable, the administration of individual intelligence tests can be a helpful tool. The administrators must take care, however, not to interpret the test results completely according to m i ddle class norms. It is often more important to consider per form a nce within and between sub-test areas than to rely upon the total s c ore. Consequently, extremely high risk students rec e iv e co n sideration but are usually thoroughly investigated.

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60 InstruotionaZ Situation Characteristios If the curriculum design is to provide factors that will enhance academic progression, more effective strategies of teaching are necessary. Ausubel (1969) suggests three considerations for an effective and appropriate teaching strategy for the educationally disadvantaged student. These are: 1. The selection of initial learning material geared to the learner's existing state of readiness. 2. Mastery and consolidation of all on-going learning tasks before new tasks are iniroduced so as to provide the necessary foundation for successful sequential learning and to prevent unreadiness for future learning tasks. 3. The use of structured learning materials optimally organized to facilitate efficient sequential learning. Readiness.-This curriculum design will take into consideration the readiness of the disadvantaged student. The st~iting point will be the student's point of existing knowledge, no matter how far down the scale this happens to be. Ausubel (1969) feels this policy demands eliminating all subject matter that the student cannot assimilate on the basis of his current level of cognitive sophistication. It may mean acquiring basic academic skills before any attempt is made to teach him the subject at hand. For example, it may be necessary to teach basic computational skills before any attempt is made to teach algebra or geometry. This is

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61 not to perpetuate the status quo; it is an important beginning step in preparing the student t0 cope with advanced subject matter. Consolidation.-Before introducing new subject matter, the ongoing subject matter should be mastered Sassenrath (1959) believes that prior learning is not transferable to new learning tasks unless they are first overlearned. This curriculum design will provide an opportunity for spaced repetitions, reviews, and immediate -fe itdb ac:"k. Stua e nfs wrrr be Tn sma rt iioi.1 p s to in teg r i. 1 te their concepts with their practical experienc e This small group discussion will provide the opportunity for over learning. Materials.-In order to provide continuity with the integrated approach of this curriculum design, materials from multimedia will be utilj zed. The material will be appropriate to the experience the student is having at the time. A survey should be made of the community for avail able media pool. Materials will be selected from such a pool as the student's experiences warrant. These may be films, libraries, newspapers, magazines, video tapes, etc. Specific Subject Matter Nursing education is essentially interaction between the nursing student, the teicher, and the patient. The

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6 2 .. content in this curriculum design is geared to develop an awareness in the disadvantaged student to changes in society and in its needs as they relate to health care; in effective communications with patients as well as other members of the health team; and in being a change agent. The needs of the patient will be a priority for the nursing student. The use of the nursing procedure will develop the student's skills in observation, information gathering, formulation of hypotheses, implementation, and evaluation. This approach allows for increasing levels of achievement, levels of conceptualizing and the develop ment of a more adaptive value system. This approach also allows for personal growth of the patient. Curriculum Structure First Year First Semester Physical and Biological Sciences English Social Sciences (Sociology and Psychology) Mathematics Nursing Laboratory Summer Session Second Semester Physical and Biological Sciences English Social Sciences (Sociology and Psychology) Mathematics Nursing Laboratory Summer Session

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Second Year First Semester Physical and Biological Concepts as They Relate to Normal Physiological Functions Nursing Laboratory Summer Session Supportive Services 63 Second Semester Physical and Biological Concepts as They Relate to Levels of Illness NuTsing Laboratory Summer Session In addition to the formal class work, this curriculum requires a learning laboratory to assist the student when help is needed. Student attendance at the learning labora tory may be by teacher assignment or by student choice. In addition to the English course the curriculum will provide a communications laboratory. Language skills will receive attention in the laboratory as well as in all other subject areas. It is believed that such language skills as grammar, spelling, and punctuation develop personal meaning and promote competency when they are integrated with other areas. They will be given special emphasis on an individual basis in the learning laboratory. This curriculum provides the following broad areas of knowledge that must be completed in lower division course work.

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64 First Year-~irst S em e ste r and Seoand Semester Physioal and Biologioal Soien ce s Anato m y a n d Physiology.-This course is designed for nurses to help them acquire knowledge and understanding of normal antl abnorm a l an a tomic and physiological functioning of the human body. Laboratory experience is geared to humans. Specimens from cadavers will be used throughout the course. This is not the traditional course of anatomy and physiology. Chemistry.-This course is designed to in c lude one-third organic chemistry, one-third inorganic chemistry, and one-third physiological chemistry. It is designed to help the nurse acquire a sufficient amount of such k n o w l e dge in a course to ~nable them to function as intellig e nt consumers of scientific information. It is not the inte n t to teach nurses to become chemists, so this course is differ e nt from the traditional course in chemistry. Miar o biol ogy .-This course is designed for nurses to help th em g ain sufficient understanding of the h a bitats, meth o d s of t r ansfer, and m e ans of control of microorganisms. This is not t he tr a ditional course of microbiology. G ene r a l Educat i on En g Z ish -~ 11is cou r s e i s design e d to help the nurs e to ga in kno wledge a n d s k ills in gr a mm a r, writing and reportin g

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65 There will be emphasis on oral and technical language. This course is different from the traditional course in com munications. PrinaipZes of SoaioZogy.-This course is designed to help the nurse gain knowledge and understanding of the basic elements of culture, communities, social institutions and social change as they relate to health care. The format as well as content is geared for nurses and is not the traditional social science course. Generat PsyahoZogy.-This course is designed to help the nurse gain an i~troduction to the study of prob lems of human behavior. The areas to be explored are heredity, development of the individual, motivation, emotion, learning, serisation and perception. This course provides the content that riurses need in the problems of adjustment that arise in the nurse as well as to the person whom ministry is given. This course is different from the traditional course. Nursing Laboratory.-This practicum is designed to give the student early exposure in a hospital or community health agency. This exposure is to afford the student a clearer picture of the nursing profession and to be sure of their choice of the profession. Mathematias.-This course is concerned with common and decimal fractions, percentages, averages, powers and

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66 roots in arithmetic, formulas, and simple equations. This knowledge would be of value to the nurse in the understanding of some of the principles of physics met in the use of certain nursing procedures and equipment, such as gastric suction, traction, and even in the use of good body mechanics. This is not the traditional basic math course, but starts where the students are and introduces them to the mathe matical operations required on the job before moving to mathematical concepts. Physical and BioZogicaZ Concepts The curriculum siructure in the second year consists of Physical and Biological Concepts being given concurrently with the Nursing Laboratory. These courses should be presented i n such a way that they complement each other. A continuous interchange and planning is required by teachers of both courses. The emphasis in this course should not be subject matter as such, but application to help the student achieve the basic assumptions noted earlier in this chapter. Junio~ Year First and Second Semester The following broad areas will be explored using an interrelatedness approach to health care. Family Dynamics Psychnsociobiological Concepts

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67 Concept of Stress Growth and Development Communication Nursing Procedure Personality Development Psychopathology A Nursing Laboratory will be a major part of this content. Senior Yea1> First and Second Semester The above broad areas will be explored in gr e ater depth, utilizing the Nursing Procedure. The Nursing Laboratory will be a major part of this content. Organizational Structure Level I Nursing-Junior Year. ---This course would be presented in an integrated approach to the development of concepts relating to communications, human growth and development, levels of health, stress, and psychosocio biological areas as they relate to normal physiological functions. Level II Nursing. This is a nursing practicum. Th e student is involved in a health agency exploring the concepts f rom Level I Nursing, utilizing the Nursing Procedure. This course is taken concurrently with Level I Nursing.

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68 Level III Nursing-Senior Year.-Concepts of psychopathology and personality development will be pre sented on an integrated approach as they relate to levels of illness. Level IV Nursing.-The student is involved in a health agency exploring Level III concepts by utilizing the health procedure. This course is taken concurrently with Level III Nursing. Subject content courses or Nursing Practicums should be completed by students at the student's own rate. Therefore, emphasis should not be placed on grades, but on successful completion of a course, even if it means tak ing a course in the span of two semesters. Such emphasis requires a change in the traditional grading system to accommodate this type of academic training for this pro fession. Whether or not a student is butstanding would be based upon individual success in any area of study and deter mined by a patt ern which would indicate a high level of conceptualization, a high level of motivation, and an acceptable value system. This design would involve training teachers in preservice as well as in in-service programs. Teachers involved iri this curriculum would need to be cognizant of the teaching strategies described above which are needed to influence the learning styles, the level of

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69 aspiration, and the value system of the disadvantaged student. Most important of all, t}1ese teachers would need to know more about the characteristics of the disadvantaged and of his subculture. Administrativ e Assist a nce This curriculum design, also, requires the assistance of administrative officers who are interested in equality of education. Morphet and Johns (1967) believe the administrative officer's democratic action will promote the group or individual creativity, productivity, and satisfaction without harni to other groups or individuals. This type of administra tive attitude respects the dignity of individuals or groups that is consistent with democratic behavior. The administration must show a definite expression or concern for the welfare of disadvantaged students. Too often, the affairs of the university are so organizationally oriented that the student is the last to be considered. The administration should periodically ask for a report of pro gress being made in the welfare of the disadvantaged student. In order for counseling services to provide effective assistance to disadvantaged students, there must be philo sophical and financial commitment. Administrative officers, counselors, and instructional staff should work together in

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70 ra~king nacessary provision s fo r courses in assisting the disadvantaged student in learning how to study as well as budgeting of time. Counseling Services This curriculum design will require the assistance of cou11selors to whom the students can relate. Counselors should realize that each student brings to the counseling scene a different set of attitudes, interests, and abilities regardless of his group membership. When the counselor has some knowledge of these differences and takes tl1em into account during the counseling sessions, all students can benefit from the counseling services. The counselor must have knowledge of the life style of the disadvantaged student. They must be able to structure a warm and accepting helping situation to enhance the success of the counseling session. Counselors need to know how to plan a goal attain ment strategy; and they need to know what alternatives the students have. Such knowledge will help the disadvantaged student make realistic attainable goal choices. Because of the low incomes of most disadvantaged students, many of them will need financial assistance. Analysis of financial need will reveal many aspects of family life which are different. Counselors assisting stud e nts with applications for financial assist a nce should

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71 be aware that the life style of a disadvantaged stude n t's family will differ from his own and that the e v aluation of financial necessity should be within the co n text of the applicant's family pattern. Further, these students may need assistance in completing the application forms. When giving such assistance special care should be tak e n so that questions w hich may prove to be embarassi n g to disadva n taged students will not harm the counseling relationships. Clarke feels guidance means to help the student through the hurdles of admission and registration proceC:.ures. She states, "Many students are lost before entering the college because of the formality of procedures. Their lack of sophistication in these procedures tends to 'turn them off'" (Clarke, 1970, p. 17). Disadvantaged students are less familiar with the formal atmospl1 c re of the college. They need special orien tation to the college. They are less apt to explore the unfamiliar environment, the y are uncomfortable in the pres ence of so many unknowns, they are reluctant to ask direc tions for f e ar of betrayi~g their lack of information. College orientation should be, if at all possible, counselor initiated activity designed to acquaint the stu dent with those aspects of college life wh1ch most students discover th e mselves. Procedures which are usually given in large orientation sessions should be reinforced irt informal

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72 casual settings. Informal introductions to those staff persons in charge of various operations of the college such as the bookstore, Registrar's staff, staff of the finance office, and the library staff should be arranged. When the disadvantaged student is enabled to bring the routine operational aspects of the college within his perceptual field and develops the ability to cope with his relation ships to these operations, he becomes more open and more accepting to his other experiences at the college. Both counselors and students can learn from each other in informal exchange in the lounges and other areas where students gather. It is in this type of exchange that the disadvantaged student becomes more communicative and begins to develop feelings of belonging. Organization for Instruction The teachers selected for the program must be able to creat e a warm and accepting classroom atmosphere and should also be capable of structuring a learning environment conducive to student success. These teachers should be selected on the basis of their genuine interest in and knowlcdg8 of the characteristic of the disadva ntaged stu dent. They should have knowledge of learning theories as well as knowledg e of teaching strategies that will enhance behavioral change in the disadvantaged student. Equally

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. ,~ important, the teachers should be self-confident and flexible. They should indicate a willingness to have their sessions audited and a willingness to consider more effective techniques for presenting different learning tasks. The organizational structure of such a curriculum as this should include persons with knowledge of many areas and with the knowledge that planning and implementing learning experiences should be a team effort. The aim of the program, therefore, is to view the student as a whole; for to isolate any area of the student's academic deficien cies and to focus on this area would insure little success. Because the student needs constant reinforcement when the knowledge, skill, and understanding of many disciplines are used to help her to develop academically and when all instructors unite in their efforts to reinforce each dis cipline the least competent student will experience success. It is evident then, that team teaching is the appropriate approach for this curriculum design. Evaluation The evaluation of the effectiveness of this curriculum will not be meast1red by the progress which the student makes on tests. However, standardized tests (in spite of their biases) of cognitive achievement (SCAT, etc.) and assessm e nt of the affective domain (self-concept scale,

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74 self-reports, etc.) will be utilized at the beginning of the program to de~elop local norms and to determine predic tive measures. The evaluation of the effectiveness of this curriculum should be measured by behavioral changes and changes in academic status of the students Evaluation should, also, include reviewing the overall objectives of the curriculum to see if these objectives have been met. Thus behavioral change in students appears to be an important facet in evaluating a design of this nature. Suggested Res e arch This program should be designed to provid e data on such issues as: 1. Different effects on the disadvantaged student's ability to learn by the teaching strategies pre sented in this design opposed to the traditional approaches. This would require that the dis advantaged students be randomly assigned to dif ferent approaches. 2. Different effects on the disadvantaged student and the nondisadvantaged student's ability to learn by the teaching strategies presented in this design opposed to the traditional approaches. This would require that nondisadvantaged students be randomly assigned 3. Such a research effort not only requires random assignment of both groups to both treatments, but

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Summary 75 also the development of a set of preand post rncasurernents. These can include the traditional achievement tests, but should also be developed and based on the specific outcomes described in this chapter. That is, for example which student, when employed as a nurse, is better able to relate observed behavior to the disease process? The ultimate test, then, of this curriculum, is job performance and the quality of life, not grades and test scores. To a considerable degree the history of the American school curriculum revolves around one important question: How can the curiiculum best provide for the educational needs of each learner? T~roughout 6ur history a general curriculum has been considered adequate for all. In the nineteenth and twentieth centuries, educators have become concerned about individual differences. The abundant knowledge about individual differences has created tre mendous conflict among curriculum planners. This question and its resolution were sharply and clearly stated in the Rockefeller Brothers' Fund (1958) report on education: From time to time one still hears arguments over quantity versus quality education. Behind such argu ments is the assumption that a society can choo s e to educate a few people exceedingly well or to educate a great number of people somewhat less well, but that it cannot do both. But a modern society such as ours cannot choose to do one or the other. It has no choice but to do both. Our kind of society calls for the maximwn development of individual potentialities at all levels (p. 22). Fortunately the demand to educate everyone up to the level of his ability and the demand for excelle~ce in

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76 education are not incompatible. We must honor both goals. We must seek excellence in the context of ~ oncern for ali. It is hoped that this design will solve some of the problems encountered by curriculum planners in nursing education. The theoretical framework which has been attempted here provides a basis for curriculum planning solutions. It is hoped that what is described and assumed in this design, if implemented, will produce behavioral changes that are 11ceded at this time for the disadvant a ged student in a Baccalaureate Nursing program.

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REFERENCES Amos, W. E., & Grambs, J. Counseling the disadvantaged yovth. New Jersey: Prentice-Hall, 1968. Anderson, B. E. Some paradoxes in nursing. Teachers CoZZ6ge Record, January, 1953, 54, 213. Ausubel, D. P. A teachi::1g strategy for culturally deprived pupils: Cognitive and motivational considerations. Readings in school learning. New York: Holt, Rinehart, & Winston, 1969, 407-417. Ausubel, D. P., & Ausubel, P. Ego development among segr e g a ted Negro children. Readings in s c ho o l learni n g. New York: Holt, Rinehart, & Winston, 1969, 418-460. Bernstein, B. Social class and linguistic development: a theory of social learning. In A.H. Halsey, J. Floud, & C. A. Anderson (Eds.) Educat i on, economy, and society. Glencoe: Free Press, 1961. P. 228. Bernstein, B. Educatidn cannot compensate for society. New Society, 1970, 26, 344-347. Berkowitz, L. chi Zd. The de v elopment of motives and vaZues ~n the New York: Macmillan, 19. 1/ Bixler, G. K., & Bixler, R. W. The professional status of nursing. American Journal of Nurs1:ng, August 1959, 59, 1144. Bloom, B. S. Stability and change in human characteristics. New York: John Wiley & Sons, 1964. Bloom, R., wn:iteman, R., & Deutsch, M. Race and social class as separate factors related to social environment. Paper presented at the meeting of the American Psychological Association, Philadelphia, September, 1963. Bridgman, M. CoZZegiate education for nursing. New York: Russell Sage Foundation, 1953. 77

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78 Bruner, J. S. A study of thinking. London: John Wiley & Sons, 1957. Bruner, J. S. On going beyond the informati on given. The eognitive pro~esses. New Jersey: Prentice-Hall, 1964. Childs, J. L. Education and morals. New York: Appleton Century-Crofts, 1950. Clarke, J. R. A curriculum design for disadvantaged community junior college students. Doctoral dissertation, University of ~lorida 5 April, 1966. Clarke, J. R. what's the hang-up? Poor people-poor education. Occupations and Education in the 70 1 s Promises and Challenges. Washington, D. C.: American Association of Junior Colleges, 1970, 15. Coleman, J. S. Equality of education opportunity. Washington: Government Printing Office, 1966. Deutsch, M. P. The disadvantaged child and the learning process. Education l~ depressed areas. New York: Bureau of Publications, Teachers College, Columbia UniveTsity, 1963. Dewey, J'. Philosophy of education. New Jersey: Littlefield, Adams, & Co., 19S0. Dole, A. Re~or~ed determinants of educational choice. Pers~nnel and Guidance Journal, 1964,42,564-570. Gardner, J. W. Excellance. New York: Harper & Row, 1961. Goldrnark, J. Nursing and nursing education in the United States. New York: Macmillan, 1923. Gordon, E.W., & Wilkerson, D. A. Compensatory education for. the disadvantaged. New York: College Entrance Examination Board, 1966. Gordon, I. J.( et al. Criteria for theories of instruction. Washirigton, D. C.: Association for Supervision and Curriculum Development, 1968, 17. Gorden, T T .J. V Human development. New York: Harper & Row, 1969. Grier, William H., & Cobb, Price M. Black ~age. New York: Basic Books, 1968.

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79 Harrington, M. The other America. New York: Macmillan, 1962. Havighurst, R. J., & Neugarten, B. Society and education. Boston: Allyn & Bacon, 1962. Hullfish, H. G., & Smith, D. G. Ref"lective thinking. New York: Dodd, Mead, & Co., 1961. Hunt, J.M. Intelligen'3e and experiences. New York: Ronald Press, 1961. McClelland, D. C. The ~chievement mo tive. New York: Appleton-Century-Crofts, 1953. McClelland, D. C. Toward a theory of motive acquisitior.. American Psychologist, 1965, 20, 321-333. Morphet, E. L., Johns, R. L., & Reller, T. L. Educational administration. New Jersey: Prentice-Hall, 1967. Moss, J. A. Program for the disadvantaged prospectives and problems. Black Academy Review, 1970, 1. Raths, L., Harmin, J., & Simon, S. Values and t~aching. Ohio: Charles E. Merrill, 1966. Riessman, F The culturally deprived. New York: Harper & Row, 1962. Riessman, F. T~e overlooked positives of disadvantaged groups. Journal of Negro Education, 1964, 33, 329-333. Ro~kefeller Brother~ Fund. The pursuit of excellence: Education and the future of Americ a panel report V of the special studies p~oject. New York: Doubleday & Company, 1958, 22. Sassenrath, J.M. Learning without awareness and transfer of learning sets. Journal o f Educational Psychology, 1959, sc 1 202-212. Sexton, P. gducation and inoomR. New York: Viking Press, 1966. Smith, H. P & Anderson: M. Racial and family experience cor~elates cf mobility aspiration. Jou r nal cf Negro Ed u caticn, 1962, 31, 117-124.

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BIOGRAPHICAL SKETCH Hattie Bessent was born, December 26, 1926, in Jacksonville, Florida. She graduated from the Florida Agricultural and Mechanical University in 1959 with a B.S. Degree in Nursing. She received the Master of Science Degree with a major in Psychiatric Nursing at Indiana University in 1962. From 1962-1967, Miss Bessent served in the capacity of Assistant Professor of Psychiatric Nursing at Florida Agricultural and Mechanical University. In 1968, she received a career teacher's grant from the National Institute of Mental Health utilized at the University of Florida. Miss Bessent has published articles in the Journal of Psychiatric Nursing and is a member of Pi Lambda Theta, Sigma Theta Tau, and Delta Sigma Theta Sororities. Miss Bessent is the sister of Miss Marion Bessent, an elementary school teacher of Jacksonville, Florida, and the granddaughter of Mrs. Susie Robinson of Jacksonville, Florida. 80

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I certify that I have read thi s study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully c1dequate in scop e and quality, as a dissertation for the degree of Doctor of Education. !t ~ g___ I certify that I have read this study and that in my opinio n it conforms to acceptable standards of scholarly pr esentation and is fully adequate, in scope and qual~ty as a dissertation for the degree of Doctor of Educ a tion. 0 '\ ~ tel c h c-. L.~-LDonald L. Avila Professor of Education I cert1ty that I h a ve read this study and that jn my opinion it conforms to acceptable standards o f scholarly presentatjon and is fully adequate in scope and qu ality, as a dissertation for the degree of Doctor of Education. J -,,. ~.//.~ II .-, J .:. -~---Polly Barton Associate Professor of Nursing

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This dissertation was submitted to the Dean of the College of E d ucation and to the Graduate Council, and was accepted as p a rtial fulfillment of the requirements for the degree of Doct o r of Education. December, 1970 ff f ~ ~,/va,v / t,' )// c : f ~L / /4 Dean, Coll ~ ge / of Education Dean, Graduate School